Category Archives: Nutrition

IgG Food Sensitivity Testing and Reducing Inflammation

Food Antibody testing is one of my favorite tools for helping patients take charge of their own health, especially if there is a chronic inflammatory concern such as eczema, joint pain, digestive upset, or even mental agitation. Virtually all chronic disease has an underlying inflammatory component–that is, any long-term health issue, regardless of what system of the body it effects, is the result of ongoing inflammation.

So what is inflammation?  

It is the natural process the body uses to repair damage to the system and get rid of organisms that make us sick.  When an infectious agent such as a virus or bacteria enter the body, our immune system will recognize that foreign agent and attack it.  White blood cells are our immune cells that mount this attack. Specialized white blood cells will make a “flag”, called an antibody, that recognize certain proteins as foreign.  When they recognize a protein, those antibodies will attach themselves to those proteins (that often are part of a virus or bacteria) and signal the rest of the immune system to eradicate it.  Other white blood cells will engulf the protein, digest it, and then spit out the remains of that protein to be eliminated by the lymph system. This process produces inflammation, which we experience as redness, swelling, heat, and the production of mucus.  

How does this relate to foods?  

Well, in some cases, the body will recognize other proteins that come into the system as foreign.  This can include things like pollen, cat dander, mold spores, or proteins in foods. The body will mount a similar type of attack as described above on these proteins in the body even though they aren’t necessarily pathogens (bugs that will make us sick).  Instead, we call them allergens. If we are continually exposed to these allergens, the body will chronically produce inflammation. While a food may not be the agent that initially triggered the inflammatory response, the body may continue to have an inflammatory response if the food is eaten regularly.  Although foods may not be the only cause of chronic inflammation, they are one factor that can easily be changed without medication that can make a great impact on reducing the inflammatory response.

So what is IgG testing?  

IgG is a type of antibody–the “flags” the body uses to tell the immune system to make inflammation in a specific place.  Our body makes a range of types of antibodies that all do something slightly different. For instance, IgE antibodies are associated with immediate sensitivity reactions–if you know anyone allergic to peanuts or shellfish, for example, you may have seen that type of immediate reaction where the body reacts right away. IgG is a delayed antibody that may take several hours or even a couple of days to react, so it can be quite difficult to pick it out which food is causing the inflammatory response.  For this reason, a delayed food sensitivity can manifest as some of the more ongoing types of reactions, such as joint pain, IBS, eczema, chronic sinus issues, asthma, autoimmune thyroid disease, and even chronic mental agitation. Of course, we can eliminate and reintroduce foods to our diet without any testing, but elimination diets can be laborious and confusing. When we test first, it gives us an idea of the best foods to eliminate first instead of choosing blindly.  Several clinical trials in recent years have found that using IgG testing to guide food elimination can have a positive impact on many chronic issues, including inflammatory bowel disease, eczema, and migraine headaches.

Once I find out which foods I’m reacting to, what do I do?  

This is my favorite part, because it allows us to be scientists with our own bodies.  In a nutshell, the scientific method involves taking a system, changing something within the system, and observing the changes. When we actively change the diet, and pay attention to what happens, we do a little scientific experiment on ourselves that gives us the power to decide how we are going to feel each day based on the decisions we make.  When we do a food elimination, I like for you to eliminate all the potential offending foods that may be causing inflammation in your body. We give your body a few weeks–usually 4 to 6 weeks–to help the system come to a more neutral state. At this point, you note how you feel without all of those foods.

How Do I Reintroduce Foods? 

Once you have eliminated foods for an appropriate amount of time, we will  start to reintroduce foods one at a time. You will find that one of three things happens: 1. You take away a food, feel no different, then add it back, and feel no different.  2. You take a away a food, feel better, then add it back and feel obviously worse. Or 3. Somewhere in the middle–you take away a food, feel better, then you can add it back in a dose-dependent fashion and feel ok. (for example–you can tolerate eggs in baked goods but don’t feel well when you eat scrambled eggs for breakfast). When you reintroduce a food and find it bothers you, I recommend continuing to stay off of that food for at least 6 months.  For some people, a food intolerance will last for life, but for some, if the body becomes healthier and more robust overall they will be able to successfully reintroduce foods.

The knowledge you gain from eliminating and reintroducing foods helps develop what I view as the most powerful tool you have to maintain your health:  self awareness. The more aware we are, the more powerfully we can act. When we understand how our actions influence our overall state of health, we gain the ability to work as our own doctors.

Thank you for letting me be a part of your health journey!

 

Zar S1, Mincher L, Benson MJ, Kumar D. Food-specific IgG4 antibody-guided exclusion diet improves symptoms and rectal compliance in irritable bowel syndrome.Scand J Gastroenterol. 2005 Jul;40(7):800-7.

Aydinlar EI1, Dikmen PY, Tiftikci A, et al.  IgG-based elimination diet in migraine plus irritable bowel syndrome. Headache. 2013 Mar;53(3):514-25.

Alpay K1, Ertas M, Orhan EK, et al. Diet restriction in migraine, based on IgG against foods: a clinical double-blind, randomised, cross-over trial. Cephalalgia. 2010 Jul;30(7):829-37.

Mitchell N1, Hewitt CE, Jayakody S, et al.  Randomised controlled trial of food elimination diet based on IgG antibodies for the prevention of migraine like headaches. Nutr J. 2011 Aug 11

Liu Y1, Yan H2, Shao F3,et al. Correlation between childhood eczema and specific IgG antibody level. J Biol Regul Homeost Agents. 2018 Mar-Apr;32(2):341-344.

 

Homemade Sauerkraut: Improve Digestion, Prevent Cancer

There is a farm at my children’s school, and every Thursday afternoon they host a farm stand where parents and students can buy fresh veggies, goat milk products, and homemade goodies. A few weeks ago, I stopped by the stand and encountered some truly amazing produce–a head of cabbage so giant I thought I was back in Alaska. I passed on buying it, not knowing what I’d actually do with the beast, but I went home and thought about it all night, came up with a plan, and the next day headed back to the farm to see if there were more. The farmer generously took me out to the field and found me this beauty. I brought this leafy 15-pounder home and started shredding.IMG_1105

Making Sauerkraut:
It turns out making sauerkraut is a relatively simple process: it requires cabbage, salt, and a good vessel for storage. I bought a large crock for making vinegar a few years ago so I decided to use this. I would recommend using something nonreactive and not plastic, so crockery or glass are good options. According to Alton Brown, my go-to resource for all cooking projects that seem a bit more like chemistry, for every 5lbs of cabbage, use 3Tbsp pickling salt (I used kosher salt and doubled the amount). He also uses 1 Tbsp of juniper berries and 2 tsp caraway, but that is optional. After shredding and mixing the cabbage with salt, pack it firmly into your sanitized fermentation vessel of choice. Place a plate on top of the cabbage, then lay a quart-sized glass jar full of water over the plate (sanitize these too).
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After a couple days, a liquid brine should form to cover the top of the cabbage, if not, add enough water to cover the cabbage. Check it every couple of days and skim the scum off the top if necessary. The sauerkraut should be ready in 10 days to 4 weeks-just take a bit out and taste it! When it is finished, pack it into sanitized quart jars and cover with brine (the spigot at the bottom of my vinegar crock was handy for this). It should keep in the refrigerator for a few months.IMG_1177

Why Sauerkraut?

In addition to being a good source of Vitamin C, B6, and iron, there are two primary health benefits to eating sauerkraut: improved digestion and cancer prevention. The digestive benefits are twofold: there are many strains of probiotic bacteria (including lactobacillus) that work together to eat the sugars in the cabbage and produce this fermented food. Eating raw sauerkraut will help to repopulate the large intestine with beneficial bacteria, which can improve digestion, relieve inflammation, and increase the strength of the immune system overall. Green cabbage is also a good source of glutamine, which is an amino acid that is the preferred food for the lining of the digestive tract. This can also help to repair damaged cells and improve the integrity of the large intestine. One word of caution; the process of fermentation can create a trisaccharide that, when consumed by the bacteria that live in the digestive tract, can cause gas for some people. The addition of caraway and juniper (as advised by Alton Brown’s recipe) can help to dispel that gas and maximize the digestive benefit of the sauerkraut.

Indole-3-carbinol (I3C) is the primary chemical present in sauerkraut that has been associated with cancer prevention. I3C can be found in all members of the cabbage (brassica) family, but particularly high levels have been found in cabbage that has been fermented for 7-9 days. After this length of time, I3C levels continue to remain elevated but will taper off over time. I3C has been shown to reduce proliferation (growth) of several types of cancer, including colon, prostate, breast, and leukemia. I3C has been discussed particularly in reference to prevention of breast and cervical cancers because it helps to metabolize and remove estrogens from the system. These types of cancer are frequently (though not always) dependent upon estrogen as a growth promoter. However, I3C also can help to initiate natural cell death (called apoptosis) and protect the liver against cancer-causing chemicals which is why benefit has been found for non-estrogen dependent cancers as well.

Making sauerkraut is a little adventure that yields a delicious, health promoting, and cost-saving product with flavor unrivaled by the canned store-bought types. You can purchase raw sauerkraut at many health food stores, but the cost can be upwards of $20/quart. Making it at home requires only the cost of the cabbage–mine cost about $1.30/quart, plus the glory of figuring out what to do with a cabbage the size of my torso.

Enjoy and be well!

Women Need More Protein In Pregnancy

This article was originally printed in the Natural Medicine Journal–if you would like to see the references, Click here
Especially during a first pregnancy, many women have a pronounced concern about diet: how to eat, what to eat, and when to eat. As providers, we have the opportunity to help guide them towards optimal nutrition and provide reassurance that they are making sound choices. Within the context of so many “don’ts” regarding maternal nutrition–foods to avoid because of possible bacterial contamination, mercury, lead, pesticides, nitrates, blood sugar dysregulation, insufficient or too much weight gain etc–it is good to also have some advice that helps women relax and trust their intuition. This study finds that the protein needs of women throughout pregnancy is higher than previously recommended and possibly closer to what women may be craving.

IAAO is a relatively new method that has become popular for determining protein requirements in human subjects.1-4 In the past, protein requirements were assessed by the nitrogen balance method which can be difficult because it requires that all nitrogen intake and output is carefully recorded and that the subject stays in the testing facility for the duration of the testing to measure nitrogen loss from urine, feces, saliva, and wounds. This testing takes much longer to perform and requires that subjects are put in a deficiency state for longer, which makes it unsuitable for pregnant women. For this reason, the current recommendations for protein intake during pregnancy (Estimated Average Requirement (EAR) of .88 g/kg and RDA of 1.1 g/kg) have been based on nitrogen balance studies of nonpregnant adults that have been extrapolated with total body potassium studies of protein deposition during pregnancy. 5 With the development of IAAO, researchers have been able to more accurately determine protein needs during pregnancy because they can run this study on pregnant women. Additionally, this is one of the first studies to distinguish maternal needs during early and late gestation.

Understanding protein requirements during pregnancy is important because protein is the macronutrient with the most influence on birth weight. This study assumes caloric sufficiency; for well nourished non-diabetic women, increasing protein intake is the macronutrient most likely to increase birth weight.6,7 In addition to neonatal complications and increased mortality, low birth weight is also correlated with long-term health problems such as type 2 diabetes, kidney disease, cardiovascular disease, and respiratory problems. 8-11 Ensuring that pregnant women have a protein-sufficient diet is therefore crucial for the short- and long-term health of their children.

It is important to keep in mind, however, that while this study showed protein needs to be higher than current recommendations, it is still by no means extraordinarily high. The average weight of the subjects during early pregnancy was 64.4 kilos, indicating a need for 78.6 grams of protein per day, or 314 calories. Calculated resting energy expenditures (REE) averaged 1370 calories per day, so subjects were given an average of 2329 calories (1.7 REE), putting sufficient protein consumption at 13% of calories. In late pregnancy, average weight was 71.1 kg, with a need for 108.1 grams of protein or 432 calories per day. REE was 1480, so subjects were given an average of 2516 calories, with sufficient protein consumption at 15% of calories. 13-15% of calories from protein is far lower than the recommended amounts in virtually any contemporary dietary plan save for some raw, vegan and pritikin diets which are rarely recommended or undertaken during pregnancy.

Based on these new recommendations the example below provides sufficient protein sources on average for late pregnancy with far fewer calories than necessary for a day; a pregnant woman could be encouraged to include these foods within the context of whatever other foods she prefers to meet her additional caloric needs:

Breakfast: 2 eggs, 2 slices toast=21g

Snack: One ounce of cheese=7g

Lunch: 1 cup cooked lentils with steamed veggies=18g

Snack: 2 Tbsp peanut butter on 2 rye krisp crackers=12g

Dinner: 1 cup cooked chicken breast with 1 cup quinoa and steamed veggies=51g

Total: 109g protein, approximately 1300 calories

With this in mind, practitioners may find that their patients may intuitively be eating an appropriate amount of protein: a current Canadian study found pregnant women generally eating amounts of protein more consistent with the findings of this study, rather than the current DRI.12 This assumes, of course, that women have adequate caloric intake and the financial and practical means to choose what foods they eat.

One question that is relevant to how complete the information is from the study is the possible impact of the types of food consumed rather than just macronutrient content. On the day of the study, all of the calories for the day were consumed as a shake consisting of the protein supplement which was based on an egg-white composition, kool aid or tang, and a shake base powder consisting of palm, soy, coconut and sunflower oils, corn syrup, corn starch, sucrose, calcium phosphate, sodium citrate, vitamins and minerals, plus unspecified “protein-free cookies.” This does meet the requirements of the macronutrient breakdown desired for the purpose of the research study, but certainly doesn’t resemble a dietary plan that would be advocated by most providers who would be counseling a pregnant woman. While this study certainly gives us a good baseline from which to advise patients, it is certainly within the realm of possibility that a pregnant woman’s metabolic and protein needs will shift if fiber, complex carbohydrates, and phytonutrients are present in the diet.

While it can be confusing to create an optimal diet for each individual during pregnancy, the findings from this study indicate that advising for protein intake may be a little more intuitive. For women who are adequately nourished with the financial means to choose what foods they eat, as long as they feel well enough and remember to eat some protein-containing food every few hours, they will probably be able to approximately meet their protein needs each day. For women who struggle to meet this recommendation for increased protein intake, it is important to instruct them on which foods contain protein and remind them to eat these foods every few hours. This will help to optimize the health of their baby as a newborn and throughout life.