Congratulations to our own Dr. Michael Mills on being named Chair of Good Samaritan Hospital’s Digestive Institute and Chief of the Esophageal Disease Center! This future institute will be a destination for patients throughout the country to experience highly coordinated care from outstanding multidisciplinary clinical care teams.
Adverse reactions to foods are on the rise, becoming more of a health concern for many. While it is true that food allergies are on the rise, there are many people who don’t have food allergies and still experience 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, problem areas in your diet can be properly addressed in order to achieve relief from symptoms and a return to wellness.
Food reactions can be separated into two 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.
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 appear barbaric in comparison to using a good food sensitivity test (not to mention I have seen many patients test reactive to lamb, rice and pears.)
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 occur 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, a protein in wheat, triggers an auto-immune response resulting 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 are no longer the treacherous tasks they 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. Due to 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, called 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 usefulness of some of the widely used food sensitivity tests is very poor. Food sensitivity tests vary greatly and some are not worth the time to perform.
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 can also be involved, as well as cell to cell reactions that do not involve antibodies at all.
You can see why testing the increase in IgG levels is minimally useful because it is only capturing a small portion of the reaction. 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.”
I prefer to use an end-point test which simply measures the volume of mediator release to give an accurate representation of to the degree to which various foods provoke symptoms. The most accurate test available for this is the MRT performed by Oxford Biomedical Technologies. 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%.
As 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 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.
You don’t have to continue allowing symptoms like diarrhea, bloating, gas, abdominal pain, headache and fatigue 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. If you or someone you love are suffering chronic symptom call (602) 422-9800 or request an appointment today and schedule an initial consultation to find out if adverse food reactions may be the missing piece of the puzzle.
A healthy family helps to create the foundation for a happy family. When Mom, Dad, the kids, and everyone else around are healthy, things just seem to run smoother! When people feel good, it is easier to manage everything that life brings. However, creating a healthy family takes more than just making a bold resolution to “Be Healthy.”
To be healthy starts with the creation of good nutrition and lifestyle habits. These habits become part of your lifestyle, and people who live a healthy lifestyle have a decreased risk of chronic diseases such as obesity, heart disease, and diabetes. This month I am sharing with you Eight Habits for a Healthy Family, tips that I have found create the foundation for a healthier and happier family!
- Eat breakfast. People who eat a healthy breakfast (blueberry donuts do not count!) are more mentally alert, perform better at work, at school and on the field, and have an easier time managing their weight than non-breakfast eaters. Breakfast is an excellent time to start the day with a nutrient-packed power meal by consuming fresh fruit and vegetables along with fiber packed complex carbohydrates, lean protein and monounsaturated fats. Breakfast is especially critical for children and adolescents; therefore, it is important to start the habit of eating a healthy breakfast early.
- Set a regular grocery date. One of the biggest challenges busy families face when it comes to mealtime is not having the right ingredients on hand to whip up a quick and healthy meal. This usually results in the need to head to the nearest fast food pick-up joint for a quick meal–and usually a not-so-healthy meal. A regular grocery date will help ensure your fridge will always be stocked with healthy food for those very hectic days!
- Prepare meals in advance. Along with setting a regular grocery date comes the important habit of meal planning in advance. Life is busy, and few families have the luxury of being spontaneous during the work and school week to figure out “what’s for dinner,” shop for the necessary ingredients and then cook the meal! Spend a little time over the weekend prepping food for the week and I can almost guarantee your week will run a whole lot smoother! Create a system that works for you.
- Monday: Meatless Monday vegetarian dish
- Tuesday: Poultry or fish night
- Wednesday: Soup or chili
- Thursday: Leftover night!
- Friday: Homemade pizzas, tacos, or breakfast for dinner
Leave the weekends for a little more impromptu eating and plan according to what is going on in your life. By following a system such as the one above, you can eliminate the stress of thinking you need to create something elaborate every week, while giving yourself the flexibility to mold the menu to your family’s likings. Try one new recipe a week and use family favorites for the other nights.
- Involve the whole family in meal planning. Parents often feel the need to take on the weekly challenge of meal planning as a solo task, when in reality, weekly meal planning should be something everyone (ages 5 and up) is involved in. If you have young children, have them participate at an early age by letting them browse through picture cookbooks and find meals that appeal to them. Give adolescents the responsibility of planning one meal a week. Involving the whole family at an early age helps create the habit of prioritizing advanced meal planning. This also helps to reduce the “I do not like this!” tantrums and to increase the overall nutrient profile and variety of foods served because everyone has a chance to give their input.
- Eat at the table. Creating the habit of eating together at the table sets the foundation for many healthy habits. In today’s fast-paced, busy world it can be hard to sit down, slow down, eat and enjoy a meal together. But this is one old fashioned habit that should be reestablished as a regular part of your routine. Eating together helps people connect and share what is going on in their lives. It helps you relax, unwind and create memories. Eating at the table also helps create the habit of mindful eating. When the TV is turned off and external distractions are put on mute (i.e. telephone, email, and text alerts), people are better able to pay attention to their internal hunger and fullness cues, helping to prevent mindless eating and overeating.
- Snack on fruits and vegetables. When it comes to eating healthy, we have all heard that we should “snack on more fruits and vegetables”! But the reality is, as a society, we are accustomed to snacks coming in fancy pre-packed containers. Unfortunately, our children are learning that “snacks” come from a box and not from Mother Earth; this is setting unhealthy habits from the start. We have the power to transform children’s snack habits by simply having more fruits and vegetables readily available on a regular basis. Children learn what they live, so if fruit and vegetables are served as snacks when they’re young, children will grow into adolescents and adults snacking on more fruits and vegetables!
- Make water the go-to beverage. Creating the habit of drinking more water is a simple but very important one. Here are some ways to increase your overall water intake and make it a family “habit”:
- Drink a glass of water first thing when waking up–even before breakfast!
- Serve water with meals.
- Keep homemade fruit-flavored water in the fridge. (You can make this by placing fresh fruit slices in a pitcher of water and letting it sit overnight.)
- Have everyone carry a water bottle.
- Dining out? Create the family habit of ordering water!
- Pack food the night before. Help your family create the daily habit of preparing for success by packing meals and/or snacks the night before. When morning time comes, it is easy to forget to make that turkey sandwich for lunch or grab some fruit, yogurt, and nuts for a mid-afternoon pick-me-up! But if you do so the night before and make this part of your daily routine, it becomes a regular habit. Having your meals and snacks in a convenient location (like a cooler) will prevent a mid-afternoon trip to the fast food drive thru, helping everyone eat healthier and saving time and money. This is a habit that will serve your young and adolescent children for many years to come!