One frustrating aspect of working with food-related diseases is that confused
and confusing people greet you at every turn. Food allergy, sensitivity and
intolerance have are topics that have been obscured by nonsense and confusion
for several decades. MDs, by in large, remain ignorant of delayed patterns of
food allergy and are often not helpful to patients who seek their advice. A
series of dubious testing procedures for “food sensitivity” have flourished in
the non-medical sub-culture. A number of bad and bizarre "tests and treatments”
have caught on as quick and easy methods of dealing with complex problems and
have contributed to the aversion some physicians display toward the subject of
food allergy. In any other context, some of these tests would be bad jokes or
ludicrous charades. What makes the popularity of these fake tests a serious
matter is that patients are suffering and are eager for solutions to their
chronic health problems. Because they are not getting help from qualified
physicians, they are vulnerable to anyone who seems at all plausible and offers
tests and treatments for food problems. Here are some examples of doubtful
and bizarre tests:
Provocation Tests by Injection
Provocation tests by needle injection of food proteins into the skin have
been used to determine food sensitivity. While these test are the most plausible
of the group of the bad and bizarre tests, they do not do what they promise and
should not be used to determine what the patients can eat. The intradermal (ID)
injection test will occasionally show a delayed, cell-mediated response in 24-48
hours. Symptoms may develop as injected antigen reacts with skin mast cells, or
reaches circulating basophils and triggers an amplified, immediate
alarm-response. There is no question that injected antigen can sometimes
demonstrate symptom-production in the allergic patient. Indeed, every allergist
is concerned about triggering life-threatening anaphylactic reactions with any
injection. If major symptoms do occur with one injected antigen, further testing
is invalid for several days.
Clinical ecologists have claimed to "neutralize" the reaction by injecting
further doses of antigen at different concentrations, and often test many
substances in one session, lasting several hours. We do not believe any
meaningful conclusions can be drawn from these testing marathons.
The subject tends to have fluctuating, confusing sensations, and is extremely
vulnerable to suggestion from the testing person. The ID provocation test is not
reliable in predicting responses to foods actually eaten, and should not be used
as the basis for recommending diet revision. A small study by Jewett and
associates in California questioned the validity of provocation tests; 18
patients were tested by this method and they concluded that subjects had
difficulty differentiating active from inactive solutions and that the
neutralizing effect was not related to the concentration of the active
This study failed to support the method of provocative-neutralization
"allergy" testing - fair enough, but an associated editorial in this esteemed
journal used this result to further a widespread prejudice against
food-sensitive patients; with the byline, "Food Sensitivity or Self-Deception",
the editorial hints darkly that all patients with food allergy are dupes. We
have noticed over the past 15 years, that the mention of food allergy invites
prejudiced if not hostile opinions from many members of the medical
establishment. Indeed, some of the worst examples of dogmatic and irrational
thinking can be elicited from MDs by food allergic patients. The only conclusion
we can reach about provocation tests and this study is that if subjects are
asked to sit in a room for several hours after breakfast or lunch, receiving a
variety of injections, with a variety of distractions and suggestions, explicit
or implicit, from testers and other subjects, everyone will come to the wrong
conclusions about what is really going on. The authors of this study did not
seem to realize that any group of subjects sitting in a room will report
symptoms, if asked. This is not a mysterious "placebo" effect; but the "noise"
of each person's body, which becomes apparent to everyone who sits quietly and
does nothing for a few hours. They may be reacting to foods they ate before they
arrived for the tests.
Cytotoxic tests were offered in the early 80s for definitive "food
sensitivity" determination and were condemned by the American College of
Allergists as ineffective. Cytotoxic tests expose blood cells to food extracts
in a chamber viewed through a microscope; cell counts before and after reveal
cell damage. Automation can be applied to cell counting and evaluation with
computer print-outs of test results. While the earlier cytotoxic tests have
little to offer, more sophisticated analysis of food antigen and blood-cell
interactions is always relevant to understanding pathogenic mechanisms. An
automated test has been offered as the ALCAT diagnostic system. The ALCAT
brochure repeats the understanding that multiple mechanisms are involved in food
allergy and that responses to food antigens by various blood components should
be measured in food allergic individuals. The predictive significance of these
measurements remains to be discovered.
Muscle testing is one of the bizarre charades used to demonstrate "food and
chemical sensitivity". The subject is invited to hold a glass vial containing
the test substance and the examiner tests the strength of the other arm that is
outstretched. Sometimes the subject is instructed to hold the vial over the body
part to be tested. Weakness is interpreted as a food reaction, and the subject
is advised to avoid the test substance. Variations on this theme have emerged.
As a party game, muscle testing could be fun. Anyone who believes that this is a
valid test of body physiology needs to be re-educated in biology. Muscle testing
is a worthless scam if you are paying real money to be "tested."
A simple resistance meter, dressed up in a fancy box (Vega meter), is used to
measure skin resistance between a ground plate and an "acupuncture point",
usually at the thumb web. A glass vial, containing test substances, is placed
somewhere (it doesn't seem to matter where) in the circuit. Meter readings are
interpreted as "positive or negative reactions". The more imaginative Vega meter
readers will tell you that they can balance levels of certain substances in your
body by doing meter readings and prescribing drops.
You might sign up for a series of tests and treatments and the cost can vary
from hundreds to thousands of dollars. Too good to be true? Of course, Vega
meters are scams. A pseudo-science explanatory system, referring to
"oscillations in the electromagnetic field", confuses and misleads the sincere
patient who just wants to get better.
Feathers, Crystals, Fantasy
We have seen machines, tests and treatments that go from impressive scams and
charades to the ludicrous and ridiculous. One patient, for example, brought 4
pages of food test results from a homeopathic practitioner who used a crystal
and a feather to evaluate her food sensitivities. This was a neatly hand-written
list showing the many foods tested and her sensitivity to them, presented as a
percentage: she was 80% sensitive to milk and so-on. Many balancing potions were
prescribed and she was to avoid the foods that had high percentage scores on the
"tests". She did improve on this regimen because she stopped eating many problem
foods; however, she soon lost her way and became confused about what she should
do long-term. We would all like either a futuristic machine that could give us
all the answers or the super-human ability to simply write down the reactive
repertoire of each person, but the emperor has no clothes! Vega machines, muscle
tests, feathers, pendulums and crystals belong in the magician’s bag of tricks
or the hypnotist’s stage show but are not part of a sincere practice of
medicine, using valid and reproducible techniques. If you have paid real money
for these tests and associated treatments, you have been cheated.
Live Blood Cell Analysis
The idea is that you put a drop of blood on a microscope slide and look at
the living cells. This could be a good idea, but there are serious flaws when
this procedure is offered as diagnostic test for food allergy or food toxicity.
So far, we have not been convinced that any office-based live cell analysis is
valid. The analysts, in our opinion would have difficulty identifying which cell
types they were observing. They have no way of differentiating cell-damage
artifacts from real pathology. Their displays of cell abnormalities appear to be
mostly artifacts, and their diagnoses defy biological knowledge. We would bet
big money against the reproducibility of this technique. Any takers?
Experienced microscopists know that looking at living specimens under the
microscope changes the specimen. Viewing live cells is difficult because they
have to be suspended in a nutrient solution, at the right temperature. It is
challenging to keep them alive. Heat from the light source tends to dry cells;
the water in which they are suspended evaporates and the cells pucker up, change
shape and develop abnormal looking membranes. They may stick together. There are
artifacts, in other words, that an uncritical observer can interpret as evidence
of disease. Even if the lab has expensive equipment and expertise to keep the
cells alive and in good condition, the observer has to be familiar with
different cell types, understand their morphological characteristics and
behavior. There are possibilities for advanced systems of live blood cell
analysis. We would like to know more about how blood cells behave in vivo, and
it is possible to simulate living conditions under the microscope, although
expensive equipment and skilled operators are prerequisites. There are proper
techniques for observing how specific living blood cells behave when exposed to
specific stimuli. One test, for example, observes whether lymphocytes begin to
multiply when they are exposed to an antigen. A clinical test based on this idea
could be useful. This is a research project, not a validated diagnostic method
and certainly not a technique that can be done by amateurs.
Listen to the Bad and Bizarre Tests for Food Allergy
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