Amy Nett: Yes, I would. There’s a little more to this question, but I would say basically, I would start thinking about what is a patient eating because remember secretory IgA is the main immunoglobulin within all of our secretions—tears, saliva, and mucus in GI tract. This is just telling me that the patient is reacting to something. Ask about diet. Is this patient gluten-free? Are they eating a common allergen—dairy, corn, something like that? If not, do you want to think about doing a Cyrex panel for food sensitivities see if there’s a high IgA for one of the foods that they’re eating? Also, one of the most common causes of a low secretory IgA is chronic stress. I tend to think the way I conceptualize that is, if we have acute stress, our immune system might sort of rev up a little bit rate. We’re looking to deal with something, if you have some stress about what a food would be but your immune system is going to be revved up kind of before it goes to that low secretory IgA. Most often I would be looking for food triggers. Is there something else in the environment that’s causing that? I haven’t seen any studies that I can think of that correlate HPA axis with secretory IgA, but definitely look into that. What’s the patient doing for stress management? Could that be a piece?
Going on to your question here, Erika says, “The patient is a 37-year-old female, wanting food sensitivity testing, but her diet is incredibly narrow since childhood. Many foods caused her to be violently ill with vomiting. She eats mainly a “white diet” with grains and dairy.” There you go. I would wonder about it then.
“She wants to be able to expand her diet. Interestingly, she’s not my sickest patient, decent but not optimal energy. She wants to eat more veggies. Would you simply treat the Candida and support gut flora? Would you suggest further testing? I hesitate to test her for gluten and dairy issues.”
You have to. You absolutely have to test her for gluten and dairy issues. I know she’s already on a limited diet, but you’re going to have to get creative. I don’t know if she’s tried SCD or GAPS. If it feels a little bit outside of your realm of comfort, would it be worth having her work with a nutritionist or a registered dietitian? But if gluten is causing some of this, it needs to come out of her diet.
“She also avoids meat for the most part. It isn’t for environmental health reasons, more of a visceral reaction to eating animals.”
Yes, unfortunately, step 1 and 2 is gluten and dairy testing, and then if those are limiting, looking for other foods. It’s tricky and I have patients who can eat four things, and so I totally get the struggle. Also, have her consider looking at something like DNRS, the dynamic neural retraining system. I’m guessing she’s had some sort of limbic system injury by now and her body/immune system/nervous system is taking sort of a hypervigilant approach. I think you need to come at this problem both from our more traditional approach, but again also look at something like dynamic neural retraining, maybe qigong, The Gupta Programme, something like that to help her nervous system/immune system/inflammatory response calm down.