Food allergies and intolerances are rapidly becoming recognized as a significant trigger to initiating
immune mediated response and inflammatory symptoms in individuals. Most chronic illnesses have a
known inflammation component that drives its progression. This issue of underlying inflammation has
become evident as a risk factor with the current pandemic.
Metaflammation (a new term used in the clinical literature) is a chronic state of hyperimmune issues that
include increased production of inflammatory cytokine release. Current literature supports the fact that food
allergies, intolerances and sensitivities are directly tied to metainflammatory sequelae and the release of
GUT mucosal IgE and IgG type antibodies.
Screening for food allergies, sensitivities and intolerances helps determine where your patient “is”
regarding underlying gut/immune responses. Identification of offending foods can provide valuable insight
into dietary suggestions to help patients with their inability to overcome chronic
inflammatory processes even with current accepted treatments.
Food intolerances/sensitivities should be assessed as a baseline to promote health and
wellbeing. Chronic inflammatory conditions like
autoimmunity, skin conditions, allergies, IBS, colitis type 2
diabetes and insulin resistance, thyroid issues, cardiovascular
issues, cognitive decline and sex hormone imbalances are all areas where
knowledge of food allergies and sensitivities could add tremendous insight to
management of these conditions.
1 Food sensitivities and intolerances
issues, which are IgG mediated, are much more common than true food allergies, with one study
estimating a prevalence of 15-20% of the population.
2
But how often should you test for food issues?
At a minimum testing for food allergies and sensitivities should be yearly so that the patient be more
proactive in disease and symptom management. If they have significant health challenges or benefit from
following the elimination guidelines, retest every 4-6 months in the first year.
The Basics – Food and GUT Interactions
The human GUT microbiome is currently becoming a focal point of health research – the importance of
GUT signaling to other organ systems has been greatly underappreciated as a major cause of
illness/imbalance, allergic conditions, food and chemical intolerances/ sensitivities, Type 2 diabetes/insulin
resistance, cardiovascular diseases, chronic inflammatory conditions, immune and autoimmune conditions,
chronic kidney and liver diseases, GUT related issues and brain disorders (mood, cognition,
inflammation).3,4,5
As we know, the GUT houses over 70% of immunity as GALT (gut associated lymphoid tissue) and MALT
(mucosal associated lymphoid tissue).
6 GALT interacts with GI functions
in a dynamic manner – GALT increases intestinal permeability in
response to particular stimulations like high stress, or orientating the
immune response towards luminal content, allowing either tolerance or
elimination/degradation of luminal antigens, which sometimes provokes
damage to the intestinal mucosa.7 Involved in this complex process are
the lymphocytes Th1 and T regulatory cells (Tregs). The results of their
interactions depend upon different contexts in which contact with external
agents occurs and may change according to different foods you
eat, stress levels, sleep patterns, and environmental toxin
exposure (like pollution, heavy metals, pesticides, plastics,
etc.). There is increasing evidence from human studies
suggesting that GUT dysbiosis, which permits food substances
to gain access to circulation (permeability changes), is
associated with pathogenesis of IgG based food
intolerances/sensitivities.
8,9,10,11 Increased production of food
specific IgG antibodies coupled with decreased production of
anti-inflammatory cytokines such as IL-10 and TGF-beta1
have been implicated in irritable bowel syndrome (IBS).12,13
Similarly, a strong association between IgG-mediated food
intolerances/sensitivities and neurological manifestations such as migraine, atherosclerosis, chronic fatigue,
asthma and even hair loss.
14,15,16
Briefly, dysbiosis occurs when the GUT microbiome is disrupted by foods
like high inflammatory, sugar and high saturated fat diets, environmental
intoxication with heavy metals/pesticides/plastics and other noxious
agents, leading to an overgrowth of yeast (Candida) and other “unfriendly”
microorganisms along with the production of lipopolysaccharides – LPS.
This increased production of LPS places stress on the signaling between
the GUT-IMMUNE-BRAIN network axes.
17,18 Eventually this will lead to
disrupting other network signaling related to brain neurochemicals,
thyroid hormone, sex hormones, insulin and cardiovascular/neurovascular
dynamics. Enhanced GUT permeability is where proteins and other substances can pass through the gut
mucosal defense and makes it through the lamina propria to the blood stream, activating the immune system
– this can lead to allergic symptoms, fatigue, “foggy headedness”, immune and mood/cognitive problems,
weight gain and a host of other conditions.
19
Factors that can influence the health of the GUT and GUT microbiome, and thereby increase the risk of a
food intolerance/sensitives include: 20,21,22,23,24
- Stress levels
- Environmental toxin exposure including from foods
- Drugs (Drug-Induced Microbiome Disruption DIMD) including
o Antibiotics
o Oral contraceptives/hormone replacement therapy
o Chemotherapy
o Corticosteroids – prednisone, others
o Statins for cholesterol
o Metformin (blood sugar regulation)
o NSAIDs – non-steroidal anti-inflammatory including ibuprofen - Factors that can influence the health of the GUT and GUT microbiome, and thereby increase the risk of a
- food intolerance/sensitives include: 20,21,22,23,24
- Stress levels
- Environmental toxin exposure including from foods
- Drugs (Drug-Induced Microbiome Disruption DIMD) including
o Antibiotics
o Oral contraceptives/hormone replacement therapy
o Chemotherapy
o Corticosteroids – prednisone, others
o Statins for cholesterol
o Metformin (blood sugar regulation)
o NSAIDs – non-steroidal anti-inflammatory including ibuprofen - o PPIs – ulcer medications proton pump inhibitors
- o Antipsychotic and antidepressant medications
- o Opioids
- o Alcohol
- o Most all drugs can affect microbiome – most drugs also contain chemical dyes and
- chemical “excipients” that aid in manufacturing
- Poor Diet – high sugar, inflammatory foods, acidic foods, artificial sweeteners and additives/dyes,
antibiotics added to foods (i.e. most shredded chesses contain natamycin), contaminated foods
(heavy metals, pesticides/herbicides/fungicides), water quality, high meat diet low in plants; low
fiber diet - Infections – LPS and leaky gut issues
- Sleep quality and quantity
- Intense exercise
Exercise is important to keep digestive processes regular. Exercise alters gut microflora, helping benefit
the “good” bacteria. HOWEVER, if you have a strenuous exercise program, to the point of over exercising,
you can damage your GUT microflora and cause metabolic imbalance. 25
Testing Annually
Unless on a strict diet and stress-controlled life, your patients GUT integrity and microbiome will vary
greatly during a year. So, in general, due to the intricate link between the GUT, metaflammation, and food
issues, most individuals will need to test for food allergies, intolerances and sensitivities at least annually.
Look not only at IgE, but for IgG, IgG4 and complement food interactions. IgG4 reactions have been tied
to development of autoimmunity and C3 b/d dramatically increases the reaction of the immune system to
food up to 10,000 fold.
Conclusion
Many people realize when they are having issues with food and can tell something in their diet is affecting
them. Others may not connect their symptoms to the foods they eat. These issues can drive significant
problems with a host of chronic health conditions in tow. Our body can be inflamed in different ways, not
only from IgE, but total IgG, IgG4, and complement. Testing for these, at least annually, can help improve
your patient’s health and well-being. Following a diet that minimizes foods that provoke these responses
will decrease many types of inflammation and symptoms and is foundational to wellness.
