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Food allergies

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In his third of five lectures, Dr. Cady reviews the concepts of food allergy testing with IgG and IgE antibodies, traces the development of this body of knowledge from the 1960's, and reviews two illustrative cases.

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Food allergies

  1. 1. New Adventures in Food Sensitivity Testing and TreatmentLouis B. Cady, MD – CEO & Founder – Cady Wellness Institute Adjunct Assoc. Professor – Indiana University School of Medicine Integrative Medicine for Mental Health Conference Santa Fe, NM September 22, 2012
  2. 2. “There are two objects of medical education: toheal the sick and to advance the science.”- Dr. Charles H. Mayo, MD “The glory of medicine is that it is always moving forward, that there is always more to learn.” - Dr. William J. Mayo
  3. 3. Is this any way to take care of the health of a nation?3.4 * 10 9 3.1 * 10 8 • 3.4 billion prescriptionsRx Peeps are written every year 13.4 Billion • 307 million people in US2Prescriptions • $630 billion to top 12 307 pharmaceutical million companies (profits!) 3 People • The majority are due to “silent syndromes” and modifiable disease risk factors. 1. Ukens C. How mail order pharmacy gained in market share in 2003. Drug Topics Mar 22, 2004; 148. 2. U.S. Census Bureau, Jul 2009 3. CNN Money, May 3, 2010; http://money.cnn.com/magazines/fortune/ ortune500/2010/industries/21/index.html accessed August 17, 2011
  4. 4. Triadic model of thinking about diagnosis or treatment puzzles• PSYCHODYNAMIC - what makes a patient the way he/she is? – (what makes them act &/or respond as they do?)• FUNCTIONAL - what are some of the underlying physiologic processes which may be pathogenic?• IMMUNOLOGIC - what are the subtle manifestations of food allergies & sensitivities?
  5. 5. How not to get overwhelmed in this presentation:
  6. 6. Stanley E. Greben, MD• Some therapists stand out as uniquely effective.• Academics are no better.• “Every potential therapist must have a floor and a ceiling to his therapeutic capacity.”• Some gifted therapists are able to say why they succeed; others can’t explain it. “A great deal of what they do ‘right’ is intuitive.”“On Being Therapeutic” [Canadian Psychiatric AssociationJournal. Vol. 22(1977) 371-380.
  7. 7. Greben’s “Seven Habits”• Empathy & concern• Warmth• Interaction• Ability to arouse hope *• Expectation of improvement• “Not to despair”• Reliability & Friendliness *Requires clinical depth and breadth of knowledge
  8. 8. Psychodynamics 101• Patients can be vexing.• Diagnostic impasses provoke narcissistic angst.• Frustrated clinicians do not relate well with patients.• The more tools and capabilities one has, the greater the freedom, the options, and the ability to positively impact the patient.• The greater the success, the better the patient feels, the doctor feels, and the doctor-patient relationship feels.• The converse, worrisomely, also exists.
  9. 9. IMMUNOLOGYThe forgotten component of “workups”
  10. 10. "What isfood forone, is toothers bitterpoison.” Lucretius – 099? B.C. – 055? A.D. De rerum natura.
  11. 11. “The Three Little Ig’s & Three Stories”• Ig E xciting oing along• Ig G norant•Ig
  12. 12. IgE Antibodies: catastrophic reactions vs. sneezes and itching (checked via skin tests or RAST) http://pathmicro.med.sc.edu/ghaffar/skintest.jpg
  13. 13. CELLULAR immunityhttp://users.rcn.com/jkimball.ma.ultranet/B www.souzaoenterprises.com/AiologyPages/M/MastCell.gif llergiescomp.jpg
  14. 14. HUMORAL Immunity “Globulin molecules capable of attacking the invading agent.” [Guyton]This model of human IgG1 was createdby E. A. Padlan -- "Anatomy of theAntibody Molecule." MolecularImmunology 31:169 (1994)
  15. 15. Actions and downstream effects• Direct action of antibodies: – Agglutination, precipitation, neutralization, lysis• Downstream effects: complement activation: – Lysis, opsonization/phagocytosis, chemotaxis, agglutination, neutralization of viruses, INFLAMMATORY EFFECTS
  16. 16. ADHD Diagnosis – Symptoms present before age 7 years – Impairment from symptoms present in 2 or more settings – Significant social, academic, or occupational impairment – Exclude other mental disorders
  17. 17. From:www.patientmedia.com(used with permission of William Esteb)
  18. 18. Food Allergies and ADHD in the Literature•Food allergies presumed to be related to ADHD • Get “THE THINKER” illustration•Before 1976 – No known relationship between FA and ADD•1976 – IgE reactivity + food allergies = decreased IQ•1985 – d/c of antigenic foods = ADHD improvement•1993 – more confirmation•1994 – some kids that got better on diet did NOT have IgEreactivity•2003 – evidence mounting for non-IgE sensitivities related to foodallergies]•2002 – 2011 Pelsser LM et al – SIX published papers (Europeanand Dutch literature, cf: www.pubmed.gov).•66 papers, at present – 8/19/2011
  19. 19. Millman, et al – the groundbreaking article• “Allergy & Learning Disabilities in Children” – Annals of Allergy, 1976 [36:3, 149-160.]• “The allergic tension-fatigue syndrome observed by Speer” – “A symptom complex accepted by many allergists.”• Food allergies established by scratch testing or intradermal injections• Positive correlation between [IgE] food allergies and IQ scores. – The more the food allergies, the lower the IQ scores.
  20. 20. Oligoantigenic diet (w/o testing)• “Controlled trial of oligoantigenic treatment in the Hyperkinetic Syndrome.” Egger et al. Lancet, March 9, 1985, 540-545.• No testing performed• Children empirically placed on restrictive diet. – Two meats, two carb sources, two fruits, one vegetable, water, calcium, vitamins.• No food allergy symptoms were provoked; ADHD improved.
  21. 21. The crossover study – no distinguishing between IgE and IgG• “Effects of a few foods diet on ADD.” Carter et al, Archives of Disease in Childhood, 1993;69:564-568.• “Few foods” elimination diet – 59 of 78 children improved.• “This trial indicates that diet can contribute to behavior disorders in children and that this effect can be shown in a double blind, placebo controlled trial.”• “The ways in which [this] diet worked remain unclear. Toxic pharmacological, or allergic mechanisms could be involved, and the physiological effects of different foods may vary.”
  22. 22. Profound cautions• “Effects of a few foods diet on ADD.” Carter et al, Archives of Disease in Childhood, 1993;69:564-568 (cont.)• “The treatment, as applied in this study, has disadvantages. It is a difficult and exacting regimen, which puts a considerable strain on the whole family. It is not yet clear whether modified diets can also be effective…. It may therefore be possible to devise a less restricted diet with similar levels of success.”• Cady impression: “Shooting in the dark is dangerous.”
  23. 23. The appearance of IgG• “Foods and additives are common causes of ADHD in children.” Boris, et. al. Annals of Allergy, vol.. 72, 1994, 462-468.• “DBPCF” - “double blind placebo controlled food challenge test”• 4/19 children who showed improvement with removal of offending foods were non- atopic.
  24. 24. “IgE and Non IgE Food Allergy”• Sabra, et al. Annals of Allergy, Asthma, and Immunology 2003;90 (Suppl 3)71-76.• “The gastrointestinal tract serves not only a nutritive function but also is a major immunologic organ. Although previously thought to be triggered primarily by an IgE mediated mechanism of injury, considerable evidence now suggests that non- IgE mechanisms may also be involved in the pathogenesis of FA (“food allergy”).
  25. 25. The patient: “Billy”• 8/1998 – 4 yo Eastern European adopted child – “ADD & behavioral problems, destructive.” – First 3 years of life in orphanage• Fam Psych Hx: – Dad – “substance induced paranoid psychosis” – Mother – “recurrent schizophrenic decompensations”
  26. 26. Billy’s symptoms• “Mercurial” – easy to get along with (except for hyperactivity) then one week at a time will be glowering, sullen, terrible mood, knock brothers over, throw food from table, etc.• MSE – very hyper. Not able to focus on Nintendo (!) Found standing on top of a box in my video room, supervised by his Dad. DSM-IV: 5/6• Previous trial of Rx: Adderall 5 mg up to 10 mg. Made him much worse• ….started on Ritalin and Clonidine
  27. 27. Billy, cont.• Some improvement• 3/1999 – increasingly vile temper. Sad, dysphoric. “Back to square one.” – Zoloft added. – Ritalin only lasting 1 ½ hours• 5/1999 - 4 ½ yoa. Rehab Center testing: – Auditory comprehension = 2 y 11 mo’s – Total language = 2 y 11 mo’s• 6/1999 – Flaxseed oil, L-tyrosine, Pediactive tabs added. In constant trouble Dad getting depressed.
  28. 28. Billy, cont – 1999 - 2000• Ritalin and Adderall not working• Temper to the point of clawing at his face. Sniffing. Now urinating in bed.• 12/1999 – started on Risperdal – 1mg in a.m. and ½ mg later in day• 2/2000 – Psych testing – IQ 78 – ADHD – Borderline intelligence – Processing problems – “r/o childhood psychosis”
  29. 29. Billy, cont.• 3/2000 – Depakote added to Risperdal for temper and “bipolar” feel. Now doing even worse. Staggering some. – DSM IV 6/7 – Risperdal, Tenex, Zoloft, Depakote, Ritalin SR (@ 6 yoa!)• Summer – Concerta tried. Seemed to respond, then “downhill trend before school started.”• 10/2000 – “staring spells.” Cleared by neurologist. Negative EEG.• Mayo suggested; insurance wouldn’t pay.
  30. 30. Billy, late 2000• Fall 2000: – Bit and stabbed his teacher with a pencil, kicked chair, wall, and desk, spat on floor and teacher. Obsessively lining up his cars in his room, tongue thrusting and smacking (? Tardive dyskinesia?)• On Risperdal, Depakote, and Concerta.• 8/2001 – 2002 some better but still unpredictable. Meltdowns. Depakote increased. Zyprexa added.• 8/2002 – throwing things against windows. Depakote not working. Mood cycling.
  31. 31. May 2002: 9th Annual IFM Conference
  32. 32. Billy, 2003• Ongoing unpredictability until Geodon started. – Less hyper – Dry in a.m. – Clearer speech and better eye contact.• July 2003 – IgG food allergy testing ordered
  33. 33. Billy – IgG Food Sensitvities July 2003• 21 + IgG reactions.. Of these….. – Cheese (3+) – Cow’s milk (3+) – Goat’s milk (2+) – Brewer’s yeast (3+) – Millet (+1) – Lettuce (!) (+1)Reviewed labs with internet savvy Mom (who did NOTHING).
  34. 34. Billy, 2003 - 2004• Variable. Food sensitivity diet not really followed.• 9/2003 “absolutely cannot sit still. Moods are flipping. Gets angry and aggressive really fast.”• 12/2003 – no better – On Depakote, Geodon, Concerta, Clonidine – 1/2004 – VPA level 122 ug/ml; {50 – 100}• 3/2004 - “An incredibly nice kid when he’s doing what he wants to do; an asshole when it comes to relating.” (per Dad)
  35. 35. June 7, 2004 – 6 years oftx; ONE YEAR AFTERIgG Testing!• “Literally bouncing off the walls in the a.m.”• Almost knocked brother off second floor balcony• Could not tolerate < 2 g VPA• Threw stool over banister and tried to hit Mom on way up stairs. (Missed)• Told Mom: “You’re going to die, I’m going to make sure you’re going to die.”• Things that make him angry: not putting peanut butter sandwich on plate “correctly.”• Waking up screaming. Making non-human, guttural sounds.• Parents pursuing IP treatment
  36. 36. Radical interventions/ workup• June 2004 – Lithium added – Made him briefly toxic but symptoms improved. – Worked on getting him inpatient tx.• Fatty acid panel ordered.• Told Mom to GET SERIOUS about food allergies/sensitivities
  37. 37. Clinical manifestations of EFAD• Dermatitis • Thirst, polydipsia,• Increased appetite and polyuria caloric intake in infants • Liver fatty infiltration (adults?!) • Increased capillary• Failure of wound healing fragility• Irritability • RBC fragility• Alopecia, dry hair, dandruff • Increased• Brittle nails Cholesterol/HDL ratio• Increased susceptibility of infections
  38. 38. Essential Fatty Acid findings Value Reference rangeEPA 3 (L) 20 - 80DHA 32 (L) 70 - 150
  39. 39. FEB2005
  40. 40. Billy – May 3, 2005• Stable. Has stopped sneaking food.• IgG restrictions: wheat, gluten*, cow’s milk, processed sugar. (Able to tolerate unprocessed cane sugar.) All forms of chocolate and caffeine.• Drinks: homemade lemonade, soy or rice milk• Doing a music program at school. “Learning songs he never could before.”• MEDS: Levocarn; 72 mg Concerta, “DHA heavy” fish oil; 20 mg Geodon (1/2 the previous) – Eliminated: Lithium, Risperdal, and Depakote• Prognosis: excellent. Still with cognitive challenges, but making progress at school and beginning to catch up. Behavior is stable. No more mood swings or rages. * Note – not originally seen on testing.
  41. 41. Billy – June 23, 2009• Stable. Teenager. “Doing well except when his will is crossed.”• IgG restrictions: wheat, gluten, cow’s milk, processed sugar. (Able to tolerate unprocessed cane sugar.) All forms of chocolate and caffeine.• More verbal: of CWI therapy pet, he comments, “This dog doesn’t growl; he likes people.”• MEDS: – “DHA heavy” fish oil twice daily – MVI in a.m – Vyvanse 70 mg, booster MPH in the afternoon; Risperdal 0.5 mg twice daily, VPA 500 mg ER twice daily .• ADHD symptoms: – zero – inattentive symptoms – ONE – hyperactive/impulsive symptom
  42. 42. Status: August 17 2011• “He’s doing great.”• Failed attempts to wean off of IgG food allergies. – Apples have been added occasionally – Still can’t do dairy, gluten, citrus, or bananas.• H.S. sophomore– one year behind (in special ed.) classroom.• Getting along well with siblings; has not progressed past 1st grade academically, but visual spatial talents excellent.• Landscaped the entire back yard. Moved 8 tons of rock
  43. 43. FROM HYPERNESS TOHEADACHES…and joint pains,migraines, brain fog,irritable bowelsyndrome, asthma,fatigue, misc. achesand pains
  44. 44. www.pubmed.com search September 1, 2012Correlations found between food allergy & : • Depression • Anxiety • Acute psychoses • Autism • Schizophrenia
  45. 45. Gluten – one of the ultimate “bad boys” in food sensitivities • Headaches • Tearing up your gut • Depression • Suicide* – * Untreated celiac disease and attempted suicide. Lancet, September 1995. Pelligrino et al
  46. 46. Gluten and neurologic disease• “More recent studies have emphasized that a wider spectrum of neurologic syndromes may be the presenting extraintestinal manifestation of gluten sensitivity with or without intestinal pathology.” – -Bushara, KO. Neurologic presentation of celiac disease – Gastroenterology. 2005 Apr; 128(4 Suppl 1):592-7.
  47. 47. “UBO’s on MRI” – the gluten connection• 10 patients – had headaches. – MRI – UBO’s• 6 – unsteady, 4 gait ataxia• 90% response rate to gluten free diet.
  48. 48. Observant pediatricians anddepressed parents – with celiac dz
  49. 49. Corvaglia, et al 1999• 3 adult patients found with undiagnosed/untreated celiac disease• Found by pediatricians who noted family history when child’s medical history obtained.• Celiac disease diagnosis was MADE in childhood, but diet was stopped due to no more GI symptoms.• In all three patients, depressive symptoms improved with gluten free diet.
  50. 50. Does it have to be celiac/gluten to mess up your head?-Migraine has high prevalence – 18%-Allergen-specific IgG in serum of patientsREFRACTORY TO TRADITIONAL TREATMENTexamined.-IgG antibodies obtained to 108 food allergens measured in56 patients with migraine and a control group.-Statistically significant differences found betweenmigraine group and control group in number of foodallergies. Answer: NO!-CONCLUSIONS: “ACCORDING TO THE RESULTSOBTAINED, serum IgG Antibodies to common foodshould be investigated in patients with migraine.”
  51. 51. What to be looking for… • Obvious GI problems • Chiro adjustments don’t “hold.” • Atypical presentations • KNOWN associations (autism) • Symptoms varying with diet • Excess ABX use (candida) • Lack of normal progression in treatment
  52. 52. Just one more: Joey - 6/28/11• 11 year old male 5th grader with dx of ADHD and Speech Apraxia; problems with reading, writing, oral expressive language, math, sequencing• Medical: – Hx of “lazy bowel” • “He doesn’t go more than once in two weeks.” • Dietary: likes cheese, chicken nuggets, ice cream, Coke, pizza. Used to like cottage cheese. – GI sxs refractory to pediatric interventions• Dx 1: ADD: 6/9 sxs of inattentiveness ON RX.• Dx 2:“Probable severe IgG food sensitivity with obvious stool retention problems”
  53. 53. Dairy IgG sensitivity suspected. Testing/Results:• Pediatrician ordered IgE RAST = NEGATIVE• 7/25/11 – no change. 2 BM’s in one month. – IgG Testing previously ordered. (Mom resistant and delayed due to cost. Finally done after this appt). RESULTS: • Milk – SEVERE • Mild: green peas, pinto beans, corn, garlic, tomato, wheat• 8/15/11 - constipation and fecal retention totally eliminated.
  54. 54. What I learned; what we can learn• Think about “the matrix” first.• Functional and immunologic inquiry and stabilization is a prerequisite for improvement in some cases. – (“You can’t tell by looking.”)• Psychodynamic errors (“blaming the patient”) can sabotage miraculous progress.• The human body has marvelous ability to heal itself naturally if given the breathing room to do so.
  55. 55. Diagnostic challenges & IgG food sensitivities - opportunities exist• “Tough cases”• Weird, multiple symptoms• Headaches• GI symptoms, food cravings, or both• ADHD and “bipolar” type symptoms• Processing issues (no pills available!)• Headaches resistant to standard chiropractic and medical tx• Fatigue, “brain fog”, temper fits
  56. 56. $3,000 vs. $5,500 – casket and funeral includedDon’t be a commodity. Acquaint yourself withdiagnostic testing available to you.
  57. 57. Personal collection - Louis B. Cady, M.D.
  58. 58. Contact information: Louis B. Cady, M.D. www.cadywellness.com www.indianaTMS-cadywellness.com Office: 812-429-0772 E-mail: lcady@cadywellness.com 4727 Rosebud Lane – Suite F Interstate Office Park Newburgh, IN 47630 (USA)

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