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FOOD SENSITIVITY AND FOOD SENSITIVITY TESTING A summary from a conventional physician learning integrative medicine The concept that some foods play a big role in chronic illness is easy to accept. For one thing, research studies of people eating a healthy diet shows enormous reductions (40‐50% or more) in a large variety of common diseases. There are many ways, however, in which food can cause symptoms, and the symptoms can be different for different people. Conventional medicine accepts the notion of IgE food allergies. In a few people, certain foods cause a type of allergy mediated by IgE antibodies. These antibodies cause certain specialized cells, called “mast cells”, to release large amounts of histamine, which typically causes hives, runny or stuffy nose, itching, sneezing and in severe cases can progress to swelling in the respiratory passages, or even anaphylaxis with a severe drop of blood pressure and death. This type of food allergy (properly called an “allergy” in this case) can be detected in the blood, and can also be suspected when there is a positive skin test. Typically, because symptoms develop within 1 or 2 hours of ingesting a food, diagnosis can be made simply by observation. The rest of the food sensitivity testing is basically all “alternative” or “complementary”, and has a weaker scientific basis. IF you think that following a diet, perhaps a strict one, will be an empowering and interesting experience that will make you feel a sense of mastery over your health, then food elimination is for you. However, many of us have a strong negative reaction: it feels stressful and not at all helpful. In this case, focus on stress reduction, which should be the true “base” of the food pyramid. Complementary medicine focuses on the fact that certain foods can cause immune responses that are not of the IgE type. They involve other immunoglobulins, such as IgM, IgG and IgA, or “cell‐mediated” problems involving T cells. Certain tests look for IgA in the stool (Enterolab), others look for IgG in the blood (Genova, Meridian Valley Labs), or even just the IgG4 subclass in the blood (Metametrix). Yet other tests attempt to look for common pathways downstream from the T‐cells and immunoglobulins (“mediator release test” or MRT). There is also a test that uses red blood cell bursting to infer food sensitivity (ALCAT). Some labs go with a fingerstick and paper dots (US Biotek), while others insist on a full vial or two. Cost can vary from under $100 to $350 or so. In California, providers are prohibited from charging fees in addition to the laboratory fee, but some do anyways. Why food would cause an immune system problem (not called an “allergy” in these cases) would be because of increased intestinal permeability, allowing food particles to enter the bloodstream before they have been properly digested. Conventional medicine did not believe in leaky gut until recently. In research it is now turning up everywhere, but there is no medication that can fix it, so it doesn’t get discussed in many of the regular medical journals. And it doesn’t get discussed by any of the drug reps that bring much of the continuing medical education to physicians. According to alternative medicine (and this is also the understanding in conventional science research), anything that gets your immune system overly excited will cause “inflammation”, a rise in the hormone cortisol, and may lead to any number of problems behind that: joint pain, mood issues, ADHD and autism, autoimmune diseases, asthma/eczema, fatigue, infertility, diabetes, cardiovascular disease, and some cancers, most notably breast cancer and prostate cancer. In spite of that understanding, conventional doctors do not give much diet advice in many of these diseases, for reasons we can discuss another time. However, in trying to reverse any of the above, if indeed they can be reversed, one would have to address inflammation from food intolerance. Then there’s reactions that are not immunological. There are reactions to food dyes and food additives (foods you buy in a box, or even at a deli, likely have preservatives; frozen foods do not have to be labeled for sulfites, but many of them contain sulfites; restaurant foods and canned foods may also have preservatives). Certain foods cause a generalized immune response (meat from animals fed corn, for example, which includes especially tilapia, other farm‐raised fish, and of course, factory‐raised beef, pork and chicken). For chicken, dark meat will cause more of an immune response than breast meat, due to its content of arachidonic acid. That’s just how this naturally occurring substance interacts with your normal body chemistry. Some people react to phenols with flushing. Some people react to lectins with stomach cramps. Many people have a problem with saccharides and polyols that can cause bloating. Some people react to something in nightshade vegetables, which unfortunately includes potatoes, tomatoes, peppers and eggplant. These can cause joint pains. Some (or maybe even many) people react to gliadin, the main culprit in gluten, in a variety of different ways, with an enormous variety of symptoms. And then some foods are cross‐reactive, pretending to be each other in your body. Now that your head is spinning, let me tell you what I do. I take a full history and I try to decide which body system is most severely involved. Usually, it’s the immune system. I try to decide if digestion is proceeding efficiently, because stress affects all aspects of digestion, and food intolerance cannot be fixed without fixing digestion. Often, I do a blood‐based food sensitivity test. I do Signet Lab’s LEAP MRT because it has worked best for me so far. I hesitate to do it only because it is expensive and because following this diet is inconvenient and restrictive. I haven’t tried the ALCAT because it got criticized in one scientific paper for lack of reliability. I have been frustrated by IgG‐based tests. Then I rush to fix intestinal permeability, otherwise the food avoidance will lead to new food sensitivites. There is no scientific study‐based information on how to do this. So I suspect any and everything, from stress to pesticides, probiotics and parasites. I believe this can best be done with a “clean” diet—avoid food made by others, where at all possible, especially commercially. The produce section or farmers’ market is your best friend. I also use a couple of supplements, a ton of stress reduction and exercise, and avoid the foods picked up by the MRT. Some people have dramatic results within weeks. Some people have more subtle results over months. It can take inflammation 6 months to resolve, but the results are worth it. UNLESS, as I warned above, the whole process is stressful and not empowering. In that case, stress reduction comes first, perhaps fixing vitamin deficiencies, and proceeding more slowly. That’s the big caveat in this. There’s lot of potential, but it can be tricky.