Hi, friends!  Depending on how long you’ve been reading HH you may or may not know how food sensitivity testing changed Mr. Hungry’s health and my career forever.  For those of you that haven’t read about it before, let me provide a quick little background.  Since I’ve known Mr. Hungry, he has ALWAYS had a sensitive stomach, but it wasn’t until a year into our marriage that things started to get bad.  This was also about a year after I passed the RD exam, I had just left my job at WIC to start working at the gym.  We were eating extremely healthy, and since we just bought our first home we were eating out only occasionally.  Despite my efforts to provide, clean and healthy foods he seemed to be getting sicker and sicker.  Yet despite numerous tests including a colonoscopy, the doctors couldn’t give him an answer.  Eventually, they diagnosed him with IBS and told him to stay away from the foods that irritated him.  Other than the obvious, spicy foods and caffeine, which he already avoided, we had no idea what those were.  I started cooking more Paleo foods hoping that would help, but his symptoms persisted.

(Best picture I could find from around that time.)

Finally, I passed my training at the gym and was able to review lab test with clients.  We had to sign him up for a membership to get the test, but finally, we got it done.  Almost immediately, his symptoms appeared magically resolve, and I absolutely couldn’t believe it.  I was angry because I hadn’t learned about food sensitivities in school, in fact at that time they were still saying nonceliac gluten intolerance didn’t exist.  I was relieved because all of a sudden he was doing so much better.  I was overwhelmed because all of a sudden I had to learn to cook Paleo minus the eggs and yeast overnight.  (You can see his original test he did at the gym here.)  However, his improvement was the most important thing overall, life calmed down, and time went on.  He was never 100% better but I’d say he made a 75% improvement.  For that, I was 100% the biggest supporter of food sensitivity testing because it so dramatically improved my husband’s health.

What I learned when I left the gym to pursue private practice is there are multiple types of food sensitivity tests, some better than others.  I also learned that my frustration of what to do six months or more after the test can from the lack of standardized protocols provided with different tests.  In every single consult I do, one of my primary goals is for the potential client to understand all their testing options when it comes to food sensitivity testing.  That way they are fully informed when they decide to invest in a test, so that is the information I’d like to share with you now.  

Food Allergy Tests

Food allergies are very different from sensitivities in that they elicit different symptoms, typically hives, swelling, throat closing, itching, etc. and that they are caused by a different immune pathway then sensitivities.  The antibody associated with food allergy testing is an IgE antibody. When you get a food allergy test, they are looking for this antibody only.  These types of tests may include skin pricks or variations of blood draws.

Food Intolerance Tests

Examples of this type of test include a fructose intolerance test or a breath hydrogen test for lactose intolerance.  Here we are not looking at the immune system at all.  What we are trying to determine is if you have an enzymatic deficiency that is causing symptoms.  For instance, if you do not make lactase, the enzyme that breaks down the sugar lactose in dairy products then you may have unfortunate digestive symptoms.  Again, this is not an immune response, and it’s different than allergies and sensitivities which are part of the immune response.

Food Sensitivity Tests

Unlike food allergies which typically cause symptoms immediately, food sensitivities cause reactions immediately to up to 72 hours later.  Yes, so you could eat something on Sunday and feel the response on Wednesday, that’s why they can be so hard to determine on their own.  This is because food sensitivities are related to low-level chronic inflammation produced by a number of different arms of the immune system.  Remember, in acute scenarios inflammation is a good thing (see what is inflammation to help better understand this.) In fact, the body will produce a low-level immune reaction to all foods, likely as a protective mechanism, you know to make sure you aren’t eating poison.  However, sometimes the immune response becomes exaggerated in reaction to normally benign foods (like spinach), this is called hypersensitivity. One way symptoms occur can relate to antibody production, so far IgG and IgM have been identified.  Remember from biology how antibodies work?  Antibodies alert the immune system to an invader, but in this case, the invader is food which in theory shouldn’t be dangerous. Another way symptoms manifest is because certain immune cells can also produce what are called cell mediators which unfortunately directly damage tissue and cause reactions.  So as you can tell, this type of response is complex and occurs through multiple pathways.  So, let’s see your options for testing.

IgG Testing (Alletess, Alcat)

This was the first type of sensitivity testing I was exposed to and what we did at the gym.

Pros:

• Gets pretty good results – this is anecdotal, aka by my observations.
•  Pricing varies depending on how many foods tested
• Can test foods and chemical reactivity (However, typically they don’t test chemicals unless you go through a higher end test)

Cons:

• You are only testing one antibody, so you are missing food sensitivities caused by IgM pathways as well as cell mediated pathways.
• Antibody presence doesn’t always signal the cascade downstream that leads to symptoms.  So you could show up with a food that isn’t harmful on the test.  However, one could argue that the presence alone is enough to avoid certain foods.
• Most facilities that do the test do not have a standardized testing protocol, see LEAP information below.
• Research is limited despite this being the most common type of testing available.
• The test is expensive, and most insurance companies won’t pay for it.

MRT Testing

Pros

• There is some research to back up this testing method, albeit the sample sizes are small.   They report the test to be over 90% specific, sensitive, and reproducible.
• Can also test food and chemical reactions.
• Identifies any non-IgE reaction.  So it is thought to determine the antibody pathways and cell mediated pathways.

Cons

• Research is limited despite being the test used by most private practice Dietitians.
• The test is expensive, and most insurance companies won’t pay for it.

Food Avoidance vs. the LEAP Protocol

Food Avoidance

So, unless you are working with a facility that does MRT testing most offices will recommend food avoidance.  This means they hand you a list and tell you to avoid those high reactive foods for 90 days.  The problem with this is that you are missing all the untested foods and chemicals that you may be reactive too.  So you could continue to cause inflammation while avoiding those foods that showed up highly reactive.  At the end of 6 months, you usually have to retest and start the process over again.

LEAP Protocol – Lifestyle Exercise And Performance

This is the protocol I currently use to help my clients truly figure out what works for them and bring down inflammation for all.  In a really quick overview, we start by limiting you to the foods that show up safe on your test, that’s about 25-30 foods.  Then we systematically add back in all safe tested foods, then untested foods, then we start trying to add back in foods that showed up highly reactive overall.  We consider food groups and take particular caution with chemicals that you react too.  We basically put your immune system in a bubble to give it time to heal.  At the end of six months, my clients know exactly what foods make them feel ill (both tested and untested foods) and have been able to incorporate many foods that used to make them feel sick.  I currently use this protocol in conjunction with MRT testing for a couple reasons.  1) Most private practice Dietitians use this type of testing so there is a great support network to help each other out with tough cases.  2) I believe it’s a better test given the research that has been presented to me. 3) The testing process is easier than other companies I could work with.  That being said, if I had a client that came ot me with a recent IgG test (like within 30 days) I would explain to them the difference between tests but if they wanted to I would still take them through the LEAP protocol using that IgG test.

PS We did end up testing Mr. Hungry and following the LEAP protocol about 6 months ago, you can see his results from that here. 

Hopefully, that helps answer some of your questions!  I will be sharing information on different conditions that LEAP benefits, probably next month. In the mean time if you are interested in a food sensitivity consult, which helps us determine if you are a good candidate for testing you can book that on my nutrition services website.  

More information about GI Health and Food Sensitivities:

• Why I Don’t Recommend Elimination Diets
• What Is Inflammation?
• Why You Need Probiotics for Optimal Health 
• Prebiotics to help retain the probiotics
• Healthy Fats for Digestion