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 Testing for Food Sensitivity
by Dr PJ Fell
Lond.
Testing for Food Sensitivity
by Dr PJ Fell
Lond.
The ALCAT test simply
measures a change in the size of white cells after they have been
incubated with individual foods, food constituents and food
chemicals.The test ranks the foods etc. as a percentage shift from the
control values giving the worst i.e. the highest percentage shift to the
least reactive i.e. the lowest percentage shift. ...Using it it is
possible to quickly construct a tailor made elimination diet.
This Whether one believes in evolution or creation it would be misguided
to think that the great variety and very efficient mechanisms for
detoxifying chemicals in the body were put in place because man would be
clever enough in the twentieth century to discover a vast array of new
chemicals called drugs. No, they have been in place for millions of
years to enable man to adapt to the environment, eat food, extract the
nutrition from it without being poisoned by the chemicals which
naturally occur in all food – the xenobiotics. This has been extended
somewhat by the food industry which adds more chemicals or by industry
which has polluted the environment, but these represent only a small
proportion of the daily chemical load processed by the body.
An individual may
vary as much as threefold in their ability to detoxify at various times
and under changing circumstances and different individuals vary several
fold so there may be a rate difference detoxifying as much as eleven
times between individuals. Thus one person may drink a cup of coffee
after dinner and be happily asleep three hours later whereas another
still suffering the effects of caffeine may still be awake in the early
hours.
When food is put in the mouth the process
of digestion begins and this consists of extraction of the nutritionally
valuable products while at the same time resisting or neutralising the
poisons which are an integral and natural part of food. Plants and
animals also want to survive and not be eaten by hostile predators so
whether it’s the chemicals in plants or the toxins in fish or the
protective coatings of progeny they are all there to resist being
ingested and digested. While these processes are continuing in the gut
they are in reality outside the body until they cross the gut wall and
are absorbed into the animal, in this case the human. It is not
surprising therefore that all along the gut wall from start to finish
there are systems to enhance the absorption and utilisation of nutrients
and others to resist or neutralise xenobiotics.
There are enzymes and hormones to degrade
the toxins or modify them for quick elimination, there are proteins to
bind on to them so they may be transported safely to the liver for
detoxification and there are a host of different white cells
manufacturing these, manufacturing local antibodies for defence and
transporting toxins for elimination themselves. These white cells are
often specific for certain molecules and in performing their tasks alter
in size, and that alteration can be detected.
The main stay of detoxification is an
enzyme system known as the cytochrome P450 system and this is versatile
in the extreme detoxifying a wide range of chemical structures, but it
has one drawback and that is it works at a set rate and cannot
accelerate as concentrations of toxins increase. The result is the body
may be overwhelmed acutely or chronically if a high intake of specific
toxins occurs and it is this situation that leads to food sensitivity.
It is not allergy, it is not necessarily permanent and it is not always
the case that illness ensues. Consider alcohol which if imbibed too
quickly or in too large an amount will lead to drunkenness, the next day
to a toxic ‘hangover’ and the next day back to normal.
Some individuals who are susceptible to
these xenobiotics may have symptoms varying from the mild to the severe
and even to death. The symptoms may be acute or chronic – so diarrhoea,
vomiting, headache, joint pain and skin irritation may be temporary or
may develop into a continuing illness. Thus irritable bowel syndrome,
migraine, rhinitis, urticaria (hives), wheezing and a host of other
symptoms may lead the individual to associate food with their symptoms.
In some instances the individual is quite clear as to what causes the
problems, eliminates the food from their diet and suffers no more,
perhaps occasionally or inadvertently ingesting it and experiencing the
same symptoms as before. However, many people though suspicious that it
is a food or foods causing the problem, cannot identify the likely
candidates. It is even more difficult if it is a constituent or chemical
or multiples of these in which case simple elimination techniques simply
do not work. Compounding this is the fact that different substances
cause problems with different times of onset, some in minutes others in
days.
For some individuals the symptoms and
severity are such that they ruin their lives; for others they are less
but they still interfere with the individual’s lifestyle or causes them
at times to perform badly.
Feeling very tired after eating, having a
low grade headache several days per week or waking stiff and fatigued
may be vague in medical terms but they are nonetheless quite clear and
debilitating to the patient. These can all be food related. Things
become more serious when some of the syndromes become permanent, such as
irritable bowel syndrome where the individual is either in great
discomfort because the bowel will not move or faces the opposite
situation of several painful bowel actions every day. Frequent migraine
headaches or severe skin irritation and swelling, though not life
threatening, are still to the patient serious and distressing. Thus
food, while most of the time, giving the majority of us great pleasure,
for a few it is the cause of great concern and ill health.
This is where some of the new laboratory
tests help. I use one imported from the USA and provided by OATS Ltd and
called the ALCAT test. I have had good results in many hundreds of
patients over the past few years. There are several others providing
similar information but essential to all of them is the correct
interpretation and application to the specific medical conditions. The
ALCAT test simply measures a change in the size of white cells after
they have been incubated with individual foods, food constituents and
food chemicals.The test ranks the foods etc. as a percentage shift from
the control values giving the worst i.e. the highest percentage shift to
the least reactive i.e. the lowest percentage shift. This is only the
first step because the results are then fed into a computer database
which identifies where those offending items can be found in the diet.
Using it it is possible to quickly construct a tailor made elimination
diet.
The next step is to ensure the
elimination diet is nutritionally sound and if it is lacking, which
dietary supplements will be necessary. It must then be followed for a
period of not less than six weeks. Sometimes this time course needs to
be longer depending on the frequency of symptoms. Some conditions such
as angioedema (swelling of the face, lips and tongue) may be less
frequent so an adequate time course must be allowed. Other conditions
such as attention deficit disorder, where the food element may be only
one component, also need other expert input if an assessment of
improvement is to be made.
Once an improvement is noted by the
patients, they then act as their own benchmark by reintroducing foods in
a structured and controlled fashion ultimately ending up, hopefully,
with a few foods identified and linked to their symptoms. It also
enables the individual to have a socially acceptable diet which is
enjoyable and free from what are often quite debilitating symptoms.
This test was initially applied to a
group of patients in a double blind controlled study. The patients
chosen were those where food might be implicated in their illness,
migraine, urticaria, eczema and irritable bowel syndrome. The results
were encouraging and showed the predictability of the test was
statistically significant. Over 200 individual food challenges were
conducted and there were approximately 30% false positives and 18% false
negatives. The next series of patients were controlled more stringently
and limited to irritable bowel syndrome only. They had all been
symptomatic for 3 years and this publication was published in the
Journal of Nutrition. The target symptoms, tiredness, bloating, number
of motions, abdominal pain, headache and nausea were significantly
different during the challenge period. A difference in score was
statistically significant.1
There then followed a number of studies
reported by other workers in other fields demonstrating the usefulness
of this test.
Two carefully controlled studies by Dr
Lene Hoj of Copenhagen showed excellent results. One study on 92
patients, highlighted the usefulness of the ALCAT test in predicting
positive result with challenge, this time using chemicals, used as food
additives and probably not via any immune mechanism. The test was shown
to have a .96 efficiency.2,3
Another study in San Antonio on dieting
supported by information on food sensitivities from ALCAT tests, showed
a change in weight following an ALCAT diet.4
By the time this work was carried out in
the 1990s we had noticed that in many of our patients being treated for
food sensitivity with diets predicted by the ALCAT test there was a loss
of weight as well as an alleviation of symptoms. This study embraced
this observation and in a controlled fashion measured the weight loss
and proved that this was a secondary beneficial effect. It opened up the
possibility that some types of obesity might be treated by diets
predicted by the ALCAT test and this work is continuing in several
centres, already having been confirmed by Dr. Cabo-Soler in Spain.
During the past ten years we have
continued to use the ALCAT test and presented a number of papers on
various medical topics besides using the test on well over two thousand
patients.
But my major interest during the last few
years has been directed towards the mechanism of action that is
demonstrated by the test, as I believe we are not witnessing the results
of immune mechanisms but are seeing the result of pharmacological or
toxic phenomenon. The white blood cells are capable of a number of
actions when in contact with non- nutrients- xenobiotics and there is a
wide and varied support for this hypothesis.
Cells may react in a number of says when
bought into contact with xenobiotics, if soluble they may be engulfed
and vacuolated and thus increase in size. The cells may degranulate and
release substances that act on blood vessels and thus diminish in size
or be exposed to such an extreme reaction that the cells disintegrate
and the cell count falls. It can be demonstrated that certain cells will
commence proliferation and an increase in DNA may be demonstrated, at
this point the cells swell then divide and produce 2 small cells. The
lining of the gut is loaded with cells capable of this series of
reactions but if overwhelmed then peripheral cells become involved and
it is almost certainly this phenomenon that the ALCAT test is detecting.
Many of these reactions are directly chemical as can be demonstrated by
subjects who are sensitive to such chemicals as Benzoic acid. Increasing
challenges to the skin will produce increasing urticarial reactions
until cells are depleted and high doses then fail to produce a reaction.
These are not histamine mediated as the process cannot be blocked by
anti-histamines.
Four patients were selected who had
positive IgE negative ALCAT to foods, a second group were the reverse,
ALCAT positive IgE negative and a control group who were negative to
both. The patients produced a resting sample of urine, were then
challenged with an individual food, and urine collected hourly over 12
hours. The results were analysed looking at the first 6 hours versus
6–12 hours. The IgE positive group were noted to have an increase in
metabolite immediately falling off by hour 6, whereas the ALCAT positive
group produced metabolites later, their peak being between 6 and 12
hours. The control group produced no histamine metabolites.
The last series of experiments were
designed to show again the predictability of the ALCAT test but this
time with substances known to be pharmacologically active in the body,
and, as many of these have been incriminated in migraine we chose to
look at healthy volunteers and patients suffering from migraine. The
substances we tested were: gluten, tryptamine, octopamine, dopamine,
lectin and chloragenic acid (naturally occurring substances), all
produced a significantly positive result in migraine sufferers versus
healthy volunteers, whereas histamine and tyramine produce similar
results in healthy volunteers.
These series of experiment encouraged us
that as important as food sensitivity may be, it is likely that both
natural and man made chemical xenobiotics may be equally if not more
important in some syndromes. Therefore, we now adapt the ALCAT test to
embrace this possibility.
There are often associated with the food
problems, other aspects which need attention; there may be disruption of
the gut flora – the bacteria in the gut, essential for providing 25% of
our energy needs and tests are necessary to determine what is the
problem and how it should be treated. Some individuals are allergic to
certain foods and this requires quite different tests to determine if
allergic antibodies are being produced and this would lead to quite
different treatment. Nutritional advice, sometimes psychological
support, general medical examinations and investigations may be
essential, so it is important that if illness is being caused by food
then it should be managed by professionals who are knowledgeable about
these matters and not simply dismissed. “I am afraid you will just have
to learn to live with it” is of no use to the patient and reflects badly
on the person giving this advice as there are now plenty of
opportunities available for these individuals to improve, they should be
investigated.
References
1. Peter J Fell
M.D., Sally Soulsby S.R.N., et al Cellular Responses to Food in
Irritable Bowel Syndrome, an Investigation of the ALCAT test.
Journal of Nutritional Medicine
2:
143–149. 1991.
2. Lene Hoj M.D. Diagnostic Value of the ALCAT Test in Intolerance to
Food Additives Compared with Double-Blind Placebo-Controlled Oral
Challenges. Journal of Allergy,
Asthma and Immunology
97 (1) Part 3. January
1996.
3. Lene Hoj M.D. Food Intolerance in Patients with Angioedema and
Chronic Urticaria: An Investigation by RAST and ALCAT Test.
European Journal Allergy & Clinical
Immunology 50:
375. 1995.
4. Gilbert Kaats, Dennis Pullin and Larry Parker The Short Term
Efficacy of the ALCAT Test of Food Sensitivity to Facilitate Changes in
Body Composition and Self-reported Disease Symptoms: A Randomised
Controlled Study. The Bariatrician.
Spring: 18–23.
1996.
About the Author
Dr P J Fell is a
Director of the Oxford Allergy Centre. He can be contacted on 01869
337323. |
