Hi, friends! Recently I’ve had a few RDs reach out to me about food sensitivity testing with questions about validity and use, etc. This post is so I can direct those who reach out here, so if you aren’t an RD/interested in food sensitivity testing skip this one and I’ll see you tomorrow for Friday Favorites!
Commission on Dietetics Registration Continuing Education
When I first got my CLT credential (certified leap therapist), you could still get CEUs for obtaining the certification. In 2016, CDR discontinued CEU’s for the CLT certification, stating:
Based on the practice paper entitled, Role of the Registered Dietitian Nutritionist in the Diagnosis and Management of Food Allergies published in the October 2016 Journal of the Academy of Nutrition and Dietetics, CDR has made the decision to cease approving LEAP and LEAP related activities (i.e., certification courses, sponsored independent learning, etc.) for CPE credit effective in October 2016. The practice paper documents that there is no evidence-base for MRT.”
Notice the words, food ALLERGIES?
This is a VERY important distinction because the words food allergy, food sensitivity, and food intolerances are very different.
Academy of Nutrition and Dietetics Practice Paper
The practice paper states:
“Food sensitivities and intolerances, for which there are few evidence-based clinical laboratory tests, will not be discussed in this paper.”
“According to the NIAID, there are a variety of nonevidence-based tests that should not be used for diagnosing a food allergy. Namely, basophil histamine release/activation, lymphocyte stimulation, facial thermography, gastric juice analysis, endoscopic allergen provocation, hair analysis, applied kinesiology, provocation neutralization, allergen specific IgG, cytotoxicity assays, electrodermal test (Vega), and mediator release assay (LEAP diet).”
Ya, I would agree, IgG testing and mediator release technology does NOT detect IgE mediated food allergies. These tests do not detect true food allergies, and to my knowledge never made the claim they could.
Food ALLERGY Diagnosis
An allergist diagnoses a food allergy, they are the only person who can do so (not a general doctor or an RD). Food allergies have mild to very severe symptoms, including anaphylaxis and death. (In contrast to food intolerances and sensitivities which will not cause you to die, be very uncomfortable.) I’m currently working with an allergist (who is an MD) for my son. Do you know what he said to me when I asked if the tests he uses (skin test and blood IgE test) are accurate?
He said, “They are about 90% accurate at ruling out an allergy and about 50% accurate at identifying one. That’s why I use the patient’s history, in addition to skin and blood testing to make a diagnosis.”
I thought to myself, “Okay, then we are speaking the same language, and you can proceed.”
He was not claiming the test to be the end all be all of the diagnosis. He was utilizing a tool in conjunction with a detailed patient history. That’s precisely what I do for food sensitivities and food intolerances.
Determining Food Sensitivities
Like an allergist uses a skin test and blood test, I use MRT blood tests (or IgG if the client has a recent test done) as a starting point. The test is merely a starting point for a customized elimination diet vs. something extensive like AIP or FODMAPS. I work with my clients to determine food intolerances and sensitivities from there. Unlike an allergist, I don’t diagnose anything at the end of the process.
I learned a lot about designing a customized dietary intervention from becoming a CLT, and I think it’s a shame they’ve removed that opportunity from other RDs. I get why they did it, but I don’t agree. The protocol taught in the CLT program is a systematic process for helping to identify food sensitivities and intolerances. I use it whether a client gets an MRT test or has a recently done IgG test. To learn more about this protocol, read what to do after a food sensitivity test.
The systematic process we use to identify intolerances and sensitivities is highly effective at identifying minute issues that would otherwise be very difficult to uncover like nightshade issues, nitrate, sulfite, and lectin sensitivities. The truth is we don’t have good tests for food allergies, sensitivities or intolerances. All of the tests currently available come with a certain degree of error. However, if you think of it as a tool that a highly trained professional can use as a starting ground, and not a diagnostic tool then you will understand why I still use it in my practice.
Here are a couple of my recent case studies to illustrate how helpful MRT testing is at identifying issues that are extremely hard to uncover.
Case Study 1
I recently had a client who said all her joint and hip pain went away 90% after whole 30. I suggested a slow introduction to identify issues, but she had already reintroduced food and didn’t want to go back on Whole 30. She wanted to do the testing to “just get to the source.” Since she had already demonstrated that her symptoms were indeed related to her food intake, I agreed to allow her to test. Her food sensitivity test results yielded many overlaps to foods eliminated on Whole 30. However, as the patient reintroduced gluten-free beer into her diet symptoms reoccurred. It was noted on the MRT test she tested positive to sulfites. Since avoiding beer, wine, and champagne, the patient has not had reoccurrence of hip or joint pain.
Case Study 2
The client was vomiting and having diarrhea daily for a few months with the GI doc unable to find anything wrong. Within 72 hours of starting the leap protocol, her symptoms resolved.
I also HEAVILY screen my clients. I make every single potential client do a consult with me to help determine if they are a good candidate for the testing. In these consults are I often redirect potential clients who are interested in food sensitivity testing into nutrition coaching because they aren’t a good candidate for it.
Here is what I’m looking for in the right candidate:
- Eating a relatively clean/unprocessed diet. If not, I redirect them to nutrition coaching to see if their symptoms improve with less processed food intake.
- Specific Conditions: IBS-D, IBD, Migraine, Psoriasis, Eczema, Asthma, Chronic Nasal Congestion – others are considered after a realistic condition
- I do not test for weight loss – I recommend focusing on healing symptoms then concentrate on weight loss. Read why in this post.
- I do not “sell the test” by itself. Because of the error associated with the tests and because the protocol is so important, I don’t sell the test without the nutrition coaching program. Sure, I could make money doing this, but to me, it would be unethical since tests are worthless without the protocol.
- Previous celiac screening with their doctor, in case they are sensitive to gluten, we need first to make sure we don’t’ miss a celiac dx.
- Autoimmune conditions – or multiple autoimmune diseases in conjunction with the conditions listed above. (Read about food sensitivities and hypothyroidism here )
- Prior demonstration that symptoms are food-related (through previous elimination diet or trial or error) is preferred (such as Case Study 1.)
Hope that helps explain why I use food sensitivity testing in my practice. Reach out if you have any questions!