Category Archives: Chronic & Acquired Diseases

Obesity-Inflammation Related; Common Thread with Diseases Part 3

For the past couple of weeks we have published articles on obesity and Michael Glade’s belief that inflammation, as the result of poor diet, environmental factors, and others is the primary cause of obesity.  People who are high is visceral fat have a high risk of developing metabolic syndrome, prediabetes, and diabetes. 

University of California, San Diego School of Medicine researchers “discovered that inflammation provoked by immune cells called macrophages leads to insulin resistance and Type 2 diabetes. Macrophages, found in white blood cells in the bone marrow, are key players in the immune response. When these immune cells get into tissues, such as adipose (fat) or liver tissue, they release cytokines, which are chemical messenger molecules used by immune and nerve cells to communicate. These cytokines cause the neighboring liver, muscle or fat cells to become insulin resistant, which in turn can lead to Type 2 diabetes. The hope is to block or disarm the macrophage inflammatory pathway to interrupt the cascade that leads to insulin resistance and diabetes. A small molecule compound to block JNK1 could prove a potent insulin-sensitizing, anti-diabetic agent. The research also proved that obesity without inflammation does not result in insulin resistance. Olefsky, researcher, explained that when an animal or a human being becomes obese, they develop steatosis, or increased fat in the liver. The steatosis leads to liver inflammation and hepatic insulin resistance.” ScienceDaily (Nov. 7, 2007)”  See this article in it’s entirety at http://www.sciencedaily.com/releases/2007/11/071106133106.htm

Of interest, the National Center for Complementary & Alternative Medicine (NCCAM)  has the following clinical trial posted on its website.  I was disappointed to see the study fell short of criteria which might further substantiate Dr. Glade’s position or lead to a broader study.  Six weeks is hardly enough time for a fair assessment of any meaningful conclusion regarding long term effects of inflammation.  I also found it interesting that fish oils were not included nor excluded since they are recognized to influence inflammation and immune system markers. The low number of participants does not represent the population adequately, either. Hopefully, this is just an initial step in a broader study that will change the way we approach the subject of inflammation and metabolic syndrome and diabetes II. 

 Recruiting -verified and sponsored  by (NCCAM), May 2008
ClinicalTrials.gov Identifier: NCT00334919 due to be completed in November 2008. ClinicalTrials.gov processed this record on December 19, 2008
RCT of the Naturopathic Anti-Inflammatory Diet
Conditions: Diabetes Mellitus, Type 2;   Prediabetes
Intervention: Behavioral: Diet (Anti-Inflammatory or standard diabetic diet)
Funded By:  NIH
Start Date:  May 2006  Current Status – Phase II
The purpose of the study is to determine which diet is better, the naturopathic Anti-inflammatory Diet or the standard diet based on current ADA (American Diabetes Association) guidelines?
 The primary outcome measures of cytokines for 13 weeks, and secondary outcome measures:
            *Glucose: 113 weeks
            *Weight:13 weeks
            *Lipids: 13 weeks

Estimated Enrollment was 36 .  Details include being on the ADA diet for 5 weeks, then randomized to either ADA or AI for 6 weeks.  Other restrictions apply related to the diet as well as looking at blood markers that show how the immune system responds to the different diets. The expectation is the AI will result in less inflammation and a better response by the immune system than the ADA diet as well as looking at the effects of lipids and glucose. Levels of blood lipids and glucose will be considered to evaluate any effects.  Of course, appropriate inclusion criteria related to diabetes is listed and the following exclusion criteria.

 *Current major debilitating mental or physical illness that would interfere  with participation (as determined by the participant’s medical history)
*Taking diabetic medication other than sulfonylurea
*Taking Gymnema silvestra (a naturopathic diabetes treatment)
*Taking medications that have anti-inflammatory affects (lipid lowering agents,   NSAIDS, COX 2 inhibitors, aspirin, HRT, oral contraceptives, testosterone, seizure medications)
*Taking weight loss medications
*Severe renal, hepatic, or heart disease
*Triglycerides >500 mg/dL
*Bulimia
*Pregnancy or lactation
*Current excessive use of alcohol
Current/recent chronic use of recreational drugs
Smoker
More than 4 hours/week of aerobic exercise
Have gained or lost more than 15 pounds during previous 6 months
Planning on moving out of the area in the next 4 months
Is a participant in another medical research study
Is following a weight loss diet
Is unwilling to accept random assignment of the experimental diets
Food preferences and/or allergies that will interfere with consumption of experimental medications
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Obesity-Inflammation Related-Common Thread with Diseases-Part 2

 We continue from last week’s Part 1 with Michael Glade and his insights into obesity as it relates to the inflammation process.  A quick overview is two types of fat are present in the body: subcutaneous and visceral. Subcutaneous fat is the type found just underneath the skin, which may cause dimpling and cellulite. Visceral fat, on the other hand, is located in the abdomen and surrounding vital organs. It can infiltrate the liver and other organs, streak through your muscles and even strangle your heart; and turns out you can have it even if you appear to be thin.  It is the latter, visceral, fat that is linked to many other diseases, everything from bad cholesterol and hypertension to diabetes, heart disease and stroke. Dr. Glade believes at the core of the problem is the issue of inflammation.  Please refer to that article as we will continue here where we left off.

Break down of fatty acids in an abnormal fashion causes an inflammatory load which does unhealthy things to body tissue. If you expose cartilage, cancer, arthritic tissue to a specific signal of inflammation called alpha, they will always respond as if they are under attack.  Chronically exposed poor dietary input can cause or predispose a downward spiral in the body upset.  For example, the problem may be a missing array of essential fatty acids.  Over nutrition seems to be a problem and not sufficient oils or anti-inflammatory products.  If the body can stabilize with eating right, exercise, not smoking or drinking, then the body becomes more stable. 

With a wound you would expect a short term inflammation situation which is a good thing.  The brain is just like other tissue.  We need to replace at least at the same pace as old stuff carrying off. The human brain also experiences changes related to inflammatory factors.  The brain wants to heal with growth of new neurons, a normal response of learning that deals with activity where they grow and dispose of old stuff. 

 Conventional approaches to control of body fat includes weight loss and exercise.  MRI can identify the infiltration of visceral fat around and in specific tissue, but Michael Glade suggests the use of a laboratory test called C Reactive Protein (CRP) to get some inkling that inflammation is present.  There may be a balance between CRP and the oil EPA (Eicosapentaenoic Acid).  Normal  ranges are tested with a group of norms which may be difficult to identify.  What is normal within a group since the control group could represent those in the elevated portion of the population?  We just don’t know. (A test we may use is a genetic test which identifies inflammation from a hereditary factor, particularly when trying to decide if the influence may be environmental rather than hereditary.)

 One of the markers for longevity is control of abdominal fat which is identified as the visceral load.  An inflammation marker is a practical approach of getting the belly fat down.  The dual nature of obesity is that if there is an imbalance in the body, then there is going to be an unintended consequence.  The goal needs to be met to control and modify abdominal fat load. 

A few of the suggestions he gives are as follows:

*Our food supplies have become disconnected from nature.

*Learned failure is when you change lifestyle and then over-exercise. If the patient losses 10 pounds but hurts and is fatigued from over exercising,  they will have an excuse to not stay the course.

*When failure of weight loss occurred due to calorie restriction becoming very aggressive with omega 3 fats using  3-5 tablespoons of flax or fish oil would give good results.  The body wouldn’t change weight but it would reshape.

*Efficiently operating digestive tract is important.

*Activity needs to be increased.  Failures often are because activity isn’t high enough.

*Cause is heightened inflammation- imbalance can be tipped either way and neither may be the most beneficial.

*Anti-inflammatory medications often are mild poisons that push the body back into less inflammation-Dr. Glade questions if this is a good thing.

*Structural fats do very important replacement of fatty acid membranes.

* Use omega oils generally for inflammatory condition.  These are not generally stored or used in the body as caloric intake as the fundamental function of fatty acids in many ways is to restore balance.  They don’t suppress or stimulate inflammation.  Balancing inflammation is what they do and are essentially not drug like, they don’t turn off signals.  

*Suggested Ratio EPA:DHA  EPA 3,000 mg of product  4,000 mg DHA to renormalize triglycerides in the system.  This information is recognized by the drug industry.

Other products:

*Diet: avoid process starches and fatty acid meat and increase fruit and veggies.

* Development of brain is dependent upon DHA and is not found in most any place other than fish. 

* Berries, diversifying your response system is appealing.Recommended are 10 servings of fruit and vegetables per day. Salads are encouraged before meals.

* Starchy vegetables are off the menu. 

*Manganese, selenium, and other trace minerals can only come from our soil.  We are at a point of having to resort to food supplements.  Even if the soil is fortified, the soil is exhausted.  Consequently, trace mineral supplements are absolutely essential.

    – Selenium 100 mcg-anti cancer effective-balance with iodine

     – Chromium 1,000 mcg for sugar regulation of the body

*Boron 2 mg- places a role in digestion -good for inflammation in digestive tract and central nervous system

*Carnatine and acetyl-carnatine- heart and skeletal-less free-radical production

*Co-Q10 increases efficiency of fat burning and make systems more efficient-less free radical production resulting in feeling and moving better. 

Calcium-drop dairy because it causes inflammation-calcium supplement, vitamin D- Take optimum dose over 5-6 times per day for absorption.

Dr. Glade notes slim people fidget 2-3 hours more times per day and are always moving.

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Obesity-Inflammation Related; Common Thread with Diseases Part 1

Obesity is thought to be a disease of inflammation, according to Michael Glade, Ph.D. 

I became acquainted with his work through a DVD given to me by NeuroScience.  We have use NeuroScience protocols with great success; a company that focuses on “Target Amino Acids” as a means to address healing of the adrenal gland and balance neurotransmitters for the treatment of many symptoms including anxiety, sleep maintenance and insomnia, depression, and memory loss.

Dr. Glade is a Certified Nutritional Specialist (CNS) with degrees from the Massachusetts Institute of Technology (MIT) and Cornell University and teaching and research experience at Rutgers University, the University of Maryland, Northwestern University and at the Nutrition Institute of the University of Bridgeport. [1] 

Dr. Glade contends that when a patient has obesity for 5 years or more, the cellular mechanism is disrupted and regulation is thrown off through nutritional and other influences.  Cancer, arthritis, allergy, digestive literature look for a common thread which is traditionally separate in peoples minds as separate diseases, but it is looking more and more that they are individual symptoms manifested in an individual similarly condition.  It starts with people who eat improperly and once the  condition of unregulated inflammation develops, then under that umbrella,  one could end up with all the listed above common disease.

Insulin resistance falls under this umbrella where something goes arye in the metabolism of glucose within muscle cells.  People don’t get better, they get worse.  It doesn’t cure or arrest with the use of any existing medications. Control of diabetes II and insulin is not cured or suppressed by any existing treatment medications.  The premise is that people who have insulin resistance will slowly but surely deteriorate.  Dr. Glade believes there is something missing in that model.  We are treating a blood level of insulin but not the disease. He suggests that something, possibly environmental is the missing piece.

Research suggest abdominal fat in the visceral organ (around organs inside) appears to be genetically different from much of the than other fat in the body.  It is the most insulin responsive part of the body. In insulin resistance patients, the insulin is not responsive on the muscle whereas the belly fat stores is over reactive and sucks the insulin up.  The degree of hypersensitive reflects as the more inflamed they become.  The more inflamed they are the more tendencies they have to over-store abdominal fat.

Insulin control in the pancreas is disturbed when the body is carrying a high amount of an inflammatory formed, abnormal cytokine molecules produced by the body so one part of the body can communicate with another part. Overreactions throughout the body because of  lifestyle, environment, diet, result in tissue not normally responsive, but will then activate due to an overexposure of inflammation.  This will force the organ to over-respond.  This condition is not well monitored or regulated in the body.  The blood has an almost unlimited capacity to carry these inflammatory molecules in the body.  This response is what needs to be brought under control and can only be accomplished by improved lifestyle, environmental factors, detoxification, and a healthy diet.

Part 2 will address what can be done about this dynamic problem.

[1]Dr. Michael Glade emphasizes  specific dietary plans and supplement protocols, especially in programs targeted at brain function, weight reduction, smoking cessation, and life extension for the terminally ill.  Dr. Glade lectures extensively across the US and Europe. Dr. Glade is a noted researcher who is deeply appreciated in the nutritional and scientific communities for providing a significant body of peer-reviewed substantiation for multiple health claims that have been approved by the FDA.

Alzheimer’s Prevention

Alzheimer’s, one of the most feared age related diseases of our time, has the attention of scientist who are intensively researching every aspect of the age-related dementia.  Once Alzheimer’s takes hold, there is no known cure. There are new drugs available that seem to provide some preventive measures and several theories as to what causes Alzheimer’s.  The prevailing thoughts include toxins accumulate within cellular structures causing damage, interruptions in blood flow, and that inflammation is a key player in the destruction of functional tissue.  Beta-amyloid, a protein, triggers inflammation in the brain of Alzheimer’s patients causing mild memory impairment or confusion. 

Vascular dementia and Alzhiemer’s may share the disruption of normal cholinergic function or acetylcholine.  In someone at risk for stroke, elevated C-reactive protein can be an indicator.  Unfortunately, there are no test that accurately measures acetylcholine in the brain.  Phosphatidyl-choline is the precursor for acetylcholine.  Some doctors and nutritionist are aware of its importance and suggest the natural agent phosphatidyl-choline to their clients.  The neurotransmitter acetycholine responsible for memory, sleep and cognition, may decline as a result of neurodegenerative process associated with aging. 

Phosphatidylserine also is a key component in brain function and an integral component of every cell membrane.  One of the vital functions of phosphatidylserine is it boosts the levels of acetylcholine, helps release dopamine, and reduces the stress hormone cortisol.

While reduction of cortisol is important if needed, phosphatidylserine should be taken only under the direction of a doctor because cortisol levels need to stay within the normal range.  Too much phosphatidylserine at the wrong time of day can produce undesirable results.   

Other natural agents may include quercitin, Vinpocetine and pregnenalone and acetyl l-carnatine. (See article Antioxidants: The Powerful Trio Part 3).  Information regarding the role of DHEA may be found in “The Metabolic Plan”  by Stephen Cherniski.  He makes a compelling argument on the aging model. 

Summary noted by Life Extention, July 2003 as follows:

Meta-analysis shows NSAIDs help prevent Alzheimer’s disease

A review of nine studies published in the July 19 2003 issue of the British Medical Journal has found that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) offers some protection against developing Alzheimer’s disease. Nonsteroidal anti-inflammatories are a class of drugs used chronically by individuals with arthritis or other painful conditions, and include aspirin and ibuprofen.

The review analyzed studies published between 1966 and October of 2002 that evaluated the NSAIDs’ ability to prevent Alzheimer’s disease in a total of 14,654 subjects. Studies examining exposure to other pain relievers or in which vascular dementia was the primary outcome were excluded from the analysis.

The researchers separately analyzed studies that determined Alzheimer’s disease risk in users of all NSAIDs, in users of aspirin, and in users of NSAIDs according to duration of use. They found that individuals over the age of 55 who used NSAIDs experienced three-fourths risk of developing the disease than that of subjects not taking the drugs, and that the longer the drugs are used, the greater their benefits appeared to be. When aspirin use alone was evaluated, a small but nonsignificant benefit was found, however, this finding may have been due to the smaller number of studies that specifically evaluated the protective effect of aspirin. The appropriate dose and duration of use of nonsteroidal anti-inflammatories to prevent Alzheimer’s disease remains to be determined.

If you are interested in being proactive against age related disease, consider the benefits of working with the alternative medical doctor who specializes in nutrition and therapies that address the toxic world we live in.  Exactly the kind of work we do.

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Neurotoxicity Explained

Everybody knows that you need good elimination habits to function optimally but few have only a basic understanding of what that means.  In a society that is becoming more focused on health and nutrition, a closer look at a group of toxins, called neurotoxins, is needed.

While elimination routes include kidney, gastrointestinal, skin and exhaled air, the liver is the most vital of body functions in the process of elimination of neurotoxins.  Common sources of neurotoxins include metals, biotoxins (viral, fungal or parasitical sources), man-made chemicals called xenobiotics that include pesticides, preservatives and excitatoxins such as MSG, aspartame, and food colorings. 

Neurotoxins are absorbed by nerve endings and travel inside the neuron to the cell body in the mammal nervous system.  As a result, they cause disruption in vital functions of the cell such as axonal transport(1) of nutrients, mitochondrial function and proper DNA transcription.

In the liver, elimination of most all products are expelled with the bile into the small intestine.  Unfortunately, because of the lipophilic and neurotropic nature of neurotoxins, most of these toxins are reabsorbed in the small intestinal wall by nerve endings of the enteric nervous system (ENS).  The ENS tissue is the same as the brain in the embryonic stage and then separates, hence sometimes referred to as the brain away from the brain.  Once these toxins are reabsorbed, they can be transported back to the brain, the liver, subclavian vein or uptake by bacteria in the bowel resulting in cause or exacerbation of illness caused by neurotoxins.

Obviously, the issue is complex.  Risk factors that can contribute to the sluggishness of the liver include allergy, poor diet of high carbohydrate and low protein, occupational exposure, prolong illness, surgeries, constipation, metal absorption and genetics to name a few.  

Solutions include evaluation of liver function for Phase I and Phase II detoxification, evaluation of toxic levels, and implementing a detoxification program.  It must include proper protein, a good mineral base and balanced electrolytes which can help displace metals. Other nutrients and food sources, including a mercury-free EPA/DHA fish oil, aide in binding up these toxins so they can be eliminated. Improving the diet, elimination and reduction of metal sources and other risk factors are a start but it needs to be done right. 

1  Axonal or axoplasmic transport is the movement of mitochondria, lipids, neurotransmitter regulation, proteins, and other cell parts to and from a neuron’s cell body through the contents of a cell that are enclosed within the plasma membrane or cytoplasm.  

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Heavy Metal Burden-Cadmium, Lead, Mercury Plus More

In the toxic environment we live it, it is hard to imagine one being able to escape the potential dangers that threaten us in our air, water and food.  Some believe, as I do, that the health of this nation, evidenced by the escalation of heart disease and chronic acquired diseases, is in direct relationship to the accumulation of the toxins within.  High levels of metals, drugs, and manmade compounds can be found in our environment.
 We hear about the effects of global warming more than we hear about how toxins are dismantling this nation of its richest resource–health.  As stewards of this earth and our bodies, we need to understand the problem and do our part to protect our families, community and self.  We aren’t hopeless or helpless in this age of information unless we choose to be. 

 Heavy metal burden is the unintended consequence of industry worldwide dating back to the Industrial Revolution in the 1700’s.  The economy that was created unquestionably changed the world…and it is still changing our world today.  The cost of healthcare continues to rise and some believe that the collection of heavy metal entities in the body contributes to acute and chronic disease, primary introduced into the body by oral or inhalation means.  Cadmium is the most toxic element to man, then lead, then mercury.   Toxins that are manmade chemicals contribute as well.  Little is considered as people wash with scrubs or work with unprotected hands in harsh chemicals.

The economy of healthcare is found in the treatment of disease.  While an enormous amount of money annually goes to research, the title of drugs is at the top of the lists.  One thing for sure, there is a drug for almost everything.  Illness is sometimes considered a synonym for disease or sometimes viewed as the subjective perception of the patient or an objectively defined disease.  If the objectively defined disease is illusive, then the problem exists only in the mind of the patient. Or does it?  

Environmental doctors and those interested in prevention of disease take a different look at the disease model. First, they consider the patient might be right!  Their symptoms might actually be an underlying cause even thought the cause may be illusive and unrelated to emotional or mental illness.   You don’t have to be a doctor or struck with illness to share wisdom.  It is easier and less expensive to prevent disease than to treat it. 

The alternative doctor looks at the body and sees it wondrously made. Food and nourishment is required to fuel and maintain the machine.  The cleaner sources the food comes from, and the more nutritious the source, the better.   If the body is unable to function properly because of enzyme and nutritional deficiencies, should you add a drug to make the process happen or inhibit another process to provide an artificial balance?  In alternative medicine, the practitioner strives to restore the balance.  Removing a toxin is preferred to adding a drug and reasonable nutritional support including a healthy diet. 

One area of alternative medicine many patients have benefited is detoxification programs including those specifically designed to remove xenobiotics (manmade chemicals including plastics and pesticides) and chelation for heavy metal burden.  A healthy BMI (body mass index) is important because toxins store in fat.  If your attitude reflects little dedication for long term effects of healthy living, then you need read no further.  If you understand investing in your health has long term rewards, then you should consult a trained practitioner in chelation to get the best care.

 For example, some professionals use blood tests but results reflect recent exposures and typically not chronic exposures. Others use hair analysis which typically reflect chronic exposure but not body stores of toxic metals.  Fecal tests can be influenced by dietary and metabolic factors.  Challenge tests may fail to produce an expected response in glutathione deficient patients, provide the best results for elevated and very elevated levels.  The challenge test, with the preferred chelator,  is the preferred test.  Often multiple toxic metals are present and increase the duration of the chelation processEach additional toxic metal lowers the toxic threshold for every other metal resulting over time in dysfunction of multiple organs and tissues, impaired chemical detoxification, excessive free-radical formation, and chronic conditions such as chronic fatigue syndrome and fibromyalgia.  Also, increased oxidative stress, related to elevated heavy metals may precondition you for heart disease.  

The impact of how heavy metal burden affects a person depends on their sensitivity. Type O blood patients seem to provide few symptoms and these are the patients who take the least care of themselves because they “feel fine”.  “Feeling fine” does not necessarily reflect the truth which is why health checkups are important.  Areas of concern may be when you see elevations of cholesterol, dysfunction of blood sugar, mental confusion and fatigue.  For example, trace mineral depletion is caused by disruption of transport by heavy metals competing for receptor sites on transport proteins and metallothioneins and by binding sulhydryl groups on many enzymes.  This process may be so gradual, you may fail to recognize the onset of persistent fatigue, decreased mental acuity, or increased issues with metabolism, yet your doctor may not know how to test for these or why they might be important.  In contrast, the type A blood patient is very sensitive and notes many more symptoms because they tend to be more sensitive to their environment.

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Food Allergy – Fixed and Aquired Part 1

Food allergy is believed to be the single most contributory factor of chronic disease and therefore warrants consideration when evaluating the patient.  Immune reactions to ingestants are much more complex than inhalants which tend to be a fixed allergy.  To the physician who understands the basic history and complex symptomology of food hypersensitivity, evaluation has a relevant place in determining cause of disease and impaired health in many patients. 

There are two major types of food allergy–fixed and cyclic. Other responses such as IgA and IgM will not be addressed here.  A fixed food allergy is designated as a IgE response that occurs each time the food is consumed regardless of how long it has been avoided and may include anaphylactic reaction.  A cyclic food allergy reaction is designated as IgG response and is related to frequency and quantity of the consumption of the offending food.  The initial consumption of the food gives a stimulus that the patient may enjoy and as this wears off, the undesirable symptoms begin.  Often the patient erroneously believes because they do not notice a symptom immediately, that the food is safe.  Theoretically food sensitivity or IgG response is the only allergic condition that can be perfectly controlled.  This is a bold statement without regard to conditions which can increase the sensitivity of the patient such as leaky gut syndrome. 

If symptoms improve with fasting for several days, then food allergy should be considered.  If symptoms worsen after a meal or symptoms are temporarily relieved after certain foods are consumed, food allergy should be considered.  And if cravings for favorite foods are common, food allergy should be considered.

A personal history should be taken to include home and occupational environment, all organ systems, and detailed history back to childhood.  Medications and supplement list should be compiled and alcohol intake should be evaluated.  The tests and methods to determine food sensitivities all have limitations but a combination of these tests often produces a treatment plan with good outcomes. 

Food Diary Evaluation:  A food diary of at least seven days, to include all fluids as well, is an important component to determine a correct diagnosis.

If a patient fasts for a period of four days, and most of the offending symptoms lessen or disappear, allergy is a contributor.  Additionally patients who tend to eat the same food over and over again, an irritation occurs in the gut resulting in small particles of the same crossing the gut barrier into the blood stream and are recognized as foreign bodies.  The immune system attacks them and sensitivity is developed, hence symptoms occur.  The diagnosis and treatment of food allergy can be accomplished by several different methods. 

Oral Food Challenge – yourtotalhealth.ivillage.com/foodchallenge-test.html

Food diary evaluation

Rotary diversified diet (Rinkel)  www.food-allergy.org/page2.html

Elimination Diet  (Rowe)  www.blackwell-synergy.com

4-day rotation food families (Randolph) www.frot.co.nz/dietnet/resources/ediet_howto.htm – 74k

Commercial tests include RAST, IgE, IgG, Elisa and usually are not covered by insurance unless certain criteria are met meeting insurance standards such as eczema, psoriasis, autoimmune disease, neuropsychiatric issues, antihistimine failure, prednisone usage or under 4 years of age.

These tests along with diagnostic criteria will be discussed further in future articles as we continue to look at allergy and its impact on health.