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  4. Received some differing information about when to order Cyrex panel and told by a few physicians that it’s good idea to run a total antibody test before running Cyrex panels. If they’re not creating enough antibodies, then the Cyrex test will show false negatives and be a waste of money. Do you do this? If vitamin D levels are low same thing can happen, is that true? Can you clarify, and do you run these arrays after Paleo reset as this would be 30 days without the wheat, dairy, etc., so antibody shows up? Your web information says it may be within 25 to 30 days. Client who has presented with what may be herpes dermatitis. He’s gone on the 30-day reset. Without the gluten, his skin is clearing up. Should he do Arrays 3 and 4 but don’t want to initiate skin outbreak again if he eats some wheat or gluten for test purposes.

Received some differing information about when to order Cyrex panel and told by a few physicians that it’s good idea to run a total antibody test before running Cyrex panels. If they’re not creating enough antibodies, then the Cyrex test will show false negatives and be a waste of money. Do you do this? If vitamin D levels are low same thing can happen, is that true? Can you clarify, and do you run these arrays after Paleo reset as this would be 30 days without the wheat, dairy, etc., so antibody shows up? Your web information says it may be within 25 to 30 days. Client who has presented with what may be herpes dermatitis. He’s gone on the 30-day reset. Without the gluten, his skin is clearing up. Should he do Arrays 3 and 4 but don’t want to initiate skin outbreak again if he eats some wheat or gluten for test purposes.

Chris Kresser:  Okay. All good questions. Let’s start with the first one. It is true that if the patient is low in antibody production, there will be a false negative on Cyrex, but those patients are definitely in the minority in my experience, maybe 5 percent or less. It just depends on how thorough you want to be and how you prioritize in terms of casting a wide net and spending a lot of money on testing upfront or doing that if necessary. We’ll be talking about this as we go through the course, but if you prioritize gathering information and money’s no object, there’s a ton of tests we could run right up front during the case review process that would be really useful. If money and time aren’t an object or aren’t a consideration and the patient’s not going to be overwhelmed by that many tests, then there’s nothing wrong with that. But in my experience, there is a limit to how much money patients will spend initially for most of them, and there’s also a limit to just how many tests someone wants to do in a short period of time. There’s also a limit to how many things you can address as a clinician all at once. In most cases, we have to decide how to structure and layer the testing and the treatment in a way that makes the most sense. It’s not just about information. It’s about process and not just the information that we give patients in terms of what we want them to change, but how we actually support them on those changes. We’re going to be talking about that in this course and also in future trainings that I offer that go into a lot more detail on how to support patients in behavior, lifestyle, and diet change. That’s kind of a personal preference. Here’s how we do it. If we have need of Cyrex test, and we really suggest the patient is reacting despite those negative tests, then we’ll go ahead and do a total IgG, IgA, IgM, and IgE antibody screen. If they’re really low on those, then the testing is not going to be helpful anyway, so you just have to start doing more of elimination provocation. I wouldn’t necessarily—I mean, you could argue then that testing was a waste of money, and you would have saved that patient money, but the other 95 percent of cases, it’s not a waste. It’s not perfect, and I don’t think there’s a way of making it perfect. Low vitamin D levels, the argument there is vitamin D promotes T regulatory cell function and then support the immune system. If D is low, the idea is that they may not be producing antibodies adequately and, therefore, may have a false negative. There is some truth to that as well, although I haven’t seen specific research on that connection with IgA and IgA antibodies that are related to food intolerance testing. In terms of the timing of when to do the test, I think we discussed this in the curriculum. We typically don’t do the Cyrex testing upfront because if you’re going to talk about the testing is a waste of money, I think where it’s more of a waste is if we’re going to tell the patient to do a 30-day reset anyways and see what happens, which I definitely recommend in doing. The gluten intolerance and cross-reactive protein and other protein intolerance testing up front may not make that much sense because if they remove those foods and they feel better, especially if they’re comfortable keeping those foods out of their diet, then doing that testing right up front is probably not the best timing. Waiting until they’re ready and want to start reintroducing some of those foods if they do and after they’ve done that for a while and if they start to experience reactions again, then that’s when they will typically do that testing.

 

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