“More bacteria live and work in one linear centimeter of your lower colon than all the humans who have ever lived … Are we in charge, or are we simply hosts for bacteria? It all depends on your outlook.”
– Neil deGrasse Tyson, Space Chronicles: Facing the Ultimate Frontier
Extra-Intestinal Symptoms of GI Imbalances & Food Reactions
Increasingly, research is linking imbalances in the gut to diseases that may not at first seem connected to gut function. Work by several researchers has linked intestinal mucosal permeability to chronic respiratory allergies/rhinitis,1-2 asthma,3-4 and eczema.5-6 Furthermore, intestinal dysbiosis is known to play a role in many chronic conditions,7 and reactions to food can manifest far from the intestines.8-10
One of the common consequences of food reactions can be headaches and migraines. Headache specialist Robert Sheeler, MD, an IFM certified practitioner, describes the many types of symptoms that can manifest in the presence of food reactions:
Eczema & The Gut
As Dr. Sheeler states, food reactions can also take the form of rashes or skin problems. On first glance, the connection between intestinal mucosal disruption and eczema may seem the most straightforward, as skin microbiome11 and barrier integrity12 are known to be affected in patients with eczema, and the connection between the skin microbiome and the gut microbiome seems intuitive.
Indeed, evidence is accumulating that treatments aimed at restoring balance in the gut microbiome, such as ingesting probiotics, may reduce eczema,13 suggesting that repairing the gut could be key to reducing eczema severity. Furthermore, Staphylococcus aureus on the skin is known to play a role in atopic dermatitis, and an unusual predominance of S. aureus is found on the skin of individuals with the condition.14-15 However, a Cochrane Review recently concluded that “currently available probiotic strains probably make little or no difference in improving patient-rated eczema symptoms.”16 Rather than alter the skin or gut microbiome with supplements, removing inflammatory triggers may be a stronger approach at this time. For instance, “marked improvement” of atopic dermatitis can be seen with removal of food triggers, and the authors also suggest inhalation of allergens may play a role in atopic dermatitis.17
In pediatric patients, eczema and food allergy (IgE-mediated) are highly correlated, with 30% of children with moderate to severe eczema having a food allergy.18 In one study on adult patients with atopic dermatitis, severity of atopic dermatitis correlated with very high IgE reactivity: 92% of patients with severe and 83% of patients with moderate atopic dermatitis showed reactivity.19 This may suggest that poly-sensitization plays a role in the progression of atopic conditions.
Further research has found that atopic dermatitis is a predictive risk factor for food sensitization in infants, further connecting the skin and gut and suggesting that skin dysbiosis or mucosal permeability may potentially precede food reactions in some cases.20
Headaches, Migraines, and Food Reactions
Individuals with chronic gastrointestinal symptoms are more likely to have headaches or migraines.21 The pro-inflammatory immune response associated with intestinal permeability likely plays a role in increasing headache and migraine frequency.21 In one large retrospective study, patients with migraines were more likely to have GERD, and migraineurs and those with tension headaches were more prone to gastric ulcers than the control groups.22
Many patients who suffer from migraines or chronic headaches state that dietary factors play a role.23-24 Dietary triggers tend to be personalized, and interventions need to emphasize overall healthy lifestyle change rather than simply food restriction.25 However, research is suggestive that certain classes of food may be more likely to trigger headaches. For example, one study of 115 children with chronic headaches excluded caffeine, MSG, cocoa, aspartame, cheese, citrus, and nitrates for six weeks.26 At the six-week mark, 87% of the children no longer suffered from headache.26 That research did not follow up with reintroduction of foods to identify which may have been the specific triggers for specific individuals. Three studies have examined how IgG antibody testing may guide exclusion of certain foods, each showing a reduction in headaches when those foods were eliminated.27-29 Only one of those studies also included an intervention to support the gut, in this case by using probiotics.
Even without IgG testing, avoiding patient-identified trigger foods can greatly reduce migraine frequency.30 However, for patients suffering from migraines who wish to avoid medications, short-term elimination of the problem classes of foods may provide relief.
Food reactions can take many forms. From the fabled ice cream headache to foggy-headedness or metabolic responses, food affects the body. Two symptoms that raise the index of concern for potential food reactions are persistent atopic issues and headaches or migraine.
Identifying and treating food reactions can be challenging, due to the range of potential symptoms. In addition to removing potential trigger foods, IFM recommends supporting gut health by reducing inflammation, improving nutritional status, and supporting the microbiome with pre- and/or probiotics. These steps can help reduce immune activation and lead to overall improved health, beyond reducing the symptoms.
- Steelant B, Farré R, Wawrzyniak, et al. Impaired barrier function in patients with house dust mite-induced allergic rhinitis is accompanied by decreased occludin and zonula occludens-1 expression. J Allergy Clin Immunol. 2016;137(4):1043-1053.e5. doi:1016/j.jaci.2015.10.050
- Soyka MB, Wawrzyniak P, Eiwegger T, et al. Defective epithelial barrier in chronic rhinosinusitis: the regulation of tight junctions by IFN-? and IL-4. J Allergy Clin Immunol. 2012;130(5):1087-1096.e10. doi:1016/j.jaci.2012.05.052
- Hijazi Z, Molla AM, Al-Habashi H, Muawad WM, Molla AM, Sharma PN. Intestinal permeability is increased in bronchial asthma. Arch Dis Child. 2004;89(3):227-229. doi:1136/adc.2003.027680
- Walker J, Dieleman L, Mah D, Park K, Meddings J, Vethanayagam D. High prevalence of abnormal gastrointestinal permeability in moderate-severe asthma. Clin Invest Med. 2014;37(2):E53-E57.
- Ukabam SO, Mann RJ, Cooper BT. Small intestinal permeability to sugars in patients with atopic eczema. Br J Dermatol. 1984;110(6):649-652. doi:1111/j.1365-2133.1984.tb04699.x
- Sheen YH, Jee HM, Kim DH, et al. Serum zonulin is associated with presence and severity of atopic dermatitis in children, independent of total IgE and eosinophil. Clin Exp Allergy. 2018;48(8):1059-1062. doi:1111/cea.13158
- van der Meulen TA, Harmsen H, Bootsma H, Spijkervet F, Kroese F, Vissink A. The microbiome-systemic diseases connection. Oral Dis. 2016;22(8):719-734. doi:1111/odi.12472
- Zanjanian MH. The intestine in allergic diseases. Ann Allergy. 1976;37(3):208-218.
- Catassi C. Gluten sensitivity. Ann Nutr Metab. 2015;67(Suppl 2):16-26. doi:1159/000440990
- Losurdo G, Principi M, Iannone A, et al. Extra-intestinal manifestations of non-celiac gluten sensitivity: an expanding paradigm. World J Gastroenterol. 2018;24(14):1521-1530. doi:3748/wjg.v24.i14.1521
- Paller AS, Kong HH, Seed P, et al. The microbiome in patients with atopic dermatitis. J Allergy Clin Immunol. 2019;143(1):26-35. doi:1016/j.jaci.2018.11.015
- Wollina U. Microbiome in atopic dermatitis. Clin Cosmet Investig Dermatol. 2017;10:51-56. doi:2147/CCID.S130013
- Rosenfeldt V, Benfeldt E, Valerius NH, Paerregaard A, Michaelsen KF. Effect of probiotics on gastrointestinal symptoms and small intestinal permeability in children with atopic dermatitis. J Pediatr. 2004;145(5):612-616. doi:1016/j.jpeds.2004.06.068
- Thomas CL, Fernández-Peñas P. The microbiome and atopic eczema: more than skin deep. Australas J Dermatol. 2017;58(1):18-24. doi:1111/ajd.12435
- Kong HH, Oh J, Deming C, et al. Temporal shifts in the skin microbiome associated with disease flares and treatment in children with atopic dermatitis. Genome Res. 2012;22(5):850-859. doi:1101/gr.131029.111
- Makrgeorgou A, Leonardi-Bee J, Bath-Hextall FJ, et al. Probiotics for treating eczema. Cochrane Database Syst Rev. 2018;11:CD006135. doi:1002/14651858.CD006135.pub3
- Caubet JC, Eigenmann PA. Allergic triggers in atopic dermatitis. Immunol Allergy Clin North Am. 2010;30(3):289-307. doi:1016/j.iac.2010.06.002
- Cartledge N, Chan S. Atopic dermatitis and food allergy: a paediatric approach. Curr Pediatr Rev. 2018;14(3):171-179. doi:2174/1573396314666180613083616
- Mittermann I, Wikberg G, Johansson C, et al. IgE sensitization profiles differ between adult patients with severe and moderate atopic dermatitis. PLoS One. 2016;11(5):e0156077. doi:1371/journal.pone.0156077
- Flohr C, Perkin M, Logan K, et al. Atopic dermatitis and disease severity are the main risk factors for food sensitization in exclusively breastfed infants. J Invest Dermatol. 2014;134(2):345-350. doi:1038/jid.2013.298
- van Hemert S, Breedveld AC, Rovers JM, et al. Migraine associated with gastrointestinal disorders: review of the literature and clinical implications. Front Neurol. 2014;5:241. doi:3389/fneur.2014.00241
- Lee SH, Lee JJ, Kwon Y, Kim JH, Sohn JH. Clinical implications of associations between headache and gastrointestinal disorders: a study using the Hallym Smart Clinical Data Warehouse. Front Neurol. 2017;8:526. doi:3389/fneur.2017.00526
- Finocchi C, Sivori G. Food as trigger and aggravating factor of migraine. Neurol Sci. 2012;33(Suppl 1):S77-S80. doi:1007/s10072-012-1046-5
- Marmura MJ. Triggers, protectors, and predictors in episodic migraine. Curr Pain Headache Rep. 2018;22(12):81. doi:1007/s11916-018-0734-0
- Slavin M, Ailani J. A clinical approach to addressing diet with migraine patients. Curr Neurol Neurosci Rep. 2017;17(2):17. doi:1007/s11910-017-0721-6
- Taheri S. Effect of exclusion of frequently consumed dietary triggers in a cohort of children with chronic primary headache. Nutr Health. 2017;23(1):47-50. doi:1177/0260106016688699
- Alpay K, Ertas M, Orhan EK, Ustay DK, Lieners C, Baykan B. Diet restriction in migraine, based on IgG against foods: a clinical double-blind, randomised, cross-over trial. Cephalalgia. 2010;30(7):829-837. doi:1177/0333102410361404
- Xie Y, Zhou G, Xu Y, et al. Effects of diet based on IgG elimination combined with probiotics on migraine plus irritable bowel syndrome. Pain Res Manag. 2019;2019:7890461. doi:1155/2019/7890461
- Aydinlar EI, Dikmen PY, Tiftikci A, et al. IgG-based elimination diet in migraine plus irritable bowel syndrome. 2013;53(3):514-525. doi:10.1111/j.1526-4610.2012.02296.x
- Özön AÖ, Karada? Ö, Özge A. Efficacy of diet restriction on migraines. Noro Psikiyatr Ars. 2016;55(3):233-237. doi:5152/npa.2016.15961
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