Food Aversions
Negative immune and digestive responses to foods have a growing number of Americans seeking medical help.
Food allergy, sensitivity or intolerance? It’s likely many Americans don’t know the difference, but many are reporting they are experiencing them.
Deborah Orlick Levy, MS, RD and New Jersey-based Carrington Farms health and nutrition consultant, has described the issues in easy-to-understand terms:
A food allergy is an over reaction of the immune system, which recognizes a specific food protein as a harmful target, she said. This causes a release of histamines, which trigger inflammatory reactions in the tissues of the body. Some of these are:
• Mouth (itchy/swelling)
• Skin (hives)
• Respiratory (wheezing/coughing)
• Gastrointestinal (GI) (vomiting/diarrhea)
• Cardiovascular (decreased blood pressure/ heartbeat irregularities)
Widespread symptoms are classified as “anaphylaxis” which is a life-threatening condition affecting multiple symptoms of the body.
A food intolerance or sensitivity does not involve the immune system. Often, the person has an enzyme deficiency, which results in improper digestion. Food intolerance may also result from certain chemicals in foods, such as food additives or salicylates or even the natural occurrence of histamine in certain foods.
The main symptoms associated with food Intolerance (according to the American Academy of Allergy, Asthma and Immunology) are:
• Intestinal gas
• Abdominal pain
• Diarrhea
Other symptoms are possible with food intolerance but the above-mentioned are considered the main symptoms.
The eight most common foods that cause allergic reactions are:
• Eggs
• Fish
• Peanuts
• Milk
• Tree nuts (Brazil nuts, walnuts, almonds and hazelnuts)
• Shellfish
• Wheat
• Soy
The most common foods that cause intolerance are:
• Beans
• Cabbage
• Citrus fruit
• Gluten-containing foods
• Lactose from milk or other dairy products
• Processed meats
Orlick Levy noted that the 2013 report “Problem Foods: Is it Allergy or Intolerance?” by the Cleveland Clinic, suggested that about Seven percent of children and one percent of adults have a food allergy. Therefore, it seems likely that most children do eventually outgrow their food allergies by adulthood.
In addition, peanut and tree nut allergies, along with fish and shellfish allergies, are usually lifelong food allergies. However, cow’s milk, egg and soy allergies may be outgrown by the age of 16. Also, worth noting is that approximately 10 percent of Americans are lactose intolerant.
According to a study in 2013 by the Centers for Disease Control and Prevention (CDC), food allergies among children increased approximately 50 percent between 1997-2011.
The bottom line, said Dr. Aimée Gould Shunney, naturopathic physician and advisory board member for California-based Nordic Naturals, is that food allergies, food sensitivities, and food intolerances are different.“Testing for them is different. What happens when you have one vs. the other is different.There are even different types of food allergies.”
What’s not different, she added, “food allergies, food sensitivities, and food intolerances are all adverse reactions to foods (ARFs), and ARFs are not good! They can affect every system of your body in insidious, hard-to-observe ways, negatively impacting your health and creating complex long-term health issues. In my private practice, trying to isolate and remove ARFs is often one of the first things I do, and I am still regularly amazed at how profound the results can be.”
Under this broad category of ARFs, there are two important distinctions:
1. Reactions involving the body’s immune system, called immune-mediated reactions, or allergies. These come in two flavors:
a. Immediate response (symptoms within two hours, can be life-threatening) and
b. Delayed response (symptoms within 72 hours, rarely life-threatening)
2. Reactions that do not involve the body’s immune system. These are non-immune mediated reactions, also called food intolerances or food sensitivities. A common example of food intolerance is the inability to digest the sugar present in milk—or lactose—known as lactose intolerance. Food sensitivities are harder to quantify, and seem changeable, perhaps related to overall health, the frequency with which we eat certain foods and stress. A food sensitivity includes any non-allergic reaction to a food, beverage, food additive, etc.
More Common?
While true food allergies are approximately five percent (15 million) of the general U.S. population, they affect one in every 13 children under the age of 18, with food allergies in children increased by almost 50 percent from 1997 to 2011, noted David J. Blyweiss, MD, chief medical officer, with Florida-based Cell Science Systems, a specialty clinical laboratory, and director of functional medicine with Maximum Wellness Centers, also in Florida.
“Because of this, ER visits for allergic reactions are approaching 200,000/year … and there is no obvious reason agreed upon for this upsurge,” he said. “There are clues though,” he said, adding that in the past 20 years our genes have not undergone any major evolutionary changes, “although epigenetically speaking (as per geneticist Dr. Arthur Riggs) ‘heritable changes in gene function that cannot be explained by changes in DNA sequence,’ the expression of our genes is chronically changing through chemical reactions turning on or off our DNA or RNA base pairs via environmental pollutants, genetically modified (GM) foods, destruction of our gut and body microbiome through the overuse of antibiotics and increasing nutrient deficiencies … any one or all of these is sufficient to affect us …from increased food allergies to increasing chronic disease in general. Both are increasing since the changes in our food supply and environment.”
Food composition is only half of the picture, agreed Kelly Heim, PhD, nutritional pharmacologist with Massachusetts-based Pure Encapsulations, Inc. “The other half—the body’s capability to handle food—may also be changing,” she noted. “Diet, lifestyle and stress may be to blame. The widely consumed refined diets are lacking in plant-derived enzymes, prebiotic substances and nutrients that the digestive system needs to maintain sensory, microbial, structural and functional homeostasis. Psychological stress alone has a profound capacity to affect the sensory and motor nerve functions, microbiota and permeability of the gastrointestinal tract. In this sense, we need to focus not only on ‘subtraction’ of insidious foods, but on ‘addition’ of nutrients, prebiotics, probiotics and adherence to a plant-based diet.”
Skilled Testing
While there are various viewpoints on which allergy testing methods are best, skin prick testing, allergen specific serum IgE tests (radioallergosorbent test aka RAST), are widely accepted and are methods employed for determining the presence of allergies, said Amy Pereira, national educator with Floridabased supplement manufacturer, Enzymedica.
“With food intolerances, the hydrogen breath test may be used to verify which dietary sugars are not properly digested,” she continued. “However, this determines just a few specific intolerances such as lactose or fructose intolerances. Keeping a food diary or journal is a commonly suggested practice and may be highly helpful in discovering or pinpointing intolerances to a wide variety of foods. Eliminating common culprits, like dairy or wheat, for an established time period and then reintroducing these foods one at a time at established intervals without the use of digestive support supplementation may help to clearly note any adverse effects. Once the digestive discomforts have been noted in relation to a particular food, practitioners may encourage reintroduction of this food with enzyme supplementation, to further clarify if enzymes will enable tolerance to and nutrient intake from this otherwise avoided food or food component.”
The “gold standard,” according to Dr. Heim, is elimination and challenge. “RAST has been used for decades to determine which substances a patient is allergic to,” he added. “In 2010, the United States National Institute of Allergy and Infectious Diseases recommended more sensitive fluorescence enzyme-labeled methods, but RAST is still useful. Testing for most food intolerances is controversial, but trial and error with the help of a professional can pinpoint the cause. For common examples such as lactose and gluten intolerance, there are clusters of symptoms that are easily identified by postprandial vigilance of symptoms, food diaries and the effect of elimination. Food sensitivities are the most difficult to characterize. A growing number of medical professionals are highly skilled in identifying food allergies, intolerances and sensitivities.”
Since food (both allergies and intolerances/sensitivities) cause us misery; itching, rashes, eczema, nausea, headaches, joint paint to name a handful, testing for them has become important for many and critical for some, added Dr. Blyweiss. “IgE testing in the blood is the fastest and easiest method for determining foods we are allergic to. For food sensitivity, IgG testing had been the go to method for years until studies by the National Institutes of Health and European Academy of Allergy and Clinical Immunology came to the conclusion that while IgG results correlated with exposure to a food, it didn’t correlate with symptoms.”
Dr. Blyweiss added that the Alcat food sensitivity test is now considered by many the preferred laboratory method for identification of non-IgE mediated reactions to foods, chemicals, and other categories of substances. “The Alcat test differs from immunoglobulin antibody tests,” he explained. “It is a functional response test and captures the final common pathway of many of the pathogenic mechanisms, immunologic, toxic, and pharmacologic, that underlie such non-IgE mediated reactions to foods and chemicals. A recent Yale School of Medicine study discovered that one of the ways Alcat positive foods induce inflammation and hence symptoms is by up regulation of CD11b on T cells.”
Other Triggers
With adverse reactions to foods on the rise, one wonders what has gone so awry. “A number of other components in foods like phenols, tyramine and food additives may be responsible for health challenges,” noted Pereira. “For those with faulty phenol processing, additives and colorings that are high in phenols (or phenol-like salicylates) must often be avoided. Tyramine, which is found in foods such as beer, aged cheeses and chocolate, is another known trigger.
Pereira added that as the long-term safety of human ingestion of genetically modified organisms (GMOs) has not been determined, it is unclear at this time if GMOs may ‘cause’ or contribute to adverse food reactions. “However, it is evident that breeding crops to contain higher gluten levels and/or adding gluten to grain products, which naturally contain gluten, contribute to greater gluten consumption and potentially ensuing reactions for those with sensitivities,” she said. “Increased pesticide application (in conjunction with crops that are genetically modified to be ‘ready’ to withstand these pesticides) may also play a role in adverse food reactions as well as overall gut health.”
Adam Killpartrick, DC, CNS with Suncook Valley Chiropractic and Functional Medicine in New Hampshire, and member of Natural Practitioner’s advisory board, said, clinically, he has ordered IgG testing which has revealed food sensitivity reactions to less commonly reactive foods such as spinach, coconut, crab meat, broccoli and chicken. “In no way am I suggesting these foods are to be avoided by everyone, only those whose results suggest an immune reaction.” As for GMOs, chemicals or other suspected digestive disruptor, “most of the companies also test for chemical sensitivities,” he said. “Some focus on environmental pollutants such as xylene, toluene, benzene, trimethybenzene, styrene along with phthalate and paraben.”
Most allergens are reactions to proteins, he added, and roughly 90 percent of food-allergic reactions in the United States are caused by allergens from only seven foods: peanuts, tree nuts, milk, eggs, wheat, soy and shellfish, Dr. Killpartrick pointed out. “Soy is only commercially available in genetically modified varieties. But if a person is allergic to conventional soy, he or she will also be allergic to GM soy as it is not different compositionally. But there has not been any data published at the time of the article to suggest that GMO create new and unique allergies.”
Carefully Monitored Diet
For a well-administered elimination and challenge diet (ECD), Dr. Shunney suggests the following to patients:
1. “Eliminate suspicious foods for three to six weeks—the big five are gluten, dairy, eggs, corn and soy. I also recommend removing sugar, caffeine, alcohol, and red meat during this time, since they often impact health negatively, and if a chief complaint is pain, I will also ask folks to eliminate nightshade vegetables. Any other food found to be positive on a blood test should also be taken out of the diet during this time.
2. “Reintroduce one at a time, eating each food twice a day (alcohol and caffeine can be reintroduced once a day as you would usually have them) and waiting to add the next food until you have had three symptom-free days.
3. “If the patient has new symptoms, stop and wait for them to clear. Reintroduce the food again and follow step No. 2. If symptoms reappear, eliminate the food for another three to six weeks.”
Dr. Shunney said she also suggests supplements to help decrease inflammation, modulate the immune system, heal the gut, and manage persistent symptoms. “This varies from person to person, but I consistently recommend an omega-3 fish oil supplement. Nordic Naturals ProOmega is a high-quality choice.Turmeric, L-glutamine, and a good probiotic are some of my other most common recommendations. For the latter, I like Nordic Naturals new Nordic Probiotic for a highly stable formula of both probiotics and prebiotics.”
After eliminating the suspected substances, Dr. Heim said to pay attention not only to Foods, but to additives that may be culpable. “Always reintroduce foods one at a time, and rotate the re-introduced foods. Dietary counseling can accelerate progress. The importance of hypoallergenic supplements is undeniable. Allergen-free probiotics, L-glutamine and digestive enzymes are extremely useful in addressing digestion and gut integrity. Nutrient repletion is straightforward with multivitamins with easily absorbed, bioavailable ingredients that are free of gluten, lactose and the common allergens.”
Lactase can be used to support lactose digestion, while specific proteases such as dipeptidyl peptidase (DPP-IV) may be used to support those with gluten (and casein) intolerance, according to Pereira.
Orlick Levy said she also encourages her clients to keep a detailed log of foods eaten and accompanying symptoms for two weeks. “The log consists of times, foods consumed, amount of food, and symptoms experienced. That information is useful to determine if there may, indeed, be a food sensitivity or intolerance. I would then work with the client on a plan to systematically eliminate potential allergic foods and, when appropriate, challenge them one at a time. This provides useful information on whether or not a certain food should be mostly avoided,” she said.
“Generally speaking, small amounts of foods can be eaten when there’s an intolerance or sensitivity,” Orlick Levy added. “I tell my clients they will begin to know how much of a particular food can be eaten without symptoms. If they overeat, symptoms will occur.”
Modern Offenders
To minimize reactions to the food we eat, Dr. Blyweiss said, “start by identifying and avoiding the offenders, then eating food untouched and unchanged by laboratory scientists, both non-GMO and organic/hydroponically grown. Rotate your foods so that you aren’t eating the same five or so main ingredients every day to avoid acquired sensitivity. Keep your gut healthy with fermented foods and added probiotics and avoid unnecessary antibiotics, which can severely damage or diminish the microbiome in your gut and throughout the body.”
According to Orlick Levy, the most notable thing learned in recent years about this topic is that with the American diet including more processed foods than ever before. “Our immune systems are exposed to more preservatives and artificial chemicals in those foods,” she said. “That is specifically what has been implicated in causing reactivity in certain susceptible people. This continued exposure to these things has wreaked havoc on our immune systems. According to Alessio Fasano, director of the University of Maryland Center for Celiac Research, food engineering has increased the average percentage of gluten in wheat from four percent to about 14 percent.”
This helps lead to Dr. Blyweiss conclusion. “When Lucretius the Roman poet and philosopher said ‘what food is to one man is bitter poison to others’ more than two thousand years ago, he couldn’t have imagined how valid his contemplations would be in our modern world.”
References:
www.ncbi.nlm.nih.gov/pubmed/18489614 Ghani A, Mehal W, Ali et al May 2014
Healthy Take Aways
A food allergy is an over reaction of the immune system, which recognizes a specific food protein as a harmful target. This causes a release of histamines, which trigger inflammatory reactions in the tissues of the body.
A food intolerance or sensitivity does not involve the immune system.Often, the person has an enzyme deficiency, which results in improper digestion. Food intolerance may also result from certain chemicals in foods, such as food additives or salicylates or even the natural occurrence of histamine in certain foods.
According to a study in 2013 by the Centers for Disease Control and Prevention, food allergies among children increased approximately 50 percent between 1997-2011.
The “gold standard” of testing traditionally has been the elimination and challenge diet. The Alcat food sensitivity test is now considered by many, the preferred laboratory method for identification of non-IgE mediated reactions to foods, chemicals and other categories of substances.
Enzymes, omega-3 fish oil, turmeric, L-glutamine, probiotics and prebiotics are commonly recommended nutrients.
FOR MORE INFORMATION:
Carrington Farms, (800) 505-9546, www.carringtonfarms.com
Cell Science Systems, (800) US-ALCAT (872-5228), www.alcat.com
Enzymedica, (888) 918-1118, www.enzymedica.com
Dr. Adam Killpatrick, (603) 435-6600
Nordic Naturals, (800) 662-2544 x1, www.nordicnaturals.com
Pure Encapsulations, (800) 753-2277, www.pureencapsulations.com
