Strong Reactions

The kids are not all right. Last week, Karen Bishop, a 35-year nurse and specialist in what she calls food allergies, showed me pictures of children with frightening and photogenic problems. One was giving the photographer the finger. Another was cowering in a corner, his head on the floor. A third was making what Bishop called "the demon face." He looked like he needed an exorcist, not a doctor. "The child had just eaten a potato," she explained. Bishop specializes in a controversial area of alternative medicine: food allergies. Not the kind that close your throat, send you into anaphylactic shock or cause other life-threatening crises within minutes of eating a nut or a plate of shrimp. Bishop's work casts a much wider net of common, modern-day symptoms, from bowel trouble to depression to "brain fog," all of which, she says, can be attributed to eating the wrong food. "These foods don't kill you," Bishop said. "They just cause fatigue, body pain, diarrhea, eczema, these kinds of things." The horrible kid pictures were from Bishop's well-bookmarked, dog-eared copy of Doris Rapp's book, "Is This Your Child's World?" In the book, Rapp says the wrong foods are making children "hyperactive, asthmatic, disruptive, and prone to colds and learning disabilities." Rapp attributes 70 percent of ADD and ADHD diagnoses to food. Bishop called such allergies, in both kids and adults, "cyclic" or "addictive." A favorite food packed with wheat, cheese, sugar or something else that's tasty and bad for you will cause a morphine-like feel-good reaction, followed by a wave of unpleasant symptoms. Good nutrition and healthy weight figure into her practice, of course, but Bishop is not a nutritionist. In 18 years of treating food allergies, she has zeroed in on a most-wanted-list of guilty foods she believes cause most of her patients' nagging health problems: wheat, corn, sugar, dairy, and, to a lesser extent, soy and rice. These — and potatoes. It seems harsh to beat up on the humble potato, but the notion that spuds can do evil isn't new. In Charles Dickens' "A Christmas Carol," Ebenezer Scrooge hallucinated that he saw his dead partner, Jacob Marley, and called him "a fragment of underdone potato." Bishop's favorite client story happens to be potato-based. She spent a few hours one afternoon with a nice gentleman, testing his sensitivities to various foods. "He was very enjoyable until I gave him a potato," Bishop said. That is to say, she gave him a dose of potato juice via needle to test his reaction. This kind of testing is called "provocative" because it's meant to provoke a reaction. Can you say Incredible Hulk? "His eyes flashed and he got incredibly angry," she said. "When I asked him how he felt, he said he wanted to stand up and throw the chair across the room." Bishop told the man he had an allergy to potatoes. Upon reflection, the patient realized that he had stormed away in a huff from many a family meal of meat and potatoes. Two years later, in Bishop's account, the man's son started seeing her as a patient. He told her his dad stopped hitting him after he stopped eating potatoes. Bishop can tell you a lot of emotional stories of food allergy miracles. She went into the food allergy field under the influence of her former boss, Dr. Douglas Wacker, an ear, nose and throat specialist and chief of surgery at Sparrow Hospital, who died last year. Wacker was diagnosed with fibromyalgia in the 1990s. It looked like he would have to retire. "His hands swelled up so much he couldn't do surgery," Bishop said. "He couldn't stand in the surgical suite because his back hurt so much." Wacker began to research the link between food and pain. He started self-treatment by fasting for three days and then cutting out foods he was "allergic" to. His pain disappeared, Bishop said. She was so impressed, she started reading up and attending conferences on food allergies and decided to add it to her practice.  To get some perspective on all of this, I called Dean Sienko, former director of the Ingham County Health Department and a 30-year veteran in public health field. Sienko is now associate dean for prevention and public health at MSU's College of Human Medicine. Sienko suggested I talk with an allergist. "See what kind of reaction you get — no pun intended," he said. Allergies are not Sienko's specialty, but he offered a couple of observations. He has found that many people think they have allergies when they don't. "In public health, we used to be concerned about giving flu shots to people who had an egg allergy," he said. It turned out that people "overstated" their egg allergies. "We don't find many people we would not give a flu shot to because we were concerned about an egg allergy," Sienko said. Sienko was circumspect about using provocative testing for food allergies. "Broadly speaking, some of these alternative treatments lack a scientific basis," he said. I followed Sienko's advice and described Bishop's practice to Dr. Dave Gupta, a Lansing allergist-immunologist. As Sienko predicted, he had an immediate reaction. The word "allergy," Gupta said, has a specific meaning in traditional medicine. "Food allergies are life threatening," Gupta said. "They typically involve the skin, lungs or G.I. tract, and the reaction is fairly immediate. If people come in with mild symptoms, we would not consider that a food allergy." The subject of provocative testing is provocative as hell when you mention it to an allergist. "Oh, boy," Gupta said with a brief sigh. "I want to be diplomatic about this. In the alternative medicine world, they offer a lot of blood testing and provocative testing, but I am not aware of any valid studies in peer-reviewed journals that have proven this is helpful." Bishop does make extraordinary claims about provocative testing. To test for milk allergy, for example she injects a patient with milk proteins — the equivalent of three glasses of milk. (She uses a No. 1 needle, which she admits "stings like a bee sting." No wonder the potato guy wanted to throw a chair.) The first injection, Bishop said, "turns on" the symptoms, if any. After five minutes, she administers a second dose, weaker than the first. The symptoms start to fade within minutes, she said. "It's instantly an improvement. I tell kids it's magic," she said. Gupta didn't enjoy that story. He said people are eagerly searching for a test that can tell them what they should or shouldn't eat, but there is no such thing. "The best test is: What happens when you eat the food?" Gupta said. Being diagnosed with potato rage, dairy depression or wheat funk is an appealing way to simplify the shocks that flesh is heir to, but Gupta isn't buying it. "Most people are not walking around with undiagnosed food allergies," Gupta said. "Food allergies are usually pretty obvious." However, the questionnaire Bishop gives to new patients, to determine if they might have a food allergy, catches "most," if not "damn near all," people. (One question: "Do you crave sugar and have a 'sweet tooth'?" Another: "Do you crave certain foods and eat them quite often and would hate to give them up?") At times, it's hard to tell where a fuss over food allergies, as Bishop defines them, ends, and good nutrition begins. To play the devil's advocate convincingly, I downed a small potato and suggested to Gupta that if the result of Bishop's food allergy treatment— eating healthier — is getting healthier, what harm does the testing process do, even if it's bogus? "We're talking about health care dollars," Gupta said. "We're talking about putting a label on someone. That's where I really have a problem." Gupta said he spends a lot of his time de-programming people who think they can't eat potatoes anymore or dire consequences will follow. "They come to my office confused," he said. "We see this all the time. 'Can I still eat this food?'" Bishop pointed out, though, that once treated, people with sensitivities may indulge in problem foods again. Treatment consists of avoiding the offending foods for six months, allowing the body to heal and "lose its sensitivity." In most cases, the food can be eaten after that, but only once every four days, to avoid spiraling into the same old problem. Despite Gupta's objections to sloppy use of the word "allergy" and the dubious testing sessions, he does meet Bishop on one little semantic island. I asked them both if the term "food sensitivity" is acceptable to describe low-level symptoms such as fatigue, "brain fog" and such complaints. They both said yes. "If patients say they have fatigue or brain fog, or some other subjective symptom, a food may be causing that problem," Gupta said. "I recommend keeping a food diary and taking out one food at a time and seeing if they feel better." Here, too, Gupta and Bishop share a common ground. Both of them urge people to be conscious of what they eat and how they feel afterwards. Bishop asks her patients about a variety of symptoms, from congestion to bowel problems to skin problems, but her ace-in-the-hole question is startlingly simple: Do you feel worse after you eat? The answer, surprisingly often, is yes. Many patients say they feel sluggish or tired after a meal, and even ask: Doesn't everyone? If every day is Thanksgiving, and you ooze straight to the couch and pass out after dessert, that's a problem, whether or not you call it an allergy.