Talk:Food intolerance

There

There is a contradiction on this page: it is said (correctly I believe) that Food intolerance is not related to the immune system, yet gluten intolerance is then mentioned. But this is an auto-immune response against the vili caused by the presence of gluten in the intestines. (the page on that topic is very well written for that matter). 07 Sep, 2006

No Contradiction

You do= not understand Celiac's Disease. There is ample reading material to describe the difference between allergic reactions, and other forms of auto-immune disorders. Celiac's Disease in particular is not an allergic response to gluten itself, but an auto-immune response to the way the body is misprocessing gluten. Hence, not an allergy.

Knowtheory (talk) 15:55, 28 February 2009 (UTC)

This is answer "correct", but not complete.

Celiac disease is an opsonization attack mediated by antibodies, or a Type 3 hypersensitivity response. For those people that define an "allergy" as any specific immune response against a foreign antigen (e.g., gluten), or as any specific immune response against a foreign antigen that relies on any antibody, then celiac disease could reasonably be described as an "allergy".

Since the 1960s, the experts have defined True allergy very restrictively, as requiring not merely any old antibody-based immune response, but an IgE-specific antibody response. Thus celiac disease is not a True™ allergy, because the antibodies are of the IgG subtype.

The food intolerance in celiac is very different from, and much closer to a true allergy, than a purely pharmacologic intolerance (e.g., Egg white intolerance), which involves no antibodies or immune response whatsoever. WhatamIdoing (talk) 19:37, 19 October 2009 (UTC)

Hello. From what I understand, it is possible to have a gluten intolerance and yet test negative to the coeliac gene test. This means that you can have a gluten intolerance but not have coeliac disease. I assumed that this page would be dealing with the gluten intolerance only. --Another287person (talk) 01:26, 12 June 2013 (UTC)

This is about any type of food intolerance, not specifically Gluten intolerance. A person could be intolerant to all sorts of foods.

Coeliac disease is one of main types of gluten intolerance. This is an oversimplification, but there's true coeliac disease, there's something very similar but without a particular type of immune reaction, and there's what's probably a sensitivity not to gluten but to certain sugars that just happen to be present in gluten-containing foods. WhatamIdoing (talk) 23:10, 13 June 2013 (UTC)

Expert

Well, its not much, but I thought it was misleading how food intolerance redirected to food allergy, since the conditions are not the same at all. Not knowing much about the subject myself, all I felt that I could contribute was a couple of sentences. I'm also adding an expert tag. If you can contribute, please do! cøøkiə Ξ _(talk) 15:25, 16 June 2006 (UTC)

Specificity

Hi. Nice work on the article so far. I think it would be helpful if the article also addressed some more of the many other foods that people have been found to be intolerant to. Additionally, one could list some common reactions people experience when exposed to a food they are intolerant to (increased heart rate, sudden thirst, etc.). The contributions of Otis Carroll could also be included as well as suggestions about where someone can discover what foods he or she is intolerant to. I am a little hesitant to dive in myself, since I have no formal training on the matter, however there are many good sites out there one could pull this information from:

http://www.wellspringofhealth.com/articles/carroll.html http://www.doctorananda.com/foodlist.html http://www.classicalformulas.com/naturopathy_and_nutrition.html

Awareness

I think it would also be good to include information about growing awareness on food intolerance in the general public. More and more airlines will let you choose a wheat and dairy free meal on longer flights. Even in supermarkets (in Europe) it is becoming more common to find wheat-free and dairy-free products. Also egg-free products can be found. 194.7.74.197 13:21, 22 August 2006 (UTC)ines194.7.74.197 13:21, 22 August 2006 (UTC)

Contributions

I have today addad some further wording/expansion and called this first section the Introduction. I will add further in near future on the food chemical aspects, including diagnosis, treatment, etc.Jagra 01:55, 23 May 2007 (UTC)

ADDED section on Diagnosis and treatment today, will add further links later Jagra 02:36, 25 May 2007 (UTC)

Enough for now but it would be good to see further references and external support group sites added. I have deliberately left out "fasting" as a means of 'unmasking' because in a society not used to this practice / custom, it should really be carried out under full time medical supervision.Jagra 04:48, 26 May 2007 (UTC)

Incidently individuals placed on a medical drip and unable to take food by mouth, if they also have food intolerance problems can unmask intolerances in 3 - 5 days inadvertantly. Not all hospital staff are familiar with this condition and the increased sensitivity and thus reactivity of the person will go undiagnosed, or cause problems on resuming a normal diet.Jagra 05:00, 27 May 2007 (UTC) Those wanting to see the Clarke L paper can find the abstract here in archives Volume 53 Issue 3 and a copy of paper here Jagra 23:46, 8 August 2007 (UTC)

Citations

I think the references you are looking for are; Leaky gut in CFS PMID 18063928 ‘Allergies’ and leaky gut PMID 16092447 Jagra (talk) 07:48, 19 March 2008 (UTC)

Vague, overgeneral, doesn't say much

This page needs a lot of work. The opening sentence demonstrates the problem: "Food intolerance or food sensitivity is a negative reaction to a food that may or may not be related to the immune system or to food poisoning." In other words, food intolorance is just about anything.

Someone with a level of expertise needs to (1) write a good definition and (2) set up a system of subheads reflecting the different types and subtypes of food intolerance.

A specific question: If an intolerance is not immune system-mediated but does produce reactions outside the gut (e.g., on the skin, etc.), what IS mediating the symptoms? —Preceding unsigned comment added by 65.212.108.131 (talk) 21:42, 8 April 2008 (UTC)

Just maybe it reflects what the article and references say ??? but who would expect a sockpuppet to knowe? Jagra (talk) 03:32, 9 April 2008 (UTC)

Elimination diet

Help writing Elimination diet would be appreciated. See Wikipedia talk:WikiProject Medicine#Elimination diet for some discussion and links. --Una Smith (talk) 05:05, 9 May 2008 (UTC)

References

Is there anyway that the editors that wrote this article can place the references after appropriate sentences instead of having a pile of references at the end of each section?PB666 ^yap 21:21, 5 August 2008 (UTC)

“The verifiability criteria require that such statements be sourced so that in principle anyone can verify them. However, in many articles it is cumbersome to provide an in-line reference for every statement. In addition, such dense referencing can obscure the logical interdependence of statements. “ “These inline citations are often inserted either after the first sentence of a paragraph or after the last sentence of the paragraph; a single convention should be chosen for each article.” here It has been. Jagra (talk) 08:24, 6 August 2008 (UTC)

There's a limit to that approach. It's reasonable to reference a paragraph that way, but entire sections of several paragraphs is over the top.LeadSongDog (talk) 05:47, 16 January 2009 (UTC)

Definitions

I see no major different views except USA definitional seems to vary a lot. If need be a Controversy section could be added. Peerev (talk) 21:48, 3 April 2009 (UTC) Ummm, perhaps best way to handle this is with a definitions section at start , this way it follows on from lead comment.Peerev (talk) 21:16, 4 April 2009 (UTC)

Reverts

With regard to recent reverts, I will have a closer look at those edits in regard to MEDRS but food intolerance is not Fringe science as many publications in main stream journals on subject, for instance Pubmed has 3440 hits on subject and 731 reviews?? Any hypothesis will be moved to relevant section.Peerev (talk) 21:06, 3 May 2009 (UTC)

There is the "real" (scientific) food intolerance, and then there is the quackery version of it. Do a diff with the article a few months ago and you'll see all the crap that was removed. Example:

- lactose intolerance, gluten intolerance and certain chemical intolerances = scientific

- someone measuring your electrical resistance and telling you that you are intolerant to red meat = quackery!

Leaky gut is not an accepted theory for food intolerance as far as I'm aware.

--sciencewatcher (talk) 03:10, 4 May 2009 (UTC)

Agree re difference and potential for quakery edits.

Early days but try searching food intolerance and bowel permeability, for instance see PMID 12404235, PMID 9482766, PMID 7769595. Peerev (talk) 22:09, 4 May 2009 (UTC)

Those all seem to be primary sources, mostly quite old. It might be worth a mention as a hypothesis, but unless you can find a good review it should be pointed out that the link between food intolerance and leaky gut is still quite speculative. I just did a few searches myself and I didn't come across any reviews. --sciencewatcher (talk) 22:45, 4 May 2009 (UTC)

I had in mind showing it as a Research direction, I think there is enough there in mainstream journals to show that with a qualifier as you suggest. At the time i was trying to avoid a link to the old problematic 'Leaky gut syndrome', but a link to the new Leaky gut would reduce need for much text.Peerev (talk) 23:00, 4 May 2009 (UTC)

Sounds reasonble. Although I can't find any reviews, there are some more recent articles. Try searching on google scholar. here is one. --sciencewatcher (talk) 00:16, 5 May 2009 (UTC)

Yes seems research has gone to specific conditions like these, NSAID's PMID 19148789, dermatitis PMID 18931598, gastrointestinal inflammation PMID 18806699 and PMID 18621505, chronic enteropathy PMID 17245093.

Also research is beginning to look at effect of certain dietary chemical components on bowels like PMID 17973645 calling for more research. And PMID 17951508, PMID 15948806

Food allergy is linked to gut permeability PMID 16292078 and PMID 12702039 which is a starting point for an edit . This one PMID 12394645 talks about 'oral tolerance' and permeability should fit the bill. I will draft something up. Peerev (talk) 22:14, 6 May 2009 (UTC)

Linked conditions

This review PMID 10742367 and now a RCT indicates intractable epilepsy PMID 18456557(primary). Gluten intolerance includes neurological and neurophysical symptoms, review PMID 15137480 Peerev (talk) 22:09, 12 May 2009 (UTC)

See PMID 17075969 (free full text online) and PMID 18803427 as well.LeadSongDog come howl 22:26, 12 May 2009 (UTC)

Yes this one also notes the neurological factor PMID 16146729, and I note your 2nd ref links it to bowel permeability as well! Also dysregulation of factors in the CNS has been associated with the development of glucose intolerance, PMID 17683024 PMID 16049395 Peerev (talk) 22:31, 13 May 2009 (UTC)

It is noted that histamine intolerance produces headaches PMID 17490952 PMID 18649066 Food intolerance is a cause of headache and migraine, including by direct stimulation of trigeminal ganglia, brainstem, and cortical neuronal pathways. PMID 12657413 Peerev (talk) 22:08, 14 May 2009 (UTC)

I suggest you read the full-text of PMID 12657413 and you'll see that its conclusions do not match the studies that it references, and it is therefore a very unreliable source. --sciencewatcher (talk) 22:40, 14 May 2009 (UTC)

There are other reviews that link migraine with food intolerance such as PMID 8681169 and a RCT PMID 8488128(primary, dated). The primary author of the one you say is unreliable has 102 published papers on Pubmed, with numerous reviews with Lancet and Neurology among the journals and it seems neurology is his field of expertise, as he is in a university medical school division of neurology. If I read MEDRS correctly we should not contrast primary sources with reviews. Given he is an expert in the field is there any particular study linked to the quote i gave above that you have difficulty with?.

It seems galactose intolerance is associated with problems of motor, speech and cognitive development. PMID 16838075 PMID 14753129. In IBS There is an intimate role for the brain-gut axis in modulating symptoms relating to underlying causes of , --- food intolerance PMID 15861740 Results of imaging studies of regional cerebral blood flow during rectal distension suggest underlying disturbances of central processing of afferent signals,PMID 12241674. This review says food intolerance can be triggered in various ways such as: interactions with the central or peripherical nervous system, PMID 8927481. I think there is enough here to show FI is said to involve the CNS with neurological symptoms.

Functional dyspepsia has been linked to FI PMID 16918725 MCS is linked to FI PMID 9167976(primary) PMID 11133405(primary) Although I agree this one PMID 12000015 is still speculative, but will be useful as a Hypothesis section together with PMID 12000012 . FI is linked to otolaryngology patients who have chronic illness PMID 14743781 Peerev (talk) 00:20, 16 May 2009 (UTC) FI and Eosinophilic esophagitis PMID 18594978, lactose intolerance PMID 17956597. This ref is from a national medical body therefore MEDRS; National Center for Infectious Diseases (2005-05-11). "Treatment of Patients with Chronic Fatigue Syndrome". Centers for Disease Control and Prevention. Retrieved 2008-04-07. Which discusses under both symptoms and treatment. Peerev (talk) 22:55, 19 May 2009 (UTC)

Sorry, but http://www.cdc.gov/ncidod/diseases/cfs/treat.htm doesn't even mention food intolerance.LeadSongDog come howl 03:27, 20 May 2009 (UTC)

Beg to differ, If you look under Info for health care professionals, Heading; Other Common Symptoms, you will find bullet point Allergies and sensitivities to food. Also under Treatment Options Management Plans heading Nutritional and Herbal Supplements, you will find; Some people with CFS report sensitivities to various foods and chemicals, ----all of which should be minimized to promote optimum health. Viz FI is linked to CFS. Peerev (talk) 21:29, 20 May 2009 (UTC)

I have no idea what other studies he has done, but if you read through the full-text you will see very clearly and obviously that it is unreliable. Look at the quotes you put above ("Food intolerance is a cause of headache and migraine, including by direct stimulation of trigeminal ganglia, brainstem, and cortical neuronal pathways") and you will see that this is NOT anywhere in the full text. The same is true for various other titbits that appear in the abstract. Did you read the full text or just the abstract of this review? --sciencewatcher (talk) 04:27, 16 May 2009 (UTC)

Also, I am very underwhelmed by your evidence of FI causing migraines. One Spanish article that uses the word "may" everywhere, and an Italian study which I can't even read because the English abstract is truncated at 250 words so you can't see the results or conclusion. --sciencewatcher (talk) 04:41, 16 May 2009 (UTC)

The literature seems to include many reviews that link migraine with food, but may only have a limited role PMID 15806385(primary). Although only an expert could specify particular pathways, it may not be in the article text but in the references reviewed did you check these? I agree several sources for this would be better, provides links if you like. Reviews linked to food would include PMID 12785281, PMID 12391526, PMID 10231608, Alcohol intolerance and caffiene intolerance PMID 17986672, PMID 11887088(primary), PMID 18231712, Blood lipid levels PMID 10839648(primary) and possibly amines PMID 121811595(bad pmid). It is not my evidence but the literature and I think it difficult to avoid that the link is made. Whilst I have seen some papers arguing against specific chemicals I have not seen ANY denying food links? Peerev (talk) 22:13, 17 May 2009 (UTC)

If you look at the studies you just posted, you'll see that one says that alcohol is beneficial for migraineurs! And PMID 15806385(primary) says "The available information relies largely on the subjective assessment of the patients", and there no evidence except for caffeine and alcohol withdrawal (and that is not intolerance). --sciencewatcher (talk) 23:10, 17 May 2009 (UTC)

If you read the article you will find withdrawal symptoms are common with intolerance. And the conclusion is Therefore, patients should be advised that food plays a limited role as a precipitating factor of migraine and TTH.It does not say "no role' This one was included for NPOV and i think it demonstrates the only other view. Where as others say; Informing patients about realistic treatment expectations, possible delayed efficacy of medications, and avoidance of caffeine and overuse of medications is critical for successful outcomes. "CONCLUSIONS: Our study (309 patients)suggests that foods may trigger not only migraine but also tension type headache attacks.".In fact, low doses of alcohol can have a beneficial effect on patients such as migraineurs, who were reported to have an increased risk of cardiovascular disease. In other words alcohol does not benefit migraine but rather cardiovascular! can you find a study that shows it is of benefit to headache !. A review of the literature indicates that high levels of blood lipids and high levels of free fatty acids are among the important factors involved in triggering migraine headaches. Children with migraine require reassurance, modification of life style and food habits, Migraine attacks can be elicited by many different trigger situations such as light, food and the menstruation cycle. Many nutritional and botanical therapies aim to reduce migraine incidence by decreasing platelet aggregation and preventing the release of vasoactive neurotransmitters, and avoiding triggering foods. The weight of opinion shows food intolerance is linked to migraine. Peerev (talk) 22:24, 18 May 2009 (UTC)

Most of those articles are only primary sources, only a few are reviews. Let's focus on the reviews that we can actually use. Unless there are objections, I'd strikethrough the others above.LeadSongDog come howl 03:47, 20 May 2009 (UTC)

Interesting comment as all came up in PubMed "Food Intolerance and --- and review" searches. NIH may catergorize some papers as reviews but may not tag them. If NIH consider it a review then it is MEDRS. If you have problems with any then list them below and i will give you the search title for it, so you can check. Agree we should now concentrate on edits I will draft some now. Peerev (talk) 21:42, 20 May 2009 (UTC)

I've stricken them above instead, marking them as (primary). If you still think any of those are reviews, please show why.LeadSongDog come howl 22:10, 20 May 2009 (UTC)

Well lets just see. To begin being primary does not necessarily exclude the citing. And not all are intended or needed for the Article. I assume you are marking for Article use? 15806385 Starts with the words "Based on a review of the literature...." it is a review. 1846557 comes up on a search 'food intolerance and review' as does 11133405, I think NIH are better at deciding this type of thing Peerev (talk) 22:12, 21 May 2009 (UTC)

All I did was check if the PMID is marked as a review or not. I didn't try to substitute my judgement for the NIH's.LeadSongDog come howl 19:54, 22 May 2009 (UTC)

Unfortunately, as I am learning it is not that simple. Also 10839648 comes up on a search 'migraine and review' and contains the words 'A review of the literature indicates'. I have no idea what 12181595 was either? But PMID 17490952 will do when it comes to edits on histamine intolerance. Others we could argue but probably not needed anyway, so if you agree, I will get on with edits. Peerev (talk) 21:54, 22 May 2009 (UTC)

Clearly PMID 10839648 is a report on a primary research study. The fact that it mentions a background literature review doesn't change that. LeadSongDog come howl 00:25, 23 May 2009 (UTC)

It says, A review of the literature indicates that high levels of blood lipids and high levels of free fatty acids are among the important factors involved in triggering migraine headaches.and then goes on to support the review. NIH classify it as a review, as i said above, this is not my interpretation. As long as we cite only the review finding it is MEDRS and this is more than adequate to show FI is linked to migraine. Peerev (talk) 21:17, 24 May 2009 (UTC)

You seem to misunderstand how NIH indicate reviews. On the pubmed page showing the abstract, there are two tabs shown. One tab is titled "All", the other is titled "Review". For review articles, they will show as "All:1 Review: 1". Additionally, if you click "Limits" and then under "Type of Article" select "Review", your queries will exclude non-review articles. Simply adding the word review to a free-text query will result in false positives where the word review appears anywhere in the abstract.LeadSongDog come howl 22:48, 24 May 2009 (UTC)

Your methodology might equally give false negatives, relevant as you seem to misunderstand that MEDRS does not require a review 'per se' but rather a 'reliable secondary source'Peerev (talk) 21:20, 26 May 2009 (UTC)

Peerev: do you have access to the full-text of this article? --sciencewatcher (talk) 22:00, 26 May 2009 (UTC)

Epilepsy, CFS and Migraine

Regarding recent reverts, the ketogenic diet aims to eliminate carbohydrate as a food component and restrict protein, therefore a food intolerance. Not my interpretation as the literature has linked FI with epilepsy viz PMID 10479881

PMID 10479881 is talking about milk intolerance, which is different. As I understand it, the ketogenic diet works by actually introducing substances to the body, not by withdrawing them. --sciencewatcher (talk) 22:09, 25 May 2009 (UTC)

If you read the link I provided to the ketogenic diet, elimination is a large part of it. Milk intolerance can be either or both allergy and intolerance. Peerev (talk) 22:25, 25 May 2009 (UTC)

Elimination doesn't imply intolerance. Carbohydrates are eliminated simply to generate ketones, not because of any intolerance to them. --sciencewatcher (talk) 22:47, 25 May 2009 (UTC)

Oops another edit conflict, As I said above it is not my interpretation, lactose is a carbohydrate so eliminating milk eliminates it and therefore is likely intolerance as they say, but to lactose or carbohydrate? PMID 19033218 classifies it as a 'metabolic adjustment diet' which puts it in same class as such as gluten and glucose or for that matter lactose intolerance. There seems to be comments that it may only be applicable to subsets, such as treatment-intractable epilepsy PMID 18456557 or GLUT1 deficiency PMID 17718830, but I am open to be convinced, can you cite any paper that debunks? Peerev (talk) 23:33, 25 May 2009 (UTC)

The difference is that in lactose intolerance, it is the lactose that causes the problem, hence intolerance. But with the ketogenic diet, carbohydrates don't actually cause the symptoms, so you can't really call it intolerance. I'm not debunking it, it's just a matter of definition. --sciencewatcher (talk) 23:59, 25 May 2009 (UTC)

Agreed the intolerance is due to errors of metabolism and if you read the article definition it says Metabolic food reactions are due to inborn or acquired errors of metabolism and are a catergory defined as FI. Which actually is true also of lactose intolerance. Peerev (talk) 22:03, 26 May 2009 (UTC)

The CDC CFS site clearly differentiates between 'allergy' and 'sensitivities' in regard to food so given there are numerous papers in the literature, if not FI what else could it be ? —Preceding unsigned comment added by Peerev (talk • contribs) 21:49, 25 May 2009 (UTC)

But my point is that it is CFS that causes the allergies/intolerances, not the other way round. Your edit said (paraphrasing) "symptoms of FI include CFS", which is not true. CFS is not a symptom of FI, but FI might be a symptom of CFS (at least according to the CDC, although there isn't really any concrete evidence - it's mostly patient reported). --sciencewatcher (talk) 22:09, 25 May 2009 (UTC)

Well no, what my edit says in a paragraph beginning Food intolerance has been found associated with .....CFS .... I certainly did not intend to make a claim that one causes the other but I agree FI may be a symptom of CFS as does the CDC and that is all I want to show, ie. there is a link. There are CFS papers of FI testing in the literature. Peerev (talk) 22:25, 25 May 2009 (UTC)

Ah, you're right. I should actually read the article carefully before opening my big mouth. I've added the CFS info again. But I still can't find any reliable sources apart from the CDC website actually saying that CFS is linked to food intolerance. --sciencewatcher (talk) 22:44, 25 May 2009 (UTC) There is a paper by an expert on the subject Prof R Loblay I will see if I can find it. Peerev (talk) 23:33, 25 May 2009 (UTC)I think this is the study you are looking for. [1] Peerev (talk) 21:52, 27 May 2009 (UTC)

Migraine PMID 19454776 is clearly a secondary source it says METHODS: A review of the English language literature on preclinical and clinical studies of any type on food triggers, vitamins, supplements, and migraine headaches was conducted. also PMID 17986672 is a review, as is PMID 12657413 Take your pick or do I include all three? I have no fixed view on the matter and dont mind objective discussion, so if you know of any reviews that debunk the link I would be interested in seeing them.? Peerev (talk) 23:33, 25 May 2009 (UTC)

As explained by LeadSongDog above, PMID 19454776 is not classed as a review. Just because they use the phrase "a review of..." doesn't automatically mean we can consider it a review. Clearly Pubmed does NOT consider it a review. As for 17986672 it doesn't seem to mention food intolerance, and I have already discussed why PMID 12657413 is not a reliable source. --sciencewatcher (talk) 00:03, 26 May 2009 (UTC)

See my response to LeadSongDog, more false negatives! Try also PMID 19454881 my error, as the quotation above comes from this one. Also 19454776 says METHODS AND OUTCOMES: We conducted a systematic review and is relevant as it reports 'dietary manipulation', viz FI. Both come up on a search of migraine and review. Although the former is just added and probably not tagged yet? Your previous comment on 12657413 was responded to previously also. PMID 17986672 clearly says and avoidance of caffeine ...is critical for successful outcomes that can only be intolerance! Peerev (talk) 22:03, 26 May 2009 (UTC)

Caffine is present in many migraine and headache remedies, so you can hardly say it causes intolerance. If you look at the research you'll see that it is caffeine withdrawal that causes headaches (not sure about migraines), but that still isn't intolerance. --sciencewatcher (talk) 02:03, 27 May 2009 (UTC)

I have already addressed the association between withdrawal and FI above. As to whether ingredients in concoctions are helpful or not is another subject, I dont think my witchdoctor uses it! 'Avoidance of caffeine' is likely to cause withdrawal symptoms not prevent them so your view is not supported by the cites i have made. Can you support your views further with the literature! Peerev (talk) 21:52, 27 May 2009 (UTC)

Peerev invited me to join this discussion. I don't have much time right now, but here are my thoughts:

• PMID 10479881, a speculative case study, fails WP:MEDRS by a wide margin.
• A ketogenic diet is not related to food intolerances. It's an effort to exploit of a side effect of perfectly normal metabolism. The carbs themselves cause no problem (particularly in GLUT1 deficiency); the need is for an increased level of the byproducts of fat metabolism. (If you boost fat and protein, but don't remove carbs, then you have to boost the fat and protein even higher [because carbs are simpler/quicker/preferred for metabolism] and you get dramatic weight gain.)
• ME/CFS is seventeen years old and therefore fails WP:MEDRS#Use up-to-date evidence. It's also self-published by a special-interest group.
• PMID 19454776 is titled "Role of movement velocity on the magnitude of grip force while lifting an object with touch from the contralateral finger," which seems irrelevant. (Typo?) However, Peerev is right that we care more about the content of the paper than about how PubMed does or doesn't classify it. Peerev started that conversation at WT:MEDRS#Review_status last week.
• PMID 17986672 and PMID 12657413 report that some patients perceive certain foods as triggers (and the list is long: please read the actual article, not just the abstract). This may be sufficient to support a claim that migraine headaches can be a symptom of a food intolerance. Caffeine withdrawal, however, is not a food intolerance, because that's based on normal metabolism, and the presence of caffeine doesn't cause the symptoms. A caffeine-withdrawal headache is no more a food intolerance than a hangover -- and withdrawal syndromes are no more signs of food intolerance than starvation is.
• PMID 19454881 can be used to support a statement that the association between foods and headaches is controversial.

I'm out of time, but hope this helps. WhatamIdoing (talk) 22:31, 27 May 2009 (UTC)

Thanks for your input. I think the article that Peerev was talking about is PMID 10839648, which says "A review of the literature indicates that high levels of blood lipids". This isn't tagged as a review on pubmed. If you read the full text of the article, you'll see that the "review of the literature" is just in the intro. The rest of the article is actually a study. --sciencewatcher (talk) 02:46, 28 May 2009 (UTC)

I invited whatamidoing for another perspective, and although i do not entirely agree i think we can can from there. As I read it epilepsy out migraine in. Peerev (talk) 22:23, 28 May 2009 (UTC) and no 19454776 should be PMID 19445776, whilst i am prone to the odd typo not to that extent! Peerev (talk) 22:46, 28 May 2009 (UTC)

I don't have access to the full text of this review. What does it say about dietary manipulation? --sciencewatcher (talk) 00:00, 29 May 2009 (UTC)

It seems I am unable to access it myself at present. In the meantime 19454881 in the text says of food triggers; Furthermore headaches triggered by certain foods can occur 24 hours after trigger exposure making it difficult to pinpoint the offending substance (i.e. not IgE allergy) In conclusion it says In the evaluation of the migraine patient a detailed nutritional history should be taken with special attention to skipped meals, caffeine consumption and the presence of perceived food triggers.----The identification of food triggers and the use of supplements are an inexpensive way in which the primary care physician or neurologist can break a cycle of frequent migraines. In the text of 17986672 it says; Approximately a quarter of patients with migraine recognize certain food as migraine triggers. Such triggers include monosodium glutamate (also known as hydrolyzed yeast extract, natural flavoring, hydrolyzed vegetable protein), often found in soups and Chinese food. Nitrites (a preservative found in lunch meats and hot dogs), tyramines (found in wines and such aged foods as cheeses), and phenylethylamine (found in chocolate, garlic, nuts, raw onions, and seeds) are other potential migraine triggers. Alcohol of any kind, artificial sweeteners, citrus fruits, pickled products, and vinegars are additional likely triggers. It should be noted that not all patients have these food triggers, so a diet totally eliminating these items is not warranted in all migraineurs. Such triggers are factors in food intolerance and with the exception of some nuts are not allergy. In 12657413 it says; Tyramine, phenylethylamine, histamine, nitrites, and sulfites are involved in the mechanism of food intolerance headache. Immunoglobulin E-mediated food allergy is an infrequent cause. Treatment begins with a headache and diet diary and the selective avoidance of foods presumed to trigger attacks. This review also differentiates caffeine in high amount and caffeine withdrawal as a separate causes of migraine. The paper discusses and differentiates between food allergy and food intolerance in relation to migraine triggers. and says; Dietary migraine is likely mediated by a variety of mechanisms, including direct chemical effects, and only rarely immunologically mediated [refs]. And includes the following table reviewed at length.

Table 1. Dietary items and chemical migraine triggers (Offending Food Item - Chemical Trigger;)

Cheese -Tyramine. Chocolate -Phenylethylamine, theobromine. Citrus fruits- Phenolic amines, octopamine. Hot dogs, ham, cured meats -Nitrites, nitric oxide. Dairy products, yogurt -Allergenic proteins (casein etc.)* Fatty and fried foods- Linoleic and oleic fatty acids. Asian, frozen, snack foods -Monosodium glutamate. Coffee, tea, cola -Caffeine, caffeine withdrawal. Food dyes, additives -Tartrazine, sulfites. Artificial sweetener -Aspartame. Wine, beer -Histamine, tyramine, sulfites. Fasting -Stress hormone release, hypoglycemia. * Ice cream headache is probably a cold-induced vasoconstrictor reflex response.

This review PMID 8761711 is a ref for non IgE allergy involvement in ‘food induced migraine’.

I consider the above sufficient to include migraine as a symptom of food intolerance.Peerev (talk) 21:58, 31 May 2009 (UTC)

PMID 12657413 is not a reliable source (see discussion previously). PMID 19454881 says the role of food in triggering headaches is controversial and some people "may be" sensitive. I think that is all you can say. --sciencewatcher (talk) 19:05, 1 June 2009 (UTC)

Despite your opinion, comments by Whatamidoing support 12657413 and 17986672 as Reliable and that is consensus, together with 8761711 is all that is needed. Also that 19454881 is not MEDRS, but might support a statement regarding controversy. Please read the articles not just the abstracts. Peerev (talk) 22:02, 2 June 2009 (UTC)

I don't think you should be putting words into Whatamidoing's mouth. Nowhere did she say that those two studies are "reliable". If you read the full text of PMID 12657413 you will see that the conclusions are not supported by the studies they review in the text, hence unreliable. PMID 17986672 is dubious because it was written by Osteopaths, i.e. quacks. --sciencewatcher (talk) 22:20, 2 June 2009 (UTC)

• PMID 12657413 is an acceptable reliable source -- for certain statements, of course. It won't do for statements like "The earth is round" or "Green is the best color", or, much more relevantly, any statement that is not carefully restricted to children. It might be capable of supporting the fact that some pediatric patients believe certain foods trigger migraines, or that a "universal migraine diet with simultaneous elimination of all potential food triggers is generally not advised" in children. It is not our job to determine whether or not the authors wrote a good and logically coherent paper; deciding whether their data is sufficient to support their conclusions is a WP:NOR problem (that's what the journal's peer review group was supposed to do).
• PMID 19445776 appears to be a systematic review in a peer-reviewed medical journal and is therefore an acceptable reliable source -- subject, of course, to all the usual caveats about what it actually says and the limitations thereon.
• PMID 17986672 is written by Associate Professor Loretta L. Mueller, DO, of the University Headache Center at the School of Osteopathic Medicine at University of Medicine and Dentistry of New Jersey. This is Osteopathic medicine in the United States, which is not quackery or even really alternative medicine (it's different from osteopathy, which is much more like being a chiropractor). She's a tenured professor at a major university medical school and a Board-certified general practice physician who specializes in headaches. Her work cannot be dismissed as mere quackery.

It might be useful to draw a distinction here between "causes" and "risk factors" (which belong in the epidemiology section). Perhaps a specific proposal for a statement to be made (together with its supporting refs) would be helpful at this time. WhatamIdoing (talk) 23:21, 2 June 2009 (UTC)

According to WP:MEDRS you should assess the evidence quality. That is not OR. Looking at the Millichap study, it mostly bases its conclusions on patient reports, which are not MEDRS. It only has one RCT (the Oligoantigenic diet), but if you search for reviews about that you'll see that the only review states "There is conflicting evidence for the use of oligoantigenic diets." Also, Millichap and Yee themselves say "Notwithstanding the impressive response demonstrated in this double-blind investigation, in practice the relationship between food allergy or intolerance and migraine is difficult to prove, because the elimination diet is too demanding and skin tests and antibody titers demonstrate inconsistent results. The concept remains controversial, and many neurologists and allergists are skeptical of the use of restrictive diets in treatment."

Osteopathy, like Chiropractic, is based on a pseudoscientific theory, and there isn't really any evidence that it actually works, therefore it meets the definition of quackery. While it may not be grounds for rejecting the article, it would certainly make me want to take a closer look at it. --sciencewatcher (talk) 01:37, 3 June 2009 (UTC)

Quick note: Osteopathy, which is based on pseudoscience, is not the same as Osteopathic medicine in the United States. The connection is historical -- purely historical, in some schools. To oversimplify, real osteopaths (like chiropractors) think that practically everything that goes wrong with the body is due to muscle and bone problems; consequently, ear infections are "caused" by muscles and bones in your neck being unhappy. Physicians that have a DO instead of an MD (or MBBS) do exactly what the MDs do when confronted with ear infections. Residency programs routinely have both DOs and MDs, and these physicians often take the same licensing exams. They are regular, mainstream physicians; they are not alt med "practitioners". Please do not confuse an "osteopath" with a "physician". WhatamIdoing (talk) 05:18, 3 June 2009 (UTC)

I would propose an edit of 'Some migraine patients including children and adolescents, recognise certain foods as triggers of migraine. Likely triggers include foods containing food chemicals; tyramine, phenylethylamine, histamine, nitrites, and sulfites found in a wide range of foods. PMID 17986672 and PMID 12657413.' Peerev (talk) 23:24, 3 June 2009 (UTC)

If you read PMID 15806385, it says there is no evidence for any of these triggers, and that "The available information relies largely on the subjective assessment of the patients". As I said for CFS, patients report lots of things. You need a placebo controlled trial to verify that it is intolerance. I'd suggest removing the edit you added. --sciencewatcher (talk) 22:51, 4 June 2009 (UTC)

As the paper you suggest above is in German i can't actually read it, and it might just be a translation error in the abstract. As you already said above there is an RCT and it does not need an RCT if a study is considered by a review. Such as PMID 16113701 so there are not grounds for your recent removal of the edit without consensus. This review says Food can be a significant factor in the precipitation of headaches..., A study of 577 migraine sufferers found sensitivity to cheese, chocolate, red wine, and beer as the most definite associations. A double blind, controlled trial showed that of 88 children with severe, frequent migraines, 93% fully recovered on oligo-antigenic diets. The children showed recurrence when the suspected foods were re-introduced to their diets. The trial showed that many foods, and food combinations, could provoke attacks in susceptible sufferers. In addition to an improvement in their headache symptoms, the authors reported improvements in symptoms such as abdominal pain, behaviour disorders, fits, asthma and eczema.Peerev (talk) 01:15, 6 June 2009 (UTC)

The German review is the one used in the Migraine article. It seems to be the most reliable source available as far as I can tell. The study of 577 patients is self-reported, so isn't much use to us here. And as I noted previously, "There is conflicting evidence for the use of oligoantigenic diets." You seem determined to prove that food intolerance causes migraines, eh? And you still haven't told us what your interest is in food intolerance, even though I have done so. Peerev...at first I thought your name was Indian, but I realised it is probably short for peer review. Are you a researcher? Have you published any articles in this field? --sciencewatcher (talk) 01:47, 6 June 2009 (UTC)

Where as I understand that other wiki articles are not reliable sources, and I and other readers cannot tell. My understanding of MEDRS is that it enables us to rate sources based upon evidence scales, not to unpick them and query the job of the peer review process? What it actually says is these should be kept in mind while assessing whether a particular viewpoint is a majority or minority one, I have now given a number of MEDRS papers which are Grade A class 1b evidence that have independently decided in peer review that the DBRCT supports the conclusions and relevance to food intolerance. Your view of the Oligoantigenic diet is therefore OR as you are unable to produce or bring forward a quote from a RS supporting your view, except for an abstract (that we are unable to assess, but based on the citations I have provided in this section are a minority one). A ref. which does not contain the words there is no evidence for any of these triggers as you claim it does but rather says "largely on " which is not conclusive but also says A selective sensitivity to red wine has been shown in some patients, Furthermore we cannot see whether the DBPCT has even been considered? Add to that the inclusion of the other references in PMID 16113701 including Another study found that headache was a common feature in patients with gluten sensitivity, with or without histological evidence of bowel involvement. Caffeine withdrawal and caffeine usage is known to cause headaches in some individuals, therefore it is important to ascertain the amount consumed throughout each day. and also says Chemicals such as tyramine (found in cheese), phenyl ethylamine (found in chocolate), tyrosine, monosodium glutamate (MSG), aspartame, caffeine, sulphites, nitrates (found in processed meats) and histamine (found in wine and beer) seem to trigger the condition by altering the pathophysiology of migraine attack This review is MEDRS and further this source now supports that Migraine is a symptom of Food intolerance. Peerev (talk) 22:25, 7 June 2009 (UTC)

I noted SW you also removed from the Article, with (from what I can tell longstanding) references to text that said FI involves symptoms of the CNS. From my recent reading of the subject that is incorrect, but a position that you seem determined to defend. I have no predermined view except to see a NPOV and query why you removed edits by others to this effect? Are you a trained psychiatrist, psychologist or related health worker by any chance, I am not? Peerev (talk) 23:38, 7 June 2009 (UTC)

I propose an edit to add to the list; ', and migraine in some people' with the cites PMID 16113701, 12657413 and 17986672. —Preceding unsigned comment added by Peerev (talk • contribs) 23:45, 9 June 2009 (UTC)

I removed the CNS statement because none of the references in the text seemed to mention CNS symptoms. If you can find a ref, let me know. --sciencewatcher (talk) 00:34, 10 June 2009 (UTC)

Regarding migraine, all the RCTs in the reviews you quote are self-reported symptoms, so it's basically just like CFS. --sciencewatcher (talk) 01:38, 10 June 2009 (UTC)

Some migraine symptoms are observable. Where is your evidence that the RCT's are self reported? For instance of the DBCT the review PMID 16113701 says of this "The children showed recurrance of ---" also that "showed that the children --fully recovered on oligo-antigenic diet." and that the "authors reported improvement in their headache symptoms" PMID 126757413 says of this study "A study in children that demonstrated a positive association". This one is IIa evidence.Peerev (talk) 01:10, 11 June 2009 (UTC)

According to the German review "the importance of chocolate has been doubted seriously", and as I pointed out before, the only review available states that "There is conflicting evidence for the use of oligoantigenic diets." --sciencewatcher (talk) 01:59, 11 June 2009 (UTC)

The German review has been dealt with unless you can provide the text requested. There have been a number of reviews validated here, and even though you have provided that quotation you have not sourced it, we need to see the strength of any conflicts in evidence, also there is a difference between recommendations for clinical use of diets and use in trials, we need to the context of the statement.Peerev (talk) 23:26, 11 June 2009 (UTC)

It is PMID 16556238. --sciencewatcher (talk) 01:00, 12 June 2009 (UTC)

Regarding PMID 16556238, I can understand why you were reluctant to bring this forward. As the sentence from the abstract you quote is not supported by the text, have you read the paper? What it actually says is “Concerning dietary manipulations vs. placebo, one small study showed that the exclusion of foods with vasoactive amines in a diet rich in fibre did not influence HA improvement (25). Two studies, however, showed that oligoantigenic diets (i.e. diets modified to exclude, for example, milk, eggs, food additives and vasoactive amine-containing foods) are more effective than placebo (26, 27).” And makes the leap to: “We conclude that there is ----- conflicting evidence for oligoantigenic diets when compared with placebo. “

Where does one begin, firstly this review is useful in that it verifies that the Italian Guariso study confirms the results of the Egger oligoantigenic study. Next, the Salfield study did not trial the oligoantigenic diet. The oligoantigenic diet excludes more than just amines, as potential trigger, therefore not a sound valid conclusion, at best it should probably say ‘there is evidence for use of oligoantigenic diets in migraine but limited evidence for the use of high fibre diets in this condition’. The Salfield amine study whilst it compared two different diets, neither of which was the oligoantigenic diet (was not placebo controlled nor do the authors claim that it is), did not blind the study or use crossover, it is of low quality compared to the two others cited, both double blinded placebo controlled studies. We are not given details of what is included or excluded generally to make the high fibre diet, and it cannot be considered placebo. The authors themselves admit there could be a food factor (other than amines) that lead to the ‘significant reduction in headaches in both groups’ on the different diets. And the amine study authors also say ” due to the small number of children that completed the trial we cannot exclude the possibility that there are a small number of children who have a genuine biochemical idiosyncrasy to vasoactive amines.” Therefore from the evidence I don’t see how that conclusion of that review is valid, and it does not detract from the evidence and other reviews, and proposed edit. Peerev (talk) 23:31, 12 June 2009 (UTC)

No, I wasn't reluctant - I was simply assuming you'd find it on google. And I hadn't actually read the full-text, but I have just done so. You are actually doing what WhatamIdoing accused me of doing - deciding that the review's data do not support their conclusions, which is WP:OR. However having said that, I do actually agree with your analysis of their paper.

As for the actual proposed edit, I'm not sure how this helps us. I would welcome some comments from other editors. --sciencewatcher (talk) 02:06, 13 June 2009 (UTC)

Here is a suggestion, I think we have shown that there are two views, I happen to think that the pro side is the majority one, and you may disagree. Can we agree on a controversy section and include both views? That way we may be able to also better handle differences in other areas until they are further resolved. Peerev (talk) 21:47, 15 June 2009 (UTC)

It's not that there are 2 views, it is just that the evidence is weak. Certainly many patients believe that food intolerances cause the migraine. That is separate from the scientific evidence, which there should not be disagreement on. We have the studies, they have conclusions, that is what we put in the article. It's just a question of wording it so it reflects the evidence, which appears to be weak and/or conflicting. --sciencewatcher (talk) 22:27, 15 June 2009 (UTC)

I consider sites such as webmd, mayo, e med, medicinenet show that it is the majority view. Lets not forget that red wine has been shown to cause migraine in some sufferers, which alone is enough to show there is a link between FI and Migraine. We can include more than just conclusions of MEDRS sources.Peerev (talk) 00:54, 16 June 2009 (UTC)

You seem to be intent on twisting the evidence to prove what you want. Looking at the science, there appears to be no evidence that dietary amines (or red wine) cause migraine. Have a look at PMID 14533654 for example. Yes, some websites and the majority of patients believe that amines and other things cause migraine, and this can certainly be mentioned (as it is in the migraine article). But the evidence seems pretty clear cut - food intolerance has not been linked to migraine. Why are you so intent on saying otherwise? You clearly have a big interest in food intolerance, and I would suggest you tell us why. You are clearly a WP:SPA and I'm wondering if you might have a WP:COI. --sciencewatcher (talk) 04:06, 16 June 2009 (UTC)

What Peerev is proposing is the clearest case of WP:SYNTH that I've seen in a while. It won't fly. If there is a clear-cut link, there will be published papers in reliable sources that say so. We should not be reading between the lines. LeadSongDog come howl 14:45, 16 June 2009 (UTC)

I am interested in presenting only the evidence that others seem intent on denying! Whilst I edit only a few articles at this time, it is largely a learning experience for me and I thank those participating. However personal attacks are not warranted, (I am certain policy would agree) I have no COI, only a general interest, and have been as forthcoming as others here! Red wines contain more than amines as potential trigger, you are still obfiscating. No reading between the lines, even the critical German review you keep raising says A selective sensitivity to red wine has been shown in some patients,That alone is MEDRS linking FI to migraine, and others say the same. The paper you link above PMID 14533654 is about amines and accepts only the gold standard DBPCRCT and rejects other levels of evidence that are MEDRS, all it shows is that higher levels of trial have not yet been carried out! Published papers are not the only reliable sources, the other sites i have noted above are reliable sources, there is no Synthesis, these are presented to establish weight, and clearly show that to be the case. So lets get back to the evidence, 'play the ball not the man'. Peerev (talk) 22:19, 16 June 2009 (UTC)

I just read the abstract for the German review, and you're right it does mention red wine. I don't have the full-text of that review, but I'm guessing that statement is based on patient reports. Also see "Relationships Between Food, Wine, and Beer-Precipitated Migrainous Headaches". They said the red wine sensitivity is correlated with sensitivity to chocolate, yet the German review says "the importance of chocolate has been doubted seriously". --sciencewatcher (talk) 22:47, 16 June 2009 (UTC)

Then again the word ‘shown’ is used not self reported The words ‘shown’ and ‘demonstrate’ in scientific papers have meaning that confirm evidence. Millichap says; Ingested in large quantities, alcohol will lead to a hangover headache, but wine even in moderate amounts can trigger a migraine headache in susceptible patients. Tyramine, histamine, phenolic flavonoids, and sulfites are generally invoked in the headache mechanism. Red wine has larger levels of histamine and phenolic flavonoids than white wine. Of tyramine he says; Hanington [20] was the first to demonstrate the relation of tyramine to migraine in controlled studies. Tyramine capsules (125 mg) induced headache in 80% of dietary migraineurs, whereas placebo was followed by headache in only 8%. A recent review [ref] of the tyramine trigger factor in migraine cites six controlled studies with positive results, -- and three negative studies [ref's]. The evidence favors an association between high levels of tyramine and the precipitation of acute migraine headache. and The ingredients in chocolate implicated in the mechanism of dietary-triggered migraine include phenylethylamine, theobromine, caffeine, and catechin. Correlated may mean an association of only one ingredient and until all possible ingredients are definately excluded does not alter or detract from the evidence. As I said above, Where is your evidence that the RCT's are self reported? For instance of the DBCT the review PMID 16113701 says of this "The children showed recurrance of ---" also that "showed that the children --fully recovered on oligo-antigenic diet." PMID 126757413 says of this study "A study in children that demonstrated a positive association".

These are placebo controlled trials, and evidence. The reason for your revert was;remove migraine as per discussion (no evidence). I have shown there is evidence and you admit this above when you say it is just that the evidence is weak. I have shown the weight is behind the evidence. It is time to end the filerbustering, and you show no sign of being willing to craft an appropriate edit. Peerev (talk) 21:53, 18 June 2009 (UTC) .

PMID 14533654 gives a very different conclusion to PMID 11480265 regarding tyramine: "The 4 conclusive studies all reported negative results. One conclusive study showed no relation between biogenic amines in red wine and wine intolerance. Two conclusive studies found no effect of tyramine on migraine. One conclusive study demonstrated no relation between the amount of phenylethylamine in chocolate and headache attacks in individuals with headache". --sciencewatcher (talk) 00:36, 19 June 2009 (UTC)

As for the olig diet, as far as I can tell there has just been one small study by Egger in 1989 which hasn't been replicated (the Italian study wasn't placebo controlled, so it doesn't count). And here is the only response to Egger's study: "The very limited turkey- and lamb-based diets of Egger et al. [see Journal of Pediatrics (1989) 114, 51-58] were given to 9 children with severe idiopathic epilepsy. The children tried 15 diets. In 13 trials there was no significant change in seizure frequency. Although in 2 trials there was a change in frequency during the third and fourth weeks chance variation in the disease provided a likely explanation. It is concluded that subjects should spend months rather than weeks on trial diets. None of the patients had severe migraine headaches." --sciencewatcher (talk) 14:40, 19 June 2009 (UTC)

CFS

As we still haven't got any other sources apart from CDC's website, I'm thinking we should remove CFS from the list of illnesses associated with FI. It says "Many patients do report intolerances..." which I'm not sure qualifies as MEDRS. --sciencewatcher (talk) 14:37, 3 June 2009 (UTC)

IMO the CDC website is generally an acceptably reliable source. However, this statement sounds much more like a risk factor/epidemiology statement than a cause/symptom/etc kind of statement. WhatamIdoing (talk) 19:30, 3 June 2009 (UTC)

On the otherhand Dr R Loblay the author of the link i provided is well published in other peer review journals, some 34 on pubmed, director of the allergy unit at Australia's largest hospital RPA, was on the Australian guideline committe for food induced anaphalaxis PMID 15569280, was Chairman for the College of Physicians committee in producing the Australian CFS guidelines , I understand is on the CDC CFS advisory group (would need confirming) and credited with having done the defining work that established food chemicals as the scientific basis for food intolerance. As such despite the choice of publisher I beleive his work is a reliable source on the subject of food intolerance and CFS, and probably forms the basis for the CDC inclusion and recommendations on removing suspect foods, I don't think it can be said on epidemiology alone. Peerev (talk) 22:13, 3 June 2009 (UTC)

For wikipedia articles, the publication does matter. For medical articles it needs to be published in a peer-reviewed journal. Also, the scientific consensus is that CFS is not linked to food intolerance, so you can't really try to prove that it is linked by using a less than reliable source.

The only reliable reference to food intolerance in CFS I can find is "Food intolerance in patients with chronic fatigue" by Peter Manu, and his conclusion is "These data suggest that intolerance to multiple foods is probably not a cause or the effect of chronic fatigue, but rather one of the manifestations of the somatization trait expressed in these patients". --sciencewatcher (talk) 23:25, 3 June 2009 (UTC)

I agree that the CFS is both trivial (thus a WP:DUE issue) and not appropriate for a statement of causes, but peer-reviewed journals are not the only acceptable reliable sources. If that were true, then sections like WP:MEDRS#Books and WP:MEDRS#Websites would not exist. WhatamIdoing (talk) 15:51, 4 June 2009 (UTC)

Yes, you're right. I suggest everyone (including me) should regularly read through WP:MEDRS. In WP:MEDRS#Websites it says "Peer-reviewed medical websites such as WebMD and UpToDate, along with websites of government health organizations such as the CDC, can be useful guides about the relevant medical literature and how much weight to give different sources; however, as much as possible Wikipedia articles should cite the literature directly." --sciencewatcher (talk) 17:02, 4 June 2009 (UTC)

It is noticed that CFS has been removed from the Article presumably on the basis that the CDC cite is not MEDRS despite the MEDRS statement on secondary souces; Review articles and specialist textbooks are examples of secondary sources, as are position statements and literature reviews by major health organizations. As the CDC do not give sources it is speculative to assume their sources. ? I therefore propose the edit Some people with CFS report sensitivities to various foods or chemicals, including refined sugar, caffeine, and alcohol, all of which should be minimized to promote optimum health. With the CDC cite' as this ablibs the CDC treatment recommendation on their site. Peerev (talk) 22:25, 4 June 2009 (UTC)

Patients report lots of things. It doesn't mean they have an intolerance. --sciencewatcher (talk) 22:48, 4 June 2009 (UTC)

Perhaps, but as discussed above the CDC also report food allergies and sensitivities, under symptoms. Peerev (talk) 23:39, 4 June 2009 (UTC)

But if you look at the actual research, you'll see that those are patient reported. The evidence points to them not being actual intolerances. --sciencewatcher (talk) 00:38, 5 June 2009 (UTC)

I would also be interested if someone could work through the reasoning as to why the medical book that Dr Loblay, an expert in the field, published in [Nightingale Research Foundation; Goldstein, Jay E.; Byron M. Hyde (1992). The Clinical and scientific basis of myalgic encephalomyelitis/chronic fatigue syndrome. Ogdensburg, N.Y: Nightingale Research Foundation. ISBN 0-9695662-0-4.{{cite book}}: CS1 maint: multiple names: authors list (link)] is not MEDRS and why the Loblay article a review, can not be cited anyway under MEDRS given firstly that Review articles and specialist textbooks are examples of secondary sources,and under provisions such as A general narrative review of a subject by an expert in the field makes a good secondary source that can be used to cover various aspects of a subject within a Wikipedia article.? 23:39, 4 June 2009 (UTC)

I'm not sure why you think Loblay is an expert in the field when he hasn't really published anything related to CFS in peer reviewed journals. All I can find are a couple of letters. You can't just pick and choose what to include in wikipedia just because it fits your POV. It has to be the other way round - read through all the research, figure out what is the current scientific consensus, then edit the article accordingly.

It would be useful if you could tell us why you are interested in food intolerance. Are you a patient? Researcher? Doctor? Interested observer? I am the latter, and I have no conflict of interest or POV on the subject. You? --sciencewatcher (talk) 00:38, 5 June 2009 (UTC)

No POV, and by the way what evidence? the paper you mention above is about chronic fatigue not CFS, according to that Article, a completely different condition, that does not support your position. If you have other evidence that contradicts the CDC then produce it, so we can discuss its merits, for your argument thus far is without merit. Loblay is published in food intolerance and you discount the fact that as convenor in effect published the Australian guidelines on CFS, I also found that he is the Australian HIC (government health insurer) scientific and medical advisor on CFS, It seems the Australian government and College of Physicians consider him an expert who am I to disagree? Peerev (talk) 22:19, 5 June 2009 (UTC)

The "Nightingale Research Foundation" book (and all of its contents) fails to be adequate support for the claim you want to make because it is self-published by a special-interest group. WhatamIdoing (talk) 01:20, 5 June 2009 (UTC)

I noted that comment earlier however the conclusion of this discussion I have discovered, would contradict that claim, it seems it does not fit the 'self published' definition of Wikipedia, and furthermore consists of papers presented at a Cambridge university international conference on CFS by experts in the field. Its contents are therefore proceedings and not self published. Proceedings are often published on websites and that does not detract from being reliable sources, why so in a book? Peerev (talk) 22:19, 5 June 2009 (UTC)

Whatamidoing in the interest of making better edits, I would appreciate it if you can outline the apparent contradiction that whilst you consider the CDC site is MEDRS that it will not support the edit I suggested above. Peerev (talk) 22:19, 5 June 2009 (UTC)

A statement like "Food intolerance has been found associated with...CFS" does not belong in ==Signs and symptoms== because it is not a medical sign or a symptom of chronic fatigue syndrome. The relevant page of the CDC website[2] does not support an implicit claim that food intolerance could be a sign or symptom of CFS.

We could include (somewhere on the page) a statement like "Patients with CFS often report food intolerances" (assuming that we decide that this fairly trivial issue isn't a WP:DUE violation), but we cannot say that is is a sign or symptom of this condition. WhatamIdoing (talk) 22:49, 5 June 2009 (UTC)

"Chronic fatigue" is a slightly broader term than CFS, although in many cases they are used interchangeably. The difference is that CFS generally has a more strict criteria, requiring a number of other symptoms. If you look at the citations for Manu's article, you'll see it is cited by quite a few CFS articles.

As for Whatamidoing's suggestion about saying that patients with CFS report food intolerance, that is fine, and you could maybe do the same for migraine. However I would suggest keeping it short, and also adding a sentence saying that it has never actually been proven (and in the case of migraine, a few trials have given negative results, e.g. in the case of chocolate - see the German literature review that is referred to in the Migraine article). --sciencewatcher (talk) 23:18, 5 June 2009 (UTC)

The source is specifically about CFS, the syndrome, not about "being tired all the time". WhatamIdoing (talk) 23:33, 5 June 2009 (UTC)

Actually I cannot find the Manu paper indexed on Pubmed, where is it published?, As the CDC site is about CFS I don't think it would support adding 'chronic fatigue' under that Cite? Your suggestion that it has not been shown still ignores the Loblay review. Peerev (talk) 23:41, 5 June 2009 (UTC)

A seventeen-year-old book self-published by a special interest group with a poor reputation is never going to be an acceptable reliable source for that statement. If you want another opinion on that subject, try asking specifically about that book at WT:MEDRS. You may want to first review RSN Archive 19 and RSN Archive 24, where the (permanently banned) CFS/ME activist User:Guido den Broeder pushed for its acceptance. WhatamIdoing (talk) 23:49, 5 June 2009 (UTC)

Another edit conflict, Thank you for your tolerance, I note the CFS article says there are many symptoms of CFS not included in the various diagnostic criteria. However they include 'food sensitivity' under the Treatment section with the CDC cite, from the look of that articles talk page (and now the links you have added above) i would say this has been well thrashed out there and i have no intention of repeating the exercise. So given the CDC recommendation I propose my edit for the Treatment section here. Peerev (talk) 00:12, 6 June 2009 (UTC)

Just for clarification, we seem to be splitting a very fine hair, Whilst it is necessary for us to ensure a cite is MEDRS, there is no such (wiki) constraint on the CDC, my comment above (to sciencewatcher) that Your suggestion that it has not been shown still ignores the Loblay review. was not an intent to cite Loblay but merely to show that such research (formal double blind, placebo-controlled challenge testing, upon 322 CFS patients) has been conducted and reported upon which the CDC has probably formed its own conclusions and recommendations regarding food intolerance. After discussion I agree it would be unwise to cite Loblay directly, but I don't think MEDRS gives us further license to unpick and dismiss CDC statements and recommendations, based on our probable opinion of third party publishers of conference proceedings! Peerev (talk) 21:54, 7 June 2009 (UTC)

If you look at the CFS articles on wikipedia, all they say is "and some patients report chemical and food sensitivities". And if you look at the "possible causes" on the CDC site, it also says "Many patients do report intolerances". So CFS patients report intolerances, but there is no evidence of actual intolerance. The 1994 CDC case definition for CFS makes no mention of sensitivities or intolerances at all. --sciencewatcher (talk) 22:21, 7 June 2009 (UTC)

That's what makes it a statement of epidemiology/risk factor instead of cause/sign/symptom: the CDC website reports a correlation, not a causation. "Being a gay male" is a validated risk factor for acquiring HIV, even though (1) the "identity" doesn't cause the infection and (2) a heterosexual woman has the same per-act risk of infection if she's receiving anal intercourse. Similarly, "having CFS" is associated with "claiming to have a food intolerance", even though CFS doesn't actually cause intolerances (as far as anyone can tell). We have a reliable source that claims correlation; we may therefore report the correlation. What we can't do is report the correlation in the previously proposed fashion (i.e., in a way pretends that food intolerance is a medical sign of CFS). WhatamIdoing (talk) 23:03, 7 June 2009 (UTC)

My intention from the outset (as mentioned previously) has not been to pretend anything, or to asign causation, but rather to show there is association between FI and CFS. (leaving aside for now whether patient reports are signs!) I am happy with the statement 'CFS patients report food intolerance', Under the heading Epidemiology and risk factors.Peerev (talk) 00:49, 8 June 2009 (UTC)

The Australian CFS Clinical Practice Guidelines published in the Med J Aust 2002 by the Working Group of the Royal Australasian College of Physicians PMID 12056987 say; Though not considered a "cause" of CFS, some patients with chronic fatigue report food intolerances that can exacerbate symptoms.115,116 This MEDRS review does add to the picture. So I would ammend my proposed edit to; Some patients with chronic fatigue syndrome (CFS) report food intolerances that can exacerbate their symptoms. Citing both the CDC and Australian Guidelines. Peerev (talk) 06:25, 8 June 2009 (UTC)

Under a heading like ==Epidemiology==, this would be fine with me, except for the WP:COPYVIO problem. We need to avoid unacknowledged direct quotations. Perhaps something like "Some people with CFS say that they experience symptoms of FI". WhatamIdoing (talk) 18:43, 8 June 2009 (UTC)

The 115, 116 references above, in http://www.mja.com.au/public/guides/cfs/cfs2.html#i1066763 are to this Loblay & Swain work (p.521) and to PMID 8477289 respectively. We've previously discussed the latter, it's a primary source. The former work is also primary. PMID 12056987 is a good ref, but the "Some patients..." should be quoted and attributed, not plagiarized nor paraphrased. If it were to be paraphrased, it would run afoul of WP:Weasel. LeadSongDog come howl 19:47, 8 June 2009 (UTC)

I will settle for quoting and attributing the College of Physicians sentence. Peerev (talk) 21:37, 8 June 2009 (UTC)

The advantage to the simple statement is that we have two reliable sources that we can cite for this fact, not just one. I don't think that we want to say "According to the Working Group of the Royal Australasian College of Physicians and the Centers for Disease Control..." Once you have more than one reliable source making an assertion, it's pretty silly to attribute it to a single source. WhatamIdoing (talk) 00:41, 10 June 2009 (UTC)

Perhaps the commonly used acrynoms RACP working group and CDC would suffice or something like 'Some sufferers of chronic fatigue syndrome have reported food intolerances, CDC cite and RACP cite, that worsens their symptoms, RACP site, the CDC recommends such foods be restricted to improve health. CDC cite.' Peerev (talk) 23:31, 10 June 2009 (UTC)

(1) About attributing a simple statement that is supported by multiple independent sources: When you find PMID 8477289 (1993), are we going to add a third set of names? And a fourth when we find that PMID 11703165 (alt med) says 54% of CFS patients modify their diets? And what will we do about these 200 books? Wikipedia generally attributes statements only when there is some doubt about it being true, because we don't want to be in the silly position of naming every source that agrees with this statement. I don't think that you will ever find a source that says that CFS patients don't report food intolerances.

(2) About what the sentence should say: The CDC website does not recommend that such foods be restricted to improve health. The RACP assertion is misrepresented, because it implies that RACP has verified that these actually worsen their symptoms, when all they've said is that the patients say that certain foods worsen their symptoms. Since I'm honestly not sure how you could have a food intolerance and not have symptoms appear and/or worsen when you eat the food, this seems redundant. WhatamIdoing (talk) 04:05, 11 June 2009 (UTC)

Thank you, I am aware of the Logan review and also how it discredits the Manu paper. It seems to me that what the RACP are saying is that patients report that food intolerance and that it worsens symptoms of chronic fatigue conditions? Which is a bit different to the CDC saying merely they report food intolerances, (and therefore have food intolerance symptoms). What the CDC say under the heading Treatment Options etc.here is Some people with CFS report sensitivities to various foods or chemicals, including refined sugar, caffeine, alcohol and tobacco, all of which should be minimized to promote optimum health. which I think means restricted to improve health? Are we able to make a more general statement attributed to these sources beforehand to the effect that "Food intolerance is considered a risk factor in chronic fatigue conditions"? Peerev (talk) 22:17, 11 June 2009 (UTC)

I understand from the CDC statement that everyone, not just CFS patients, should restrict refined sugar, caffeine, alcohol and tobacco to promote optimum health.

I don't think that we can declare FI to be a risk factor for CFS. (It's more probable that CFS is a risk factor for FI, but even that goes beyond our sources.) What we can say is very simple and obviously supported by both sources: Some people with CFS say that they have FI. WhatamIdoing (talk) 23:50, 11 June 2009 (UTC)

Or just as probably that some other factor, such as say atopy or environmental exposures, is a risk factor for both? I agree that the CDC recommendation can be read two ways, but more likely under a heading treatment options it is intended to apply to CFS sensitivities, I am aware that intolerance to alcohol is common in CFS, the others I don't know and may be just general health advice! I was not aware of the Wikipedia connotation with attribution and agree needs to be reconsidered. The reported alcohol intolerance is reviewed in Logan, and on re reading that paper it does review other studies that found a link between FI and CFS (although I am not sure that they can be cited?), although Logan's summary can be Of the CFS patients who complied, the results were remarkable: 90 percent reported improvement in the severity of symptoms across multiple body symptoms, with significant reduction in fatigue, recurrent fever, sore throat, muscle pain, headache, joint pain, and cognitive dysfunction. Furthermore, the elimination protocol resulted in a marked improvement in IBS-like symptoms among all patients; a significant finding because CFS patients have a high rate of IBS and concludes In addition, research on food intolerance is discussed, since food intolerance may be involved in CFS symptom presentation and in oxidation via cytokine induction. Finally, recent evidence suggests celiac disease can present with neurological symptoms in the absence of gastrointestinal symptoms; therefore, celiac disease should be included in the differential diagnosis of CFS. I am also not convinced that 'reporting of symptom severity' is not MEDRS as it is evidence in this context. Peerev (talk) 23:57, 15 June 2009 (UTC)

So we have the RACP saying that patients report food intolerance and that it worsens symptoms of chronic fatigue conditions and Logan saying food intolerance may be involved in CFS symptom presentation, so I think we can say more than just that patients report food intolerances.Peerev (talk) 23:57, 15 June 2009 (UTC) It is noted that Medlineplus mayo article includes Additional signs and symptoms In addition, people with chronic fatigue syndrome have reported other various signs and symptoms that aren't part of the official definition. These include: Allergies or sensitivities to foods, alcohol, odors, chemicals, medications or noise another reliable source linking FI with CFS . Peerev (talk) 01:58, 16 June 2009 (UTC)

Coeliac Disease

Hi I removed the line about Coeliac disease and fructose intolerance - the part about fructose intolerance didn't make much sense. Coeliac disease should not be mentioned in a food intolerance article. Although this article is very confused about what it wants to be - instead of being a medical definition of intolerance (i.e. lack of or poorly functioning enzyme as in lactose intolerance, phenylketonuria as opposed to allergy or other immune conditions) it has bloated to include assorted other conditions. That's okay as I understand that this article is trying to be more than the narrow definintion we get taught in medical school.

Coeliac disease does not fit here however because the introduction to this aricle states food intolerance "is not considered directly related to the immune system". Coeliac disease is obvioulsy directly related to the immune system as seen in the introduction page of Coeliac disease in which the first line states that it is an autoimmune disorder. Since this article purports to be about non-immune-related disorders it has been removed. —Preceding unsigned comment added by 124.169.175.35 (talk) 12:22, 18 October 2009 (UTC)

You are correct. However Celiac disease is also called "gluten intolerance", so I think it should be in this article. I would suggest changing that first sentence to say "not considered a true allergy" rather than "not considered directly related to the immune system". --sciencewatcher (talk) 20:04, 19 October 2009 (UTC)

Actually, the definition in the lead is wrong, and that's the part that ought to be fixed. WhatamIdoing (talk) 20:06, 19 October 2009 (UTC)

Isn't that precisely what I said?! In fact I see you have done exactly what I suggested. --sciencewatcher (talk) 21:14, 19 October 2009 (UTC)

So it is. I didn't see your comment when I typed mine. The wonders of the mediawiki software are evident. WhatamIdoing (talk) 21:47, 19 October 2009 (UTC)

Ah, ok. No worries. --sciencewatcher (talk) 21:55, 19 October 2009 (UTC)

Coeliac Disease is not called gluten intolerance anymore. It is an old term and is no longer used because it is misleading - it implies that it is a food intolerance, which I would and most of the medical proffesion would argue it is not. However, this article incorporates far more than the medical definition so I can accept the reasons for keeping it in. 124.169.148.196 (talk) 14:39, 26 October 2009 (UTC)

And how would you classify it, if it is neither "food allergy" nor "food intolerance"? More pointfully, perhaps, can you provide sources that support this view? I'm confident that could trivially provide dozens of high-quality sources that disagree with it. WhatamIdoing (talk) 16:59, 26 October 2009 (UTC)

I (as does wikipedia) would classify it as an autoimmune disorder and would not try and fit it in to food allergy or food intolerance (though it does share some features of an allergy). I doubt very much that you'll find any 'high-quality sources' that disagree with that. As for the definition of food intolerance according to the US National Institute of Allergy of Infectious Diseases " Food intolerance is more common than food allergy. The immune system does not cause the symptoms of food intolerance, though these symptoms may look and feel like those of a food allergy" from http://www3.niaid.nih.gov/topics/foodAllergy/understanding/whatIsIt.htm. This definition is also found on medlineplus patient information and the American Academy of Asthma, Allergy and Immunology (http://www.aaaai.org/patients/gallery/foodallergy.asp?item=1c). A google scholar search for food allergy + intolerance shows articles such as http://linkinghub.elsevier.com/retrieve/pii/S0091674999704112 that define it like so "Nontoxic reactions depend on individual susceptibilities and may be the result of immune mechanisms (allergy or hypersensitivity)or nonimmune mechanisms (intolerance)." As I said above however these definitions of food allergy and intolerance are not universally agreed upon and this article has a different definition to mine (and the sources listed above), which I disagree with, but I accept that this article does not need to use my definition 124.169.9.107 (talk) 09:53, 1 November 2009 (UTC)

Many scholarly sources say that celiac disease is either a "gluten intolerance"[3] and/or a "food intolerance"[4], including peer-reviewed journal articles that say things like "celiac disease is the most common food intolerance in the world" (PMID 15285531). I think, therefore, that we can safely include it in this article.

If you want to start an article specifically on pharmacological reactions, then please feel free to do that. WhatamIdoing (talk) 03:32, 7 November 2009 (UTC)

Did you even read my reply? I just showed reliable sources explaining how it is an autoimmune disorder. I think you should read wikipedia's own article on coeliac disease as a place to start learning about it. Also coeliac disease does cause temporary lactose intolerance so when you edit please do it for the good of the article do not remove things that are true just for your own personal vendettas. The reference was in support of the fructose intolerance statement the lactose statement did not have its own reference but instead of removing it you could easily do something constructive and find a reference for it. Remember the idea of wikipedia is to make good articles and not to just delte anything that you don't agree with. Of course if you find something to be false then remove it but in this case is true so it's unhelpful and lazy to just delete it. 203.206.94.48 (talk) 12:58, 18 November 2009 (UTC)

It's not helpful calling people 'lazy' or saying they have 'vendettas'. Add to that, the fact that you don't have a user account automatically reduces the credibility of anything you say. Having said that, let me address the point about gluten intolerance. If you look at this page you will see that the National Institute of Allergy and Infectious Diseases actually includes Gluten Intolerance in their 'food intolerance' page. So the fact that they say on another page 'The immune system does not cause the symptoms of food intolerance' is clearly a contradiction. If you read between the lines, I think you'll see that it is an error and what they actually meant to say was 'Food intolerance does not involve an IgE reaction of the immune system'. Sometimes web pages, even when written by government health organisations, have mistakes - they are not peer reviewed like journals! --sciencewatcher (talk) 15:32, 18 November 2009 (UTC)

(ec)While there are WP:MEDRS (such as this) which justify classifying CeD as an autoimmune disorder, that is a separate question from whether or not it is also a form of food intolerance. This review article addresses recent advances and remaining questions. Also, please understand that no WP article can be used as a reliable source. The policy explicitly reads "Wikipedia itself, although a tertiary source, should not be used as a source within articles, nor should any mirrors or forks of Wikipedia be accepted as reliable sources for any purpose." Without this policy, WP would be subject to the self-referential internal propagation of errors. LeadSongDog come howl 17:02, 18 November 2009 (UTC)

LeadSongDog has it right: this is a case of "both/and", not "either/or". WhatamIdoing (talk) 00:37, 19 November 2009 (UTC)

Hello, new editor here (be gentle). My understanding is that gluten intolerance is separate from coeliac disease. People who test negative to the coeliac gene test (ie Coeliac disease is ruled out) can still have a gluten intolerance. It seems reasonable to address gluten intolerance in this article, while adding a comment that people who suspect gluten intolerance should first rule out coeliac disease with the existing medical tests.--Another287person (talk) 02:38, 12 June 2013 (UTC)

Coeliac does not technically require a particular gene. It just happens that people with the gene are far more likely to get it than people without the gene. And the result is still that they are unable to tolerate gluten, but are (strictly speaking) not allergic to it, so they technically do have gluten intolerance. WhatamIdoing (talk) 23:13, 13 June 2013 (UTC)

Fascinating. Thanks :) --Another287person (talk) 06:29, 15 June 2013 (UTC)

I suggest that celiac disease be mentioned in this article, BUT it should be said that it is an immune reaction, and redirected to the celiac disease article. Also mention here that celiac disease can cause lactose intolerance.

IgA antibodies to gluten (gliadin) are elevated in celiac disease, also autoimmune antibodies (TtG, EMA) are elevated.

Celiac disease isn't diagnosed with a genetic test, but rather with a blood test or biopsy.

There are various kinds of gluten sensitivity, i.e. non-celiac immune reactions to gluten.

These also aren't "intolerances". The newer nomenclature is that a food reaction that does involve the immune system, but isn't a classical IgE-mediated allergy, would be called a "food sensitivity".

Puffysphere (talk) 12:31, 24 June 2013 (UTC)

Food intolerance vs food allergy ...

• http://scholar.google.com/scholar?hl=en&q=allintitle%3A+food+allergy+intolerance&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0

--222.64.22.16 (talk) 10:24, 24 February 2010 (UTC)

• http://scholar.google.com/scholar?hl=en&q=food+intolerance+immunoglobulin+E&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0

--222.64.22.16 (talk) 10:32, 24 February 2010 (UTC)

• http://scholar.google.com/scholar?hl=en&q=food+intolerance+allergy+immunoglobulin+E&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0

--222.64.22.16 (talk) 10:38, 24 February 2010 (UTC)

• Talk:ICD-10#Nomenclature...in ICD-10...???

--124.78.214.100 (talk) 11:13, 24 February 2010 (UTC)

The topic of sulfa intolerance is created based on the following....

• Talk:Sodium metabisulfite#Info about sulfa (sulfite/sulfate) allergy....

--222.67.205.141 (talk) 04:59, 19 March 2010 (UTC)

Bias and accuracy

Hi, I have edited the article. I'm new to editing wikipedia. I felt the citing of one article stating IgG4 mediated food intolerances could have no bearing on food related complaints should be balanced by a study showing the success of avoiding these foods for IBS.

I would like to remove the following sentence as the diagnosis the article refers to is for food allergies not intolerances. Diagnosis is made using medical history and cutaneous and serological tests to exclude other causes, but to obtain final confirmation a Double Blind Controlled Food Challenge must be performed.[7]

I would like to move this line to the treatment section: Treatment can involve long-term avoidance, or if possible re-establishing a level of tolerance.

I have added in malabsorption as a type of food intolerance. There is no international standard (or tests, or aetiology etc.) regarding intolerances, or professional body associated. I believe for all intents and purposes, all food "reactions" should be included.

There is still more work to be done on this page. I will see if I have more time.

Thanks, Eloerc (talk) 15:54, 7 April 2010 (UTC)

About the sentence you propose removing: I think that excluding a "true allergy" is a perfectly normal and reasonable approach to diagnosing a food intolerance. If you have a true, IgE-mediated Egg allergy, then you won't receive a diagnosis of Egg white#Intolerance (even if you have both conditions, which in this instance is actually possible). WhatamIdoing (talk) 03:00, 8 April 2010 (UTC)

Migraine and FI

In spite of extensive discussion above & in the migraine article, I find it remarkable that there is currently no reference to migraine in this article.

As a long term sufferer from migraine with a family history over several generations, I find it amazing that it is controversial that migraines can be triggered by certain foods. Perhaps there are no scientific papers on this subject that can be cited, since the causal link is so obvious... I suspect that it might be equally difficult to find citations that link dogs with barking! On behalf of fellow sufferers I would misquote Dickens “If [science] supposes that ... science is a ass — a idiot ... the worst I wish [science] is that his eye may be opened by experience — by experience.”

I suggest adding a suitably worded statement, linked to the migraine article. In view of the previous discussions I hesitate to do it myself.GilesW (talk) 17:22, 5 May 2010 (UTC)

I think a lot of studies have looked at it, but have not found any correlation. People have a habit of blaming their food for various health problems. I have been thinking of having a hard look at all that unreferenced stuff in the migraine article, but I haven't had a chance yet. If you are interested, I'd suggest you look on google scholar and pubmed for high quality, well-cited reviews that look into this. There may already be such reviews cited in the migraine article. If you need any advice or help in looking for research and evaluating it, let me know. --sciencewatcher (talk) 18:01, 5 May 2010 (UTC)

There are certainly some diet-related triggers for migraines. For example, the "weekend headache" is a well-known and well-documented phenomenon. Presumably they would fall under ICHD 8 (ICD10 G44.4 or G44.83), "Headache attributed to a substance or its withdrawal". I'm just not convinced that "symptom provoked by the absence of caffeine" is quite the same as a food intolerance.

This news story discusses a new/non-mainstream test for IgG-mediated food intolerances, called the Yorktest. This webpage claims the association was reported in ancient Hippocratic texts and what they describe as "Living's classic monograph of 1873".

It might depend on the age of the population: PMID 8488128 shows a fairly clear association between foods and headaches among children and adolescents with common migraines. PMID 12657413, a 2003 review, also accepts the existence of dietary triggers of migraines in a small population of children and adolescents. There are oral challenge studies in adults that support an association, e.g., PMID 8376104, but systematic reviews like PMID 14533654 tend to reject them, since it's essentially impossible to prevent people from figuring out what kind of regular food they're eating (and thus it can't be a double-blind study).

All of this is a long-winded way of saying that there are conflicts in the literature. What we can say, without fear of contradiction, is that some migraineurs say that certain foods trigger their headaches. There's no particular reason why this fact can't be included in this article. WhatamIdoing (talk) 18:03, 7 May 2010 (UTC)

Reference to the connection between FI & migrane: Loblay RH and Swain AR, 'Food intolerance'. In: Wahlqvist ML and Truswell AS editors. Recent Advances in Clinical Nutrition. 1986 London: John Libbey, 169-177. This comes from a source I trust, but I don't know how to look it up. Could someone check it out, please? --Another287person (talk) 02:50, 12 June 2013 (UTC)

Well, it's available here, but a 27 year old source is hardly "recent". There should be much newer reviews, informed by later research papers:

• PMID 10885103 dates to 2000, which is still rather dated, but better.
• Hikmat Hayder, Utz Mueller, Andrew Bartholomaeus Review of Intolerance Reactions to Food and Food Additives Int. food risk anal. j. 2011, 1(2):23-32 -- this one is quite current, but in a brand new journal that has no established reputation for reliability.
• Guandalini S, Newland C. Differentiating food allergies from food intolerances. Curr Gastroenterol Rep. 2011 Oct;13(5):426-34. doi: 10.1007/s11894-011-0215-7. PMID 21792544 -- 2011 review in a PubMed indexed journal, may be useful

LeadSongDog come howl! 05:14, 12 June 2013 (UTC)

There's also mention of food intolerance causing headaches here: http://www.sswahs.nsw.gov.au/rpa/allergy/resources/foodintol/ffintro.html This book was first published in 2004 and has been reprinted every year since then. This book, "Friendly Food" was written by "allergy experts at the Royal Prince Alfred Hospital Allergy Unit." So the institution has put its name on the book, rather than any individual(s) there. The Royal Prince Alfred Hospital is over a hundred years old and employs over 20,000 staff. It's also a world leader on food intolerance research. This book is not a journal, nor is it designed to be "scholarly". It is designed to be accessible information (a recipe book, actually) put out by a reputable institution. Does this count as an adequate reference? --Another287person (talk) 06:46, 15 June 2013 (UTC)

The British Allergy association (currently linked from the article, bottom) talks about migraine in connection to FI. http://www.allergyuk.org/migraine/migraine Specifically it says:

"Migraine is one of a number of chronic conditions in which food is not the underlying cause, but some foods may exacerbate or trigger symptoms in some sufferers."

So, this is a reputable/approved source, clearly stating that there is a connection between migraine and FI. Not underlying, but certainly able to exacerbate or trigger symptoms in some cases. Does this mean that headaches or migraine is worth mentioning on the FI page? --Another287person (talk) 10:42, 16 June 2013 (UTC)

Re-reading the symptoms section, I notice that "headache" is currently listed as a symptom of FI. Please feel free to tell me if I'm continuing to bore you about something that is already agreed upon. Am still learning how to navigate Wikipedia editing. I assume there is some sort of "recent edits" page that I am missing...? --Another287person (talk) 11:32, 16 June 2013 (UTC)

Welcome to Wikipedia, which is incredibly complicated.

A published source needs to be strong enough to support the claim. A patient-oriented brochure is usually strong enough to support simple claims (e.g., antibiotics don't kill viruses). For an extraordinary claim (e.g., this new drug cures cancer), you need the strongest possible source, which is a review article in a reputable medical journal or a textbook used for medical school students. So the answer is that it depends on exactly what you want to write in the article. WhatamIdoing (talk) 14:13, 20 June 2013 (UTC)

Helpful External Links

http://www.sswahs.nsw.gov.au/rpa/allergy/resources/foodintol/ffintro.html Introduction to Food Intolerance by the Allergy Dept of the Royal Prince Alfred Hospital (RPAH) in Sydney, Australia. These authors downplay the seriousness of food intolerance as being merely uncomfortable/inconvenient, as food intolerance is not immediately life threatening the way that allergies are. However, the RPAH are the main(only?) source internationally of objective research on the salicylate/amine/glutimate levels naturally occurring in foods. The RPAH elimination diet and challenge method is the best diagnostic process for determining food intolerance in an individual. I highly recommend that anyone considering a major edit of this Wiki page check out this link.

http://fedup.com.au/factsheets/symptom-factsheets Fairly exhaustive collation of information on FI symptoms. Includes both scientific references and a lot of individual case data.

Food Intolerance can be a difficult area to talk about objectively/scientifically because of the huge diversity in the type and severity of symptoms. Each individual diagnosis is effectively a scientific experiment, where the patient must abide by strict test conditions, and record careful observations over a long period of time, for analysis by their Dietician. Diagnostic results of this kind are not generalizable, in the way that clinical results are. However, each individual patient's diagnostic result is a valid, scientific diagnosis of their particular food sensitivity. When dealing with both individually diagnosed results and clinical study results, it is important to keep each piece of data in it's context.

Individual data is very important in the field of Food Intolerance, because the diversity of symptoms. Someone else's symptoms are not evidence of your symptoms. However, information on the breadth of symptoms in the community provides the individual with pattern matching ideas in working out their individual diagnostic hypotheses, which they can then test experimentally using the elimination diet diagnostic process, under the supervision of their dietician.

This is why I include the Fed Up site as a critical source of information on food intolerance, even though it does not seem to pass the wikipedia medical "sniff test". --Another287person (talk) 04:01, 12 June 2013 (UTC)

No responses yet. Does this mean that it is ok to go and put these links in the actual article? Is there a polite amount of time to wait? --Another287person (talk) 07:28, 15 June 2013 (UTC)

The relevant guideline is WP:EL. I don't think the fedup.com.au link is relevant enough to keep. I'll need time to go over the other. --Ronz (talk) 15:52, 15 June 2013 (UTC)

Thanks for taking a look Ronz. I appreciate you pointing out the WP:EL page. It seems to clearly indicate that the "Fed Up" site is relevant for inclusion.

"3.1 What Can Normally Be Linked"

"3. Sites that contain neutral and accurate material that is relevant to an encyclopedic understanding of the subject and cannot be integrated into the Wikipedia article due to copyright issues,[3] amount of detail (such as professional athlete statistics, movie or television credits, interview transcripts, or online textbooks), or other reasons."

The "Fed Up" site is neutral, accurate, and relevant to an understanding of the symptoms of food intolerance. There is no more thorough collation of information on FI symptoms available.

Did you perhaps mean to refer me to some other part of the policy, or do you have doubts about my assertions of this source's neutrality and accuracy (above)? Happy to discuss either. --Another287person (talk) 11:14, 16 June 2013 (UTC)

Re-write Food Intolerance as umbrella page

I think the article on Food Intolerance would benefit from being made into an "umbrella" page.

There are some quite distinct diagnostic paths that are currently crammed under one heading.

• 1 - FODMAP (fructose, lactose, etc) have a breath test, for two types of FODMAPs (fructose, lactose). However, for the other FODMAPs (incl. fructans, polyols & others) elimination diet is the only diagnostic process. Also, the breath test was designed around irritable bowl symptoms, so people with other types of FODMAP symptoms will often test clear on the breath test.
• 2 - Salicylate, Amine, Glutimate (flavor enhancers), Additives (colourings, flavourings, preservatives) Sensitivity to the food chemicals in this group is only diagnosable through elimination diet.
• 3 - Gluten (non-coeliac intolerance) People who suspect gluten intolerance should start by doing the coeliac gene test, and following the ordinary medical diagnostic process. Those with a negative on the gene test and endoscopy who still suspect gluten intolerance can diagnose it through elimination diet.
• 4 - Milk protein (not lactose)

There are also fundamental differences in the Management/Treatment of the different streams. People with gluten issues typically avoid all traces of gluten. By contrast, people who avoid the fructans(FODMAP) in wheat take a dosage-control approach, only needing to stay below their symptoms threshold. I'm also pretty sure that gluten tends to be a lifetime condition, while they recommend you re-test for FODMAPs every three years in the hope of seeing an improvement.

While there is a lot of good information on the FI page, a person trying to follow all the headings through could very easily confuse a piece of FODMAP information with the gluten information. The ambitious scope of this page makes it very easy for the reader to end up taking information out of context. I think that making Food Intolerance into an umbrella page would go a long way to de-tangling the threads going through it.

I am not offering to do this. One of you experienced folk will need to think about it. Just putting it out there to see what people think. --Another287person (talk) 07:27, 15 June 2013 (UTC)

Behavioral Symptoms

I notice that no behavioral symptoms are currently mentioned in the symptoms section of the FI page. This is a significant symptom category which is worthy of it's own little paragraph. The Wikipedia Salicylate sensitivity page already mentions the following behavioral symptoms: Hyperactivity, Memory loss and poor concentration, and Depression.

The Food Intolerance Network has collated extensive information on behavioral symptoms and FI. Some symptoms are caused by the FI, and other symptoms (like autism) are merely exacerbated by food chemicals (in some people). Those who have the food intolerance, can use diet to assist in the management of their underlaying condition.

Here are some links to give you an idea of the breadth of behavioral symptoms of FI. If someone is interested in pursuing this, you will need to chase down the proper WP:IRS links, but the following links are a heads up on what to look for. Food Intolerance Network Symptom Factsheet Index ADHD Autism and Asperger Down Syndrome Eating Disorders Head banging Opposition Defiance Disorder Self harm Sensitivity to sound Sleep disturbance and insomnia Speech Delay Stuttering Tantrums Teeth grinding Tics and Tourettes Trichitillomania (compulsive hair pulling)

--Another287person (talk) 13:36, 16 June 2013 (UTC)

However, food intolerance is here defined as a food reaction that does not involve the immune system, and these kinds of symptoms may well result from immune reactions. Puffysphere (talk) 22:03, 23 June 2013 (UTC)

Diagnosis

The diagnosis section needs to start with a clear paragraph saying that it is important to seek a formal diagnosis. Something like:

"Medical advice should be sought, in order to determine that symptoms do not have another more readily identifiable cause. Where food intolerance remains a possibility, some medical tests have been developed for some types of food intolerance (see below). Where there is no reputable medical test, diagnosis must be made through the analysis of careful observations made in conjunction with an Elimination Diet and challenge program, preferably under the supervision of a dietician who is familiar with food intolerance diagnosis. Dieticians warn that if diagnosis is not formalized, unnecessary dietary restriction can lead to adverse effects on nutrition and health [needs a reference]."

I think that a paragraph of this sort helps to further establish the necessity of a scientific approach to this subject, and will improve the quality of the FI page. --Another287person (talk) 13:31, 16 June 2013 (UTC)

I think that telling people that they ought to seek medical advice violates our rules against giving medical advice. WhatamIdoing (talk) 14:18, 20 June 2013 (UTC)

Not only that, but food challenges can be dangerous. Not necessarily recommended. And, repeated illnesses from food challenges may damage the body in some way we don't know yet. Puffysphere (talk) 18:50, 23 June 2013 (UTC)

New info on non-classical food allergies

This article is outdated and I found it confusing.

First, the nomenclature has been changed such that "food intolerance" is understood to be a food reaction that doesn't involve the immune system.

Thus, the very definition of the subject of this article is wrong!

I have looked at many definitions of "food intolerance" and they all say that food intolerance does not involve the immune system!

"Food intolerance" is being used in this article as an umbrella term. That is inconsistent with the Food Allergy article.

There should probably be a Food Hypersensitivity page, where "Food Hypersensitivity" is the umbrella term.

It has been discovered that the immune system is compartmentalized to some extent. So, one can have an IgE-mediated allergy that is associated with a particular mucous membrane. This is known to happen in the nose (look up "local allergic rhinitis"). Less is known about IgE-mediated allergies that might be localized in the GI tract, but I saw a reference to locally produced IgE antibodies in the gut. The various mucous membranes communicate immune system information among each other. Non-classical food allergies have passed double-blind placebo-controlled food challenges.

ALSO, it has been discovered that allergic reactions can be mediated by immunoglobulin free light chains, as well as IgE. FLC's can degranulate mast cells when bound to an antigen. IgE-mediated allergic reactions also are initiated via mast cell degranulation. The FLC-mediated reactions might cause the same symptoms as IgE-mediated reactions, or FLC's might more gradually degranulate mast cells. Since these reactions start with mast cells degranulating, it makes sense to call them allergies.

FLC's are increased in (at least some) autoimmune diseases, so it makes sense that people with autoimmune diseases would be liable to have allergies that are FLC-mediated to some extent.

A 2012 thesis with some current research on FLC's in the Netherlands: http://igitur-archive.library.uu.nl/dissertations/2012-0120-200303/UUindex.html

Casein hypersensitivity may involve FLC's: http://www.ncbi.nlm.nih.gov/pubmed/20434201

A review article on the evidence for localized IgE allergies, along with a discussion of possible non-IgE mechanisms: http://www.ncbi.nlm.nih.gov/pubmed/20642577

The details of how IgE and FLC mediated allergies interact, and exactly how FLC binds to mast cells, are not yet known.

I don't have the energy or time right now to work on the article, but I'm hoping someone else will, because this is important information. So many people report food allergies that don't show up on skin or blood tests for IgE antibodies. Puffysphere (talk) 18:24, 23 June 2013 (UTC)

Can you provide a good source for your claim that "First, the nomenclature has been changed such that "food intolerance" is understood to be a food reaction that doesn't involve the immune system"?

Last I checked, food allergy required an IgE-based reaction, and food intolerance and food sensitivity were synonyms for all other reactions, including non-IgE-based immune reactions. Egg white intolerance, for example, is a food intolerance even though the mechanism (pharmacological degranulation of mast cells) is very much dependent on the immune system.

Do you know much about the difference between anaphylaxis and pseudoanaphylaxis? That's the distinction that we're making here between food intolerance/sensitivity and true food allergy. WhatamIdoing (talk) 08:53, 26 June 2013 (UTC)

OK, at http://www.mayoclinic.com/health/food-allergy/AN01109 it says "Food intolerance symptoms generally come on gradually and don't involve an immune system reaction."

At http://apfed.org/drupal/drupal/sites/default/files/files/IgE%20vs%20nonIgE%20reactions.pdf

"Food allergy is the term used to refer to reactions to foods that are primarily caused by the immune system. In the recently published guidelines for the diagnosis and management of food allergy in the United States, a food allergy was defined as “an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food.” Allergic reactions to foods are categorized based on the part of the immune system involved as immunoglobulin E (IgE)-mediated (common type of allergic response), non-IgE-mediated, mixed IgE- and non-IgE mediated or cell mediated. "

There has been a lot of new research finding new immune reactions to foods, so the terminology is in flux. There's a gray area - what about non-celiac gluten sensitivity that results from innate immunity, not acquired immunity? And, we aren't used to thinking of celiac disease as an allergy. The phrase "food allergy" still carries an implication of "IgE-mediated" in many people's minds.

But when immunoglobulin free light chains are found to degranulate mast cells in a specific and acquired way, initiating a similar process to IgE-mediated allergy, it should qualify as an allergy.

I have heard the classification

food intolerance = food reaction that isn't an immune response"

food sensitivity = food reaction that is an immune response

food allergy certainly includes IgE-mediated, but can also include non-IgE mediated if you specify that.

The Hypersensitivity Wikipedia article made me think that "food sensitivity" might be understood recently in this sense - since "hypersensitivity" in that article is used to describe various immune reactions.

However, the Hypersensitivity article is also outdated.

I doubt there IS a nailed-down terminology in existence, because the research on non-IgE food allergies is too recent for that.

But, "food intolerance" encompasses a huge number of different non-immune kinds of food reactions anyway - so I don't think it should be stretched even more, to include immune reactions. It's complicated enough as it is.

How about "food intolerance" for non-immune reaction, "food hypersensitivity" for immune reaction - that would be consistent.

Puffysphere (talk) 18:00, 26 June 2013 (UTC)

I haven't found scientific support for the idea that eggwhites release histamine from mast cells through some non-immune mechanism. According to the article http://www.njmonline.nl/getpdf.php?id=418 , "histamine-releasing foods" are an unproven idea.

I should have said, a food intolerance reaction is not initiated by the immune system. It could involve the immune system in subsequent steps. Puffysphere (talk) 02:00, 27 June 2013 (UTC)

Please take the time to read and understand wp:MEDREV. We need high quality secondary sources such as review articles and systematic reviews. LeadSongDog come howl! 05:42, 27 June 2013 (UTC)

If you haven't "found scientific support for the idea that eggwhites release histamine from mast cells through some non-immune mechanism", then you haven't read the medical reference works cited at egg white intolerance. The key word is "pharmacological". WhatamIdoing (talk) 16:26, 30 June 2013 (UTC)

"food chemicals"

There's a lot of talk of food chemicals in the article which looks silly. 87.83.31.234 (talk) 22:22, 6 May 2015 (UTC)

Leaky gut

Recent reviews show that leakage though tight junctions is modulated by zonulin. This impacts immune, autoimmune, and inflammatory responses. PMID 21248165 and PMID 22731712 pertain. LeadSongDog come howl! 02:41, 7 May 2015 (UTC)

"Feed intolerance" <-- new page required **

Feed intolerance isn't the same as food intolerance. We need a new page for the Neonatal disorder, whichi smore behavioral. Attn @User:Doc James 1.129.97.99 (talk) 11:36, 17 April 2016 (UTC)

What is the difference? And do we have enough sources to support separate pages? Best Doc James (talk · contribs · email) 13:33, 17 April 2016 (UTC)

Not supported

"A very early and influential popular book on the subject of "food intolerance", including gluten sensitivity and elimination diets, was "Not All in the Mind" by Richard Mackarness which was published by Macmillan on January 16th, 1976 ."

Not supported by the ref. Doc James (talk · contribs · email) 04:39, 4 November 2016 (UTC)

I'd have removed it as advertising. --Ronz (talk) 16:59, 4 November 2016 (UTC)

References

Diagnosis

Besides hydrogen breath testing for lactose intolerance and fructose malabsorption, DNA tests can also be useful to detect coeliac disease and lactosa intolerance (MCM6 gene, and HLA-DQ gene). See here KVDP (talk) 17:19, 8 March 2018 (UTC)

Yeat

Alergy 130.218.6.112 (talk) 17:53, 30 January 2023 (UTC)