# Intolerance-Craziness, I shouldn't be like this I know, Guilt..!



## bonniei (Jan 25, 2001)

Bread intolerance is driving me crazy to the point of guilt.Because I have bread intolerance I am doing both the gluten test panel and the yeast sensitivity. http://www.enterolab.com/Information_About...ten_sensitivity I know I shouldn't be like this. It just causes gas while other people have more incapicitating problems. Does anyone have any comments on this test?


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## Mike NoLomotil (Jun 6, 2000)

The test is a valid assay for what is assays. Gluten intolernace, however, is not the sole (or even in many patients the primary) source of gastrointestinal sysmpotms from food and chemcial intolerances. So this is a valid test to take to rule-in or rule-out this particular form of "food intolerence".However, research has shown many times that patients with the types of symptoms which are diagnosed as "diarrheic prone IBS" or "cyclic diarrhea and constipation" IBS will test negative for food allergies (no circualting antibodies) and negative for gluten sensitivity but then siffere an inflammatory reaction in the small bowel which results in their general symptoms. And the array of possible foods is the entire diet...from one or two meats or vegetables or fruits to a whole bunch. Depends on the person.So I would not discourage one from being tested. Just do not be disappointed if it does not solve the whole problem. At least you may get a piece of it...or rule it our.MNL


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## bonniei (Jan 25, 2001)

Thanks Mike NL. I posted a thread on the main BB which I addressed to you when I "saw" you before thinking of checking this thread out.


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## bonniei (Jan 25, 2001)

Mike why do you say it is a valid test?I did the Eneterolab test and gluten, tissue transglutamase, egg, milk and yeast sensitivity all came out positive. How can that be? Sounds like there is something terribly wrong with the test.These are the numbersGluten 28 Tissue trans gluatamase21Milk 25 egg19 yeast 21 . They did not reveal the units as it is trademarked. They said anything over 10 was positive. Only fat turned to be negative. I had done the traditional test for malabsorption and had a a diet high in fat and it had turned out negative.So atleast there is a match there. What does it mean? Any insight from anyone would be appreciated.


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## Mike NoLomotil (Jun 6, 2000)

The probelm with Oral Tolerance is that it is a very complicated gastroimmune process that evn in its normative state is stuill being studied as it is not well understood. its only in the last 8-9 years that enough reserch has been done to even begin to pie4ce toegther some of the mechanisms.When you look at it, the complication is not only understanding how the gut and the gut immunocytes and systemic immunocytes work together to process antigens, and to keep us from reactiong to foods as if they are pathogens, but the process is also dependent on the proper digestive processing (digeation) of foods into antigen-components the immune system is designed to be able to identify as safe.Anything which disrupts that process will not only eleicit problems from the primary dysfunction (like lactose intolerance or fructose intolerance) borad carbohydrate dysuction can occur when the gut flora is disrupted.And then what is any persons normal flora? How do we know if that is at the root of the probelm and if so how to corect it? If you don't even know what normal temperature is how would you tell someone has a fever?







SLIDE SHOWORAL TOLERANCEUNIVERSITY OF SUNDERLAND, U.K. http://www.sunderland.ac.uk/~hs0acu/lec01.ppt Amny times what constitutes a valid test is related to both whether it detetcs a process which is actually relevant, or if it is relevenat can it distinguish dysfucntion from normative function...and then is there any treatment available based on the results anyway?SOme tests also must be able to be reproduced over time in the same patient. But if the process being assessed is not static (such as IgE....once it is there it is there) but dynamic (loss of ortal tolerance can be dynamic and change based on lifestyle and eating patterns and changes within the state of the gut...homeostasis...so at any time non antibody testing is a snapshot tof the moment.Some lost tolerance is so severe that it does not change...some is transient....then there si the reversible which is secondary to an active enteritis. This is where we see symptoms reversed by antibitotic therapy in patients with negative stool cultures...the imbalance is in the small bowel and does not appear i stool culture.Would that mean that the stool culture procedures are invalid? No, they just have limitiations as to the information they can provide. You have to assess the small bowel directly (hence the invention of the disqueiting jejnual isolation methods).Rambling man?Yep. Those dcotoprs who live their lives making a study of such things make ti clear that the subject is not cut and dried, as it is the study of a dynamic set of processes as yet not fully understood...they are just in that phase.This is why we are left with tedious, but effective, means of assessing response to oral challenges or being forced to use multiple assays eachd esigned to assess a very specific and narrow field of possible dysfunction.Where the problem lies is when some innventors try to pursuade people that their particualr test or assay will solve a wider array of problems than it actually can simply to try to improve the possible utilization of the assay.THIS is what you have to guard against. Respiratory Therapists and Pulmonary Doctors used to have a saying "All that wheezes is not asthma." Well the same applies to other symptoms. All that "diarrheas" is not [fill in the claimed single dysfunction, like gluten intoelrance]. Just not a valid claim.To quote "Pathophysiology of Intestinal Food Allergy."Shah U, Walker WA.Advances in Pediatrics 2002;49:299-316Combined Program in Pediatric Gastroenterology and Nutrition, Children's Hospital and Massachusetts General Hospital, Boston, USA."...The role of B cells and T cells in the development of food allergy/sensitivity is incompletely understood, but advances in the evaluation and characterization of food allergens has opened exciting new avenues in this study."Sux we are at this stage....but its better than where we were just 10 years ago!MNL


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## bonniei (Jan 25, 2001)

Why are you talking about allergies Mike? Gluten sensitivity is not a true food allergy right? No IgE involved. IgA involvement means cell mediated hypersensitivity and that is what gluten sensitivity is I presume?Interesting slide show Mike NL but half of it flew over my head, I am afraid. Must be the igA getting in the way







Or maybe once I read Brostoff's book I will understand. I got Brostoff's book fronm the medical library with all the medical talk and that too is difficult to follow probably because I try to read the book from the middle in bits and pieces. The index is not very good I am afraid. Maybe it is meant for doctors. I am waiting for the book for the layperson to arrive from amazon.com


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## Mike NoLomotil (Jun 6, 2000)

Hey BonBon!In answer to your root question, it's because the demarcation line between food ALLERGY and other forms of "immunologic intolerances" to foods is not as clearly demarcated as was once thought. "The times they are a'changin'..." [MNDylan]As invasive studies of both the bowel and the systemic response of the immune system (cell mediated) to food antigens progresses, lets use simple words...many weird things are being recognized.For example subjects with IBS symptoms accoring to the ROME criteria but who are negatibve for atopy and negative to any circulating antibodies to any foods will respons with an inflammatory reaction inthe small bowel locally and systemically when the jejunum is isolated ana various food slurries are introduced directly to the small bowel blinded (there is no way for the subject to know what if anything is being put down the tube..and you can blind it to the investigator this way as well).When thi types of cells involved are evaluated you can see a range of different responses...from antigen-aremd T Cells to antigen armed Mast cells locally in the gut (some patients gut mast cells are armed with IgE for the foods they react to, then some are not...oddly some of the asymptkmcatic controls have and some have not IgE in the gut as well, but show no systemic response and no mediator release).there's more but the botom line is that in the last several years the investigators who are studyinf what happens in the gut-immune uinterface of people with food induced GI symptoms and global symptoms in the absence of circulating antibodies basically have begunm to observe what they are calling now (for lack of a better word) 'INTESTINAL ALLERGY'. This describes, to them, the LOCAL abnormal immune repsonse to stple foods seen in people whoe are being diagnosed as having a diosease with no known pathology...IBS....when in fact there is an observable, quantifiable, reproducible abnormal immune response (loss of oral tolerance) to some normally tolerated foods which characterizes these patients and which accounts for their symptoms.This of course is sometimes overlooked or disregarded by some people as it does not fit their own postukates or self-invented theories that all IBS symtpoms have a common physiologic defect and it is [efect du jour insert here]. Hey it also makes som traditional old-line allergists crazy too...systemic T Cell resposne to food antigens???? How to we charge for skin testing for that?????







makes people crazy but that is the nature of evolution of understanding of body systems and diseases which are not yet fully understood...old ideas, old theories, old beliefs die hard especially when there is money involved!So you will see as time passes, and if you hang out on the side of the road where the guys looking directly at the Oral Tolerance Mechanisms live, that words and terms and descriptions are in a state of change....and the old lines defined by Gel & Coombs classifications (I,II,II,IV) of immune response are basically obsolete in the context of defining the actions of the immune system...it is clearly only part of the picture.Does that help a little?MNL


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## bonniei (Jan 25, 2001)

yeah times are-a-changing is what I got from it and things are not as well demarcated. Thanks!


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## Julia37 (May 9, 2001)

bonniei,While you're waiting for Dr. B.'s book and the next round of tests, you could try approaching the problem from the other end.For example, you could try eating only gluten free bread for a couple of weeks and see if that helps. If it does, that probably means gluten is causing some of your symptoms. I say "probably" because there might be variables in the other ingredients of the breads. Maybe you could make bread in a bread machine so you can have complete control of the ingredients and you would know what the variables are.Or you could eat yeast-free flatbread for 2 weeks and see if that helps - that would help you determine if yeast is part or all of the problem.To me this approach is easier than trying to make sense of a multitude of tests, and less time consuming also.I've had pain from gas and bloating so I know what that's like and it can be almost as awful as D, especially when you feel like you're about to have D! It's very understandable that it bums you out. It would me too, if I could stay awake - I used to get fatigue along with the cramps before I stopped eating dairy.


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## bonniei (Jan 25, 2001)

Thanks Julia! I have the genes for gluten sensitivity. I have tested positive for the enterolab test for yeast sensitivity. So can you get yeast free, gluten free bread?


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## Julia37 (May 9, 2001)

Probably the easiest way to get such a thing would be as rice crackers or something like that. If you normally eat as much bread as I do, you'd go through about one box a day







You could look up gluten-free quick bread recipes for a yeast free gluten free bread. I'm sure it can be done, but I've never done it. Try Miss Roben's for mixes. I would think it would use rice flour and xanthan gum, or maybe quinoa flour, or maybe barley flour? Hmmm......


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## bonniei (Jan 25, 2001)

Thanks Julia. Forgot to check out this forum. I hate cooking so while these possibilities might seem endless to you, I have limited talents. Oink!


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## Julia37 (May 9, 2001)

I wouldn't mind cooking if I had nothing else to do, but I have a day job and a life...I cook fast things. Pasta, microwave a potato, throw a frozen turkey burger or piece of sausage in a pan. I rarely spend more than 1/2 hour fixing a meal.I cook a batch of food with rice on Saturday and pack it in the freezer for my weekday lunches. There again, fast. It's usually something along the lines of meat cooked in a pan and rice cooked with greens, celery, dried tomatos, or some combo thereof. I almost always use pork sausage, which I alternate with chicken occasionally.I make bread in a bread machine, it only takes 10-15 minutes to put together. I make both yeast and quickbreads in it. If you had a bread machine you could use gluten-free mixes (assuming no other allergens) to make breads in it. The only thing is it takes 2 to 3 1/2 hours and I have to be around to take the bread out. If I can't get that together I rely on Jewel or Sara Lee plain bagels, which are also good for traveling.You could start by finding a readily available substitute for bread that you can buy if you haven't made any. The things that come to mind are Manischevitz matzos, if you're near a Jewish store, or rice crackers at Whole Foods. I get the Hol-Grain salted rice crackers because I like them, they're delicious and make excellent sandwiches with nut butter. Yummm.....


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## bonniei (Jan 25, 2001)

Thanks for the ideas Julia!


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