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Food Intolerance: Does the Combination Really Matter?

Your Intolerance: Is the Combination Really Important?

Every dietary intolerance prescribed by our Naturopathic doctors includes at least one food category that must be avoided completely, and a combination of foods that should not be eaten within a certain number of hours of each other.

The combination of foods is the part of the intolerances that is most often misunderstood or completely ignored.

The combinations are typically a starch and a sugar, a starch and a protein, or two starches. The most common ones are:

Fruit with Sugar

Potato with Grain

Sugar with Grain

Egg with Grain

Dairy with Grain

Fruit with Grain

In your intolerance report, you will be told which combination of foods to avoid, and how many hours they must be separated by. The hours are usually 4, 6, or 8. This has to do with how well your digestive system is functioning.

For example, my intolerance is Egg and the combination of Fruit with Sugar with at least 4 hours between them.

Does it mean that I can’t eat fruit or sugar (a question we are often asked)?


I can eat fruit.

I can eat sugar.

But I don’t eat them together, whether that’s in the same food item or separately but still within 4 hours. An example of them being in the same food item could be your typical apple pie. Apples are fruit and pies are usually sweetened with sugar. It could also be having them in the same meal - like an apple for breakfast along with coffee sweetened with sugar. In fact, I would need to wait for 4 hours until having a coffee with sugar. (For more about what sweeteners to use instead of sugar, check out our article on Alternative Sweeteners.)

To do this correctly it is important to read ingredients in all processed foods. Some are easier to avoid than others, but it is likely that processed foods will contain the combination you’re supposed to avoid.

It’s often easiest to just avoid one of the categories completely. Whichever one seems the easiest for you to cut out of your diet. In general I just don’t eat sugar, because it's easier than keeping track of what time I ate something that might have fruit in it.

But why is it important to avoid your intolerance combination?

We know that the primary food that we avoid entirely causes inflammation in the digestive system because we lack the enzymes to break it down properly. This causes inflammation, allowing toxemia to get into the circulatory system and travel throughout the body, forming the basis of chronic disease. (For more about that, here is our article on What is a Food Intolerance)

But what does the combination do to us? We can digest those foods individually, so it’s not quite the same thing…Right?

According to Dr. Zeff, the end result of mal-digestion and inflammation causing toxicity into the bloodstream is the same whether you’re eating the primary food you’re intolerant to or the combination of foods.

The process of mal-digestion differs depending on the combination of foods in question, however. Eating the combination can cause putrefaction (proteins), fermentation (sugars/grains), or rancidity (fats) to occur in the gut faster than they can be eliminated.

That sounds pretty bad.

Let’s explore fermentation to better understand this.

Intestinal fermentation is something that happens in the intestines of all mammals. This produces volatile fatty acids and gas that aid in cellular energy metabolism. In fact, the large intestine is structured for fermentation to occur in the last stage of digestion, with bacteria breaking down the hard-to-digest carbohydrates that are passed through the small intestine.

It’s a perfectly normal and good process - as long as it happens where it’s supposed to. But what if fermentation happens somewhere else in the gut?

People with conditions like IBS have been seen to have fermentation occur lower in the colon than the regular part of the large intestine.

Diarrhea, IBS, and ulcerative colitis have been all linked to intestinal fermentation and the production of short chain fatty acids being developed lower than they should be.

What about fermentation happening higher than it should? If eating the intolerance combination of foods causes fermentation in the small intestine or even the stomach, other disruptions in digestion could occur, such as the growth of bacteria where it shouldn’t.

An example of this is SIBO (small intestinal bacterial overgrowth), a condition in which bacteria grows in the small intestine. The symptoms of this are common in people with digestive issues: “Loss of appetite, Abdominal pain, Nausea, Bloating, An uncomfortable feeling of fullness after eating, Diarrhea, Unintentional weight loss, and Malnutrition”.

Can these things happen even when the foods aren’t eaten in the same meal?

Yes. The rates of time differ depending on how well the digestive system is functioning, as well as the vitality of the person. So, a young and generally healthy person will have faster digestion than an older person who is sick. That is what the hours of separation (4, 6 or 8 hours) is based on. The closer together the foods are eaten, the more problems they cause.

Some people experience more issues due to their intolerance combination than their primary food category.

In short - yes it is just as important to avoid the combination of foods you’re intolerant to as it is the primary one. Do what the doctor ordered!

Need some more help with this? Contact us to get more help with meal planning, recipe adjustment, grocery shopping, and more!

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