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Is It Really All FI?
on September 12, 2013
As many readers are aware, the food intolerance and elimination diet ideas have been around for a very long time. This book is a decent synthesis of that tradition, but the author's many statements of certainty leave me cold.
I am a physiologist working in the field of adult metabolic dysfunction, and I agree with her that diet is the cause of pretty much all the ills we experience. I read and generally follow the authors that she lists in her recommended reading as well as seriously read the medical literature, personally eat aligned with Weston Price, and think the GAPS diet is superior for healing a leaky gut. I do agree that there is mounting evidence that leaky gut is at the root of many autoimmune problems, and I define autoimmune in a very general way that includes anything that causes inflammation (that is to say, much more general than establishment medicine uses the terms for a limited set of specific illnesses).
But, in my opinion, she kind of mashes up a number of suspected metabolic derangements into the "IT!!" of food intolerance in order to sell her newest best thing, which oversimplifies the issue and sets people up to think that their weight and their cravings are all about their exposure to food antigens. To begin, of course people are going to lose weight when they clean up their diets, and how much of her claimed results are the result of folks giving this 3-week protocol a whirl and eating a clean and portion-controlled diet? Secondly, many of the foods on her list are well-known players in the insulin problem. How do we know that her results are not actually related to positive impacts on insulin and the resulting decrease in inflammation and cravings that accompany better regulation of it? She does talk about insulin effects, but again, it's sort of mashed in there with her primary goal of making everything about FI.
So, for example, while I agree with her that gluten is a huge problem for a lot of people, many folks will switch to non-gluten foods like high quality oats or rice, and still not be able to lose weight because those foods still cause a problematic insulin response for them. She also claims that cravings are about circulating IgG immune complexes on the hunt for their partner food particle (an idea I could find zero evidence for in the scientific literature), whereas in our work with disordered eating patients we found cravings and bingeing were related to not eating a breakfast that included protein, and suggest that it's actually more of a blood sugar issue. In fact, the Sweetness Trap chapter is mostly about sugar's effect on insulin drive and blood sugar. A food can be extremely problematic hormonally and have little or no impact on your immune system's response to it (which is what defines a food intolerance).
There's also that whole IgG thing; lots of blow back in the medical literature about what IgG really indicates and if it's bad or protective, and also significant discussion about the lack of sensitivity and validity of the IgG tests that are on the market. I had an IgG panel done and it did not flag foods that I have definite problems with. Clinicians who use the test (mostly naturopaths) have reported similar problems with it. She touts the test with certainty on her PBS show as a certain way to find out if you have a food intolerance to something, and knows that she's got a problem with eggs because she had the test.
Finally, I have problems with the whole dairy thing. Firstly, I think we need to really describe two separate types of dairy foods: pastured and raw vs. pasturized. These are really two different food groups. She does a whole chapter on how problematic dairy is, and then in fact makes the statement that pastured and raw dairy are something else entirely, and invites her readers to check that food out. Pastured dairy is becoming more easy to find (heck, you can find Kerrygold Irish butter and cheese in most supermarkets in the NYC area). I'm lucky in that I live across the river from PA where raw pastured dairy is a legally sold staple. However, if you have lactose intolerance, you'll know it and no amount of pastured or organic or raw will help you probably. But if you don't, then pastured and raw dairy may be a great food for you. Some animal studies have found a relationship between the milk protein cassein and cancer incidence, and there is human study evidence to show autoimmune reaction to cassein in Type 1 diabetics with celiac disease - which is a very specific and limited case, but my personal opinion is that this is an area of knowledge in human nutrition still to be figured out. I believe our diets should be as diverse and nutrition dense as possible, and eliminating so many foods can be a nightmare. If you have autoimmune symptoms, then eliminate it for a couple of weeks and see what happens. If not, or if eliminating it doesn't clear up your health problems, then raw dairy can be a great source of nutrition.
There are folks in the paleo community (for example, Robb Wolf and his mentor Loren Cordain and now Terry Wahls, MD of the Wahls Protocol) who are extremely respected and who believe that dairy is a no-no. They base their opinions on a few studies that concluded that while dairy does not have a big impact on your blood sugar, it still causes a rise in your insulin. This is one of the points that JJ Virgin makes in her chapter on dairy, which would be based on these studies. I read all of those studies, and I have problems with them. For example, the yogurt food used in the study most cited, which increased insulin very significantly, was actually yogurt with a fruit preserve it in. Whey increased insulin, even in a "combination" meal, but that combination was with white bread. How much would whey protein impact your insulin response if it was combined in a shake with a couple of tablespoons of coconut oil? That result would likely be much different. I am most miffed in that chapter, however, by her blatant misuse of the scientific literature in her statement that dairy makes you fat. She makes that statement as a bold section heading on page 96, and supports that statement with a study that didn't find that at all!!! (Barr, 2003). That review found that in 9 studies that looked at *increasing* dairy (not just eating dairy, but increasing it), 7 found no difference in weight to controls and 2 found an increase in weight in an elderly population for which they could not "accurately determine the extent of dietary compensation for the increment in energy intake provided by the added dairy products"; that is, they couldn't determine that the weight gain was due to the dairy itself or the increased calories. She maneuvers around this by saying in the text "if you drink *more* milk you gain weight". That's just dirty pool, and if she's got nothing more than that weak study (which the study authors even say was statistically weak), and she has to play word games with it to make the point, then there is no point.
So might many folks who have weight problems or inflammatory problems or mood problems also have food intolerances? Probably. But is FI the REAL cause of weight gain as her book states on the cover in no uncertain terms? Maybe not so much. I absolutely think humans should avoid modern grains, industrial seed oils, sugar, HFCS, GMOs, pasturized dairy and feedlot meat, but I'm not at all certain like she is that every thing is caused by a food intolerance.