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Food Intolerance Test – Types and Procedure

A food intolerance test determines whether the body has difficulty digesting certain foods. It helps identify intolerances early and supports targeted dietary management.

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Things worth knowing about "Food Intolerance Test"

A food intolerance test determines whether the body has difficulty digesting certain foods. It helps identify intolerances early and supports targeted dietary management.

What Is a Food Intolerance Test?

A food intolerance test is a diagnostic procedure used to determine whether a person has difficulty tolerating certain foods or their components. Unlike a true food allergy, which involves an IgE-mediated immune response, food intolerances are typically caused by enzyme deficiencies, transporter disorders, or heightened sensitivity of the digestive tract to specific substances.

Common examples of food intolerances include lactose intolerance (inability to digest milk sugar), fructose intolerance (difficulty absorbing fruit sugar), histamine intolerance, and non-celiac gluten sensitivity.

Types of Food Intolerance Tests

Breath Tests (H2 Breath Tests)

The hydrogen breath test (H2 breath test) is a well-established, non-invasive method for diagnosing lactose, fructose, or sorbitol intolerance. The patient drinks a defined amount of the relevant sugar dissolved in water. Undigested sugars are fermented by bacteria in the large intestine, producing hydrogen (H2) gas that is exhaled through the lungs. Elevated H2 levels in the breath indicate an intolerance.

Blood Tests

Certain blood tests can provide indications of food intolerances, including:

IgG antibody tests: These measure specific immunoglobulin G antibodies against various foods. However, elevated IgG levels only indicate exposure to certain foods and are not a reliable indicator of a clinically relevant intolerance. The scientific validity of these tests is debated.
Celiac disease serology: Blood tests for specific antibodies (e.g., anti-tissue transglutaminase IgA) are an established method for diagnosing celiac disease (gluten intolerance).
Diamine oxidase (DAO) measurement: Low DAO levels in the blood may suggest histamine intolerance.

Elimination Diet and Oral Provocation Test

The gold standard for diagnosing food intolerances is the controlled elimination diet combined with an oral provocation test. Suspected foods are removed from the diet for a defined period (elimination phase). They are then reintroduced gradually and in a controlled manner to observe whether symptoms recur.

Stool and Genetic Testing

In some cases, stool tests or genetic analyses (e.g., genetic testing for lactase deficiency or HLA typing in suspected celiac disease) can provide additional diagnostic information.

Symptoms That May Indicate a Food Intolerance

The symptoms of food intolerances vary widely depending on the type of intolerance. Common complaints include:

Bloating, a feeling of fullness, and abdominal cramps
Diarrhea or constipation
Nausea and vomiting
Skin reactions such as redness or rash
Headaches and migraines
Fatigue and general malaise

When Should a Food Intolerance Test Be Done?

Testing is recommended when recurring digestive or other symptoms after eating cannot be attributed to another cause. A healthcare professional should be consulted to select the appropriate testing method and to correctly interpret the results. Over-the-counter self-tests should always be accompanied by medical guidance.

Treatment for Confirmed Food Intolerance

Treatment depends on the type of intolerance identified:

Lactose intolerance: Reducing or avoiding lactose-containing foods; taking lactase enzyme supplements.
Fructose intolerance: Following a low-fructose diet and avoiding sorbitol.
Histamine intolerance: Eating a low-histamine diet and, if needed, taking DAO enzyme supplements.
Celiac disease: Strict, lifelong adherence to a gluten-free diet.

References

German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS): Guidelines on Food Intolerances. www.dgvs.de
Schäfer, C. et al. - Food Allergies and Intolerances. Wissenschaftliche Verlagsgesellschaft Stuttgart, 2020.
Turnbull, J. L. et al. - Review article: the diagnosis and management of food allergy and food intolerances. Alimentary Pharmacology and Therapeutics, 2015.

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