Terence Lim, 64, first realised that his stomach couldn’t properly digest instant noodles when he was around 50 years old. He suffered from indigestion for at least six hours after eating them and also sometimes got acid reflux. He has developed a food intolerance.
For a few years after the discovery, he was still able to enjoy this much-loved dish after a process of elimination determined which brands and types of instant noodles his stomach could tolerate – down to what type of flour was used, the level of saturated fats it contained, even where it was manufactured. However, even that isn’t possible for him now.
"My stomach can also no longer digest mee sua, something my wife insists I must eat as a birthday dish – for long life, apparently."
Credit: Terence Lim
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Phoebe Lam developed a lactose intolerance in her late 50s. She initially handled it by taking lactaid tablets, which contain lactase enzymes that make dairy easier to digest. At the age of 65, the tablets stopped working and she’d get diarrhoea almost instantly after consuming food or drinks with lactose.
"Although I don't take dairy products now, I find that I can have pizza, cheese fondue and certain lactose-free cheeses."
These stories are not unique. Getting reactions to foods you never had before is quite common as we get older. However, while we might think of these as food allergies, they are actually food intolerances.
Differences between food intolerance and food allergy
Jaclyn Reutens, a dietitian at Aptima Nutrition, explains that food intolerances – such as lactose intolerance – do not involve the immune system but food allergies do. Also, food allergies occur rapidly, produce immunoglobulin E (IgE) antibodies (a type of antibody that causes an allergic reaction) and can be fatal, such as a peanut allergy.
"They are rarely fatal but are dose-dependent, for example, having a wheat or gluten sensitivity where you get diarrhoea or an abdominal pain the day after."
Dr John Mok Shao Rong, consultant, division of gastroenterology and hepatology, department of medicine, National University Hospital (NUH) and Alexandra Hospital (AH), reveals that acquired food allergy in the elderly is not common in our population. Food intolerance, however, is more commonly seen and the most common trigger is lactose.
No more spicy food?
Jaclyn reveals that foods we tend to get more sensitive or develop intolerances to as we age are crustaceans, fish, peanuts, tree nuts, soy, wheat, dairy, as well as some fruits and vegetables.
And, if you find that you can’t digest spicy food well anymore, this is because our digestive system gets less tolerant as we age. Stress and some medications can increase the sensitivity to spicy food that contains capsaicin, which is an irritant for the gut, says Jaclyn.
Dr Mok explains that the types of food that trigger symptoms of indigestion, such as bloating, differ from person to person. Some common foods that cause these symptoms are oily food, deep-fried food, spicy food, caffeine, carbonated drinks and alcohol.
"In general, eating a balanced diet with a focus on minimally processed whole foods is advisable. Avoiding overeating and having a regular bowel movement is also helpful."
Menopause may play a part
Women may also develop food sensitivities throughout menopause as hormonal changes can trigger issues of gut permeability, gut motility and changes in the gut microbiome.
"It's common to feel tired from all these symptoms. Oestrogen affects histamine tolerance, increasing the risk of food intolerances and sensitivities."
Credit:NUH
Dr Mok says that most cases of food-related gastrointestinal disturbance are chronic and, if symptoms are present at the time of menopause, it is likely this will continue to be the case and severity may vary over time.
And, while there is insufficient evidence to conclude that menopause is a consistent trigger for food intolerance, many gastrointestinal symptoms do get more common as we age, he adds.
Heartburn is one of the common symptoms
Eating certain foods could also lead to heartburn and Dr Mok says that foods that are high in oil and fats are usually the culprits. Other commonly reported triggers include spicy foods and carbonated drinks.
"Other lifestyle habits are also helpful, such as taking smaller meals, avoiding taking meals close to bedtime, staying upright or taking a walk after a meal rather than sitting or lying down."
You might reach for instant cures when you’re suffering from heartburn but Dr Mok says there have been no major clinical studies to prove the effectiveness of fruit salt (such as ENO fruit salt) for heartburn. Antacids are effective medicines and many are available over the counter.
If you’re having adverse reactions to any foods, Jaclyn advises to eat possible trigger food in small doses such that your gut does not have to ‘work too hard’ to digest it. That can help to lessen the impact.
"A high-fibre diet with less red meat is helpful. Take a probiotic daily to improve gut health and gut microbiome."
Most common triggers
Credit:Aptima Nutrition
Jaclyn takes us through some foods that could trigger a reaction as we get older and why this happens:
- Raw fruits and vegetables
This is known as oral allergy syndrome or pollen-food allergy syndrome. The proteins responsible for both of them are similar, leading your immune system to react similarly – swelling in your throat, mouth and tongue and an itchy mouth. Citrus fruits, kiwis, melons, bananas, tomatoes and tree nuts are some fruits and vegetables that you can develop an allergy to later in life.
- Lactose
Our digestive system gets less tolerant as we age and food intolerances such as lactose, gluten and seafood allergies can develop. You can take lactase supplements to counter the effects of lactose intolerance.
- Yellow noodles
It’s usually made from wheat flour, water, salt and eggs. The gluten found in wheat flour can trigger a food intolerance. Compare this with kway teow, which is gluten-free.
- Glutinous rice
While it is gluten-free, it’s starchy and has a gelatinous texture that makes it harder to digest for some individuals – and this can be confused with an intolerance. A rice allergy is possible but it is extremely rare. Try eating a quarter portion of your glutinous rice dish, wait and observe, instead of the whole portion at one time.
- Bean curd, ikan bilis, red meat and beer
Uric acid is the by-product of purines that are found in these foods. The kidneys are responsible for removing uric acid in our body via urine. As we age, our kidney functions can slow down, leading to higher uric acid levels in the body, giving rise to gout attacks. These are not intolerances per se, because there are no IgE or IgG antibodies being produced.
"Being dehydrated increases the risk of gout attacks and other medical problems that can be avoided. Develop a habit of drinking six to eight cups of water a day."
As with most issues we might face as we get older, knowing how to handle our food intolerances and sensitivities will lead to a better quality of life.
