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Month: April 2024

Dear Dr. K;

Dear Dr. K;

I recently underwent food allergy testing at the behest of my gastroenterologist to see if food allergies are causing or contributing to my irritable bowel syndrome.  It turns out I’m allergic to five foods.  My question is how do I determine if all five are causing my symptoms or just one or two?

That is a great question.  The guidelines I’m going to share with you were worked out in clinical research units.  In these settings patients are kept in a controlled environment (typically a hotel appended to the university hospital) and avoid the implicated (food allergy test positive) foods for two weeks.  It seems to take this long to fully “clean the system”.  Then, one food at a time is re-introduced.  In the research setting this is done double blinded and placebo controlled by putting the food to be tested inside gel-caps.  On a given day the patient may receive a placebo or an actual food.  Now, obviously this is a very tedious and protracted protocol.  But it has led to some basic rules to be used at home.

So, first of all, you need to avoid all five foods at the same time for two weeks.  If food allergy is causing your IBS, you will feel better at the end of two weeks. 

Then start adding a single food. You should have this food in “a usual portion size” and have it at least three days in a row.  If you have “tummy troubles” the very first day it could be due to the food or serendipity.  So, you need to repeat the experiment to verify. 

Now here is the hard part.  If you have symptoms you need to go back to the elimination diet until you feel well again before you try the next food.  Unfortunately, this could take up to two weeks again.  But you need a symptom reduced baseline to have clarity. 

Once you’ve tested all the foods there is another step you might need to take.  But this is necessary only if all the individual tests were negative.  This step involves testing food combos.  By way of example let’s say you tested positive to cheese, tomato and wheat.  Tested individually: no issue.  But tested together might reveal synergism.  So, pizza would be a mechanism to test all three.  Good luck, be patient. 

Omalizumab for Food Allergies

Omalizumab for Food Allergies

The FDA recently approved omalizumab (Xolair) to treat patients with food allergy including children as young as one year.  The approval came from several research trials including one recently published in the New England Journal of Medicine (NEJM) that was conducted at John’s Hopkins.  This particular study looked at allergy to peanut, cashew, egg, milk, walnut, hazelnut and wheat.  In the case of peanut allergy 67% of the test patients were able to consume 600 mg of peanut (equivalent to four peanuts) without adverse symptoms. 

The current recommendation is to only consider this therapy in people with severe (anaphylactic) food allergy.  In addition, the intent is not to enable ongoing ingestion of the food but to protect against anaphylaxis due to accidental exposure.  

An accompanying editorial in the NEJM was a bit of a devil’s advocate pointing out that the treatment is not curative but only works as long as the medication is continued.  It further argued that avoidance is still the lynch pin of therapy in severe food allergy.

The editorial did point out the potential safety net for children who otherwise run the risk of anaphylaxis from accidental exposure. 

That’s Bananas!

That’s Bananas!

By:  Sasha Klemawesch, MD

If I asked you to tell me one fact about bananas, you’d probably cite how rich they are in Potassium.  And you wouldn’t be wrong.

But, in addition to having approximately 10% of your daily value for potassium, they also contain about 10% of your daily needs for Magnesium, Vitamin C and Fiber.  While potassium is great for lowering blood pressure, maintaining muscle (including heart muscle) strength, and avoiding certain types of kidney stones, foods with high potassium content may also be slightly radioactive!

This is because included in their potassium stores is a tiny bit of Potassium-40, which is a radioactive isotope. But don’t worry, there is not a human being out there – or monkey for that matter – who could possibly consume the volume of bananas necessary to incur any harm from them (it’d take like 20 million to reach a dangerous dose).

There is enough of the isotope however that you wouldn’t be allowed to bring bananas into a nuclear power plant due to their potential to trigger the (highly sensitive) alarms.  So, while you may not need to worry about getting radiation poisoning from bananas, if you have a latex allergy; you should probably avoid them. It seems unusual for a man-made material and a natural fruit to be related, but latex actually shares several allergens in common not only with bananas, but also avocados and kiwis.

Other groups who should avoid bananas are male mice. If you are one, #1 congratulations on becoming literate enough to read this! and #2, you have probably already realized that you feel stressed out when you smell banana pudding. This is because pregnant female mice’s urine contains n-pentyl-acetate; the same compound that imparts bananas their distinct odor. It’s also the hormone pregnant mice secrete in

order to repel males, thereby preventing them from eating their babies.

Lastly, if you still enjoy listening to CD’s, and you have run out of toothpaste to fix your favorite one’s scratches, try rubbing a banana peel over the defect. The oils in it will do the same thing the toothpaste does and repair the skip!



There is a memorable scene from the movie The Graduate where Ben (Dustin Hoffman) is taken outside at his college graduation party by a friend of his fathers’.  The friend says (regarding Ben’s future) “I have just one word for you: plastics”. 

Fifty years ago, plastics seemed to be a boom in terms of both convenience and commerce.  Now, plastics are doom in terms of environmental harm and human health.  Once plastics are released into the environment (soil and water) they gradually degrade, leading to the formation of micro plastics (smaller than 5mm) and nano plastics (smaller than 1000 nanometers).  These in turn can enter the human body through ingestion, inhalation and skin absorption.  Ninety five percent of Americans have micro/nano plastics in their bodies.  The health consequences are myriad:  interstitial lung disease, increased rates of premature birth, asthma, certain types of cancer, and liver and kidney disease. Now a new concern has recently been reported by scientists at the University of Campania in Italy regarding cardio vascular events.  Their research found 60% of their patients having surgery to remove arterial plaque had micro/nano plastics (MNP) in the plaque itself.  More distressing was that the 60% with MNP had much higher risk for heart attack, stroke or death in the ensuing 34 months than the 40% who did not have MNP. 

What to do?  Unfortunately making a personal choice to use less plastic will not protect individuals since it is primarily the degradation of discarded plastic that is the prime mover.  It will take a global initiative to make a difference.