I have a patient wanting to do an ELISA test for various health problems. She had a case of EBV infection last year, lost her voice, and had no energy. She worked with a nutritionist in San Diego and started the GAPS Diet. She is feeling better overall, but still reacts to almost everything food-wise. She had an organic acids test, which showed yeast overgrowth. I told her we probably need to focus on the gut first, but she wants to proceed with an ELISA test to help her avoid foods that could be setting her off. Any suggestions when you get a patient with lots of pre-knowledge on the subject?

Dr. Amy Nett: There’s so much out there to read, and as we all know, medicine is much more an art and a practice than it really is a firm science because there are certainly a lot of opinions. When patients come to our practice, they often have read a lot. We have sometimes a pretty long wait list for new patients to get in, so they’ve sometimes scoured the internet and found some pretty interesting resources and have some pretty interesting ideas. I think it’s worth providing as much education as you can, and that may be providing additional resources, or it may be just taking the time to talk with her. What is she looking for with the ELISA? I think if she wants to do a food sensitivity test, that’s fine, but Chris did the podcast on the different types of food sensitivity testing, so it may be helpful to point her in that direction so that she would understand why you would recommend the Cyrex food testing.

If she’s already gluten free, you could run Cyrex Array 4 and Cyrex Array 10, and if that helps her tweak her diet to something that’s more tolerable for her, that would be an option, but maybe just explain to her why you feel ELISAs are a little bit less reliable and maybe not as validated, and provide her the resources. Patients want to be conscientious about where their time, energy, and money are going, so I think if you explain why you think she’s going to get a lot more benefit from other types of testing, that can be helpful. In general, it’s really just about education and why you’re making the recommendations you are and the choices you are. That can go a long way.

It sounds like she’s already doing GAPS. It’s interesting that she’s still reacting to things, so I would be curious what she’s still reacting to. I don’t know if she started on Intro GAPS, but if she’s doing regular GAPS, she might go to an Intro GAPS Diet and see if that’s even a little bit more soothing for her.

Hopefully she’ll agree, and you know, when it comes down to it, if patients feel really strongly about doing a test, I often just share with them my concerns about the validity of those test results, but if it’s important to them, then I’m generally OK with that and we can go forward with that test.