Gastroenterologists’ Stance on Alternative Testing (IgG Food Antigens, Salivary IgA, Intestinal Permeability, etc.)

The duck-rabbit, made famous by Wittgenstein

Quack? (Photo credit: Wikipedia)

Do you have irritable bowel syndrome or some other GI related issues?  Have you had some alternative tests ordered?  Maybe you’re considering alternative tests?  Have you ever wondered if they are legitimate tests?  As I’m reviewing my short chain fatty acid results and the research about short chain fatty acids, I came across this fairly recent article and statement from some doctors submitting to The Journal of Gastroenterology and Hepatology.  They looked at the analytical and clinical validity, clinical utility and ethical implications for some alternative tests, specifically:

  • Serum immunoglobulin G (IgG) to food antigens,
  • Salivary IgA,
  • Intestinal permeability,
  • Fecal short-chain fatty acids, and
  • Fecal microbial analysis.

Their conclusion on the ethics of these tests:

“It is the opinion of the authors that for a test to be viewed as ethically sound it must confer benefit and not do harm to the patient. As the rationale, validity and reliability of all of the investigations are questionable, the benefit to the patient is hence not readily apparent. Moreover as the investigations cost the patient money, the potential to do harm (in a fiscal sense) is apparent.”

Their conclusion overall regarding these tests:

“…None of the investigations examined by the authors can be recommended for routine clinical practice. Not only are the scientific underpinnings for the individual investigations questionable (the validity and rationale for testing), but the reliability of the individual assays are poor. Clinical decisions made on the basis of the test results are not evidence-based. Alternative investigations for IBS should for now be limited to the research laboratory.”

My take:  The more I know, the less I understand. (What?  Seriously?  You wanted me to come over to the “Dark Side” that easily?  I’ll bet you wanted a ranting and a raving. “Those doctors are wrong and arrogant.”  At least a strong opinion either way.  “These lab tests are a waste of time, money–and they manipulate naïve, desperate patients.”  Sorry.  Life doesn’t and ought not work that way.  Most of the time.  I’ll keep to my middle-ground today, with a caution to proceed carefully, not spend more than you have, and not to expect too much.  I’ve taken the microbial test and short chain fatty acid test.  They didn’t rock my world or fix my problem.  As clues, they may prove helpful eventually.  But by then, I and other medical doctors could just call it a chance improvement.)

Closing and Important Disclaimer:

Don’t neglect your health.  Make sure you’ve been evaluated by a doctor for your health concerns.  This blog is not intended for self-treatment or self-diagnosis.  It is intended to share the story of a mainstream medical doctor coming to terms with nutrition and alternative health, now that she has time to research some of it.

Source:
Hamish Philpott, Sanjay Nandurkar, John Lubel, and Peter R Gibson.  Alternative Investigations for irritable bowel syndrome.  Journal of Gastroenterology and Hepatology.  2013.  Jan; 28(1): 73-77.

8 thoughts on “Gastroenterologists’ Stance on Alternative Testing (IgG Food Antigens, Salivary IgA, Intestinal Permeability, etc.)

    1. thehomeschoolingdoctor Post author

      Two of them in our house! But honestly, it wasn’t until we intensively changed our eating that with such great health results that we realized we had to think outside the box. Thanks for your comment!

      Reply
      1. thehomeschoolingdoctor Post author

        Man! Some of these are so expensive! Perhaps in a few years I can say if they provided a true advantage. If a clue turns into a break. Or more likely, 7 clues lead to a break. Or actually, probably, yeah, no break. 😦

  1. Mary

    What lab tests would you consider the best for judging/measuring inflammation and/or reactions when reintroducing lectin containing foods? IL-6? IgE?

    Reply
    1. thehomeschoolingdoctor Post author

      Dear Mary,

      Hello! In my humble and non-clinical opinion, it just seems that in the case of food sensitivities/intolerances (I’m not talking true food allergies! What I’m about to say does not hold true food allergies involving IgE reactions! Can’t emphasize that enough!) that personal experience is the main indicator of issues. IgE wouldn’t be valuable. Many (even most probably) people don’t have IgE reactions underlying their sensitivites/intolerances. Many are cellular, innate reactions rather than antibody mediated–and thus don’t produce IgE. So I wouldn’t go for IgE.

      IL-6, hmmm. I don’t practice anymore, but I guess that’s just not a test I ever ordered. Upon searching, it’s not a commonly ordered test. I see why that could be ordered. I just don’t see much to guide actually checking it in re-introduction. Do you have something you’ve seen that would make you lean towards this? Something I could peruse for you and try to interpret? If so, I’d love and be willing to learn more!

      Definitely, if you chose this route, then a baseline test would be very valuable and important.

      Best wishes for success in your endeavors.

      Sincerely,

      Terri

      Reply
      1. Mary

        I know the gold standard is to see how you feel/react during reintroduction, but my grandson gets so anxious when reintroducing and or introducing a new food that it is almost impossible to tell. He drives himself crazy, and usually gives up on the food. The placebo effect is unreal. I wish there were some type of clinical number I could show him to say “it’s not the blueberries, it’s just in your head”. The mind is so darn powerful. Thanks for your time,

      2. thehomeschoolingdoctor Post author

        I agree with you! It would be nice to have a test. And if it helps you feel any better, we feel the same things here. We have a person in our home with eosinophilic esophagitis, which science strongly links to food sensitivities (Gasp! Yes! One disease they actually admit is due to food!). But food allergy testing is not helpful in this disorder much because it’s not usually systemic IgE mediated. So it comes down to elimination/re-introduction of suspected foods. We’re pretty (really) sure it’s dairy. But would goat cheese be okay? Or sheep? Or properly fermented cow’s milk yogurt? Is it worth the chance? Well, this person thinks so and tries goat cheese. Then doesn’t get full-out symptoms, but was that a little, mild burning sensation? Or was it in this person’s head? I offer reassurance and say let’s just take this slow! A little here. A little there. Overdoing it one day. And eventually, you’ll know for sure.

        Food re-introduction is a bear because we want an answer TODAY about whether we do or do not tolerate something! TODAY! 🙂 We want an absolute answer. Sometimes the nutrition is worth mild responses. Sometimes it’s not. Such a balance. And yes, the mind is so darn powerful. Check! And helping other people see and maneuver that is hard. Heck, even when you know it, the mind still plays tricks!

        Slow and steady. Except when it’s fast. Life. Food. Health.

        Sometimes, it’s good to read about hormesis and think about how it applies to the food we eat and our food reactions. That might be something to think about and discuss.

        Terri

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