Food allergies: Elimination & Re-challenge Experiment

We've been talking about food sensitivities. The science, the testing options, and here, the "Gold Standard" prove-it-to-yourself Elimination & Re-challenge experiment.  No science or testing can ever trump the wisdom of learning to listen to your body and responding by giving it what it needs for optimum health.  Plan on 6-8 weeks total for this experiment.

First is a 4 week “Elimination Phase” during which you remove certain foods, and food categories, from your diet.  We recommend starting with a food sensitivity blood test, but you can also start with your own list of questionable foods or the most common allergens. The most common foods that cause symptoms for N. Americans are wheat, dairy, soy, egg, corn, and citrus.

Eliminate the foods from your diet for a month, if your symptoms improve during the four week period, you’ll carefully add foods back into your diet one at a time to see which foods may be triggering symptoms. Most often, individuals on the elimination diet report increased energy, mental alertness, decrease in muscle or joint pain, and a general sense of improved well-being. Many people lose weight. However, some people report some initial reactions to the diet, especially in the first week. This can include caffeine withdrawal headaches and other “Herxheimer-type” reactions. These are hangover-like symptoms as the body metabolizes accumulated antigen. Symptoms you may experience in the first week can include changes in sleep patterns, lightheadedness, headaches, joint or muscle stiffness and changes in gastrointestinal function.  If you are working with a doctor on your health, s/he will want to see you at the end of the month to evaluate the changes in your health.

Next, is the “Challenge Phase” during which foods are systematically added back into the diet and careful notes are made about the appearance of any symptoms. It’s best to keep a journal to track your symptoms.  You will introduce a new food every 48 hours, assuming you feel well. Here’s the general process: select the food you want to challenge. Eat the test food at least twice a day and in a fairly large amount.  Often an offending food will provoke symptoms quickly—within in 10 minutes to 12 hours. Signs to look for include:  headache, itching, bloating, nausea, dizziness, fatigue, diarrhea, indigestion, anal itching, sleepy 30 minutes after a meal, flushing, rapid heartbeat.  Sometime you won’t notice symptoms until the next morning: puffy eyes, can’t get out of bed, brain-fog, more typing errors. If you are unsure, take the food back out of your diet for at least one week and try it again.  Be sure to test foods in a pure form:  for example test milk or cheese or wheat, but not macaroni and cheese that contains milk, cheese and wheat! 

·       If you find that you have symptoms after eating some foods, it is not a death sentence! Your experience during the Elimination & Challenge diet is information and with it, you are empowered to choose what you want to eat and how you want to feel.  Sometimes, sharing a piece of birthday cake with someone special is completely worth gas, bloating and baggy eyes!  For people whose food sensitivities are related to intestinal permeability or inflammation, they may be able to incorporate small amounts of reactive foods in 4-6 months, after they have healed their digestive system.  People who have auto-immune cross-reactions to foods should minimize exposure their whole lives.

·       Ideally, you eliminate all sources of potentially reactive foods which means you need to read all labels carefully to find hidden allergens. However, life happens – people forget to tell you what ingredients they used, waiters are wrong, etc.  Don’t sweat it – do the best you can.  If you are exposed to a lot of allergens, you may want to extend the Elimination Phase a little longer.

·       Eat a wide variety of foods and do not try to restrict your calorie intake. Use the opportunity to try new ingredients and venture into new ethnic restaurants; this is a journey of self-exploration and discovery!

Food Allergies, food intolerances, food sensitivities - science and common sense

Most people intuitively appreciate that there is a connection between what we eat and how we feel.  I have witnessed this in probably thousands of patients and in myself. Personally, I know if I eat a lot of gluten, I'll get puffy eyes, dark circles, and feel fatigued.  I also know that if I eat tomato & pepper-filled Italian sauce for dinner my joints will be stiff due to accumulation of solanines. Nightshade family vegetables have a lot of this phytochemical and irritates joints, but it isn't a true "allergy". The fact that some people have sensitivities to some foods just makes sense.  Yet, when we talk about food sensitivities, medically-speaking, the topic becomes a hotbed of critiques on the science. So what's the deal - science or old wive's tale? And it is just your imagination, is it becoming more and more common?

 "Food allergies"  is a label that covers many different physiologic phenomena, ranging from the classical IgE-mediated immune reaction (anaphylaxis) to deficiency of lactase enzyme termed lactose intolerance.  There are people who have frank celiac disease; characterized by autoimmune attack and destruction of the cilia of the intestines. And there are people who have a different type problem with gluten characterized by an enzyme deficiency (DPP-4, specifically) that prevents them from breaking down proteins in gluten. While immunologically, these conditions have different causes and may have different symptoms, both people will be healthier if they follow a gluten-free diet.  So will people who have other types of immune reactions which could include IgG antibodies to gluten-related molecules, like wheat bran. Additionally, immune reactions can occur to patient's own tissues, such as their cerebellum, because of auto-immune cross-reactivity with gliadin antigen (Datis Kharrazian, DC has expertly summarized this body of research).  All of these phenomena can be labeled "food allergies" and can be tested for, albeit with varying degrees of predictive power. I'll review the testing options specifically for Celiac and gluten in a future blog.

So, where should one start if they want more information about foods they may be potentially sensitive to? Three major options exist:  get tested for immune-mediated food sensitivities with a blood test, get tested for non-specific food intolerances with a electrodermal bioimpedance system, or conduct your own experiment with an Elimination and Re-Challenge process. Here are some of the pros and cons of each.

Blood tests for food sensitivities typically cover a panel of 50-150 different foods and test for immunologic reactions, specifically whether your white blood cells produce IgE, IgG, or IgA in response to exposure to the food antigen. You can read about the scientific differences between these types of antibodies here, but the short of it is this:

*IgE antibodies trigger immediate anaphylactic-type reactions through triggering the release of histamine from mast cells.  Anti-histamines, like Benadryl or an Epi-Pen stop these reactions. Bioflavonoids like quercetin, hesperidin, and vitamin C reduce the mast cell reactivity.  More on treating food sensitivities later.
*IgA antibodies are primarily located in mucosal tissue, like the digestive system and genitourinary tract.  Having a strong localized IgA response to prevent bacteria or viruses from colonizing our systems, but having a localized response to a food particle doesn't necessarily make sense.
*IgG antibodies are the most common ones in the body and take care of most of our immune responses, to viruses, bacteria, mutant cells, food particles, and sometimes to our own tissues (like in auto-immune disease). These are also called delayed-immune responses because it takes the body 24-72 hours to make sufficient IgG to respond to the invader.

Depending on your symptoms, you and your doctor may want to test for different types of Ig responses.  If your symptoms are non-specific, a comprehensive IgG food panel is a good place to start.

However, I always advise my patients that test results are just information. Using the results from the testing, it is best to proceed to a month-long elimination of the reactive foods.  See how you feel. Without constantly introducing foods that cause the immune system to produce antibodies, the immune system can quiet down and symptoms typically improve. After a month, you may want to conduct the Re-Challenge phase of the experiment.  More on that later.

Importance of Iron for Energy

A common reason for fatigue is iron deficiency.  Iron deficiency is labeled anemia and can be diagnosed based on low hematocrit, hemoglobin, and MCV on a Complete Blood Count (CBC). More common and less frequently tested by conventional medicine, iron insufficiency can be detected much sooner and therefore treated to correct fatigue before it progresses to frank anemia by running more precise blood tests.  To determine if iron insufficiency is a causative factor in fatigue, blood tests should include a ferritin, serum iron, and total iron binding capacity as well as a CBC.  
 

Iron is an essential mineral needed to transport oxygen to tissues.  It is also necessary for DNA repair and mitochondrial energy production.  Insufficient iron can cause anemia and symptoms of fatigue, pallor, hair loss, poor exercise tolerance, restless legs, and poor cognitive development in children.  Too much iron can accumulate in tissues and cause oxidative stress (called hemochromatosis).

Most iron comes from heme sources or animal protein. Because of this vegetarians are at risk for deficiency as are people who limit red meat intake for health reasons.  Others at risk include women with heavy menstrual bleeding, athletes engaged in intense endurance exercise, and people with impaired digestion and absorption. We encourage consuming iron-rich foods along with Vitamin C to increase absorption.  

How much do I need? The recommended daily allowance is 8mg for men, 19mg for women, and 27mg during pregnancy.  Individualized intake should be based on lab results including your CBC and ferritin. Often, we recommend around 40mg per day to correct deficiencies. Cooking in cast-iron skillets can also increase your intake – add 5mg per saucy, vitamin C-rich dish that you cook in cast iron.

Dirty Chocolate Cupcakes

Here's another of my favorite "dessert for breakfast" recipes! These chocolate muffins/cupcakes are filled with fiber-ful beets. Along with a bonus serving of veggies, you'll get compliments on the rich, moist flavor of these little guys!

Wet ingredients
2c boiled/roasted beets, rubbed of their skins and very soft (about 2 beets)
2 eggs
1/2c raw sugar
1t vanilla
1/4c coconut oil or butter
Mix very well with a hand mixer or in the food processor until light and fluffy

Add Dry stuff
2/3c each sorghum flour, rice flour, and tapioca flour (or 2c premixed GF baking mix or 1c wheat flour)
1/2 tsp xanthan gum (skip if using baking mix or wheat flour)
1/3c cocoa powder
2 t baking powder
1 t baking soda
1/2t salt
Mix together and add to beets, then add
1/2c chocolate chips
1 T to 1/2c water/almond milk to make the batter the consistency like cake mix.

Spoon into lined a cupcake pan (I like the little tiny bite-sized muffin pans). Fill cups generously (makes 12 normal sized cupcakes or 24 tiny ones)
Bake at 350 20-25 minutes until a toothpick comes out clean.  Don't overbake.

To make them cupcakes, top with a cocoa cream cheese frosting.  Note:  the red from the beets will bleed into the frosting if you make a normal white cream cheese frosting.  Just so you know - you might not care!

Autumn = apple pie (or gluten-free apple hemp breakfast tart!)

Dessert for breakfast - my favorite! My sweet tooth is always strongest first thing in the morning.  It could be the low blood sugar after a long night's fast, a lag in my circadian rhythm while tryptophan metabolism switches to preferentially producing serotonin (or feel-good chemical) instead of melatonin (our sleep-deep chemical), or maybe I just like dessert and when I eat it in the morning, I know I can balance out the sugar and calories with more activity throughout the day.

This is surprisingly easy to make if you put your Cuisinart to use!

Nutritional kudos:  vegan, rich in good fats and protein (from the nuts & coconut oil), provides a serving of high-fiber, low glycemic-index fruit, omega-3s from the hemp seeds.



Make a crust
In the bowl of the food processor, put about 1 cup of almonds, cashews, macadamias or a mix.  Chop for 30 seconds.  Add 2 spoonfuls of coconut oil, 1 spoonful sweetener (maple syrup, honey, non-GMO, fair trade raw sugar are our favorite choices), and a smaller spoonful of vanilla extract.  Pulse the mixer to make it dough-like. Add more nuts or more liquids as needed.  Pat it into a greased pan with a removable bottom.

Make the filling
Without bothering to clean out the food processor, switch the blade to the thin slicer.  Core the apples and push them through the slicer into the bowl with the crust residue.  Add another spoonful of oil & sweetener, maybe a smaller spoonful of cinnamon.  Pack the apple slices firmly into the crust, filling the tart pan to the very top.  Sprinkle generously with hemp seeds (or save a bit fo the nut crust and sprinkle that on top).

Bake at 375 or more if you are in a hurry (cover with foil so you don't burn the top if you are using higher temperatures).  Cook until it smells delicious and the apples are to the texture you like (I like them really soft - about 45 minutes).

Serve by itself or in a bowl with vanilla hemp milk or with Coconut Bliss "ice cream."  Easily keeps in the refrigerator for a few days, providing breakfast for dessert all week!

Low cost, quick, and healthy - what more could you want for your (or your kids) lunchbox?

Here comes fall! Time to head back to school and back to routine.  It's a great time to re-commit to some systems to help you and your family stay on track for eating well.  A favorite way for us to do this is to make a big batch of something that is easily frozen in serving-size quantities, or that can be re-arranged into different meals over the week. The Environmental Working Group published their Back-to-School guide for low cost healthy ideas.  It's a great resource.  I love their modular recipes. Check it out!

Bread & Butter Pickles - and the health benefits of acetic acid

 I love pickles, especially the hard-to-find bread and butter ones. I once received a jar of handmade bread & butter pickles in a CSA box, over a decade ago and I've been thinking of them ever since!

Pickles are a good snack option, although their high salt content can be problematic for some people with high blood pressure or edema. And, some of the brands are filled with high fructose corn syrup. For most people, however, they are an excellent functional food. A tasty and healthy way to get a few more vegetables into you diet, plus, the health benefits of vinegar.

Vinegar is acetic acid, and acetic acid slows gastric emptying. That is, it helps your feel full faster and longer - which helps you eat less.  One great way to include vinegar is to eat salad at the beginning of your meal with a simple dressing of olive oil, vinegar, salt, and pepper. Any vinegar will be beneficial, it doesn't just have to be apple cider vinegar. Balsamic vinegar, white wine vinegar, rice vinegar all do it.  Pickles, of course, are another great way to get acetic acid.

The other week, we got a box of "field cucs" and a fistful of whole dill from the farm stand and decided to make some homemade pickles.  They are delicious - in fact, I'm eating one right now! I'm posting the recipe below for making approximately a single quart jar of pickles. Classic dill pickles are excellent too.

Assembling the ingredients

Sterilized hot jars, ready for filling

Once the jars are filled, the boiling brine mixture is poured over the cucumbers.  Then hot sterile lids are put on...

And you've got pickles!

Recipe

Bread & Butter Pickles (here's the original from Saveur)

4 persian or kirby or other small cucumbers, thickly sliced

1 shallot, chopped

1/4 red pepper, julienned

1 clove garlic

2-3 whole cloves

1 grape leaf (optional but it makes the pickles more crunchy)

1 T salt

1 cup hot water

2/3c. cider vinegar

3/4c. sugar

1 tsp mustard seed 

1/4 tsp celery seed

1/2 tsp turmeric

Make brine: In a pan, bring the salt, vinegar, water and spices to a full boil.

Pack the first 5(6) ingredients into a sterile, hot quart jar (dip the jar in boiling water) leaving 1/2 at the top.

Pour the brine over the cucumbers, covering everything but leaving an air space.

Cover with a new canning lid and gently tighten a ring to secure it.

Leave the jar sitting on the counter to cool - you'll hear a ping/pop when it cools enough to seal the jar.  If it doesn't seal, keep it in the refrigerator. 

Let it pickle for 2-3 days before eating.