“I can barely leave the house,” Heidi said, squinting her eyes the entire time.
“Perhaps if we turned off the fluorescent lights, you’d be more comfortable. I can see well enough with the light coming through my window treatments.”
“Thank you Dr. Woliner. Bright lights definitely make my migraines worse. If you could only fix my IBS with a flip of a switch …”
“Tell me more.”
“Some weeks I’m constipated, not having a BM for five days or more, even with laxatives. Lately it’s been the opposite; I’m in the bathroom at least ten times a day. My bum is so irritated that I now see blood on the toilet paper each time I go. And the bloating! I can go from being normal to 5 months pregnant in the span of a few hours.”
I empathized, “I can see how frustrating that can be. What have your doctors told you?”
“The GI looked at me from top to bottom, literally. He said I had acid reflux, so he put me on Nexium. I don’t have Crohn’s, just hemorrhoids that bleed pretty bad.”
“Anything else?”
“I had ‘sludge’ in my gallbladder, so they took that out. Didn’t help. The ER thought I had appendicitis, so they removed that too.”
“Have you ever been tested for food allergies?”
“Like peanuts? I had a skin test that came out normal.”
“There are many types of adverse reactions to food, and swelling up due to a nut allergy is only one of them. I was actually thinking about the other things: lactose intolerance, gluten allergy, and intolerances to food and food additives, such as MSG [1].”
“Dr. Woliner, I brought you all my old records. If it isn’t in there, then I guess not.”
I moved onto my physical exam, “Say Ahhhh.” As I looked into her mouth, I saw this white/yellow coating all over Heidi’s tongue, as well as two canker sores on the inside of her cheek. Heidi’s breath didn’t smell too good either …
“I think we have our answer. You’re not digesting your food, you’re fermenting it!”
“I don’t understand.”
“In addition to our teeth (and a fork and knife), we digest our food chemically, with stomach acid, digestive enzymes, and good bacteria (Lactobacillus acidophillus, etc). Acid blocking drugs such as Nexium interfere with that process, allowing bad bacteria to grow and putrefy your food [2]. The byproducts irritate your gut, causing canker sores, dyspepsia, and diarrhea [3]. Proteins you’d normally break down, are absorbed intact, leading to food allergy symptoms of migraines, arthritis, and depression [4].”
“How do we find out what I’m allergic to?”
“I start with a blood test for 150 different foods and additives to see which ones are most likely to be a problem, but the gold standard is a ‘Double-Blind, Placebo-Controlled, Food Challenge’ [5]. I want to know for sure you have a bad reaction, so I don’t restrict your diet unnecessarily.”
“So I’ll have to avoid some foods the rest of my life?”
“Perhaps not. That bad bacteria, ‘Small Intestine Bacteria Overgrowth (SIBO)’ is what they call it, causes a ruckus inside your gut [6]. Eliminating the bad bugs, and replacing them with friendly probiotics helps reduce food allergy symptoms [7]. After your GI tract is cleaned up, you may be able to tolerate foods you were previously sensitive to.”
In addition to having an overgrowth of Pseudomonas, which happened to be resistant to several antibiotics; Heidi’s tests showed responses to egg white, pork, onion, chicken, milk and coffee [8]. Challenge testing proved that coffee was a false positive, for which Heidi was extremely thankful. A short course of treatment, combined with a pharmacologic dose of probiotics improved Heidi’s bowel movements to two “Class 4-5 Stools” per day [9].
Upon Heidi’s follow-up visit three months later, “Dr. Woliner, you can keep the lights on; I don’t get headaches anymore [10].”
REFERENCES:
[1] Degaetani MA, Crowe SE. A 41-year-old woman with abdominal complaints: is it food allergy or food intolerance? How to tell the difference. Clin Gastroenterol Hepatol. 2010 Sep;8(9):755-9.
[2] Uzunismail H, et al. PPIs and food allergy. Am J Gastroenterol. 2010 Apr;105(4):963-4.
[3]CampbellAK, et al. Bacterial metabolic ‘toxins’: a new mechanism for lactose and food intolerance, and irritable bowel syndrome. Toxicology. 2010 Dec 30;278(3):268-76.
[4] Zopf Y, et al. The differential diagnosis of food intolerance. Dtsch Arztebl Int. 2009 May;106(21):359-69.
[5] MacDermott RP. Treatment of irritable bowel syndrome in outpatients with inflammatory bowel disease using a food and beverage intolerance, food and beverage avoidance diet. Inflamm Bowel Dis. 2007 Jan;13(1):91-6.
[6] Ghoshal UC, et al. Frequency of small intestinal bacterial overgrowth in patients with irritable bowel syndrome and chronic non-specific diarrhea. J Neurogastroenterol Motil. 2010 Jan;16(1):40-6.
[7] Savilahti E, et al. Pre and probiotics in the prevention and treatment of food allergy. Curr Opin Allergy Clin Immunol. 2008 Jun;8(3):243-8.
[8] Breneman JC. Allergy elimination diet as the most effective gallbladder diet. Ann Allergy. 1968 Feb;26(2):83-7.
[9] BristolStool Scale. http://en.wikipedia.org/wiki/Bristol_Stool_Scale
[10] Arroyave Hernández CM, et al. Food allergy mediated by IgG antibodies associated with migraine in adults. Rev Alerg Mex. 2007 Sep-Oct;54(5):162-8.
