We have grown accustomed to debating conventional medicine over a variety of topics, but this one is even debated within the functional medicine world. So many patients want to know if a food is causing their symptoms. They ask, “How do I know which food it is?” Conventional medicine either doubts the possibility or refers to an allergist for skin testing. The functional medicine world offers more variety, but still debate over which type of testing is best.
At Sanctuary, we begin with our usual intensive approach, asking questions, listening and looking for any clue that a food might be a root cause of our patient’s illness. The story which includes an immediate and objective reaction to a food repeated in occurrence poses no great challenge. These are usually IgE, type I allergies to things like peanuts and shellfish. Sanctuary’s “average” patient story rarely follows this simple path however.
Our patients have often seen many conventional, even functional providers before. Their stories are more subtle and complex. They sometime suspect certain foods, but a delayed or inconsistent reaction leaves them puzzled. Some IgG triggered reactions may require 48 to 72 hours before symptoms are noticed. For these same reactions, the same food may trigger a reaction only 3 out of 4 times. A confident self-discovered answer continues to elude them.
For others, they have not a single suspicion that any food is behind their symptoms. They may have one of many autoimmune diseases such as Hashimoto’s thyroiditis. They may have hay fever symptoms or irritable bowel syndrome. They may just be a child with behavioral/learning issues. Some have tried the normal gluten free and dairy free diets, but either are not sure they were better or simply did not follow the food plan accurately enough for a noticeable benefit. Even without any minor suspicion, some of these patients show food sensitivities on IgG testing.
Upon reaching this point of a gathered story, if we suspect their illness could be related to dietary ingredients, we have two options. We discuss with patients whether they would prefer to do an elimination diet for 6-8 weeks or take some IgG and IgE blood tests for food antibodies. Some choose the elimination diet in which they cut out a list of specific foods by 100% in their diet. This can be the simple: gluten, soy, dairy, egg, peanuts, fish, coffee. This could be complex and restricted: Autoimmune Paleo diet or an elemental diet extreme. For many these dietary options lead to symptom improvement or resolution. At the end, they reintroduce the eliminated foods to see if symptoms return. Patients find that with some dietary changes, they can get better.
This elimination diet option not only sheds light on immune based sensitivities, but may also uncover non-immune based issues. Many of our patients suffer from histamine intolerance, salicylate intolerance, oxalate excess, FODMAPS, vasoactive amine reactions, lactose intolerance, or chemically based responses to gluten as it is digested. If we suspect these non-immune mechanisms, we guide our patients toward the elimination diet or at least a self-awareness diary. We guide our patients to either lower/eliminate that type of food or at least monitor their responses when they eat them. In a few weeks many message us with stories of enlightenment. They discover connections between their food and their symptoms that they would have never guessed were due to something like a high histamine or high oxalate food group.