For millennia, people ate whatever everyone around them was eating. Few people attempted to alter their diets in order to solve health problems until the late 1800’s when “failure to thrive” was identified by a British doctor as an intolerance by some infants to wheat based pablum.
In the past few decades however, the idea of altering the diet in order to attain optimal health became a more important concept to Americans. One early change was the emergence of low-fat foods. Our population was encouraged to avoid foods with high levels of saturated fat, and were encouraged to consume low-fat versions of their favorite foods. (Ironically, currently literature says there was no justification for this shift)
Over the past couple of decades, the idea of personalizing the diet to avoid foods that create inflammation has also been occurring. For the past 30 years, some physicians, nutritionists and other health practitioners have advocated the elimination of all commonly allergenic foods such as wheat, dairy (cow’s milk), soy, peanuts, and eggs and would encourage patient to abstain from consuming these foods. Some patients responded beautifully to this type of avoidance, other did a little better but still had issues. These patients were felt to be reactive to foods other than those on the “most-common” list. Trying to guess what other foods to eliminate was frustrating and not always effective.
Chronic diseases like heart disease, cancer, arthiritis and diabetes, are by far the leading cause of death and disability among the populations of developed countries. While these were not traditionally thought to be inflammatory diseases, recent research has focused on the role of inflammation in these diseases. Many studies now link biomarkers of inflammation to the risk of heart attack and stroke, to an increased risk of developing cancer, and to a poorer prognosis in those who have been diagnosed with cancer. These markers have been identified with prostate, colorectal, and breast cancers.
The scientific literature linking inflammation to the chronic diseases mentioned is large and is being added to everyday, leading some health care providers and many people to try to reduce the levels of inflammation in their bodies. We now know that gastro-intestinal issues (irritable bowel syndrome (IBS), Crohn’s, celiac and ulcerative colitis), skin conditions such as eczema and hives, migraine headaches, and chronic fatigue can be related to chronic inflammation. The problem with knowing what substances or foods to avoid can be difficult being that are exposed to a large number of daily.
70% of the immune system is in the gastro-intestinal tract. The immune system is comprised primarily of white blood cells which spend most of their time circulating through the body searching for and destroying foreign invaders such as bacteria. There are a number of different types of white blood cells, each specialized for a particular function. One function is to remember previously encountered antigens (foreign protein invaders) and uses antibodies to attack and destroy them.
This part of the immune system consists of white blood cells called lymphocytes, of which there are several types. One kind of lymphocytes produces a group of proteins called immunoglobulins (“Ig”s), which are what we would know as antibodies. Other white blood cells called lymphocytes are designed to respond to immunoglobulin antibodies that have bound to proteins they recognize. While only a small percentage of white blood cells are lymphocytes, these cells are extremely important as they allow the targeted destruction of foreign particles identified by the antibodies. Like antibodies, they also possess the capacity to “remember” previously encountered proteins in order to mount a quick and effective defense. In some people, the adaptive immune system becomes inappropriately sensitized to the patient’s own tissues; this is called autoimmunity, and leads to a variety of diseases.
Another larger part of the immune system functions to cleaning up cellular debris and waste, and destroying invaders. More than 50% of your white bloods cells belong to this category. Called neutrophils, when activated to clean up damaged tissue, they secrete a variety of toxic substances to kill whatever type of invader they have encountered. These neutrophils are thought to be a major reason behind the inflammation that causes chronic disease. They are toxic not only to bacterial cells, but in large amounts, they are toxic to human cells also, raising inflammatory markers and leading to inflammatory symptoms in addition to contributing to chronic diseases.
The ALCAT Test
The ALCAT test is a blood test that was developed in order to look for foods that the body may be treating a foreign invaders. This test looks at the entire population of white blood cells present in the blood. Recall that only a small percentage of leukocytes are lymphocytes that produce antibodies; a typical food allergy test would look only at this small population of cells. The ALCAT test, however, includes all of the patient’s leukocytes.
When a neutrophil encounters an antigen that activates it, it releases a toxic substances it has stored inside its granules. As these are released, the cell changes size, becoming significantly smaller. Sometimes, the cell will even break open (lyse) due to this antigen encounter. (Pus or thick mucus is made up primarily of neutrophils that have completed their mission and then died.) The ALCAT test compares the size and number of leukocytes present in the patient’s blood at baseline with the size and number of leukocytes after the blood has been exposed to a particular antigen. If the antigen caused a significant degree of activation of leukocytes, there will be detectable decreases in the number of cells and the average size of each cell. The test classifies each antigen as “non-reactive,” meaning that no change in these measurements was detected; “reactive,” meaning that a large change was detected; or “borderline,” meaning that a small change was detected. This classification can then be used by the patient in deciding which foods to consume. The recommendation is to consume only non-reactive foods for a period of time, rotating in the borderline foods; eventually, the patient can try gradually re-introducing reactive foods, as the immune system may no longer be sensitive to these foods after a period of “rest” from them. Some foods may need to be avoided permanently.
Several scientific studies of the ALCAT test indicate its potential usefulness in helping patients heal disease through the avoidance of foods causing inflammation. Two studies, conducted in the United Kingdom in the 1980s, indicated that the ALCAT test could be useful to patients in real-world situations. In both of these studies, patients were recruited who had chronic health conditions that hadn’t been satisfactorily treated by conventional medicine. These patients’ symptoms were recorded then they received an ALCAT test. For two weeks, they completely avoided any food to which they reacted on the test. Then, for the next six weeks, test foods were rotated into the diet; some were foods that the patients had been reactive to, and others were foods to which patients had been non-reactive. This was a placebo-controlled study, meaning that neither the patients nor their doctors were aware of whether the foods being added to the diet were reactive or non-reactive on the patient’s ALCAT.
Some of the patients dropped out of the study because they simply could not tolerate bringing particular foods back into the diet; their symptoms were too bad. 90% of such patients had reacted on foods identified by ALCAT as moderate or severely reactive. Of those who remained in the study, a majority had improvement in their symptoms when they followed the diet indicated by the ALCAT. Symptoms as diverse as migraine, eczema, and hay fever were each improved by 70% or more. Over 80% of the patients whose symptoms periodically worsened were identified as being due to ingestion of foods to which the patient was reactive. The remaining 20% of symptom exacerbations were due to life factors such as stress, exercise, and lack of sleep.
The 3 decades since these initial studies occurred, additional continuing up to the present day have indicated that many patients experience improvements in their symptoms by using the results of the ALCAT to choose their diets. Over half of patients with irritable bowel syndrome (IBS) experienced improvement. Given that conventional medicine has very little to offer these patients, this is a significant number. Other studies have shown significant improvements in migraine, skin conditions such as eczema, gastrointestinal conditions, allergic rhinitis (hay fever), and chronic fatigue. In these studies, at least 50% of patients reported improvement in their health conditions after following the ALCAT-recommended diet.
Currently, Yale School of Medicine is conducting research to further understanding of the complex pathways underlying the ALCAT Test.
For more information on this type of testing, please contact (636)928-5588 to set up an appointment with Dr. Crosby or Dr. Garrett.