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• You mention chemotherapy, corticosteroids and antibiotics being risk factors for leaky gut. I work with cancer patients, and it's not atypical for them to have all three of these. Is there research or evidence connecting risk of leaky gut for cancer patients?
  
  • There is some research, especially if they have radiation going on to the stomach area there will be some damage in the gut. I have had a post-cancer patient and he had radiation to abdomen for prostate cancer and ever since he had chronic diarrhea along with some accidents. He hasn't had accidents since doing food sensitivity testing. There is some dysbiosis with cancer patients so this can help after their treatment is complete.
• What is the minimum age for MRT testing?
  • I've tested as young as 18 months. There have been other practitioners who have tested as young as 9 months
• For RDs I thought food intolerance testing, including MRT, is not evidenced based practice and as such is not advised from both AND and the leading American Allergy org?
  • There is controversy there. It is evidence-based and there are several research articles that connects oral food intolerance with something happening in the body. Don't know the complete story with AND; too much history and politics involved.
• Have you ever heard of food sensitivity leading to a esophagus spams (smooth muscle)?
  • Yes, there have been quite a few people who suffer from EOE or esophagus-type issues. Go through MRT protocol and they feel enough resolved that their quality of life is improved.
• Do you suspect the BT-protein in corn to be the sensitivity? How do you address corn sensitivities with your clients?
  • I have no idea what it is in corn. I know corn sensitivities in my own practice have been on the rise. I have huge list of corn-derived products, but not an all-encompassing list. Look at everything like lipsticks, chapsticks, or toothpaste, etc. If real reactive to corn I look at things you put on your skin since what you put on your skin can be absorbed in your bloodstream and cells can react to that. I have a big list of corn-derived products that I share and have them review because it's not just foods we eat but it can be products as well.
• How much does an average MRT test cost for a client? Are any of these tests covered by insurance?
  • Practitioner pricing is around $350 for the kit if you go through someone certified through Oxford. The test itself does not run through insurance; all out of pocket
• If someone was told they were “allergic” to a food (such as shellfish) as a child and now as a youth/young adult is able to eat it without issues, was it an allergy or intolerance or sensitivity?
  • If it's done with allergy skin prick testing, that is a true IgE response so that's an allergy response. As kids grow, their immune systems can change. I don't know how that all works because I'm not all allergist but yes, you can outgrow an allergy.
• Do you have a resource to share with providers to educate them about the difference between the MRT and an IgG mediated food sensitivity test?
  • Infographic on social media @liveeatperformnutrition. There is also a good article written that goes through everything in detail: https://www.functionalnutritionanswers.com/what-is-the-best-food-sensitivity-test/
• Are your clients also eliminating processed foods, sugars, fried foods as well as the yellow or red foods? Could there be confounding factors with that and your results?
  • Yes, all processed foods. No confounding factors with results because they are eliminating/removing all of their reactive foods with MRT which is basically all processed foods.
• Can you also speak a bit to how the dietitian can navigate the "remove" phase for athletes struggling with an eating disorder in a way that is not triggering and/or encourages further restriction?
  • I don't do this with people with active eating disorders or disordered eating patterns. I want them to figure that out first because this can exacerbate restriction and can feed into restrictive habits. I tell clients, "I don't think this is for you right now. I think we need to work on the eating disorder issues first before we can assess any food sensitivities."
• Also, do you find that many athletes are open to trying this elimination diet? It seems to be very time consuming for individuals who are already busy with school, training, etc and have limited cooking skills/accessibility to resources. What is your client base demographic?
  
  • Yes, they are usually open to it if they are suffering enough. It can be time consuming if they are eating at a training table. At Nebraska, everything was cooked on site so I could work with them but it would be hard if they are limited financially. If I know that then we will just avoid the highest reactive stuff knowing that it might not help everything but it will help them enough to feel better. Client demographic: I don't work with near as many athletes as I used to but I see a lot of gut health issues. I do get clients who know its a food sensitivity issue; they find you and we work together and they feel better. I see anyone from 18 mos. old to 75-80 years old
• What resources and / or reading materials would you recommend to get more familiar with functional nutrition and understanding food sensitivities?
  • Start with Oxford Biomedical Technologies https://www.nowleap.com. There are different programs you can go through. I've done SIBO Academy, both their SIBO stuff and GI/Gut Program. There's also the Integrative and Functional Nutrition Academy (IFNA). There's also Susan Allen-Evenson's program. There are different programs you can look into for that.
    
• Do you use any software to facilitate back and forth with clients/patients?
  • I have a BAA with my Google business so I use Google Sheets. No EMR or anything yet.
• Is it not difficult to meet the macros and micros if the LEAP phases coincide with in season phase of athletes?
  • It depends on what foods they have available with their program. If it is athlete I'm going to make sure they have 2-3 different carb sources so we can meet their carb needs, especially if they are in a high-training phase. I try not to implement this if they are in a high-training/in-season phase.
• Can people develop new food intolerances throughout their lifetime and/or have former food intolerances disappear? Why does this occur?
  • We want to distinguish between intolerance and sensitivity but I have had a couple clients do the testing more than once about 3-4 years apart. The only reason they developed new sensitivities is because their gut became compromised again. Both of them went through very stressful times and then got sick with antibiotics so their gut became compromised and they developed more food sensitivities.
• I've been taught that "leaky gut" is not a valid diagnosis and the pathophysiology discussed is not quite accurate...any feedback on this?
  • No, I've just shared what I've learned with my resources. Leaky gut is not an ICD-10 code diagnosis at all. There are indicators; you can't just do one test and say you have leaky gut but you assess different indicators and biomarkers. I do the GI comprehensive stool panel test and there are certain things in there you can look for that can point towards more of a leaky gut issue.
• Pelvic floor PT here. I’d be curious to know what was removed from their diets and whether it was a true sensitivity to a certain food or if it was in fact a bladder irritant that was removed (caffeine, carbonation, etc). Did they change anything else in their life? Increase strength training? More time to heal postpartum. The reason for their decrease in urinary incontinence may be multi factorial and not contributed to a food sensitivity elimination only.
  • She had only changed her diet. She wasn't doing any pelvic floor strengthening exercises or anything. Her youngest child was about 6 years old so the only thing she did was the MRT test, that's it.
• Are your clients able to tolerate all these problematic foods after a period of abstinence? Or only some of these foods. Are there some foods they will never be able to tolerate?
  • Yes, a lot are to tolerate them again. I wouldn't say they won't tolerate them ever again. I couldn't tolerate wheat for 5-6 years and then after I had my first kid something changed in my gut and I could eat it again. So some people might have one thing that bothers them for a long time and others don't.
• Is it possible to have a positive skin prick test reaction due to highly sensitive/reactive skin, but in actual effect NOT be allergic to the food
  • That is a good question for an allergist.
• What are your thoughts on this type of testing and it’s subsequent eating patterns being linked to the promotion of disordered eating?
  • I could see where it could be linked to promoting disordered eating but I think it's how you handle it with your clients and how you encourage them. I think most learn after reintroducing foods that they can physically feel the difference. I haven't had anyone go through this with me and then develop a disordered eating pattern. If they have a history then I usually don't do this with them and we try a different route or I'm more hypervigilant with their process.
• For clarity, these modulators are measuring stress responses (or presence of inflammation)…isn’t inflammation considered normal to some degree. Exercise is an example of necessary inflammation. How do we differentiate good/bad inflammation?
  • I think it's bad if its causing a whole bunch of symptoms - if there's joint pain, extra fatigue, or brain fog and things like that. We do know that over-exercising/over-training does cause "bad" inflammation rather than "good" inflammation. So its kind of the same principle.