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 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.