“I used to eat this without any trouble. Why does it upset my stomach now?”
Over 25 years in gastroenterology, I have heard this concern increasingly often. Patients find themselves avoiding another food, then another. Some have Crohn’s disease or ulcerative colitis that is well controlled, yet the food reactions remain.
That is why the study I discuss in this video caught my attention. The researchers went beyond recording which foods caused trouble. They asked what had changed in the gut.
Why am I suddenly reacting to food?
Your gut's ability to handle a food can change, even when the food itself has not. In IBD, this research suggests that inflammation can deplete bacteria that help break down food proteins, potentially leaving the gut more reactive afterwards. That may help explain reactions that continue during remission. It is one possible explanation, so the symptoms still need to be understood in your own clinical context.
Watch my short explanation
Dr Pranab Gyawali explains why food reactions may persist even when IBD is in remission.
How common were food reactions in the study?
The McMaster study published in Gastroenterology included 104 people with IBD in remission and 44 people without IBD. In the journal society’s report and investigator interview, about 85% of those with IBD reported food reactions, compared with 33% of those without IBD.
So the bowel disease was in remission, but eating was still a problem for many. That is the situation I hear about in consultations. These were reported reactions in this particular group, not proof of food allergy or figures for everyone with digestive symptoms.
What had changed, and could the researchers change it back?
They found fewer bacteria involved in breaking down food components. In mice, inflammation disrupted this process, and later exposure to dairy or gluten proteins triggered immune reactions and gut pain.
What interested me most was the next step. The researchers restored selected bacteria, or used medicines that calm mast cells, the immune cells involved in these reactions. The food-triggered responses improved in the mice.
That gives us something to investigate in people. It does not yet establish a probiotic or medicine I can prescribe to restore your food tolerance.
What if I do not have Crohn’s or colitis?
The question is still worth asking, but this study cannot give everyone the same answer. IBS, lactose or fructose malabsorption and coeliac disease can require a different approach. If bloating after food is new or persistent, I want to understand the pattern before recommending more exclusions.
Nor does this mean everyone needs a microbiome test. My explanation of what microbiome results can tell you covers those limits.
Should I stop eating the foods that bother me?
A diary can help us see what happens after particular meals. When a dietary trial is appropriate, reducing a suspected trigger and planning reintroduction with your clinician or dietitian is preferable to letting the avoidance list grow indefinitely. My food intolerance assessment page explains that practical next step.
Breathing difficulty or swelling of the mouth or throat after food needs emergency care. Do not try reintroducing a food yourself if an allergy is suspected.
My view
I find this research encouraging because it asks whether we might eventually help people tolerate foods again. For patients whose meals have become increasingly restricted, that would be useful. I will be following the human studies closely.
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Related reading
Food reactions and your gut bacteria
If you have Crohn’s disease or ulcerative colitis
This article is educational and does not diagnose the cause of an individual food reaction.
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