This article, written by Dr. Stephen J. Gisason has been abstracted and adapted from material going into a revision of his book "Nutritional Therapy".

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Index
Hypersensitivity diseases and CFS
Hypersensitivity and it's meaning
Allergy (external)
Autoimmune diseases (internal)
Food Allergy and increased immune dysfunction
Cytokines and immune activity

I and my clincial and research associates have worked for several years on an effective management program for food allergic diseases. We believe that food-triggered hypersensitivity diseases are common health problems in our society. Our program features an elmental nutrient formula and complete diet revision. Each patient is taught new skills in self-diagnosis and self-regulation. We have successfully treated over 5,000 patients with symptoms complexes which match or overlap the pattern of illness you are calling ME and/or CFIDS. We will advocate diet revision as a primary strategy of solving this health problem.

We live in sensitive bodies which interact with the environment.  Immune defenses are active every day, often responding to substances entering our bodies through air, water, and the food supply. Increased immune activity leads to hypersensitivity diseases. A general state of hypersensitivity exists in many patients we see with chronic fatigue symptoms. Careful studies have revealed that no single pattern of immunological abnormaility exists in groups of patients with CFIDS. Nor is there any consistent pattern of viral antibody production. Instead, various indices of immune activation point to hypersensitivity state.

The term, "hypersensitivity", refers to immunie-mediated diseases. Increased immune activity leads to hypersensitivity diseases.
Allergy can be thought of as hypersensitity disorders with external causes.
Internal hypersensitivity disorders are thought of as autoimmune diseases. Although medical descriptions pretend there are distinct boundaries it is unlikely that distinct inside or outside diseases exist. The human body is in continuous relationship with the environment and a constant molecular stream connects inside and outside. Autoimmune disorders have inside, self-perpetuating causes as well as outside factors such as ingested drugs and food materials. Non-specific hypersensitivity is often expressed as food allergy and chemcial hypersensitivity with limited food tolerance and even complete loss of tolerance to foods. Patients in this predicament may notice reactions to numerous foods and airborne chemicals and often need radical changes in their diet, and their environoment to get better.

Food allergy is a hypersensitivity disorder with increased immune responses to ingested materials. Food allergy involves the broadest set of immune reactions to food materials. Since food-body interactions are usually occurring every moment we live, immune responses to food are diverse and capable of producing many symptoms and many diseases. The idea of food allergy has been missing from the medical model, leaving a great gap in our understanding of modern disease. For example, individual studies have shown that milk and wheat ingestion can cause many disease states - eczema, asthama, migraine headaches, celiac disease, arthritis - but little is ever said about these problems in general medicine and no major public investigation has ever been undertaken. If we were really interested in the truth of disease, mil, wheat, and other foods should be under investigation as causes of common diseases. There is, however, no agreement about the prevalence and importance of food allergy as a set of disease mechanisms. Specialists, including allergists with narrow viewpoints, often deny that food allergy is a common problem. Outside the community of allergists there is general ignorance and neglect of these disease possiblities. and it is impossible to estimate the prevalence of food allergy by using medical diagnoses. The presence of food allergy is concealed in a variety of other diagnoses. Most allergists with an interest in the problems of food allergy would agree that the expressions of food alllergic disease are diverse, profound and not completely discovered or described. We suggest that the concept of food allergy is to modern disease concepts as the idea of infection was to disease concepts in the 19th century.
When you do not know about food allergy you are surrounded by mysterious diseases. When you know about food allergy, a lot of common illness patterns begin to make sense. Linda Gamlin who reviewed the concepts of food allergy writes"The medical establishment finds many aspects of food intolerance difficult to swallow, but the main problem is the plethora of symptoms and the variations from one patient to another.  Doctors working with food intolerance report more than 40 possible symtoms and conditions....the severity also varies.  Some patients are said to have nothing more than the occassional migraine or bout of fatigue, while at the other end of the scale the sufferer is unable to work or lead any sort of normal life" (3,4).

Immune responses to food antigens create many symptoms in complex patterns.  Four mechanisms of immune injury, described in immunology literature as Types 1, 2, 3 and 4 hypersensitivity are responsible for the different forms of food allergy. We are immunized to food molecules by GIT and then develop immune-mediated or allergic disease after entry of food antigens into the body by GIT error and/or inappropriate selection of food. Combinations of the four hypersensitivity mechanisms are likely to occur in response to food materials. Immune mediators produce symptoms such as flushing, fever, anger, fear, itching, swelling, pain, coughing, wheezing, vomitting and diarrhea. The effect of mediators released in the blood circulates throughout the body in a matter of seconds.  Mediators released in tissues may remain localized. The local effect depends on how important that tissue is and how disruptive the imune event is. A hive appearing in the skin is a minor annoyance; a similar event in the retina of the eye may result in the loss of vision.
Cytokines are potent mediators of immune activity. These chemicals carry messages from one cell group to another and invoke the most powerful of whole-body defense responses. The cytokines include the inerferons and interleukins which cause many of the symptoms of bacterial and viral infections - fever, headache, generalized aching, fatigue, weakness, and clouded consciousness. The same symptoms are produced by cytokines during food allergic reactions. Overproduction of one or more cytokines may be responsible for non-specific hypersensititivty.  patients presenting with chronic fatigue, muscle aching, and brain dysfunctions often have increased blood cytokine activity. If they are reacting to food (and most are) the elevations of cytokines would be variable and inconsistent and are therefore are not likely to be reliable tests of food allergy.


Symtpoms may be limited to the digestive tract - pain and diarrhea, triggered by eating certain foods, for example. The lungs are the major target organ in food-induces asthma, the skin in atopic dermatitis and the joints are target organs in food allergic arthritis. Muscles and connective tissue react with pain, stiffness, and swelling which, along with fatigue, are among the most common food allergy symptoms. The brain is the target organ when disorganized, disturbed thinking, feeling, remembering, and behaving occur. Our psyche is completely vulnerable to the biological mechanisms involved in food allergy. Mental-emotioanl disturbances are a consequence of food allergy, not a cause of it.

The idea of "boosting your immune system" has become popular. Odd diets, herbs, gland extracts and vitamin-mineral products are promoted to enhance the immune system. From the hypersensitivity point-of-view, we want less, immune response, not more. Allergic reactions involve increased, damaging immune responses or hypersensitivity. If the immune system is working overtime to defend against materials arriving in the body in air, water and food, there is a penalty to pay.
When patients report recurrent colds, flus, or chronic fatigue, they often refer to their "depressed immunity". Actually, they are experiencing hypersensitivity symptoms. The solution is stop the intake of allergenic foods and wait for the immune activity to subside. If the allergic disease is severe we use immune-suppressant drugs to save patients from immune injury.

An oversimplified, but convenient description of allergic patterns separates immediate hypersensitivity patterns of illness. We often refer to the other, more complicated problems as "Delayed Patterns of Food Allergy", following the lead of Dr.William Knicker(5), Dr. J. Brostoff(6), and others. Our focus is on the interface between things ingested and the inner body space.
The boundary is the wall of the gastrointestinal tract (GIT). Understanding what crosses this boundary is critical to the new understanding of food-related dysfunction and disease. Now we realize that GIT errors mingle with all body responses to food ingestion everyday. Drs.Coombs and McLaughlin summarized the problem :"Food proteins in the gastrointestinal tract and their absorption into the body as antigenci molecules have immunoligic significance both in (i) initiating an allergic state and (ii) in the subsequent challenge(s) where, by a variety of mechanisms, they may cause some form of food-allergic disease".

Immediate food reactions such as lip and mouth swelling are more obviously connected to food intake. The connection between food ingestion and delayed symptoms is less obvious. Most people do not notice the connection between food eaten and their body pains, fatigue or mood disturbances.  A variety of other terms are used by other authors to refer to distinctions that are either obscure or misleading. We do not use terms such as "food sensitivity" or "food intolerance" when the term "food allergy" would do. Some physicians insist on limiting the use of the word allergy; others use the term in its orginial snese of immune mediated disease. We use the diagnostic term "delayed pattern food allergy" to refer to a collection of nonspecific illness patters caused by the ingestion of certain foods.

The chronic fatigue syndrome has been described in the medical literature over many years. Indeed, the onset of many well-known diseases begins with aching, fatigue and cognitive dysfunctions. Viral hepatitis, for example, may simmer for many years and presents with these symptoms. Similar symptom complexes occur in the early stages of autoimmune diseases such as lupus erythematosis and multiiple sclerosis. These hypersensitivity diseases, driven by immune activity. A.J. Rowe, T.G.Randolph , and Fredrick Speer were among the first American allergists to associate CFS with food and inhalant allergies. Rowe described "allergic toxemia" in 1930 with the symptoms - drowsiness, mental confusion, lack of initiative and ambition, irritability, fatigue, aching and a feeling of being poisoned. Mental and emotional symptoms arise from the same biological mechanisms that produce physical symptoms. Rowe developed a number of elimination diets to treat allergic toxemia and reproted that a wide spectrum of mental-emotional and physical symptoms could be relieved by elimination diets. Dr. Theron Randolph and Dr. Fredrick Speer also associated the symptom complex of CFIDS with food and inhalant allergies. Dr.Speer referred to the "allergic-tension-fatigue syndrome and described "motor fatigue". Stephen Strauss and associates at the National Institute of Health noted a high prevalence of allergy (of mediate hypersensitivity variety) in patients with CFS. The authors of this paper failed to differentiate food from airborne allergy and ignored the delayed patterns of food allergy which are well-described in the medical literature. Strauss, in another paper on the history of the chronic fatigue syndrome, studiously ignores all the work done on food allergy.  These references to a limited definition of allergy need to be clarified by a better-informed, more sophisticated model of hypersensitivity disease.
The majority of patients we see with CFS do not have skin-test-positive food allergy and they do get better with diet revision.
We are convinced that muscle testing, vega meters and may blood test for food allergy or "sensitivity" have no validity.  Often, patients spend a lot of money on tests and treatments which have no value, but benefit from diet revision. The only proper test and proper treatment for chronic fatigue is complete diet revision.

The most common presentation of food allergy is as a nonspecific illness with many symptoms in many parts of the body. The illness may be mild and include nose congestion, headache, indigestion, flatulence, aching, stiffness and fatigue. Flushing of face, ears, and neck is a common symptom, often occurring during or shortly after eating. Dark circles around the eyes are known as allergic shiners and are associated with edema or "bags" under the eyes, which conspicuously mark people with chronic food allergy. An astute observer can make the diagnosis of food allergy from across the room (congestion, flushing, shiners).  often tonsils, adenoids and neck lymph nodes are enlarged. These immune system organs cotain the sensing, reacting cells, which are stimulated by food allergens ingested every day, and enlarge to defend the body against the perceived "enemies" in food. Respiratory symptoms are often associated with headaches, digestive symptoms, abdominal pain, muscle and joint pains, itches, rashes, hives, eczema, irritability, sleep disturbances and nightmares. Resless or irritable behavior may be linked to difficulty concentrating, mental fogginess, memory loss, angry outbursts, moodiness, crying and low self-esteem.
Since food allergy is a whole-body disease, a lottery selection of disturbances may evolve over many years. In many patients, we can trace the illness pattern back to infancy with slow, intermittent emergence of symptoms over many years.  In other patients the illness begins abruptly with few prior symptoms and progresses rapidly.

The illness may become severe and progress towards a disabling symptom complex such as chronic fatigue syndrome. Food allergy also presents as specific disorders such as migraines, asthama, chronic diarrhea, depression, exzema, inflmmatory bowel disease or arthritis. Food allergy is often confused with infections, bacterial and viral. The diagnosis may be "colds", "flue", Epstein Barr virus, candida yeast infection, chronic fatigue, fibromyalgia, myalgic encephalomyelitis, or just "a virus". Food allergy is best diagnosed from the characteristic history of illness. The best clue is the presence of many symptoms, in many different parts of the body, over months to years. Skin tests do not reveal food allergy. Even if some skin tests are positive, these tests do not accurately predict the responses to foods eaten. Allergy expresses itself as inflammation: redness, swelling, heat, and pain. In medical diagnosis the suffix "itis" means inflammation. Thus, "rhinitis" means nose inflammation and "arthritis" means joint inflammation. A simple rule of thumb is that any disease whose description ends in "itis" could be caused by food allergy.

Most of the patients we see with CFS do not acurately identify food allergy as a cause of their illness.  Many have disorganized eating habits; some with compulsive eating and drinking habits. Toxicity from air pollution, including tobacco smoke, industrial and domestic sources is also seldom considered. A surprising number of sick people continue to smoke cigaretts, drink coffee and eat junk foods. These people believe that they are helpless victims of a virus or environmental pollution.  They fail to recognize that their illness begins at home with their eating habits and their local environment. Cigarette smoking is so toxic that any other source of pollution is insignificant until all smoking has stopped and the home environment has been completely cleaned of hydrocarbon residues. We have discovered that after you remove obvious problems such as cigarettes, coffee, tea, alocholic beverages, chocolate and junk foods, the majority of patients have symptoms from dairy, eggs, meat, and wheat (rye, oats, barley) ingestion. Other foods are also involved in more individual, idosyncratic reaction patterns.

Complete diet revision is necessary to restore health. We begin our therapy by removing all food and beverage intake, supplying complete nutrition with an elemental nurtrient formual, ENFood. This is a highly specialized formula that safely boosts nutrient intake while all the problems related to the food supply are eliminated. Some patients discover that fasting alleviates their symptoms, although it still takes up to two weeks to clear completely - too long for a healthy fast. Symptoms worsen during the first few day of elimination, and then begin to clear.   Following a clearing period of seven to fourteen days, food is carefuly reintroduced following a well tested plan, the "Core Program". Nutritional supplements are always helpful, but without complete diet revision few recover from their illness. Recovering patients report increased awareness of food and environmental hypersensitivity.

This hypersensitivity might last a few month to several years.  Our impression is that this extreme form of hypersensitivity is on the increase and manifests increased toxicity of the environment. A number of airborne chemicals, native food chemcials, food additives and contaminants are suspects in the health crime of hypersensitivity. Even detergents and emulsifying agents in food are suspects(19). Some patients we have treated with CFIDS have a complex illness which takes months or years to resolve. They seem to have lost all tolerance to foods and only feel well if they live on a minimal diet supplemented with ENFood for several months. They are hypersensitivity to chemicals in their environment, and often need special protection. They often need medication to modify or suppress their immune response. Some are threatened by tissue damage from allergic reations to food antigens and need protection with medications, including antihistamines, prednisone, ketotifen and/or sodium cromoglycate.

Landay A.L., Jessop C., Lennette E.T., and Levy J.A.Chronic Fatigue Syndrome: Clincial Condition Associated with Immune Activation. Lancet 1991; 21 September: 707-711.

Knicker, W. Immunologically Medicated Reactions to Food: State of the Art.Annals of Allergy 1987: 59 (II): 60-70.

Gamlin L. Cooking Up a Storm. New Scientist 1989; 8 July: 45-9.

Gamlin L. Another Man's Poison. New Scientist 1990: 15 July: 48-53

Knicker W. Non-IgE Mediated and Delayed Adverse Reactions to Food Additives. Handbook on Food Allergies, Ed.
Breneman J.C.; Marcel Kekker Inc. N.Y 1985.

Brostoff J. Mechanisms: Food Allergy and Intolerance: Balliere Tinbdal. l987 and Implications Of, Passage of Intact Peptides Across the Intestinal Mucosa. Bioche. Soc Trans 1983; 11:813.

Reinhardt M.C. Macromolecular Abosrption of Food Antigens in Health and Disease. Ann Allergy 1984: 53: 597-601

NcNeish A.S. Enzymatic Maturation of the Gastrointestinal Tract and its Relevance to Food Allergy and Intolerance in Infancy. Ann Allergy 1985: 53: 643

Coombs, R.R.A., McLaughlan P. Ann Allergy 1984: 53: 592

Rowe, A. J. Allergic Toxemia and Migraine Due to Food Allergy. Calif West Med 1930; 33: 785

Randolph T.G. Allergy As a Causative Factor in Fatiuge, Irritability, and Behavior Problems in Children J. Pediat 1947:: 31: 560.

Speer, F. THe Allergic-Tension-Fatigue Syndrome. Pediat Clin N. Amer 1954; 1: 1019

The Allergic-Tension-Fatigue Syndrome: Allergy of the Nervous System. Charles C. Thomas Pub. 1970: 14-27

Strauss, S.E., Dale J.K., Wright R.N., Metcalfe D. Allergy and the Chronic Fatigue Syndrome, J. Allergy CLin Immunol 1988: 81(5,1): 791-795

Gislason S.J., Nutritional Therapy 1991: Personal Publ 200 1601 Yew St. Vancouver, BC.,V6K 3E6 (604) 731-5898

Hilgers L.A.T. et al. Immunomodulating Properties of Amphilic Agents, Auto-immunity and Toxicology 1989: 293-306
Elsvier Science Publ.

Reprinted from the MEssenger May 1992, Volune 4, Issue 4 which was reprinted with permission by Dr. S. J. Gislason and Environmed Research Inc., 200 1601 Yew St., Vancouver, B.C. V6K 3E6.

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