Food allergies - an immune response to food sensed as harmful

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A food allergy is an immune system response to a food that the body perceives as harmful.

Although an individual could be allergic to any food, such as fruits, vegetables, and meats, there are eight foods that account for 90% of all food-allergic reactions - milk, egg, peanut, tree nut (walnut, cashew, etc.), fish, shellfish, soy, and wheat.

Anaphylaxis is a sudden, severe, potentially fatal, systemic allergic reaction that can involve various areas of the body (such as the skin, respiratory tract, gastrointestinal tract, and cardiovascular system).

When the term “allergy” was first coined, it meant an adverse reaction to any substance that does not bother most people. Then, in the 1920's, it was discovered that a type of antibody called “Reagin” or IgE was involved in many allergic reactions, especially inhalants.

So allergy became defined as an IgE-mediated response. IgE-mediated allergies are easily detected by standard blood or skin tests.

The reactions happen rapidly, usually within a few minutes of exposure to inhaled substances or eating a food. Small amounts of the offending substance trigger the reactions, which commonly occur in the respiratory tract, digestive system, or skin. IgE-mediated food reactions are often “fixed.” This means that after months or years of avoiding a problem food, eating any amount of it will still cause symptoms.

Many adverse reactions to foods do not involve IgE antibodies. They are called a food “sensitivity” or “intolerance.” Other immune mechanisms, such as IgG antibodies, immune complexes, or cell-mediated reactions are involved instead. These reactions can happen quickly or delayed for two to seventy-two hours or longer. Standard IgE-based blood tests and skin tests are often negative.

Virtually any part of the body can be affected by these types of allergies. About 95% of IgG-mediated reactions are not fixed. Therefore, after several months of avoidance, problem foods can be reintroduced into the diet in moderate amounts without causing symptoms as long as they are not eaten too frequently.

Over seventy medical conditions are thought to be associated with food allergies. These conditions can be respiratory (hay fever, asthma, bronchitis, recurring ear infections, sinus conditions, rhinitis, laryngitis, allergic sore throat, hoarseness); digestive (gastroenteritis, irritable bowel syndrome, celiac disease, inflammatory bowel disease, diarrhea, constipation, colic, malabsorption); cerebral (headaches, dizziness, sleep disorders, learning disorders, tension-fatigue syndrome, foggy thinking, irritability, depression); skin-related (dermatitis, eczema, angioedema, hives, rashes); or related to other body systems (arthritis, myalgia, urinary irritation, conjunctivitis, edema, hypoglycemia, diabetes, overweight, underweight, premenstrual syndrome, fatigue).

Why Do We Have Food Allergies?

Heredity is often cited as a cause of food allergies, and certainly plays a role since a recessive gene has been identified as being linked to IgE-mediated food allergies. Repeated exposure to the same foods, especially in large quantities, is also implicated. Other factors contribute to the severity and number of allergies most allergy-prone people endure.

The most common cause of multiple food allergies is having a “leaky gut,” or increased intestinal permeability. Small openings can occur in the lining of the intestine, which allow large molecules of undigested or incompletely digested food to enter the bloodstream. If the quantity is too great for the liver to “clear” almost immediately, the immune system has a chance to recognize these molecules as being foreign to the body and produces antibodies against them. When the food is eaten again and again passes into the bloodstream undigested or only partially digested, the antibodies bind with the food. These antibody-food complexes can travel through the bloodstream to any part of the body where they then cause problems.

There are many causes of “leaky gut.” Immaturity is one of them. Babies are born with higher intestinal permeability than older children or adults. Therefore, ideally infants should consume only breast milk for the first several months of life and other foods should be introduced cautiously. If breast feeding is impossible, a completely hydrolyzed formula such as Nutramigen should be used because it is already broken down into simple sugars, free amino acids, and other very small units. Cow’s milk is highly allergenic and should not be given to babies.

Toxins of many kinds can also increase intestinal permeability. These include alcohol, nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, arthritis medications, and many others), cytotoxic drugs used to treat cancer, corticosteroid drugs, and, by their action on bowel flora, antibiotics. Radiation therapy to the abdomen also increases intestinal permeability.

Internal factors in a patient's body can cause or contribute. These include nutritional deficiencies, inflammatory bowel disease, poor digestion, and food allergies. There is a vicious cycle involved with these internal factors since the leaky gut also causes them or contributes to their severity.

“Unfriendly” organisms present in the digestive tract can cause increased intestinal permeability. These infections can involve protozoan parasites, yeasts such as Candida albicans, bacteria that are conventionally considered “pathogens,” such as Salmonella, or an overgrowth of bacteria usually considered nonpathogenic, such as Klebsiella, Proteus, or Pseudomonas. Many other organisms not mentioned here can also increase intestinal permeability.

Most of the factors that increase intestinal permeability can be treated or eliminated from the lives of patients with food allergies. By doing this, the “why” of our leaky guts can be treated, and therefore our food allergies can be lessened and our health can be greatly improved.

The diagnosis of food allergies can seem complicated because reactions to foods are often delayed and may be affected by many factors, including insufficient rest, stress, and other allergens we are exposed to at the same time. Indeed, it is usually impossible to determine what you are allergic to on your own if you have more than a very few food allergies. Therefore, medical testing and help from the right health professionals is important.

Food allergies are often treated from several directions at the same time, such as eliminating allergens, strengthening the patient nutritionally, and modifying the patient's immune response. It is not something your doctor can do for you by himself or herself. (Indeed, many physicians do not understand allergies other than those mediated by IgE). As a patient with food allergies, YOU must be actively involved in your treatment. The most important parts of your treatment YOU will do, not your doctor.

Food allergy is a very individual problem, and you know your body better than anyone else does. It may be difficult to take action because of your health, but if you want to get well, YOU must take responsibility for yourself. YOU must make the necessary changes in your lifestyle. YOU must become a well-informed, active participant in your own health care. Then YOU will be the one to enjoy the benefits of improved health.

Diagnostic Tools

Elimination and challenge was the first type of testing used for food allergies. It is still often used in the clinical ecology units of hospitals or clinics and is considered the "gold standard" method of allergy testing for foods. The patient either fasts for several days (in a clinic under medical supervision) or at home eliminates the foods to be tested from the diet for five to ten days. The suspected foods are then eaten one at a time and symptoms are recorded. This method is difficult to use for delayed (non-IgE) food allergies.

Intradermal or scratch skin tests are used by many conventional allergists and are good for inhalant allergies. However, they are usually not reliable for food allergies because they detect only IgE-mediated food allergies, which make up only about five percent of all food reactions.

Provocation-neutralization testing is the most common in-office, or in-vivo test for food allergies. A small amount of a dilute extract of the food to be tested is injected into the skin of the patient's arm or given under the tongue. Any symptoms that result are recorded and the skin reaction is monitored. Then injections or sublingual drops of weaker or stronger dilutions of the same food extract are given. The dilution which does not provoke a skin reaction and clears up the patient's symptoms is the “neutralizing dose" and is used for neutralization treatment. This test works best with food reactions that happen quickly whether mediated by IgE or lgG.

Blood tests are the easiest tests for the patient to take. Hundreds of foods can be tested using one blood sample. There are several types of tests including RAST (Radio-Allergo-Sorbent Test), ELISA (Enzyme Linked Immuno-Sorbent Assay), and ELISA/ACT (Enzyme Linked Immuno-Sorbent Assay/ Activated Cell Test). RAST and ELISA tests can detect either IgE or IgG antibodies to foods in the blood sample.5 ELISA/ACT tests can detect IgG, IgA, and IgM antibodies, immune complexes, and cell activated reactions. They may also be able to direct you to a nearby clinic that uses these tests for diagnosis.) Blood tests can detect delayed as well as immediate food allergies. Food allergies that show up as positive on a blood test should be confirmed by an elimination and challenge test.

Treatment of food allergies

Special diets are the most commonly used treatment for food allergies. If the patient is allergic to only one or two foods, eliminating the offending foods may be the only treatment necessary. This is the course usually taken in the case of children with peanut anaphylaxis.

When a patient has multiple food allergies, the offending foods must be eliminated and all other foods should be eaten at intervals of four to five days or longer. This is know an a " rotation" or "rotary diversified" diet. Rotation diets are necessary for patients with multiple allergies because if you have overt allergies to many foods, it is likely that you have slight, subclinical allergies to many other foods that you consider safe. Eating them on a rotated basis reduces your exposure to them and hopefully will help preserve your tolerance for them.

Doctors prescribe rotation diets of varying degrees of strictness depending on the severity of your allergies. On the most strict diets each food is eaten only once on its rotation day and the length of the rotation cycle may be much longer than four to five days.

Some doctors consider rotation diets with very long cycles to be counterproductive. For most patients, a four to five day interval between eating foods gives the best masking of symptoms. A longer cycle may lead to "unmasking;" the patient reacts to and "loses" yet another food. However, there are patients who find that some foods agree with them better if they are rotated at longer intervals. The ideal rotation interval can vary from patient to patient and from food to food, but should never be less than four days.

On most patients’ rotation diets each food may be eaten more than once on the rotation day and the cycle is usually four to five days long. The rotation day can be any twenty-four hour period, not necessarily a calendar day. This means that leftovers from dinner can be eaten for tomorrow’s lunch. No food should be eaten in extremely large quantities. (For example, rice should not make up half of the food you eat on its rotation day). As long as many foods are included in the diet, this is an easy rule to follow. However, if patients become allergic to almost all foods and find themselves left with only two or three foods per rotation day, they will of necessity be eating those foods in large quantities. In this situation they will probably eventually become sensitive to the few foods they are eating. Efforts must be made to seek out new and unusual foods so the number of foods they are eating can be increased.

On a rotation diet, foods are rotated according to their biological classification in food families because foods in the same family have similar antigens. Usually the entire family is kept on the same rotation day. However, some doctors allow their less severely allergic patients to eat a different member of certain families on each day of the cycle. The families most often treated this way are the grain family and the cattle family. The rotation diet in the book 5 Years Without Food: The Food Allergy Survival Guide, treats the grain and cattle families this way.

On a rotation diet, food families that are not a major problem for you can be “split.” This means that you eat some of the foods in the family on, for example, day 1 of a four day cycle, and others of them on day 3.

When you first start on rotation, you may find it easiest to follow a set rotation diet such as the one in 5 Years Without Food: The Food Allergy Survival Guide. However, after a while you may tire of eating the same combinations of foods every fourth day. For variety you may wish to rotate different categories of foods on different lengths of cycles. For example, rotate your grains or non-grain alternatives, oils (and other foods in the same family), and fruit sweeteners used in baking (and therefore also the fruits they come from) on a four day cycle, so leftover baked goods from Monday can be frozen and eaten on Friday. Rotate meats or other protein foods and vegetables on longer cycles. Decide each day what vegetables and proteins you want to eat and record them so you can be sure you have not eaten the same or related foods for at least four days. Rotating foods at longer intervals this way may also improve your tolerance for them, although this is not the case for all patients.

Since most food allergies are not “fixed,” after you have avoided your problem foods for several months, your doctor may advise you to try to reintroduce them into your diet. When you are ready to liberalize your diet, you should eat your problem foods in moderate amounts and on a strictly rotated basis. You may find that you can eat some of them every fourth day with no problems, but that others must be rotated at longer intervals in order for you to tolerate them.

Medications and supplements may be used to help deal with food allergy symptoms. Gastrocrom is a prescription medication that can give people with food allergies some relief. It is sodium cromolyn, a drug which is taken by inhalation for hay fever and asthma and orally for food allergies. It must be used before exposure to an allergen, and works by preventing the release of histamine and other chemicals which initiate and mediate the allergic response. Because Gastrocrom suppresses symptoms without having any effect at all on the causes of food allergies, patients may get progressively worse while taking it, although they may initially feel better. Other allergy medications such as antihistamines may also help suppress your symptoms.

Digestive enzymes help you break down your food into smaller less allergenic molecules, thus decreasing your reaction to the foods you eat. They can be quite useful for short term use as part of the recovery process. Because digestive enzymes are large complex protein molecules, you may not want to use them for long periods of time without rotating the sources they come from or you could become allergic to the enzyme preparations themselves.

Vitamin C is a general anti-allergy supplement. We experience allergic symptoms when an allergen-antibody complex causes mast cells to release histamine and other allergy-mediating chemicals. Vitamin C helps stabilize mast cells so they are less likely to release these substances.

Large doses of quercitin, such as 4 to 6 grams per day, may also be helpful to some allergy patients.

Pantothenic acid is sometimes used for general allergy relief. It supports the function of the adrenal glands which make hormones that help us cope with allergic reactions. Bicarbonate preparations such as Alka Seltzer GoldTM, Vital Life Bi-Carb FormulaTM, or Tri-Salts are useful as a “quick fix” for food reactions. The pH of the body becomes more acid during an allergic reaction, and these supplements help alkalinize the blood, thus making you feel better. However, they should not be over-used because they neutralize stomach acid, which is essential to good digestion and to the support of healthy intestinal flora. Bicarbonate preparations are best used twenty minutes to an hour following the meal to which you react so they do not interfere with the digestion of your next meal. The bicarbonate preparations, as all supplements you use, should be hypoallergenic themselves. Alka Seltzer Gold contains corn and thus is not appropriate for corn-sensitive patients.

Immunotherapy may also be used to treat food allergies by modifying the immune response to allergenic foods. While standard conventional allergy shots are not effective for food allergies, two types of immunotherapy were developed in the 1960's that are useful. In this country, neutralization is the most widely used type of immunotherapy for food allergies. The patient is tested using the provocation-neutralization method described at the beginning of this part of the website, and the dilutions of food extracts which “neutralize” the patient's reactions are determined. These dilutions are called “neutralizing doses.” The doctor’s office then prepares a solution containing neutralizing doses of extracts for all the foods to which the patient is allergic. The patient takes this neutralizing solution either under the tongue or by self-injection. When an allergenic food is eaten, the neutralizing solution should turn off the patient’s reaction to the food. Because neutralizing doses change, patients must be retested frequently to keep their neutralizing drops current and working effectively.

The second kind of immunotherapy is low dose immunotherapy. Enzyme potentiated desensitization (EPD) is a type of low dose immunotherapy which has been used in England for about thirty years and was used for several years in this country as part of a study. When the study expired and problems were encountered with the FDA, an American-made injection called LDA, for low dose allergens, was developed. LDA is based on the same principle as EPD but is different and improved in significant ways, such as in that it in addition to common allergens it contains uniquely American allergens which are not present in EPD (cottonwood, sage, mountain juniper, some evergreens, American perfumes, "new" foods such as avocado, and more). Low dose immunotherapy is used to treat inhalant allergies, adverse reactions to chemicals, and food allergies all at the same time. It stimulates the body to make T-suppressor lymphocytes specific for allergen suppression. These lymphocytes retrain the body not to react to allergenic substances. The shots are taken every two months at first and then at progressively longer intervals. Many patients can discontinue treatment and remain symptom free after several years. Because the shots’ effectiveness is dependent on having the correct, very low dose exposure to allergens at the time the enzyme is given, the patient must avoid exposure to high amounts of allergens around the time of their shots. For severely allergic persons, it may take two to three years of treatment to achieve good results with all food allergens, but after that, most patients’ diets are usually unrestricted except for around the time of their shots. Retesting is never required.

LDA is new and American patients have had very good results with it. LDA works better than EPD for American patients because it is designed to "fit" the allergic exposures Americans experience rather than the exposures that the British experience.

The most effective treatments for any health problem are those that address the root cause of the condition rather than just treat the symptoms. By correcting the factors that contribute to food allergies and leaky gut, you can enhance the effectiveness of the treatments described in the last chapter and overcome your allergies.

Nutrition and Diet

Our bodies depend on the nutrients from our food for energy, repair, and all the functions of life. Even with a good diet, those of us with food allergies are often malnourished because our nutritional status does not depend only on what we eat, but also on what we digest and absorb. Therefore, attention to diet and nutrition is crucial to repairing our leaky guts and recovering our health.

Because we may not absorb nutrients from foods to which we are allergic, and because these foods contribute to the irritation of our intestine and further decrease absorption, the first thing to consider in planning your diet is that you do not eat foods to which you are allergic. If you have reached the point of having some degree of allergy to most common foods, seek out new foods which you have never tried before. Sources for unusual starches, flours, and game meats are also listed in the book. Large health food stores often carry unusual vegetables and fruits in their produce departments. You might also shop for produce at an international market or in the “exotics” section of the produce department in a large supermarket. As your health improves, or if your diet still contains only a few foods after you have added all the new ones possible, add back some of your least problematic foods on a carefully rotated basis, possibly using a longer cycle than four to five days. The extremely restricted diets often required by the severely allergic may add to the problem of malnourishment. A highly varied diet is the most healthy kind of diet for everyone to eat.

Vegetables and fruits should make up a large part of your diet because of the vitamins, minerals, phytochemicals, and fiber they contain. Dark green leafy vegetables are nutritional powerhouses in every way, and even contain good quantities of essential fatty acids.

High quality, non-allergenic protein is essential for the tissue repair involved in healing your intestine. Vegetarian diets are popular among those with health problems and, properly used, can supply this protein. However, if you are allergic to the beans and grains that are the best protein sources on vegetarian diets and must omit them or not eat them frequently, you will often be better off eating unusual fish or game meat and taking a hydrochloric acid supplement to help your digestion.

You also should pay attention to the types of fats you eat. While the fat in commercially raised beef is unhealthy, game meat is a good source of some essential fatty acids. Essential fatty acids are important to intestinal integrity, and are especially high in fatty fish, such as salmon and mackerel, and cold pressed oils, such as flaxseed oil. As with all foods, if you take flax oil every day, you may become allergic to it. Rotating a variety of oils is safer.

Supplementation is an excellent way to improve your nutritional status. The supplements you take should be hypoallergenic because, as with foods, you may not absorb nutrients well from preparations which come from or contain fillers made from foods to which you are allergic. The need for certain nutrients can vary as much as 30-fold from person to person. Food allergy patients can be profoundly deficient in some nutrients, so restoring the balance is essential to recovery. However, taking large quantities of single nutrients can cause deficiencies of other nutrients. Nutrient imbalances, like food allergies, can be complicated to determine without, or sometimes even with, professional help. If your doctor is not experienced in this area, you may benefit from consulting a nutritionist who, from your history, symptoms, and laboratory tests, can help determine your individual needs.

What we eat also affects our health through the presence of undesirable organisms in our food. All animal foods should be thoroughly cooked before you eat them. Thorough cooking is also the only way to be completely certain that plant foods contain no infectious agents. Plant foods that will be eaten raw should be treated with a disinfectant before you eat them. In Guess What Came to Dinner, Ann Louise Gittleman gives detailed instructions on how to disinfect food using CloroxTM and how to prevent getting a parasitic infestation from your food, water, travel, or pets. If you are not able to use CloroxTM due to chemical sensitivities, NutribioticTM, a grapefruit seed extract, can be used instead. In laboratory testing, it has been shown to be active against a wide range of bacteria, yeasts, fungi, and parasites.

Improving digestion

There are several things you can do to improve your digestion. The most basic is to pay attention to how you eat. Try to be in a relaxed frame of mind when you eat. Chew your food very thoroughly. Chewing breaks the food down into smaller particles that can be acted on more easily by your digestive system, starting in the mouth. When you chew well, you begin the process of starch digestion by mixing the food with the enzyme salivary amylase.

Drinking water with meals is a controversial subject. Some have suggested that it “dilutes the digestive juices.” Using large quantities of water to wash down food rather than taking the time to chew thoroughly is a practice to be avoided. However, studies have shown that a moderate intake of one to two glasses of water with a meal improves digestion by facilitating both the production of gastric secretions at the time you eat and also the secretion of bicarbonate into the small intestine that normally occurs one to two hours after a meal.

The presence of undigested food in the stool indicates a deficiency in the secretion of hydrochloric acid by the stomach, of digestive enzymes by the pancreas, or both. These deficiencies can be helped by supplementation. Digestive enzymes are available as supplements in several forms. Pancreatin is an extract of the pancreas of cows or pigs and is a very potent, broad-spectrum aid for the digestion of proteins, fats, and carbohydrates. However, if you are allergic to beef or pork, you will probably not tolerate pancreatin.

Dr. William Philpott recommends the rotation of digestive enzymes on a four day cycle. This can be accomplished by using pancreatin (from pork and beef), plant enzymes (from Aspergillus orazeae), bromelain (from pineapple), and papain (from papaya). Bromelain and papain are active in the digestion of protein only.

In his book, Digestive Enzymes, Dr. Jeffrey Bland says that while enzyme supplements can be an important part of breaking the vicious cycle of maldigestion and starting us on the road back to health, we should not have to take them forever. He recommends a regimen of vitamin C, vitamin A, zinc, and pantothenic acid to improve digestive health in general. You might want to discuss this protocol with your doctor or nutritionist and consider trying it.

It is estimated that 80% of patients with food allergies suffer from some degree of impairment of hydrochloric acid secretion by their stomachs. This can range from the complete absence of hydrochloric acid (achlorhydria) to a deficiency in the amount of hydrochloric acid secreted (hypochlorhydria). The passage of acidic stomach contents into the small intestine is the stimulus for the pancreas to release digestive enzymes and bicarbonate. Therefore, if you have hypochlorhydria or achlorhydria, you may not secrete digestive enzymes properly even if your pancreas is fully able to do so. This is one of several reasons that hydrochloric acid supplements may be essential to your return to health.

However, hydrochloric acid supplements, if not needed or if taken in too large amounts, can cause ulceration of the stomach. Supplementation with betaine-HCl (from beets) or glutamic-HCl (from grains) should be done only under medical supervision. Your doctor may perform a Heidelberg gastrogram, which is a test that determines your ability to secrete hydrochloric acid. To do this test, the patient swallows an instrument the size of a large capsule which has a string attached to it for retrieval. The instrument then transmits information about the pH of the digestive tract and how it changes when the patient drinks a bicarbonate solution. Or your doctor might suspect hypochlorhydria because of the presence of undigested food in a stool analysis. Rather than doing a Heidelberg gastrogram, he may have you take gradually increasing amounts of a hydrochloric acid supplement and report your symptoms to determine your degree of need for hydrochloric acid.

Surprisingly, a common symptom of hypochlorhydria is heartburn. Television commercials tell us when we have heartburn we should neutralize our stomach acid with various antacids, or, even more drastically, take medications which have recently become available “over the counter,” such as ranitidine, cimetidine, nizatidine, or famotidine, which reduce our production of stomach acid. For those who have heartburn because of hypochlorhydria, these medications may bring relief of heartburn but could lead to poor digestion and thus to dysbiosis, leaky gut, and food allergies. Before you risk compromising your health with these medications, ask your doctor to help you find out if your real problem might be inefficient production of hydrochloric acid.

In addition to stimulating the release of digestive enzymes, hydrochloric acid plays other roles in your health. It is essential for the ionization of minerals so they can be absorbed. It is interesting to note that some cases of iron deficiency anemia and other mineral deficiencies can be traced to low hydrochloric acid production. Protein cannot be digested without sufficient hydrochloric acid. This acid is responsible for nearly sterilizing food in the stomach, so insufficient secretion can result in bacterial overgrowth of the small intestine, as discussed in the section on dysbiosis later in this part of the website. Finally, hydrochloric acid promotes a friendly pH for the growth of Lactobacillus and Bifidobacterium in the small and large intestine.

A final possible way to improve your digestion, in addition to chewing thoroughly, relaxing at mealtimes, and taking any necessary hydrochloric acid or digestive enzyme supplements, is the system of "food combining." Although there is no proof of its validity, this system has been in use for over eighty years and there are many testimonials of improved health as a result of following it. It is based on the principle that protein and starch require different conditions in the stomach for optimal digestion. A very acid stomach is best for protein digestion and a less acid stomach, in which salivary amylase is more active, is best for starch digestion. Therefore, to make the job of your digestive system a little easier, protein and starch should not be eaten together in the same meal. Some food combining schemes are very restrictive and eliminate whole groups of foods. A highly varied diet of all the nutritious foods you can tolerate is vital to your recovery. However, other food combining plans are less strict and include all foods except refined flours and sugar.

In the more liberal food combining plans, the "rules" are simple. Foods are divided into three groups: protein, starch, and neutral. Foods from the neutral group may be eaten with either starch group or protein group foods. An example of such a food combining plan is included in 5 Years Without Food: The Food Allergy Survival Guide. Some of the stricter plans direct that fruit be eaten alone on an empty stomach for quick, thorough digestion. This seems to help some people with yeast problems to tolerate eating fruits better.

The Body Ecology Diet by Donna Gates is based in part on the principles of food combining. Patients with candidiasis who have tried many other ways to overcome it report finally achieving good health after using the body ecology diet. Food combining may make things a little easier for your digestive system, improve nutrient absorption, and decrease the amount of undigested food present to feed unfriendly organisms.

A healthy person lives in harmony with his or her intestinal flora. The person provides a home and food to over 400 species of bacteria. The bacteria, which in a healthy person will be predominantly "friendly" types, do a myriad of health-promoting things for the person, including detoxification, the production of vitamins, and protecting us from unfriendly organisms.

Sometimes this state of happy balance does not exist because of the presence of frankly pathogenic organisms, the overgrowth of unfriendly organisms that are often not considered pathogenic, or the absence of friendly bacteria. Then, dys-symbiosis, or dysbiosis exists. Dysbiosis can be caused by protozoan parasites (Entamoeba histolytica, Entamoeba coli, other Entamoeba, Dientamoeba fragilis, Endolimax nana, Giardia lamblia, Blastocystis hominis, Chilomastix mesnili, and others); yeast (Candida albicans, other Candida species, Torulopsis glabrata, and others); or bacteria (Salmonella, Shigella, Campylobacter jejuni, Yersinia enterocolitica, Klebsiella pneumoniae, Citrobacter freundii, Citrobacter diversus, Proteus mirabilis, Pseudomonas aeruginosa, some strains of Escherichia coli, Staphylococcus aureus, some strains of Bacteriodes, Clostridium difficile, and others). Some of these organisms are not considered "pathogenic" by conventional medicine. However, weak pathogens, or a predominance of "unfriendly" organisms can cause severe illness in a chronically ill, weakened, or malnourished patient. The eradication of these organisms can make a dramatic difference in the patient's health.

A very common cause of bacterial or fungal dysbiosis is often the repeated or long term use of antibiotics. Antibiotics kill both the bacteria you want them to kill and the "friendly" bacteria in the intestine and the vagina. This leaves these areas open to be colonized by yeast, unfriendly bacteria, and parasites.

Parasitic infestations are on the increase because of changes in our lifestyles that have occurred over the last few decades. International travel is now commonplace. If you are not a traveler, the world and its parasites will come to you, brought by imported produce and immigrants from countries where sanitation is sub-standard. Eating out in restaurants frequently and the close contact of day care centers contribute to the spread of parasites.

Maldigestion can also promote dysbiosis. Dr. Martin Lee says, “Colonic flora is a reflection of what it is fed.” If food is completely and rapidly digested and absorbed in the small intestine, it is not available to nourish unfriendly bacteria or yeast in either the small or large intestine. Almost all that is left to reach the large intestine is fiber, which is a favorite food for friendly bacteria such as Lactobacillus and Bifidobacterium and promotes their growth.

Diet can also contribute to dysbiosis. A diet high in flesh protein and low in plant foods promotes the growth of Bacteroides species, but a lacto-vegetarian diet, based on milk products and plant foods, promotes the growth of Lactobacillus and Bifidobacterium. Elaine Gottshalls's book Breaking the Vicious Cycle prescribes the “specific carbohydrate diet" for patients with inflammatory bowel disease. This diet eliminates all grains, sugar, lactose, other disaccharides, and some starches that such patients may be unable to digest and absorb. This leads to a shift in bowel flora towards normal and improvement in symptoms.

The ideal diet for patients with candidiasis is the subject of considerable debate. Several years ago, high-protein, low-carbohydrate diets, on which the grams of carbohydrate may have even been counted, were used. Then Dr. William Crook began using diets higher in complex carbohydrates for his patients. Simple carbohydrates, such as fruits, were still restricted initially. Dr. Crook said that, in his many years of experience, the only absolute he had determined to be essential for the diet was that sugar had to be avoided. He said that all the Nystatin or Diflucan in the world will not eradicate Candida if a patient continues to eat sugar. Recent German studies suggest that very low carbohydrate diets may be counterproductive because they cause the Candida to become invasive and penetrate deeper into the tissues in search of food.

Dysbiosis caused by bacteria or yeast can be diagnosed using a stool test called a comprehensive digestive stool analysis (CDSA). The microbiology part of this test differs from a standard “stool culture,” which usually only reports the presence or absence of aerobic (oxygen-loving) bacteria considered "pathogenic" by conventional medicine, such as Salmonella and Shigella. A CDSA tests for the presence and amount or absence of all aerobic organisms and the friendly facultatively anaerobic organisms Lactobacillus and Bifidobacterium. The organisms a CDSA reports include yeast of all kinds, all normal and abnormal aerobic bacteria, Bacteroides, Lactobacillus, and Bifidobacterium. A CDSA also gives your doctor chemical information that reflects the health of your digestive system. This information includes the presence and amount or absence of undigested protein and plant fibers, fats, fatty acids, occult blood, and other metabolic markers. This information may be suggestive of conditions that are affecting your health in general. Tests for dysbiosis, such as a CDSA or a parasitology test, as discussed below, may be the most important tests you do and should not be omitted for any patient with severe food allergies or digestive problems. Great Smokies Diagnostic Laboratory can refer you to doctors in your area who use the CDSA to evaluate their patients.

In-depth parasitology testing should also be done to determine if parasites are causing dysbiosis. Such in-depth testing can be done best by a specialized parasitology lab such as the Institute for Parasitic Diseases. The parasitology testing you should have done differs from the standard “ova and parasites” test done at most hospital laboratories in several ways. This testing will report organisms that would not be reported on a standard test because they are not considered “pathogenic” by many in conventional medicine, such as Blastocystis homonis. Also, since specialized laboratories have more experience in looking for parasites, they are more likely to find any that are there. However, even when the test is done by an experienced laboratory, Dr. Leo Galland says that parasitology testing should be “taken with a grain of salt.” Stool samples, by their very nature, contain a lot of debris mixed with a very few parasites, eggs, or cysts. It not always easy to distinguish a degrading white blood cell or other material from something significant. For this reason the test may be reported as negative when the patient DOES have parasites, even if it is done by a competent technician at an excellent laboratory. The more samples submitted, the more likely a parasite will be picked up. The use of purged stool specimens or rectal swabs also increases the chance of recovering parasites because they are dislodged from the intestinal wall. A patient may have several negative tests and still have parasites.

Intestinal dysbiosis can be treated with a variety of prescription and botanical medicines to rid your body of unfriendly organisms. Your CDSA results include sensitivity testing which indicates which medicines are effective against your particular unfriendly bacteria and yeast. Treatment of dysbiosis caused by bacteria and/or yeast will also usually include supplementation with friendly probiotic organisms such as Lactobacillus and Bifidobacterium. Dr. Leo Galland does not recommend taking probiotics while under treatment for parasitic infestations because bacteria are “food” for protozoal parasites: save your probiotics to take after the course of anti-parasitic treatment is completed. Your doctor may also direct you to take nutrients that help your intestine heal, such as L-glutamine (the major source of nourishment for the cells lining the small intestine), N-acetyl-glucosamine (which stimulates the production of intestinal secretary IgA, a protective factor), and butyric acid (which promotes healing in the large intestine), or other nutrients.

A few supplements you may be taking can be counterproductive to the treatment of dysbiosis and are mentioned here so you can avoid them. Iron supplements feed unfriendly bacteria and protozoan parasites. Fructooligosaccharides (FOS) also feed some unfriendly bacteria, especially Klebsiella pneumoniae, hemolytic E. coli, Bacteroides species, and Staphylococcus aureus. As mentioned above, protozoal parasites “eat" bacteria, so your doctor may advise you to avoid probiotics during the course of anti-parasitic treatment. Cysteine, glycine, and glutathione, while important antioxidants, can stimulate the growth of yeast in some patients with candidiasis. If you are taking botanical remedies for dysbiosis, your doctor may tell you to temporarily avoid all antioxidants because botanical medicines kill parasites and bacteria by oxidizing them, and thus, antioxidants reduce the effectiveness of these remedies.

Some substances cause increased intestinal permeability and can compound the problem of "leaky gut " and contribute to food allergies. They include alcoholic beverages, nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, ketoprofen, naproxen, prescription arthritis medications, etc.), chemotherapeutic drugs for cancer, radiation therapy to the abdomen, and corticosteroid drugs. There may be times, such as if you have cancer, when you have to take some of these treatments. But “just say no” to using the ones that you have a choice about, such as alcohol and nonsteroidal anti-inflammatory drugs for pain relief.

Nonsteroidal anti-inflammatory drugs are now being sold without a prescription and without much warning about their side effects. For anyone with even the possibility of compromised intestinal health, a single dose of a nonsteroidal anti-inflammatory drug can increase intestinal permeability tremendously. Food allergy patients and first degree relatives of people with Crohn's disease fall into the “possibly compromised” category. If you need pain relief medication, try using heat, herbal pain relief remedies, supplements such as DL-phenylalanine, or acupuncture rather than resorting to nonsteroidal anti-inflammatory drugs.

In a study of factors that might cause inflammatory bowel disease in mice, indomethacin, a prescription nonsteroidal anti-inflammatory drug, induced symptoms of Crohn's disease in normal mice, but not in germ-free mice. The study concluded that some interaction between the indomethacin and intestinal flora produced inflammation. Perhaps the indomethacin caused “leaky gut,” which then allowed the mice to become sensitive to their intestinal flora. The Physician's Desk Reference warns about the possibility of gastrointestinal bleeding, ulceration, and perforation when using nonsteroidal inflammatory drugs, and reports that one arthritis drug can lead to the development of inflammatory bowel disease. Dr. W. A. Shrader, Jr. says that all nonsteroidal anti-inflammatory drugs cause some degree of mucosal atrophy in the intestine.

If people with food allergies avoid harmful substances and address the factors at the root of their problems, such as nutrition, digestion, and dysbiosis, their allergies CAN be overcome. It may take time and some of the medical treatments discussed in this website may also be needed, but good health can be possible.

Internet resources

American EPD Society - http://www.epdallergy.com/

Foods: Purity Foods (spelt flour) - http://www.purityfoods.com

Special Foods (exotic tuber flours) - http://www.specialfoods.com

For a list of doctors in your area, contact
American Academy of Allergy, Asthma & Immunology 800-822-ASMA
American College of Allergy, Asthma & Immunology
800-842-7777
American Academy of Pediatrics
800-433-9016

Special Foods for Special Kids Practical Solutions & Great Recipes for Children With Food Allergies by Todd Adelman, Jodi Behrend provides support, special diets, recipes, and resources for parents who have children with food allergies or intolerances.

A great book for all parents and care providers faced with nutritional and healthy diet challenges. Realistic solutions and recipes for special foods geared exclusively toward children's tastes.

The cover shouts that this will be a fun cookbook to use, as well as a practical one. Imagine the families who have children with allergies or special dietary needs. It must be frustrating to try to adapt recipes for every meal on a regular basis. The authors of this book have done all the work for those parents. At the same time, they've created a book that anyone with kids will enjoy cooking with.

The authors start with a little background about how many suffer from food allergies and the type of symptoms which can occur. For us lucky parents who don't have to deal with this, it is eye-opening to consider how careful other parents have to be with every single thing that goes into their children's mouths. The authors are experienced chefs and educators who are adept at sharing information without boring their readers. This book is not just about recipes, but nutrition as well, including appropriate substitutions for each possible culprit in the pantry.

Recipes are included for every meal as well as snacks, desserts and drinks. Through a combination of pictures, each recipe notes what substitutes can be made for potential allergens like dairy, gluten and eggs. A complete nutritional guide is also included. My son was eager to try the corn dogs, his favorite menu choice at the fine dining establishments we frequent. The recipes are printed in an easy-to-read format so children can use it as well as adults. This was my first attempt at making corn dogs however, and I found it difficult to wrap the hot dog pieces in the dough. It could be that my cornmeal was not ground fine enough. They tasted good even if they weren't restaurant quality!

Todd Adelman and Jodi Behrend also included an extensive resource list in Special Foods for Special Kids for parents to look up more information for their children's issues. I would recommend "Special Foods for Special Kids" to anyone with children or food allergies. You never know when you might have one of your children's friends over who is allergic to gluten. Or you have to take cupcakes to school and you can't include peanuts. Keep this cookbook handy and refer to it often. Remember there is always something cooking in the kitchen, but it doesn't have to make your children sick.

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