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Gastrointestinal - Food sensitivities and disease by Paul Bergner Medical Herbalism 11(1):7-13 Food allergies and sensitivities are commonly seen in a clinical herbal practice. The science behind the phenomenon, which was noted even in the Hippocratic medical literature, is controversial; sometimes no objective evidence from standard immunological tests can explain the observed result of consumption of the offending food. This article, then, is based on clinical traditions and the observations of the author over 25 years of practice. Identification of food intolerances is vitally important to the clinical herbalist, because many conditions will not improve, despite the best herbal treatment, until the offending food is removed. Dr. Otis Carroll, a naturopathic physician who practiced in Spokane Washington from 1908 through 1962, was one of the first modern physicians to systematically screen his patients for food intolerances. Carroll, who was also an accomplished Thomsonian herbalist, was trained to look for food sensitivities as an obstacle to cure in stubborn cases during his study early in the century with Henry Lindlahr, M.D., N.D. of Chicago. He cured a number of difficult cases by removing offending foods during the 1930s, and began to screen for them routinely. He eventually applied an intuitive screening method which usually was verified by withdrawal and rechallenge of the food. Carrol came to believe that everyone has one or more foods that they are constitutionally intolerant of, and which, if consumed by that person, will impair digestion and health. Carroll’s students were in turn teachers of many of the older generation of naturopathic physicians practicing today. More complete discussions of Carroll’s methods are available in Nature Doctors (Medicine Biologica; Portland, Oregon, 1994) and Lectures in Naturopathic Hydrotherapy (Eclectic Medical Publications, Portland, Oregon, 1988) Carroll found one or more of the following food sensitivities in nearly all patients tested: Food Frequency Typical manifestations Dairy 20% of patients tested Crohn’s disease or ulcerative colitis (70% of patients with these were dairy intolerant). Asthma,sinusitis, mental dullness Fruit (not melons) 20% arthritis, hypertension, autoimmune diseases, emotional problems Sugar 20% Upper respiratory and middle ear infections. (not honey or pure maple syrup) Eggs 15% Headaches, skin problems, infections Potatoes 15% "Rheumatic” problems Table
salt
15%
Fatigue, headaches
(but not sea salt) Meat,
lard, gelatin, etc
10%
Intolerances
develop late in serious disease process (but not
fish) Fish Less than 1% Soy Less than 1% Grains (but not buckwheat) “Common in combination with the other intolerances” Carroll’s observations are from before his death in 1962, and other intolerances may be common today because of the rapid industrialization of farming and food production in the second half of the twentieth century. Carroll’s student Dr. Harold Dick, also of Spokane, noticed the appearance of widespread sensitivities to turkey meat during the 1980s which may correspond to the breeding and special strains of turkeys for the commercial market. Likewise, soy allergies, which Carroll hardly observed during his career, are very common today in a generation that was fed soy formula instead of breast milk of cows’ milk during infancy. In looking at Carroll’s list, notice that with the exception of meat intolerance, which he only saw develop later in the case in advanced pathologies, all the foods are recent additions to the human diet, relative to the 2.4 million year history of the Homo species. Grains were first introduced as regular foods between 3 and 10 thousand years ago, and milk about 5,000 years ago. Fruit was consumed in the past, but only in season, not as regular or prominent part of the diet. Thus the intolerances may simply reflect that possessors of the human genome are not designed to digest these foods, and for some, they are viewed as foreign antigens. “Health must at all times come from and be maintained by digested foods. Naturopathic physicians understand this principle and use it to repair the damage done to organs, tissues, and cells which have become depleted of the necessary constructive elements. These necessary elements can come only from digested foods. After a food is digested, it goes through a process of assimilation which converts it into nutrition which is carried by the circulation to every organ, tissue, and cell. Remember, this process begins first with the digestion of food, and no drug yet offered can rectify damage done by failure of digestion” Otis J. Carroll, D.C., N.D. Diagnosis A number
of tests for food allergies exist, some of them
laboratory based, and some
intuitive. All, including intuitive methods such
as muscle testing or the
pendulum, are prone to false positives and false
negatives. I find in my
experience three things that may indicate food
allergies and suggest which
food or foods cause reactions.
The first is an examination of the clinical signs an symptoms. A complete evaluation of digestive symptoms is the best indicator that food intolerances exist. Upper gastrointestinal pain or abdominal bloating, without other obvious causes, are the first indicator. Often, a triangle of symptom patterns is present: the above digestive symptoms, plus predominant mood or energy symptoms plus musculoskeletal complaints ranging from muscle aches to autoimmune connective tissue disorders. When that symptom triangle is present, and all three legs of the triangle improve after elimination of a food, that’s a pretty good sign that the individual is constitutionally intolerant of the food (See cases 1 and 2 accompanying this article). The clincher would be the reappearance of the symptoms on rechallenge with the food, which most patients are unwilling to do intentionally after they improve from the first withdrawal. Abdominal bloating alone should be investigated as to its cause, and this usually leads to food sensitivities. Another clinical sign of food intolerances may be chronic immune weakness in upper respiratory tract. Weakness there may be due to migration of circulating white blood cells to the surface of the challenged gut lining, leaving defenses depleted in the rest of the system. One of the first tests for food sensitivities, first published in 1950, was to measure the drop in white blood cell count after challenge with a suspected allergenic food (See Food Allergy, C.C. Thomas, Springfield Ill.) White blood cell counts may drop up to 50% in the 30-60 minutes after ingestion of food allergen (following a four-day withdrawal), presumably because of their sequestration in the mucous membranes of the gut. A final clinical sign of food intolerances is when a patient fells greatly improved after a 3-4 day fast, but energy crashes and symptoms reappear after the reintroduction of food. Then, detective work is necessary to identify the specific food or foods causing the discomfort. A combination of the above digestive symptoms with one or more of the other symptom sets being present, may well define a “food intolerance syndrome” which may be a better indicator of food allergies than any of the individual tests available today. A second indicator that food allergies are present — good for pointing the way for a trial elimination of a specific food — is an addictive pattern of eating one of the foods on Carroll’s list, a pattern which is usually evident in the diet diary. The food is regularly consumed, every day and at most meals, and If the food is missed for one or two days in the diary, a binge pattern may follow the next day or at the next meal. The best question on interview to uncover this addictive pattern is: “What is the one food that you simply cannot do without?” The physiology of such addiction may have to do with a sympathetic adrenal response to the presence of the irritant in the gut. Eating the food at regular intervals becomes woven into the systemic response to stress. One way this sympathetic response has traditionally been measured is the Coca pulse test: the pulse rate may rise 5-10% in the half hour after ingesting the food. Carroll noted the sympathetic response in the quality of the heart sounds on auscultation. All food intolerances do not necessarily elicit this response, however, and false negatives are common with the Coca pulse test. The
third indicator of food intolerances is to ask the
patient. It is very
common for a patient in interview to say “I think
I may have a dairy allergy”
or even “I have a dairy allergy” yet find the food
consumed regularly in
the diet diary anway. The individual may cut out
milk, for instance, but
still eat cheese every day. Sometimes the patient
will identify an allergy,
and say that they tried removal and it did no
good. This may be true, but
more than likely they did not do a complete
withdrawal for long enough,
or objectively compare symptoms before and after
the withdrawal. See the
discussion of symptoms checklists below. Of course
some patients have no
idea that they have a food sensitivity, or which
food it might be, but
this method is extremely valuable, and any
suggestion by the patient that
they may be sensitive to a particular food should
be investigated with
a complete supervised withdrawal.
Withdrawal from a food allergy with an addictive pattern is extremely difficult for most patients. It often involves some psychological self-confrontation and growth, a repatterning of the stress response, and even reeavluation of the whole psychological approach to self-nourishing. In my practice, I consider the use of flower essences so helpful in this process that I don’t see much success in food withdrawals without them (See cases 1 and 2 accompanying this article. ) Confirmation of a suspected food sensitivity requires elimination of the food, and sometimes rechallenge. The first principle of the elimination trial is that the food must be completely withdrawn. This includes all forms of the food hidden in processed or restaurant foods, so complete withdrawal is difficult. An excellent resource on identifying hidden components of processed foods is Coping With Food Intolerances by Dick Thom, D.D.S., N.D. (GELD Publications, Portland Oregon). Milk protein solids are present in many luncheon meats, in margarine, and even in “soy cheese.” A sensitivity to wheat is usually to the gluten protein it contains, and all other gluten containing grains, such as barley, rye, corn, and oats must be removed as well during the trial period. for instance. People with corn allergy (independent of the gluten content) may be sensitive to anything with corn syrup in it, such as health food store soft drinks, most canned vegetables, most processed sweetened foods. It may be helpful to begin the withdrawal with a four day complete or modified fast. Various supplements for a modified elimination fast are available in the marketplace. This can produce rapid improvement in troublesome symptoms – the author has seen pitting edema from kidney failure disappear after a week on a modified fast. The fast can also quickly clarify whether elimination of food with improve the symptom picture, and provide impetus for the patient to continue with the withdrawal. Being careful not to flood the system with juices of high glycemic index – fruits juices, carrot, beet, and so on during the fast. Vegetable broths are better than juices. The
second requirement for a withdrawal test is a
before-and-after symptom
checklist. See cases one and two for examples. An
excellent before-and-after
symptom checklist appears in Thom’s Coping With
Food Intolerances, but
a less formal list may be compiled of all the
presenting complaints of
the patient. Use a rating system for each symptom,
such as 1-10 on a severity
scale, or the methods used in the two example
cases. I prefer the latter
method because it takes into account severity as
well as frequency of the
symptom, rather than just assessing severity at
the time of intake. In
cae two, notice that the patient expressed anger
that she was not improving
despite dairy elimination, when in fact many of
her symptoms had improved
dramatically – more than 50% in all key areas. Her
reaction is the rule
rather than some individual peculiarity. Patients
do monitor their own
gradual progress very well, perhaps because it is
difficult to remember
how one felt subjectively more than a week
previously. For example, one
patient had the complete disappearance of what she
had classified as severe
hip pain after six weeks, but forgot that she had
it, so thought she was
not making progress.
The progress in the two example cases is typical of improvements after food withdrawal. Notice some symptoms worsening in a few areas for both patients. These fit the pattern of a true healing crisis. Overall health, mood and energy improved, indicating a boost to the vital force, and the symptoms which worsened were discharges, possibly indicating some degree of “housecleaning” going on now that an irritant has been removed and the vitality has increased sufficiently to do so. Patient 2, who was not entirely strict in her avoidance of milk products, had a worsening of abdominal bloating despite overall improvement. This may reflect the common observation that once a addictive food irritant is removed, the patient is much more sensitive to it than when previously overloaded with it, and has stronger surface reaction to it. Other things to consider along with food allergies are intestinal dysbiosis or parasite infection. Most cases in the author’s practice which had previously been diagnosed as parasite infection, and given heroic bitter herbs, have actually been food sensitivities, and the strong bitters have further injured the sensitive gut wall. The food sensitivity syndrome is also often misdiagnosed as a “candida infection.” Although yeast overgrowth may accompany food allergies and general gastrointestinal dysfuntion, the diagnosis of candida is uncomfirmable. In an unpublished study at National College of Naturopathic Medicine in the early 1990s, scores on a standard “candida questionaire” were compared to stool counts of candida, and no correlation was found. The accompanying formula may relive some of the discomfort of withdrawal and hasten healing of the irritated gut. Relief is often obtained within four days. The composition or proportions of the herbs in the formula can be tailored to each patient. A patient with bloating predominant and nausea may need less demulcent and more astringency in the formula, or a patient with more upper gastrointestinal pain may require more demulcent effect. These can easily be accomplished by referring to the formula by action, and increasing, reducing , or eliminating herbs as necessary. Note: This or related formula can temporarily mask the effects of a food allergy, then once discontinued, the symptoms invariably return if the irritant has not been removed. A Basic Formula for Food Allergies or Leaky Gut Syndrome Herb Common name Actions Calendula
off.
pot
marigold
anti-inflammatory,
antispasmodic, Matricaria
recutita chamomile
digestive bitter, topical
anti-inflammatory, Mentha
piperita
peppermint
digestive antispasmodic,
carminative, Foeniculum vulg. fennel seed carminative, anti-inflammatory, warming, Glycyrrhiza
glabra licorice
root
systemic anti-inflammatory,
demulcent, Althea officinalis marshmallow demulcent, immunostimulant, cooling, moistening Actions are traditional actions, based on actions list compiled by Rocky Mountain Center for Botanical Studies. Formula arranged by action Effects on gut wall Anti-inflammatory matricaria, foeniculum, glycyrrhiza, calendula Carminative matricaria, mentha, foeniculum Antispasmodic matricaria, mentha, calendula Demulcent glycyrrhiza, althea Antiseptic mentha, calendula Antihemorrhagic calendula Vulnerary calendula Anti-emetic mentha Immunostimulant althea Digestive bitter matricaria Effects on liver Hepatoprotectant glycyrrhiza Mild hepatic calendula Effects on nervous/endocrine system Adaptogen glycyrrhiza Sedative matricaria Nervine matricaria Energetics Warming
mentha,
foeniculum
Cooling matricaria, calendula, althea Moistening glycyrrhiza, althea Drying calendula Actions are traditional actions, based on actions list compiled from traditional medical sources by Rocky Mountain Center for Botanical Studies, Boulder, Colorado. Patient One – Symptom Checklist 0 - never have the symptom; 1 - rarely have the symptom; 2 - occasionally have mild symptom; 3 - occasionally have severe symptom; 4 - frequently have mild symptom; 5 - frequently have severe symptom Mouth and Throat Visit #1 Visit #3 ( 6 weeks) canker sores 2 0 Digestive tract diarrhea 4 1 constipation 5 2 bloated feeling 4 2 belching or passing gas 4 2 stomach pains or cramps 2 1 heartburn 1 0 Total Digestive 20 8 Joints and muscles pains or aches in joints 5 2 stiffness 4 2 pains or aches in muscles 5 2 weakness 4 2 numbness 4 1 Total musculoskeletal 22 9 Energy and activity Restlessness
4 2
fatigue, sluggishness 5 2 apathy, lethargy 5 2 Total energy 14 6 Emotions mood swings 3 2 anxiety, fears 5 2 nervousness 2 2 anger, irritability 3 2 aggressiveness 3 2 depression 3 2 Total energy and emotions 34 19 Other Lost 5 of 135 lbs during first 3 weeks Note: These are only selected symptoms from a larger list, many of which did not change. Treatment for Patient One 1. Removal all wheat and gluten from diet 2. Decoction: Matricaria recutita (chamomile flower) Mentha piperita (peppermint leaf) Foeniculum vulgare (fennel seed) Glycyrrhiza glabra (licorice root) Calendula officinalis (pot marigold flowers) Equal parts Strong decoction – 1-2 ounces per quart Sig: 1 quart per day 3.
Flower essence, changed on the second visit.
Tomato – cleansing Yellow yarrow – protection of psychic barriers Cucumber – depression and detachment from life. Corn – body-soul balance and grounding Summer squash – courage to face daily routine of life Gruss-an-Aachen rose – coordinated evolution of body and soul during time of evolution Patient Two – Symptom Checklist 0 - never have the symptom; 1 - rarely have the symptom; 2 - occasionally have mild symptom; 3 - occasionally have severe symptom; 4 - frequently have mild symptom; 5 - frequently have severe symptom Digestive tract Visit #1 Visit #2 ( 3 weeks) constipation 3 0 bloated feeling 3 5 belching or passing gas 5 3 stomach pains or cramps 5 3 heartburn 3 1 Total Digestive 19 12 Joints and muscles pains or aches in joints 5 3 pains or aches in muscles 3 0 Total musculoskeletal 8 3 Energy and activity Insomnia 5 1 fatigue, sluggishness 3 3 apathy, lethargy 3 0 Total energy 11 4 Emotions mood
swings
5 0
anxiety, fears 5 1 nervousness 5 2 anger, irritability 5 2 depression 3 2 Total energy and emotions 23 7 Other: Patient came to visit #2 angry, complaining of no improvement. Sinus discharge, clearing throat, and bloated feeling worsened On visit #1, patient was despondent about ever working in the field she wanted to. By visit #2, she had arranged a volunteer apprenticeship in that field. Note: These are only selected symptoms (initial score 3-5) from a larger list, many of which did not change. Treatment for Patient Two 1. Remove all dairy from diet. Client did not fully comply. 2. Decoction Matricaria recutita (chamomile) Mentha piperita (peppermint) Foeniculum vulgare (fennell) Glycyrrhiza glabra (licorice) Althea officinalis (marshmallow) Taraxacum officinalis (dandelion) Melissa officinalis (lemon balm) Scutellaria lateriflora (scullcap) 3. Peppermint altoids and ginger candy symptomatically (She
was already taking these and wanted to continue)
4. Flower essence combination Eclipse rose – acceptance and insight, overcoming blind acceptance and resignation Sonia rose – stabilizing a new situation Okra blossom – Seeing the positive in one’s life Summer squash – courage to face the day-to-day routine. |
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