​Our last deep dive into the ketogenic diet was a big topic, and this one is too- you guys know how to pick ‘em! Thank you!

After taking a deep dive into the available research and clinical opinion on food sensitivity testing, the results are… mixed; I found them to be surprisingly uncertain! Like many topics in the health/nutrition field, there are full-on advocates for it, and those that are completely against their use.

Before we get into all of that, let’s first cover some basic definitions:

DEFINING FOOD ALLERGIES AND SENSITIVITIES:

Food allergies, intolerances, and sensitivities are becoming an increasingly experienced, and therefore, investigated health issue. According  to one report, food allergies impact 220 million people worldwide and approximately 14 million people in the United States (1), and even greater numbers are affected by the broader category of food hypersensitivities. A food allergy is defined as “an immune system reaction that occurs soon after eating a certain food.” (2) With an allergy, one can react to even microscopic amounts of the allergen, with symptoms that range from being slightly uncomfortable to severe and even life-threatening. These can include forms of skin irritations such as hives and eczema, swelling of the face, lips, and throat, gastrointestinal discomfort, lightheadedness and fainting, and on the severe end, anaphylaxis and death (2).

Food intolerances can be experienced soon after ingesting a food, and are thought to be caused by difficulty in digesting certain foods (3); this may be due to a lack of enzyme production (as in the case of lactose intolerance), and though the reaction may be extremely uncomfortable and involve a wide array of GI symptomatology, including: cramping, painful bloat, constipation, diarrhea, nausea, and vomiting, the side effects are not typically life-threatening (19).

The term food sensitivity is less universally defined and is often used interchangeably with the term food intolerance; however, as it is tested, it generally involves a reaction to a food protein that elicits an immune response that is distinct to food allergies (20). The underlying mechanism maybe that of leaky gut, gut dysbiosis, or the inability to assimilate a nutrient.  Like food intolerances, symptoms can include digestive upset (3), but they may also present as delayed onset allergic reactions (19), a flare in autoimmune symptoms (4),or as weight gain, pain, and fatigue (5) .

Because our immune and digestive systems are incredibly complex, the methods of testing for food allergies and sensitivities are of a wide variety as well. Let’s start with the more standard implementation of food allergy testing.

TESTING FOOD ALLERGIES:

Traditionally, testing for a particular food allergy begins with a clinical history to get a clear picture of the patient’s symptoms, severity, and onset (which are often quite immediate)(1). The age of the patient is considered, along with consistency of reaction, and the type of food implicated, as up to 90% of food allergies are encompassed within just a few food categories: eggs, milk, wheat, soy, fish, shellfish, nuts, and peanuts (1).

Next, tests may be performed to confirm the patient account, such as Skin Prick Tests (SPT), in which a tiny amount of the food protein or extract is exposed to the skin via a grid (e.g., on the back of the patient) and then observed for a reaction (e.g., red, swollen skin). At this point, a bit of immunology is required! The skin contains one specific immune antibody, called immunoglobulin E (IgE) that SPTs test for. Allergic reactions are often described as being IgE mediated, while sensitivities are portrayed as being mediated by other immune antibody classes (e.g., IgA, IgG, IgM, IgD), and intolerances by non-immune related digestive challenges. As skin tests can only detect the presence or absence of an IgE mediated reaction (1),  if the food sample is scratched onto or injected beneath the skin and the skin responds with redness, swelling, and blistering, shortly thereafter, there is likely a reaction happening in the body with that food substance (5, 1) (although the purity of the food extract and clinical history should be considered before drawing conclusions). However, there are many other immunoglobulins (contained in the gut for example) implicated in food reactions that the skin DOES NOT contain (5). Therefore, a non-reactive skin test result does NOT mean that the body is not reacting negatively to that food/substance, it simply means that the IgE pathway is not activated, by the amount given in the sample (5). Additionally, skin sensitivity varies, and so the amount of redness and swelling should not be taken to be indicative of the clinical reaction to the food/substance (1).

Beyond SPTs, serum IgE tests can be done, and are usually best with specific suspected allergens indicated in the patient’s history, due to the risk of false positives and unnecessary food eliminations (especially in pediatric populations), as well as false negatives and the potential for severe side effects (1). Thus, the “gold standard” for detecting an allergy remains an “oral challenge” test, where the Physician can supervise the response and administer appropriate precautions (6). As you can see, allergy testing is not as clear cut as we might think. And often, if someone has a true allergy to a specific substance that is easy to tease out (e.g., a specific food or environmental allergen), they are aware of it and avoid it, with or without a test.

What becomes more tricky is when reactions are delayed in onset, and more subtle and variable. How do we know what we are reacting too? How do we test for it? Let’s take a look!

TESTING FOR FOOD INTOLERANCES & SENSITIVITIES:

When it comes to testing for these more variable reactions, there are MANY approaches, from pulse testing, to muscle tests, to testing for various immune antibodies and other mediators of reaction (5).  The reason that there are so many variations of tests available is likely because our immune systems are amazingly complex and changing all of the time, and no one test or theory of food sensitivity has been able to pinpoint all forms of reactivity. For these reasons, some researchers have concluded that multiple forms of food sensitivity testing in combination with a physician-guided lifestyle modifications (such as elimination and reintroduction diets) may be the best way to work with food reactivity, as no one test appears to be able to detect all reactions conclusively (7).

Perhaps one of the more common ways to test for non-allergy food reactions, especially delayed hypersensitivity reactions, is IgG testing (especially IgG substrate 4) via the ELISA (enzyme-linked immunosorbent assay) method. This test measures the size of an immune antibody reaction to specific food proteins (20). The idea is that, of all the immune antibodies, the concentration of IgG is the highest. IgG has four substrates, with IgG1 being the highest, and IgG4 being the lowest under normal “healthy” physiological conditions (11). However, the concentration of IgG4 rises dramatically when one is reacting to an antigen (e.g., food protein). Therefore, if there is a strong IgG4 response to a substance, there is likely an inflammatory reaction to it.  The way that this is most often measured is via a blood test, which is sent to a lab, where technicians place droplets of the patient’s blood into (usually, depending on the test) hundreds of different food samples/extract solutions, and the degree of IgG antibody binding to each food particle sample is monitored (8). The greater the binding or clotting noted, the greater the patient is thought to react to that food. The patient is often then presented with a handout of the various reactive foods and is told to avoid them for a certain length of time or altogether, and may work with the physician to devise a diet plan around them.

Although this is an increasingly common method of food sensitivity testing, it entails many challenges. For example, because IgG has been observed in both non-reactive and reactive patients, it may be that the presence of IgG after ingesting a food is a normal physiological response; one that may even indicate tolerance for a food (8). Additionally, unlike IgE antibody reactions, which the immune system keeps long-term memory of in allergies, if the patient has already cut a food out of the diet for a period of time (e.g., 3 months to 2 years), the body will have likely stopped producing antibodies to it, even if it is a reactive food for them (12). Another large problem is the actual reliability of the tests being utilized. A common way to test the reliability of these tests, is to take two samples from the same patient at the same time, and send them into the same lab (or a different lab that runs the same test). If the test is reliable, there should be no greater than about a 10% discrepancy between the two tests (indicating a split sample reliability of 90%). However, the variance between tests is often much higher, with reports as high as 73% (which is less than chance!) (9), although certain labs have reported higher rates of reliability through consistent testing (10). Additional concerns include variables in the testing process, such as whether the food extracts are raw or cooked, organic and fresh or not, free of additives that the body might independently react to, and whether the testing solutions have been purified so they aren’t the cause of the reaction (12). Also of note, many tests report for whole foods or even broad categories (e.g., dairy, milk, yogurt) when a patient’s immune system may be reacting to a specific component of that food (e.g., casein or whey).

Despite these flaws, there appears to be a place for their use. Two respectable Functional Physicians, Dr. Chris Kresser and Dr. Alan Christianson, both report utilization of food sensitivity testing in their work with patients (12; 5), albeit careful and hesitant. Dr. Kresser utilizes different Cyrex arrays in specific cases as there tests are quite extensive and account for variables such as both raw and cooked foods, and solution purity (13). Dr. Christianson reports that through conducting his own experiments with split sample reliability, he has found the KMBO FIT test, USBiotek, and Meridian valley labs most useful (5). Another functional practitioner, Dr. Michael Ruscio, finds that sensitivity tests are too unreliable, expensive and potentially restrictive to be of best use for his patients; he prefers to start with a whole foods elimination diet approach (14). Utilizing a professionally supervised elimination and challenge/reintroduction diet has been reported as a practice gold standard by others as well (4, 20).

Beyond IgG and single immune antibody food testing, are theories that posit that multiple mediators (e.g., many different white blood cells, cytokines, histamines, prostaglandins) released during a reaction are actually what cause the negative effects we experience with a food sensitivity, such as the MRT test offered by Oxford Biomedical Technologies (15). The creator of this and the previous ALCAT mediator test, Immunologist Mark J. Pasula, PhD, explains in a 2014 Towsend Letter, “The inflammatory process associated with food sensitivities is significantly more complex than IgE-mediated food allergies. Multiple triggering mechanisms and pathways, multiple classes of reacting white cells, a vast number of pro-inflammatory mediators, and a wide array of symptoms and conditions make sensitivities a highly complex category of adverse food reactions.” (16; {see diagram 1}).

Like the IgG and single immune complex tests, a blood draw is completed in a lab, and a specific amount of the patient’s blood is placed into each vial (e.g. 140 vials of specific foods and chemical additives are tested with the MRT). Next the vials are observed for reactions by technicians at specific time intervals via changes in the solution, which are comprised of the patient’s blood cells and plasma. According to this immunological theory, if there is a reaction, mediators from within the many different immune cells will be released; the cells then become smaller in size while the plasma remains the same (15). Significant changes to the total volume of the cells indicate a significant reaction, while modest changes indicate a low reactive substance. Patients then receive a print out of all substances tested with a reactivity bar of green (low reactivity), yellow (moderate reactivity), or red (high reactivity), and can make dietary adjustments accordingly. Although the mechanism of the food reaction is measured differently than immune antibody (e.g., IgG) tests, it is noted in these tests too that in some cases degree of reactivity may not correlate with clinical reactivity, and while it is recommended that one avoid all high and moderate reactivity foods, that low reactivity is likely “safe” IF that food has been consumed regularly before testing (taken from my own MRT printout). So similar to IgG testing, these tests must be interpreted and dietary modifications implemented with careful consideration of patient history.

Beyond the pretty dated research available on Oxford Biomedical’s website, I found it challenging to locate updated information on the MRT III proprietary testing method (e.g., are the food extracts raw or cooked?). Similar to the procedure with IgG testing, I looked for indications of how reliable the test results actually are. It has been referenced by clinicians that split sample reliability is consistently greater than 90% (e.g., 17), and a research poster on Oxford Biomedical’s website (15) as well as one report I was able to locate (18) confirm this. Functional practitioners views of this form of testing are mixed (5;12; 17).


PERSONAL OPINIONS AND ADDITIONAL CONSIDERATIONS:

There is no doubt opportunity to go into even greater depth on each of the food reaction test methods mentioned, and many more. I myself, after examining all the research and available options, found that, much like embarking upon any approach to health, the right tool must be chosen carefully for the right person.

My views also align with other practitioners (5; 7; 12; 14; 20;) in finding that a comprehensive approach to food sensitivity is one that may involve a hypo-allergenic or therapeutic food menu implemented for a certain period of time, along with additional testing (if and where it feels aligned), all under the guidance of a skilled practitioner. I think that as a consumer it is important to be aware of the clinical limitations of each of these tests, and I hope that you have a greater view into these through reading this article.

Personally, I have quite a bit of experience with different elimination and reintroduction diets and have found them to be extremely helpful and informative; when it comes to testing, I have experience only with the MRT test, and what follows about it is purely anecdotal. This was the test my practitioner and I chose, along with stool testing, after experiencing a GI flare a few months ago, as a part of informing our approach to a gut healing protocol. After spending the past few years really invested in system wide healing, I feel like I am able to receive pretty clear messages from my body as far as what food, forms of movement, and social interactions feel really good (which changes throughout the month and life events). Prior to receiving test results back, there were a few foods that didn’t particularly feel great in my system, including coffee, green peppers, and bananas. Interestingly enough (even though I hadn’t consumed any of them for a month or longer), the test results showed them to be reactive foods in my system.

However, there are other foods that also seem to elicit a particular response in my body; for example, my body has a higher tendency toward bloating, joint aches, eczema flares and skin rashes when I am regularly consuming grains. And when I eat dairy (in any form besides butter and including sheep’s, goat’s, and cow’s milk forms), I notice after three days worth that I feel sinus pressure, my ears drain, my throat hurts, my eyes water and burn, and my chest feels heavy. For these reasons, I have for the greater part of the last few years, kept them out of my diet. Interestingly, all forms of dairy and most grains tested came back in the ‘green’. Because of this, I tried reincorporating them, and just didn’t feel good! I talked to my practitioner about this and she basically said what I tell my clients which is TRUST YOURSELF and your body’s feedback.

What I also found interesting and what became a key part of my healing protocol was the fact that many of the foods in the seafood and meats/poultry sections came back reactive. Looking at my history (which includes periods of food and caloric restriction, chronic stress, over-exercise, and higher alcohol, caffeine, and sugar consumption than my body prefers), it became clear that part of the root cause to the GI distress was low stomach acid (which declines with age and can be affected by each of the life markers mentioned above). So in addition to the nurturing food preparations and mindful eating practices that became priority, we added in digestive and stomach acid support.

So, much like other health practitioners have found with their clients, my experience with this test was mixed. I am grateful for (and fascinated by) the testing options available and the researches behind them working to improve understanding, methodology, and reliability. I do think that they have a place and can be helpful in developing healing protocols, as long as their limitations are acknowledged, and the patient’s history and experience is given equal consideration.

Whew!

That was a biggie, and I hope that you found it helpful!

**PLEASE NOTE, ALL INFORMATION PROVIDED HERE IS INTENDED FOR EDUCATIONAL PURPOSES ONLY; PLEASE CONSULT WITH YOUR HEALTH CARE PROVIDER BEFORE MAKING ANY CHANGES.***

*** Are you currently struggling with chronic burnout? I understand and would LOVE to support you on getting out of burnout and into THRIVING! Please click here to schedule a FREE call with me to learn more! 

Resources

1. Manea, I., Alenei, E., & Deleanu, D. (2016). Overview of food allergy diagnosis. Clujul Medical 89(1), 5-10. doi:  10.14386/cjmed-413
2. Mayo Clinic Staff. Food allergy. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/diseases-conditions/food-allergy/symptoms-causes/syc-20344094
3. Food intolerance definition. American Academy of Allergy, Asthma, and Immunology. Retrieved from: https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/food-intolerance
4. Laird, E. (2/16/15). Why food intolerance testing doesn’t work. Autoimmune Wellness: Seeking health + building community. Retrieved from: https://autoimmunewellness.com/why-food-intolerance-testing-doesnt-work/
5. The ultimate guide to food intolerance testing. Dr. Christianson.com. Retrieved from: http://drchristianson.com/the-ultimate-guide-to-food-intolerance-testing/
6. Lieberman J.A., & Sicherer, S.H. (2011). Diagnosis of food allergy: epicutaneous skin tests, in vitro tests, and oral food challenge. Current Allergy and Asthma Reports, 11(1), 58-64. doi: 10.1007/s11882-010-0149-4.
7. Herman, P.M., & Drost, L.M. (2004). Evaluating the clinical relevance of food sensitivity tests: A single subject experiment. Alternative Medicine Review, 9(2), 198-207.
8. Lavine, E., MD. Blood testing for sensitivity, allergy or intolerance to food. Canadian Medical Association Journal, 184(6), 666-668. doi:  10.1503/cmaj.110026
9. Miller, S.B. (1998). IgG food allergy testing by ELISA/EIA what do they really tell us? Townsend Letter for Doctors and Patients. Retrieved from: http://www.betterhealthusa.com/public/282.cfm
10. Rebello, J, MD. Bloodprint: A new benchmark for reliability in food allergy testing. Townsend Letter for Doctors and Patients. Retrieved from: http://www.betterhealthusa.com/public/289.cfm
11. About food sensitivities. Meridian Valley Lab. Retrieved from: https://www.meridianvalleylab.com/areas-of-testing/allergies-food-allergy/
12. Kresser, C. (September 3, 2015). RHR: Are food intolerance tests accurate? Chris Kresser: Let’s Take Back Your Health- Starting Now. Retrieved from: https://chriskresser.com/are-food-intolerance-tests-accurate/
13. Cyrex Labs: Array10 food testing. Cyrex Laboratories. Retrieved from: https://www.cyrexlabs.com/Array10Video1/tabid/238/Default.aspx
14. Ruscio, M, DC. (May 15, 2015). New food allergy testing. Dr. Michael Ruscio, DC: Get Healthy - and Get Back To Your Life. Retrieved from: https://drruscio.com/new-food-allergy-testing/
15. The Patented Mediator Release Test (MRT). Oxford Biomedical Technologies. Retrieved from: https://nowleap.com/the-patented-mediator-release-test-mrt/
16. Pasula, M.J., PhD. (2014). The patented Mediator Release Test (MRT): A comprehensive blood test for inflammation caused by food and food-chemical sensitivities. Retrieved from: https://www.food4lifecounseling.com/files/pdfs/Townsend-Letter-Jan-2014.pdf
17. Mynar, S. (August 4, 2016). Food Sensitivity Tests V. Elimination Diets. Shawn Mynar. Retrieved from: http://www.shawnmynar.com/food-sensitivity-testing-vs-elimination-diets/
18. Mediator Release Test: Principles & Method. Lifestyle Eating and Performance. Retrieved from: http://acupuncturenutrition.com/wp-content/uploads/2011/12/MRTPrinciplesMethod71051.pdf
19. Ballantyne, S., PhD. (May 28, 2018). Can Paleo or AIP Diets Cause Loss of Immune Tolerance? The Paleo Mom. Retrieved from: https://www.thepaleomom.com/can-paleo-or-aip-diets-cause-loss-of-immune-tolerance/
20. Ferguson, K, ND. (September 6, 2012). Food Sensitivity testing: Let’s talk about your options! The Paleo Mom. Retrieved from: https://www.thepaleomom.com/guest-post-by-dr-kellie-ferguson-food-sensitivity-testing-lets-talk-about-your-options/

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I received this question last week, and with the many 30-day programs that have cropped up over the past few years and the greater interest in them, thought it would make a great EP topic!

So the question/comment was: “I am on the last week of a 30-day reset, and once it finishes, I’m not sure what to do.”

This is a great question, and in my experience, and a very common place to land finishing a reset/plan/elimination diet. Often times, there are pretty specific rules offered along with these, and perhaps even daily meal plans.

This can be great starting out, because it takes the guesswork out of everything; which can be a valuable asset when making changes or trying something new. If not instructed or guided though, I find it can also take the INTUITION and INNER TRUST out of the experience as well.

So to answer this question, I am going to offer a question, or a few questions to consider throughout this process, as the answer for one person will likely differ from the next.

Question 1: What was your intention in undertaking the reset?

• Weight loss?
• Energy?
• Mood?
• Skin health?
• Gut health?
• Improved sleep?
• To discover food sensitivities?
• To explore your relationship with food?
• To decrease inflammation in the body?

Question 2: What have you noticed throughout the process? (write it down!)

• Changes/shifts in any of the above?
• When?
• How did that show up for you?
• How do the changes you’ve noticed connect to the changes in foods eaten?
• What felt really good/worked for you?
• What didn’t feel so good/felt like a constant struggle?
• What have you learned about your body in the process?

Question 3: What is important to you NOW?

• Did this past 30 days feel good for you?
• In flow?
• Allow you to participate in your life fully?
• Did you feel restricted or deprived in any way?
• How does your relationship with food/body feel now?
  • Do you feel more in touch with your body/ further away?
  • Are you scared to re-incorporate any foods now?
  • What’s underneath that?

This may feel like a lot to consider (and a little deep!), and IT IS. Food IS deep. It is one of the first and the longest relationships we’ve had throughout life. Food is often with us in the highest of highs and lowest of lows. People have created tribes and cultures around food, and staked a lot of identity on it, too. And often, in the food and diet industry, along with the meal plan is an implicit promise: this is THE thing that will get you everything you want- love, belonging, beauty, health, harmonious relationships, confidence, and full self expression. This is an impossible promise because no one and nothing can give this to you unconditionally except for yourself. YOU get to decide that you are worthy of love, compassion, patience, caring, success, and health, and you decide the TERMS, too. If you decide that your life can only be lived at its best when you are X pounds, then you make it so. Conversely, if you decide that you are UNCONDITIONALLY worthy of love, and are willing to BE THAT SOURCE OF LOVE for yourself, always, nothing can stop you, and from this space decisions can be made with unwavering love for yourself.

That unwavering love may lead you to undertake a reset or cleanse or any number of health changes that, from the outside, may look the same, but will FEEL very different than coming at it from a place of not good enough, and needing this thing (and then the next and the next) to make you whole and complete.

From this space, what feel important to you, right now? Many elimination/reset diets are enacted with the guidance of health practitioners for the purposes of providing the widest amount of food variety with the greatest amount of health, energy, and vitality to be channeled into all the areas of life.

So as one comes near the end of a reset, I would encourage taking note of all of the changes mentioned above, and then slowly begin to re-incorporate the food/s that were eliminated that you’d like to re-incorporate. That may be all foods, that may be some. There may be a few foods that you feel better without, most of the time; that’s great awareness, too! If you are interested in re-incorporating foods that may be connected with symptoms you’ve experienced in the past, I would recommend working with a health practitioner, who can guide you on when/how to re-incorporate foods in a way that works best for you. Commonly, this includes reincorporation of one food at a time, for at least three days, taking note of your experience, and then adding in another food, sticking with it for three days, taking note, and so on.

One of the beautiful opportunities of closing out a reset, is that often the body has a greater sensitivity. What this means is people often find that when incorporating a food or beverage back in, they know pretty quickly whether it feels good in their system or not. This is not always the case, and not with every food. But it is my hope that if you are embarking on or closing out a reset of some sort, whether it be with food, exercise, or technology, that you’ve set a clear intention for why it is that you are taking the action, that you’ve given yourself space to check in and be with what you are noticing, and that you come away with greater awareness of yourself and confidence in what works well for you and where your threshold lies with things.

If you are not feeling that way, if you feel worse, or feel even more confused about what foods are “healthy” for you, please ask for support. I am a practicing Health Coach and I specialize in helping women who feel lost confused, or stuck on their health journeys to get very clear on which diet and lifestyle patterns will serve them best right now, and how to navigate that change in a way that feels BALANCED. I would love to support you, so if it feels aligned, please reach out to jadiengels@gmail.com with the subject line:  "I’d Love to Receive Support!"

As always, hoping that this conversation serves you, and if you have a specific topic you’d like to see covered on the Empowered Patient, please comment below!

Thank you and sending you so much love,
Jadi

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