(This is a sample entry from our Q&A Treasure chest, a database with hundreds of entries to support students with their client needs… Unlimited access is included as part of our Core 101 Semester program.)
I have a new client – a 46-year-old lady who is literally allergic/sensitive to every good edible food, it seems!
Her doctor did an ELISA Basic Food Panel, and there is nothing for her to eat! I have no idea what to do. She’s frustrated and lost. Can you help me in any way? There are three panels with Low, Moderate and Avoid results. Now, if she is ‘sensitive’ to foods, wouldn’t they also irritate her? She has a few foods in LOW, but they are not foods she enjoys or can even ‘stomach’, such as fish, due to their strong smell. Surprisingly, she had no intolerance to all the sugars, corn starch, and MSG (at least on this test)! What am I missing?
Great question! First of all, I encourage you to confirm exactly what type of food sensitivity testing was performed. For purposes of this reply, I am going to assume that this was a Total IgG food antibody panel which measures “sensitivities” (which can progress to officially be “type 3 hypersensitivity”) and are a marker of the adaptive immune system’s reactions to foods. Essentially, the test is measuring when the immune system is reacting to a consumed (and perhaps quite healthy!) food with hypervigilance. Important information, but one that is not as targeted as we might assume.
First of all, it’s important to realize that no single food allergy/sensitivity/intolerance panel is going to yield a comprehensive and fully accurate list of all foods that might be causing inflammation and/or discomfort in your clients. IgG antibodies are only one type of reaction that the body can have to a perceived threat (e.g. a food). We can also have an IgA-mediated response (which happens in the mucous membranes of the body, such as the gut lining). Similarly, someone may have an outright (even violent) allergy to a food and thus generate significant IgE antibodies in reaction to that food, but there may be no IgG or IgA antibody generation. Food intolerances such as lactose or fructose intolerance are not reactions from the immune system at all, but your client will still suffer from consuming these foods. The body can also react to lectins, mycotoxins, chemical additives, and other triggers in food which will not show up on a typical food antibody panel. And going back to Total IgG measurements, note we can have high levels of these antibodies simply due to high consumption, and there may be little/no complement activation to trigger an inflammatory response. Bottom line: this complexity can make it hard to “nail down” food sensitivities/allergies clearly via a lab test. And it’s one of the reasons why the “gold standard” of identification of these issues is through 100% food elimination followed by a reintroduction challenge.
Sure, testing can be helpful! But only as one puzzle piece. I believe the current best-in-class food sensitivity test is available from Cyrex (Array 10, specifically) which measures a combination of both IgG and IgA, while taking many precautions to anticipate and weed out false positives. Cyrex also makes the provision to ensure foods are tested in the form in which they are usually consumed (i.e. cooked vs. raw chicken and raw vs. cooked banana). However, this test is quite expensive. Vibrant Wellness also offers a series of test panels which test for both IgG and IgA reactions. My second choice in food sensitivity testing would be KBMO which measures IgG antibody specifically in immune complexes with complement (which dramatically helps eliminate false positives but may have false negatives). This one is notably less expensive but still a sizable investment. For patients who can afford to do so, these are excellent choices. There are also high quality Total IgG panels (more vulnerable to false positives) from functional lab companies such as Genova and Alletesse. But the point I made above is key here: none of these tests is fully comprehensive for all inflammatory reactions to foods. There is no such thing. The body has MANY ways in which it can react negatively to foods, including mechanisms that don’t involve antibodies or measurable immune reactivity. Testing can be valuable for some clients but is not always necessary. Again, the gold standard is food elimination and structured reintroduction.
A test called Mediator Release Testing (MRT) is designed to assess the body’s innate immune system response to a food. Some practitioners use these panels with great results; others (including myself) question the lack of clinical study validating their accuracy and repeatable results (and our overall ability to assess innate immune system sensitivity to foods in general).
But back to your client! In my experience, the best way to eliminate the effect of the severe IgG-mediated food sensitivities is to eliminate them for a time. Not just reduce it. But rather 100% eliminate it – cold turkey – for a time to allow IgG antibodies to disappear and then reintroduce the food. I believe she likely needs to eliminate all the Severe and Moderate sensitivities 100% for at least 3-4 months initially (perhaps longer but this is a good starting point). The “Low” foods are likely fine for her to continue to eat occasionally (1-2x/week) but not every day, so be sure to have her look through the list carefully and decide what foods need more rotation. The good news is that if she can eliminate her most severe sensitivities cold-turkey (*and* prioritize calming the immune system and healing any enhanced intestinal permeability in the interim), there is a very good chance she will be able to reintroduce all or nearly all of them with no effects after a few months (and thus be able to add them back into her diet).
I usually recommend a 4-month elimination because it usually takes the client a few weeks to fully eliminate them (and officially “start the clock”) and get in a true 3 months of full elimination which given the average half-life of IgG antibodies will render their level to <10% of their original amount. Of course, during those precious three months, we must, must also work on addressing the root causes of the immune hypervigilance! Assess and explore sleep, movement, insufficient nutrients (especially Vitamins D and A and zinc), stress, toxic exposure/overload, enhanced intestinal permeability, and microbiome imbalance. We must shift the environment overall that our immune and nervous systems are responding to if we wish them to have a more tolerant response to our foods. Just eliminating the foods is not enough!
Your opportunity is to help her creatively to find alternative, healthy foods that she can use to nourish herself over the next few months. Reassure her that this is not “forever” – just for a healing window. If she feels she cannot eliminate all the Severe and Moderate foods right away, then start with all the Severe items, at least as a starting points. Some clients needs a little time to develop new habits/choices and progressively move into the full elimination.
Keep in mind that the development of a sensitivity is not an indication in any way of the “healthiness” (or toxicity) of a food – just a measure of her unique immune system’s response to it. And she may feel uncomfortable after eating some low-IgG-ranked foods due to maldigestion vs. any type of immune response.
If she has many Severe category foods and most of them are foods she eats often, then it’s likely that she has Enhanced Intestinal permeability (aka Leaky Gut), a situation in which the immune system has extended exposure to semi-digested food in our immune system “police station” in the gut lining (called our “GALT”, gut-associated lymphoid tissue). Obviously the immune system is going to react to this event with alarm (maldigested food is on the wrong side of the intestinal “fence”!). I have written many times about intestinal permeability, and this post might be helpful. Unfortunately, this situation is not uncommon given our cultural bias toward large use of antibiotics, over-the-counter painkillers, Vitamin D deficiency, and chronic stress – all potentially very damaging to the gut. In the case of leaky gut, people tend to develop sensitivities to the foods they consume most often (simply due to more frequent exposure). It’s important to heal the excessive permeability while eliminating the foods, or an individual is likely to develop a follow-on set of sensitivities to the new foods they are choosing (alas, I’ve worked with several clients with poly-autoimmune disease who had experienced this frustrating cycle). After she begins eliminating the foods fully, I recommend you consider all of the following, important steps:
After she has fully eliminated a food 100% for at least 3 full months, she can do a “reintroduction challenge” of one food at a time. Let’s say one of her sensitivities is to broccoli. While continuing to eliminate all other sensitivities, she can “challenge” her immune system with broccoli by consuming two normally-sized servings twice during the day for three days in a row. Then stop. Not little bites here and there – real, full servings (~1 cup). Have her pay careful attention to any inflammatory response from her body during those 3-4 days. Symptoms may include reactions like headache, acid reflux, strong fatigue, brain fog, eczema, aching joint, sustained nasal congestion (or post nasal drip with clearing of throat). Note that it might be physiological or it might be purely neurological. If there is no reaction, then she is likely fine to resume eating that food (in a well-balanced diet). Take at least a few-day break in between each new food challenge, and only challenge one food at a time. After ~4 months, I find most foods can now be tolerated. However, there is often a food or two that requires a further elimination (for a total of 6-7 months). Very occasionally, I find there is a food that simply cannot be successfully reintroduced, even after a year of elimination; these are likely permanent sensitivities that simply need to be avoided long-term.
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