• Food Sensitivity Testing: Interview with Dr. Sage Wheeler

    snapshot of ALCAT results for my son

    It’s a beautiful thing when you find a health care provider that you sync with. They’re open to your suggestions, give you clear evidence why something may or may not work, and they’re ready to take a leap with you – and catch you if you fall.

    After many years of searching for that provider, we found Dr. Sage Wheeler. Dr. Wheeler recently answered some questions about food sensitivity testing for Comfy Belly readers. You can read his complete bio at the end of this post.

    What is a food sensitivity?

    Food reactions can be separated into three distinct categories: allergy, intolerance, and sensitivity.

    Allergy is a classic immediate reaction of itching, swelling, and, with increasing frequency, anaphylactic shock.

    Intolerance refers to the lack of an enzyme, which impairs digestion. The classic example of intolerance is lactase enzyme deficiency which leads to lactose intolerance. These reactions usually occur within hours of eating reactive foods.

    Finally, sensitivities are immune reactions. This occurs when offending food particles find their way into the bloodstream, by means of a “leaky gut”, and your body creates antibodies to them. These antibodies become reactive and secrete inflammatory agents that increase global inflammation. These reactions can be within hours or can take 3-4 days to manifest.

    Allergy and intolerance are very easy to identify because of the rapid reactions and clear causality. You eat a peanut, you can’t breathe – very hard to miss. Sensitivities are more subtle and require food diaries, elimination diets, and lab sensitivity testing.

    What kinds of food sensitivity tests are available?

    There are basically two types of tests: Total IgG and Cell Culture.

    IgG testing measures the quantity of antibodies produced in response to a specific food. These are performed using a technique called ELISA. These tests are relatively rapid and inexpensive.

    In cell culture testing, white blood cells are harvested and cultured and then exposed to food antigens (particles). The reaction is then measured in various ways (size, shape, and texture) and given a magnitude of severity. These tests are much more expensive, give a better idea of actual reactivity, but suffer from more reproducibility issues.

    Does food sensitivity testing work for all ages?

    No, food sensitivity is not very practical for infants or toddlers less than two years old. Their immune systems are still very naive and infants by nature have very permeable guts, which would make their results appear falsely elevated and lead to unnecessary food restrictions. Of course, there are exceptions, such as in those with very severe family histories of food sensitivities, but that should be rare.

    How reliable is food sensitivity testing? I’ve heard some medical professionals say this test is not reliable and that it can change from time to time. Is this true?

    This is true in the same way a tire gauge may give you a different reading every time you check your old leaky tires. It is difficult to get consistent readings, but that doesn’t mean it is not a viable tool.

    In any lab test you want accuracy and precision. Accuracy means the results you get accurately indicate what is causing problems in your body. Precision means that you get similar results each time you run the test on the same sample. Unfortunately, there are no tests that have both excellent accuracy and precision.

    I use ALCAT testing because I believe it offers a more accurate snapshot of current, clinically relevant conditions. I also use US Biotek’s IgG test that is very precise, but I feel lacks clinical accuracy in adults with a long history of gut permeability.

    How does this testing compare to an elimination diet? Can it yield the same results?

    The elimination-rechallenge diet is the gold standard of food sensitivity testing and much more effective than laboratory testing by itself. Unfortunately, it is quite difficult to do and can lead to significant calorie and nutrient deprivation if not done correctly. Most clinicians use a combination of lab testing in combination with modified elimination diets. Laboratory testing gives you a head start in the elimination diet by showing you a list of non-reactive foods. This helps you start your elimination diet with a broader food base and greatly decreases the time it takes to complete the testing.

    Do I have to go to a naturopath to have this test? What role does a naturopath play in this testing?

    Most companies will only sell test kits to physicians. The reason being that ethical lab testing requires that you be given a thorough explanation of results and safe treatment guidelines. You can find kits online, but I definitely recommend doing elimination diets under the care of a qualified healthcare professional. A naturopath will not only guide you through the results, but can also help you address the cause of your food sensitivities – which would be a great topic for another article.

    How does this compare to other diets, like SCD and vegetarian?

    Food elimination diets are quite different. The objective in elimination is to decrease inflammation and toxic exposure while treating the underlying cause of the gut permeability. In the absence of significant organic disease (like an active Crohn’s or UC lesion) you can often do the elimination diet for a year or so, heal your gut, and resume eating some of your reactive foods – the exception being gluten and casein, which are often lifelong issues for other reasons.

    Specific Carbohydrate (SCD), vegan, and vegetarian diets are long-term diets used for a specific reason. The Specific Carbohydrate Diet helps balance the good versus bad bacteria by altering their food source.

    The vegan/vegetarian diets focus on plant-based foods to reduce your exposure to inflammatory, fatty animal products. Animal products are inflammatory because of their relatively high levels of arachidonic acid.

    All these diets are helpful. The problem lies in the fact that most people use them as maintenance for their condition instead of as a part of a comprehensive treatment plan focused on the cause of the problem. For example, the SCD diet works well, but it would be difficult to follow for a lifetime. So, often people will “fall off the diet wagon” and suffer a relapse or a flare because their underlying pathology has been left untreated.

    How do you use the ALCAT or other food sensitivity testing in your practice?

    I use the ALCAT testing to give me a snapshot of two things: one, the overall permeability of the gut (indicated by the number of reactions) and the overall reactivity of the immune system (indicated by the severity of the reactions). I will then have patients follow the elimination guidelines suggested by the test and monitor for symptom resolution. When symptoms have resolved, I will then reintroduce them one at a time and monitor for reappearance of symptoms. Foods that cause symptomatic reactions are then eliminated on a longer term basis. Well tolerated foods are reintegrated in a rotation diet.

    It is important to reiterate that these foods are not the cause of the condition. Rather, the reaction to these foods indicates an underlying pathology of the gut – dysbiosis, toxic exposure damage, inflammation, and genetic susceptibility. It is very hard to treat these things in the presence of food sensitivities, but food sensitivity elimination in itself is not the treatment.

    What is the treatment?

    That really depends on the condition. However, for almost any gut complaint the general rules of GI treatment are classically known as the four “R’s”.

    Briefly, they look something like this…

    • Remove: toxic exposure, infection, food reactions.
    • Replace: stimulate or replace production of digestive enzymes, replace essential nutrients.
    • Re-inoculate with appropriate pharmaceutical-grade probiotics.
    • Restore: repair gut tissue with targeted nutrients, herbs, and pharmaceuticals and restore the immune system to a healthy state of tolerance.

    Finally, I like to add a 5th “R” – Rebalance. Often, the genesis of gut dysfunction lies in an imbalance of emotion. I can’t tell you not to stress. I can’t tell you not to worry, grieve, or get angry. But we can always balance stress with fun, worry with hope, grief with laughter, and anger with love.

    About Dr. Sage Wheeler

    Dr. Sage WheelerDr. Sage Wheeler is a graduate of Bastyr University, the world leader in natural health sciences. After graduation, Dr. Wheeler was the recipient of the prestigious ITI-STAIR residency. During this additional one year of training and practical clinical experience he practiced under the mentorship of a conventional medical doctor as well as an experienced naturopathic doctor. This opportunity has given him a uniquely integrated perspective and way of practice.

    Prior to attending Bastyr, Dr. Wheeler was afflicted with a genetic bowel condition that caused severe chronic pain which, for 5 years, was misdiagnosed as IBS. This experience led him to seek further training in functional gastroenterology as part of his medical training, and gives him a unique ability to genuinely sympathize with his IBD patients.

    Dr. Wheeler enjoys frequently attending conferences and seminars to continually improve his practice and offer cutting edge knowledge and treatments to his patients. He is a member of the Institute of Functional Medicine, American Association of Naturopathic Physicians, and candidate of the Naturopathic Board of Functional Gastroenterology.

    While Dr. Wheeler can’t answer your questions here, he is available for consultation. Visit his website, where you can find supplements, office hours, and more information on his growing practice.

    Tip Use this link to find a naturopath near you.

    Note I’d like to continue to interview Dr. Wheeler about other subjects of interest to Comfy Belly readers, so if you have a suggestion, please leave it in the comments.

    Posted in Interviews  |  24 Comments

    24 Responses to Food Sensitivity Testing: Interview with Dr. Sage Wheeler

    1. Jennifer Kiman says:

      I am so interested in what I just read. I have a 5 year old son who has so many problems with IBS. He has had 2 colonascopy, and 1 endoscopy, tested for chrones, celiac, cf, and lactose. Came up positive for lactose, but still very sick even on a pill every day. Has these black like jelly bean looking so called henroids that only come out during a bowl movement. We were told it’s rectil prolapse by one yale doctor and hemroids by another. They have both told be they disagree with eachother, but agree to to disagree, and then told me that it’s IBS and nerves. Sometimes he is in th bathroom 5-6 times, it sometimes floats, is green, mucus or just normal looking. I do know if i let him just eat what ever he wants like on Easter or a birthday party he gets very sick.

      I would love to hear back from someone. I have been told about food sensitivity, but did not know where to begin or what doctor to ask since all the other ones have told me nothing is wrong…he will grow out of this and his rectum will get better as he gets older and his nerves aren’t so bad.
      Hope to hear from you soon!
      Thank you,
      Jennifer Kiman
      Trevor’s mom

      • Erica says:

        Here’s an explanation of the difference between dark and red stools that I found helpful: http://www.nlm.nih.gov/medlineplus/ency/article/003130.htm

        I think you need to get a third opinion, at the least.

      • Bonnie says:

        Jennifer, I really believe looking into food intolerance can help you. It has been life changing for me and other’s I know.

        I had the Carrol Food Intolerance test done last October through Windrose Clinic – here is a link that tells a little about it: http://www.windroseclinic.com/FIT.html. The ND at this office is also an adjunct professor at Bastyr and she teaches this method of testing. Perhaps you could call or email them and ask some questions specific to your son?

        Sorry you are going through such a difficult time, I have 3 little boys and I cannot imagine the stress and worry these issues are adding to your life.

        I wish you the best as you look for answers,


      • Karen says:

        I am so sorry to hear about the gastro issues your son suffers from and in turn, yourself, because you are trying to do your best to keep him well. My heart goes out to you. My son also has undiagnosed gastro issues and has been thru the gamet of tests with no concrete results, but using the SCD diet we are able to minimize his issues. I am wondering if you have know about the Specific Carbohydrate Diet, have tried it and if so whether you have had any results? This diet eliminates complex carbohydrates and is found in the book “Breaking the Vicious Cycle” by Elaine Gottschall and there is a website called Pecanbread which elaborates on it. If you would like to contact me my email address is southg8@telus.net.

        Take care! Karen

    2. Thank you so much for posting this. My husband and I have both been tested and under the care of a similar physician. I feel that it’s so important for everyone to get tested for IgG allergies because that was a real eye opener for us. My husband was severely allergic to mustard (which he had almost daily in our homemade salad dressings!); however, this was more an indication of his overall health, as Dr. Wheeler indicated in the interview, and he was put on a program of resting and restoring his gut. Now, he is healthier and has more energy than when we first got married! It is amazing what people can live with when unaware of what a true healthy, functioning gut can be like. I was thinking of posting on just such a topic so I will be directing people to this great, informative interview when I do!


    3. Lorena says:

      Great interview.
      Other topic ideas:
      -Seasonal Allergies
      -Thoughts on Rifaximin (antibiotic thats trying to get passed for IBS-D)
      -Supplements to be taking

    4. Emily Williams says:

      I had the Alcat testing (due to leaky gut) done in January and made it through my first 3 months of elimination (57 on my yellow list). I feel great!!! I only react to 2 of the foods. I highly recommend this testing for those who don’t know which foods trigger your symptoms. Thanks for Dr. Sage’s website, it is great information. Good luck to all.

    5. Casey says:

      Great post! I just stumbled across your blog when I was looking for a coconut flour pancake recipe I’ve used from another before. Talk about luck! I just had the ALCAT done in February. This gave some extra info and I’ll certainly be following your blog now. My belly needs help, too. Happy healing! 🙂

    6. Karen says:

      Thank you so much for such a great post!!! I have always wondered what the differences between sensitivities, intolerance and allergies were, and now I know. I have been enjoying your website for sometime now, as I have a family full of digestive woes,we love your recipes and articles like this are so informative for all of us! Thank you for the time and effort you put into your cooking, and blogging! It is greatly appreciated.


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    8. Annie says:

      Thanks so much for this post!!! I’d love to hear more about Dr. Wheeler’s thoughts on how to manage figuring out food sensitivities and elimination diets with a child under the age of 2. I’m particularly interested in hearing thoughts on how to manage all this while continuing to breastfeed, which is of course extremely beneficial for a kiddo with food sensitivities but also extremely difficult for a mom who must follow the child’s dietary restrictions.

    9. What perfect timing for finding this post. I just recently recieved my Biotek testing results to find that I am intolerant to ALL dairy products, Spelt, and Almonds. Intuitively, I knew dairy wasn’t my gig, so I replaced cow’s milk with almond milk. Little did I know that it was just as bad! I’m surprised that my test results did not show any severe wheat or gluten sensitivity, as I find that I feel a bit inflamed after eating such foods. I would like to try the other more expensive test in the future, I think. Anyway, enough rambling. Thanks so much for this post and interview, I would love to hear more in the future from Dr. Wheeler. Love your blog, so glad to have found it 🙂

      • Erica says:

        Too bad – I find almond milk the most appealing sub for cow milk. Although, keep in mind that some of these foods will change if you rotate them back in 6 months or a year later. It take a lot of patience to go through this so hang in there. Thanks!

    10. This was a very informative post. Thanks so much for sharing.

    11. Marissa says:

      Great website! I just wanted to comment on Dr. Wheeler’s statement,

      “Animal products are inflammatory because of their relatively high levels of arachidonic acid.”

      Araschidonic is an omega-6 fatty acid, and those types of omega-6s are inflammatory by nature. There are so many foods that contain 6s, and a vegetarian/vegan’s main dietary components are chock full of them (after grains, vegetable oils, and nuts are removed what else is there?). In my studies, the most important way to keep inflammation down is to consume the perfect ratio of omega-3’s to 6’s. This can be done by limited omega-6 intake or supplementing with cod liver oil (as recommend by Weston A. Price Foundation). High inflammation can also be reduced by drinking tea, which is high in polyphenols. Is there another reason other than the araschidonic acid that is concerning in meat and egg consumption?

      Once again, thank you for your blog. I’ll be visiting it often!

    12. Rosy says:

      Two thoughts- Jennifer, I have a son with a few issues like you described- you might find it very helpful to read the book, “Gut and Psychology Syndrome” by Dr. Natasha Campbell McBride. It talks about how to heal severe digestive issues and seal “leaky gut syndrome”.

      Also, random note about cow milk substitutions- we find we like coconut milk best, and because of it’s higher fat content, I find that it bakes the closest to cow milk in my recipes.

      Thanks for the post- it was really informative!

    13. Vanessa says:

      Great article! My 13 mo old was given an IGG test before I knew that it isn’t recommended in young babies her age. She was diagnosed w juvenile arthritis and uveitis and we wanted to make sure we approached her treatment aggressively from all angles. I am breastfeeding her too. We immediately began following a paleo diet – the autoimmune protocol – but quickly added egg yolks back in bc she loves them and has had them since 8 mo old seemingly without issue. We were shocked when the only food the was moderate to high on her biotek test was egg yolks and egg whites. We cut them out of her diet again (at the time of the test we were off eggs for about 3 weeks) but had added them back in before results came back in. Because of her diagnosis, she gets frequent lab work and her crp normalized. Her Sed rate is fluctuating between 15 and 20. She didn’t react to dairy at all on the test but when I tried to intro it she got eczema on her face. I guess my question to answer you is given her age, and the test results, and her serious diagnosis, should we continue to leave out eggs or add them back in? Thx!!

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