SHOW NOTES

What is a food intolerance [1:10]

• The American Academy of Allergy, Asthma & Immunology (AAAAI) & The Australasian Society of Clinical Immunology and Allergy (ASCIA) define a food intolerance as: a reaction to a food or food group that only impacts the gastrointestinal tract in a negative way
  • Australasian adds headaches and mouth/canker sores to definition
• Dr. Pastore’s definition differs slightly
  • He has seen food intolerance symptoms transpire outside the gastrointestinal tract in many patients he has treated

Food intolerance symptoms [2:50]

• Example: lactose intolerance
  • Lack enzyme required to break down lactose
• Example: hereditary fructose intolerance
  • Lack enzyme required to break down fructose
• Gastrointestinal symptoms
  • Bloating & stomach distention
  • Gas & flatulence (often fowl smelling)
  • Cramping and pain
  • Diarrhea
• Food intolerances cause a myriad of effects
  • Decreased performance
  • Aches & pains
  • Increased injury risk
  • Reduced absorption of key nutrients
    • B12, Iron
    • Diarrhea
    • Nutrient deficiencies can cause fatigue
  • Reduced healing/recovery

Intolerance vs. Allergy vs. Autoimmune Disease [4:55]

• Dr. Pastore has the autoimmune disease celiac disease
  • Inability to digestion protein found in gluten
  • Causes autoimmune reaction that destroys lining of gastrointestinal tract
  • If left untreated can cause cancer
• Dr. Pastore also has a severe allergy to dairy
  • Causes severe migraines on top of gastrointestinal symptoms
  • Tightness & closing of throat
  • Joint swelling
• Antihistamines for allergy disrupt acetylcholine, which disrupts normal neurological access to thoughts & memories

Food allergies [10:30]

• Immune system response to a normally harmless substance in the diet, that is more serious in nature
  • Can be life-threatening, require epinephrine pen during anaphylactic reactions
    • Inability to swallow/breathe
  • Common: peanuts, shellfish, corn, dairy
  • Not all food allergies cause that severe of a reaction
    • Asthma can be directly caused by food allergies, or be a comorbidity (something that happens alongside another medical issue) made worse by a food allergy
      • Example - allergic to eggs, consume eggs, makes asthma triggered by tree pollen worse
• Symptoms can be:
  • Vomiting
  • Colic in infants
  • Diarrhea
  • Eczema
    • find the cause of your skin trouble, don’t just treat the symptoms
  • Atopic dermatitis (skin rash)
  • Rhinitis / sinus problems / rhinoconjunctivitis
  • Hives / urticaria
  • Esophagitis - food stays in stomach longer

• Food allergies have mass immunoglobulin / antibody reaction that can cause serious medical conditions that can be repeated multiple times with eating a specific food

• Food intolerances can also cause immunological reaction, but will never cause anaphylaxis

• Symptoms & severity vary from person to person

Most common food intolerances Dr. Pastore has seen in practice [16:00]

• Overwhelming dairy reactions, #1 most common food reaction
• #2 Egg
• #3 Wheat / gluten
• One person’s food can be another person’s reaction/intolerant food
• Could be ANYTHING
• More rare cases Dr. Pastore has seen:
  • Severe oak tree allergy
  • Alpha-gal syndrome from tick bite causing delayed allergy reaction to red meat (4-7 days after consumption)
• Family history & genetics can be helpful - family members may have same intolerances/allergies
• Extremely common to have more than one food intolerance or allergy

Diagnosing Intolerances [21:30]

• Just 1 test will not reveal everything
• Celiac diagnosis required genetic test to identify risk, then blood test that may not be accurate, the biopsy to confirm
• Food journaling, self-reporting symptoms
  • Add date, time, food, portion size
• Run multiple tests to find multiple food intolerances
  • IgE - immediate antibody reaction in food reaction
  • Non-IgE mediated reactions: IgG4 subclasses
  • ALCAT test - accurate up to 96%
  • Skin scratch test
• If you remove one intolerant food but are still experiencing symptoms, may be an additional food intolerance
  • Can simply follow an elimination diet, removing & adding one food at a time
  • Food frequency questionnaires available online to food intake and notice digestion patterns

• 4 tests to ask your physician for the following tests to get a true diagnosis:
  • IgE rast blood test for foods & inhalants
  • IgG4 subclass
    • IgG alone has high rate of false intolerant foods
    • Hair test food intolerance tests not accurate
    • Mouth swab test not accurate
  • ALCAT test
    • Backed by Yale in double-blind studies
    • Up to 92-96% accurate
    • Shows intolerant foods without consuming them
  • Skin scratch analysis
    • Traditional allergist test
    • Inject small amount of potential reactants under skin to identify wheel rash

Is it possible to develop food intolerance from eating too much of a certain food? [33:15]

• Under certain circumstances, yes
• There are things that happen to our body in our lives that can increase our risk of food-mediated reactions (allergy or intolerance)
  • Behaviour or experience magnified by regular foods consumed
  • Trauma or stress on the body
  • High intensity training athletes at risk
  • Travelling to an exotic country & ingesting parasite/foodborne illness can increase risk
  • Digestive enzyme insufficiency caused by medication you’ve been prescribed
  • Finishing multiple courses of antibiotics
• Athletes, those that workout 4+ days a week more susceptible to developing food intolerance
  • Hard training impacts tight junction cells of small intestine (like a wall)
  • Mouth to anus is seen as outside the body
    • Consumed food must be processed in digestive tract to be used elsewhere in the body
  • Training hard increases oxidative damage, disrupts healthy epithelial tight junction cells [37:25]
    • Bulk of human immune system in the gut - immune system designed to protect body from bad foods
  • Oxidative damage produces substance in intestines called luminal endotoxins
    • Lumen = inside space of a tubular structure (such as intestines)
    • Luminal endotoxins can promote systemic immune system response
  • Prolonged exercise results in in chemical change if substances that we normally have in our intestines
    • Occludin & claudin change after intense exercise, which can start to seperate tight junction cells
    • Like microtears in bicep muscles after bicep curls, it can open up tight junction cells
  • When tight junction cells separate, undigested food fragments can slip through the cracks & cause immunological reactivity
    • Food fragments should not be outside the gastrointestinal tract, immune system sees it as a threat & creates food antibody
    • Daily consumption of the same foods may increase likelihood of developing these intolerances
    • Could be reacting to one food, causing tight junction cells to separate, and think you’re reacting to another food
      • Ex - chicken 3x a day, whey protein 3x a day - whey protein (dairy) showed as positive food test

In Dr. Pastore’s experience in practice, professional athletes were most common patient group for having food reactions [42:00]

• Over 40% of players on a professional baseball team had at least 1 food intolerance

Can you reverse/outgrow a food intolerance? [43:00]

• In some cases, yes
• “Absence makes the immune system grow fonder”
• “The solution to pollution is dilution”
• When you consume something you react to:
  • Flood interstitial cells with fluid - causes bloating & water retention
• True allergies & autoimmune diseases will remain for life
• Food intolerances can go away for some, if addressing the underlying condition (infection, parasite)
  • Zinc l-carnosine has been shown to increase tightening of tight junction cells
  • Glutamine has been shown to increase tightening of tight junction cells in severe gastrointestinal cases
  • Correcting gut microbiome with probiotics & increasing “good” bacteria
  • Bone morphogenetic protein 4 - genetic pathway towards bone associated with repairing intestinal cells
  • Correcting clinical deficiencies & suboptimal vitamin/nutrient levels
  • Eliminate intolerant food for 3+ months
  • Reintroduce intolerant food and look for symptoms, then if feeling okay, rerun tests originally used for diagnosis
• Some food intolerances may never go away

Can you out-eat a food intolerance? [46:30]

• No
• Especially no if it’s an allergy
• Cannot outeat if genetically deficient in an enzyme (don’t produce the enzyme lactase for lactose breakdown)
  • Taking lactase enzyme for lactose intolerance can still affect nutrient absorption

Reintroduce food at a later date, but wait 3-4 months before doing so [48:25]

• One week is not enough
• “Small” amounts will still affect reactions
• Gastroenteritis in children - recommended to stop dairy, could develop a lifelong allergy to dairy  if consumption continues during gastrointestinal infection