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.