FOOD INTOLERANCE AND PSYCHOSOMATIC EXPERIENCE

The mechanism behind food intolerance is regarded as one of the greate st enigmas in modern medicine. Its multidisciplinary modalities, shari ng properties with immunologic, environmental and psychosomatic reacti on patterns, make the grouping and individual approach rather complex in regard to classification of disease, diagnosis, and therapy. In thi s presentation, emphasis is placed on emerging knowledge about immunol ogic reactions in the bowel and blood circulation as a balance against the evidence for psychosomatic reactions. As a basis for discussion, the psychosomatic experience of patients with food intolerance is illu strated by a brief presentation of three studies. The first was cross- sectional. The second was prospective and controlled. The third was a double-blind placebo-controlled study using provocation with an active substance in comparison with a placebo. Both the patients and referen ts were characterized by interviews and scoring systems based on quest ionnaires. When either combined or kept separately, the results of the se studies suggest a correlation between somatic and neuropsychiatric symptoms and emotional disturbances. It also seems that patients ident ifying themselves as sensitive to food and chemicals have higher score s for depression, anxiety, shyness, and defensiveness. On the other ha nd, in 62% of the cases, there was agreement between diet history and provocation. The next-of-kin of the food intolerant subjects also had various diseases more frequently, increased immunoglobulin E levels, a nd a higher prevalence of allergy and infectious diseases. For the sam e patients, major distress or trauma during childhood, as well as undi fferentiated somatoform disorders, were common. In conclusion, both so matic symptomatology and self-reported psychological disturbances can be regarded as rather weak documentations. The experience within these fields today may, however, seem promising for further research. One s hould then emphasize the importance of the nature of exposure and the nature of disposition, represented by immunologic or psychological mec hanisms, or a combination of both. Future studies should be aimed at c lassifying patients into subgroups through the use of improved diagnos tic and clinical methods, assessment of organ sensitivity, and immunol ogic and psychological tests.