Last week, we chatted about the different types of reactions we can have to food, the biochemical processes that drive the three key food reaction types and why it is important to identify them.
Today, we are going to explore how to test for food sensitivities and what to do to support yourself. Before we explore the testing options, it is important to recap on the content in last week's blog. The visual below shows the three categories of food reactions we talked about and some of the key features of each reaction type.
To make today’s blog easier to digest, focus on the immune mediated food sensitivities section on the left and the food sensitivities category in yellow.
A refresher on food sensitivities:
Food sensitivities happen when the body produces antibodies (immunoglobulins) to proteins in specific foods, much the same way as it is activated by proteins on bacteria, viruses, yeast and/or parasites to protect us against infection. This production of immunoglobulins (e.g. IgA and IgG) leads to activation of the immune system and an inflammatory response.
This complex response can cause inflammation at the gut level but can also produce an inflammatory reaction throughout the whole body.
This complex response can cause inflammation at the gut level but can also produce an inflammatory reaction throughout the whole body. The complex nature of these immune reactions, enables food based-sensitivities to trigger a number of different symptoms at varying levels of severity.
This is why removing specific foods that trigger these types of reactions can improve a whole host of inflammation mediated aches, pains and discomforts.
The most common of these complaints are skin conditions, GI discomfort and behaviour difficulties in children.
The most common of these complaints are skin conditions (e.g. eczema or psoriasis), GI discomfort (e.g. heartburn or diarrhoea), and behaviour difficulties in children (ADHD or Autism Spectrum Disorder).
Individuals with autoimmune disorders, arthritis and/or recurring migraines also benefit from knowing what foods they are sensitive too as the extra inflammation induced by eating foods that produce these types of immune responses can aggravate their symptoms.
One man's food can truly be another man’s (or woman’s) poison.
Now that your brains have been refreshed on food sensitivities and we have identified why it is important to check for these types of food based reactions, we can focus on how to test for immune mediated IgG and IgA responses and what to do about them.
ELISA TESTING – the most convenient option
The type of testing we use in the BePure Health Clinic that can provide us with some information about food allergies and sensitivities, is called ELISA testing.
ELISA stands for, enzyme-linked immunosorbent assay, and is a medical standard test that detects and measures antibodies in the blood. This type of test is used in a number of different industries and has a number of applications, but is primarily used in medical laboratories to determine if an individual has antibodies related to certain infectious conditions or diseases.
In relation to food sensitivities and allergies, ELISA testing can be used to measure the quantity and type (IgG, IgA and/or IgE) of an antibody reaction (immune reaction) an individual is producing to specific food based proteins.
There are several classes of antibodies but there are only three that are relevant for food testing; IgG and IgA for food sensitivities and IgE for food allergies.
IgG is the most commonly tested antibody for food sensitivities since it's the most abundant and long lasting antibody in the body.
Total IgG levels are used to provide an overall view of an immune sensitivity reaction and are used to identify delayed food reactions. These are reactions that occur 48-72 hours post eating a trigger food.
For example, you may have a glass of milk on Monday, and develop itchy skin on Thursday. These types of reactions are the hardest to determine without testing and are often the foods clients are unaware they have issues with.
Mild IgG reactions are often not a problem and do not provoke symptoms when eaten once every 4-7 days. Mild IgG reactions can continue to be included in the diet in a rotational manner whilst severe IgG reactions need to be eliminated as they are more inflammatory and are more likely to provoke symptoms.
IgA is the only antibody that gets secreted into the digestive fluids and so is very specific to digestive sensitivity symptoms and produce a less delayed response than IgG reactions. Mild to severe IgA reactions can provoke symptoms and are best eliminated from the diet for a trial period or extended period of time, depending on an individuals circumstances.
When removing IgA’s from the diet of trial period of 4-6 weeks, an elimination protocol is often adopted to slowly reintroduce foods back into the diet 1 by 1 via dietary challenge (more on how to do this below).
IgE or allergic reactions have a very short life and are much more difficult to test. The number of foods tested for this type of reaction is generally limited to most common allergens and must be done through a blood draw.
IgE testing is sometimes done with a slightly different test called a RAST test, which is almost identical to ELISA testing but is conducted using a slightly different laboratory testing procedure.
Whilst RAST testing is the standard test used by medical professionals to diagnose true food allergies, ELISA tests can also identify IgE reactions and is a very useful way of determining IgE food based reactions that are more severe in nature than those produced by IgG and/or IgA.
Note: It is possible to have a negative IgG reaction to some foods but positive IgA and/or IgE reaction and vice versa. This is one of the reasons why, testing two or all three can be very helpful in the mitigation of food based symptoms.
There are many lab companies that offer testing for food sensitivities and allergies that range in pricing and reliability.
The testing we use in the BePure clinic is a gold standard ELISA test and requires a blood sample either by blood draw or a dried blood spot test taken via finger prick. The test we use has different food lists available that can be chosen to meet the specific client needs, i.e., vegetarian panels, asian panels and/or specific IgE, IgG or IgA panels. We use this test due to the incredible people and business that operate this lab and the reputability of their testing methods.
Most testing methods will show that there are many reactions on a scale of none/fairly mild to severe and our practitioner team help our clients to show them which foods to avoid that could be significant triggers.
By measuring IgG and IgA antibodies specific to antigenic food proteins, it is possible to identify which foods may be responsible for hard-to-define symptoms. The ELISA test we use in clinic measures 90+ foods and provides broad look at food groups common in the western diet (asian and vegetarian samples are also available).
Like almost all of functional tests that are available on the market today, this test can only be accessed via a health practitioner (with the exception of our sister company EVE). This is due to the complexity of the results and the knowledge needed to interpret them appropriately. And also due to the underlying work needing to be done on other areas of the body to help change the way the body responds to food.
From a primordial perspective, it does not make sense for us to react to nature given the essential need for us to consume food consumption to maintain life. Thus, whilst food reactions can contribute to an individual's aches, pains and discomforts, the underlying work needing to be done is always around gut health. We will dive into this and the concept of ‘leaky gut’ next week – keep an eye out.
Like all lab tests, ELISA tests are not 100% accurate and there is always room for false positives and false negatives. This means that the test is able falsely identify some foods as being problematic when they are not (false positive) or is unable to identify a food that is problematic (false negative).
This is why we monitor client’s symptoms and reactions in conjunction with apply ELISA test results and will never encourage a client to consume a food they react to despite their test coming back negative for this food. These test results can aid in the structuring of an elimination diet (see below) for an individual and is our next point of call if ELISA testing application, does not lead to the desired outcome.
THE ELIMINATION DIET: the most inconvenient option
An elimination diet is a process of removing and reintroducing foods from the diet over an observational period to evaluate any reactions an individual may be having to the things they are eating. This is best done with a practitioner but is relatively safe enough to be done in the comfort of your own home.
This elimination and challenge protocol begins with a 4-6 week period of dietary restriction during which, the amount or caloric content of food is not controlled but the type foods permitted to be consumed are limited to a list that are commonly deemed to be hypo-allergenic for most people. Strict adherence to this list of hypo-allergenic foods is crucial to the efficacy of the process and any ‘episodes’ of non-compliance, requires the individual to restart the process of elimination from the beginning.
Do not pass go. Do not collect $200. Back to the starting line you go.
After this strict food avoidance period of 4-6 weeks has been achieved, each of the foods that have been avoided during this period are reintroduced or ‘challenged’ one by one.
Each food is reintroduced very slowly at a rate of one new food per week so that any delayed or immediate reaction can be observed and the body is given time to heal in between insults. The goal of this process is to allow the body a chance to heal during the elimination period and before slowly adding each individual food, one at a time to gauge for reactions and determine what foods to keep or discard from the diet.
HOW TO DO A FOOD ELIMINATION DIET: patience, patience, patience...
Step 1: Eliminate gluten, dairy, eggs, nuts, seeds, nightshades, grains, legumes, soy, coffee, alcohol, sugar, yeast and cocoa/cacao strictly for 4 weeks.
Step 2: Wait until you see improvement in your symptoms. You should see at least some improvement in your symptoms within one month of following the elimination protocol however, for some individuals, it may take as long as three months to notice any improvements.
Step 3: Reintroduce each removed food item via food challenge. First select a food to challenge. Be prepared to eat it two or three times in one day but not again for the next few days.
- The first time you eat the food, eat half a teaspoon or even less (one teensy little nibble). Wait fifteen minutes and see how you feel.
- If you have any symptoms, don’t eat any more. Next, eat one teaspoon of the food (a tiny bite). Wait fifteen minutes. Again see how you feel. If you have any symptoms, don’t eat any more.
- Next, eat one tablespoon of the food (a slightly bigger bite).
- That’s it for now. Wait two to three hours and monitor yourself for symptoms.
- Now eat a normal-size portion of the food—either by itself or as part of a meal. e.g. ½ cup of mashed potato (a normal serving)
- Do not eat that food again for four to seven days OR reintroduce any other foods during this time frame. Monitor yourself for symptoms.
- If you have no symptoms in the next three to seven days, you may reincorporate this food into your diet.
What order should restricted foods be reintroduced?
I have classified foods from lowest to highest likelihood to be problematic into four stages of reintroduction. Start with stage 1 and work your way up to stage 4.
Stage 1: Least likely to be problematic
Egg yolk, ghee from grass-fed dairy, seed-based spices, FODMAP foods if you have been avoiding them, Salicylate or High Histamine foods if you have been avoiding them.
Stage 2: The next least likely to be problematic
Seeds, nuts, alcohol in small quantities (e.g. 120ml wine, 1-3 per week maximum), coffee (occasional - i.e. 1-2x per week), grass-fed butter
Stage 3: Moderately likely to be problematic
Eggplant and sweet peppers, paprika, coffee (daily), cocoa/chocolate, yeast (nutritional and bakers), grass-fed raw cream (not the supermarket stuff), fermented grass-fed dairy: kefir, yoghurt.
Stage 4: Most likely to be problematic
Egg white, chilli peppers, potatoes (better if peeled).
- Within each category, just pick the food that you miss the most to introduce or test out.
- If you have had food sensitivity testing done (IgG/IgA, leave any foods you have an identified sensitivity to reintroduce last and after having done some work on your gut health (and perhaps before nightshades).
- Do not try to reintroduce any foods you have a known allergic reaction to or you already know causes a reaction in your body – your body will appreciate not having to experience the inflammation this will incur.
Symptoms to watch for with reintroduction:
- Any symptoms of your disease returning or worsening, e.g. aching joints for Rheumatoid arthritis.
- Any gastrointestinal symptoms: tummy ache, changes in bowel habits, heartburn, nausea, constipation, diarrhoea, gas, bloating, undigested/partially digested food particles in stool.
- Reduced energy, brain fog or fatigue.
- Strong food cravings (overwhelming need to eat): sugar, fat, pica (mineral cravings - expressed as craving for non-foods like dirt).
- Trouble sleeping: either falling asleep, staying asleep or just not feeling as rested in the morning.
- Headaches, migraines or dizziness.
- Aches and pains: muscle, joint, or tendon/ligament pain.
- Changes in your skin: rashes, acne, dry skin, little pink bumps or spots on your arms, dry hair or nails.
- Mood issues: feeling low, depressed or apathetic, having a lower ability to handle stressful situations, increased anxiety or irritability.
In summary
Food sensitivities can contribute to a whole host of aches, pains and discomfort. While they can be obvious but are also cryptic in nature and can be difficult to identify, which is why we use testing at the BePure Health Clinic to help identify hidden food sensitivities that may be contributing to an individual's symptoms and sense of well being.
This can be done in conjunction with or as an alternative to an elimination diet – an incredible (and cheap!) way of finding food base reactions but do take time, vigilance and dedication.
As we are designed to thrive in nature and need to consume food to survive, it doesn’t make sense for us to react to a large variety of the foods in our environment. This is why it is important to make sure we are looking after our gut health when addressing or preventing food based reactions. This process may require testing but can be significantly improved by just applying the basics.
