Right Testing, At The Right Time

Wellness is a practice, not just a word.

Welcome to the Synergy Podcast, where myself, Kelly Engelman and Lori Essery shed light on powerful tools and topics that nourish.

Your body and most importantly, feed your soul. Welcome, Synergy Podcast listeners. We are so excited to be with you today. Kelly and I are just going to have a casual conversation about a common topic that many of our patients come to our clinics about. And we're hoping to maybe dispel some myths and maybe answer some questions that have been burning about food allergies, food intolerances, and food sensitivity. So listen up. So, Kelly, I'm excited to have this conversation with you because we don't always get a chance to talk about kind of what we're seeing in our clinics. But, you know, one day we were talking about how many times people come into the clinic, had a lot of testing. You know, they're sick and tired of feeling sick and tired, and they just want to know what test to do, or they've already done a lot of testing, and most recently, people are coming into the clinic having already had some food allergy or. And food intolerance testing. So what do you. When clients come in with those questions and with those tests, what is the first thing that you do with them that. That you say to them?

Great question, Lori. The first thing that I like to do is I like to sit down with them and just see, like, when did they have the testing done? What were the circumstances that led them to initiate testing in the first place? You know, to your point, a lot of them are just sick and tired of being sick and tired. And so, I mean, now it's direct to consumer market. They can order these tests online for themselves. They may not even understand the technology behind the test or when it's appropriate to do the test. So I try to get some backstory and history as to when that test was done, why it was done, and what they expected to get out of the test, and then what they've done since they've had the testing. Right. Those are the things I like to dig into as a provider to really have a better understanding of how to fully answer their questions and to help them navigate what that testing actually means.

Right? Yeah. When they come into the clinic and they have already had testing, you know, oftentimes they're saying, you know, I had this testing, I got these results, I've made these changes, and I don't feel better, and in some cases I feel worse, and they're extremely frustrated. Do you get that, too?

Absolutely. I see that all the time, actually. And I think, you know, I had a case last week that really took me back, you know, really took my breath away. She had had two separate food sensitivity panels completed. One was an IGG panel, and then six months later, she had a full panel looking at ige, igg, IGG subclass, IV complement. It was a very extensive panel that I just love. But she had taken that information and basically eliminated. With the first set of testing, she eliminated those foods. She took a few supplements, but never really understood how. How to walk through a GUT protocol. And then with the second set of testing, she restricted her diet even more. She'd been eating avocado oil and avocado and she'd been eating olive oil. Those were now on her food sensitivity panel, coconut oil. So basically, she removed all fats from her diet because she couldn't. The oils she was reacting to. Supposedly, as a result of that, she developed severe fatty acid deficiency and her skin started breaking down. She was covered head to toe in a rash. Her histamine symptoms were through the roof. And, you know, and I think, gosh, how was she communicated to. She's a kindergarten teacher who was a rule follower and followed the rules to a T from what she understood. And I think that's where you and I in our practices vary from kind of the standard practice in that we spend a lot of time educating our patients as to what they think the test actually means, what to do about the test, and for how long. You know, we're not meant to live on an elimination diet forever. You know, we want diversity in the diet as much as possible. And when we start eliminating things for a prolonged period of time, we can run into problems with nutrient deficiencies, whether that's mineral deficiencies, antioxidant deficiencies, or fatty acid deficiencies. And those oftentimes show up differently. But that's the risk, right, in having a test done that. That you don't fully understand how to execute those results.

Right. So not the wrong test, but definitely not with the trained eye looking at it through the lens of what else is going on. So you bring up a really good point. It's right test for the right patient at the right time, because otherwise you are going to end up really frustrated. So you touched a little bit and you threw out a lot of IG terms.

Yes.

And I know what all of that means, but I do think it's important to kind of talk about, you know, because we have people that come in that have had skin testing, you know, which is More of that reaction that ige. Right. Testing. And then we have blood tests that are ig, which is more of that immediate allergy response. And then you spoke of food intolerances versus food sensitivity. So tell us a little bit more about the IGG and IGA that you were talking about.

Yeah. So let's define food allergy, which is IGE that Lori mentioned. That's the skin prick test. And you can also do that in a blood. That would be an immediate reaction to the food. And then there's igg, which is a delayed reaction. We oftentimes call those sensitivities. It's not a true allergy. And the symptoms that appear may appear 72 hours after eating the food. They can be very challenging to pin down because you may not remember what you had three days ago, but all of a sudden you have that symptom. So those can be difficult to understand. And then an intolerance would be like a lactose intolerance, like you don't have enzymes to break down that food. And then there is another type of testing that we can do is iga. So there are food sensitivity panels that look at IGA independently, or maybe a combination of igg and IGA is still a delayed response to that food.

Right. So lots of different tests that are available out there. But I think what we really want to impress upon each and every person listening here today is that it really is about what are your symptoms, what are we looking for to specifically order the right test for you, and then in delivering those results to you. You know, oftentimes you can have a lot of these food reactions due to a very unhealthy gut. You could light up like a Christmas tree. And we're not going to eliminate all of those foods. We shouldn't eliminate all those foods. That's what you just said, Kelly And I agree 110% is because you cannot live that way, nor is that the right thing to do. We have to really focus on your gut lining and the health of your gut and those healthy bacteria and everything going on. All things gut. Right. All things gut health. As we are really working on developing a plan that you can implement that's going to be successful for you to feel better and to achieve your optimal health and wellness.

So what Lori is saying is that just doing a food elimination based on the food sensitivity panel may or may not give you symptom relief initially. Right. There are some people that get relief initially, but then three months down the line, the symptoms are back. If we use a Food elimination independent of a gut protocol for restoration and repair and repopulating the gut microbiome, then what happens is six months later you repeat your food sensitivity panel and it just changed. The things that you were reactive to before, you're not reacting to anymore because you're not consuming them. And now you have a whole new list of food sensitivities that show up because you're still reacting to things you're commonly eating. Right. That's what we oftentimes see is the list just changes. On the other hand, if we invest in working through a very thoughtful protocol designed around repairing the gut lining and retraining the immune system to accept these foods, then the outcome for that looks much different most of the time. Right, right. Is that what you said? Yes.

You feel better and you're more. You are able to consume a more nutrient dense diet. Right. Because when we do pull a lot of those foods out, and that's kind of what you were saying with the patient experience that you mentioned ended up with a ton of skin related issues and fatty acid deficiencies. You know, when you pull a lot of those foods out of your diet, unfortunately, you are also eliminating or reducing quite a bit of nutrients which then manifest in other symptoms. So you end up chasing something and never getting results. So it's so important to really, you know, find that qualified healthcare practitioner and really sit down, make sure, as you said, Kelly, in the very beginning, getting a detailed history, what are your symptoms, you know, determining what are the right tests for you, and then really making sure that when we deliver those results, we're delivering a treatment plan. And not just results, a treatment plan of how to get you to that ideal state of health that you're looking for.

So, Laurie, I don't know about you and your practice, but when I'm reviewing a food sensitivity panel, in addition to other lab results that that patient may have invested in at the time, the last thing I go over is their food sensitivity panel. Because what I have found is if you put that in front of them in the very beginning, they can't think of anything else. Their brain is like monkey mind. All they can think about is going to the grocery store, what are they going to be able to eat, how are they going to navigate and they can't concentrate on anything else. And so I bring that up, what.

Am I going to do?

Right. I bring that up because when you're working with the provider on food sensitivities and gut restoration, it's not a one visit plan. You know, we may Map out the plan in one visit. But to execute that in a way that's going to create healing typically requires multiple touch points. So we want to make sure that you don't get lost in the sauce and you don't think that that food panel is the end all, be all. But we're really working toward restoring your overall health and really monitoring those keystone factors. They're going to dictate whether you heal or not. And oftentimes a lot of life happens in between those visits. And you know, things stressors happened, circumstances change and those play into your overall health picture too. And so your healthcare provider needs to have a better understanding of of those things to help you navigate the process. Because if you have food sensitivities, there are other things going on. Food sensitivities do not happen unless there is gut destruction that lead to food sensitivity. So it's not the problem, it's part of the problem. But it's typically a symptom of a bigger problem that unless you address the bigger problem, then that way of life of having to avoid and having to avoid will continue to evolve despite your best efforts.

Yeah, absolutely. And you know, when is the right time to. Some of the things that we talk about is, you know, some people are on antihistamines, some people are on steroids and we have to be very cognizant of medications that can interfere in testing results too. So that's all part of that history also is when is the right time to do it. I remember a time where I had a patient that who had recently had a colonoscopy. And what happens with a colonoscopy? The colonoscopy prep, right. We wipe out the entire gut microbiome in the cleansing prep and then shortly after had testing and lit up like a Christmas tree. And this was a person who had been a long term patient of mine who had been working very, very hard and really didn't feel bad. We were doing a follow up test. I didn't know she had a colonoscopy. And it wasn't until months after when I was so perplexed asking her questions. And one day that light bulb went off and she said, could it have been the colonoscopy? Do you remember me sharing that with you?

I do remember you sharing that with me. I want to back up. That is, that is interesting, but I want to back up because you've said it a couple of times. Lit up like a Christmas tree. What Lori is saying is that that panel and we get those results back it's very colorful. So if we get back a panel that there's a lot of color on the page that is lit up like a Christmas tree and you do not want to see a lot of color on your page. When you get back your food sensitivity panel, you want that to be as boring as possible.

I mean, we love lit up Christmas trees, don't we?

We love Christmas trees, but we don't.

Like them on your diagnostic.

But we do not like them on your diagnostic testing. Right. And so, yeah, things can interfere with that testing. As Lori mentioned, steroids, antibiotic use, colonoscopies, those are things. An illness two weeks prior to your testing. You know, I oftentimes will educate my patients. Listen, if you have an illness, especially once Covid happened, we had to have this conversation more often. If you have an illness and you're scheduled for blood work within the next two weeks, and it's routine blood work where we're tracking in trending numbers. Let's delay it a little bit. Let's not do that just yet because it may be a little bit askew for a couple of weeks after having an illness like that. And so really being aware of things that could affect your panel in an abnormal way, that may create more anxiety than really you need in looking at those results.

And mentioning steroid injections too, we often forget about that. You know, a lot of people have joint injections where they have those steroid injections. So just kind of thinking about not just oral use of medications, but also injectable use of medications to too, that can definitely interfere in test results.

So whereas something like an illness would cause that panel maybe to be hyper reactive, something like taking antihistamines or taking a steroid would cause that to be falsely negative sometimes. So you may get a panel that doesn't match the clinical symptoms because of use of those medications prior to testing.

Hence the reason I really do recommend avoidance of ordering tests online just based on symptoms. But I do know that we do talk to a lot of people who live in areas that they don't have access to providers of care who offer these tests. And so, you know, I understand that people do, they're just looking for an answer, but I would really caution just ordering something online again through the clinical eyes of someone who's qualified to look at all of those things for you is so important.

Absolutely. I remember back when I first started practice and became aware of food sensitivity testing, I tested myself. My panel was not pretty. And going to the grocery store that first time was overwhelming in Fact, my story goes, I went to three grocery stores that day and the only thing I bought was tea. I came home and I think I cried a little bit and went for a run and pouted a little bit. And then I decided to put on my big girl panties and figure it out. But it was a bit overwhelming. That was, you know, 14 years ago when I had very little knowledge of functional medicine and I liked what I like. My palate was not very well developed in the way of vegetables. And it really challenged me to start thinking about food in a very different way.

Absolutely. Yeah, I laugh. I've heard you tell that story. But I laugh every single time you tell that story. Because it's really, as a provider of care, sitting down with patients, it has made me really take a different approach with how I share results. You know, very empathetic because I've been on that journey too. I've been in that seat before where I looked at my own and felt the same way. And so it's really treading lightly, saying what needs to be said, but again, and being sensitive to it, but developing a plan. We could sit there and develop a plan that's a really good plan. But at the end of the day, if it's not a plan that our patients can execute, then it's not a very good plan. And so being very sensitive to how we unroll that, what are the most important things to pull out of the diet? Because there are going to be some things that need to be pulled out completely, but there are things that will rotate into again depending upon what other actions you're willing to take. You know, if you're willing to change and walk through a gut restoration program, you're willing to be aggressive with that, you're willing to work on your environment, get better sleep, decrease that incoming burden. The more you're willing to do, the better the outcome is going to be, for sure. But I think all in all, we all have to be sensitive to each other's initial frustration of what emotions can make you feel.

Yeah, that emotional attachment to food that we have, that we all have, and the four year old in our head, that needs to be nurtured a little bit. So I want to encourage our listeners, you know, if you've had some food sensitivity testing or you're thinking about having some food sensitivity testing, I want to encourage you to be, be in it, be in it to win it and be in it to really talk to your provider about what those results mean. If you're hitting stumbling blocks, if you're struggling, that's the time to lean in and ask more questions and get more direction. Oftentimes that's the time people disappear and they go on about their way and they're, they're miserable as a result of it and feel oftentimes defeated. And so, you know, there's no question that's a dumb question. There typically is always a substance substitute for a food that perhaps you haven't thought of. And then the other thing I want to remind you is that your taste buds do regenerate every 14 days. So the things that you think you absolutely do not like. It's interesting how the body works. You know, when you start consuming those foods, you actually start liking them, oftentimes start craving them. So be patient with the process of that retraining of the palate, too.

Absolutely. Well, that's definitely good advice. Well, our listeners sent in some questions that we want to answer for you. So, Kelly, how much does a test cost? Like, are there specific, are there ranges?

Yeah, there are.

That we can give.

Yeah, there are ranges. You know, the least expensive test, and I'll say possibly the least reliable test too, is the IGA test. And there's an IGA test that tests for four major food sensitivities, gluten, dairy, egg and soy. And that test is around 120, $140 for that panel. If someone has a low IGA, though, that test may not be the best because you may get some false negatives, but it is a screening. And then, you know, so they can range anywhere from about $140 all the way up to 4 or $500, depending on how deep you're going into the immune system. What you're trying to look at depends on the complexity of the test as to the cost of the test.

And I think you hit on a great point that yes, the least expensive test that you just brought up is the least reliable test. But I also want to add that the most expensive test doesn't necessarily mean that it's the most reliable test. Right. So I think it's very important to go back to, you know, what we've said before is making sure that before you decide what test you would like to do is get with a qualified health practitioner who understands your history, what are you looking for and making sure that you're, you're ordering and getting the right test for you. Because even if you only pay $150 for it, if that test doesn't achieve the outcome and it's not reliable, it could Be a very expensive test, something you spent a little bit of money on, that just didn't do anything for you and may have made you feel worse in the long run, Right?

And then the opposite end of that is you could spend a whole lot of money on a very complex food panel that was done at the wrong time and maybe has false information on it, too, because there's a lot of what we call molecular mimicry goes on in the world of food sensitivities. And so your test may show things that you react to that aren't true reactions because of the position of the immune system at the time of the test. So to Lori's point, working with a healthcare provider that really understands timing and understands how to prep you for that test in a way that's going to be the most meaningful and make the most use of your dollars, let's face it, this is an investment in your health, and you want to make sure you're investing at the right test at the right time, and you have the right plan to execute those results.

And that transitions really nicely into the next question was how do you determine what tests are best for your patients? And it really is making sure that there's a wonderful history, taking the time to really dig into what your symptoms are, what you've tried, what's worked, what hasn't worked, you know, what you've been exposed to. It's really making sure that that's all been disclosed. And then on top of it, really making sure that, you know, your provider of care understands what symptoms you're having, when they started, you know, when they get better, when they're not better, you know, just really the triggers, the antecedents, you know, what comes before, what comes after. All of that history is essential to choosing the best test. And, you know, unfortunately, I say unfortunately, you know, sometimes it does come down to dollars and cents. And as a provider of care, I have to help my patients make very difficult decisions because, you know, we don't want to just order testing for testing sake, but we also want to make sure that if we are. If you're investing in testing, we want to make sure it's the right test for you. So all of those things play into that. Determining the best test for you and anything else you would add to that. Kelly?

No, I think you said that. Well, I mean, I think having a thoughtful position as to what tests are ordered, when they're ordered, and then how they're interpreted, I think that's the bottom line, is making sure all of those bases have been covered before you have that test drawn. Yep.

Right. And there are some. The next question is, you know, what's the best or most shocking positive outcome that you've achieved? You know, when. With testing results. And there are very, very positive things that come out of doing the right test at the right time. And the most positive is, you know, I've. I have people that go from a life that's not very quality filled. It's very disruptive to have multiple food intolerances, particularly if it causes your skin to itch unbearably and, you know, causing problems with sleep or. And you end up in the bathroom. Maybe it's a GI response.

Right.

You know, that's very disruptive to quality of life. So I truly believe that the best outcome is when you can give someone back their quality of life because they got the right results, they were willing to do the work, and they see the benefit of that.

Absolutely. And the fun part is we get to see that most every day with our patients and the healing that they have, you know, anything that we can do to lower their inflammatory burden long term is a win. And when you have these food sensitivities that are going on and progressive, it's creating an inflammatory burden within the body. So our goal is to remove the offender, to really work on repairing the body in a way and then reintroducing those foods in a way that's going to help retrain that immune system to accept that food.

Yeah. And when you talk dollars and cents, and this is a question we get a lot is, you know, how can proper testing be what we refer to as an investment? Right. It's not a cost. It's really an investment in the long run. And, you know, you can spend your money on a lot of things. You really can. So having a good exhaustive history determining what the right test is, it's no longer a cost. It truly is an investment in your health. And, you know, you say it, Kelly all the time, and so do I, is either we're going to pay now or pay later.

Right, Right.

We're going to pay an hour, pay later. So getting, you know, that investment, and that's why we call it an investment, because it's an investment that pays you back in significant reward.

That's right.

When you get the right test and you get the right information and you get the right treatment plan, as we spoke of earlier, the right treatment plan, because it's not just the test. We say in our line of work, the diagnostic results are 20% of the equation, 80% is that history. And when you pair that all together, that's, that's where the sweet sauce is.

Right. And I say it's only an expense if you don't do anything with that result in a positive way. Right. That's when it becomes an expense. Otherwise it's an investment that's going to pay you back considerably with the way that you feel, the way you're able to function and enjoy your life.

And that's why it's so important to understand the test results, to work with someone who can really break down that information for you in a way that makes sense, that you can execute the plan because the outcome is definitely, you know, a result of, like you said, it's the action steps that you take. And it's a waste to take no action otherwise. Then it's just another test that you put in your three ring binder. And I know a lot of people come into our practices with really thick three ring binders with lots of good testing.

Right.

But in many cases, not having had someone really explain that information to them in a way that they could understand and execute a plan.

Yeah. So the other question that we got was what happens when your, your primary care provider has prescribed antihistamines and gave you a list of foods to avoid, but they're perhaps not treating the deeper issue? You know, what do you say to that person? How do you help them navigate that process?

Yes. So that's not uncommon, you know, for people to come into my practice, and I'm sure, Kelly, yours as well, that have done a lot of things, you know, the reaction is taking antihistamine if you're having this rash or the skin itching to reduce that, you know, histamine burden, which oftentimes in the short term can make symptoms lessened. But as soon as that's pulled back out again, they're going to have the symptoms again. So, you know, how do you navigate that? It's really helping them understand root cause, what's the driver, and that a treatment plan isn't just about lessening the histamine response with drugs, medications like antihistamines. It's really about understanding what's causing that to happen. Get the right testing again and educate. Now, we do know that antihistamines and some of those medications do interfere in the testing. So I think, you know, that the real question is how do you time that in such a way not to make our patients be driven nuts for a period of 72 hours while they're holding those Medications. And so, you know, I just really ask them to hold them as long as they can, you know, if it's 48 hours, if it's only 24 hours, so that we can get those results. If they've been on steroids, it's, you know, I would prefer them to be off of steroids for approximately two weeks prior to getting their testing done because nothing's worse than, you know, having tests done at the wrong time under the wrong conditions that really give you false negatives, you know, that nothing shows up. And then you're more perplexed after you get the results.

Absolutely. Sometimes, you know, one of the strategies I'll often use in that situation is getting them on a histamine balancing meal plan for a couple of weeks. So it's not pulling foods necessarily out of the diet that we would be testing for, but helping them learn how to balance those foods so that they have a little bit of symptom control until we can get the testing done. So I have used that strategy a few times. It's complicated. It's a complicated strategy, but in that situation, we're usually in a bit of a pickle that we have to work our way out of.

Right. And I think one of the difficult situations for some of our patients is that they've gone to so many medical providers prior to coming to us who have given them different advice, just trying to get them some answers. And so they typically show up on having had a lot of things, are currently taking things. And so, you know, I think if that place is where this question. Question is coming from, I want you to know that you don't need to pick sides, that, you know, our goal truly is to team up with you to understand where you're currently at. And, you know, to your point, Kelly, you know, going into the testing, first of all, choosing the right testing, but going into the testing, doing some things to really calm down that response and kind of talking with you about what those medications, why they've been prescribed to you and why we need to decrease them so we get the right results. And really just part. I think what we want you to know is being a partner with you is really being a partner with you and that you don't have to choose traditional medicine versus nutritional lifestyle medicine is we're on your team to help you understand your body better, to help you make better decisions about your health and really talk real with you about that and not force you to make a decision of one camp or the other. Does that make sense, Kelly?

Yeah, it's an integrative approach. We're integrating with your other practitioners in a way that's going to be meaningful and give you the result that you want to see and that's feeling better, functioning better.

And a lot of these tests aren't offered in the traditional medical model. Right. So, you know, some people come in and say, well, why wasn't this test offered to me?

Right.

You know, and I want you to know that, you know, many of the traditional providers of care aren't utilizing and perhaps don't really know these tests are available. You know, we could go into a whole nother discussion about that, and that's not what today's, you know, topic is about. But it's not that they intended to hold back a test from you that you needed to have at the end of the day. Oftentimes they just don't have that tool in their toolbox to use for you. And that's why it is so important to seek out providers of care that are looking at more advanced testing that's out there to get some answers for you that you haven't been able to get absolutely.

Well, this was a great discussion on the difference between food sensitivities, food intolerances, and food allergies. I hope that you learned something from today, and I look forward to getting you back on here for future podcasts. So stay tuned for more to come.

Thanks so much for listening to today's episode. You can find more information about synergy at Synergy for Life. That's S Y N E R g e e the number four life.com and.

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