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Adverse Food Reactions – Food Allergies, sensitivities, and intolerances

Adverse reactions to foods are on the rise, becoming more of a health concern for many.  While true food allergies are certainly on the rise, there are many people who don’t have food allergies who are still experiencing adverse food reactions.  It is important not to misinterpret a negative food allergy test result to mean the foods you eat are not provoking symptoms.  Sometimes a patient will tell me “I thought I was reacting to foods but when I was tested they found I don’t have food allergies, so that’s not the problem.”  When you understand the many different types of food reactions that can take place, diet can be properly addressed in order to achieve relief from symptoms and a return to wellness.

Food reactions can be separated into 2 main categories:  those mediated by the immune system, and those which are not.  Reactions that are immune-mediated include food allergies, food sensitivities, and auto-immune food reactions.  Reactions that are not immune-mediated are referred to as intolerances.  A food intolerance results from the deficiency in an enzyme needed to digest a certain component of a food.

Immune-mediated Adverse Food reactions

Food sensitivities are characterized by symptoms that can be delayed, dose-related, and resulting from a combined effect of multiple foods.  Symptoms associated with food sensitivity include diarrhea, bloating, gas, abdominal pain, headache, fatigue, migraine, brain fog, edema, excess mucous production, muscle or joint pain, malaise, and others.  There are many medical conditions associated with food sensitivity, including irritable bowel syndrome (IBS), fibromyalgia, migraine, chronic fatigue, arthritis, and others.

Food sensitivities can be difficult to identify due to the subtle, chronic, and insidious nature of their reactions.  For many years the standard of care has been to conduct an elimination diet which involves the elimination of most foods followed by oral challenge, using a food diary to help identify problematic foods.  I still believe an elimination diet is the best method to use, because there is no one test that will identify every type of food reaction, nor is there a test that can possibly test for all the different foods and food chemicals you may be exposed to with a typical diet.  However, we are extremely fortunate to have the benefit of food sensitivity testing to help guide an elimination diet, and the use of testing is invaluable in developing a much more effective diet protocol that does not involve severe dietary restriction.  The days of the lamb, rice, and pear elimination diets in comparison to using a good food sensitivity test appear barbaric in comparison (not to mention I have seen many patients test reactive to lamb, rice, and pears.) I will discuss food sensitivity testing and elimination diets more later in this article.

Food allergies involve IgE antibodies which result in histamine release.  Generally, food allergy symptoms are more immediate and noticeable than foods sensitivities, and often are easier to trace back to the offending food.  Symptoms of food allergy include itching or swelling of the skin, eczema, itching or swelling of the tongue, lips, or mouth, difficulty breathing, nasal congestion, abdominal pain, nausea, or vomiting.  Although the tests available for food allergies vary in their accuracy, a food allergy test can be a helpful tool in tough cases where offending foods are difficult to identify.

Auto-immune food reactions

Auto-immune disease occurs when the body’s immune system attacks its own cells.  The most well-researched auto-immune food reaction is the role gluten plays in celiac disease.  In the case of celiac disease, gluten, which is a protein in wheat, triggers the auto-immune response which results in damage to the villi in the intestines.  Eliminating gluten completely from the diet is the only known treatment for this condition.  Gluten is suspected in playing a role in other auto-immune conditions such as Hashimoto’s, although this is not as well-established or as widely accepted.


Non-Immune-mediated Adverse Food reactions

Food intolerance – The most common and well-known type of food intolerance is lactose intolerance.  The lactase enzyme is necessary to digest lactose, the sugar found in cow’s milk.  When lactase is absent or present in insufficient quantities, the lactose consumed is instead digested by bacteria in the gut.  This results in the production of gas and/or lactic acid which causes bloating, abdominal discomfort, loose stools, or diarrhea.  Lactose intolerance can be tested for using a breath test, although many people are able to determine they are intolerant without the use of testing.  By avoiding lactose-containing foods, or taking a lactase enzyme supplement when dairy is consumed, symptoms of lactose intolerance can be managed and eliminated.  Other food intolerances include fructose intolerance, bile salt deficiency, and FODMAP intolerance.  While in many cases food intolerances are irreversible, it is my experience that symptoms can be managed and in some cases, tolerance can return once the cause of the intolerance is properly addressed.


The use of testing and elimination diet to identify adverse food reactions

Identifying and eliminating offending foods is no longer the treacherous task it used to be.  With the use of quality testing, elimination diet, and food records patients can navigate their way to a state of wellness that many have come to believe they could never achieve again.  Because of the delayed, dose-dependent, and combined nature of food sensitivity reactions, these can be the most difficult to identify without testing.  For this reason, I prefer to conduct a LEAP diet, which combines the use of a highly accurate food sensitivity test call the Mediator Release Test (MRT), with a very specific elimination protocol that yields fantastic results when done properly.

Often patients who are still suffering greatly will visit me and say they’ve already had food sensitivity testing done with minimal results. This does not surprise me at all, because the utility of some of the food sensitivity tests that are still widely used is very poor.  Because food sensitivity tests vary greatly, I would like to explain a little more about the mechanism in which food sensitivities occur to demonstrate why some tests are a waste of time.

The first, and most commonly used type of food sensitivity test is the IgG ELISA test.  IgG is an antibody of the immune system that can be activated in response to a perceived threat.  This can result in the release of mediators which wreak havoc on the invader and surrounding tissues. It is the mediators, not the IgG itself, that are the direct cause of inflammation and symptoms.  Examples of mediators include histamine, cytokines, and prostaglandins.  There are about 100 different kinds of mediators.  To further complicate things, IgG is not the only branch of the immune system called upon in these reactions.  IgM and IgA are examples of other antibodies that can also be involved, as well as complement, and cell to cell reactions that do not involve antibodies at all.

You can see, therefore, why testing the increase in IgG levels when blood is exposed to a food is minimally useful because it is only capturing a small portion of degree of reaction, not to mention that IgG release can occur as a protective response or simply as an indication of exposure to a food, and therefore its presence does not always indicate there is any mediator release taking place at all.  A 2008 article in the journal Allergy states “Testing of IgG to foods is considered irrelevant for the laboratory work-up of food allergy and intolerance and should not be performed in case of food-related complaints.”

Because of this, I prefer to use an end-point test which simply measures the volume of mediator release to give an accurate representation of to what degree various foods provoke symptoms.  The most accurate test available for this is the MRT, which is performed by Oxford Biomedical Technologies, and I am continually amazed at the astounding improvement my patients achieve when this test is used to guide their dietary protocol (the LEAP diet).  I do not recommend the ALCAT test because although it is also an end-point test, the test has very low split-sample reproducibility (60% according to an article published in Natural Medicine Journal).  The MRT, in comparison, has a sensitivity, specificity, and reliability above 90%.

Because IgE is involved in all allergic reactions, food allergy tests that measure IgE response when blood or skin is exposed to a particular food are considered a valid way to measure for food allergy. Skin prick testing involves introducing the skin to the potential allergen and measuring the wheal response that results on the skin.  While this method of testing is very good for inhalant allergies, it is not as accurate when testing for food allergies. Another test, IgE RAST or ELISA testing is a bit more accurate than skin prick testing. I find however, that although the use of food allergy testing can complement the LEAP protocol, it is not necessary in most cases as the elimination diet helps any unidentified food allergies that may be present come to light.

If you or someone you love are suffering chronic symptoms related to like the ones discussed here, you don’t have to continue allowing those symptoms to claim more and more of your quality of life.  I’m constantly amazed that something as simple as dietary modification can be the answer in restoring a normal life for so many patients.  Please call (602) 422-9800 today and schedule an initial consultation with me to find out if adverse food reactions may be the missing piece of the puzzle for you.


The Good Guys

Beneficial bacteria and how it affects your digestion

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Most people know a little about probiotics – they are a beneficial type of bacteria that aid us with digestion.  They can be found in yogurt or you can take a probiotic supplement.  However as time goes on we are learning more and more about what is called the “microbiome,” referring to the dynamic community of microorganisms in our gastrointestinal tract.  This community is comprised of beneficial organisms, pathogenic organisms, and symbiotic organisms that cohabitate peacefully with the rest.  But how many of these little buggers are inside of us?  Well, the numbers are more impressive than you might think!  Did you know:

  • Bacteria compose 10% of our dry weight.
  • You have 10 times more bacteria in your gut than you have cells in your body
  • Those bacteria comprise 99% of the DNA in your body
  • You have billions of microbes in your mouth, several billion in your small intestine, and trillions in your large intestine.
  • You have between 500-1000 types of bacteria in your digestive system, each type having hundreds of strains

While your first though might be “get them out!”  these organisms have many purposes and play a critical role in our health.

These “good guys”  function in symbiosis with your immune system and play an integral role protecting you from parasitic infection, yeast overgrowth such as candida albicans, and bacterial overgrowth such as H-pylori.  These healthy bacteria help us by aiding in digestion, balancing gut ph, reducing inflammation, regulating our bowel movements, manufacturing B vitamins and essential fatty acids, aiding in mineral absorption, protecting against toxic substances, and many other functions.

When our good guys become compromised and disease-causing bacteria, parasites, and yeast are allowed to proliferate, it can lead to a multitude of symptoms, including gas, bloating, diarrhea, and many others. This is referred to as dysbiosis.  Dysbiosis is an imbalance in gut bacteria that leads to problems in susceptible people, and can be a significant part of the problem for people experiencing functional digestive problems.   Dysbiosis is also commonly connected to inflammation in the gut and food sensitivities, and is at play in many GI conditions including IBS, celiac disease, Crohn’s disease, ulcerative colitis, and GERD.    Many factors can affect the balance of good and pathogenic microorganisms in your gut, including medications such as antacids and proton pump inhibitors, chemical exposure, stress, poor diet, antibiotic use in humans and in our food supply,  and alcohol intake.

Treatments for Dysbiosis include taking in probiotics and prebiotics from food and/or supplements, medical nutrition therapy such as an elimination diet or anti-candida diet, herbal therapy, and/or pharmaceuticals.  The type of therapy is very patient-specific but there are medications and herbs that effectively fight off unwanted bacteria, yeast, and parasites while lifestyle changes are implemented to prevent the condition from persisting or re-occurring long-term.

You can start to replenish your good guys by eating cultured dairy products such as yogurt or kefir, fermented foods such as sauerkraut, raw vinegar, or miso, and by taking a probiotic supplement.  When selecting a probiotic supplement it is important to use one that contains living, viable organisms, preferably refrigerated varieties which will stay viable longer.  Choose a combination supplement containing several different kinds of flora, including Lactobacillus acidophilus and Bifidobacteria bifidum, in addition to any condition-specific strain that is appropriate for you.   Check with your doctor or dietitian to determine what specific probiotic strain would be best for you. Prebiotics are carbohydrates that fuel probiotics and can help probiotics proliferate and work more effectively.  Many probiotic supplements will contain prebiotics such as inulin or FOS (Fructo-Oligosaccharides).  Food sources of prebiotics include onions, garlic, various vegetables and fruits, and honey.

If you suffer from a gastrointestinal condition or chronic GI symptoms, your microbiome is likely an important factor to properly address.  As a Registered Dietitian I can help you determine which type of probiotics would be most beneficial for you, and how to work more probiotics and prebiotics into your diet.  I can also help you to plan a therapeutic diet and lifestyle changes to help you rebalance your system and find relief from your symptoms.  Call (602) 422-9800 to schedule an appointment.

Everyday Health Diabetes Series

Everyday Health Diabetes Series

I recently had the privilege of working with on a video piece they produced to educate their visitors on diabetes management.  The team included myself as the diabetes educator, another dietitian, a fitness trainer, and a physician, as well as a couple of patients living with diabetes.   In the videos we impart practical information on how to live well with diabetes and prevent the progression and complications of the disease.  The video is now posted on and you can access it by clicking here:

Everyday Health Diabetes Videos