Right Testing, At The Right Time

Lori Esarey: Wellness is a practice, not just a word. 

Kelly Engelmann: Welcome to the Synergee Podcast, where myself, Kelly Engelmann and Lori Esery shed light on powerful tools and topics that nourish your body, 

Lori Esarey: and most importantly, feed your soul.

Welcome, Synergee Podcast listeners. We are so excited to be with you today. Kelly and I are just gonna have a casual conversation about a common topic that many of our patients come to our clinics about, and we’re hoping to maybe dispel some myths and maybe answer some questions that have been burning about food allergies, food intolerances, and food sensitivities.

So listen up. So Kelly, I’m excited to have this conversation with you because we don’t always get a chance to talk about kinda what we’re seeing in our clinics. But you know, one day we were talking about how many times people come into the clinic. Had a lot of testing. You know, they’re sick and tired of feeling sick and tired and they just wanna know what tests to do.

Or they’ve already done a lot of testing and most recently people are coming into the clinic having already had some food allergy or, and food intolerance testing. So what did you, when clients come in with those questions and with those tests, what is the first thing that you do with them that, that you say to them?

Kelly Engelmann: Great question, Lori. The first thing that I like to do is I like to sit down with them and just see like, when did they have the testing done? What were the circumstances that led them to initiate testing in the first place? You know, to your point, a lot of them are just sick and tired of being sick and tired.

And so, I mean, now it’s direct to consumer market. They can order these tests online for themselves. They may not even understand the technology behind the test or when it’s appropriate to do the test. So I, I try to get some backstory in history as. To when that test was done, why it was done, and what they expected to get out of the testing, and then what they’ve done since they’ve had the testing.

Right, right. Those are the things I like to dig into as a provider to really have a better understanding of how to fully answer their questions and to help them navigate what that testing actually means. 

Lori Esarey: Right. Yeah. I, when they come into the clinic and they have already had testing, you know, oftentimes they’re saying, you know, I had this testing.

I got these results. I’ve made these changes and I don’t feel better. And in some cases I feel worse and they’re extremely frustrated. Do you get that too? 

Kelly Engelmann: Absolutely. I see that all the time actually. And I think, you know, and I had a case last week that really, I. Took me back, you know, really took my breath away.

She had had two separate food sensitivity panels completed. One was an IgG G panel, and then six months later she had a full panel looking at IgE, IgG, G IgG, subclass four compliment. It was a very, Extensive panel that I just love, but she had taken that information and basically eliminated with the first set of testing.

She eliminated those foods. She took a few supplements, but never really understood how to walk through a gut protocol. And then with the second set of testing, she restricted her diet even more. She’d been eating avocado oil and avocado, and she’d been eating. Olive oil. Those were now on her food sensitivity panel, coconut oil.

So basically she removed all fats from her diet because she couldn’t. The oils she was reacting to supposedly. Hmm. As a result of that, she developed severe fatty acid deficiency and her skin started breaking down. She was covered head to toe in a rash. Her histamine Right symptoms were through the roof and you know, and I think, gosh, how was she communicated to, she’s a kindergarten teacher who was a rule follower.

And followed the rules to a t from what she understood. And I think that’s where you and I in our practices vary from kind of the standard practice in that we spend a lot of time educating our patients as to what the, the test actually means, what to do about the test, and for how long. You know, we’re not meant to live on an elimination diet forever.

You know, we want diversity in the diet as much as possible, and when we start eliminating things for a prolonged period of time, we can run into problems with nutrient deficiencies, whether that’s mineral deficiencies, antioxidant deficiencies, or fatty acid deficiencies. And those oftentimes show up differently, but that’s the risk, right?

And having a test done that you don’t fully understand how to execute those results, right? 

Lori Esarey: So not the wrong test. But definitely not with the trained eye. Looking at it through the lens of what else is going on. So you bring up a really good point. It’s right test for the right patient. At the right time because otherwise you’re, you’re, you are gonna end up really frustrated.

So you touched a little bit and you threw out a lot of IG terms. Yes. And um, I, I know what all of that means, but I, I do think it’s important to kind of talk about, you know, cause we have people that come in that have had skin testing, you know, which is more of that reaction that IgE Right. Testing. And then we have blood tests that are IgE, which is more of that immediate.

Allergy response. And then you spoke of food intolerances versus, uh, food sensitivity. So tell us a little bit more about the IgG and IgA that you were talking about. 

Kelly Engelmann: Yeah. So let’s define food allergy, which is IgE that Lori mentioned. That’s the skin prick test. And you can also do that in a blood test.

That would be an immediate reaction to the food. And then there’s I G G, which is a delayed reaction. We oftentimes call those sensitivities. It’s not a true allergy, and the symptoms that appear may appear. 72 hours after eating the food. They can be very challenging to pin down because you may not remember what you had three days ago, but all of a sudden you have that symptom.

So those can be difficult to understand. And then an intolerance would be like a lactose intolerance, like you don’t have enzymes to break down that food. And then there is another type of testing that we can do as iga. So there are. Food sensitivity panels that look at IGA independently, or maybe a combination of IgG G and IGA is still a delayed response to that food, right?

Lori Esarey: So, lots of different tests that are available out there, but I think what we really want to impress upon each and every person listening here today is that it really is about. What are your symptoms? What are we looking for to specifically order the right test for you and then in delivering those results to you?

You know, oftentimes you can have a lot of these food reactions due to a very unhealthy gut. You could light up like a Christmas tree and we’re not gonna eliminate all of those foods. We shouldn’t eliminate all those foods. That’s what you just said, Kelly, and, and I agree 110% is because you cannot live that way, nor is that the right thing to do.

We have to really focus on. Your gut lining and the, the health of your gut and those healthy bacteria and everything going on, all things gut, right? All things gut health as we are really working on developing a plan that you can implement that’s gonna be successful for you to feel better and to achieve your optimal health and wellness.

Kelly Engelmann: So what Lori is saying is that, Just doing a food elimination based on a food sensitivity panel may or may not give you symptom relief initially, right? There are some people that get relief initially, but then three months down the line, the symptoms are back. If we use a food elimination independent of a gut protocol for restoration and repair and repopulating the gut microbiome, then what happens is six months later, you repeat your food sensitivity panel.

And it just changed the things that you were reactive to before you’re not reacting to anymore because you’re not consuming them. And now you have a whole new list of food sensitivities that show up because you’re still reacting to things you’re commonly eating. Right. That’s what we oftentimes see is the list just changes.

On the other hand, if we invest in working through a very thoughtful protocol designed around repairing the gut lining and retraining the immune system to accept these foods, then the outcome for that looks much different most of the time. Right, right. Is that what you see as well? 

Lori Esarey: Yeah. You feel better and you’re more… you are able to consume a more nutrient dense diet, right? Because when we do pull a lot of those foods out, and that’s kind of what you were saying with the patient experience mm-hmm. That you mentioned ended up with a ton of skin related issues and fatty acid deficiencies. You know, when you pull a lot of those foods out of your diet, unfortunately you are also eliminating or reducing quite a bit of nutrients, which then manifest in.

Other symptoms, right? So you end up chasing something and never getting results. So it’s so important to really, you know, find that qualified healthcare practitioner and really sit down, make sure, as you said Kelly, in the very beginning, getting a detailed history. What are your symptoms? You know, determining what are the right tests for you?

And then, Really making sure that when we deliver those results, we’re delivering a treatment plan and not just results, a treatment plan of how to get you to that ideal state of health that you’re looking for. 

Kelly Engelmann: So, Lori, I don’t know about you in your practice, but when I’m reviewing a food sensitivity panel, In addition to other lab results that that patient may have invested in at the time.

The last thing I go over is their food sensitivity panel. Absolutely. Because absolutely. What I have found is if you put that in front of them in the very beginning, they can’t think of anything else. Their brain is like, Monkey mind, all they can think about is going to the grocery store. What are they gonna be able to eat?

How are they gonna navigate? And they can’t concentrate on anything else. And so I bring that and what am I gonna do? Right? I’m bringing that up because when you’re working with the provider on food sensitivities and, and gut restoration, it’s not a one visit plan. You know, we may map out the plan in one visit, but to execute that in a way that’s going to create healing re typically requires multiple touchpoints.

So we wanna make sure that you don’t get lost in the sauce and you don’t think that that. Food panel is the end all be all, but we’re really working toward restoring your overall health and really monitoring those keystone factors. They’re gonna dictate whether you heal or not. And oftentimes a lot of life happens in between those visits and you know, things, stressors happen, circumstances change, and those play into your overall health picture too.

And so your healthcare provider needs to have a better understanding. Of those things to help you navigate the process, because if you have food sensitivities, there are other things going on. Food sensitivities do not happen unless there is gut destruction that lead to food sensitivity. So it’s not the problem.

It’s part of the problem, but it’s typically a symptom of a bigger problem that unless you address the bigger problem mm-hmm. Then that way of life of having to avoid and having to avoid will continue to evolve despite your best efforts. 

Lori Esarey: Yeah, absolutely. And you know, when is the right time to, some of the things that we talk about is, you know, some people are on antihistamines, some people are on steroids, and.

We have to be very cognizant of medications that can interfere in testing results too. So that’s all part of that history also is when is the right time to do it. I remember a time where I had a patient who had recently had a colonoscopy, and what happens with a colonoscopy? The colonoscopy prep, right?

We wipe out the entire gut microbiome in the cleansing prep. And then shortly after had testing and lit up like a Christmas tree. And this was a person who had been a long-term patient of mine who had been working very, very hard and really didn’t feel bad. We were doing a follow-up test. I didn’t know she had a colonoscopy.

And it wasn’t until months after when I was so perplexed asking her questions, and one day that light bulb went off and she said, could it have been the colonoscopy? Do you remember me sharing that with you?

Kelly Engelmann: I do remember you sharing that with me. I wanna back up. That is, that is interesting, but I wanna back up because you’ve said it a couple of times, lit up like a Christmas tree.

What Lori is saying is that that panel, when we get those results back, it’s very colorful. So if we get back a panel that there’s a lot of color on the page that is lit up like a Christmas tree, and you do not wanna see a lot of color on your page when you get back your food sensitivity panel, you want that to be as boring as possible.

Lori Esarey: I mean, we love lit up Christmas trees, don’t we? 

Kelly Engelmann: We love Christmas trees, but we don’t like them on your diagnostic. But we do not like them on your diagnostic testing. Right. And so, yeah. Uh, things can interfere with that testing. As Lori mentioned, steroids, antibiotic use, colonoscopies, those are things an illness two weeks prior to your testing.

You know, I, I oftentimes will educate my patients, least listen, if you have an illness, especially once covid happened, we, we had to have this conversation more often. If you have an illness and you’re scheduled for blood work within the next two weeks, and it’s routine blood work where we’re tracking and trending numbers, let’s delay it a little bit.

Let’s not do that just yet because it may be a little bit of skew for a couple of weeks after having an illness like that. And so really being aware of things that could affect your panel in an abnormal way that may create more anxiety than, than really you need. And looking at those results.

Lori Esarey: And mentioning, um, steroid injections too, we often forget about that.

Um, you know, a lot of people have. Joint injections where they have those steroid injections. So just kind of thinking about not just oral use of medications, but also injectable use of medications too that can definitely interfere and test results. 

Kelly Engelmann: So whereas something like an illness would cause that panel maybe to be hyperreactive, something like taking in a histamines or taking a steroid.

Would cause that to be falsely negative sometimes. So you may get a panel that doesn’t match the clinical symptoms because of use of those medications prior to testing. 

Lori Esarey: Hence the reason I really do, um, recommend avoidance of ordering tests online just based on symptoms. But I do know that. We do talk to a lot of people who live in areas that they don’t have access to, providers of care who offer these tests.

And so, you know, I understand that people do, they’re just looking for an answer. Um, but I would really caution just ordering something online, again, through the clinical eyes of someone who’s qualified to look at all of those things. For you is, is so. Important. 

Kelly Engelmann: Absolutely. I, I remember back, um, when I first started practice and became aware of food sensitivity testing, I tested myself.

My panel was not pretty, and going to the grocery store that first time was overwhelming. In fact, my story goes, I went to three grocery stores that day and the only thing I bought was tea.

I came home and I, I think I cried a little bit and went for a run and pouted a little bit, and then I decided to put on my big girl panties and figure it out. But it was, it was a bit overwhelming. That was, you know, 14 years ago when I had very little knowledge. A functional medicine and I liked what I liked.

My palate was not wear very well developed in the way of vegetables, and it really challenged me to start thinking about food in a very different way. 

Lori Esarey: Absolutely. Yeah. I, I laugh. I’ve heard you tell that story, but I laugh every single time you tell that story because it’s really, as a provider of care sitting down with patients.

It has made me really take a different approach with how I share results. You know, very empathetic because I’ve been on that journey too. I’ve, I’ve been in that seat before where I’ve looked at my own and felt the same way. And so it’s really treading lightly saying what needs to be said, but again, and being sensitive to it, but developing a plan, we could sit there and develop a plan.

That’s a really good plan, but at the end of the day, if it’s not a plan that our patients can execute, Then it’s not a very good plan. And so being very sensitive to how we unroll that, what are the most important things to pull out of the diet, because there are gonna be some things that need to be pulled out completely, but there are things that will rotate in too, again, depending upon.

What other actions you’re willing to take. You know, if you’re willing to change and walk through a gut restoration program, you’re willing to be aggressive with that. You’re willing to work on your environment, get better sleep, decrease that incoming burden. The more you’re willing to do, the better the outcome’s going to be, for sure.

But I think all in all, we all have to be sensitive to each other’s. Initial frustration Yes. Of what and emotional can make you feel. 

Kelly Engelmann: Yeah. That emotional attachment to food that we have, that we all have, and, uh, the four-year-old in our head, that needs to be nurtured a little bit. So I wanna encourage our listeners, you know, if you’ve had some food sensitivity testing or you’re thinking about having some food sensitivity testing, I wanna encourage you to be, be in it, be in it, to win it, and be in it to really talk to your provider.

About what those results mean. If you’re hitting stumbling blocks, if you’re struggling, that’s the time to lean in and ask more questions and get more direction. Oftentimes, that’s the time people disappear and they go on about their way and they’re, they’re miserable as a result of it and feel oftentimes defeated.

And so, you know, there’s no question that’s a dumb question. There typically is. Always a substitute for a food that perhaps you haven’t thought of. And then the other thing I wanna remind you is that your taste buds do regenerate every 14 days. So the things that you think you absolutely do not like, it’s interesting how the body works.

You know when you start consuming those foods, you actually start liking them. Oftentimes start craving them. So be patient with the process of that retraining of the palate too. 

Lori Esarey: Absolutely. Well, that’s definitely good advice. Well, our listeners send in some questions that we wanna answer for you. So Kelly, how much does a test cost? Like are there specific, are there ranges for tests? Yeah, there are. Um, that we can give. 

Kelly Engelmann: Yeah, there are ranges. You know, the, the least expensive test and I, I’ll say, Possibly the least reliable test too is the IGA test, and there’s an IGA test that tests for four major food sensitivities, gluten, dairy, egg, and soy.

And that test is around 120, $140 for that panel. If someone has a low iga, though, that test may. Not be the best because you may get some false negatives, but it is a screening. And then, you know, so they can range anywhere from about $140 all the way up to four or $500, depending on how deep you’re going into the immune system.

What you’re trying to look at depends on the complexity of the test as to the cost of the test. 

Lori Esarey: And I, I think you hit on a great point that. Yes, the least expensive test that you just brought up is the least reliable test. But I also wanna add that the most expensive test doesn’t necessarily mean that it’s the most reliable test, right?

Yes. So I think it’s very important to go back to, you know, what we’ve said before is making sure that before. You decide what test you would like to do is get with a qualified health practitioner who understands your history, what are you looking for, and making sure that you’re, you’re ordering and getting the right test for you.

Because even if you only pay $150 for it, if that test doesn’t achieve the outcome, and it’s not reliable, It could be a very expensive test. Yes. Something you spent a little bit of money on that just didn’t do anything for you, and may have made you feel worse in the long run. 

Kelly Engelmann: Right. And then the opposite end of that is you could spend a whole lot of money on a very complex food panel that was done at the wrong time.

And maybe has false information on it too, because there’s a lot of what we call molecular mimicry goes on in the world of food sensitivities. And so your test may show things that you react to that aren’t true reactions because of the position of the immune system at the time of the test. So to Lori’s point, working with the healthcare provider that really understands timing and understands how to prep you for that test in a way that’s gonna be the most meaningful and make the most use of your dollars.

Let’s face it, this is an investment in your help and you wanna make sure you’re investing at the right test at the right time, and you have the right plan to execute those results. 

Lori Esarey: And that transitions really nicely into the next question was how do you determine what tests are best for your patients?

And it really is making sure that there’s a. Wonderful history. Taking the time to really dig into what your symptoms are, what you’ve tried, what’s worked, what hasn’t worked, you know, what you’ve been exposed to. It’s really making sure that that’s all been disclosed. And then on top of it, really making sure that you know, your provider of care understands what symptoms you’re having when they started, you know, when they get better, when they’re not better.

You know, just really the triggers. The antecedents, you know, what comes before, what comes after all of that history is essential to choosing the best test. And you know, unfortunately, I, I say unfortunately, you know, sometimes it does come down to dollars and cents and as a provider of care, I have to help.

My patients make very difficult decisions because, you know, we don’t wanna just order testing for testing’s sake, but we also wanna make sure that if we are, if you’re investing in testing, we wanna make sure it’s the right test for you. So, um, all of those things play into. That determining the best test for you and anything else you would add to that, Kelly? 

Kelly Engelmann: No, I think you said that well, I mean, I think having a thoughtful position as to what tests are ordered, when they’re ordered, and then how they’re interpreted. I think that’s the bottom line, is making sure all of those bases have been covered before you have that test drawn. Mm-hmm. Yep. 

Lori Esarey: Right, and there are some, the, the next question is, you know, what’s the best or most shocking, positive outcome that you’ve achieved?

You know, when with testing results, and there are very, very positive things that come out of. Doing the right test at the right time. And the most positive is, you know, I have, I have people that go from a life that’s not very quality filled. It’s very disruptive to have multiple food intolerances, particularly if it causes your skin to itch, unbearably, and you know, causing.

Problems with sleep or, and you end up in the bathroom, maybe it’s a, a gi response. Right. You know, that’s very disruptive to quality of life. So I, I truly believe that the, the best outcome is when you can give someone back their quality of life because they got the right results. They were willing to do the work, and they see the benefit of that.

Kelly Engelmann: Absolutely. And the fun part is we get to see that. Most every day with our patients and the healing that they have. You know, anything that we can do to lower their inflammatory burden long-term is a win. And when you have these food sensitivities that are going on and progressive, it’s creating an inflammatory burden within the body.

So our goal is to remove the offender to really work on repairing the body in a way, and then reintroducing those foods in a way that’s going to help retrain that immune system to accept that food. 

Lori Esarey: Yeah, and when you talk dollars and cents, and this is a question we get a lot, is, you know, how can proper testing be?

What we refer to as an investment, right? It’s not a cost. It’s really an investment in the long run. And you know, you can spend your money on a lot of things. You really can. So having a good exhaustive history, determining what the right test is, it’s no longer a cost. It truly is an investment in your health.

And you know, you say it Kelly all the time, and so do I. Is either we’re gonna pay an hour pay later, right? Right. We’re gonna pay an hour pay later. So getting, you know, that investment and, and that’s why we call it an investment because it’s an investment that pays you back in significant reward. That’s right.

When you get the right test and you get the right information and you get the right treatment plan, as we spoke of earlier, the right treatment plan, cuz it’s not just the test we say in our line of work. The diagnostic results are 20% of the equation. 80% is that history. And when you pair that all together, that’s, that’s where the sweet sauce is, right?

Kelly Engelmann: And I say it’s only an expense if you don’t do anything with that result in a positive way, right? That’s when it becomes an expense. Otherwise, it’s an investment that’s gonna pay you back. Considerably with the way that you feel, the way you’re able to function and, um, enjoy your life. 

Lori Esarey: And that’s why it’s so important to understand the test results, to work with someone who can really break down that information for you in a way that makes sense.

That you can execute the plan because the outcome is definitely, you know, a result of, like you said, it’s the action steps that you take and it’s a waste to take no action otherwise, then it’s just another test that you put in your three ring binder. Right? And I know a lot of people come into our practices with really thick three ring binders with lots of good testing, right?

But. In many cases, not having had someone really explain that information to them in a way that they could understand and execute a plan. 

Kelly Engelmann: Yeah. So the other question that we got was, what happens when your, your primary care provider has prescribed antihistamines and gave you a list of foods to avoid, but.

They’re perhaps not treating the deeper issue, you know, what do you say to that person? How do you help them navigate that process? 

Lori Esarey: Yeah. So that’s not uncommon, you know, for people to come into my practice and I’m, I’m sure Kelly, yours as well, that. Have done a lot of things. You know, the, the reaction is take an antihistamine if you’re having this rash or this skin itching to reduce that, you know, histamine burden, which oftentimes in the short term can make symptoms lessened.

But as soon as that’s pulled back out again, They’re gonna have the symptoms again. So, you know, how do you navigate that? It’s really helping them, um, understand root cause, what’s the driver, and that a treatment plan isn’t just about lessening the histamine response with drugs, medications like antihistamines.

It’s really about understanding what’s causing that to happen. Get the right testing again and educate. Now we do know that antihistamines and some of those medications do. Interfere in the testing. So I think, you know, the, the real question is how do you tie that in such a way not to make our patients be driven nuts for a period of 72 hours while they’re holding those medications.

And so, you know, I just really ask them to hold ’em as long as they can. You know, if it’s 48 hours, if it’s only 24 hours, So that we can get those results. If they’ve been on steroids, it’s, you know, I, I would prefer them to be off of steroids for approximately two weeks prior to getting their testing done, because nothing’s worse than, you know, having tests done at the wrong time under the wrong conditions.

That really give you false negatives, right? You know that nothing shows up and then you’re more perplexed after you get the results. 

Kelly Engelmann: Absolutely. Sometimes, you know, one of the strategies I’ll often use in that situation is getting them on a histamine balancing meal plan for a couple of weeks. So it’s not pulling foods necessarily out of the diet that we would be testing for.

Mm-hmm. But helping them learn how to balance those foods so that they have a little bit of symptom control. Until we can get the testing done. So I have used that strategy a few times. It’s complicated. It’s a complicated strategy, but in that situation, we’re usually in a bit of a pickle that we have to work our way out of. 

Lori Esarey: Right. And I think one of the difficult situations for some of our patients is that they’ve gone to so many medical providers prior to coming to us. Who have given them different advice, just trying to get them some answers. And so they typically show up on having had a lot of things or currently taking things.

And so, you know, I think if that place is where this question is coming from. I want you to know that you don’t need to pick sides that you know, our goal truly is to team up with you to understand where you’re currently at and you know, to your point, Kelly, you know, going into the testing, first of all, choosing the right testing, but going into the testing, doing some things to really calm down that response and kind of talking with you about what those medications.

Why they’ve been prescribed to you and why we need to decrease them so we get the right results. And really just part, I think what I, what we want you to know is being a partner with you. Is really being a partner with you and that you don’t have to choose traditional medicine versus nutritional lifestyle.

Medicine is we’re on your team to help you understand your body better, to help you make better decisions about. Your health and really talk real with you about that and not force you to make a decision of one camp or the other. Does that make sense to you, Kelly? 

Kelly Engelmann: Yeah. Yeah. It’s an integrative approach. We’re integrating with your other practitioners in a way that’s gonna be meaningful and give you the result that you want to see. And that’s feeling better, functioning better. 

Lori Esarey: And a lot of these tests aren’t offered in the traditional medical model. Right? Right. So, you know, some people come in and say, well, why wasn’t this test offered to me?

Kelly Engelmann: Right. 

Lori Esarey: You know, and I, I, I want you to know that, you know, many of the traditional providers of care aren’t utilizing. And perhaps don’t really know these tests are available. You know, we could go into a whole nother discussion about that. And that’s not what today’s, you know, topic is about, but it’s not that they intended to hold back a test from you that you needed to have at the end of the day, oftentimes they just don’t have that tool in their toolbox.

To use for you, and that’s why it is so important to seek out providers of care that are looking at more advanced testing that’s out there to get some answers for you that you haven’t been able to get. 

Kelly Engelmann: Absolutely. Well, this was a great discussion. On the difference between food sensitivities, food intolerances, and food allergies. I hope that you learned something from today, and I look forward to getting you back on here for future podcasts. So stay tuned for more to come. 

Lori Esarey: Thanks so much for listening to today’s episode. You can find more information about Synergee at Synergee 4 Life. That’s S Y N E R G E E, the number four life.com. 

Kelly Engelmann: And then Synergee Connect. Next is our Facebook, and then please make sure to follow us on your favorite podcast app so that you make sure you get future notifications of episodes.

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