KBMO Diagnostics is a fully integrated medical diagnostics company that offer Food Sensitivity Testing that measures sensitivities to up to 132 different foods, coloring and additives using the Food Inflammation Test, also known as the FIT Test.
The KBMO Diagnostics FIT Test is a patented, multi-pathway delayed food sensitivity test. The test uses new technology that measures both IgG and Immune Complexes, the most common food-related pathways in the body.
Whether you’re new to functional medicine or you’ve been practicing in the field for a while, you know that inflammation is a root cause of many chronic conditions and debilitating symptoms—and that one of the biggest drivers of inflammation is food sensitivities. The gold standard for diagnosing food sensitivities is the elimination diet, but compliance is low.
In this episode of New Frontiers, I talk with Dr. Joel Evans the Medical Director at KBMO Diagnostics, which provides state-of-the-art food sensitivity testing. He explains how KBMO tests can help pinpoint food sensitivities with more precision than other tests, helping improve compliance and expedite treatment outcomes.
In this podcast, you’ll hear:
- Inflammation as a root cause of chronic conditions and frustrating symptoms
- The limitations of many current food sensitivity tests
- How the KBMO test avoids generating false positives
- The importance of C3D testing and how the KBMO test looks for that molecule
- Why a surprising number of people have a sensitivity to curcumin
- The role of food sensitivity in miscarriage
- Why Dr. Evans has made the KBMO test the first one he uses with new patients
Joel M. Evans, M.D. is the Director of The Center for Functional Medicine in Stamford, CT and the Medical Director of KBMO Diagnostics, which provides state of the art food sensitivity testing. In addition, he serves as the Director of Curriculum development of the Functional Medicine Coaching Academy.
He is a member of the senior faculty of The Institute for Functional Medicine and continues to serve as the “external lead” of the IFM Advanced Practice Module in Hormone Health since its inception. He has a special interest in Breast Cancer and serves as the Medical Director of the Keep-A-Breast Foundation.
Dr. Evans is a peer reviewer for Alternative Therapies in Health and Medicine and Global Advances in Health and Medicine and a member of the editorial advisory board of Holistic Primary Care. He recently authored a chapter on Nutrition and Sociogenomics.
Dr. Kara Fitzgerald: Hi, everybody. Welcome to New Frontiers in Functional Medicine where we are interviewing the best minds in functional medicine, and today is no exception. Now, before I introduce our interviewee, I just want to remind you if you’re enjoying our podcast to please swing over to iTunes and leave us a review. I would so much appreciate it.
Okay, today we’re talking to my friend and IFM colleague, Dr. Joel Evans. He is the Director of the Center for Functional Medicine in Stamford Connecticut in the same county as me actually, I think, right? Just around the corner. You’re also the Medical Director at KBMO Diagnostics, which provides state-of-the-art food sensitivity testing. In addition, he serves as the Director of Curriculum Development at the Functional Medicine Coaching Academy; he is a member of the senior faculty at the Institute for Functional Medicine; and he continues to serve as the external lead of the IFM Advanced Practice Module in Hormone Health since its inception. He has a special interest in breast cancer and serves as a Medical Director at the Keep A Breast Foundation. Dr. Evans is peer reviewer for alternative therapies in health and medicine and global advances in health and medicine and he’s a member of the Editorial Advisory Board of Holistic Primary Care. He recently authored a chapter on nutrition and socio genomics. Dr. Evans, welcome to New Frontiers.
Dr. Joel Evans: Thank you for having me.
Dr. Kara Fitzgerald: I know! It’s just very, very nice to connect with you, it always is. As we were just talking, we rarely, if ever, see each other in Connecticut. It’s usually at conferences, but it’s nice to have this time to catch up with you. As usual, you’re up to just a lot of interesting stuff in addition to very active patient practice so I was surprised, I have to admit, when I found out that you were the Chief Medical Officer over at KBMO. So you’re an OBGYN by training, you’ve got a bustling, really highly regarded practice here in Connecticut, you’re on IFM faculty and you were actually doing that really cool work at the UN that you and I talked about once upon a time, so not only do you have a really full plate but this seemed like a little bit of a left turn that you jumped into KBMO, and I could be totally wrong maybe it was a direct center choice for you, but I want to hear…
Dr. Joel Evans: It was a right turn.
Dr. Kara Fitzgerald: It was a right turn, yeah. Okay. But just talk to me about it, how you decided to jump in with KBMO.
Dr. Joel Evans: Well, what I would say is as even the most beginner student of functional medicine knows, inflammation is probably the most important driver of all the complex chronic disease that we see in our practice, and one of the most important drivers of inflammation is inflammation that comes from eating foods to which we’re sensitive, and the problem has always been how do I identify those foods. The traditional functional medicine teaching has always been to use the elimination diet, and the elimination diet has really been in use and taught by IFM ever since the very, very beginning and that’s because we understood the importance of triggers for different issues that come from food. We had to use a diet that would eliminate the most common foods to which people are sensitive and then slowly reintroduce them and see if the reintroduction sparked a return of symptoms.
So that’s the basic understanding that I’ve always had about how important foods are in creating inflammation and creating chronic complex illness. However, in clinical practice, I always had a hard time keeping patients motivated to stay on the elimination diet. The elimination diet for me in practice was very, very challenging and maybe, and I hate to say this on the air, but maybe if I was lucky I got 50% compliance. So I’ve always been looking for the right food sensitivity test because why have patients eliminate common foods that people are allergic to or sensitive to when they themselves may not be sensitive to them.
So take soy, for example, maybe a particular patient isn’t sensitive to soy so to make them eliminate all of that food in the elimination diet just never made sense to me. So I just happened to come across this particular test and I saw that it was called the food inflammation test, or the FIT test, and I happened to run into the CEO at a conference and we just struck up a conversation and I said, this really intrigues me because I understand the importance of inflammation as one of the main upstream causes of everything that’s wrong with my patients, and tell me why you call this the food inflammation test. He explained how this test is the only one out there that actually looks for foods that trigger inflammation, not just foods that trigger some sort of immune response. That really resonated with me because I’ve always been an educator at IFM that has looked for the right food sensitivity test and I will tell you that, to me, food sensitivity testing has been essentially the Wild West, that it’s been very, very hard to identify a good test that was reproducible and correlated with symptoms and didn’t always come up with a hundred foods that people had to avoid.
So what I liked about this test was, number one, that it found foods that triggered inflammation, because we know the importance of inflammation, and number two, it didn’t come back with a lot of positive. Maybe there would be 10 or 12 foods on average that people had to avoid out of testing 132 foods and additives, so that was important to me.
The other thing that was important to me is that it tested for the common food additives that people use, or are exposed to, which checks for things like aspartame. And then it also is a way to diagnose leaky gut because if the test comes back showing a sensitivity to candida, then that means that leaky gut is present because we all have candida in our GI tract and if we have increased intestinal permeability and things are passing through this barrier that shouldn’t, like candida, we create this immune response, and if we see the immune response to candida that makes the diagnosis of increased intestinal permeability. So it’s the ability to do two tests in one, that there were not a lot of positives so it was the elimination piece would be easier than other tests. And number three, that are identified inflammations through a unique testing sequence where they’re looking at both complement and IGG one through four, which is also unique.
Dr. Kara Fitzgerald: We’re going to talk about that because that does separate FIT from every other IGG test out there. So you did your fair share of experimenting, there are a lot of tests out there that suggest they diagnosis food sensitivity, and so you used your share of IGGs and some of the other emerging tests?
Dr. Joel Evans: Yes. Absolutely.
Dr. Kara Fitzgerald: Okay.
Dr. Joel Evans: What’s interesting is if, and we can certainly get to this when we talk about clinical data, but the clinical data on our tests is better than the published data on the other forms of testing.
Dr. Kara Fitzgerald: All right, I’m going to definitely ask you that, specifically why is it better, and we’ll talk about it. So what is special about the FIT test? I mean, talk to me about what they’ve designed, go into some detail on why this test, that as you said, looks at IGG but now it’s actually looking at complement as well. First of all, what it is, and how they determine it’s actually more reliable.
Dr. Joel Evans: Okay. So we all know that what we’re talking about are food sensitivities and not food allergies…
Dr. Kara Fitzgerald: Yes, good point.
Dr. Joel Evans: That’s an important point. Food allergy, IGE, type one hyper-sensitivity, that’s not what we’re talking about. We’re not talking about anaphylaxis, that’s all handled through allergists.
Dr. Kara Fitzgerald: Yes, actually, define it. I think it’s good that we back up here for a second. Define this delayed hyper-sensitivity.
Dr. Joel Evans: So what we’re talking about is a food intolerance, or non-IGE food sensitivity, and that’s primarily through IGG one through four as opposed to an IGE reaction. IGE reactions happen roughly 5% of the population as an IGE reaction. And roughly 3 to 5% will have these food intolerance-type reactions. That’s just based on literature through conventional allergy literature, but if we flip it and we look at what people are experiencing, a third of the US population feels that they have a…
Dr. Kara Fitzgerald: Conservatively.
Dr. Joel Evans: Exactly, and that’s from JAMA.
Dr. Kara Fitzgerald: Yes, that’s right.
Dr. Joel Evans: What happens is that when you throw in leaky gut or increased intestinal permeability, almost a hundred percent of patients who had an increase in intestinal permeability have a food reaction, and if we look at intestinal permeability as a continuum, even when people have a fully intact intestinal membrane so that there is zero leaky gut, 2% of food fragments, 2% of ingested food fragments, actually cross in an improper way and expose the immune system to undigested protein. So that’s why people have food sensitivities. So what happens is that our immune systems gets exposed to food particles that are too big, undigested and that’s not the food’s fault. What it is, it’s usually due to problems with digestive health. So, for example, not enough hydrochloric acid, or poor enzyme function, so that you’re presenting undigested food fragment further distal in the intestinal tract so that those cross, so it’s really the primary upstream cause of all of these food sensitivities is the amount of poorly digested food fragments that wash through or are propelled through the gut.
Therefore, when we’re talking about upstream treatments or root cause medicine for whatever the inflammation based on this is that we’re treating, yes, we have to identify the foods that are causing inflammation and eliminate them, but at the same time we have to do a 5R program to heal the gut so we’re not going to just keep this hamster wheel turning with different foods because we have to stop these undigested protein fragments from being exposed to the immune system.
So to answer your question about what happens, so the immune systems gets exposed to these protein fragments that are too large, or they’re exposed to lipopolysaccharides from bacterial cell membranes, for example, they can be exposed to fungi, whatever it is, and we create an antibody response.
Now, in the case of lipopolysaccharides, which are triggers of inflammation themselves, we create this antibody response to various antigenic molecules on this lipopolysaccharide, and sometimes just by pure random sequence, or random act, that these sequences are the same as on the surface of different foods. So by creating an antibody to a lipopolysaccharide, you create an antibody to a food and therefore, become sensitive to a food. That’s why, for example, we can see responses or reactions to foods that someone says they’ve never ate.
The funniest story is that I had a rabbi come in and he was sensitive to clams, and he said, “I’ve never had a clam, I’ve been kosher all my life. This is impossible. There’s a problem with your test. I want my money back.” The whole bet. And so then I explained this concept of molecular mimicry, and he was fine with that. But the piece that’s really, really funny is somebody came to me, another patient, and he said, same thing, “I’ve never eaten clams,” and I said, “Well, can I tell you a funny story, there was this rabbi that came in,” I went through that story and he goes, “Well, I’m glad you told me that story because I’m also a rabbi.”
Dr. Kara Fitzgerald: This is not funny, a rabbi walked into the doctor’s office…
Dr. Joel Evans: Exactly, exactly!
Dr. Kara Fitzgerald: Two rabbis walked into the doctor’s office.
Dr. Joel Evans: Exactly. Feel free to use that anytime because it’s been replicated. So anyway, so what happens is, so this antibody response gets triggered through IGG. Now, the complement system is a separate system but also very interrelated…
Dr. Kara Fitzgerald: Well, then I just want to point out that this is unique to KBMO and you moved away from the others just to back up the other tests because you were finding a lot of false positives and…
Dr. Joel Evans: The IGG alone wasn’t as accurate because you would get a lot of false positives. A lot of IGG can react to food and we don’t know the clinical significance of that.
Dr. Kara Fitzgerald: Yes. Yes, we do see that. Okay, so KBMO…
Dr. Joel Evans: Right, so KBMO. This is sort of a fine piece here but I think it’s important.
Dr. Kara Fitzgerald: It’s important, yeah.
Dr. Joel Evans: Is the type of complement that we’re talking about, which is the C3D form, or part of it, is that 30 years ago KBMO, or I should say KBMO owns the cell line responsible, the only FDA approved cell line for producing C3D. So because now the market place is understanding the importance of C3D, we may see other labs that come up with C3D testing, but ours is the only one that had the actual approval and certified accurate C3D molecule. So that’s an important test … I mean, that’s an important piece that practitioners need to understand.
So what happens with complement is complement is an enhancer for the immune system, basically what it does is it functions almost like one of these infrared target systems that the military uses to find military targets as you get somebody out there to shine a light so they know where to direct their weapons. So what complement does, specifically C3D, is it up-regulates the inflammatory response and helps the immune system know what to target. And so you have foreign invaders, or foods, that the C3D attaches to and then the immunoglobulin knows what to attach to and then you have the C3D attaching to the immunoglobulin and to the food and you get a complex, and that complex is most active in producing pro-inflammatory cytokines.
So by identifying the IGG molecules that are attached to C3D, you can identify the foods that cause the most amount of inflammation. So what they do is they put food in a plate and then they wash the patient’s blood over the plate and then they send a target to see what sticks, and what they look for is not just sending an IGG target because if a patient’s blood has an IGG molecule targeted to a food it’ll stick to that food, but they also have an anti-C3D target, and that has to be attached to the IGG. So they send a target for an anti-IGG, anti-C3D, complex. And if that lights up, that’s how you know they’re sensitive to the food. That’s the way they identify the foods that cause the most significant amount of inflammation and that’s why clinically, by eliminating those foods, patients have such dramatic responses.
Dr. Kara Fitzgerald: So what’s the background on how they figured it out? Are there basic science papers out there that support this mechanism?
Dr. Joel Evans: There are absolutely science papers that support that, and I will tell you that the paper itself cites a lot of other paper. So there’s an original paper on this and that is on Alternative Therapies in January and February of 2015, so it’s relatively recent, and it’s about the relevance of using C3D immunoglobulin G testing in clinical intervention. The first author is Damian Clarke, C-L-A-R-K-E, and there’s a whole list of references in that paper as well.
Dr. Kara Fitzgerald: They do. I was just reviewing it again, I’m familiar with that paper and there is a nice discussion generated there. If you need to refresh yourself on the complement cascade, they’ve reprinted it and outlines where C3D shows up.
Dr. Joel Evans: Right, and there’s a lot of references there, and as I said, the key piece here is that we’re the only lab that has a certified source of C3D.
Dr. Kara Fitzgerald: That’s really interesting. Okay, we will absolutely link to that reference in the show notes from Dr. Evan’s podcast. Well, talk to me about that paper, I mean it was a pretty interesting study.
Dr. Joel Evans: Yeah, yeah. I think that basically this was just to see if you could change levels by eliminating the food, so it really wasn’t much of what we do in practice, which is a 5R program, this was just purely a single intervention of eliminating the foods. So by eliminating the foods we were able to see that that changed over time, and so that is sort of the first step of saying yes, it’s good to test this, but we also know that by removing the source of inflammation, that you will then decrease the number of foods to which you’re sensitive and the foods that you aren’t sensitive to no longer create an inflammation response.
Dr. Kara Fitzgerald: And they tracked clinical outcome as well?
Dr. Joel Evans: Absolutely. Absolutely. So patients started feeling better. But I’ll tell you, what’s nice about this test is that it’s both tracking clinical outcome and then tracking the test.
What I’d say is a little bit of a weakness of this study is that this was lengthy, so this was 10 months.
Dr. Kara Fitzgerald: Right. That’s right.
Dr. Joel Evans: I don’t do that in practice.
Dr. Kara Fitzgerald: Yeah, an elimination diet for 10 months, even if it’s abridged elimination diet, is still an elimination diet for 10 months.
Dr. Joel Evans: Right. Yeah. No, no, so you can’t do that.
Now, I would say that I do it for 6 to 12 weeks, and so the thinking that I use is if you look at the half-life of IGG, it’s roughly three weeks, so if you want to reduce half the antibodies it’s three weeks of elimination. If you want to reduce three quarters, or another half, it would be two half-lives, and so on. So I like to go a minimum of two half-lives but I really like to go four half-lives, which is 12 weeks.
Dr. Kara Fitzgerald: Are you getting reasonable patient compliance for 12 weeks?
Dr. Joel Evans: Well, I do, but I’m able to get good compliance only because I see my patients at least once a month, and this is where my position as Director of Curriculum Development with the Functional Medicine Coaching Academy is helpful because in order to best practice functional medicine, coaches can be so important in this process. So it’s about looking at a list of foods, and I as the doctor can say, “Eliminate them all,” but then if they stayed with the coach and they say, “Coffee came up and I cannot give up my coffee,” it’s up to the coach to work with patients to come up with a strategy so that they will ultimately get to eliminating everything. The busy practitioner may not always have the chance to do that.
So the way my compliance has increases is through, number one, frequent visits, number two, the use of coaches so that patients can feel that what they’re about to do is doable and that it’s not overwhelming, because it can be overwhelming at times. When you look at the triad of gluten, dairy, and eggs, which is unfortunately very common, I call that the three-legged stool, avoiding gluten, dairy and eggs all at once really can be overwhelming. So it’s important to hold hands through that process, and then when you can do that, then they can see the positive changes and then it becomes a self-fulfilling way for them to see results and then they want to continue.
Dr. Kara Fitzgerald: There’s the top eight antigenic foods, I mean those are IGEs, wheat, dairy, soy, egg, as you mentioned those are commonly there, are you seeing often in your patients when you do their baseline report before they’ve ever done an elimination, these most common foods show up as often as we might expect to?
Dr. Joel Evans: I’d say it’s the gluten, dairy, egg for sure. I see a lot of curcumin, and we’re one of the few labs that test for curcumin, but I see a lot of curcumin sensitivity, and that I attribute to the fact that so many of our patients are taking curcumin supplements and have leaky gut.
Dr. Kara Fitzgerald: Interesting.
Dr. Joel Evans: That’s a really important thing to identify and then have them stop taking the curcumin, and the one I always get is, well, I thought that was good for you. I say, it’s good for most people, it’s just not good for you.
Dr. Kara Fitzgerald: Well, it’s not good for you right now, I mean…
Dr. Joel Evans: Exactly.
Dr. Kara Fitzgerald: Yeah. Okay, talk about that re-introduction.
Dr. Joel Evans: Yeah. So it’s really not good for you, and that’s only for now. It’s not good for you for now. Curcumin is something that when we heal the gut and eliminate the curcumin, it often doesn’t persist. Sometimes with gluten and dairy it can take more than three months to defeat the sensitivity, but most of the time 80 to 90% of the time you can eliminate a curcumin sensitivity in three months.
Dr. Kara Fitzgerald: Okay. Well, that is good to know. Yeah, that’s my clinical experience as well with regard to gluten and dairy, that they may be deal-breakers long-term or just the dose, the amount of exposure that they might be able to handle, is lowered.
I know you’ve got some cases you were going to talk about, but I want to know, as the external lead, as a significant player in the Hormone Module … By the way, I need to go to the Hormone Module again, we were just talking about modules. I saw you guys in one of their first iterations, when you were in New Orleans, and it was right after Mardi Gras, I mean there were still many drunk people, leftovers from the week before, but it was a…
Dr. Joel Evans: I remember. I remember walking around the sidewalk, stepping over people.
Dr. Kara Fitzgerald: Yeah, yeah, yeah. That’s right. I know it’s a not a commonly encountered happening, say, if you’re in Connecticut. Yeah, but it was a great module, and I definitely need to go because that was quite a while ago.
What’s the relationship between food sensitivities and hormone health? I mean, you’ve got to have a better understanding, a more sensitive understanding, than most of us.
Dr. Joel Evans: It’s such a simple explanation, and that is anything that stresses the body will cause hormone imbalance or hormone disequilibrium, and so one of the continued stressors can be eating foods to which we’re sensitive. A stressor can be being exposed to environmental toxins, a stressor can be emotional stress, all of these things create a stress on the body which then causes hormone imbalance, and specifically food sensitivity will drive inflammation, as we’ve spoken about multiple times, and will also cause adrenal stress, and food sensitivities can create autoimmune disease or make immune health an issue because you end up with molecular mimicry from foods that cross the intestinal lining. And instead of just having a food, or reacting to a food because you had a bacterial lipopolysaccharide that mimics the food, well now you can be attacking the thyroid, for example. So it can affect hormones in many ways, but the primary driver, the primary way, is by creating inflammation and inflammation affects the adrenals, the inflammation affects the thyroid and inflammation ultimately affects sex hormones and causes problems with sex hormone production, lowers testosterone production in men, creates issues with estrogen progesterone balance, leads to breast cancer, leads to fibroids, leads to endometriosis.
So when people come in with breast cancer, fibroids, or endometriosis, which people see as primarily hormone driven events, we talk about the role that food sensitivity can play, leading to inflammation, leading to increase prostaglandin E2, prostaglandin E2 directly drives the growth of endometriosis in fibroids, and inflammation directly drives breast cancer.
Dr. Kara Fitzgerald: Yeah, that’s right it does. Yeah. That’s a nice succinct explanation. So it’s fundamental in the root cause approach to all hormone imbalances, you say?
Dr. Joel Evans: Yeah.
Dr. Kara Fitzgerald: Yeah, yeah, hormone imbalances and beyond. Talk to me about some good cases in your practice where KBMO was a big decision maker for you, or a big help.
Dr. Joel Evans: I’d say that what’s interesting here is the different, what I would say clinical categories, that are so important here. So because my practice has transitioned from primarily women’s health to now every aspect of functional medicine where I’m treating men, I’m treating children, it’s just been…
Dr. Kara Fitzgerald: That’s really good to know.
Dr. Joel Evans: Yeah. Yeah.
Dr. Kara Fitzgerald: I hadn’t realized that.
Dr. Joel Evans: Yeah. It’s really been amazing how important this test has been and how now I would say almost every single patient that I see, every new patient, gets a sensitivity test. And what’s interesting is if we look at the women’s health aspect of it, we already touched upon fibroids, we touched open endometriosis, we’ve touched upon breast cancer, but what we didn’t touch upon would be miscarriage. So miscarriage is increased in a pro-inflammatory state and, as we said, one of the main causes of the inflammatory state are food sensitivities. When we talk about conception and a pre-conception visit, and optimizing pregnancy outcome, almost all pregnancy complications are made worse in the setting of inflammation. So if we want to reduce premature labor, if we want to reduce preeclampsia, we need to work on reducing inflammation. And again, what’s special about this test is it finds the foods that cause inflammation, so I used it in all of my preconception visits. This study, migraines, fatigue, inflammation, a major issue with fatigue, a major issue with mitochondrial disfunction and all issues for neurologic health, cognitive impairment, getting rid of inflammation … Depression we now know is inflammation in the brain, so people are coming in with depression or anxiety that has been refractory to other forms of treatment, and just by eliminating foods their mood is lifted. So it’s really been a wonderful intervention.
At this point if I had to pick one test, my most important single test in my practice, it would be this test because by identifying what I need to do to reduce inflammation in the body, that’s the homerun. I mean, think about it, people are eating three times a day, if they’re eating the wrong foods they’re creating an inflammatory response three times a day. Imagine how much better they’ll feel when they stop doing that.
Dr. Kara Fitzgerald: Yeah. Yeah. Yeah, it’s powerful. That’s a really important reminder in preconception, I think.
Dr. Joel Evans: Yeah.
Dr. Kara Fitzgerald: I mean, we’re all thinking about foods, but I appreciate how this might zero in on the heavy-lifters as far as inflammation goes.
Dr. Joel Evans: PCOS also is inflammation. I mean, every women’s health issue, every men’s health issue, cardiology, cardiovascular disease, inflammation based, right? So whatever my patient suffers from, they’ll improve by eliminating the foods that create inflammation.
Dr. Kara Fitzgerald: Well, thank you for this synopsis on KBMO and what prompted you to jump onboard as their Medical Director. Congratulations.
Dr. Joel Evans: Thank you, Kara. Can I add one more thing?
Dr. Kara Fitzgerald: Yes, you can. Absolutely. We’re not done yet, but yes.
Dr. Joel Evans: Good.
Dr. Kara Fitzgerald: I have another question for you too, but yes do add one more thing.
Dr. Joel Evans: I just wanted to talk to you about our clinical study which just came out.
Dr. Kara Fitzgerald: Yes. By all means. Please. That’s a big deal.
Dr. Joel Evans: That’s a huge deal because, and I just thought of this, so I just got this data yesterday and I just thought of the tagline already, which is that this study now takes this whole KBMO FIT test and it moves it from biologic plausibility to clinical efficacy. And in terms of laboratory testing, that’s the holy grail, not just biologic plausibility but clinical efficacy. So this was a test in patients with IBS, so they looked at 100 patients with IBS over three months, and what they did was they just did a general healthy eating plan in a control group, in the study group, they eliminated the foods that were positive on the FIT test … So there’s something called the IBS Symptom Severity Scale, and so all patients had a high score, the number greater than 175, which means that they were symptomatic enough, and of those 100 patients what we found was a significant decrease in score of over 125 points when they eliminated the foods from our test. The control group, which had just general nutritional counseling, had a drop of 46 points. That is a tremendous difference. If you look at food sensitivity data in IBS groups, for example the IGG alone, the best of those studies have 100 point decrease, so this is 26% better than the IGG alone. And most importantly, is we had a decrease of .47 of almost .5 in CRP, which is, as we all know, the marker of inflammation.
Dr. Kara Fitzgerald: That’s pretty interesting. Did you publish this yet?
Dr. Joel Evans: No, this just came back now from the study and now we’re going to write together and make the paper.
Dr. Kara Fitzgerald: Wow. That’s great. Did you stratify for type of IBS?
Dr. Joel Evans: No, it was randomized. Just referral from any healthcare practitioner, a patient with IBS that had a high score, and the reason we did that was because we wanted the effectiveness of this test to be studied with what people see, which is people that walk in the door. So I wanted the inclusion criteria to be as wide as possible, which is basically sick patients.
Now, when we go back and analyze this data and look for subgroups, we certainly may find in a certain subgroup that’s even more effective, for example.
Dr. Kara Fitzgerald: Right. That would be interesting to know. I mean, in a lot of our patients who have got IBS have SIBO, interesting to see if you can tease that out.
Dr. Joel Evans: But the most important part is when people walk into your office, either with a pre-existing diagnosis of IBS or you make a diagnosis of IBS, this test has value. That’s the question I wanted answered and that’s the question that was answered emphatically.
Dr. Kara Fitzgerald: All right. Well, I look forward to … We all look forward to the publication. Would you keep me in the loop so that I can pop it on your show notes and I have to read it myself?
Dr. Joel Evans: Yeah. Absolutely.
Dr. Kara Fitzgerald: Great. Yeah. So you also looked at CRP, did you look at any other…
Dr. Joel Evans: We looked at homocysteine, and homocysteine dropped as well. The other thing we looked at was office visits, which decreased over 50% for symptomatic office visits.
Dr. Kara Fitzgerald: How long was the study?
Dr. Joel Evans: Three months.
Dr. Kara Fitzgerald: Three months. Okay. Well, I know everybody will look forward to reading about it and I’m particularly curious about subgroups. I mean, could you use this instead of a FODMAP, or would you use it concurrently with the FOADMAP?
Dr. Joel Evans: Yeah, that’s a great question, they use this concurrently with the FODMAP.
Dr. Kara Fitzgerald: Okay. They didn’t in the study, however, they just did…
Dr. Joel Evans: Correct. Right, because this was about the most common denominator, least sophisticated practitioner and you only have one test.
Dr. Kara Fitzgerald: Yeah. Yeah. You just made an important comment that you use the KBMO and you’ll layer that into another therapeutic diet such as FODMAP.
Dr. Joel Evans: Yeah.
Dr. Kara Fitzgerald: Okay.
Dr. Joel Evans: I think that’s important because…
Dr. Kara Fitzgerald: Yes.
Dr. Joel Evans: Yeah. You don’t want to create more inflammation when you’ve already get SIBO.
Dr. Kara Fitzgerald: By continuing to consume FODMAPs?
Dr. Joel Evans: Correct. Or, by … No, you’re already doing a FODMAP elimination for the SIBO and then you don’t want to create more inflammation by eating a food that…
Dr. Kara Fitzgerald: Right, right, right, that’s positive on the FIT … Yeah, I got it. I got it. We do that routinely as well, look at FODMAP plus reactions.
Okay, so interesting. In the final few minutes I just want to pick your brain as a senior IFM-er and long-time integrative doc in our space, lots of people listening to this are clinicians transitioning into functional medicine. Can you just share with me some words of wisdom for these folks, some pearls from your experience for these folks making this amazing transition?
Dr. Joel Evans: Well, what I would say is don’t get discouraged and keep your eye on the prize you know that functional medicine is the right way to take care of your patients, and unfortunately it doesn’t quite fit in well with the existing healthcare system yet. There are a lot of very bright people trying to make functional medicine a better fit for insurance and the reimbursement processes, it’s just not there yet. Don’t lose sight of the prize. Your colleagues may not believe in you, you may get comments that you’re in this just for the money because you’re just selling supplements, it may mean spending more time, it may mean making less money, there are lots of reasons why one can easily be derailed and not continue on this path of practicing functional medicine.
So I would just say that it takes a long time to learn how to do this well, but if you keep to it you will get that level or achieve that level of expertise. Your patients are going to start getting better quicker, they will not only thank you but love you for it, you will get that internal reward from practicing medicine authentically because most of us are changing our practice to functional medicine because we know that conventional medicine doesn’t approach things in the right way. And so you’ll get that inner reward as well for practicing in an authentic way and reconnecting with why you went into medicine in the first place.
Dr. Kara Fitzgerald: Right. Amen. Thanks for that. Well, Dr. Evans, it’s just been a delight to reconnect with you and talk to you about your journey and your work with KBMO.
Dr. Joel Evans: Well, thank you. Thank you so much for having me and I want to congratulate all of your listeners for spending their free time to learn about functional medicine.