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Are hidden food sensitivities making you miserable?

July 12, 2010 5:59 pm \

Adverse food reactions—allergies or intolerances—often play a role in arthritis, fibromyalgia, chronic fatigue, migraines, IBS, colitis, Crohn’s disease, autism, multiple sclerosis, acne, eczema, rashes, seizures, interstitial cystitis, hyperactivity, learning difficulties, ADD, sleep difficulties, depression, anxiety and many other disorders.

Although food may be a significant factor in your health challenges, you may never realize it and your doctor may not tell you either.  You may continue to suffer year after year without knowing that dietary changes could reduce or completely eliminate your symptoms.

Many different forms of food sensitivity

Although there are many different forms of food sensitivity, traditional allergists focus only upon classic IgE-meditated food allergy.  These are the immediate onset allergies that trigger anaphylaxis, allergic asthma, urticaria, angioedema, allergic rhinitis, some types of drug reactions, and atopic dermatitis—although some of these conditions can be caused by non-IgE mechanisms as well.  IgE meditated allergies affect just a small segment of the food reactive population—only the tip of the iceberg.  A visit to a regular allergist’s office may leave you without any solutions whatsoever to your food induced symptoms.

There are many different types of food sensitivity.  According to Janice Vickerstaff-Joneja, author of Dealing with Food Allergies, food sensitivity can be broadly divided into two major categories:

  1. Food allergies are immune-mediated reactions to a food.  Within this category, the word “allergy” is generally reserved for the classic IgE meditated allergies described above.  Other forms of adverse immune-related reactions like IgG and cytotoxic responses are referred to as “immune-meditated” responses.
  2. Food intolerances are non-immunological adverse reactions to a food or food additive.  These include intolerance to lactose, tyramine, histamine, sulfites, MSG (free glutamate), artificial colors and preservatives, oxalates, benzoates, and other naturally occurring substances in foods.

These are two distinct and non-interchangeable terms with precise definitions, whereas the term “food sensitivity” may be applied to either.

Alternative approaches to identifying food sensitivities

If you suspect that you are your children might have an IgE mediated allergy, it is important to be properly evaluated by an allergist since these can be life-threatening.  However, as you now know, most food sensitivities are not IgE mediated.  While IgE mediated allergies are well understood, many other types of food sensitivity are not. This may be why allopathic doctors exclude the use of other forms of food sensitivity testing from their practice.

Fortunately, alternative testing methods are routinely used by physicians who practice naturopathy and integrative medicine as well as physicians and allergists who specialize in environmental medicine.  Many licensed nutritionists are also at the cutting edge of this science. Given the vast array of causes for food sensitivities, no one test or method is adequate for detecting them all.  Ferreting out food sensitivies among all the possible causes is not necessarily easy and requires determination, expertise, and skilled detective work.

Following is information on blood tests used to assess IgE, IgG, and IgA immune-mediated reactions only.  They don’t assess for food intolerances as defined in the first part of this article nor do they assess cytotoxic reactions.

There is debate about the efficacy of blood testing for food sensitivity since it does not show 100% reliability.  However, standard skin prick tests are also not 100% reliable, as is the case with most medical tests, and they only indicate IgE reactions.  Although blood tests for food sensitivity may have some false negatives or positives, they can provide invaluable guidance when the results are seen within this framework.  They have the added advantage of providing quick results.  On the downside, alternative testing methods are not always covered by insurance.

Many allergists recommend a supervised elimination diet as the gold-standard for diagnosing food sensitivity. These require strong discipline over an extended period of time, which is not necessarily practical for everyone. Allergists view bood tests as indicators, and generally recommend confirming the results with follow-up elimination and challenge trials.

Despite the differences of opinion and approach, many alternative physicians successfully use serum Antibody Assessment (ELISA) for testing IgE, IgG, and/or IgA reactions to food and inhalants.   Several friends have reported positive outcomes using these alternative antibody assessments and this approach has proven effective for me as well.

What are IgG immune-mediated food responses?

IgE mediated allergies have been explained above.  So what are IgG immune-mediated food responses?  U.S. BioTek Laboratories explains IgG mediated food sensitivity in this way:

“IgG antibodies represent the most prevalent class found in the blood. It is produced after reimmunization, or secondary response to antigen. It is the primary mediator of the memory immune response. Often involved in Type III delayed hypersensitivity reactions, IgG forms an immune complex with the allergen. This antibody/antigen complex activates complement (a group of small proteins found circulating in the blood stream that are involved in the release of inflammatory mediators), and enhances phagocytosis by opsonization. The inflammatory process is gradual and may take anywhere from several hours to several days, which is why this type of reaction is termed, delayed. Although immune cells called macrophages dispose of these immune complexes immediately, they only have a finite capacity to do so. Excess antigen may saturate the macrophages capacity resulting in the prolonged circulation of complexes and their deposition into the body tissues. Depending on which tissues are involved, it is thought that these complexes may be implicated in many different conditions/symptoms.”

Information about IgA immune-mediated reactions is available at the BioTek web site.

Taking the ELISA test

Labs typically offer a choice of panels that might include a general food panel, a vegetarian food panel, an Asian food panel (select labs), and an inhalant panel. Food panels usually test for 90 plus foods. In consultation with your physician, you are able to select IgE, IgG testing or both and some labs also offer IgA testing.  A blood sample is taken according to specific instructions and sent to the lab for evaluation.  Your doctor receives your test results about two weeks later.

Following is an image of one part of a sample test report for all three assessment panels (Ige, IgG, and IgA) combined together.  The length of the bar indicates the degree of reaction to each food.

 

Your doctor will evaluate your results and make appropriate recommendations, which may include eliminating highly reactive foods and rotating others or eliminating all reactive foods for a period and then moving over to rotation.  I highly recommend working with a qualified physician or nutritionist who is well versed in interpreting these particular tests.  There are subtleties that can be missed by someone who is not familiar with food sensitivity or these tests.  Even low scores can be indicative if you are familiar with patterns that may occur on the tests.

IgE and IgG Antibody Assessment (ELISA) testing is available from U. S. BioTek Lab, Genova Diagnostics (USA and International), Great Plains Laboratory and other innovative testing laboratories.   The tests can be ordered through any doctor, but most standard physicians and allergists will scoff at the idea.  My former allergist warmed me not to order any of those “alternative tests from California.”  I’m so glad I didn’t listen to him or I might still be lost in an unending maze of unwellness.  I can assure you that not one of these labs is located in California!

Other forms of food sensitivity testing include:

  • A supervised elimination diet conducted by a nutritionist
  • Conducting your own elimination diet using one of the published books on the topic like The Allergy Exclusion Diet by Jill Carter and Alison Edwards.
  • Cytotoxic and mediator release testing (The Alcat; Mediator Release Testing (Signet Lab); FACTest, Food Antigen Cellular Test (Genova International).  Some forms of testing may also represent IgG reactions.

Dr. Lewey, a board certified gastroenterologist, highly recommends the Meditator Release Testing when IgE allergies are not the case.  This test is available in both the U.S. and Europe, but not in some locations like Hawai’i.

I suspect the effectiveness of a particular type of test will vary depending upon the precise mechanism behind an individual’s sensitivity.  In addition, results may be less reliable if you have a limited diet, but may still show some basic trends.  It can be difficult to decide which type of test to take.  Therefore, it’s important to research the options thoroughly and see which tests seem to best fit your profile. Friends have reported good results with the ELISA IgG Antibody testing, the Mediator Release Testing, and the Alcat.

Some forms of food sensitivity testing are very expensive so shop around.  The BioTek tests are the most reasonably priced that I’ve found, but your choices will also depend upon which tests your doctor prefers.  And remember, these tests will only reveal immune-mediated responses.  Your food sensitivities could be determined by entirely different mechanisms and this type of testing may have less relevance for you.  Food intolerances (lactose, benzoates, histamine, tyramine, oxalates, and so on) are an entirely different ball game.

Do you have one or more food sensitivities?  How did you discover them?

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The low oxalate diet

April 30, 2010 9:16 pm \

Many people have reported relief from pain, inflammation, and a range of disorders on a low oxalate diet. If you haven’t done so already, please read Part 1 of this series -  High oxalate foods can trigger pain and inflammation -  to learn about oxalate and its link to a variety of conditions from fibromylagia to IBS to thyroid dysfunction in susceptible individuals.  This is Part 2, where we explore the low oxalate diet and reliable resources for obtaining information about the oxalate levels in food.   I will also provide a  synopsis of my own experience having been on the diet for a year.

Oxalate levels in food

Oxalate occurs in low to high amounts in a wide range of plant foods including fruits, vegetables, legumes, grains, spices, herbs, and almost all nuts and seeds.  Meat, dairy, and eggs contain negligible amounts of oxalate. Many people are able to process oxalate in their body without any problem whatsoever, but others absorb too many oxalate which can then link to calcium and form into sharp crystals that lodge in almost any tissue in the body causing or contributing to pain, inflammation, and other conditions.  The amount of oxalate in a particular food can vary depending upon the soil in which it is grown, the climate, how it’s cooked and other factors.  Despite this caveat, a good amount of useful information has been garnered in recent years on oxalate levels in foods using more reliable testing methods.  This data serves as a guide for trying a low oxalate diet.

Here are a few examples of high oxalate foods:

  • Almonds
  • Tahini
  • Sesame seeds
  • Beets
  • Beet greens
  • Spinach
  • Sweet potato
  • Swiss chard
  • Soy milk
  • Miso
  • Starfruit
  • Rhubarb
  • Figs
  • Potato
  • Tomato
  • Quinoa
  • Most grains
  • Most legumes

Reliable resources for oxalate content

Inaccurate information on the oxalate content of food abounds on the internet.  It is often based on outdated analysis techniques and typically has not been revised as new information has emerged.  This can include information provided on medical sites for dealing with calcium oxalate kidney stones or even information from a medical provider if they have not updated their materials.  Finer methods of content analysis have evolved in recent years and these provide much more accurate data.  In addition, several patient groups who are using the low oxalate diet compile and share their knowledge and experience in online forums.  If a low oxalate diet did not work for you in the past, it may be due to not having accurate information or not implementing the diet correctly due to lack of proper instructions.

These are the most reliable resources I have found:

  • The Low-Oxalate Cookbook, Book Two, The VP Foundation – This “cookbook, ” published by the Vulvar Pain Foundation, is a vital resource for anyone trying the low oxalate diet.  In addition to  comprehensive food lists with tested oxalate levels plus recipes, the book provides an overview of connective tissue research and treatment, guidance for implementing the diet, and answers to frequently asked questions.  Be sure to obtain the updated version—book two—which contains corrections to data contained in the first book.  This book incorporates the experience of many individuals with a wide range of disorders who have used the diet successfully.
  • Trying Low Oxalates Yahoo Group – This is a discussion group for those trying a low oxalate diet.  Susan Owens, M. A., researcher and list owner, regularly updates the forum with information on breaking research about oxalate and its effect in the body.  There is a wealth of useful information in the files section of the group and much to be learned from the experience of other members.  Susan also provides an overview of oxalate information and the diet at www.lowoxalate.info too.  The information there is excellent, however the food tables are not always as current as the information available in the forum.  The forum is an incredibly helpful resource for learning how to implement the diet correctly and thus avoiding potential pitfalls.

Both groups use data from testing done at the labs of Dr. Liebman, Ph.D., a professor of Human Nutrition at the University of Wyoming.  He is a specialist in oxalate research.

Implementing the low oxalate diet

The menu options on a low oxalate diet are numerous and varied.  The diet provides a good nutritional base as long as your eat an array of the available foods.

Implementing the diet requires study, counting numbers, and ongoing dedication.  A low oxalate diet generally means keeping your intake of oxalate from food and beverages between 40 and 60 mg. per day, depending upon your weight.  Some people find they need a very low oxalate intake, while others can tolerate more.  Each person needs to experiment and find their own level.  To use the diet correctly, you will have to count your daily intake and be cognizant of portion sizes.

It is also helpful to bear in mind that oxalate levels can vary dramatically due to growing conditions as well as cooking methods.  The lists provided are guides, not the ultimate truth.  While some foods routinely test low for oxalate and people rarely report problems with them, others do not.  Zucchini and green beans are examples of foods that test at different levels.  There may also be reasons other than oxalate content for why you react to a particular food.  Each person needs to experiment in order to find the foods they best tolerate, but having accurate low oxalate lists and support from others on the diet gives an excellent starting ground.

Meat, dairy, and eggs contain negligible amounts of oxalate.  However, eating large amounts of meat is not advisable as this can also contribute biochemically to increasing oxalate levels in the body.

Cooking and preparation methods influence oxalate content of foods.  For example, some vegetables have a lower oxalate content when boiled, although it appears there are different explanations for this.  One explanation is that the oxalate leaches into the water.  Therefore, you never want to drink or use the water in which your vegetables are cooked.  While boiling vegetables goes contrary to modern nutritional advice in terms of retaining the most nutrients, there are plenty of good nutritional choices on the diet.  Obviously, avid juicing is not part of the diet, although small amounts of specific juices can be used.

It’s also recommended not to make a dramatic shift to a low oxalate diet.  Most people begin by cutting out high oxalate foods and then over a period of time gradually reducing their intake of medium oxalate foods.  This gives your body time to adjust to the change. Some people find they can tolerate up to 2 servings of medium oxalate foods per day, as long as the remainder of their foods are low oxalate.  Others find they can only tolerate foods in the low and very low oxalate category and some can only handle very low oxalate foods.

There can be a short term increase in symptoms when the diet is started and symptoms can flare periodically while on the diet.  One theory is that during the low oxalate diet a chemical shift occurs at a cellular level from time-to-time causing larger amounts of oxalate to be released from tissue and therefore symptoms as well.  The term “dumping” has been coined to describe this feature.  Ascertaining whether symptoms are due to eating too much oxalate or simply a biochemical shift is not necessarily easy.  This is where support from others on the diet is really useful.

Both approaches to the diet provide a recommended list of supplements either for connective tissue stabilization or to help optimize the processing of oxalate in the body and reduce symptoms.

At times, people report very quick results on the diet, but others find it can take 6 months to see results.  According to Susan Owens, it can take 1-4 years on the diet for the stores of excess oxalate to leave tissues.

There’s much more to learn about the diet than can be provided in a brief article.  The best approach is to obtain the Low-Oxalate Cookbook from the Vulvar Pain Foundation and to utilize the information available from the Trying Low Oxalates Yahoo forum hosted by Susan Owens, which includes participation from people with a variety of conditions with autism being one of the main ones.

Remember, this is cutting edge research so it’s almost like participating in an experiment in process, rather than being an exact science.

My experience on the diet

I started the diet after my medical doctor found that I had numerous calcium oxalate crystals in my urine. He told me that I was absorbing too much oxalate via the gut and that this could be causing or contributing to my muscle pain, digestive distress, and other symptoms.

I’ve been on the low oxalate diet for a year.  After being on the diet for four months, I saw shifts in my blood work including positive changes in unconjugated Bilirubin (a marker for Gilbert’s Syndrome) , TSH, C-Reactive Protein, and Serum Tryptase.  I was also restricting, though not entirely, my exposure to toxic chemicals, so I can’t say for certain whether these changes were due to the diet or to limiting exposures or to both. Since chemical sensitivity contributes to my gut problems, the low-oxalate diet could not fully do it’s work until I was able to completely remove myself from chemical exposures.  This only took place about four months ago.

There have been significant symptom improvements since being on the diet in addition to the blood tests indicated above.   However, I still have a long way to go to heal my gut completely.   For most of us, multiple factors often contribute to our conditions and one remedy is usually not sufficient to effect full recovery.  Nevertheless, the low-oxalate diet has been and continues to be an essential piece of my health puzzle and recovery process.

If you suffer from any of the conditions listed in Part 1 of this series, you might consider exploring the low-oxalate diet.  Naturally, it’s important to consult with your health care provider before embarking upon any diet.  Since excess oxalate reduces glutathione, which is essential for processing many toxic chemicals that enter or are produced by the body, the low-oxalate diet may also be of benefit to those with chemical sensitivity or Gilbert’s Syndrome, especially if they have digestive problems as well.  In the case of Gilbert’s Syndrome, gluthatione is one of two pathways the degrade bilirubin.

There’s a learning curve when it comes to the low oxalate approach, but the efforts required are well worth it for those who achieve reductions in pain, inflammation, and other troublesome symptoms.

To read Part 1:   High oxalate foods can trigger pain and inflammation

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High Oxalate Foods Can Trigger Pain and Inflammation

April 27, 2010 2:16 pm \

Foods high in oxalate may cause or increase inflammation, pain, and burning, irritate tissues and mucous membranes, and contribute to the formation of calcium oxalate kidney stones.

Oxalate is found in varying degrees primarily in plant foods including vegetables, fruits, grains, legumes, spices, herbs, and almost all nuts and seeds.

When too much oxalate is absorbed into the bloodstream via the gut, it can team up with calcium to form sharp calcium-oxalate crystals.  These crystals can then wedge themselves into tissue almost anywhere in the body causing damage and/or exacerbating pain and inflammation.  Excess oxalate can also lead to oxidative damage and the depletion of glutathione.  The latter is essential for metabolizing many toxic environmental chemicals that enter the body.

How do high oxalate foods cause problems?

Most people are able to safely metabolize and process oxalate out of the gut through the stool. According to researcher Susan Owens, M.A., Director of the Autism Oxalate Project, a problem occurs when excess oxalate is absorbed through the gut due to intestinal permeability, poor fat digestion, inflammation, or prolonged diarrhea or constipation.  Overuse of antibiotics may also pose a problem since this can reduce or eliminate the oxalate-degrading bacteria in the intestines. In her overview of the scientific research, Owens says there may be a link between excess oxalate in the body and the following conditions:

  • Thyroid disease
  • Vulvodynia
  • Calcium-oxalate Kidney Stones
  • Cystic Fibrosis
  • Sarcoidosis
  • Asthma
  • COPD
  • Autism

Excess oxalate may be one among several factors like genetics and environmental triggers that contribute to these disorders and to other conditions reported by members of the Trying Low Oxalates Yahoo forum, started by Owens.

Oxalate and the Pain Project

Taking a slightly different twist, Clive Solomons, Ph.D., former director of research at the University of Colorado Health Sciences Center, has explored the connection between excess oxalate, pain, and weakened connective tissue in his research, which is aptly called the Pain Project.   In addition to a low-oxalate diet, he recommends that a graded program of connective tissue stabilization, using a small number of supplements, also be employed to gain relief from symptoms and provide longer-term healing of connective tissue.  People who have participated in the Pain Project have reported recovery or improvement from a variety of painful conditions including:

  • Fibromyalgia
  • Irritable bowel syndrome
  • Vulvodynia (vulvar pain)
  • Vulvar vestibulitis
  • Lichen sclerosus
  • Lichen planus
  • Dyspareunia (painful sex)
  • Nonbacterial prostatitis
  • Urethral syndrome
  • Interstitial cystitis
  • Pelvic floor dysfunction

Solomons has observed that almost every participant in the Pain Project with these diagnosis’ reveal periodic hyperoxaluria upon testing.  The term hyperoxaluria refers to excreting greater than normal amounts of oxalate via the urine at certain times of the day, but normal amounts at other times.

The Low Oxalate Cookbook, which explains Solomon’s research underscores:

“It is important to understand that the metabolic abnormality that causes pain is internal.  The amount of oxalate that appears in urine is determined not only by dietary intake of oxalate (food), but also by intestinal bacteria that are able to degrade oxalate, intestinal permeability (how easily the intestinal wall lets substances like oxalate pass through it into the body’s tissues), endogenous (internal) synthesis of oxalate within the body, and the handling of oxalate by the kidneys.

Foods and beverages high in oxalate content merely add fuel to the flame.  In addition, tissues are affected by exposure to chemicals in the environment such as chlorine and formaldehyde.

Although reducing dietary oxalate may only have a partial effect, any reduction in pain is a good thing.  Over 70% of patients in the Pain Project, who utilize connective tissue stabilization supplements in addition to the low-oxalate diet, have reported significant improvements or complete recovery.

If you have any of the above conditions, you may want to explore the potential benefits of trying a low-oxalate diet, after consultation with a medical professional.  Be forewarned that there is a great deal of incomplete and incorrect information about the low-oxalate diet on the internet.

Read Part 2 of this series on the Low-Oxalate Diet and resources for reliable information.

If you liked this article, please share the link with others.  Thanks so much!  Sandra

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