Diagnosis & Treatment Series I
Defining Reactions to Food
Reactions to food are increasingly common and fall into a couple of categories: immune mediated (known as food allergies or food sensitivities) and non-immune mediated (often referred to as food intolerances). These non-immune mediated responses can include reactions to a variety of food compounds or additives (tyramine, histamine, aspartame (Nutrasweet), salicylates, lectins and lactose intolerance). A food allergy is an Immunoglobulin (Ig)E mediated reaction, whereas a food sensitivity is an immunologic reaction mediated by IgA or IgG. IgE-mediated reactions are immediate hypersensitivity reactions (peanut allergy with anaphylaxis (throat swelling up/closed, hives, etc.)). What I see most often in practice are food sensitivities and food intolerances – which can slowly erode health and vitality if not addressed.
Causes of food reactions
Before I get into the diagnosis and treatment sections, I want to give you a little background on factors responsible for the growing prevalence of food reactions. These include, but are not limited to:
- Nutrient deficiencies
- Processed food (including food made with Genetically Modified Organisms (GMOs))
- Environmental toxins/pollutants
- Hypochlorhydria (low stomach acid)
- Changes to the microbiota of the gut (from infection/insult/injury)
- Medications (antibiotics, vaccines, Chemotherapeutic drugs, Non Steroidal Antiinflammatory Drugs (NSAIDs))
- Stress (lowers the gut’s immune strength and predisposes to inflammation)
- Genetic/epigenetic factors
- Shift work
- High intensity interval training (in elite athletes)
- Traumatic Brain Injury
Regarding the mechanisms underlying food reactions, a number of these diet and lifestyle factors impact the integrity of the gastrointestinal/gut lining and lead to increased Intestinal Permeability (also known as ‘Leaky Gut’) which then lays the groundwork for immune-mediated reactions to occur (the gut is more porous/leaky so molecules that usually should not get across the gut barrier can pass and the immune system sees these molecules as foreign, and mounts a reaction against the molecule (or food antigen)). From the list above, the factor ‘hypochlorhydria’ deserves a little more unpacking; those with a history of proton pump inhibitor use are prone to hypochlorhydria (as well as several nutrient deficiencies that can occur as a result of decreased acid for proper digestion of proteins and other food components/nutrients).
Due to the delayed reaction of many of these food-based reactions (all but IgE-mediated food allergies) may mount (and/or sustain) a reaction anywhere from 3 days to 3-4 weeks after consuming a problem food. So how can one determine what foods one reacts to on any given day or week? One can play the odds; armed with the knowledge that the majority of food allergies result from consumption of:
- Tree nuts (walnuts, cashews and almonds),
one can try eliminating one or more of these foods to see if food allergies may be a contributing factor to ill health or disease. This, in a comprehensive and methodical manner, is in essence what an elimination diet does. For a 3-4 week period, the diet is greatly simplified to avoid several common allergens and inflammatory foods and drink (beef, veal, cold cuts, eggs, pork, whey, soy, dairy, peanuts, corn, gluten-containing grains, stimulants (coffee, tea, chocolate), sugar and alcohol.
The Elimination Diet
The Elimination Diet (with oral food challenge) is considered the gold standard of testing for food reactions. I have often used food allergy testing (IgA, IgG (and IgE as needed)), with good results, but this testing does not identify non-immune mediated food reactions and, if allergens are identified, still necessitates an elimination phase. Moreover, the testing typically runs $200-300.
Having recently completed an Elimination Diet myself (to be able to guide my patients through it and as a means to further identify/address my own food reactions), I can speak to its capacity as both a diagnostic measure and a therapeutic intervention. Furthermore, in following this diet, I was reminded that changing one thing in one’s diet/lifestyle regimen, seems to pave the way for additional changes to be made more readily. And eliminating more inflammatory/allergic foods also provides some cleansing or detoxification and can give one a sense of renewed clarity and purpose as a result.
So to put all this into context, I will use myself as an example, having completed a 3 week elimination diet with all of the above foods as well as almonds and citrus taken out of my diet, I systematically re-introduced most of the foods that were eliminated with the reintroduction protocol (one food at a time with a washout period between) and determined that I could tolerate a number of the foods eliminated, but had a strong, negative reaction to eggs – no omelets or paleo baking for me for a while! The next step is to heal the GI tract (while continuing to eliminate the reactive foods). I will write more on this process (and the 5R protocol for gut restoration) in a future post.
If you suspect that you have adverse reactions to food, or have persistent/chronic health issues without a known cause or solution, you may wish to try an Elimination diet. I frequently see those in my practice with gastrointestinal complaints (abdominal pain, bloating, gas, nausea, constipation/diarrhea), asthma, skin rashes or lesions, migraine headaches, arthritic pain, behavioral issues, disorganization or disturbances in thinking and feeling, memory disturbances, psychosis and schizophrenia, as well as those suffering from autoimmune disorders (Hashimoto’s thyroiditis among other conditions) have one or more food reactions. Patients at AHSOM are given thorough instructions with a menu, shopping guide and recipes and are carefully guided through both the Elimination and Reintroduction phases of the diet. I am always a fan of efficient and cost-effective tools for diagnosis and treatment, and with the Elimination Diet, we are very fortunate to have a highly accurate and free diagnostic and treatment tool in one!
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Lukaczer, D. (2017, June). Food Allergies, Hypersensitivity, and Intolerances. Diagnosis and Treatment. Institute of Functional Medicine (IFM). Presented at AFMCP, Washington, DC.