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I Think It Was Something I Ate!

Food Allergies Food Allergies
Longevity By Nature

Bad reactions to foods are common. And they can beset anyone at any age, masquerading as other issues. Here’s how to help identify food-borne issues.

That meal or snack may have been quite pleasant going down. But a little while later, the ugly side may rear up: the uncomfortable post-prandial effects may be distressing, irritating, annoying, embarrassing or any combination thereof.

The rate of development of a food intolerance, sensitivity or even allergy, is increasing in individuals as more foods are being introduced to the American palate. More people are epicurean-curious, spurring the creation of numerous new food trends with exotic, foreign origins.

This area of practice may, at first blush, have blurred lines. The terms “sensitivity,” “intolerance” and “allergy” are all well defined and it may take a while for you, the practitioner, to root out what the result is and of course, what’s causing it.

According to research from Georgia-based Diagnostics Solutions Laboratory (DSL), food sensitivities occur when a harmless food causes an adverse immune system response. Adverse reactions instigated by the food can strike from three to 72 hours after ingestion. Food sensitivities also tend to be highly individualized.

Your client may present any of a number of symptoms both direct (GI) and indirect (para-GI). Along with the usual gut-related/digestive complaints, musculoskeletal/joint pain, mood swings, anxiety, food cravings, autoimmune conditions, headaches and blood sugar imbalances are highly suggestive that a food is at the center.

“Food immune reactions have been implicated in a variety of health conditions,” stated Chad Larson, NMD, DC, CCN, CSCS, clinical consultant for Cyrex Laboratories, California. “Therefore, food sensitivity testing should be considered for nearly any chronic health condition, not just ones that include gastrointestinal symptoms. We know that food immune reactions can potentially influence many other organ systems outside the gut, including the brain, immune system, thyroid, muscles, joints and pancreas.”

Jaquel Patterson, ND, medical director of Fairfield Family Health in Connecticut, explained that a food allergy is immunoglobulin E (IgE) mediated versus food sensitivity and intolerance, which involve immunoglobulin G (IgG). Elevated IgG antibodies often cause systemic inflammation, creating an opportunistic environment for symptoms to emerge. “Food intolerance typically relates to the digestive system and its ability to break down the food well,” she explained. “Food sensitivities trigger IgG antibodies that may cause reactions hours or even days later; symptoms may include bloating, abdominal pain, migraines or fatigue and are less significant than a food allergy.”

She observed that the incidence of food allergies is increasing, and it is important to also consider these in conjunction with environmental allergies. There is a lot of cross reactivity between foods like apples, peaches or cherries, for example, with environmental allergies like tree pollens.

According to the American Society of Agronomy, in 2020, food allergies affected approximately 7 percent of children and 2 percent of adults in the U.S., costing a dramatic $25 billion in health care each year. And there’s the risk of serious complications, even death.

Daina Parent, ND, naturopathic liaison at Standard Process (Palmyra, WI), elaborated that food allergies are based in abnormal immune-reactive responses, while food
intolerances (which are not related to the immune system) may be caused by digestive-related conditions, such as enzyme deficiencies. “Most food intolerances are tied to a type of macronutrient, specific edible plant or food component, histamine or food additives and bioactive food chemicals,” she said.

The prevalence of adults with a food intolerance is 15-20 percent, and more than 65 percent of the human population has a reduced ability to digest lactose or experiences some form of lactose intolerance as they age, reported Ryan Sensenbrenner, director of marketing for Enzyme Science, Florida. Common food intolerances are experienced by consuming dairy, gluten, caffeine, sulfites, fructose, amines, salicylates and FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols).

According to Lindsay Goddard, RD, nutrition consultant, The Great Plains Laboratory, the foods that tend to be the most problematic are dairy (particularly casein), wheat (mainly gluten), soy, chicken eggs, tree nuts, peanuts, shellfish, citrus and yeast.

Because common foods consumed may exert symptoms that can indicate either a food allergy or intolerance, it is crucial to ensure that the client knows the differences. “Since there may be an overlap of gastrointestinal symptoms between food allergy and intolerance, individuals often confuse the two,” Sensenbrenner remarked. “In contrast to a food allergy, food intolerance does not involve the immune system nor present life-threatening reactions. While allergies are brought on by an adverse reaction to specific food proteins, symptoms of intolerance are brought on by a lack of enzymes to properly break down food.”

Another significant difference between a food allergy and intolerance lies in the onset of the reaction, Dr. Parent added. A food allergy tends to trigger a sudden onset of symptoms while symptoms from a food intolerance may not be felt until later. “Sources of food allergies should be avoided, while sources of food intolerance may have a place in the diet with the help of supplemental digestive enzymes,” she noted.

If you suspect the existence of IgG-mediated food sensitivities, this may signal that your client may be developing intestinal permeability (leaky gut), and he or she may complain of frequent poor gut health and digestion. There will also be presence of dysbiosis and inflammation in the gut, characteristic of a permeable gut barrier and sub-optimal digestion. In this case, food proteins which are not properly digested will cross the intestinal barrier through gaps and the immune system will swing into action, tagging the food protein as invasive.

Dr. Patterson, who noted that many clients seen in her practice present with food intolerances, stated that in those with leaky gut, their food sensitivities will increase, as their gut barrier is too weak to defend itself. “It is important to remove the offender and also to repair the defenses of the gut itself so that these foods, specifically intolerances or sensitivities, can be re-introduced into the diet,” she advised. “I’ve seen it make large impacts on individuals’ physical symptoms like brain fog, body pain, headaches and even energy levels, when these allergens have been identified and resolved.”

The intestinal barrier is composed of several layers (microbiota, mucous, epithelium with tight junctions and immune system) and an insult to any layer will throw off the balance and create a ripe opportunity for leaky gut.

Additionally, Fairfield Health practitioners see many clients with autoimmune conditions who have a greater propensity to deal with food intolerances. Of those who have sensitivities, Dr. Patterson reported, the most common culprits are wheat, dairy, eggs corn (especially the widely prevalent high-fructose corn syrup). “I have also seen foods like eggs and dairy commonly correlated with skin manifestations like eczema and acne,” she commented.

Supplement Recommendations

Enzyme Science’s Intolerance Complex includes a multitude of high potency protease, amylase, lipase and cellulase, including enzymes dipeptidyl peptidase IV (DPP-IV), lactase, xylanase and alpha-galactosidase for targeted gluten, dairy, phenol and complex carbohydrate digestion. There are several questions the practitioner can ask to see if this supplement is right to recommend, according to Sensenbrenner. Such questions include: Do you notice any digestive discomforts after eating any particular foods? Have you noticed any changes in your diet starting to occur? Are you finding that foods you used to be able to eat now make you feel gassy, bloated, heavy or full?

Dr. Parent added, “Naturopaths should also ask their clients to provide a food recollection over the past 24-48 hours. This diet diary/food recollection/diet recall might help to determine what foods could be causing some of the client’s common symptoms. Creating awareness for the client that there is an association between what they eat and how they feel is imperative for success.”

Standard Process has two products that contain digestive enzymes that may be useful for supporting healthy digestion and nutrient absorption. Vegan-friendly Enzycore contains digestive enzymes, glutamine and whole food ingredients such as kale and beet powder to support digestion, according to Dr. Parent. Multizyme contains digestive enzymes that support the normal breakdown of macronutrients and general support of digestion. Multizyme is a pancreatic enzyme supplement that supports the breakdown of macronutrients while Enzycore contains microbial enzymes and glutamine that is known to provide energy to the intestinal cells.

Testing Recommendations

According to Goddard, the science of food intolerances and allergies continues to evolve, especially as more advances develop in testing. She noted that ELISA is the most common test used to measure inflammatory response to foods and there are other methodologies, such as looking at white blood cell volumetric changes, though these are not as reproducible as the ELISA.

The reason measuring inflammation caused by particular foods has begun gaining more popularity is because clients get results when they begin to eliminate the problem-causing foods. “The most common symptoms that get resolved with food intolerance testing is GI complaints, neurological and mood issues, and dermatological complaints,” she said.

Goddard reported that Great Plains Laboratory recently updated its original ELISA plate methodology to a new and innovative technology called XMAP, a multiplexed bead-based immunoassay that has food antigenic proteins covalently bound to the beads. When these beads are mixed with the patient’s sample, the bead-bound antigens capture the specific IgG antibodies that are present in the sample, and are identified by the fluorescent-labeled antibody against IgG. There are also control beads to ensure the accuracy of the results. This methodology has been proven to be more sensitive than the more commonly used ELISA method, she emphasized, while also being more environmentally friendly by utilizing less plastic. It also allows even more foods to be tested, now with 190 foods being evaluated.

“Naturopaths should recommend IgG Food Testing anytime anyone is having food intolerances, difficulty with certain foods, and/or any GI issues, especially if dysbiosis is suspected,” Goddard suggested. “It can be a helpful tool in place of an elimination diet. Elimination diets are difficult to execute, and they are subjective, while the IgG testing is more objective, and is fairly easy to administer. Other rationales for using IgG food testing include symptoms associated with immune dysregulation, neuropsychiatric and/or dermatological dysfunction.”

DSL’s IgG Food Explorer is an ELISA-based multiplex food sensitivity test measuring total IgG antibodies to a vast array of foods. IgG Food Explorer is an at-home-collection tool that evaluates more than 250 food antigens.

DSL’s compatible GI-MAP (microbial assay plus) test can be used in conjunction with IgG Food Explorer when practitioners want to dig deeper into the root cause(s) of their client’s food sensitivities. Key markers on the GI-MAP can help you evaluate gut health and food reactions at the same time. When evaluating a client with food sensitivities, the following sections of the GI-MAP (and key biomarkers) that provide further insight include: pathogens, normal/commensal bacteria, Akkermansia muciniphila, opportunistic bacteria such as Pseudomonas, SigA, calprotectin and zonulin.

According to Dr. Larson, Cyrex was first to industry on all three of its main food sensitivity panels. The Array 3x was the first laboratory test to take a deep dive in evaluating wheat and gluten reactivity; it remains the most comprehensive wheat and gluten sensitivity test available, significantly decreasing the chance of a potential false-negative that was common from other labs prior to the development of Array 3x.

Cyrex’s Array 4 was the first food panel to evaluate the problem of gluten-associated cross-reactivity. Certain dietary proteins, such as dairy and yeast, can trigger gluten antibodies to react even though the individual may be on a totally gluten-free diet. An ongoing gluten-related disorder such as celiac disease or non-celiac wheat sensitivity can be alleviated by identifying and removing these potential cross-reactive foods.

“Our Array 10 was the first and still is the only food panel that evaluates foods in the form that they are usually consumed in. If a certain food is typically consumed cooked like animal proteins, grains and beans, they should be evaluated in the cooked form,” she explained.

And because food allergies, as a type 1 allergy, have potentially more serious health impacts than intolerances, researchers created a novel test method that may reduce diagnostic complexity and time. Researchers from the University of Bern (Switzerland) and Bern University Hospital developed an allergy test that they stated greatly simplifies diagnosis and also can reliably predict the success of immunotherapy. The new in vitro cell culture, with the help of several molecular biological techniques, can generate almost any desired number of mature mast cells within a few days. These mast cells contain IgE receptors on their surface and behave very similarly to mast cells in the human body when they are exposed to IgE and allergens. In the test, these mast cells are brought into contact with blood serum from allergic individuals—thereby binding the IgE antibodies from the serum to the cells—and then stimulated with the allergens to be tested. At this point, the activation of the cells can be quantified very easily and quickly using so-called flow cytometry.

“We were surprised and delighted to see that our mast cells could be activated at almost 100 percent. To our knowledge, there are no comparable cell lines that can be activated so well,” commented study leader Alexander Eggel. “Another important advantage is that the test works with serum, which is very stable and can be stored frozen for a long time, allowing for retrospective tests. In contrast, other comparable tests use whole blood, which cannot be stored and must be processed within hours.”

This test and its results were published in the Journal of Allergy and Clinical Immunology, March 2022.

Dr. Patterson related that she is excited about new research supporting the use of sublingual immunotherapy to help support allergy sensitivities. “The treatment requires a reduced frequency of in-office visits, as well as preventing having a physical shot as it is administered under the tongue,” she explained. “It does require daily administration over a period of months to years. At Fairfield Family Health, we offer both sublingual immunotherapy, low dose allergen as well as elimination diet plans. These provide for several approaches to responding to the actual allergic trigger.”

Eating food should be a joyful experience with the only after-effects a feeling of satiety and satisfaction. And of course, a feeling of good health and well-being!

Healthy Take Aways

• Food sensitivities occur when a harmless food causes an adverse immune system response.
• A food allergy is immunoglobulin E (IgE) mediated versus food sensitivity and intolerance, which involve immunoglobulin G (IgG).
• Common food intolerances are experienced by consuming dairy, gluten, caffeine, sulfites, fructose, amines, salicylates and FODMAPs.
• The most common symptoms that get resolved with food intolerance testing is GI complaints, neurological and mood issues, and dermatological complaints.

For More Information:

Cyrex Laboratories, www.cyrexlabs.com; www.joincyrex.com
Diagnostics Solutions Laboratory, www.diagnosticssolutionslab.com
Enzyme Science, www.enzyscience.com
Standard Process, www.standardprocess.com
The Great Plains Laboratory, www.gpl4u.com