No longer will simply “organic” do. More and more grocery products at natural foods stores, and even supermarkets, carry disclaimers warning that production was in a facility that works with tree nuts, or bear labels touting gluten or dairy free. Gluten-free food sales, reports Natural Foods Merchandiser magazine, grew a significant 12 percent in 2009 over the previous year.
For some consumers, like L.A.-resident Amy Rettberg, food allergies are a life-threatening concern—allergies to poultry, plums and salmon induce symptoms ranging from throat itching to respiratory difficulty so severe it has landed her in the ER. But for others, they are a misdiagnosis. This dichotomy is the primary impetus for the current push for a standardized definition and diagnostic criterion. A recent summary report in the Journal of the American Medical Association (JAMA), “Diagnosing and Managing Common Food Allergies,” has launched intense controversy in the world of food allergies.
Food Allergy vs. Food Intolerance
Commissioned to lead the above-referenced study by the National Institute of Allergy and Infectious Diseases, West Los Angeles internist Paul Shekelle was daunted by the dearth of definitions for the term “food allergy.” Reports Shekelle, “There was not an index term that produced any results.” Shekelle and his team of experts started at square one, researching the definition and diagnostics of food allergies in an attempt to “come up with a set criterion so that going forward everyone is working from the same play book.”
One major priority was differentiating between food allergies and food intolerance, sometimes called food sensitivity. “A food allergy involves an immune response [in extreme cases, anaphylactic shock] and is testable,” asserts Orange County based allergist Otto Liao, whereas, “Food intolerance is an uncomfortable reaction that will not show up through diagnostic testing and is not life threatening.”
Although 25 percent of Americans claim to have a food allergy, more accurately, claim Liao and the JAMA report, only 2–5 percent of adults (and 6– 8 percent of children under the age of three) have an identifiable food allergy, one that produces a testable immune response, whereas the others simply suffer from food intolerance, often characterized by bloating, gas, gastric pain, constipation or diarrhea; or even nasal congestion, migraines or leg pains. But this statistic has some food allergy advocates up in arms.
“It doesn’t matter if it is a food allergy or food intolerance—you still can’t eat the food—and it doesn’t negate the fact that people are having problems eating certain foods and reacting to them,” counters L.A.-based Cybele Pascal, author of The Allergen-Free Bakers Handbook and The Whole Foods Allergy Cookbook.
Diagnosing
There are four commonly used tools for diagnosing food allergies: self-reporting, skin test, blood serum test and a food challenge. Most often, patients self-report to their doctors or health practitioners the symptoms they’ve experienced when eating a certain food. If the symptoms are serious enough, a skin or blood serum test to reveal the presence of IgE antibodies for the food in question may be recommended. However, “These tests are not completely conclusive and can be misinterpreted,” says Shekelle.
Even with a positive result, having antibodies does not automatically mean you have food allergies, Liao cautions. “Foods should be tested specifically, down to the smallest protein.”
Liao and Shekelle agree that the gold standard for testing is the food challenge, which eliminates the placebo effect. While under observation, the patient is given disguised food that contains the potential allergen to determine if there is a reaction. This type of testing is time consuming, however, and can be frightening and even dangerous if a serious reaction occurs. Understandably, “most doctors are reluctant to do it,” states Liao.
While every method of testing has its challenges, current accepted practice for diagnosing is through patient history, self-reporting, and an appropriately interpreted antibody test showing a strong presence of IgE antibodies.
Hazards of Over-Diagnosis
There are issues associated with the increased trend of misdiagnosing food allergies. “People are putting two pieces together that don’t always fit—slightly increased levels of antibodies in testing, with mild symptoms—and calling themselves food allergic. This causes over-diagnosis,” says Shekelle. His concern is that “the seriousness of severe food allergies is diluted because people are getting misdiagnosed.”
In addition to minimizing and negating the severity of bona fide food allergies, a false label can be highly stressful and prompt drastically altered food consumption and lifestyle, explains Liao. Amy Rettberg laments that, “I can’t enjoy food with my friends and family. If I go to functions I may have to skip a whole course, since often they serve chicken or salmon; and trading recipes and going to restaurants are limited.”
This could be a self-perpetuating problem. A 2008 study reported in The Journal of Allergy and Clinical Immunology stated that children who completely avoided peanuts and had little or no exposure to common allergens were ten times more likely to develop peanut allergies. The study did not include other foods, but it indicates the possibility that restricting the diet carries the risk that your body will “mount responses that are unnecessary, making your immune system react to needed nutrients [as] seemingly foreign,” cautions Angela Agrios, N.D., a Pacific Palisades naturopath. In other words, one school of thought holds that rigorously avoiding foods due to sensitivity or intolerance issues can actually create a weaker immune system and increase the likelihood of genetically passing on IgE antibodies.
Despite the hubbub around attempted new guidelines, there is consensus regarding the need for better diagnostics and public education. “Life will be easier if we come up with a set index for defining, diagnosing and treating food allergies,” says Shekelle. Results of the study, projected for midsummer, will hopefully give the field of food allergies a consistent foundation to assist those suffering from something many of us take for granted.
If you think you have a food allergy . . .
If a genuine food allergy is to blame for a symptom, avoidance is the safest, only option. Ultimately, however, a food sensitivity does not mean a specific food or food category needs to be completely avoided, since it will never be life threatening. Having an uncomfortable reaction to a food understandably makes those intolerant prefer to avoid the food, but there are other alternatives. Both homeopathy and Ayurveda address food sensitivity by looking at the whole system and root causes.
L.A.-based Mary-Alice Quinn, an instructor for the California College of Ayurveda, says, “The fundamental issue with all diseases, including food sensitivity, is that we look for the cause outside ourselves when often the problem lies within.” Both she and Angela Agrios agree that food sensitivity can be reversed through better digestion, balancing the system and improving immune response. Through the ancient practice of Ayurveda, Quinn assists patients suffering from food intolerance through a routine of detoxifying and rejuvenating the digestive system. “This optimizes digestion and balances agni—the digestive fire—to help the system fully process food down to the most basic nutrient.” Food sensitivity often occurs because the body is not able to properly assimilate nutrients and break them down appropriately. To change this, Quinn suggests eating in a way that serves your constitution or mind/body type, having a healthy daily lifestyle including when and how you eat, and taking appropriate herbal supports. “Each of these enhances your body’s own capacity to heal and optimizes your immune system” she says.
In her naturopathic practice, Agrios employs a combination of an elimination/reintroduction diet and gastrointestinal work, including the use of supplemental herbs over a period of three to six months. Avoiding the food and rebuilding the digestive system allows healing, which can be followed by reintroduction.
Since low stomach acid, low pancreatic enzyme, overconsumption and chronic stress produce more protein, which can seem foreign to the immune system and make it react, Agrios often prescribes a full spectrum digestive enzyme containing hydrochloric acid. This helps to balance the digestive system while decreasing the permeability of the digestive lining, and to assist the immune system. “Food avoidance for those with sensitivities does not need to be permanent,” claims Agrios, “Digestive repair, eating with more awareness and naturopathic supports will improve the quality of digestive health.”
Malibu naturopath Theresa Dale suggests there is a difference between sensitivities to chemicals in food and allergies to the phenols in food. She believes that phenols—intrinsic chemicals found in all foods and also produced to varying degrees by the body—can be a cause of food allergies. In certain situations they bind with other substances to create phenolic compounds that have unique chemical properties. “These are very soluble in both organic solvents (such as alcohol, ether, and the fatty components of the body) and water (aqueous solution), where they are strongly acidic,” says Dale. “They exert toxic effects in the brain, where normally certain enzymes prevent their accumulation.”
To cure allergies to phenols, Dale believes homeopathy is the best treatment, since “any phenol can be made into a homeopathic medicine.”
