Navigating IgG elimination diets

Undertaking a food sensitivity test with your patients requires careful support and specific knowledge. It takes time to plan and up to 6 months for your patient to fully benefit. The first 3 months should be used for the initial elimination elevated foods in their diet.

Elimination, Reintroduction and Symptom Monitoring

After 3 months, and only when symptoms have subsided, elevated foods can then be reintroduced into the diet. This should be a gradual and process and will require support and careful planning. Please refer to the detailed instructions in the Patient Guidebook for more information.

The reintroduction phase is when your patient’s new tolerance threshold to those excluded foods is tested, which will form their future diet. For example, after 3 months of cow’s milk elimination and resolution of symptoms, how much dairy can now be tolerated?

The gold standard of a food sensitivity test is the exclusion of foods to achieve symptom improvement, followed by gradual reintroduction and subsequent symptom monitoring to identify tolerance levels. Following this method, individual foods can be directly related to symptoms and the patient will gain knowledge of their tolerance threshold to each food.

When reintroducing foods, you should advise your patients to start with the elevated food with the lowest antibody concentration (least elevated). Each food is listed in a report alongside its corresponding antibody concentration, expressed in U/ml. We suggest that one portion per day is eaten for 5 days. Introduce one food at a time and monitor symptoms over the 5-day period. If symptoms return, this food is still likely to be a problem so revert to the elimination diet for a further 1-2 months before a second reintroduction challenge. Allow time for symptoms from each food to subside, perhaps 5 days, before reintroducing another food.

Example Food Reintroduction Diary

Elevated foods on a report may always be problematic, but following the reintroduction period, your patient will have a new understanding of their tolerance thresholds and food sensitivity reactions may be kept to a manageable level. We encourage a wide variety of foods to be kept in the diet, but some foods may need to be eaten less often, in reduced amounts, and rotated in diet. This keeps the diet diverse and encourages a balanced gut microbiome to further support optimal health. 

Selecting which foods to eliminate will depend on several factors. These may include your assessment of your patient’s ability and motivation to make changes, and of their individual compliance levels.   

You may suggest that your patient removes the top six most elevated foods if they have many elevated foods within their report. If several of these top foods are within the same food group, for example eggs and dairy, this may pose a challenge for your client to undertake and therefore you may wish to only eliminate three of the most elevated foods initially.

Consultation Direction

Patients with severe symptoms may wish to eliminate all elevated and borderline foods. Navigate this scenario with caution as the diet may become unnecessarily restricted, and it is not recommended. Focus on those foods that your patient is eating most regularly that are stimulating the highest U/ml response. These foods will be the main symptom culprits. 

All other foods not chosen for elimination in the elevated section, plus those in the borderline section, should be rotated and eaten only twice per week. Rotation supports diet diversity, a healthy gut microbiome, and a reduction in IgG antibody stimulation. Focus on encouraging plenty of foods in the normal section of a report.

We recommend, irrespective of the results of an IgG food sensitivity test, that any foods the patient knows or suspects may be responsible for inducing symptoms should also be avoided. This includes any IgE allergies for which FoodPrint® or Food Detective® does not test, and food intolerances.  

Our Food Sensitivity Tests

FoodPrint® and Food Detective® test for immune-mediated responses to foods only. The production of IgG antibodies is the immune system’s natural ‘testing’ response to any potentially harmful proteins entering the body. These may derive from poorly digested foods, or from viruses, bacteria, toxins, yeasts and other chemicals and microorganisms that have ‘leaked’ through a damaged epithelial gut barrier, or that have been inhaled or gained access through the skin.

Understanding Immune Responses

To underline an important distinction, IgG food sensitivities sit under the umbrella of immune-mediated reactions and are delayed responses denoted as type III allergies. 

IgE allergies, also known as ‘true’ allergies, involve the production of IgE antibodies which stimulate mast cells to produce mediators, such as histamine. IgE allergic reactions are immediate and result in symptoms such as tightness of airways, swelling, pain, skin wheals and rashes, gut symptoms such as vomiting and diarrhoea, and are potentially life-threatening. If an allergic reaction to food is suspected, immediate medical attention should be sought. 

IgG allergies are not life-threatening. They may be a potential cause of inflammation as they attach to food proteins which, if not broken down easily, build up to form immune complexes that lodge in tissues and are a potential cause of inflammation. 

All other reactions to foods which do not involve the immune system are non-immune food intolerances. Food intolerances can be caused by reactions to certain chemicals or additives found in foods, or due to enzyme deficiencies, such as lactase.

A food may stimulate both an immune and a non-immune response. For example, a patient may have a casein sensitivity and be lactose intolerant.

Foods that show as elevated on a patient’s report may always be problematic if eaten too frequently or in too high a quantity where tolerance thresholds are breached.

Retesting and Ongoing Patient Support

Patients may be keen to retest after a few months, expecting their reports to reflect their symptom improvement. We do not recommend retesting before 9 months. This ensures there has been sufficient time for the successful breakdown and clearance of immune complexes following the removal of foods, estimated to take a minimum of 6 months. This timeframe also allows for the systematic reintroduction of foods, monitoring of symptoms and for new tolerance thresholds to be understood. Limiting consumption of these foods, perhaps strategically reducing to twice per week only, will avoid a significant build-up of antibodies and immune complexes. If retesting is performed too soon IgG levels will not have changed significantly. 

Testing provides the perfect opportunity to discuss the link between the number of foods elevated on a report and intestinal permeability, and the role of stress disrupting gut function. Testing may provoke discussions about the cross-reactive potential between foods, particularly within a food group, as these show up frequently on a report. Testing creates a unique opportunity to work on a positive and targeted meal plan with your patient, based on the wide variety of normal foods listed on their report.  An elimination diet should not be viewed as restrictive, as it only involves the temporary removal of a few foods with alternatives offered. It provides the opportunity to experiment with menu ideas and explore a wider selection of foods based on those that do not provoke an immune response. 

Symptom tolerance is the aim of the elimination programme. This allows patients to manage their tolerance threshold and symptoms for the future and adapt their diet and lifestyle accordingly.