Low Dose Naltrexone Easing Pain from Fibromyalgia and Other Painful Conditions

Jarrod Younger PhD

When researchers began to look at how low the dosage of naltrexone could be and still be effective in helping patients overcome addiction, unexpected things began to happen.

A low dose of the drug had a paradoxical effect. Given an hour before bedtime, it lowered endorphins as expected for a few hours. Then, in the early hours of the morning when the body manufactures endorphins, there was a rebound effect, increasing endorphins up to triple the previous day’s level. That in itself has implications for many physical and mental health conditions.

Researcher Jarrod Younger PhD, director of UAB’s Neuroinflammation, Pain and Fatigue Laboratory, has been studying another way low dose naltrexone (LDN) seems to be easing pain and fatigue from conditions such as fibromyalgia, chronic fatigue syndrome and Gulf War syndrome.

“Low dose naltrexone crosses the blood brain barrier and has a novel anti-inflammatory effect that modulates inflammation in microglia,” Younger said. “Current thinking is that it goes beyond endorphins to directly act on the receptor that activates the inflammatory process in microglia. In reducing the inflammation, it also reduces the cascade of cytokines and toxins assaulting neurons.

More than half of the participants in the study reported a meaningful improvement in symptoms after taking a nightly 4.5 mg dose of LDN for 90 days. Although this was a small study, results were promising enough to warrant further investigation.

On the other side of the blood brain barrier, a similar calming of immune cells in the body has been reported in a number of other small studies looking at the use of LDN in a wide range of autoimmune conditions, with a corresponding improvement in symptoms.

As naltrexone is a low cost generic drug, there are no financial incentives for funding large studies to get separate FDA approval for low dose use. So funded by foundations and small government grants, studies around the world, particularly in the UK, have been investigating the effects of LDN on autoimmune conditions like Crohn’s and MS, depression, and even looking at possible effects on tumors with opioid receptors. The studies are small, but the number is adding up to an impressive volume of positive results.

Health care providers who have been following the studies are taking notice and beginning to use LDN off label. This is especially true for patients who have experienced side effects with other medications or who haven’t been able to achieve adequate relief from the usual therapies.

One of those providers is UAB rheumatology nurse practitioner Vanessa Hill, CRNP.

“I was intrigued by the results Dr. Younger was seeing, especially when I saw the data and understood how LDN modulates inflammation in microglia,” she said. “I see so many patients with fibromyalgia and a whole range of arthritic conditions who are hurting in spite of treatment. So I started to discuss LDN with some of them. Naltrexone has a good history of being generally well tolerated at a much higher dose of 50 mg. or more for addiction and alcoholism. Low dose for pain usually starts at around 2.5 mg. and steps up to 4.5 mg. depending on how the patient is doing.

“When I saw how my patients responded, I could hardly believe it. I have never seen so many patients respond so well to any one medication. Several have told me it has changed their lives. Some merely say they are feeling better, but then they start talking about all the new things they are doing and realize what a difference it has made in more energy and less pain.

One of those patients was Karen, a UAB research nurse who was experiencing chronic, widespread tendonitis, muscle pain, poor sleep and fatigue.

“I constantly had to get injections just to make it through the day,” she said. “The steroids didn’t do enough or last long enough, and there are limits to how often you can have them without health consequences. Since I work in clinical research, I saw how well people in Dr. Younger’s study were doing, and realized LDN might be the answer for me. I asked my rheumatology nurse practitioner at my next visit and she had heard Dr. Younger’s lecture and was beginning to prescribe it.

“I was her third patient using it, but I would have been first in line if I had known sooner. I have seen 80 percent improvement for a year and a half now. The pain is so much less. I’m sleeping better and have less fatigue. I was worried that I was going to have to give up nursing, but now I’m doing so much better.”

Hill often gets calls from other physicians around UAB and even out of state.

“I tell them about it and refer them to the research data,” she said. “Since it is low dose, prescriptions have to be filled at a compounding pharmacy and I always prescribe a 90-day supply. It isn’t covered by insurance, but it is a low cost generic drug. Compounding costs vary widely, but most of my patients have found sources that charge between $35 and $45 for a 90-day supply.

“Patients should take it every night about an hour before bedtime. It takes a while for such a small dose to turn around so much inflammation. They need to take LDN consistently for 90 days to get a clear sense of how well it will work for them.

“You may find additional benefits. One of my patients was prescribed opioids by a pain clinic. A while after she started LDN, a doctor at the pain clinic called to ask how on earth I got her down from several opioid pills a day to using just 45 pills over 90 days. I told him about LDN, and now he is prescribing it.

Dr. Younger is also studying other well-tolerated medications and readily available substances to find more alternatives that can pass through the blood brain barrier and calm inflamed microglia.

“We may one day have drugs with the financial incentives to fund large studies, but discovery, development, clinical testing and FDA approval could take years,” he said. “Meanwhile, people are suffering. We need more research to find options that are available now to relieve symptoms.

“For the next few weeks, we will be continuing to recruit fibromyalgia patients for an ongoing pilot study using low dose dextromethorphan, the cough suppressant in cold medicines, which seems to have a similar effect on microglia inflammation, but doesn’t block opioid receptors. This would offer another alternative for people who need the pain relief of opioids for other conditions, or need the usual higher dose of naltrexone to fight addiction or alcoholism.”

Toward the end of the year, Younger hopes to be evaluating preliminary findings on this study and another that evaluates the effectiveness of commonly available substances with anti-inflammatory properties such as curcumin and resveratrol.

To refer fibromyalgia patients who may be candidates for the low dose dextromethorphan trial, contact UAB’s Neuroinflammation, Pain and Fatigue laboratory, youngerlab@uab.edu or call 205 975-5907.

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Infections, scarring and hepatitis B and C are just some of the health problems caused by body piercing. Laurence Monneret/The Image Bank via Getty Images

Body piercings may be artistic, but they bring risks of infection, allergic reactions, scarring and urine leakage

Published: October 11, 2022 11.18pm AEDT

Author

1. Vijaya Daniel Dermatology Resident, UMass Chan Medical School

Disclosure statement

Vijaya Daniel does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

We believe in the free flow of information

Throughout history, body piercing has been a symbol of beauty, sexuality, ritual initiation and rites of passage.

Mayan royalty had their tongues and genitals pierced; during the Victorian era, many women pierced their nipples. After World War II, tongue, nipple and genital piercings occurred in Germany. Today, body piercing remains common in tribal societies throughout Africa, Asia and South America.

In the U.S., piercing became mainstream during the 1990s and is perhaps more popular than ever.

I am a physician specializing in dermatology. My colleagues and I have seen the medical complications that body piercing can cause. While people shouldn’t necessarily avoid piercings, they should be aware of the risks and best practices. It’s also critical to distinguish relatively safe ear piercings from more problematic and potentially dangerous piercings.

Infections, scarring and nerve damage

Medical problems arising from body piercings happen a lot; the incidence of complications could be as high as one out of every five individuals.

Some problems are relatively minor: jewelry allergy, bleeding, scarring and the formation of keloids, which are thick overgrowths of scar tissue. Nerve damage complications are also possible – and sometimes they affect internal organs or lead to sepsis, a potentially fatal illness that requires immediate medical attention. Should children have their ears pierced? A pediatric physician offers advice.

Other complications, less common, include brain abscess and endocarditis, a heart inflammation that can be life-threatening. It is unclear how these complications occur, but one hypothesis is that they are caused by infections from needles, perhaps from contaminated equipment used during the piercing.

Body piercing is also associated with transmission of hepatitis B and hepatitis C. The risk may be from the piercing procedure. However, it’s also possible that piercings are not the problem; instead, the cause is other high-risk behaviors – drug use, gang affiliations and school truancy, for example – that can be associated with piercings.

It is not uncommon for me to see skin inflammations caused by contact with jewelry metal. The prevalence of the jewelry allergy increases with the increase in the number of piercings a person has.

Up to 30% of people with body piercings are allergic to nickel, which is a common metal found in jewelry. If you have a nickel allergy, you can still wear jewelry, but just avoid nickel and wear platinum, stainless steel or gold instead. But don’t wear white gold – it may contain nickel.

A warning on tongue and genital piercings

Oral piercings – which include piercings of the upper or lower lip and tongue – can be associated with gingivitis, teeth chips, cracks and fractures, and gum recession. These are caused by continuous traumatization of teeth and gums when the individual plays with the piercing.

Those with tongue piercings often experience temporary tongue swelling, pain, difficulty eating and excessive salivation. When the tongue or penis are pierced, a small amount of bleeding is expected, but severe bleeding sometimes can occur.

Indeed, many men with genital piercings have reported complications. The Prince Albert piercing – occurring at the end of the penis – is associated with a narrowing of the opening for urine; sometimes, new tracts are created that leak semen and urine. Rarely, it is associated with squamous cell carcinoma of the penis.

Although piercings are generally safe when proper hygiene is followed, it’s critical to know the risks. Make sure you know the safety precautions and insist that they are used. Piercing salons may vary in terms of cleanliness and the experience of the practitioner. If you have questions about the establishment performing the piercing, you might try checking with your medical provider.

And a special word of warning for children who are undergoing a piercing: An experienced technician, nurse or doctor should perform the procedure. And because proper care is crucial to decrease the chances of infection, piercings should occur only once the child is mature enough to care for the area.

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Having ‘good’ posture doesn’t prevent back pain, and ‘bad’ posture doesn’t cause it

Published: August 18, 2022 6.04am AEST

Authors

1. Peter O’Sullivan Professor of Musculoskeletal Physiotherapy, Curtin University
2. Leon Straker Professor of Physiotherapy, Curtin University
3. Nic Saraceni Lecturer, Curtin University

Disclosure statement

Peter O’Sullivan is a Director at Bodylogic.physio in Perth where he reviews and treats patients with low back pain. He sometimes receives fee’s for teaching on evidence based care of people with pain.

Leon Straker and Nic Saraceni do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

Curtin University provides funding as a member of The Conversation AU.

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Republish our articles for free, online or in print, under Creative Commons licence.

Back pain is the leading cause of disability worldwide. Most people experience an episode of back pain in their lifetime. It often emerges during adolescence and becomes more common in adults.

For 25% of people who develop back pain, it can become persistent, disabling and distressing. It can affect a person’s ability to participate in activities of daily living, physical activity and work. Activities such as sitting, standing, bending and lifting frequently aggravate back pain.

There is a common belief that “good” posture is important to protect the spine from damage, as well as prevent and treat back pain. Good posture is commonly defined as sitting “upright”, standing “tall and aligned”, and lifting with a squat technique and “straight back”.

Conversely, “slump” sitting, “slouch” standing and lifting with a “round back” or stooped posture are frequently warned against. This view is widely held by people with and without back pain, as well as clinicians in both occupational health and primary care settings.

Surprisingly, there is a lack of evidence for a strong relationship between “good” posture and back pain. Perceptions of “good” posture originate from a combination of social desirability and unfounded presumptions.

Systematic reviews (studies looking at a number of studies in one area) have found ergonomic interventions for workers, and advice for manual workers on the best posture for lifting, have not reduced work-related back pain.

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Read more: Ouch! The drugs don’t work for back pain, but here’s what does

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Sitting and standing posture

Our group has conducted several studies exploring the relationship between spine posture and back pain. We investigated whether “slump” sitting or “non-neutral” standing postures (overarching or slouching the back, for example), in a large population of adolescents, were associated with, or predicted future back pain. We found little support for this view.

These findings are consistent with systematic reviews that have found no consistent differences in sitting or standing posture between adult populations with and without back pain.

People adopt a range of different spine postures, and no single posture protects a person from back pain. People with both slumped and upright postures can experience back pain.

Lifting posture

Globally accepted occupational health practices about “good” or safe back postures during lifting also lack evidence. Our systematic review found no evidence lifting with a round-back posture is associated with or predictive of back pain.

Our recent lab study found people without back pain, employed in manual work for more than five years, were more likely to lift with a more stooped, round-back posture.

In comparison, manual workers with back pain tended to adopt more of a squat lift with a straighter back.

In other words, people with back pain tend to follow “good” posture advice, but people who don’t lift in the “good” way don’t have more back pain.

In a small study, as people with disabling back pain recovered, they became less protective and generally moved away from the “good” posture advice.

If not posture – what else?

There is no evidence for a single “good posture” to prevent or reduce back pain. People’s spines come in all shapes and sizes, so posture is highly individual. Movement is important for back health, so learning to vary and adopt different postures that are comfortable is likely to be more helpful than rigidly adhering to a specific “good” posture.

While back pain can be intense and distressing, for most people (90%) back pain is not associated with identifiable tissue damage or pathology. Back pain can be like a sprain related to awkward, sudden, heavy or unaccustomed loads on our back, but can also occur like a bad headache where there is no injury.

Importantly, people are more vulnerable to back pain when their health is compromised, such as if someone is:

• feeling stressed
• experiencing low mood
• tired or fatigued
• sleeping poorly
• being less active.

Back pain is more likely to persist if a person:

• becomes overly worried and fearful about their back pain
• overprotects their back and avoids movement, physical activity, work and social engagement.

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Read more: Put down the paracetamol, it’s just a placebo for low back pain

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What can people do about back pain?

In a small group (1-5%), back pain can be caused by pathology including a fracture, malignancy, infection or nerve compression (the latter is associated with leg pain, and a loss of muscle power and sensation). In these cases, seek medical care.

For most people (90%), back pain is associated with sensitisation of the back structures, but not identifiable tissue damage.

In this situation, too much focus on maintaining “good” posture can be a distraction from other factors known to be important for spine health.

These include:

• moving and relaxing your back
• engaging in regular physical activity of your preference
• building confidence and keeping fit and strong for usual daily tasks
• maintaining healthy sleep habits and body weight
• caring for your general physical and mental health.

Sometimes this requires some support and coaching with a skilled clinician.

So if you are sitting or standing, find comfortable, relaxed postures and vary them. If you are lifting, the current evidence suggests it’s OK to lift naturally – even with a round back. But make sure you are fit and strong enough for the task, and care for your overall health.

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These 12 things can reduce your dementia risk – but many Australians don’t know them all

Published: September 29, 2022 2.16pm AEST

Authors

1. Joyce Siette Research Theme Fellow, Western Sydney University
2. Laura Dodds PhD Candidate, Western Sydney University

Disclosure statement

Joyce Siette is the Co-Chair for the Australian Association of Gerontology NSW Division.

Laura Dodds receives funding from Western Sydney University.

We believe in the free flow of information

Republish our articles for free, online or in print, under Creative Commons licence.

Dementia is a leading cause of death in Australia.

Although dementia mainly affects older people, it is an avoidable part of ageing. In fact, we all have the power to reduce our risk of developing dementia, no matter your age.

Research shows your risk of developing dementia could be reduced by up to 40% (and even higher if you live in a low or middle-income country) by addressing lifestyle factors such as healthy diet, exercise and alcohol consumption.

But the first step to reducing population-wide dementia risk is to understand how well people understand the risk factors and the barriers they may face to making lifestyle changes.

Join 175,000 people who subscribe to free evidence-based news.

Our new paper, published this week in the Journal of Ageing and Longevity, found most older people are aware that dementia is a modifiable condition and that they have the power to change their dementia risk.

We also found the key barrier to making brain healthy lifestyle choices was a lack of knowledge, which suggests a public awareness campaign is urgently needed.

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Read more: What do aged care residents do all day? We tracked their time use to find out

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What we did

We began by reviewing the published research to identify 12 factors shown to reduce dementia risk. We surveyed 834 older Australians about their awareness of the 12 factors, which were:

1. having a mentally active lifestyle
2. doing physical activity
3. having a healthy diet
4. having strong mental health
5. not smoking
6. not consuming alcohol
7. controlling high blood pressure
8. maintaining a healthy weight
9. managing high cholesterol
10. preventing heart disease
11. not having kidney disease
12. not having diabetes

The Lancet subsequently published its own list of factors that help reduce dementia risk, which covered much the same territory (but included a few others, such as reducing air pollution, treating hearing impairment and being socially engaged).

Of course, there is no way to cut your dementia risk to zero. Some people do all the “right” things and still get dementia. But there is good evidence managing lifestyle factors help make it less likely you will get dementia over your lifetime.

Our study shows many older Australians are quite aware, with over 75% able to correctly identify more than four of the factors in our list of 12.

However, few were able to name the less well-known risk factors, such as preventing heart disease and health conditions like kidney disease.

The good news is that close to half of the sample correctly identified more than six of the 12 protective factors, with mentally active lifestyle, physical activity and healthy diet in the top three spots.

Two key issues

Two things stood out as strongly linked with the ability to identify factors influencing dementia risk.

Education was key. People who received more than 12 years of formal schooling were more likely to agree that dementia was a modifiable condition. We are first exposed to health management in our school years and thus more likely to form healthier habits.

Age was the other key factor. Younger respondents (less than 75 years old) were able to accurately identify more protective factors compared to older respondents. This is why health promotion initiatives and public education efforts about dementia are vital (such as Dementia Awareness Month and Memory, Walk and Jog initiatives).

How can these findings be used in practice?

Our findings suggest we need to target education across the different age groups, from children to older Australians.

This could involve a whole system approach, from programs targeted at families, to educational sessions for school-aged children, to involving GPs in awareness promotion.

We also need to tackle barriers that hinder dementia risk reduction. This means doing activities that motivate you, finding programs that suit your needs and schedule, and are accessible.

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Read more: Dogs can get dementia – but lots of walks may lower the risk

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What does this mean for you?

Reducing your dementia risk means recognizing change starts with you.

We are all familiar with the everyday challenges that stop us from starting an exercise program or sticking to a meal plan.

There are simple and easy changes we can begin with. Our team has developed a program that can help. We are offering limited free brain health boxes, which include information resources and physical items such as a pedometer. These boxes aim to help rural Australians aged 55 years and over to adopt lifestyle changes that support healthy brain ageing. If you’re interested in signing up, visit our website.

Now is the time to think about your brain health. Let’s start now

Interestinjg article in today’s The Australian newspaper. Worth getting the paper to read this article. Why are women so reticent to discuss menopause?

Calls for government to report how menopause is affecting women’s employment

TICKY FULLERTON
Birgitte Nyborg, the former Danish prime minister, in TV series Borgen. The show smashes the stigma in its recent series.

“Is it me or is it hot in here?”

A typical workplace question perhaps but it’s guaranteed no woman in a boardroom would be caught uttering those words.

This week the Australian Institute for Superannuation Trustees that represents the $1.7 trillion super sector called on the government to measure and report how menopause is affecting women’s employment and retirement decisions. If just 10 per cent of women retired early because of menopausal symptoms, the AIST estimates a loss of earnings and super of more than $17bn.

It is worried that women in droves are leaving the workforce at the top of their game aged around 50 because of menopause.

Around 80 per cent of women experience some of the hormone-related symptoms. Up to a quarter of them are severely affected.

Symptoms include hot flashes, irregular heartbeats, mood swings, brain fog, vaginal dryness, visible ageing, a feeling of disempowerment, night sweats and weight gain.

There has been fulsome public debate on the earnings and super lost by women who leave the workforce to have children. But the loss from and early exit or a late break in a woman’s career can actually be far more costly to her.

Mel Birks, deputy CEO and head of advocacy for the AIST, says average earnings for Australian women aged 50 are about $70,000 a year.

“Even if they were to work for another seven years to take them up to the same age that men retire, that is over $500,000 in earnings, plus the super. For a typical worker, this is half a million dollars,” she says.

Birks is equally concerned about women leaving because of menopause symptoms and then try to return to the workforce some years later.

“It hits usually at around 51 and it can last for five to 10 years. It’s not a flash in the pan,” she says. “It is harder to get back in when you are older and they have lost a number of years at their peak earning capacity, people who have the corporate knowledge, the skills. That is a huge loss for the economy and the organisation they work for.”

Undoubtedly one reason why menopause has received so little attention from policy makers and the media is the stigma around it.

The cult TV show Borgen smashes the stigma in its recent fourth series. In it Birgitte Nyborg, the former Danish PM, is now back battling in parliament but has to rush to the bathroom to deal with hot flashes. “I can’t keep changing my shirt three times a day, I’m the Foreign Minister,” she says.

Her doctor refuses, with little sympathy, to give her hormone replacement therapy because of a family risk of breast cancer. HRT is used by many women to counter symptoms.

Scottish National Party leader Nicola Sturgeon certainly could relate to Nyborg. “Now she’s a 50-something menopausal woman, angry at the world so there are a lot of parallels there.’’

The UK is leading the debate on menopause with HRT available over the counter. In May a British survey of 4000 women found one in 10 who worked while going through menopause left because of their symptoms, 14 per cent cut their hours, another 14 per cent went part time and 8 per cent had not applied for promotion.

In Australia, the AIST marks 30 years of compulsory super contributions. The earliest of those female contributors hit menopause right around now.

“If people are leaving the workforce earlier than they intended that means they are also retiring with less super than perhaps they planned on having. But we don’t seem to have any robust data on the impact it is having,” says Birks.

In its budget submission to the government, the AIST uses ABS data. Women in the 45-54 age group intend to retire at 64 compared to men at 65. But the actual average retirement age is 52.1 for women and 59.5 for men, demonstrating that unforeseen circumstances can thwart intentions.

And of this female cohort 44.9 per cent cite “sickness, injury or disability” as the reason. The AIST wants the government to drill down on how much of this is menopause related.

Spare a thought for female CEO or director, those at the top of the pyramid who get hit hard by menopause just when they need to be Helen Reddy invincible.

It is hardly surprising that peak body groups like the Australian Institute of Company Directors and Chief Executive Women have kept their heads down.

“If anyone has had to do a presentation while having a hot flash, you can’t hide that, I don’t care what boardroom you are in,” says Birks. “It is about normalising it and destigmatising it. And then getting on with dealing with it.

“There needs to be better understanding of what employees can do and for women to be able to speak to their doctors about what treatment they can have. I’m concerned that in some cases a lot of women are actually reluctant to ask for help.”
Ticky Fullerton
Editor-at-large, The Australian Business ReviewFollow
Ticky Fullerton is one of Australia’s most experienced commentators and journalists. She was previously Sky News Business Editor and co-anchor of Business Weekend on Sky News Australia.

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Why does everyone seem to have food intolerances these days?

Published: June 22, 2022 5.55am AEST

Author

1. Evangeline Mantzioris Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South Australia

Disclosure statement

Evangeline Mantzioris is affiliated with Alliance for Research in Nutrition, Exercise and Activity (ARENA) at the University of South Australia. Evangeline Mantzioris has received funding from the National Health and Medical Research Council, and has been appointed to the National Health and Medical Research Council Dietary Guideline Expert Committee.

Most of you will have noticed hosting a dinner party is harder than it used to be. One friend is gluten-free, another is dairy-free, one can’t eat onion and two more are vegetarian. Are food intolerances increasing? Or do we just hear more about them now?

What are food intolerances?

Food intolerances are reactions to eating foods, in normal quantities, that do not involve the immune system.

They are very different to food allergies which is when the body mounts an immune response to a food that is either ingested or even touches the skin. This immune response is very quick (within 20 minutes to two hours) and releases chemicals that can affect the person’s breathing, gastrointestinal tract and heart.

Common food allergies include eggs, peanuts, wheat and shellfish. Allergies differ from intolerances in that the most severe allergies cause anaphylaxis: severe allergic reactions that are life-threatening.

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The mechanisms behind food intolerances can vary greatly. One common mechanism is when people lack enzymes that are needed for breaking down nutrients.

In one of the most common food intolerances, lactose intolerance, people lack the enzyme “lactase” which is used to break down this carbohydrate naturally found in milk and some other dairy products. Lactose is broken down into glucose and galactose in the small intestine, and then absorbed.

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Read more: Everything you need to know about coeliac disease (and whether you really have it)

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Without lactase, lactose stays in the intestine, where it draws water in from the blood supply to dilute the amount of lactose. Initially this leads to diarrhoea, and then as the lactose enters the large intestine it is fermented by the bacteria in our gut, which results in gas causing abdominal bloating, pain and discomfort.

Other food intolerances due to the lack of enzymes include intolerances to histamine and caffeine. Some people are unable to break down histamine, which is found in red wine, strong and blue cheeses, tuna, tomatoes and pork products.

This can lead to symptoms such as itching, red flushing on the skin, abdominal pain, nausea, dizziness, headaches and migraines. Similarly, people can also have a sensitivity to caffeine (found in coffee and cocoa).

Food intolerances are also different from auto-immune responses, such as in coeliac disease. In this case, people develop an auto-immune response in the small intestine to a protein in wheat called gluten. The auto-immune response also damages the villi, the small finger-like structures that absorb all the nutrients.

Many people who experience gastrointestinal symptoms in reaction to wheat products assume they have coeliac disease. However, they may have a sensitivity to fructan, a type of carbohydrate in wheat. Fructan is a naturally fermentable carbohydrate and a “FODMAP” – which stands for Fermentable Oligo- Di- Monosacharides and Polyols, a group of nutrients that can cause sensitivity.

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Read more: The FODMAP diet is everywhere, but researchers warn it’s not for weight loss

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Like in the case of lactose (which is also a FODMAP carbohydrate), some people are unable to absorb large amounts of fructans (also present in onions and garlic). Like lactose, this causes diarrhoea, and then the bacteria in the large intestine ferment the fructan, producing gas, abdominal pain and discomfort.

So are food intolerances increasing?

While it may seem as if food intolerances are increasing, we have no good evidence this is really the case. Data is lacking on actual numbers, perhaps as food intolerances generally do not lead to the requirement to take medications or seek urgent medical treatment.

A 2009 report suggests about 20% of the population has one or more food intolerances, with no apparent change since 1994. A more recent survey from 2020 of self-reported intolerances in internet users indicated about 25% of the population.

The perceived increase may reflect many other factors. Some people may self-diagnose a food intolerance from well-intended but misleading health advice from family and friends.

Additionally, people may incorrectly attribute medical symptoms to foods they have eaten. We also have an increased ability to self-diagnose, thanks to Dr Google. In other cases dietary requests may reflect ethical choices about food.

We all know from attending social events with food how often we need to provide our dietary requirements. This is also contributing to normalising food intolerances, compared to even a decade ago. Previously people would have suffered in silence or simply avoided consuming their problematic trigger foods at events.

Another factor could be the greater proportion of people of different ethnicities living in Australia, some of whom are genetically more likely to have an intolerance.

If you suspect you have a food intolerance it’s best to get diagnosed by a doctor, to ensure you are not overlooking a potentially concerning medical problem. Also you may be needlessly avoiding a particular food group and missing out on essential nutrients required for optimal health.