In general, I am a fan of IgG food sensitivity testing. While we can in some cases manage just fine using a standard elimination and challenge protocol, IgG testing can benefit patients in a few ways, such as: providing motivating data, individualizing the foods needing to be removed and identify less-common antigenic foods. However, if you are using IgG food sensitivity testing in practice, you’ve no doubt encountered false negatives and positives. (Indeed, you may have abandoned IgG testing for these reasons!) Dr. Brent Dorval, through a rather remarkable epiphany during his post-doctorate work, formed the hypothesis that testing for IgG/food immune complexes, along with the specific complement protein (C3d) that induces the inflammatory response, would increase the reliability of the test considerably. After a number of years of bench and clinical research, Brent finalized the methodology for his assay (now called the FIT Test, offered through KBMO Diagnostics) and the rest is history.
Tune into our podcast for an overview on IgG food sensitivity testing (great if you are new to using this laboratory test, or an individual interested in this testing), and specific details about the unique FIT test, including case studies.
See the links below for all the info on the FIT Test, including his current publication. Stay tuned for more research in the pipeline!
Brent Dorval, PhD has over 25 years of experience in strategic management of research, manufacturing and regulatory affairs in the area of medical devices and diagnostics. Previously, Dr. Dorval held a number of management positions and served as an advisor to the World Health Organization committee on vaccines and diagnostics. Brent is the inventor of the FIT Test which measures IgG and Immune Complexes against a variety of food antigens. In addition, he has several patents covering rapid assays, novel biomarkers and a novel Polio Virus vaccine. Brent holds a Ph.D. in Medical Microbiology and Immunology from the College of Medicine, The Ohio State University and performed postdoctoral studies and was a Visiting Scholar in the Department of Chemistry at the Massachusetts Institute of Technology.
Contact (clinicians and interested individuals): www.KBMOdiagnostics.com
- The FIT test developed by Dr. Dorval and offered through KBMO Diagnostics, measures IgG/food immune complex, plus associated split complement protein C3d.
- The mechanism behind IgG/food immune complex-driven inflammation is centered around the activation of complement (C3d).
- These components are measured simultaneously with 132 different foods and food additives.
- Blood spot or serum testing available
- KBMO’s nutrition team is available for consultation and support for both patient and ordering clinician as needed. The team designs an individualized elimination and rotation diet based on the results. (For new clinicians without a practice nutritionist, this assistance is priceless!)
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Kara Fitzgerald: Hi everybody, it’s Dr. Kara Fitzgerald and it’s another edition of New Frontiers in Functional Medicine. Today we are talking about IgG, Immune Complex Measurement for food sensitivities. My guest is, actually the rather brilliant, Dr. Brent Dorval who has 25 years of experience with strategic management in research manufacturing and regulatory affairs in the area of medical devices and diagnostics.
Dr. Dorval has held a number of management positions and served as an advisor to the World Health Organization committee on vaccines and diagnostics but the focus or our podcast today is the fact that Brent is the inventor of the FIT test, which measures IgG and immune complexes against a variety of food antigens. We’re going to spend our conversation today really doing a good drill down into this test. What’s it about, why is it different from the other tools we’re using, and so forth.
Brent also has a number of patents covering novel biomarkers, and a novel polio vaccine. He’s got a pretty neat background. His PhD is in medical microbiology and immunology from the College of Medicine, Ohio State University, and he performed post-doc studies and was a visiting scholar in the department of chemistry at Massachusetts Institute of Technology.
So welcome to New Frontiers, Dr. Dorval.
Brent Dorval: Thank you very much Dr. Fitzgerald. It’s a pleasure to be here this afternoon.
Kara Fitzgerald: Well, let’s just dive right in. Talk to me about-
Brent Dorval: [inaudible 00:01:42]
Kara Fitzgerald: Yeah, absolutely. Because I want to get to the meat of it and hear all about this test, and what you’re doing, and how you developed it. So, the IgG immune complex test measures for food sensitivities. So, what is a food sensitivity?
Brent Dorval: A food sensitivity occurs when a person ingests a food and the food antigens cross from the lumen of the gut into the bloodstream, and then cause the production of antibodies, IgG antibodies, which then precipitates the formation of immune complex, which then activates complement, and then causes the intended inflammation.
Really, the important word here is inflammation because the immune complexes, when they activate complement, they cause inflammation and then that generates the symptoms that are associated with food sensitivities.
Kara Fitzgerald: Right. And food sensitivities, we’re not talking about allergies. I think most people, most of the clinicians in the functional medicine space get it, but can you just differentiate for us again?
Brent Dorval: Yes, absolutely. So food sensitivities are mediated by IgG immune complexes. And these are delayed reactions which means that when you form theimmune complexes and then complements activated, the symptoms associated with the inflammation may not show up for three or four days. They typically cause a wide variety of symptoms, anywhere from the digestive tract to the eyes, head, weight gain. Pretty diffuse type of reactions.
Now, by contrast, food allergy is caused when a person is exposed to a food or food antigen, and IgE is produced. And the big difference is that IgE is produced almost immediately within minutes. So, the reaction is very fast, within minutes, or certainly within a half an hour. The IgE then binds to [inaudible 00:04:12] basophils in the body and when crosslinked then generates a huge kind of anaphylactic reaction.
So, the food allergies tend to be much quicker and much more severe when they occur.
Kara Fitzgerald: Right, right. Although certainly IgG sensitivities can be really significantly debilitating. So, talk about the KBMO test. So, the IgG food immune complex assay that you’ve developed, I mean you just gave us an overview, but talk to us about the test, what you’re measuring, and I want to understand a little bit more about your decision to include the immune complex in the test, because that sets you apart, I think, from every other IgG assay out there. If I’m not mistaken. Is that right?
Brent Dorval: That’s actually absolutely accurate, Dr. Fitzgerald. Our test measures IgG one through four, plus C3d, which is the inflammatory component that gets deposited on the immune complex. So, why we developed it that way is it’s really the inflammation that causes the symptoms, so it made good sense to measure the immune complex which activates the complement and causes the inflammation.
And the real crux of it is that when you look at how you set up the assay, the IgG generates a signal that we can detect, but the immune complex through C3d generates a separate signal. And those signals are additive. So you get a nice, clean response so that when you visualize that in the report it’s clearly a reactivity and you get a very low background.
Now, by contrast, other IgG tests, they only measure IgG. They only get one signal by comparison so that the overall sensitivity of an IgG-only assay is at least 50% less than what is observed in the FIT test.
So, we get added sensitivity, which is great. We get a much higher signal and as a result when you visualize that as a clinician or as a patient, you can clearly depict the positive versus the negative reactions. Very, very clean.
Kara Fitzgerald: That’s really interesting.
Brent Dorval: So-
Kara Fitzgerald: Yeah, go ahead. Go ahead.
Brent Dorval: So I said that’s the basis of that and there’s a whole host of other types of assays out there, but basically we’re the only assay that measures those two signals simultaneously, and that’s patented, so no other company can use that particular technology.
Kara Fitzgerald: Wow. And you’ve published on this, correct?
Brent Dorval: Yes, we’ve published one clinical paper, about two years ago, that clearly shows the utility of this test. Not only from a technical perspective but also from a clinical perspective when we looked at a small study of 30 patients retrospectively. So that’s the previous, and we have another study with 100 patients which is a prospective study, and that’s in the works right now.
Kara Fitzgerald: Okay, that’s great. Well if, you know, I’d love to have a link to that reference if possible, and I look forward to seeing the new study that you’re doing. Because it is unique and I know that we see a lot of false positives, and there’s false negatives… there’s definitely holes in the IgG which I’ve used in my practice and I recommend, but I also… You coming forth and adding this complement makes an awful lot of sense and I know that I’ve enjoyed using this test in my practice. We’ll talk about some of the cases that I’ve experienced later on.
So what exactly is the KBMO test, the FIT test, measuring? What are the main foods, what are the additional things that you’re looking at?
Brent Dorval: The FIT test, or the food sensitivity test that we offer at KBMO Diagnostics, again measures IgG one through four, plus immune complex associated C3d, which is the inflammatory component. So, we measure those two components simultaneously and we measure it against 132 different foods and food additives.
Now, these foods come from all the major dietary regions that you would expect to be eating as mostly as an American citizen, although it does contain a lot of food additives that are world-wide. So, anything from fruits and dairy to food additives, which includes dyes and preservatives, meats, fish, vegetables, and those sorts of things. So that it’s very, very comprehensive in it’s scope so therefore if you test a given patient using this test you can very effectively determine which foods and which categories cause the problem for the patient.
And then it makes it easy to design an elimination diet which then you can implement, and the patient generally benefits quite a bit from.
Kara Fitzgerald: So you know the top food allergies in this country are wheat, soy, tree nuts, fish, et cetera. I mean, what are the top ones that you’re seeing on the FIT test?
Brent Dorval: Pretty much that mirrors the big eight that we see for food sensitivities, so you’re absolutely right. You see milk, eggs, wheat, nuts, shellfish, fish in general, some meat, and even certainly some additives. But the main ones are… about 70% of the food sensitivities we see come from four main groups which is milk, eggs, wheat, and there’s a lot of nut sensitivities. So those are the big four and those cover probably about 70% of what we see. And then the other ones, although they’re just as important, are less prevalent.
Kara Fitzgerald: Right. Yeah, that’s been my experience as well. And it makes sense because those are foods with a lot of potentially antigenic proteins present in them, so it does make sense that you would see them, I think.
You have the addition of the food additives, which is pretty neat. I mean, I actually was talking to a patient yesterday who’s got, who was recently diagnosed with ulcerative colitis and she’s coming back with polysorbate-80, interestingly, as one of her… it’s not her strongest reaction. Her strongest reaction was dairy, not surprisingly, but polysorbate-80 is way up there.
I mean, what can you say, like what do you see in about… when people are flagging positive to these various additives? I mean, how significant are they contributing to their symptomatology?
Brent Dorval: It’s an integral part of the whole picture for a patient, and you mentioned something like polysorbate-80. It’s a small molecule. It’s also called tween-80, and what happens is it’s used as an emulsifier in all kinds of pharmaceuticals and cosmetics, and foods like emulsified foods, hot dogs and sausages, as well as ice cream and other types of foods. So, it is wide-spread and people get exposed to it. Most of the time they don’t even realize that they’re consuming it.
Even though it’s a small molecule, a lot of times it can still generate an IgG response and form an immune complex, and even though it’s small, still have as big a problem as some of the other proteins, which would be much larger.
You mentioned Crohn’s and those sorts of diseases. Polysorbate-80 is a particular problem in that cohort of patients, and it has to do, again, with its binding properties and its unique properties, to kind of, because it’s a detergent-type of molecule, it can cross the intestinal wall very, very readily.
Kara Fitzgerald: Right, right. Well, her results were helpful.
So, what’s the testing process?
Brent Dorval: Well, what we do is the sample is first taken, so that could be traditional blood draw, you simply draw into an 8 or 10 ml red-top tube, and then you send that off to the lab, we spin it down and we test the antibodies and the immune complexes that are in the serum component.
Now, we also have another sample type which is a blood spot. In that case you do a simple finger-stick, and then you apply the blood to the circles on filter paper, let it dry, and then just mail it back to the company. And then what we do there is we’re also measuring the serum component because we elute the serum out of the filter paper and then we apply that to the test.
So in either case the serum contains antibodies and immune complexes. We add that to, add those samples to a plate which is coded with food antigens. We have 132 food antigens coded on standard Elisa plates. We add a sample to each of those wells and then we have a standard curve as well as a background control as just procedural controls on the test, and then we simply incubate that overnight, we let the antibodies and immune complexes bind to the foods. We come back the next day, we add the anti-human IgG, and anti-human C3d to the plate.
So those are the two markers we’re looking for. C3d and IgG. And then we go ahead and put that in a standard spectrophotometer after adding substrate, and we get a signal. So, the process from start to finish takes about two days as we’re doing it now.
And then what we do is we use that data to produce a report that then is sent to the patient as well as to the healthcare provider, and that’s used as a basis to then design an elimination diet based on the reactivities. So it’s a pretty straightforward process.
Kara Fitzgerald: So blood spot versus a full draw. I mean is there a difference?
Brent Dorval: Mm-hmm (affirmative). There is. I mean the blood spot’s really nice because it’s convenient. People really love it these days. It’s cheap, it’s quick, you can do it at home and in general it just simplifies the process of having to go to a blood-draw center or have a blood-drawn in the office. A lot of people don’t like needles, you know, and this being a puncture, so it takes that bit of fear out of it as well.
Now, when you look at the comparison of blood spot, the accuracy of blood spot versus serum test, they’re virtually identical. The blood spot is a slightly less sensitive. That’s just because there’s slightly less sample to test. But the important takeaway is that the high positives that we’re looking for in this test are identical when you look at a blood spot versus serum. And by identical they’re 90 or 95% the same, which is a pretty good rate of accuracy. And given the simplicity, it seems to have a little niche in the marketplace right now.
Kara Fitzgerald: Yes, well you know I have a lot of patients who don’t live in the same state, and they might come in to see me annually, and if I want to do a follow-up test the blood spot is so easy rather than needing to find a site for them to get drawn.
So the only thing that you’re sacrificing is maybe some of those low-grade positives might not flag quite as high, but the major players I can expect to reliably show up?
Brent Dorval: Yes, that’s absolutely correct. So, always in the test you have borderline positives, and so some of the borderlines will drop and they’ll be a little bit more negative. But, suffice to say you’re absolutely correct. The high-positives are, like I say, 95% the same and we’ve done that comparison and testing in-house prior to releasing the assay about a year and a half ago.
Kara Fitzgerald: So, on the test, I’m actually looking at the IBD patient’s results now from yesterday, I was just mentioning. She’s got… you know the front page of the test you have… and actually if you have a sample report we’ll upload it to the transcription page so people can see what they’re getting. You’ve got plus two reactions, plus three reactions, and plus four reactions.
Now, these are the reactions that the blood spot and serum are both going to be able to pick up. These are the ones that you’re considering to be the mother load, the ones that need to be eliminated. The ones most likely clinically relevant. Is that correct?
Brent Dorval: That’s correct. And the reason is on a test, this test shows 95% accuracy and that means that if you have a positive, and that was the yellow, the tan, or the red, there’s a 95% chance it’s a true positive. And if you have a negative, which is the dark green, there’s a 95% chance it’s a true negative.
Now, there’s the 5% error zone which is represented by the very light green bars, and if you test the sample several times some will be light green, and that same sample might be dark green.
So within that narrow zone there you get a little bit of flip flop. But those, in general, are not the clinically relevant ones. It’s generally the ones overwhelming that have the three, four reactions, and also the two plus reactions.
Kara Fitzgerald: So, folks, you can look at the sample report on the transcription page for this podcast, and you’ll see on page two the mild reactions, the green bar.
I have, in some cases actually, decided to remove those but it’s a case-by-case basis and it’s, you know I may… maybe they’ve just finished a steroid taper or something like that, and I might think their reactions are a little bit blunted and so I’ve chosen to say look, let’s just do a trial where we pull out those plus ones as well.
What are your thoughts on that?
Brent Dorval: Yes, I mean, again I think that that’s a good approach and every doctor, every practitioner has a slight different interpretation which is very normal. What you kind of do is go for the low hanging fruit first, so the four, three, and two plus are overwhelmingly the foods or food additives that will cause the problem. So, those are focused on, generally, right up front.
Now, if you see no relief in symptoms or the patient doesn’t feel better after removing those foods, which can happen, generally then you can go back and say, “Okay, well maybe, maybe there’s a couple of these in the light green zone, the plus one zone, that we could focus on and see if those have any impact on your symptoms.”. But, generally, that’s after you’ve suspected the two, the three, and the four plus reactions in the elimination phase.
Kara Fitzgerald: Right, okay. That’s fair enough, that makes sense to me.
Now, well just thinking about this, it can be a lot. I’m looking my patient, this patient doesn’t look particularly egregious, the things that she’s going to need to remove. Cow’s milk, she’s going to have to pull out egg, which she was actually pretty disappointed about. Yeast, she’s having a yeast reaction, I suppose not hugely surprising. But, you know we’ve got a handful of things we’re going to need to… we’ll start on.
How do you, what are you guys doing to support clinicians in this whole process of initiating this very individualized elimination diet? I mean, I think in a way, my patient’s is fairly straightforward although she’s really bummed out that she’s going to have to let go of eggs, but sometimes these things can be very onerous, they can be highly restrictive. So how are you doing this, how long are you recommending they follow the protocol and what kind of support features do you have?
Brent Dorval: Okay, yup, very, very good question. So, we start off with the testing followed by the reports. And I’d just like to emphasize, and we will upload one and everybody will be able to see, how easy and intuitive it is for the patient as well as the provider to just scan it and within five seconds you know exactly where the reactivities lie. So it’s intuitive, quick, and you don’t have to be a scientist or a doctor to understand it.
So then we take that information and we use that to design an elimination diet. We have a PhD, a nutritionist, on staff whose job is to design diets for people. So we take the information from the report and then we design the diet for people. And, I know, it could be onerous when you say you can’t have milk products, oi, that covers a lot of ground.
Kara Fitzgerald: Or gluten, or if you can’t have a whole bunch of your staples…
Brent Dorval: No, you’re absolutely correct. So the nutritionist is very, very good at designing a nutritionally balanced diet yet at the same time eliminating the foods that may be responsible for the food sensitivities, and then substituting those foods for foods that can be eaten. It’s never a perfect trade off from one food or another, but let’s put it this way, they’re acceptable.
The way I look at it is… a lot of the patients, they’re really feeling quite bad, they have some pretty severe symptoms as you stated earlier, Dr. Fitzgerald. So, even though milk or wheat may be a big part of their diet, these patients we find are very willing to comply with a diet that’s designed for them with the goal of making them feel better.
And then we’ve taken it one step further. We’ve designed a simple phone app, and it’s free, you download it onto your phone, and you download the report onto the phone app, and if you’re out to eat and you say, “Oh my god can I eat that?” You can scan your phone app. Or if you’re shopping you can what you’re sensitive to while you’re doing your shopping.
It’s all about patient awareness at this point. So you design the diet, you make sure they’re aware of what they’re sensitive to, and then you make it, you make that information easy and accessible which just enhances their ability to comply.
Kara Fitzgerald: Right, right, and I think it’s really empowering. In fact, actually, just because I happen to have her test pulled up, this patient yesterday you know we gave her access to her results and she immediately did jump ahead and get the app and start the whole process. She had it a few days in advance and she came to me already working it out. She was really excited. I have a nutrition team here who enacts the nutrition plans for my patients and we’ll work with her on it, but she was just kind of inspired and you’re right, the results are extremely straightforward and she has access to your tools, to the app, and she can do her thing.
So this is basically turnkey for clinicians, if I’m hearing you right. Your team…
Brent Dorval: Turnkey is the operative word. And we even take it one step further. We also offer technical help to doctors if there’s any questions that arise. If you’ve got something that you thought were peculiar, or odd, or some reaction that you needed an explanation on, or you wanted to send a patient to the company for some help. You can direct them directly to me, that’s a bit part of my job is to make sure I’m the customer interface for providers and patients. I get back to people quickly, I give them informed information, and that just enhances their ability to comply with the results and get the best result that’s possible.
Kara Fitzgerald: So you are actually making yourself available to consult with not only the provider but you’ll answer patient questions as well?
Brent Dorval: Yes I will, but only if… the way that works is a doctor can call, a provider can call anytime, I’ll pick up the phone and I’ll answer the question, and that’s pretty straightforward. If a patient wants to talk to me then what we encourage, and in fact today we demand it, is that they get the okay from their doctor or provider to call me and talk to me directly, and I’m happy to talk to the patient.
And then what I do is I’ll circle back with the doctor and then just kind of summarize what we talked about and what I thought the main features were, just to kind of close the loop. And all that is free, so you can call practically any time and I’ll do my best to answer the question immediately. If not I’ll gather the information and I’ll get back to you as quickly as I can.
Kara Fitzgerald: That’s incredibly useful. I mean, just the fact that you’re generating the report and that you’ll work with… the nutritionists will generate a meal plan, it’s just, you know, for the busy clinician you just can’t beat it. And it’s really neat that you’ve created an app.
So how long are you generally recommending people follow the elimination diet that you design for them?
Brent Dorval: Initially what we recommend is that once we’ve got the elimination diet designed that it’s a six to eight week period that you abstain from those foods. Now during that time, and I’m going to talk generalities, in most people what occurs is that the antibodies and immune complexes are cleared quickly and 70, 80, 90% are gone during that particular phase, the six to eight period.
Now, some clinicians may bend more towards six weeks, some say, “Oh no, I’d rather go more towards eight to ten weeks”, and again some is individualized depending on the protocol. But the take-home message is the antibodies and immune complexes are cleared during that phase, and in general you almost see sometimes the patient is starting to feel a little bit better. Then what you do is you say, okay if you’ve had four or five things you’ve removed from the diet you’d say, “Okay, now we’re going to reintroduce those foods” and that after the elimination phase, so you’d say, “Okay, on Monday I’ll have a normal size glass of milk, six or eight ounces”, because you were sensitive to it.
And then you keep a diary and follow how you feel on Monday, Tuesday, Wednesday, Thursday, to see if any symptoms either reappear or worsen. And if they do, then you’ve identified a food that triggers a symptom in that particular patient. And then if they say, “Oh no, I drank milk and I felt fine the whole week and nothing seemed to happen”, you say okay, that doesn’t seem to trigger a symptom. Then you can move onto the next food.
What’s really important is you remove the four or five all at once, but you only add back one food at a time and keep track of it so that if something reappears you’ll know and you can associate it with that food. That’s the hard part of food sensitivities is you eat so many things it’s, like, which one or ones cause problems for me? So we try to encourage just one food reintroduced at a time.
Kara Fitzgerald: Right, no that makes absolute sense. And then if they are reactive do you suggest they stop eating it for a longer period of time? Forever? I mean, what is the protocol that you’re suggesting?
Brent Dorval: Yes, so then what we’ve shown, and I’ll upload the paper that we’ve published on the clinical study, is that if a patient is sensitive after the elimination phase, so I’m using milk as an example. So they had it on Monday and then by Tuesday their bowel problems are back, or they’re getting hives, or some other symptom is either worsening or reappears. You say, “Okay, that’s a trigger food. Now you’ve got to remove that from the diet for as much as 10 months, 11 months”.
The reason you do that is you not only want the antibodies and immune complexes to go down to very low levels, I mean, virtually 99%. You want to stop the activation of the cells in the lymph glands from being activated, the B cells. And those get kind of quiescent after 10 or 11 months. So then after 10 or 11 months you say, “Okay, you were sensitive to milk, that triggered a negative symptom, let’s do the same thing again”.
So you try it on Monday, and just have a normal amount, and say, “Oh, Tuesday, Wednesday, Thursday, Friday I felt fine”.
You say, “Oh geez, okay. Let’s try it one more time”.
So the next week follow one with another glass of milk. “I feel fine.” So, by all accounts, if the patient is no longer sensitive to that food it’s because the antibodies [inaudible 00:32:59], the amount in the blood, the immune complexes particularly, are not at very low levels. So what we recommend there is just don’t eat the food too frequently. So, rotate your diet and in general patients can then eat that food again.
You know, people tend to eat something they like three, four, five times a week or more, yeah all the time. So you say instead of that, eat it once or twice a week and generally people can get away with that.
But there are some foods and some people where after 10 or 11 months, you’ll reintroduce it on Monday, it doesn’t matter, by Tuesday they’re feeling unwell again. So, you have to then exclude that from the diet on a more permanent basis, and then find a permanent substitution.
Kara Fitzgerald: And I find that usually whatever that individual is presenting with, they’re absolutely relieved to have it gone, so they don’t mind having one or two foods out of the diet long-term. I had one patient who developed really severe sinusitis with dairy. Severe, actually. I worked at a tertiary care pain center and he was referred there for pain management, they were just so poorly controlled. And it was dairy. I mean, it was really that simple. It was dairy. And now, so he’s clearly committed to… he avoids the same room when there’s dairy. Maybe not quite that, but, you know it was just very, very, very [inaudible 00:34:46] for him.
So just along… actually let me just ask one more question, because again I’m just looking at this in front of me and it’s kind of interesting. And then I just want to talk about I know you’ve heard a lot of, I mean you’ve been talking to people doing this for a long time so I want to hear some of your cases, too.
So my patient, one of the interesting things about her results is that she’s really, she’s got a strong positive to cow’s milk, so that’s her severe reaction. But casein, the dairy protein, is actually only a mild, and she’s not reactive, she had no reaction to goat’s milk. So kind of an interesting picture, and you know, can you just walk us through?
Brent Dorval: Yes, so the reason, we’ll use milk as the example, we test whole milk and we test casein separately, and then we test goat’s milk, obviously which is a different species. One’s bovine, one’s a goat [inaudible 00:35:54] breed. So the importance there is that there are a lot of proteins in milk, whole milk, beside casein. Casein is about 70% of the total protein in milk, you know a little bit more or a little bit less depending on the species of cow and what they’re consuming.
So a lot of times what we’ll find is that there’s no reactivity at all to whole milk, let’s say, because it’s a mixture of proteins and casein, but casein’s very high. And by no reactivity in milk a very low reactivity is what you see. So the profile shows casein might be three or four plus, and whole milk might be two plus. The importance there is that kind of flags that and says that, “Hmm, milk is positive but the major component here of that dairy is casein”, and overwhelmingly casein naturally, since it’s the highest concentration, generally causes the biggest problem for people who are dairy sensitive.
The reason we test goat milk, now goat milk, different species, but the proteins, the casein and there’s a whole host of other proteins in milk, are what we call homologous. That means the protein structure is similar but not the same. So, sometimes people can’t eat cow’s milk, or consume cow’s milk, but they can consume goat’s milk and the minor differences are in the proteins that are found in goat’s milk enable that to be not immunogenic to that person so therefore they don’t show any symptoms.
And the same thing follows a lot of times for other types of species of milk even that we don’t test in our particular test. So the take home message is that casein is many times the problem for people, and that sometimes you can substitute goat milk for cow’s milk, and you can get away with consuming that without triggering any negative symptoms.
Kara Fitzgerald: Right, which looks to be the case of my patient but I just actually negotiated her doing the dairy-free trial altogether. But I think if a patient was really, really wanting dairy they should safely be able to go with goat’s, according to this profile, because she’s not reactive.
All right, well talk to me about some of your cases. I mean, you’ve been doing the test for a while now, you’ve been talking to clinicians all over the country. What kind of successes are you seeing?
Brent Dorval: Well we’ve got… I pulled one that is kind of a typical case study that we see overwhelmingly, and this happens to be a female patient of about 35 years old. She was showing weight gain over time, blood pressure was elevated, 174 over 107, so not crazy high but certainly elevated. The key for her was she had extraordinarily low energy. She used to be a professional woman, high-powered, “I’ve always had a lot of energy, I got up out of bed in the morning like a rocket and was ready to do 10, 12 hours at work, and then come home and finish my day”, and over time she lost her energy levels.
So what we did was we said, “Okay, this may be a case. Let’s test this person”, so we tested her and what we found that she was particularly sensitive and it’s funny that you mentioned it, to both cow’s milk and casein. She showed some sensitivities to seafood which she consumed on a regular basis. And by that I mean mostly scallops and some codfish. And she had some various other sensitivities to fruits and stuff like that. She liked fruits, it was easy for her as somebody on the go to just grab fruits, put them in your briefcase and consume them.
We say, “Okay, we’ve identified these foods. You had four plus, three plus, two plus to these foods. Let’s get them out of the diet”. We retested her after the elimination phase and what we found was, so six to eight weeks, and what we found was her antibody titers had gone down quite a bit. Not to zero, but quite a bit. So the fours, probably you’re looking at threes and twos, and the threes went to twos. So they diminished a little bit which happens over time.
When we introduced these foods she had certain reactivities to these. Anything from, again not so much the weight gain, but what we noticed was she just felt tired especially with milk. And the fruits were giving her skin reactivity. Just, I mean, very pronounced blotchy skin reactivity and particularly in her face.
So, we said, “Okay, you’re sensitive to these foods. Let’s remove these from the diet for…” the average was 10.5 months. So we got these foods out for about 10.5 months and then we retested her then. Her antibody titers had dropped to practically zero. So the four pluses went down to two plus, one plus. The three pluses when down to sometimes one plus and even negative. The take home message is her antibody titers went down significantly and during that time she reported feeling much, much better.
And then when we looked at just some of the typical parameters such as weight, at that point after 11 months, and it wasn’t just calorie related, she had lost 33 pounds. So that’s a lot of times weight is associated with inflammation. Her blood pressure now was down to 138 over 85, and so her blood pressure again is inching in the right direction.
The most notable thing that she could recount was that she felt better. And by feeling better she meant she felt more like herself and her energy levels had resumed. So we brought her through the process of testing/ retesting in the rotation phase, and some of the foods that she was abstaining from she could eat, and some of the foods she could not. And then from there on out she just basically followed a diet that was kind of prescribed for her, if you will, and she’s been happy as of this day.
So that is typically what we see is that a patient comes in, they feel unwell for a variety of reasons and we test them and find out what your reactivities are. We then also look at what your symptoms are, so we provide a symptom checklist and the patient can then say, “Okay, migraines are unbearable. I get them every day and they’re debilitating.”, so you try to score how they feel. And then upon retest you find the antibodies are reduced, and then when you look at the symptom checklist at the very least the symptoms have been reduced and in some cases eliminated.
Now, we look at this test, it’s not… this isn’t a test where someone is cured, but the goal here is to reduce inflammation and when you do that, in general and overwhelmingly, the patient feels much better. A lot of times, I think, as you know Dr. Fitzgerald, these patients come in and they have other physiological things going on. They may even, we get some people that might have diabetes, or rheumatoid arthritis, or some other organic illness. So, you can’t cure somebody, but the goal is can you lessen their symptoms or the severity of their symptoms and make them feel better as a result. And the answer, overwhelmingly, is yes. Patients feel much, much better once you’ve identified the trigger foods.
Kara Fitzgerald: Yup, absolutely. Absolutely. A couple of interesting cases for me were some… two individuals with particularly challenging conditions, another IBD patient and an allergy patient who we had taken a good distance in wellness, but still had some refractory symptoms. The KBMO really helped us identify some foods that I would not have suspected to be problems.
In fact, in the IBD patient chicken was a pretty profound irritant, and she had a really good response to pulling it out and I was surprised. And I do, just like you said earlier, you expect to see the top eight common allergens not only the top eight IgE’s, you know those are the proteins we see for IgG’s as well and that’s my experience. But she was really on a hypoallergenic diet already. She was still symptomatic so she was off of dairy, she was off gluten, et cetera. So she was on a pretty rigorous diet, still symptomatic. Identified chicken as a major player for her and it turned her… it was the missing link.
I found it to be quite helpful, and similar to the skin patient. Still reactive with eczema despite lots of work. I mean, you know, good, careful eliminations and same thing.
So in my experience, especially with those tougher cases that’s just pretty [crosstalk 00:46:25], because I would not, you know I generally think of chicken as pretty hypoallergenic, you know, it’s usually not an issue. But for whatever reason she was reacting to it.
Brent Dorval: And I agree 100% with you because sometimes the result of eliminating a food can be almost miraculous and I don’t want to sound like some kook, but I mean it can really be dramatic in a person. Other times you get a more graded response where, like for some people that we’ve had with migraines, they’ll say, “I get a migraine almost every day, it lasts for hours, I take drugs for it, it doesn’t help, and I’m at my wits end at this point.”. And then you put them on the diet and you identify a food, or two, or more that they’re sensitive to and they’ll come back months later and they’ll say, “You know, I still get migraines but now I only get one every two or three weeks and it’s far less severe and debilitating than what I used to get”, and they’re happy as a clam because-
Kara Fitzgerald: Oh yeah, price of gold.
Brent Dorval: To them, that’s huge.
Kara Fitzgerald: Yup, absolutely. Total price of gold. So we are at the end but I just want to assure our listeners today that… well you can go to the website which is easy. It’s kbmodiagnostics.com but again if you swing by the transcription page attached to this podcast we’ll have a sample report, we’ll have some research. We’ll just be able to connect you with all things about the KBMO FIT test.
Dr. Dorval, thank you so much for joining me today on New Frontiers.
Brent Dorval: Well, a pleasure, Dr. Fitzgerald, and I thank the web audience for attending today.