by J. C. Waterhouse, Ph.D
Many people have found that reducing food allergies, sensitivities and intolerances has been helpful in reducing a wide range of symptoms and reducing exacerbations in many diseases in which the immune, endocrine or nervous systems are involved (e.g., chronic fatigue syndrome, fibromyalgia, migraines, asthma, inflammatory bowel disease, irritable bowel syndrome and autoimmune illnesses, such as multiple sclerosis, lupus, and rheumatoid arthritis). This article focuses on food reactions, although reactions to inhaled chemicals are also important and will be touched on briefly. Food allergies/sensitivities/intolerances are often neglected because the reactions may be complex and variable, and involve multiple immune and non-immune mechanisms. Only a small proportion of people experience very obvious reactions, like an immediate rash or anaphylactic reaction (IgE mediated, Type I reaction). More common and more difficult to detect are the delayed immune sensitivities (Types II, III and IV) and the intolerances, such as lactose, gluten or fructose intolerance, or problems due to lectins or oxalates. Even the IgE mediated reactions are not always easy to identify and may include a late-phase reaction. Reactions are not limited to proteins, but have been shown to occur when other substances combine with proteins to form haptens. Increases in intestinal permeability due to a variety of causes can allow potentially allergenic substances to enter the blood stream. (Note: for convenience, allergy or allergen is meant to include all types of IgE and non IgE reactions.)
Unfortunately, many people do not realize that food and chemical allergies are contributing to or causing their symptoms. The phenomenon of masking, the multiplicity of mechanisms and tests, the effects on systems other than the gastrointestinal tract and the changing level of sensitivity with exposure, all complicate the identification of food reactions. Some people try just one type of test and eliminate a few foods and believe this is all they can do. Many do benefit greatly in this way, especially if the test is fairly comprehensive, like the ELISA/ACT test (covers 390 foods and chemicals and Types II, III and IV sensitivities; a controlled study showed that use of the test results led to a 30-50% symptom reduction in fibromyalgia patients). However, for others, an incomplete approach leads them to miss many foods that cause reactions via a different mechanism and/or they develop new sensitivities to the foods that replace those they eliminated. As a consequence, there is an underestimation of the role of food reactions in many illness.
This article briefly discusses four reasons food allergies/sensitivities/intolerances are often neglected and five reasons it is important to detect and eliminate or treat them. Next, the article presents the pulse test, as described by Arthur Coca, M.D., as well as a shortcut version of the test and ways of maximizing the test’s effectiveness. Then follows a discussion of some other methods, along with some of the experiences of the author from 15 years of learning about and dealing with severe food sensitivities. Among the ideas and issues included are: 1) a brief outline of eight types of food reactions, including ideas on how to minimize problems with oxalate-containing foods, 2) the elimination diet with food “challenge” testing, 3) the rotation diet and how it may be modified to reduce problems with “unmasking” that may intensify symptoms, 4) how food cravings and other “withdrawal” symptoms may be used to help identify allergens, 5) a brief discussion of immunotherapy, 6) the importance of striving for maximal avoidance of allergens, including chemicals, to allow the body to become less hyper vigilant, 7) the potential role of microbes, such as newly-identified Mycoplasma species, Entamoeba histolytica, Candida albicans and certain viruses in creating a vicious cycle, in which microbes may increase allergies and allergies may make it harder to eradicate microbes, 8) other ways proposed to reduce reactions, such as guaifenesin and low carbohydrate diets for hypoglycemia, 9) survey results showing avoidance of problem foods and chemicals being rated one of the most successful treatments by chronic fatigue syndrome patients, 10) increased knowledge seems likely to increase benefit for those who have not had as much success with allergy testing. The final section includes a Reference section and a Resource section, providing lists of companies and organizations that offer products and services that may be of use in combating allergies.
For those with moderate to severe sensitivities, the help of a physician, preferably one trained by the American Academy of Environmental Medicine (AAEM), is highly recommended. However, it is the view of the author, that even with the physician’s assistance, do-it-yourself methods are a helpful, and for some, an essential adjunct to achieve maximal health benefits.
In this article, I will describe the general properties of food allergies, sensitivities and intolerances and some testing methods currently used by environmental physicians. I will also discuss some of my own experiences with food reactions, based on 15 years of experimenting with different methods. The topic of food allergy/sensitivity testing is a large one, and is somewhat controversial among mainstream doctors. The bottom line for an allergy/sensitivity testing method or combination of methods is, of course, whether it arrives at a diet that leads to symptom reduction or disappearance. And if one finds a diet that makes one feel better over the long run and perhaps even causes a remission in an illness, even the most skeptical doctor generally will not argue with it as long as you are obtaining an adequate supply of essential nutrients and the diet is not in any way harmful.
I herein present an overview and refer readers to the references for more information. Where a specific citation is not made, the reader is referred to proceedings of past conferences of the American Academy of Environmental Medicine, to the tapes made of the conference speakers, and to AAEM instructional courses. If one wants more references from the scientific literature, I suggest Roitt & Brostoff (1998), Rowat (1998), Ashford and Miller (1998), Brostoff and Challacombe (1987 and 1989), and Rogers (1994). There is also a four-volume set of books by William Rea, M.D., on chemical sensitivity (see Resource section, under AEHF). For convenience, the terms “sensitivity”or “hypersensitivity” used below, will include traditional IgE mediated allergies and non-IgE immune sensitivities, as well as intolerances. Also, for convenience, “allergen” will refer to any item that causes immune (IgE or non IgE) or non-immune hypersensitivity reactions. The main thing to remember is that there are many mechanisms involved, and I will be more specific only when it is necessary to single out a particular type of reaction or mechanism. For my purposes, I will regard “sensitivity” and “hypersensitivity” as synonymous.
Why Food Allergies and Sensitivities Are Often Neglected
1. The symptoms of food and chemical hypersensitivity reactions are diverse, complex and variable and may result from a wide variety of substances. The most common allergens in the diet include wheat, milk, cheese, beef, eggs, soy, corn, chocolate, peanuts, citrus, fermented foods, potato, tomato, shellfish, coffee, alcohol, food additives, pesticide residues and aspartame. They may even be foods we crave. Items that showed reactions in 20-42% of fibromyalgia patients using the ELISA/ACT Lymphocyte Response Assay were: MSG, Candida albicans, chocolate, food colorings, cola beverages, shrimp, dairy, sulfite, xylene, yogurt, aspartame, BHA, cadmium, lead, Tylenol, sodium benzoate and orange. Symptoms include headache, irritable bowel syndrome, fatigue, indigestion, ulcers, sinus symptoms, rashes, hyperactivity, irritability, depression, sleep disturbances, asthma and joint and muscle pain. Sometimes one experiences the more traditionally recognized rashes and allergic rhinitis initially, and then later the symptoms become more subtle and chronic (e.g. fatigue, achiness, and immune suppression), and one no longer connects them to the allergen. Sometimes one assumes the sensitivity is gone when it has just changed its manifestation. Oftentimes, the patient is totally unaware of the connection between their diet and their symptoms.
2. Food and chemical sensitivities are often hard to detect because of the multiple immune and non-immune mechanisms involved in the several types of sensitivity reactions (for a discussion of the four major types of immune sensitivity, Types I, II, III, and IV, see Roitt et al, 1998; Donovan, 1991; Rogers, 1994, notes that there are probably at least 12 mechanisms). Only a small proportion of people have an anaphylactic reaction or immediate nausea or rash. The complexity of the immune system’s reactions and the inability of the more commonly used food allergy tests (i.e. the scratch tests or IgE RAST test) to detect delayed reactions and non-immune reactions has resulted in controversy regarding the magnitude and frequency of food sensitivity problems. My experience suggests that in some people the severity of their reactions may be mediated by elevated calcium and phosphate and reduced ATP production within cells in those susceptible to fibromyalgia (Waterhouse, 1998). This might account for part of the variability of response and the more severe, sometimes disabling consequence of sensitivities in some people (see Waterhouse, 1997 and the pre fibromyalgia article, Waterhouse, 1999).
3. Many people don’t consider food sensitivities because they are reluctant to undergo restrictions on their diet or the effort of diagnosis and treatment or because their doctor has not told them of their importance. Unfortunately, most doctors are not adequately informed in this area and feel justified in ignoring it because most of their colleagues do. A recent book, entitled The Scientific Basis of Environmental Medicine Techniques, by Dr. S. A. Rogers, provides some details on a number of reasons behind this situation, including natural conservatism of the medical community and a few pieces of error-ridden research. In many cases, universities and government agencies have affirmed the importance and validity of environmental medicine and the need for more research (Ashford & Miller, 1998). The complexity of the subject and the fact that relatively little was known about the immune system when most doctors were in medical school adds to the problem. Many doctors were taught that only proteins can cause reactions, but it is now known that many substances can combine with protein to form haptens to produce reactions (see Donovan, 1991 for a good overview of the research). Guyton & Hall’s (1995) standard medical physiology textbook also discusses the role of haptens and the potential for delayed hypersensitivity to a variety of things including cosmetics, drugs, poison ivy and household chemicals. It is widely recognized that prescription drugs can cause serious allergic and so-called “idiopathic” reactions. Chemicals present in our food and environment can do so as well. Poor digestion and intestinal permeability can lead to large molecules entering the blood stream (Galland, 1997). Research in the area of food and chemical sensitivities or multiple chemical sensitivity (MCS) has also been slowed by the efforts of the chemical industry (see review of MCS video, Waterhouse, 1999). Despite this, numerous scientific studies, including a number of carefully designed double blind placebo controlled studies, have successfully demonstrated the value of environmental medicine approaches (for some examples, see Rogers, 1994).
4. The phenomenon of “masking” may hide the extent of reactions (Ashford & Miller, 1998). Some food allergies/sensitivities produce rashes and immediate nausea. If all reactions were like that the task of identifying them would be simple. However, with many foods and chemicals that we are sensitized to and that we eat on a regular basis, our body becomes partially adapted to them and this is called “masking.” With masking, the allergens cause our body to react to them like a stressor/stimulant that might be compared to the effect of caffeine in producing increased adrenaline. The result is that consuming the item causes a brief lift in energy via our stress hormones and may even suppress pain in this way. For this reason, these reactive foods are often favorites that we may even feel we need in order to feel better. This can lead to problems with weight control and food cravings. In other cases, the food can result in nausea, cramps and diarrhea and result in weight loss. When we stop the reactive food, some people go through a “withdrawal reaction,” analogous to what occurs when caffeine consumption is abruptly stopped. One may experience a variety of “withdrawal symptoms,” which may include headaches, fatigue, depression, cravings, and constipation. These reactions generally only last two-seven days, but can occasionally last up to two weeks, and one usually feels considerably better after the offending items are eliminated. Trying the reactive food after one week of avoidance will usually result in a more noticeable reaction for those foods that are most problematic. If one finds the withdrawal symptoms too difficult, one might gradually reduce the allergen, just as one might gradually reduce coffee in order to reduce the withdrawal reaction. (Many books cover these topics. Two examples are: An Alternative Approach to Allergies, by T.G. Randolph, M.D., and R.W. Moss, Ph.D., and The E.I. Syndrome, by S. A. Rogers, M.D., see Reference section).
Reasons it is Important to Detect and Eliminate or Treat Food Sensitivities
1. Symptomatic treatment (e.g., pain medications, antibiotics, antihistamines etc.) ultimately serves to mask the problem and the drugs used may exhibit harmful side effects with frequent and long-term use.
2. Allergies/sensitivities may be an important component in serious diseases such as arthritis, chronic fatigue syndrome, fibromyalgia, autoimmune illnesses and certain bowel and lung diseases, where chronic inflammation from allergens may exacerbate the condition and hinder the healing processes of the body. Food and chemical hypersensitivity reactions can also trigger asthma and migraine attacks. Illnesses involving the nervous system, including attention deficit disorder, autism, Tourette syndrome, depression, bipolar disorder and some anxiety disorders have also been found to improve when sensitivities are reduced. For example, a recent review of 23 studies demonstrates the role of certain food additives, food colors and foods in producing behavioral disorders in children (refer to the report from the Center for Science in the Public Interest–see Resource section). The psychologist Lynne Freeman’s book on anxiety/panic disorders (Panic Free, 1998) describes how food reactions can contribute to anxiety attacks by causing adrenaline levels and heart rate to increase.
3. Poor digestion of food due to sensitivities may provide opportunities for bacterial and yeast overgrowth in the intestinal tract. In time, one may even become sensitized to the bacteria and yeast and their byproducts. This, along with the allergen-induced increase in intestinal permeability shown in laboratory studies, allows toxins produced by the microbes to enter the blood stream and put a strain on other organs, especially the liver. Poor absorption of needed vitamins, minerals and other nutrients can accompany the poor digestion, putting a further strain on the body.
4. The immune system’s imbalance resulting from the sensitivities takes energy away from the body’s mechanisms that deal with infections and other stressors. In many cases, antibiotic treatments become less effective, since they are typically unable to completely wipe out the infecting organism. Instead, they serve to reduce the bacteria down to a level that the body’s own immune mechanisms can handle. If the body’s immune system is too depleted and dys-regulated (e.g., the TH1 and TH2 components of the immune response may be imbalanced), it cannot complete the task, and a chronic infection may result. Chronic sinusitis, for example, is known to be more common in those with allergic rhinitis (Fauci et al., 1997). The person can also become hypersensitive to the bacteria or its products and thus become less able to eradicate it (Rea, 1996). Even normal components of our microbial flora can become a problem. A weakened immune system also makes one susceptible to viruses, for which there is little effective drug treatment available.
5. Allergens stress the adrenal glands and stimulate excess insulin production. The rise in pulse that may follow allergen exposure (see information on pulse test, below) reflects the stimulation of the autonomic nervous system, which could lead to increased production of stress hormones, like norepinephrine and cortisol, and the long-term negative effects associated with chronic stress. Excess insulin production can lead to hypoglycemia, insulin resistance and diabetes (for more on the allergy-insulin connection, see Philpott & Kalita, 1983).
What Can You Do?
Fortunately, if you can identify and avoid the foods and chemicals to which you are sensitive, symptoms usually improve, and over time, many of the sensitivities decline or disappear. There are also clinical and laboratory tests and treatments that can help with the problem. More research certainly needs to be done, and the work of many dedicated doctors and researchers has led to continual improvements in testing and treatment methodologies in recent years. It may take years before mainstream, conservative doctors are sufficiently convinced to adopt these methods. But that is no reason why many who are now currently using symptom-suppressing medical treatments and/or failing to improve sufficiently should not take advantage of what has been learned during the decades of clinical experience in the area of environmental medicine.
Do-It-Yourself Methods and Other Strategies
Important: see Caution for At-Home Food Testing at the end of this article.
Although no single method is going to find all allergens in all people, many doctors and patients over the years have found the pulse test to be useful. I think many will find the best results if they include at-home testing methods together with laboratory tests and intradermal skin testing available through AAEM doctors, although for some, at-home testing may be sufficient. First, I will briefly describe the method used in Arthur Coca, M.D.’s book, The Pulse Test. Then, I will share a shortcut version and some additional thoughts of my own on how to use it most effectively.
Caution: Anyone who has a tendency to anaphylactic reactions (severe reactions in which tissues swell and wheezing may occur–it can be fatal without timely emergency treatment) should avoid any at-home testing or only test foods which you are already eating and that you know won’t cause a serious reaction. Remember that reactions often increase when you have eliminated the food for a week and then are exposed to it (“unmasking,” see above, Part I). So, be even more cautious if you have never stopped and started the food before or have a history of asthma or wheezing; there is a small possibility that you could have your first anaphylactic reaction. If you have ever have had an anaphylactic reaction or believe there may be danger of one, you should consult your doctor about having injectable epinephrine and other needed medications on hand and know the instructions for their use while on the way to the emergency room, in case of accidental exposures. Peanuts and shellfish are two of the worst offenders when it comes to anaphylactic reactions to foods and it may only take a very small quantity in those who are susceptible to anaphylaxis. Once again, do not do any at-home testing that puts you at any risk of an anaphylactic reaction. If you have any doubts or further questions, discuss the issue with a knowledgeable doctor who is familiar with your health situation.)
In his book, The Pulse Test, Dr. Coca first tells the reader to stop smoking and then gives the following instructions:
“1. You count your pulse (one minute) a) just before each meal; b) three times after each meal at half-hour intervals; c) just before retiring; d) just after waking, before rising in the morning. All pulse counts are to be made sitting except the important one on waking. This is made before you sit up.
2) You record all the items you eat at each meal.
3) You continue the pulse-dietary records for two or three days with the usual three meals.
4) You then make single-food tests for two or more whole days every hour. You count the pulse before you eat the food and again 30 minutes later.”
Using this method, you discover which foods cause pulse increases of more than six to eight beats per minute, and you eliminate those foods from your diet. You may also detect a chemical exposure that might account for a pulse increase, for example between rising and eating your first meal. Over time, the minimum and maximum pulse rates decline, as one eliminates offending items. It can be a bit complicated to detect the delayed reactions that might occur one to three days later, so it does have its limitations (see below). Nevertheless, it can prove useful.
Some Experiences Using the Pulse Test
I have found that it may be useful for routine monitoring to do the first 3 steps to get a sense as to what foods cause the largest pulse increases. By taking the pulse several times a day you can get a general sense of your exposure to allergens and note trends. For instance, some time ago, I found that my pulse was almost always in the 70’s and frequently in the 80’s (I take mine when I am lying down). I knew this was higher than at previous times, when my allergen load had been reduced. I discovered that I had become sensitive to the psyllium fiber I was taking. I was better after stopping the psyllium, and my pulse declined to its normal level.
As the level of allergen-induced stimulation declines (as reflected by the declining pulse), I found it necessary to reduce sedating types of medication (e.g., for sinequan: I went from 100 mg to 1 or 2 mg). Alternatively, you might try a very gradual approach to reducing certain allergens, since your body may have become adapted to their presence. For instance, my allergens have caused a tendency to diarrhea for years. At one point I had reduced the allergens to such an extent that I began to have a problem with constipation. I think this is similar to what might happen if I was to abruptly terminate the chronic use of a laxative. My body had become used to the “laxative effect” of the allergen, and it responds to the sudden removal of the allergen by becoming constipated. So, now I have taken the approach of adding a few drops of walnut oil to my morning and evening meals. When I used a tablespoon of walnut oil daily, possibly due to a mild sensitivity to it, diarrhea and cramps were worse, but just a few drops with each meal, seems to be fine, and I am not constipated. An alternative way of avoiding constipation that has helped me is to find just the right dose of magnesium, usually around 400-450 mg, in my case (larger amounts are needed if you use the type of magnesium that is well absorbed, like magnesium glycinate or other amino acid chelate forms, and if you are deficient in magnesium.
In interpreting the results of the pulse test, I have noticed a tendency to have a secondary increase in symptoms and pulse near the time the poorly-digested antigen-containing food passes out of the colon. Sometimes the withdrawal symptoms, which may include hunger, thirst, sleep disturbance, headaches, irritability, depression and overall achiness, intensify around that time as well, usually two to seven days after consuming the food. The withdrawal symptoms can be rather unpleasant, but I have found them much easier to tolerate now that I know their cause and can anticipate the improvement which usually follows.
Shortcut Version of the Pulse Test
The shortcut version of the pulse test has the advantage of not only being quicker, but allowing you to avoid actually consuming the item, thus reducing the potential length of the reaction, if one occurs.
1. Establish your baseline pulse by counting your pulse for a full minute before trying a particular food. (I have found that it is possible to do the test sitting or lying down, as long as you always do the before and after pulse readings in the same manner.)
2. Put a food in your mouth (on your tongue). Do not swallow it. Let it rest on your tongue, so that you can taste it for approximately two minutes. The taste will send a signal to your brain, which will send a signal through the sympathetic nervous system to the rest of your body. Test only one food at a time. Testing individual ingredients provides more valuable information than testing foods containing multiple ingredients.
3. Retake your pulse while the food is still in your mouth. An increase of 10% or more may be considered an allergy/sensitivity reaction. The greater the degree of allergenicity, the higher the pulse will be. (Some may want to consider increases of 7-10% as borderline reactions. I find that sometimes I need to avoid certain borderline foods as well, especially if I experience increased symptoms during the test.)
4. Discard the tested ingredients (again, do not swallow). Rinse your mouth out with some purified water (spit the water out). Wait two minutes, then you can retest your pulse to see if it has returned to baseline. If it hasn’t, wait 10 minutes more and retest until you have returned to your baseline pulse. You can then test the next food, repeating the procedure as frequently as you like, as long as your pulse returns to its baseline between tests.
[If you experience an increased pulse, perform the test two more times to rule out other factors.]
NOTE: This test may not be valid if you are taking a drug that controls your heart rate, e.g., a calcium-channel blocker or a beta-blocker. However, you might try the test anyway, and perhaps you would detect some reactions, though it may not be as sensitive. This test also may not be valid for foods which cause delayed sensitivity reactions. Blood tests, such as the ELISA/ACT test (Serammune Physicians Lab: 800/553-5472) or other tests done by physicians trained in this field (e.g., the ALCAT or IgG specific RAST), will tend to be more sensitive to the “hidden” delayed immune sensitivities.
Some Additional Pulse Test Tips
According to Russell Jaffe, M.D., Ph.D. (personal communication), the pulse test is as “a valuable self-assessment tool that is too often overlooked.” However, he believes it is important to remember that other factors can increase adrenaline and thus cause a pulse increase (e.g., stressors, like bright lights or loud noises, or psychological anxiety). He suggests performing tests in triplicate to be more confident that the reaction is a true one and not a coincidence. He feels that “this is particularly important for people who are chemically or environmentally sensitive as their neuroimmunohormonal control system may be more poised to respond nonspecifically due to loss of feedback, adaptive control.” He also points out that when people are chronically overstimulated their system may not respond with an increase in pulse even when they are reactive to a substance. This is a kind of “overstimulation to exhaustion phenomenon.”
I find that sometimes my pulse is less stable when I am still in the midst of a reaction from a previous meal, or when I have slept poorly. My pulse was also less stable when I was still eating a high carbohydrate diet. All these things seem to contribute to autonomic nervous system instability and hence a more variable pulse. I find the pulse test works better for me in the middle of the day, in a relatively quiet, peaceful, chemical-free environment. In any case, it is preferable not to do the test when the baseline pulse seems particularly unstable. Clearly, the pulse test will not be equally appropriate or effective for everyone, it is just one more tool to try out.
Also, I would suggest watching T.V. or listening to a book-on-tape or the radio while doing it (as long as it is not something that stimulates you significantly). I find this is helpful because one doesn’t want to become too focused on the pulse, and it also helps to pass the time. I have found that if one focuses on the pulse too much, one can inadvertently speed it up through anticipation. If there is doubt about the results, one can repeat the test later or simply rely on observing “challenge” test symptoms (see below). I have found I can even sometimes do the pulse test “blinded” for items that aren’t too distinctive, by putting several items on a plate and closing my eyes before choosing one. This approach minimizes the potential role of preconceptions about how you will react to the item.
It should be remembered that except for a few “fixed” allergies, most reactions vary to some degree depending on how much you have been exposed to an item. You need to be particularly wary about interpreting the results for foods you have not eaten in a long time. The sensitivity may come back once you begin eating the item, so you should be particularly careful to retest the food at intervals. You may also be able to cautiously return an allergenic item to the diet after avoiding it for several months, but again, retest periodically. Sometimes, it is even possible to use the test to evaluate supplements and even some medications (if they are not too acidic or caustic). In this way, I have revealed my sensitivities to calcium citrate and certain fiber supplements.
I decided to try the test on 3 items that I had known delayed sensitivities to. Chocolate and apples had been highly reactive on the ELISA/ACT test (for more on ELISA/ACT test, see Waterhouse, 1997; Donovan, 1991) and peanuts had shown a very large delayed reaction on an intradermal skin test. I knew I was taking a chance doing the test, since the skin reaction for the peanuts had made me feel very achy and tired for an entire week. It was the strongest reaction to a skin test exposure I had ever had week (however, I knew there was no danger of anaphylaxis in my case, see above, Cautions). The only skin test that had been nearly so severe was the Candida intradermal skin test. I tested all 3 items and only chocolate showed an increase in pulse of 4 beats per minute, which is not even considered a borderline reaction. However, I was very symptomatic for several days after and think it probable that the delayed reaction to one or more of the items tested was the cause. This suggests that this test is less than ideal for the delayed reactions. The pulse change was not very helpful and I was unable to avoid the symptoms even though I did not swallow the food.
After many years of dealing with hypersensitivities to foods, I know that there are frequently psychological issues involved in finding allergens and staying with the optimal diet. I used to become frustrated and depressed when I found that I could no longer tolerate a food that I had been relying upon. The wish to continuing eating a particular food for which I had an allergy/addiction would even subconsciously keep me from testing it. Later, I realized that discovery of a food reaction was actually something to welcome, because it meant that I was likely to feel better within 7-10 days, simply by stopping the food. It was really the easiest and quickest way I had to feel better. (For other tips on the practical, psychological and social side of diet change, see the second article in this issue).
Types of Allergy, Sensitivity and Intolerance
I have mentioned that there are a number of types of food allergies, sensitivities and intolerances. Immediate (IgE, Type I) reactions, the 3 delayed immune sensitivities (Types II, III, and IV), lactose intolerance (from milk), gluten intolerance (from grains, like wheat, barley, rye and oat), fructose intolerance (from fruit, some processed foods, and corn syrup, and in asparagus and some dried beans) and problems with certain plant lectins that depend on your blood type (for lectin information, see D’Adamo, 1996). You can see that if you only test for one or two types of reactions, eliminating those foods might well lead you to increase your intake of another food you are sensitive to by another mechanism. In fact, you may be more likely to gravitate to foods that cause a reaction, since they often initially serve as a stimulant (the allergy/addiction phenomenon, discussed in Randolph and Moss, 1989). For this reason, you have to be a little suspicious of any food you begin to crave.
In listing the types of reactions, I should mention one other irritant, though I have good news that there is a way you can probably avoid the negative effects. I am referring to oxalates, which are abundant in spinach, tomatoes, nuts, rhubarb, tea, figs, berries, whole wheat and wheat bran, green beans and a number of other things (see Vulvar Pain Foundation’s The Low Oxalate Cookbook, 336/226-0704). Oxalates seem to be a problem for vulvodynia patients and can cause intestinal problems if one already has a sensitive or inflamed gastrointestinal tract. So, I was happy to read in Harrison’s Principles of Internal Medicine (1997, p. 1572) that consuming calcium lactate causes the oxalate to precipitate out and is recommended for hyperoxaluria (they also mention using cholestyramine, an oxalate-binding resin). Since I found sunflower seeds to be a relatively hypoallergenic food for me, I was relieved to find that a calcium lactate capsule with the seeds seemed to eliminate the gastrointestinal irritation from the oxalates that I experienced when I ate them. It was suggested that 8 to 14 g/day of calcium lactate be taken to bind the oxalates. I took only about two grams/day (yields 300 mg calcium), but perhaps some people need more, depending on how much oxalate they consume. Other forms of calcium should also work, but perhaps not quite as well as the lactate. You may want to determine whether high oxalate foods bother you and see whether calcium supplements eliminate the negative effect.
Other Do-It-Yourself Testing Strategies
The Elimination Diet and Challenge Tests
One of the most commonly used strategies for revealing food allergies, sensitivities and intolerances is the elimination diet, followed by individual food “challenges.” First, you eliminate a number of the foods that are commonly the cause of reactions, for instance, wheat and other gluten-containing grains, dairy products, beef, eggs, soy, corn, chocolate, peanuts, citrus, potato, tomato, shellfish, coffee, alcohol, food additives and aspartame. Also eliminate any others you have reason to suspect from symptoms, laboratory or clinical tests, or your tendency to crave and over consume them. If you can eliminate pesticide contaminants by buying organically grown foods, that is also helpful. Then after 7-10 days of observing how you feel, you begin adding back foods that you had eliminated, one every day or two, and writing down any symptoms that return with a particular food. This is the food “challenge” part of the test. For your more allergenic foods, the reaction will be greater after having avoided it for a week. If you want to minimize the effect of the allergens, you might use the shortcut pulse test first, before adding the food to your diet, since the shortcut pulse test doesn’t require you to swallow the food. Then if the pulse test reaction shows it is a problem food for you, you don’t have to experience the more extensive and longer lasting symptoms which would have occurred if you had eaten it in a meal. You can also do the elimination and the reintroduction of the foods along with Dr. Coca’s manner of pulse testing, to aid in the identification of reaction-producing foods. It is best to add foods back and test them in their simplest and purest form, since many items contain many foods (e.g., bread contains wheat, egg, sugar, additives etc…). A food and symptom diary is clearly a necessary tool for keeping track of the reactions.
Dr. Kendall Gerdes, current Fellow and past President of the American Academy of Environmental Medicine thinks the “gold standard” for food allergy testing is the elimination and challenge test, with a minimum one week avoidance for adults (5 days for younger children). He often finds that laboratory tests may not be enough, and the elimination diet will pick up foods misidentified by the lab work or that occur by a different mechanism than the particular test they used was designed to detect. He emphasizes that after the elimination phase, the challenge food should be taken in as pure a form as possible, so that foods will not unnecessarily be taken out of the diet. For example, you should test milk, not cheese, and wheat, not bread. It might be that you are sensitive to the mold in cheese, but can tolerate certain other dairy products like milk or yogurt. You might react to bread because of soy protein in it, and not because of the wheat. Also, he pushes people to take as big a quantity as possible, so that they will be more likely to pick up borderline reactions. Hence, he requires that the challenge food be all they eat at that meal. If they are then hungry a couple hours later, and having no symptoms, he advises another ¼ to ½ serving of the challenge food. He has patients rate their symptoms on a scale from 0 to 4, with a “one plus food” causing symptoms that you notice, but which are not bad enough to interfere with work or social activities. “Four plus foods” are bad enough so that work or socializing would be very hard to do. Two and three plus foods fall in between. He believes the ratings are valuable, in that, with strict and complete avoidance of the reactive food for a number of months (with the number of months required approximately equal to the reaction rating number), the patient may be able to return the food to the diet, if only on an occasional basis (e.g., one meal per 5-7 days).
The Rotary Diversified Diet
Many people will find it sufficient to remove a few of their worst allergens from their diet, without going any further. However, others may find the rotary diversified diet is useful to help prevent development of new sensitivities by rotating foods that they have little or no sensitivity to, in a cycle of 4 to 7 days. Thus, in a 4 day rotation cycle, you would only eat food in the nightshade family (tomato, potato, eggplant etc..) on every 4th day. It is often done using food families because foods in the same family seem to be more likely to cross react. After you have determined what foods you tolerate, you construct a rotation diet of the foods you tolerate. It is beyond the scope of this article to go into detail on the rotary diet and you are referred to the numerous books that cover this topic (see Randolph and Moss, 1989; or Rogers, 1986, and other books carried by NEEDS, see Resource section).
As well as the rotation diet works for some people, you should be aware that the rotation diet may not work very well if there are too many foods that you are sensitive to. If you rotate foods you are sensitive to on a schedule like the one mentioned above, you may actually increase symptoms because your reactions are no longer “masked” (see above). This phenomenon led, in my own case, to the discovery that the typical rotation diet caused me to lose more and more weight and become increasingly debilitated. Some rotation diets suggest switching to exotic or rarely eaten foods. However, I found I was very quickly sensitized (e.g., after 2-10 exposures) to most exotic or rare foods that I was exposed to (e.g., amaranth, buckwheat, poi, millet, kamut, tahini, chestnuts). I did much better by rotating on a much different schedule, with the few foods I could tolerate. For example, I found that white rice and chicken breasts were my most “durable” foods, in that I could stay on them longest with the least symptoms. I could eat white rice as my main and sometimes only carbohydrate source for 6-8 weeks before become very sensitized to it and then rotate to oat bread for 10 days. After 10 days off the rice, the sensitivity and symptoms were lessened and I could return to it. Similarly, I could stay on chicken breasts as my main protein source for several months at a time, and then rotate to pork for 2 weeks. It was this change to my unusual form of rotation diet in the late 1980’s that allowed me to regain the 25 pounds I had lost, and no longer appear “skeletal” (Waterhouse, 1998). I also found that different parts of a particular food caused different levels of reaction, since they contain different biochemical components. For example, I had to eat white rice, and avoid brown rice, since the bran component of brown rice was much more allergenic for me. Also, I did much better if I ate chicken breasts, and avoided the dark meat, skin, fat and even the browned outer edges. Since you may have already overused a few foods, like chicken and rice, due to their generally lower level of allergenicity, you may have to stop them for a few weeks (because you have become sensitive to them as well). But you may find that when you return to the foods, you can tolerate them well once again.
Most people will not have nearly as extensive food allergies as I have had and will obtain benefits from allergy avoidance without limiting their diet nearly as much as I have had to do at times. There are probably both genetic and environmental factors that determine the tendency to allergies/sensitivities. I have reason to believe, based on several lines of evidence (which I will discuss in a future article), that those who have particularly fair complexions and sensitive skin, may be more susceptible to very extensive food sensitivities; so the methods discussed in this article might be of particular importance in this type of person. Epidemiological research by Dr. David Barker has detected a correlation between post mature birth (i.e., being born several weeks after the due date) and onset of allergies later in life. The reason for the correlation is unknown at present but may relate to developments occurring in the thymus (discussed in the new book, Life in the Womb by Cornell University researcher, Dr. Peter Nathaniels). I would appreciate it if readers would let me know if either or both these ideas are supported by their experiences. The above relationships might be hints to help you to determine whether you might need to look into the connections between your symptoms and allergies. There are certainly other factors that are important in the development of food sensitivities, for example, chemical exposures (see MCS video review in previous issue, Waterhouse, 1999).
Other Methods, Inhalants, Infections
Immunotherapy, done by an AAEM doctor, can also reduce the allergy/sensitivity reactions, and increase the number of foods which you can tolerate. This topic will be covered in more detail in a future issue, however, it should be remembered, that techniques that rely on immediate reactions, like provocative/neutralization testing, are unlikely to work well on items that produce delayed reactions. Also, certain types of immunotherapy may not work well on those with very abnormal levels of certain immune system components, for instance, for those with very high or very low levels of B lymphocytes (based on my observation and confirmed by Darryl See, M.D., personal communication). I have found intradermal testing using serial dilution endpoint titration (SDET, preferably using a non-phenol preservative), done by an AAEM-trained physician, to be helpful in my case. However, since my case has been a particularly difficult one, it has required my active participation in the process, and I have needed to use much of the knowledge I have presented in this article to receive maximal benefit from the immunotherapy (also, see Waterhouse, 1998, for more on my experiences).
To really reverse the overall tendency to hypersensitivity, you may need to use a comprehensive approach, reducing antigen exposures from inhalant and other chemical exposures, pollen and dust mites, as well as foods. As Russell Jaffe, M.D., Ph.D., vividly explained (personal communication), the lower you can make your exposure to antigens, perceived by the immune system as “terrorists,” the more readily your immune system will reduce its excessive reactions, i.e., its “counter attack.” In other words, according to this view, the closer you can get to 100% avoidance of exposure to provoking antigens, the more likely it will be that you will be able to allow your body to return to a less hypersensitive, less hyper-vigilant state. Among inhalants, dust and dust mites are frequent offenders. Addition of a few drops of Dr. Bonner’s liquid eucalyptus soap, available in health food stores, to hot water wash with regular detergent, is suggested as a way to kill dust mites. Barrier cloth covers can be used to prevent your mattress and box springs from serving as a reservoir for dust mites. Air filters can also be helpful for chemicals and other inhalants. The Resource section, below, supplies sources of additional information on these strategies.
Other approaches that may help reduce sensitivities include hypoallergenic multivitamin and mineral supplements, antioxidants like vitamin C and E, and stress reduction (for more on the role of stress, see Ilyia, 1996; Rowat, 1998). Dr. St. Amand’s and my own experiences suggest that a low carbohydrate diet (only for hypoglycemics/carbohydrate cravers) and guaifenesin (see Waterhouse, 1997 and 1998; St. Amand, 1998, 1999) also tend to reduce symptoms associated with allergy/sensitivity, chronic fatigue syndrome and fibromyalgia (note: Dr. St. Amand does not use environmental medicine methods).
Avoidance of antigens from infectious agents may play a role, since they may stimulate antibody production and thus increase response to allergens, as well. For instance, Dr. Garth Nicholson (1999) reports that patients treated with antibiotics for Mycoplasma fermentans (and other bacterial) infections become less prone to chemical sensitivities (MCS). I have noticed in my own case that stomach flus, to which I have been susceptible, tend to increase my food sensitivities, and the food sensitivities increase the frequency and duration of the stomach flus. The result is a vicious cycle that I have found can be broken most effectively by allergen reduction and adequate rest. Other types of infections, such as the parasitic infections, amoebiasis or giardiasis, may contribute to similar vicious cycles, and may be particularly important for those with frequent or intermittent diarrhea (I have found Diagnos-Techs Lab’s tests for salivary antibodies to be the most sensitive parasite test for amoebiasis, which is fairly common in the U.S. 800-87-TESTS, also, see Waterhouse, 1998).
Another vicious cycle that may be important to break in some people involves “dysbiosis,” in which certain carbohydrates, poorly digested allergenic foods and even certain types of fiber may lead to overgrowth of bacteria and yeast (Candida) in the gut. “Leaky gut” syndrome then occurs (as shown by laboratory tests of intestinal permeability, see Galland, 1997; Crook, 1992 and 1995), in which allergenic substances and chemicals produced by the microbes in the gut “leak” into the blood stream, further sensitizing the patient to foods and chemicals (Gottschall, 1994).
Developing Your Own Tests and Identifying Signs of Reactions
Besides elimination diets and pulse tests, other types of at-home tests may be useful, depending on the nature of your individual reactions. For instance, I used to have very chapped lips, and discovered this was due to allergens that came into contact with my lips when I ate. It was worsened by the lip balms I used, since they also contained allergens. I devised a test for food allergy that utilized this phenomenon. I found that I could apply a bit of moistened food to my lip and produce a reaction that varied from a mild tingling to a stinging feeling. For the more subtle reactions, it was helpful to apply the item to one side of my lower lip and a drop of water to the other side as a control, for comparison purposes. If the test item caused a stronger tingling than the water, then I considered it a reaction. Later, when my lips were healed and became less sensitive (due to reduced allergens and a hypoallergenic lip balm from Special Foods, Inc., see Resource section, below), the test became less useful.
When you become more familiar with your reactions, you might find other tests, signs or symptoms that are helpful in detecting allergens in your own case. For instance, I have spots that appear on my face when I eat an allergen (often they appear when I first awake in the morning), and these spots tend to increase during the period of the withdrawal reaction, during the week after I have stopped eating the allergen. I typically get a rash on my face following a shower, when I have been exposed to something I react to.
Sometimes, my most noticeable symptoms are during the withdrawal phase and provide confirmation of my suspicions based on other test results. I usually have at least one poor night of sleep, two-five days after I stop eating an allergen (during the worst times, a very small dose of Klonopin or Ambien, often only ¼ tablet, has been very helpful for sleep–but use caution as they can be habit forming). During the withdrawal period, I will also tend to go through a period of one to three days, in which the hypoallergenic food I am eating will not be at all appealing to me, and I will feel hungry much of the time, even just after eating. If this happens to you, do not let this discourage you, because when this period passes, your food will be more appetizing once again (though perhaps not as stimulating as the foods to which you had an allergy/addiction). If you unknowingly replace the allergenic food with a more allergenic one, however, you may have little if any withdrawal reaction. If contemplating adding more of a particular food, you might try some shortcut pulse tests to find which would be best to add, and retest the new food periodically (however, remember, the pulse test doesn’t work well for everyone or for every type of reaction, so symptom response should take precedence over pulse test response). Each person will vary in the symptoms they exhibit, but if you are a careful observer, these symptoms can help you in your allergy/sensitivity detective work.
Conclusions, References and Resources
I know it may seem like a big task, but it really can be well worth the effort to detect and avoid symptom-provoking foods and chemicals. For examples of how it can help in chronic fatigue syndrome, see The CFIDS Chronicle article, by LeRoy (1997). In the “1999 Chronicle Reader Survey” (Hoh, 1999), out of 28 treatments shown in the survey results, avoiding chemicals and avoiding problem foods ranked 5th and 6th in reports of things that “helped a lot.” And it seems likely that with more complete knowledge of the complexities of detecting and eliminating allergens, the level of benefit could be increased further. The only things to rank higher in the survey were pacing activities, changing outlook, anti-depressants and treatment for sleep. It is interesting to note that one of the most widely used types of anti-depressant and sleep medications are from the tricyclic category. These drugs have potent antihistaminic effects even at the low doses sometimes used, thus possibly linking their effectiveness with some partial reduction of the effects of the allergens.
Many wish, as I do, that there was a “magic bullet” supplement or drug to cure food allergy/sensitivity. Supplement companies frequently offer products that they claim “cure” allergies, and though they may help some people, the many drugs and supplements I have tried have been of little help. In fact, I have experienced sensitivity reactions from many of the supplements I have tried, especially things like herbs and blue-green algae, but even from things like calcium citrate, evening primrose oil, fish oil, MSM and Vitamin C (the types of vitamin C that I have found I tolerate best are TwinLabs Ester C and Natrol Ester C without bioflavonoids). I have never found the negative effects of a sensitivity reaction to a food or supplement to be outweighed by its nutritional benefit (assuming I obtain adequate calories, protein and essential nutrients from other better tolerated foods and hypoallergenic multivitamin and mineral supplements). As beneficial as it is to eat fruits and vegetables as a general practice, it was better for me, with my extreme sensitivities, to do without them at times, than to consume ones that caused reactions. It also was helpful to keep my diet as simple as possible during periods of testing for food reactions. With all the emphasis on the importance of phytochemicals in our diet, we should remember that as long as we get the essential vitamins and minerals, the phytochemicals themselves are not really necessary to life. After all, doctors who provide intravenous nutrition to very ill people for months at a time do not feel the need to add vegetable extracts to the intravenous fluid. Despite the above cautions, however, the great majority of people, who do not have extreme and extensive food sensitivities, can eat fruits and vegetables, and I would encourage them to eat any they are certain they do not react to.
It should be remembered that these strategies are not simply useful for those who already know they have food allergies/sensitivities/intolerances. Jaffe (1996) found that all 32 fibromyalgia patients tested in a community-based study using the ELISA/ACT Lymphocyte Response Assay had between 15 and 32 delayed food sensitivities (Types II, III, and IV), whereas healthy people generally have none (Jaffe, personal communication, for more on the test, see the Resource section, below). The treatment group, who removed the offending items and took the prescribed supplements, improved significantly as compared to the control group. Due to the masking phenomenon and the diversity of symptoms caused (including non gastrointestinal symptoms, like pain, sleep disturbance, cognitive effects), you may not know that food or chemical sensitivities are contributing to your symptoms until you give some of these methods a try. Many people find a considerable improvement can be achieved just by removing a few foods from their diet and avoiding some chemicals. They might find they would improve even more if they took some additional steps, as suggested in this article. A few people, like myself, will only achieve adequate symptom reduction by making more extensive changes and devoting more time to the problem of reducing allergies, sensitivities and intolerances.
Ashford, Nicholas, A., Ph.D., J.D., and Claudia S. Miller, M.D., M.S. 1998. Chemical Exposures: Low Levels and High Stakes, 2d ed., John Wiley.
Brostoff, J. and S.J. Challacombe, eds. 1987. Food Allergy and Intolerance. Balliere Tindall. Eastbourne, England.
Brostoff, J. and L. Gammlin. The Complete Guide to Food Allergy and Intolerance. Bloomsbury. London, England.
Crook, William G., M.D. 1992. Chronic Fatigue Syndrome and the Yeast Connection. Professional Books, Jackson, TN.
Crook, M.D. 1995. The Yeast Connection and the Woman. Professional Books, Jackson, TN.
Coca, Arthur F., M.D. 1959. The Pulse Test. Lyle Stuart, New York.
D’Adamo, Peter, N.D. 1996. Eat Right for Your Blood Type. Putnam. New York.
Donovan, P. M., N.D. 1991. The ELISA/ACT Test — Part I: Its role in identifying time-delayed reactive environmental toxicants. Townsend Letter for Doctors, #94 & June #95. (Reprint available from Serammune Physicians Lab–800/553-5472.)
Fauci, Anthony S., M.D., and others, editors. 1997. Harrison’s Principles of Internal Medicine. McGraw Hill.
Freeman, Lynne, Ph.D. 1998. Panic Free. Colorado Springs, CO.
Galland, Leo, M.D., 1997. The Four Pillars of Healing: How Integrated Medicine Can Heal You. Random House, NY.
Gottschall, Elaine G., et al. 1994. Breaking the Vicious Cycle: Intestinal Health Through Diet. The Kirkton Press. Kirkton, Canada.
Guyton, A.C. and J.E. Hall. 1995. Textbook of Medical Physiology. WB Saunders Co.
Hoh, D. 1999 Chronicle Reader Survey. The CFIDS Chronicle, Vol. 12(4). CFIDS Assoc. of America, Charlotte, NC.
Ilyia, E. Ph.D. 1996. Stress dynamics: its objective evaluation and pertinent clinical correlates in health and illness. American Academy of Environmental Medicine Annual Meeting. Boston, MA. (Dr. Ilyia is the Director, Diagnos-Techs Lab, 800-87-TESTS. Tape of lecture available from Insta Tape, 800-NOW-TAPE.)
Jaffe, R.M., M.D., Ph.D. 1996. A novel treatment for fibromyalgia improves clinical outcomes in a community-based study, draft copy, based on presentation at American Assoc. for the Advancement of Science Meeting, Baltimore, MD. (Reprint available from Serammune Physicians Lab–800/553-5472.)
LeRoy, Jim. 1997. Management of chemical sensitivities in CFIDS. The CFIDS Chronicle, Vol. 10(2). CFIDS Assoc. of America, Charlotte, NC.
Nathaniels, Peter W. 1999. Life in the Womb: The Origin of Health and Disease. Promethean Press.
Nicholson, Garth L., Ph.D. 1999. The role of microorganism infections in chronic illnesses: support for antibiotic regimens. The CFIDS Chronicle, Vol. 12(5). CFIDS Assoc. of America, Charlotte, NC. (for more on Mycoplasma testing and treatment, also see: http://www.immed.org or http://www.rheumatic.org, for rheumatic diseases).
Philpott, William H. and D.K. Kalita. 1983. Victory Over Diabetes: A Bio-Ecologic Triumph. Keats, New Haven, Conn.
Randolph, Theron G., M.D. and Ralph W. Moss, Ph.D. 1989. An Alternative Approach to Allergies. Bantam, New York.
Rea, William, M.D., 1996. Autogenous bacterial and fungal vaccines in the treatment of chronic recurrent infections. American Academy of Environmental Medicine Annual Meeting. Boston, MA. (Tape of lecture available from Insta Tape, 800-NOW-TAPE.)
Roitt, I., Brostoff, J. & Male D. 1998. Immunology. Mosby Co. New York.
Rogers, S. A., M.D. 1986. The E.I. Syndrome: An Rx for Environmental Medicine. Prestige Publishing. Syracuse, NY.
Rogers, S. A., M.D. 1994. The Scientific Basis for Selected Environmental Medicine Techniques. SK Publications. Sarasota, FL.
Rowat, Steven C. 1998. Integrated defense system overlaps as a disease model: with examples for multiple chemical sensitivity. Environ. Health Perspect. 106(Suppl 1): 85-109. (Editor’s note: includes over 300 references).
St. Amand, R. Paul, M.D. 1998. A description of fibromyalgia and hypoglycemia: their combined morbidity and therapy with guaifenesin and diet. American Academy of Environmental Medicine Annual Meeting. Baltimore, MD.
St. Amand, R. Paul, M.D., 1999. Papers on “Fibromyalgia: For Patients,” “Fibromyalgia: For Physicians,” and “Hypoglycemia,” and Salicylate-Free Product list, all available by sending an SASE with 2 stamps to Dr. St. Amand, 4560 Admiralty Way, Suite 355, Marina Del Rey, CA 90292. Also available on the web, at http://www.csusm.edu/public/guests/nancym/fibromt.htm
St. Amand, R. Paul, M.D. ,and Claudia Marek, M.A. 1999. What Your Doctor May Not Tell You About Fibromyalgia: The Revolutionary Treatment that Can Reverse the Disease. Warner Books, New York.
Waterhouse, J.C. 1997. Innovative approaches to fibromyalgia: Part I. An environmental medicine approach, and Part II. The role of guaifenesin and hypoglycemia, CISRA’s Synergy Health Newsletter, Issue 1, Vol. 1(1), P.O. Box 70166, Pasadena, CA.
Waterhouse, J.C. 1998. A case history of FMS/CFIDS/MCS and the roles of guaifenesin, a low carbohydrate diet and environmental medicine in recovery, CISRA’s Synergy Health Newsletter, Issue 2, Vol. 1(2), P.O. Box 70166, Pasadena, CA.
Waterhouse, J.C. 1999. How to “map” fibromyalgia: review of video and comments, CISRA’s Synergy Health Newsletter, Issue 4, Vol. 2(1), P.O. Box 70166, Pasadena, CA.
Waterhouse, J.C. 1999. Pre Fibromyalgia: A possible explanation for many common idiopathic, functional, and pain disorders, CISRA’s Synergy Health Newsletter, Issue 4, Vol. 2(1), P.O. Box 70166, Pasadena, CA.
AAEM. For physician information and information on instructional meetings for doctors and conference proceedings, contact:
American Academy of Environmental Medicine (AAEM) at: 7701 East Kellogg, Suite 625, Wichita, KS 67207, 316/684-5500; web site: http://www.aaem.com, or contact Insta-Tape (800-NOW-TAPE) for lists of tapes of talks given at annual conferences and instructional meetings of the AAEM.
Books, Foods and Products
NEEDS. To order books on the subjects discussed here, including several books by Dr. Rogers, you can contact Nutritional, Ecological & Environmental Delivery System (NEEDS), 800-634-1380, web site: http://www.needs.com. They also have a wide range of supplements and allergy products from many different companies.
Allergy Asthma Technology Ltd. For help in reducing exposures to inhalants, like dust, pollen and mold, one may obtain a catalog from Allergy Asthma Technology Ltd. (800-621-5545).
Bio-Designs By Allergy Resources, Broomfield, CO, phone: 800-873-3529. They carry a variety of unusual foods, as well as allergy equipment, bedding, water & air purifiers etc…
Flora, Inc., 800/446-2110, has organic walnut oil and other unusual fresh organic vegetable oils, among other things.
Goldmine Foods, 800/475-FOOD, has a large variety of mail order organic foods.
Janice Corporation (800-JANICES, 973/691-2979, http://www.janices.com) carries organic cotton barrier cloth, organic clothing and other products for the chemically sensitive.
Seattle’s Finest Exotic Meats, 800/680-4375, http://www.exoticmeats.com, in case you need to try some different meats that you may be less sensitive to.
Special Foods: 9207 Shotgun Court, Springfield, Virginia 22153, phone: 703/644-0991; FAX: 703/644-1006; web site: http://www.specialfoods.com; email: email@example.com. This company sells unusual foods, including carbohydrates (like lotus, cassava, and milo flours and baked goods), lip balms, and cellophane bags, among other products for those with food and chemical sensitivities.
Support Groups and other Resources
Human Ecology Action League. This is a national nonprofit with local chapters that deals with chemical and food sensitivities. They also publish a quarterly newsletter. Address: P.O. Box 29629, Atlanta, GA 30359-0629. Email: HEALNatnl@aol.com, web site: http://members.aol.com/HEALNatnl, Phone: 404-248-1898 Fax: 404-248-016.
Alison Johnson, MCS Information Exchange, P.O. Box 213, Brunswick, ME 04011, 207-725-8570, web site: http://www.alisonjohnsonmcs.com/index.html. Ms. Johnson has videotapes, brochures and booklets, as well as survey results covering many different treatments tried by patients with multiple chemical sensitivities (MCS). She has also recently written a book (Casualties of Progress), with anecdotal, but very convincing accounts of the experiences of 57 MCS patients, as well as a book on Gulf War syndrome and has created several DVDs.
Share, Care and Prayer, Inc. P.O. Box 2080, Frazier Park, CA 93225 (Janet Dauble, Director), http://www.sharecareprayer.org. This is a nonprofit Christian organization devoted to providing information and support for people with environmental and food sensitivities, CFS and fibromyalgia. They have newsletters and a book/tape library that allows you to borrow via the mail, along with other services and publications. Their tape library includes audio tapes recorded at a 1999 Gulf War Syndrome research planning conference held by the Centers for Disease Control, which clearly recognized environmental sensitivities as an important area for research and included some talks on some of the latest research. Another very interesting videotape that can be borrowed is a BBC documentary entitled “Food Allergy Wars.” This program provides an overview of the controversy surrounding food allergies and discusses a number of carefully controlled double blind studies that support a role for food reactions in a number of diseases. (Editor’s Note: The above group is recommended for their medical information, however it should be noted that CISRA does not endorse any particular religious views.)
ELISA/ACT Lymphocyte Response Assay, Serammune Physicians Lab, 14 Pidgeon Hill Road #300, Sterling, VA 20165, 800/553-5472 ext. 217, 218 or 206 for client services. Some additional information from Dr. Russell Jaffe, Director, SPL: “The ELISA/ACT™ is a true lymphocyte response assay — thus it measures cell-mediated reactions. In addition, since lymphocytes are the mediators of reactive antibodies of all classes, these can be functionally detected in a proper, autologous lymphocyte response assay, i.e. one that uses the person’s own plasma as the incubation medium. In this way, protective antibodies are not detected (an intrinsic problem in antibody assays — such as IgG or IgG4– where all antibodies are detected, both those that provoke symptoms and those that protect, i.e., neutralizing, healthy antibody). Indeed, the goal of immunotherapy is to increase the IgG4 levels of protective antibody to balance out and neutralize the IgE. Similarly, when we recover from an infection, we should form protective antibody (IgA, IgG or IgM) as a sign that we are protected from future infection–not as a sign that we are hypersensitive to the infection. Each item tested is a separate lymphocyte response assay and the person can select how many items are tested, for example, just foods (from a few to 223), just chemicals (from a few to 59), preservatives and additives, toxic minerals, molds, danders, feathers and medications. Some people only need to test for a specific category of items or do the testing in a stepwise fashion to lower the load on their immune defense and repair system.”
A book about the ELISA/ACT fibromyalgia study by the patient who helped organize it has recently been published: Fibromyalgia: My Journey to Wellness, 1999, by Claire Musickant, Peanut Butter Publishing, Milwaukee, Wisconisin.
AMTL Corporation. For more information on their ALCAT test for food sensitivities, call 800/881-AMTL, or go to http://www.alcat.com.
Center for Science in the Public Interest. CSPI-Behavior, Suite 300, 1875 Connecticut Ave., Washington, D.C. 20009. Single copies of the report, “Diet, ADHD and Behavior,” are available by sending $8 to the above address. The report is also posted on the web at http://www.cspinet.org.
American Environmental Health Foundation (AEHF, 800-428-2343, http://www.ehcd.com/ehc.html). This nonprofit foundation has information on treatment in an ecological control unit (providing a chemical-free environment for treating patients who are extremely sensitive to chemicals). They provide an excellent resource for products and services, including an extensive collection of books and articles that may be ordered, including the 4 volume set on chemical sensitivity by William Rea, M.D.
The Road Back Foundation, 1985 N. Lake Hill Rd, Delaware, Ohio 43015-9249 (phone: 614/881-5601). This is an organization that publishes a newsletter concerning rheumatoid diseases. They have a particular interest in the use of antibiotics for these conditions.
Traditional allergy testing and treatment. Another alternative, if one is primarily concerned with the classical allergic symptoms, such as asthma, rashes and rhinitis caused by pollen, mold and animal dander, is to obtain a referral to a traditional allergist from your doctor or HMO. Unlike AAEM trained physicians, they emphasize symptomatic treatment with drugs, with occasional use of desensitization using injections for inhalant allergies. They are typically much more limited in their approach to food, chemical and non-IgE mediated sensitivities, in general. In my view, their main advantage is that it may be the only thing covered by your HMO or Medicaid, and may be the only thing some patients can afford, other than do-it-yourself methods. Some insurance, however, does cover AAEM methods, at least in part.
Acknowledgements: I would like to thank Kendall Gerdes, M.D., Russell Jaffe, M.D., Ph.D., Fred Furr, M.D., Anne Jackson, Director, Environmental Health Association and Kellie Warwick for their suggestions and comments on various drafts of this article. Thanks to Rona Halpern, Ph.D., for passing along the tip about the eucalyptus soap killing dust mites when added to the regular hot water laundering.
(Note: ELISA/ACT is a registered trademark of Serammune Physicians Lab. ALCAT is a registered trademark of American Medical Testing Laboratorises (AMTL) Corporation. Diagnos-Techs is also a registered trademark. However, neither CISRA nor the editor receive funding from any doctor, lab, or manufacturer of any medication or associated products. CISRA is a not-for-profit volunteer-run organization, providing information and opinion, but not medical advice.)
Caution for At-Home Food Testing: Anyone who has a tendency to anaphylactic reactions (severe reactions in which tissues swell and wheezing may occur–it can be fatal without timely emergency treatment) should avoid any at-home testing or only test foods which you are already eating and that you know won’t cause a serious reaction. Remember that reactions often increase when you have eliminated the food for a week and then are exposed to it (“unmasking,” see above). So, be even more cautious if you have never stopped and started the food before or have a history of asthma or wheezing; there is a small possibility that you could have your first anaphylactic reaction. If you have ever had an anaphylactic reaction or believe there may be danger of one, you should consult your doctor about having injectable epinephrine and other needed medications on hand and know the instructions for their use while on the way to the emergency room, in case of accidental exposures. Peanuts and shellfish are two of the worst offenders when it comes to anaphylactic reactions to foods and it may only take a very small quantity in those who are susceptible to anaphylaxis. Once again, do not do any at-home testing that puts you at any risk of an anaphylactic reaction. If you have any doubts or further questions, discuss the issue with a knowledgeable doctor who is familiar with your health situation.
Disclaimer: The above is for information only and is not medical advice. Consult your doctor regarding your medical condition.