Following on from last Thursday’s article (linked here) which took a deep dive into immune function, reactivity, sensitivity and all the sensitivity testing available (and the problems with it!)… Here is Part 2 – where I worry about it all openly here so you understand my clinical musings on this topic…
And I really do worry about all immune/sensitivity testing because, by its very nature, it isolates food from the human consuming it. By dropping blood on substances and checking for antibodies, or even testing for immune mediators in the white blood cells with MRT, you’re still abstracting this whole process from the very core of the human being.
Forget about test validity, forget about the problems with the way foods are prepared for a moment…
I don’t know about you but I rarely eat food by simply exposing my blood to it. I kind of put it in my mouth, chew, swallow, digest, let it swish around in my stomach for a bit and then get pulverised, broken down and basically … you get the picture.
Testing blood markers for an indication of how that food will interact with your complete human biology therefore seems… well… a bit like looking at way less than half a story.
Antibodies are just a small part of the body’s response. What about things like mast cell degranulation on contact, which releases a host of cytokines – no antibodies required? What about the dysbiotic gut environment which makes digesting certain foods so difficult that there is congestion, toxins recirculate and then there is an immune response…
None of the total-body responsiveness to foods is shown on sensitivity tests. Which means that for patient utility, they don’t rank highly in gauging how the body will respond to the consumption of certain foods.
What About The Good Old Elimination Diet?
The only thing that will show us the whole-body response, and for once there is a bit of a consensus in Functional Medicine, is an Elimination Diet.
The purpose of this, as I have said many, many times, is not only for the 4-6 week period eating very limited, low inflammatory foods. The bigger role of any Elimination Diet is the journey you go on when you add foods back in to the diet.
Some would say that having a Cyrex or MRT test for food sensitivities can advance this process. It could be argued that by eliminating only the foods which have shown positive through testing, the elimination phase is less punitive and more personalised. It is also true that there are some foods even on elimination diets which may cause reactivity which will be flagged on sensitivity tests and excluded alongside the other eliminations. Theoretically, therefore, a sensitivity test prior to commencing would truly nuance this process.
However, immunity is a funny and finicky thing. We know that you can develop immune reactivity to substances you repeatedly consume. We also know you can develop intestinal permeability in periods of high stress – so what your immune system is producing antibodies to may be more to do with how stressed you are and what you’ve eaten a lot of, rather than a true difficulty with each food.
A sensitivity test in this case would more than likely exclude perfectly ‘safe’ foods, just because of a moment in time where the immune system noticed that food and made an antibody… just in case.
This highlights my main struggle with food sensitivity testing: it is not held by practitioners in the light that it should be. However sparkly and flash the test, it is (as all tests are) just a snapshot in time of one, very singular, part of immune function.
I get it totally: with patients for whom food has become an issue and a battlefield, with reactivities popping up everywhere, there is often a sense of a state of complete confusion. A very expensive food intolerance test is often held up by practitioners as a route through that confusion – a beacon of clarity at the end of a process of going through hell with your body and its behaviour in response to foods.
This is an unfair and unrealistic expectation.
There is nothing wrong with the (good quality) testing, per se, but these food sensitivity tests MUST be interpreted in the light of the whole patient and their struggles, their recent diet and their long-avoided foods. It’s no good assuming that a negative to a food you have never eaten means you should go forth and consume that food freely, ignoring symptoms which occur because you “can’t possibly be sensitive to it” (your food sensitivity test told you so!).
These sensitivity tests are also not ‘the only thing you need to do’ to resolve reactivity. Eliminating the foods that crop up on them is not a cure, and it possibly isn’t even necessary – certainly not long term.
I have seen clients who are still avoiding common foods (like green beans or cauliflower) long, long after their food tolerance test. Years after they have been told they are ‘reactive’ to these foods, they’re still stuck in the place where they can’t let themselves have them because they believe they have immune sensitivity to them
Food sensitivity tests are just one more tool in the Functional Practitioner’s armoury, and should be used as such – appropriately, in context of case history and with awareness of what they can and cannot tell you about a patient’s immune health.
Yes, I do use them. I use them in cases where I need to express to a client that they are reacting badly to gluten and it is causing them immune challenges that they may feel healthier if they weren’t experiencing.
I use them if my patient is so completely frightened and out of touch with their own body that they could do with some support and boundaries – hard ‘paper’ evidence, if you like – in order to feel comfortable within a slow elimination process.
I also use the more complex Cyrex autoimmunity and neurological testing for certain involved cases, and also for those who want ‘proof’ that their body is creating antibodies to some of their own tissues. Having this ‘reason’ or ‘evidence’ is sometimes a huge motivator for lifestyle change.
What I don’t use these tests for is to make money (I have seen practitioners charge ludicrous commissions on top of Cyrex tests, and they’re already expensive). And I don’t use them just so I can get a basis for my clients’ diets – because that’s lazy “nutritionalism” and bears no relationship to gaining clinic data by listening to client stories of how they feel and how they digest certain foods.
Is All This Focus on Intolerances Even Necessary?
Beyond all of the debate of testing appropriateness and usage, I do have one last comment to make about all of this focus on allergens, intolerances, sensitivities and immune dysregulation…
I have recently been looking over clinical notes from some of my countless hospital inpatients stays. It has become eminently clear to me that in my lifetime the understanding of how the immune system interacts with the world around it has radically evolved. When I first became ill no-one even concentrated on basic vitamin and mineral deficiencies, let alone the intricate balance of sensitised immune function. (In my early days of illness, being gluten free wasn’t even a ‘thing’ yet…)
Now, intolerances are everywhere. You can argue about whether that’s due to vaccines, excessively toxic environments, increased electricity exposure and/or the prevalence of poor-quality foodstuffs in our diets. I have my own thoughts about the issue of increased reactivity, which I won’t go into here.
However, as a patient myself I have had to find a way to deal with the burden of awareness that arises when you understand your immune system is sensitised – whatever the reason.
What absolutely does NOT help in the light of an awareness of immune sensitivity, is scaremongering.
What seriously doesn’t help is perpetuating a myth that if you don’t know what a food is doing to you, it might be causing you ‘hidden’ damage that you ‘can’t even see’. The concept of how ‘silent autoimmunity’ might destroy your body from the inside out if you continue to eat [fill in the blank] (gluten/sugar/dairy/soy/GMO/corn/eggs/nightshades etc. etc.) is psychologically damaging – and this alone is enough to exacerbate stress and undermine health.
I am watching it happen in my practice – my clients are so much more afraid these days. “Healing” diets, nutritional manipulations, healthcare books on elimination protocols or biohacking and internet blogs about longevity, neurodegeneration and ‘improving health outcomes’ flood our brains – and we are creating an environment where fear dominates the healthcare dialogue.
“Health” becomes a list of things that we must avoid – an encyclopaedia of ways to protect ourselves – and a laundry list of ‘supplements’ for support…
Being healthy becomes a scary mountain to climb and seems an impossible task in an environment of constant threat.
Food sensitivity testing feeds into this paranoia. Somewhere we are sold the lie that the only way to truly know how to eat is to microanalyse our bodies’ blood in order to see what makes it happy, or not. To my mind this is corrupting the very essence of what it is to be a human being, with complex, multi-layered systems at work within every biological situation – especially immune sensitisation.
It reinforces the separation of mind and body that is becoming common in our modern world. We have long forgotten how to tune into our bodies and listen to their messages. Instead we are outsourcing our decision making to apps, bits of paper and the propaganda of those for whom certain foods (gluten, sugar, even ‘all carbohydrates’) have become a toxin.
In environments like this, I would argue that, far more toxic than the foods themselves, is the attitude.
But before I write a whole, epic rant about fear mongering in healthcare – which could go on for literally pages – and slam how money-making propaganda backing food testing can play on people’s paranoia… (and before I go into what is really necessary to restore, recover and pacify an immune system) I will conclude with the following:
Food sensitivity tests can, and do, have a place in clinical practice. For some, they are absolutely worth it.
What they are not, however, is a roadmap to healing. Following the recommendations to eliminate the foods you are sensitive to is not a guarantee of digestive wellbeing and symptom reduction. And they are, in no way, a reflection of your immune system’s lifelong ability to tolerate certain foods.
Food sensitivity tests, as with all tests, have their place. But they are powerful tools and must be used appropriately, held lightly – and put down when there is no longer a call for them.
If you’re wondering what your sensitivity tests mean, how to interpret or use them – or why you’re not getting better even though you’re following them closely – the likelihood there’s other ‘stuff’ going on that you need to figure out. Please do reach out if you think that I could be of any help to you and I would love to assist you with navigating your way back to eating without fear or symptoms…