Is pain an important part of food sensitivity symptoms that change with diet?
In May 2010 I listened to a well presented talk on reflux in babies and children by a senior paediatric Gastroenterologist at RCH Brisbane. He reported that the amount of distress in the baby or child does not equal the amount of damage to the oesophagus in reflux babies. He further mentioned that the sensitivity to pain does seem to vary in different children. This reminded me of teens and adults with irritable bowel syndrome (IBS), or children who complain of ‘tummy aches’, all of whom are often seen as ‘overnoticing’ their pain.
Yet I have seen other food sensitive people who have a very high pain tolerance. I have been in the fortunate position of working with food sensitive people for over 30 years. Food sensitive people have a variety of symptoms including allergic ones (especially eczema), as well as headaches, migraine, IBS, mouth ulcers, Attention Deficit Hyperactivity Disorder (ADHD), chronic fatigue (i.e. hypoactivity), sleep problems, and mood changes. Because I was not concentrating on only one symptom I was able to see the overall phenomenon of food sensitivity and therefore where pain fitted in.
Many of the parents of the ADHD children (usually boys) reported that their child did not report pain when it would have been expected. Being hyperactive they had more that the usual bumps and falls of other children. Yet they would get up and run on. As well many of these mothers reported being told by their doctor that the child must be in agony with the severity of their ear infection when they presented for care, with the implication that the mother was neglectful. Yet the mothers of these children said that the child had not complained and they had only bought the child in for a check as the ear was red or because the child was pulling at the ear. Intriguingly these mothers also reported that the brother or (more often) the sister of the ADHD child complained of hurt out of proportion to their bumps and scraps. This child would be encouraged to ‘toughen up’ and be like their sibling. These low pain tolerance siblings usually had symptoms such as tummy aches, headaches and carsickness, and when they had ear ache they did report pain. It made sense that if the child with the high pain tolerance felt little pain, it was valid to respect the other children’s increased sensitivity to pain.
Because of this I was very appreciative of the cramping pain felt by those children with ‘tummy aches’ and teens and adults with IBS (more often women). So it was with interest that I noted in the informative 2008 UK Guidelines on IBS that there are some people with ‘painless bowel dysfunction … though it is likely that some share underlying pathology with their respective IBS subtypes’.
At the end of May I attended a presentation at the DAA conference in Melbourne and listened to an equally interesting presentation on eosinophillic oesophagitis (EO). The dietitian (K Murray ) reported that “the number of eosinophils does not correlate with the patient symptoms or the histological severity of the disease”. Researchers in this area also pose the question of whether the symptoms (most common is abdominal pain) are related to a “Visceral hyperalgesia” ( deep gut heightened sensitivity to pain.) They further report that 10% of patients with EO have no pain symptoms. After diet treatment some reintroduce foods with no return of symptoms but the histology shows that the condition has deteriorated for them.
Is this variation in pain sensitivity present in the normal population? It is certainly present in food sensitive people: that is those families who have had their symptoms including the amount of pain reduced by an elimination diet. This tendency runs in families who have members with a variety of implicated symptoms. Members have what is called ‘target organ sensitivity’ whereby they have their particular cluster of symptoms which are ‘aggravated by’ the suspect foods and chemicals implicated. (See Are You Food Sensitive? for detail on the symptoms that occur, the suspect chemicals and the diet investigation process.) Perhaps different sensitivity to pain is another part of what makes food sensitive people different from others in the population. I have written elsewhere about the various ways that food sensitive people are supersensitive to sensory input, such as to smells, or light. Here I want to emphasise that pain is an important part of this.
Thinking this through raises some interesting ideas. Most people with migraines have severe pain, but there are those who have all the disturbed vision effects with no pain. Another interesting point is that many food sensitive women report having, or having had in their teens, much greater cramping pain with monthly bleeding. Their pain with waves of nausea, feeling faint, vomiting and diarrhoea is similar to the cramping pain of some patients with IBS. What is happening here? We already know that there are a variety of symptoms that occur in food sensitive families. Separately there is individual variation in the amount of pain they have. So I would suggest that the pain itself, with the amount and the pain, and the target organ where most pain is felt should be appreciated, and considered a separate symptom in food sensitivity and its investigation. Some of these people say they do not find other pain such as a knock on the head or on the shin nearly as upsetting. It can seem unusual that not all the pain the person feels is severe. But it is as reasonable that we consider the concept of target organ for pain sensitivity just as we consider target organ sensitivity for the other symptoms the patient has. Those with lower gut pain clarify that there is no upper pain and vice versa. ‘Limb pains’ that are not growing pains are another type of pain reported to change with diet investigation. Those with this symptom rarely get any sympathy but report much gratitude when the symptom is relieved with diet.
Dietitians with food sensitive patients see those with bad pain as the people with the most pain are those who are prepared to go on elimination diets and stick to them. Others may say “I have IBS, or migraine, but I wouldn’t want to change my diet. It’s not that bad!” And they are right. For them the pain is not as bad, but they need to realise that the amount of pain they feel may not be the same as the amount felt by others with similar symptoms, even others in the same family.
This concept of different amounts of pain has made me stop and think about many aspects of diet and food sensitivity. I have found it interesting that those with chronic headaches are often more consistent with diet adherence than some with migraine. Once some of those with migraine learn that their symptoms are related to diet, and that they do not have a more serious or life threatening condition, such as a brain tumour, they do not mind putting up with the occasional migraine, especially if they enjoy the rich food that may produce it!
Like other food sensitivity symptoms the amount of pain felt depends on the ‘total body load’ of all the suspect foods as well as all other factors reported to affect food sensitivity. These include hormone changes, the presence of infections or significant stress, liked and disliked smells, seasonal changes, etc. (See Are You Food Sensitive? for detail.) That food sensitive people feel pain at the ends of the tolerance scale is not surprising when we consider other food sensitivity symptoms that change with diet investigation, such as diarrhoea or constipation, hyperactivity (In ADHD children) and hypoactivity (in those with chronic fatigue syndrome), happy-high and silly and tearful and anxious, or who have very light sleep and those who sleep very long and deeply.
Adding all the above ideas together it is reasonable to say that pain is a separate symptom which needs to be considered in diet investigation. That is, there can be one or more main symptom that responds to diet and – as an entirely separate question – there is an issue of the amount of pain associated with that symptom and its response to diet investigation.
Joan Breakey MAppSc BSc Cert Diet DNFS TTTC