Tuesday, October 27, 2015

Inflammatory Bowel Disease Part 3: Food Sensitivity Testing

By: Dr. Kimberley Ramberan, ND

There are several laboratory tests that provide value in assisting with the management of inflammatory bowel disease (IBD) and that provide supporting information to assist in determining the best treatment plan.  Standard laboratory tests are markers that allow your doctor or naturopathic doctor to assess for inflammation, nutritional status and to look for deficiencies of necessary vitamins and minerals.  Most of this testing in Ontario is considered standard of care and should be done on a somewhat regular basis.  However, there are very specific tests that are generally not part of conventional medicine that can be done by naturopathic doctors to provide specific information about foods, the way you break down your food and pathological microbes that could contribute to the onset of disease and the progression of disease.

This blog is part of a series on IBD and my personal journey on learning how to live with it. Please check out my previous blogs:

IBD Part 1: My Story
IBD Part 2: Food Does Matter

File:Bread wheat.jpg

Now, remember when I said I had more lessons to learn...

While studying to become a naturopathic doctor, I experienced symptoms of IBD for about two and a half years and then it went into remission for two years. For me, the stress of school, performance and grades triggered an IBD flare. While stress was a contributing factor to my flare, I knew that I had to also get my diet back on track.  Like most people with IBD, when symptoms go away for a long enough time, the thought is that we can "cheat" a bit with the foods we eat, which is the trap I fell into. 

Being in school and learning about the different types of therapeutic diet regimes, I decided I would try the "Hypoallergenic Diet", also known as the Elimination Diet.  This is a diet that has great clinical value in establishing what and how foods affect you.  I use this diet in practice regularly with patients.  However, for some it may not be specific enough and may be too labour intensive.  

After being on the hypoallergenic diet for awhile, I noticed improvements but not remission.  I was disappointed and could not understand why I was still having symptoms.  I was eating gluten-free, dairy-free, egg-free and still not feeling 100%. One of my naturopathic professors told me about a blood food sensitivity test that was commonly used by naturopathic doctors in order to determine what foods the immune system was overreacting to and, therefore, causing inflammation in the body. 

Food Sensitivity Testing

The immune system exists to defend the body against bacteria, viruses and any other potentially harmful organisms.  It protects the body by producing cells called immunoglobulins, also called antibodies.  There are five major immunoglobulins: IgA, IgD, IgE, IgG and IgM.  Each one of these components produces a different kind of physical reaction in the body. Let's compare. 

Food Allergy vs Food Sensitivity 

When you go to the medical doctor or an Allergist to test for food allergies, they will typically perform a skin prick test or a double-blind, placebo-controlled oral food challenge in order to test for IgE reactions.  IgE reactions are considered true food allergies.  IgE reactions typically occur within minutes of exposure to or ingestion of a food antigen.  Commonly observed IgE reactions include: hives, itchy watery eyes and breathing difficulties.  They are considered anaphylactic-type reactions.

Food Sensitivity is a term that usually refers to delayed immune reactions to foods.  For example, IgG and IgA reactions to foods are commonly referred to as food sensitivities because they don't always cause immediate reactions.  They can take anywhere from the time the food hits our digestive tract to 3 days later.  The reactions can vary and compound based on the amount and combination of foods we consume.

In an IgG reaction, the IgG antibodies attach themselves to the food antigen and create an anti-body-antigen complex.  Special cells called macrophages normally remove these complexes.  However, if they are present in large numbers and the reactive food is still being consumed, the macrophages can't remove them quickly enough.  The food antigen-antibody complexes accumulate and are deposited in body tissues.  Once in tissue, these complexes cause inflammation which plays a role in numerous disease and conditions.

Of the five major antibodies circulating in the bloodstream, IgA is produced in the greatest quantity on a daily basis.  IgA antibodies are the first line of defence against suspected disease-causing agents like viruses and bacteria.  IgA antibodies to specific foods may form when the lining of the intestinal tract becomes inflamed or damaged due to stress, alcohol, medications or other inflammation-causing conditions.  Elevated IgA to specific foods is widely believed to be a sign of damage to the mucous membranes in the gut.  Individuals with Crohn's Disease or Ulcerative Colitis, or even those with suspected "leaky gut", may benefit from testing IgA food reactions.

Allow me to illustrate this case in point with Sumo wrestlers:

Imagine your body is a pool.  Now imagine Sumo wrestlers have decided to have a pool party using your pool.  The 1st Sumo wrestler named "Dairy" cannonball jumps into the pool.  He makes a big splash.  Then the water calms down fairly quickly, but the water level of the pool rises.  Then the 2nd Sumo wrestler, "Eggs", dives in.  The water levels rises a bit more.  Now here comes the 3rd, "Gluten", who gracefully slips in.  Now the water level is as high as the pool can hold.  Now comes along skinny little "Sesame". He is all ready with his water noodle and jumps right in the middle of all the Sumo wrestlers. YOUR POOL EXPLODES!

So, whose fault is it that the pool exploded?  
The answer: EVERYONE

Your body is like a pool, in the sense that it is designed to hold a certain load.  We all have different foods that cause our systems to reach capacity.  So, when that happens, symptoms of inflammation occur (i.e. the pool exploding).  This is what happens when our body is having an IgG/IgA reaction.

I will often hear patients say "Sometimes foods bother me and sometimes they don't.  I can't figure it out!"  That is how I felt before I completed a food sensitivity test and discovered that I had an extremely high sensitivity to sesame seeds!  Five to ten years ago there were not many options for gluten-free or dairy-free foods that did not contain sesame seeds. No wonder I wasn't getting better.  After my food sensitivity test, I adjusted my diet accordingly and very quickly saw and felt the benefits.  I never would have figured that out without doing a food sensitivity test.

Food sensitivity testing is a valuable and cost-effective way of determining what specific foods you should be avoiding, whether you are dealing with IBD, Crohn's disease or any other symptoms or conditions.  Many naturopathic doctors recommend determining your food sensitivities as the starting point to creating a treatment plan that works for you.

To find out more about food sensitivity testing, contact Naturopathic Foundations at 905-940-2727 to book an appointment with Dr. Kimberley Ramberan, ND.

This is the third in a 12-part series on the Irritable Bowel Disease.  We encourage you to check out the other blogs by Dr. Kimberley Ramberan, ND.