Have you done food allergy tests or food antibody tests for your kids, but aren’t sure what it all meant? Tried elimination diets to remove the reactive foods, but didn’t see results?
Scratch tests, IgE blood draw, IgG food sensitivity, skin prick testing, Mediator Release Testing (MRT), and more – there are many ways to assess food reactions, food allergies, and food sensitivities.
It gets confusing. There are different types of reactions to foods, different ways to assess these, and possibly, different inter-actions between food and gut microbes that aren’t well studied. For example: In some cases, it’s unclear if the food is the issue, or if symptoms are due to an imbalanced gut microbe that eats the food – causing production of toxins from disruptive microbes that lead to symptoms. In many cases, I’ve found that just balancing gut microbiome allows a child to eat a food that was suspect for reaction.
In general, mainstream medicine – that is, your MD allergist – only recognizes one type of food reaction (hives, anaphylaxis), and typically only recognizes drug treatments with avoidance of the extreme triggers. That’s all well and good …if that is what your child needs. But what about all the other symptoms and reactions that don’t need the Epi Pen, Zyrtec, steroids, or other drugs? Symptoms that leave your kids feeling lousy with painful gas, bloating, mixed irritable stools that swing between mucousy loose stuff or hard pebbles, chronic stomach aches, migraines, headaches, joint pain, frequent colds or rhinitis, acne, eczema, asthma, hives or rashes that come and go, trouble with focus and attention… All of these can come from reactions to foods your child eats on the regular. How do you sort it out?
Because an MD allergist will only screen for food allergy (with skin prick testing or blood draw for IgE reactions), many kids go without correct diagnosis and continue to feel lousy, for no reason. Food allergy is only one type of reaction to a food. At the very least, there are three types of food reactions:
- They occur without immune response when we lack enzymes needed to break down certain foods. An example would be lactose intolerance, where the body can’t break down the milk sugar lactose. The result is gas, bloating, and diarrhea. Rashes are usually absent (except perhaps diaper rash, from the skin-irritating loose stools). Kids who are lactose intolerance can often manage yogurt (because the lactose has been fermented into smaller sugars), Lactaid products (because the lactose has been enzymatically treated in manufacturing), or harder cheeses (which don’t contain as much lactose as softer cheeses) – but not regular ice cream, fluid milk, frozen custard, or other products with a lot of milk or softer cheese (because these still contain lactose).
- Another example of food intolerance due to poor enzymatic action on a food component is when opiate like peptides are absorbed from food proteins. If you’ve got a super picky eater, this may be your problem. Learn more here.
- Food intolerances can also happen with immune involvement when too much histamine is made. In this scenario, IgE or hives to a food can be negative, but tingling, stomach pain, or reflux may ensue. This can be part of mast cell activation syndrome (MCAS). Mast cells are white blood cells that help regulate the immune system and are responsible for histamine release. A human stomach has mast cells scattered throughout its lining, where they play a role in regulating stomach acid secretion (we need strong acid to break down food and prepare it for the small intestine). In fact, mast cells can be found along all of the GI tract. A variety of conditions – including chronic exposure to a triggering food – can disrupt mast cell function so that too much histamine is released.
2) Food allergies: Food allergies do involve the immune system. They occur when the body creates IgE antibodies to a food, which then trigger the release of histamine and other pro-inflammatory mediators from mast cells next time you eat that food. These reactions are typically rapid, occurring within minutes or hours. An example would be a peanut allergy that causes swelling, hives, and difficulty breathing.
3) Food sensitivities: Food sensitivities ALSO involve the immune system, but not IgE antibodies.
- Food sensitivities may involve IgG antibodies instead, in which an IgG antibody is made to a food. This can create a delayed reaction that might play out several hours or even a day or two after eating the food. The reaction can be dull pain, loosened stool, explosive stool, mild rash, migraine, behavior changes, bloating, gradual build up of eczema, or mild congestion.
- Food sensitivities can also occur when white blood cells might react to a food protein, additive, or chemical, and release pro-inflammatory chemicals known as “mediators” into the bloodstream, which cause symptoms throughout the body. These reactions are often delayed and dose-dependent.
- An example of either would be a gluten sensitivity that causes stomach aches, diarrhea, or brain fog the day after eating a moderate amount of wheat; a strong behavioral reaction to food colors or artificial ingredients; or eczema that comes and goes, but improves dramatically once a trigger food is removed.
Any one of, or all of these, can happen at the same time!
How To Tackle It All – Where to start? Here are five steps to get rolling.
- Get IgE and skin prick testing done with your MD allergist. Rule out the big offenders this way. If there are multiple positives, start only by removing the most serious offenders that are actually life threatening to eat, or that cause significant discomfort (vomiting, hives, diarrhea, stomach pain). If some of the positives are tolerable to eat, keep them in rotation.
- If working with your allergist MD doesn’t give resolution or if symptoms persist and food allergy screening was negative, move on to IgG food antibody testing. As above, work with only the top two or three high offenders on your findings. This testing is my preference – tho white blood cell media release tests (MRT) are also popular among some practitioners, I have found in my practice with children – especially young children – that MRT is an over-sensitive test that doesn’t yield the actionable information I need to organize and build a supportive, growth-worthy food intake for a child.
- Remove an offending food completely only if:
- eating it is life threatening (ER visit, Epi Pen, hives)
- your child eats it every single day (give the body a break from it for two months to start)
- your child has significant and noticeable impact from that food. This can mean impact on mood, volatility, and attention and focus as much as stomach pain or stool changes that are untenable.
- always replace a withdrawn food with another one of equal or better nutritional value. For example if replacing cows milk with almond milk, you must add protein and a fat source because there is little protein or fat in almond milk. Use a clean collagen boost and some coconut milk or MCT oil and blend as a shake, or give extra servings of chicken, eggs, avocado, ghee, grass fed beef, or nut/seed butters if safe. You can also ask your provider about elemental formulas if your child has multiple food allergies.
- Work with high potency probiotics, especially histamine degrading strains: Lactobacillus reteuri, Lactobacillus salivarius, Lactobacillus rhamnosus to name a few, plus Bifido strains. Start low, with a 10 billion CFU dose daily and if possible work up to 50 or 100 billion CFU daily. Use probiotics year round.
- Keep good anti-inflammatory supplements in rotation. These can be used even if your child uses medications like antihistamines or steroids, always let your doctor know:
- DHA fish oils to 800-2000 mg/day (many liquids available)
- curcumin and turmeric 400-1200 mg/day
- D-Hist Junior chewables, 2-6/day (quercetin, N-Acetyl cysteine, nettles, vitamin C)
If you’re using one, give an elimination trial a go for a solid six months. Food proteins like gluten and casein (milk protein) are especially good at triggering all kinds of reactions at the same time, so elimination trials will only work with those proteins if you do it for 4-6 month duration; have zero known cheats including trace amounts in processed foods; also avoid pea protein concentrates at the same time (think Ripple Milk, Daiya cheese, or most “vegan” protein bars, powders and drinks), which look a lot like gluten and casein to the gut; and eat strong replacements for these foods (plain almond milk and French fries won’t cut it!).
If you’ve achieved that, and it’s smooth sailing, go for the re-introduction trial. See how it goes! If you’ve got leaky gut resolved – this is what got the food reactions going to begin with – you won’t see the reactions return. If you’re part of the way there, you’ll see a slow build up of those old symptoms after your child resumes eating the old offenders. In that case, you can judge if you want to continue elimination diet, rotation diet, and/or how much support with anti-inflammatory tools like probiotics you can use ongoing. Good luck and share your experiences below!
I listened to a podcast with you and Dr. Jill Carnahan tonight about ADHD and gut biome. I was struck by many of the topics you discussed because so many of the issues you touched upon reminded me of my son’s struggles with being a picky eater, brain fog, explosive behavior and chronic constipation. He is now 23 and still struggling with constipation.
He was diagnosed with neuro Lyme in high school and treated with IV antibiotics for a month.
I was wondering if you can recommend a good functional Dr in the NYC area who deals with chronic gut biome issues as well as constipation. I think he’s ready for some good guidance at this point.
I look forward to hearing back from you.
Hi Lynn, reach out to Dr Carnahan’s team for a recommendation on a good functional medicine doc in your area. Let her staff know that you heard our podcast and they may be able to direct you.