May 04 2010
Last week I wrote about the CME presentations at an obesity course put on by the American Society of Bariatric Physicians. I saved the most controversial one for last. Dr. Kendall Gerdes is a former president of the American Academy of Environmental Medicine, which I have previously written about. The AAEM is not recognized by the American Board of Medical Specialties and is categorized by Quackwatch as a questionable organization. Dr. Gerdes spoke on food allergies and food addiction.
I wasn’t convinced: I thought much of what he said was questionable. I thought, as a challenge for our readers, it might be an interesting exercise to present his information without comment and let readers look for flaws and form their own opinions. At the end, I’ll offer some suggestions of things to think about.
He described the concept of food addiction as a powerful tool to free patients from compulsive eating. Patients may “have the experience of” being addicted to foods or have symptoms of hunger and of just not feeling well. Specific symptoms of food addiction include fatigue, fibromyalgia, GI symptoms, cardiac arrhythmias, asthma, rhinitis, arthritis and seizures. There is no “gold standard” way to diagnose food allergies. He relies mainly on avoidance and challenge.
Heroin Addiction: A Model for Foods
- As long as the junkie gets the “right dose” at the “right time,” he has no symptoms.
- If too small a dose, or too long an interval, will get withdrawal symptoms.
- Over time, the interval shortens and the needed dose increases.
- If the junkie is having withdrawal symptoms, the “right” dose gives immediate relief.
- After heroin is out of the system, a previously tolerated dose will now cause symptoms.
- Symptoms for food addicted patients follow the same pattern. The addictive food seems “good for me” and makes them feel better.
He says that research shows that partial digestion products of milk, wheat, soy and other proteins bind to brain endorphin receptors.
- Trouble with weight.
- Possibly otherwise no complaints.
- Subtle symptoms may be multiple.
- Key feature is variability (random or same time every day)
- Will not know they are addicted.
- Symptoms come when they have not had the food.
- “Favorite” food seems to relieve symptoms
Foods to Suspect
- “Recent” foods (since agriculture) like grains and milk products
- Foods heavily used in our society (coffee, chocolate, soy)
- Foods where patient had allergy as a child that was “outgrown.”
- Examine diet diary looking for heavy reliance on a few foods used 2-3 times a day.
- Watch for multiple forms (milk, cheese, yogurt, ice cream)
- Foods related to known food allergen
- Foods family members don’t tolerate.
Elimination and Challenge
- Avoid all suspect foods for 7-10 days
- If all addictive foods are removed, patient feels better
- Watch for withdrawal symptoms
- If no withdrawal symptoms and/or patient not better
- Check for adherence to elimination diet
- Check what foods were used to replace suspect foods
- Challenge after 7-30 days avoidance
- If a challenge makes symptoms recur, patient is easily convinced
- Easily missed food reactions:
- “I really feel wonderful” from initial stimulation, followed hours later by “downer.”
- “Gee, I’m thirsty” – reactions dump fluid into tissues
- “Same old, same old” – symptoms are so familiar, patient doesn’t recognize that they * came after a time of no or low symptoms
- List all symptoms, even if you don’t think they’re due to the food challenge
He offers elaborate rules for grading severity of reactions and deciding how soon to re-challenge.
Avoiding the “Next” Addiction
- Remember patient has an addictive pattern
- Limit members of the same food family
- Avoid daily use of any food
- Watch out for foods patient “loves”
- Develop a list of food options such as quinoa, amaranth, parsnips, jicama, lichi nuts, cuttlefish, taro, nuts like pine, filberts, macadamia, etc.
There were a number of slides in the syllabus that the speaker didn’t get to. They indicated that he believes in “the yeast connection.” Lab tests are unreliable, so he makes the diagnosis with a clinical trial of a low-yeast, no sugar diet followed by challenges with foods that he thinks promote yeast growth in the body (milk, wheat, beer, mushrooms, fruit, sugar, etc.) He treats “yeast overgrowth” symptoms with elaborate and very restrictive “low-yeast” diet rules and anti-yeast medications like Nystatin and Amphotericin.
Try It, You’ll Like It
In a private conversation before his talk, Dr. Gerdes told me how he spends an hour with each patient and feels that the benefits justify the extra money he has to charge them. He mentioned one patient who was very grateful and insisted he had helped her when he hadn’t really done anything but listen to her. In his talk, he advised audience members to do their own elimination diet. If you have a positive reaction, you will be better able to see addictions in patients as well as ridding yourself of bothersome symptoms.
Instead of a Conclusion, Food for Thought
I invite readers to examine this material and form their own conclusions. Consider psychological factors, placebo/nocebo responses, confirmation bias, possible confounding factors, the meaning of “allergy” and “addiction,” what we know about physiology, the lack of blinding in elimination/challenge trials, the unreliability of “in my experience” recommendations, and the possibility that inadvertent collusion between patient and doctor might lead to deceptive conclusions. Can you spot any logical fallacies? Is the food addiction hypothesis a falsifiable one? How could it be properly tested? I look forward to an interesting discussion in the comments.
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