Faking Allergies – Don’t do it, but don’t assume others are faking

This article describing the process restaurant kitchens go through to avoid cross-contamination for customers with allergies was fascinating. Labels, separate cutting boards, the whole nine yards.

I have mixed feelings on the article as a whole. I think it points out a real problem but is also too quick to paint people who go gluten-free without celiac or a wheat allergy as bandwagon-hoppers.

11 percent of American households are following a gluten-free diet, even though only a quarter of them said they were doing it because of celiac or gluten intolerance.

The gluten-free spectrum is diverse. About 0.3 percent of Americans have a wheat allergy, meaning that ingesting even a trace amount could send them into anaphylactic shock. Then there is the 1 percent with celiac. Finally, there are people with gluten sensitivity, who suffer symptoms like diarrhea, bloating, or fatigue after eating gluten. Given the absence of diagnostic tools, the size of this last group is particularly fuzzy, though Fasano’s research suggests it’s in the 5 to 6 percent range.

Fasano is troubled that so many people are diagnosing themselves with gluten intolerance, changing their diet without ever going to the doctor. “You don’t say, ‘I’m drinking a lot and peeing a lot, so I must have diabetes,’ and then start injecting yourself with insulin.”

Many who go gluten-free find themselves feeling better and see that as proof that they have gluten intolerance. But a genuine gluten problem is only one of three possible explanations for their improved health, and statistically the least likely. Another reason could be the placebo effect. The most likely explanation is that paying closer attention to diet and avoiding fried and junk food — which tends to be loaded with gluten — is bound to make anyone feel better.

What’s the big deal if gluten-tolerant people go gluten-free, especially since they’ll be eating fewer Pop-Tarts?

The problem is the more these bandwagon-jumpers demand special attention, the more likely that restaurants and wider society will come to see all gluten-free people as phonies.

The assumption, based on a single poll, is that the majority of people doing a gluten-free diet are simply following the fad. But I don’t think the math holds up. If 1 percent of people have celiac disease, .3% have a wheat allergy, and somewhere in the neighborhood of 5-6% have gluten intolerance, and 11% are doing gluten-free, then the majority (6-7 of 11) of those have an allergy or intolerance to gluten. That’s odd considering that it was the main reason given by only a quarter of the gluten-free respondents to the survey quoted. (The summary of the study itself doesn’t list all the potential reasons or indicate whether respondents had to select a single main reason. And only 25% of the respondents believed that a gluten-free diet was generally healthy for everyone. So, a large majority are well aware that gluten isn’t some dietary bogeyman, but something that some people react badly to.

As another confounding factor, gluten-free diets are hawked as a potential weight loss method, and I don’t know whether “weight loss” was a reason given in that survey. And while gluten-free in and of itself isn’t likely to result in weight loss, having severely limited carb options certainly can, at least in the short term. When doctors push weight loss as the solution to any and all problems, it’s not surprising that people would flock to anything that’s promising that as a potential benefit. In their view, they are doing it for a legitimate health reason. The article mentions claiming allergies to dairy as a weight-loss tactic, but doesn’t connect that with a fatphobic culture or pressure to be thin at any cost.

I also think the “you wouldn’t just diagnose yourself as diabetic and start taking insulin” analogy is way off. If eating something makes you feel crappy, and taking it out of your diet makes you feel better, you are under no obligation to prove to anyone else that your issue with that food is legitimate. You get to eat whatever you want, period, end of story, diagnosis or no diagnosis. Sure, if you’re cutting out whole food groups, you should probably work with a doctor and/or dietitian both to verify that it’s necessary and to make sure you’re not missing important nutrients. And if you’re having symptoms that seem allergy-related, then seeing a doctor is an extremely good idea. Both to make sure you have emergency meds if needed and to nail down what precisely you’re allergic to. But if it’s a mild intolerance, and you can cut something out without stressing yourself out or severely limiting your diet, that’s your call and no one else’s. Eliminating a food from your diet isn’t even in the same ballpark as randomly deciding to take prescription medications with no diagnosis.

For example, I don’t eat pad thai. I’ve had it twice, once at a restaurant and once homemade. Both times, it tasted delicious, then sat in my stomach like lead, and I felt lousy. Did I just eat too much of it? Is there something in it or some combination of things that I react badly to? Was it a total coincidence? I have no idea. But when given the opportunity to eat pad thai, I think “ick,” associate it with an upset stomach, and don’t want to repeat the experience. But as long as green curry, chicken satay, and tom kah gai exist in the world, I can live quite happily without ever eating pad thai.

If we decide that I’m not allowed to go “pad thai-free” without a real medical diagnosis, how do I accomplish this? If I go to the doctor and say, “When I eat pad thai, I feel sick to my stomach?” do you think they’re going to run tests or try to figure out if I’m intolerant to fish sauce or tamarind or beansprouts, or do you think they’ll tell me not to eat pad thai? Yes, I know there’s a difference between cutting out one highly specific food and avoiding a staple like wheat, but even people with definite gluten sensitivity often have trouble getting a diagnosis. So they do what they need to do for themselves to feel better. If there are barriers to their getting appropriate medical care (and there are an awful lot of those in the US), we should work on those, but in the mean time, people are still going to take care of themselves as best they know how.

I agree that people shouldn’t lie about allergies. If something upsets your stomach or gives you gas or triggers a gag reflex, it’s not an allergy. That doesn’t mean you should be expected to eat it for politeness’ sake, but lying about allergies does cause people to jump through totally unnecessary hoops to avoid cross-contamination. But I also think that people are too eager to “catch” somebody faking and that they jump on inconsistencies that may or may not be dishonesty. The person who can’t have dairy and then ordered ice cream? Maybe they lied. Maybe they weighed the risks and decided it was worth it. Getting to make your own decisions includes making decisions that aren’t optimal. And sometimes people have multiple competing things going on with food that they don’t feel the need to fully explain, which might look inconsistent or dishonest on the surface. This Captain Awkward post about a part-time vegetarian is a good example. People seem really quick to jump to “Lying!” “Attention-seeking!” instead of “Needed protein!” or “Don’t fit fully into either the carnivore or vegetarian box!”

Personal example time again. I don’t generally tolerate spicy foods well, both in taste and in GI unpleasantness afterwards. But it really depends on the day. There will be times when I think, “Bring on the heat!” and times when lamb korma somehow tastes “hot” to me. And while I’ve had GI unpleasantness from Mexican food, I’ve never had that reaction to hot wings. (Possibly because they go with pizza, so the percentage of “hot foods” to “overall meal” is lower.) So, if I turn something down because it’s too spicy and then next week you see me eating hot wings, it may look like I’m bullshitting you, but that’s not actually the case.

I do think it’s impolite to put other people to trouble you won’t go to yourself. If you’re going to expect a kitchen to slow way down to do the allergy dance for you, then you should be willing to forgo the tasty food with the ingredient you just told them you can’t have. And it would be kind of jerk-like as a semi-vegetarian to insist that your steak-loving friends always go to the vegetarian place rather than having your once-every-so-often chicken come from the place they like.

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2 thoughts on “Faking Allergies – Don’t do it, but don’t assume others are faking

  1. Elizabeth says:

    I don’t think the math is off. Your calculation assumes that everyone who’s gluten intolerant is already doing a gluten-free diet. But undoubtedly quite a large portion of that 5-6% of the population who’s gluten intolerant doesn’t know it, and so is not eliminating gluten from their diet. There are even a good many people with celiac who go for years without realizing they have the disease (I’ve known several of them). So if 11 percent of households are following gluten-free diets, that means there are an awful lot of people eliminating gluten from their diets who aren’t allergic, don’t have celiac, and aren’t gluten-intolerant.

    • KellyK says:

      Good point! You’re absolutely right that I shouldn’t assume that everyone with a gluten intolerance is already on a gluten-free diet. But at the same time, those numbers also don’t account for people who have a real, but misidentified, intolerance and are helped by a gluten-free diet. Because it mentions households, another confounding factor is people who go gluten free because a family member has an intolerance.

      Either way, even if fully *half* the people following gluten-free diets don’t really need to be, that’s a whopping five and a half percent of the population, and I don’t think it justifies the hand-wringing tone of the article.

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