Integrative Medicine perspective by Dr. Julie: food allergies.
Subject: Food allergy (Diagnosis)
Food allergy (Care and treatment)
Integrative medicine (Forecasts and trends)
Author: Chen, Julie T.
Pub Date: 02/01/2012
Publication: Name: Townsend Letter Publisher: The Townsend Letter Group Audience: General; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 The Townsend Letter Group ISSN: 1940-5464
Issue: Date: Feb-March, 2012 Source Issue: 343-344
Topic: Event Code: 010 Forecasts, trends, outlooks Computer Subject: Market trend/market analysis
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 282825235
Full Text: I don't always test my patients for food allergies, primarily because of the issue of cost to them from the labs. However, in almost every clinical visit, we discuss how food can affect their various health issues.

Food is something that we come into contact with daily, and thus if we are sensitive or allergic to certain foods and unaware of it, our bodies may be assaulted multiple times daily. So, given this potential daily exposure to factors that can trigger inflammation in the body, the topic bears enough weight to be discussed with every patient I have.

One of the main concepts that I discuss is that food allergies or sensitivities do not necessarily have to present as just gastrointestinal symptoms. Some of my patients have consistent fatigue or malaise or myalgias with a certain food sensitivity but not many gastrointestinal symptoms. For patients with rheumatic diseases, the food sensitivity might only present as increased joint swelling or pain and not much else insofar as clinical symptoms are concerned.

So, one of the main ideas that I try to convey is that food sensitivities may or may not present as gastrointestinal symptoms, and to monitor for physiological symptoms throughout the body to look for recurrent patterns associated with various food exposures if your goal is to see if you have a food sensitivity.

The gold standard is to do elimination trial diets and remove common allergens from your diet for several weeks, then slowly reintroduce them to see if you have any clinical changes off the foods or when you reintroduce them. If you notice that you do have a food sensitivity, the impact on your health is significant enough to remove the offending food from your diet indefinitely. If you have numerous food sensitivities, I always recommend to schedule a few appointments with a nutritionist or dietitian to go over every detail in the diet so as to avoid missing important nutrients on a long-term basis.

[ILLUSTRATION OMITTED]

I would like to utilize a patient case to help delineate some key points about food-allergy testing and how food sensitivities can significantly affect overall health.

J.P.* is a 23-year-old female sent to me for evaluation for inflammatory bowel disease (IBD). She was diagnosed with Crohn's disease about two years prior to her seeing me, and she has been on immunosuppressant medications such as sulfasalazine, prednisone, and 6-mercaptopurinefora while and was finally relatively stable in clinical symptoms. She was still having occasional abdominal cramps, especially if she didn't "watch what she ate." She wanted to fine-tune her diet and wanted food allergy testing, since she had heard that it could affect her IBD status if she was allergic to foods and still consuming them.

As a student, she thought that she wouldn't be able to do a sufficient food elimination trial diet, so she wanted lab testing instead. She tested for foods and was found to have celiac disease, as well as multiple food allergies, including various legumes, spices, soy, and fish, which she had been eating a lot of because she thought that they were good for her. She reported that her symptoms didn't seem worse with these foods, but since she was intermittently having abdominal cramps, she couldn't pinpoint what was causing the symptoms.

She was concerned about the validity of the test because she knew from prior limited food testing that she was allergic to nuts, but she showed up as only having trace allergic reaction to nuts on this test. On further questioning, she said that she rarely eats nuts since she thought she was allergic to them. I explained that since she wasn't being exposed to nuts and was avoiding intake of them, then the test would likely show a false negative. The fact that she was still showing some level of reactivity despite not eating nuts shows that she does indeed have allergies and should avoid them.

We discussed her test results and she agreed to see a registered dietitian for nutritional counseling to ensure that she gets a broad spectrum of nutrients while eating a more restricted diet. We then moved on to a discussion about supplements to help her IBD symptoms. She was started on curcumin without black pepper to maintain curcumin in the intestinal tract, since black pepper increases systemic absorption of it. She was also started on omega-3 supplements along with free-form amino acid powder as well as a probiotic for bowel mucosal integrity therapy. Since she was still in school, she did not want to take too many supplements and wanted to start with the minimum while making dietary changes as the mainstay of her therapy.

I saw her again after she had been on dietary changes for five months, and she reported that her intermittent abdominal cramping had improved significantly. She said that her overall fatigue and insomnia also improved, as well as her skin clarity and quality and seasonal allergy symptoms.

She wanted to know whether she should have repeat testing to see if she had improved with food sensitivities. I reiterated that since she had been avoiding the foods, the test would likely come back false negative and wouldn't mean that she is no longer sensitive to these foods, just that she hasn't had as much exposure to the antigens of the sensitive foods. We discussed how we would follow her clinically and, as long as her symptoms remained stable or were improving, we would probably keep her on the current regimen.

I did, however, test her for nutritional vitamin and mineral deficiencies to ensure that she is getting adequate nutrients on her more restricted diet. Whenever she had any deficiencies, we supplemented her to an adequate level and sent her back to the nutritionist to help her fine-tune her diet. I reemphasized to her that this is not just a temporary change but an overall indefinite lifestyle change.

As with most food sensitivity cases, I would recommend the dietary change for life because even with minor sensitivities, the fact that the food factor is going to cause even minor levels of inflammation is less than ideal in the overall scheme of health maintenance and disease prevention. Over time, as we age, we naturally become more pro-inflammatory, and the concern with minor food sensitivities is that they will worsen over time unbeknownst to the patient and have greater negative health impacts than the patient is aware of. So, I always err on the side of caution, having patients indefinitely remove food allergens if they are testing positive or if they are having consistent symptoms to any given food.

As you can see from this case, making dietary changes for patients who have food sensitivities may be somewhat arduous for them. But, once they become accustomed to the changes, the benefits far outweigh the inconveniences of making that transition. In the long run, performing the food elimination trial or having food allergy testing may be well worth the time, effort, and cost, if the patients are willing to make the lifestyle changes necessary to achieve health improvement. Because ultimately, the improvement in health from elimination of food allergens goes far beyond that of gastrointestinal symptom improvement ... it can positively affect everything from our skin down to our organs and cells.

* Patient's name and background information have been altered to maintain anonymity.

by Julie T. Chen, MD

www.makinghealthyez.com
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