In his third of five lectures, Dr. Cady reviews the concepts of food allergy testing with IgG and IgE antibodies, traces the development of this body of knowledge from the 1960's, and reviews two illustrative cases.

1. New Adventures in Food Sensitivity
Testing and Treatment
Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute
Adjunct Assoc. Professor – Indiana University School of Medicine
Integrative Medicine for Mental Health
Conference
Santa Fe, NM September 22, 2012

2. “There are two objects of medical education: to
heal the sick and to advance the science.”
- Dr. Charles H. Mayo, MD
“The glory of medicine is that it is always moving
forward, that there is always more to learn.”
- Dr. William J. Mayo

3. Is this any way to take care of the
health of a nation?
3.4 * 10 9 3.1 * 10 8 • 3.4 billion prescriptions
Rx Peeps are written every year 1
3.4 Billion • 307 million people in US2
Prescriptions
• $630 billion to top 12
307 pharmaceutical
million companies (profits!) 3
People
• The majority are due to
“silent syndromes” and
modifiable disease risk
factors.
1. Ukens C. How mail order pharmacy gained in market share in 2003. Drug Topics Mar 22, 2004; 148. 2. U.S.
Census Bureau, Jul 2009 3. CNN Money, May 3, 2010; http://money.cnn.com/magazines/fortune/
ortune500/2010/industries/21/index.html accessed August 17, 2011

4. Triadic model of thinking about
diagnosis or treatment puzzles
• PSYCHODYNAMIC - what makes a patient
the way he/she is?
– (what makes them act &/or respond as they
do?)
• FUNCTIONAL - what are some of the
underlying physiologic processes which
may be pathogenic?
• IMMUNOLOGIC - what are the subtle
manifestations of food allergies &
sensitivities?

5. How not to get overwhelmed in this presentation:

6. Stanley E. Greben, MD
• Some therapists stand out as uniquely
effective.
• Academics are no better.
• “Every potential therapist must have a floor
and a ceiling to his therapeutic capacity.”
• Some gifted therapists are able to say why
they succeed; others can’t explain it. “A
great deal of what they do ‘right’ is intuitive.”
“On Being Therapeutic” [Canadian Psychiatric Association
Journal. Vol. 22(1977) 371-380.

7. Greben’s “Seven Habits”
• Empathy & concern
• Warmth
• Interaction
• Ability to arouse hope
*
• Expectation of improvement
• “Not to despair”
• Reliability & Friendliness
*Requires clinical depth and breadth of knowledge

8. Psychodynamics 101
• Patients can be vexing.
• Diagnostic impasses provoke narcissistic angst.
• Frustrated clinicians do not relate well with
patients.
• The more tools and capabilities one has, the
greater the freedom, the options, and the ability to
positively impact the patient.
• The greater the success, the better the patient
feels, the doctor feels, and the doctor-patient
relationship feels.
• The converse, worrisomely, also exists.

9. IMMUNOLOGY
The forgotten component
of “workups”

10. "What is
food for
one, is to
others bitter
poison.”
Lucretius – 099? B.C.
– 055? A.D.
De rerum natura.

11. “The Three Little Ig’s & Three Stories”
• Ig E xciting
oing along
• Ig G
norant
•Ig

12. IgE Antibodies: catastrophic reactions vs. sneezes
and itching (checked via skin tests or RAST)
http://pathmicro.med.sc.edu/ghaffar/skintest.jpg

13. CELLULAR immunity
http://users.rcn.com/jkimball.ma.ultranet/B www.souzaoenterprises.com/A
iologyPages/M/MastCell.gif llergiescomp.jpg

14. HUMORAL Immunity
“Globulin molecules
capable of attacking the
invading agent.” [Guyton]
This model of human IgG1 was created
by E. A. Padlan -- "Anatomy of the
Antibody Molecule." Molecular
Immunology 31:169 (1994)

15. Actions and downstream effects
• Direct action of antibodies:
– Agglutination, precipitation, neutralization,
lysis
• Downstream effects: complement
activation:
– Lysis, opsonization/phagocytosis, chemotaxis,
agglutination, neutralization of viruses,
INFLAMMATORY EFFECTS

16. ADHD Diagnosis
– Symptoms present before
age 7 years
– Impairment from symptoms
present in 2 or
more settings
– Significant social,
academic, or occupational
impairment
– Exclude other mental
disorders

17. From:
www.patientmedia.com
(used with permission of
William Esteb)

18. Food Allergies and ADHD in the Literature
•Food allergies presumed to be related to ADHD
• Get “THE THINKER” illustration
•Before 1976 – No known relationship between FA and ADD
•1976 – IgE reactivity + food allergies = decreased IQ
•1985 – d/c of antigenic foods = ADHD improvement
•1993 – more confirmation
•1994 – some kids that got better on diet did NOT have IgE
reactivity
•2003 – evidence mounting for non-IgE sensitivities related to food
allergies]
•2002 – 2011 Pelsser LM et al – SIX published papers (European
and Dutch literature, cf: www.pubmed.gov).
•66 papers, at present – 8/19/2011

19. Millman, et al – the groundbreaking
article
• “Allergy & Learning Disabilities in Children” – Annals
of Allergy, 1976 [36:3, 149-160.]
• “The allergic tension-fatigue syndrome observed by Speer”
– “A symptom complex accepted by many allergists.”
• Food allergies established by scratch testing or intradermal
injections
• Positive correlation between [IgE] food
allergies and IQ scores.
– The more the food allergies, the
lower the IQ scores.

20. Oligoantigenic diet (w/o testing)
• “Controlled trial of oligoantigenic treatment in the
Hyperkinetic Syndrome.” Egger et al. Lancet,
March 9, 1985, 540-545.
• No testing performed
• Children empirically placed on restrictive diet.
– Two meats, two carb sources, two fruits, one vegetable,
water, calcium, vitamins.
• No food allergy symptoms were provoked; ADHD
improved.

21. The crossover study – no
distinguishing between IgE and IgG
• “Effects of a few foods diet on ADD.” Carter et al, Archives
of Disease in Childhood, 1993;69:564-568.
• “Few foods” elimination diet
– 59 of 78 children improved.
• “This trial indicates that diet can contribute to behavior
disorders in children and that this effect can be shown in a
double blind, placebo controlled trial.”
• “The ways in which [this] diet worked remain
unclear. Toxic pharmacological, or allergic
mechanisms could be involved, and the
physiological effects of different foods may vary.”

22. Profound cautions
• “Effects of a few foods diet on ADD.” Carter et al, Archives
of Disease in Childhood, 1993;69:564-568 (cont.)
• “The treatment, as applied in this study, has
disadvantages. It is a difficult and exacting
regimen, which puts a considerable strain on
the whole family. It is not yet clear whether modified
diets can also be effective…. It may therefore be possible
to devise a less restricted diet with similar levels of
success.”
• Cady impression: “Shooting in the dark is dangerous.”

23. The appearance of IgG
• “Foods and additives are common causes of
ADHD in children.” Boris, et. al. Annals of Allergy,
vol.. 72, 1994, 462-468.
• “DBPCF” - “double blind placebo controlled
food challenge test”
• 4/19 children who showed improvement
with removal of offending foods were non-
atopic.

24. “IgE and Non IgE Food Allergy”
• Sabra, et al. Annals of Allergy, Asthma, and
Immunology 2003;90 (Suppl 3)71-76.
• “The gastrointestinal tract serves not only a
nutritive function but also is a major immunologic
organ. Although previously thought to be triggered
primarily by an IgE mediated mechanism of injury,
considerable evidence now suggests that non-
IgE mechanisms may also be involved in the
pathogenesis of FA (“food allergy”).

25. The patient: “Billy”
• 8/1998 – 4 yo Eastern European adopted
child – “ADD & behavioral problems,
destructive.”
– First 3 years of life in orphanage
• Fam Psych Hx:
– Dad – “substance induced paranoid psychosis”
– Mother – “recurrent schizophrenic
decompensations”

26. Billy’s symptoms
• “Mercurial” – easy to get along with (except for
hyperactivity) then one week at a time will be
glowering, sullen, terrible mood, knock brothers
over, throw food from table, etc.
• MSE – very hyper. Not able to focus on Nintendo
(!) Found standing on top of a box in my video
room, supervised by his Dad. DSM-IV: 5/6
• Previous trial of Rx: Adderall 5 mg up to 10 mg.
Made him much worse
• ….started on Ritalin and Clonidine

27. Billy, cont.
• Some improvement
• 3/1999 – increasingly vile temper. Sad, dysphoric.
“Back to square one.”
– Zoloft added.
– Ritalin only lasting 1 ½ hours
• 5/1999 - 4 ½ yoa. Rehab Center testing:
– Auditory comprehension = 2 y 11 mo’s
– Total language = 2 y 11 mo’s
• 6/1999 – Flaxseed oil, L-tyrosine, Pediactive tabs
added. In constant trouble Dad getting
depressed.

28. Billy, cont – 1999 - 2000
• Ritalin and Adderall not working
• Temper to the point of clawing at his face.
Sniffing. Now urinating in bed.
• 12/1999 – started on Risperdal – 1mg in a.m. and
½ mg later in day
• 2/2000 – Psych testing – IQ 78
– ADHD
– Borderline intelligence
– Processing problems
– “r/o childhood psychosis”

29. Billy, cont.
• 3/2000 – Depakote added to Risperdal for temper
and “bipolar” feel. Now doing even worse.
Staggering some.
– DSM IV 6/7
– Risperdal, Tenex, Zoloft, Depakote, Ritalin SR (@ 6
yoa!)
• Summer – Concerta tried. Seemed to respond,
then “downhill trend before school started.”
• 10/2000 – “staring spells.” Cleared by neurologist.
Negative EEG.
• Mayo suggested; insurance wouldn’t pay.

30. Billy, late 2000
• Fall 2000:
– Bit and stabbed his teacher with a pencil, kicked
chair, wall, and desk, spat on floor and teacher.
Obsessively lining up his cars in his room, tongue
thrusting and smacking (? Tardive dyskinesia?)
• On Risperdal, Depakote, and Concerta.
• 8/2001 – 2002 some better but still
unpredictable. Meltdowns. Depakote increased.
Zyprexa added.
• 8/2002 – throwing things against windows.
Depakote not working. Mood cycling.

31. May 2002: 9th Annual IFM Conference

32. Billy, 2003
• Ongoing unpredictability until Geodon
started.
– Less hyper
– Dry in a.m.
– Clearer speech and better eye contact.
• July 2003 – IgG food allergy testing ordered

33. Billy – IgG Food Sensitvities
July 2003
• 21 + IgG reactions.. Of these…..
– Cheese (3+)
– Cow’s milk (3+)
– Goat’s milk (2+)
– Brewer’s yeast (3+)
– Millet (+1)
– Lettuce (!) (+1)
Reviewed labs with internet savvy Mom (who did NOTHING).

34. Billy, 2003 - 2004
• Variable. Food sensitivity diet not really followed.
• 9/2003 “absolutely cannot sit still. Moods are
flipping. Gets angry and aggressive really fast.”
• 12/2003 – no better
– On Depakote, Geodon, Concerta, Clonidine
– 1/2004 – VPA level 122 ug/ml; {50 – 100}
• 3/2004 - “An incredibly nice kid when he’s doing
what he wants to do; an asshole when it comes to
relating.” (per Dad)

35. June 7, 2004 – 6 years of
tx; ONE YEAR AFTER
IgG Testing!
• “Literally bouncing off the walls in the a.m.”
• Almost knocked brother off second floor balcony
• Could not tolerate < 2 g VPA
• Threw stool over banister and tried to hit Mom on
way up stairs. (Missed)
• Told Mom: “You’re going to die, I’m going to
make sure you’re going to die.”
• Things that make him angry: not putting peanut
butter sandwich on plate “correctly.”
• Waking up screaming. Making non-human,
guttural sounds.
• Parents pursuing IP treatment

36. Radical interventions/ workup
• June 2004 – Lithium added
– Made him briefly toxic but symptoms improved.
– Worked on getting him inpatient tx.
• Fatty acid panel ordered.
• Told Mom to GET SERIOUS
about food allergies/sensitivities

37. Clinical manifestations of EFAD
• Dermatitis • Thirst, polydipsia,
• Increased appetite and polyuria
caloric intake in infants • Liver fatty infiltration
(adults?!) • Increased capillary
• Failure of wound healing fragility
• Irritability • RBC fragility
• Alopecia, dry hair, dandruff • Increased
• Brittle nails Cholesterol/HDL ratio
• Increased susceptibility
of infections

38. Essential Fatty Acid findings
Value Reference range
EPA 3 (L) 20 - 80
DHA 32 (L) 70 - 150

40. FEB
2005

41. Billy – May 3, 2005
• Stable. Has stopped sneaking food.
• IgG restrictions: wheat, gluten*, cow’s milk, processed
sugar. (Able to tolerate unprocessed cane sugar.) All
forms of chocolate and caffeine.
• Drinks: homemade lemonade, soy or rice milk
• Doing a music program at school. “Learning songs he
never could before.”
• MEDS: Levocarn; 72 mg Concerta, “DHA heavy” fish oil;
20 mg Geodon (1/2 the previous)
– Eliminated: Lithium, Risperdal, and Depakote
• Prognosis: excellent. Still with cognitive challenges, but
making progress at school and beginning to catch up.
Behavior is stable. No more mood swings or rages.
* Note – not originally seen on testing.

42. Billy – June 23, 2009
• Stable. Teenager. “Doing well except when his will is
crossed.”
• IgG restrictions: wheat, gluten, cow’s milk, processed
sugar. (Able to tolerate unprocessed cane sugar.) All
forms of chocolate and caffeine.
• More verbal: of CWI therapy pet, he comments, “This
dog doesn’t growl; he likes people.”
• MEDS:
– “DHA heavy” fish oil twice daily
– MVI in a.m
– Vyvanse 70 mg, booster MPH in the afternoon; Risperdal 0.5 mg
twice daily, VPA 500 mg ER twice daily .
• ADHD symptoms:
– zero – inattentive symptoms
– ONE – hyperactive/impulsive symptom

43. Status: August 17 2011
• “He’s doing great.”
• Failed attempts to wean off of IgG food allergies.
– Apples have been added occasionally
– Still can’t do dairy, gluten, citrus, or bananas.
• H.S. sophomore– one year behind (in special ed.)
classroom.
• Getting along well with siblings; has not
progressed past 1st grade academically, but visual
spatial talents excellent.
• Landscaped the entire back yard. Moved 8 tons of
rock

44. FROM HYPERNESS TO
HEADACHES
…and joint pains,
migraines, brain fog,
irritable bowel
syndrome, asthma,
fatigue, misc. aches
and pains

45. www.pubmed.com search September 1, 2012
Correlations found between food allergy & :
• Depression
• Anxiety
• Acute psychoses
• Autism
• Schizophrenia

46. Gluten – one of the ultimate “bad
boys” in food sensitivities
• Headaches
• Tearing up your gut
• Depression
• Suicide*
– * Untreated celiac
disease and
attempted suicide.
Lancet, September
1995. Pelligrino et al

47. Gluten and neurologic disease
• “More recent studies have emphasized that
a wider spectrum of neurologic syndromes
may be the presenting extraintestinal
manifestation of gluten sensitivity with or
without intestinal pathology.”
– -Bushara, KO. Neurologic presentation of
celiac disease – Gastroenterology. 2005 Apr;
128(4 Suppl 1):592-7.

48. “UBO’s on MRI” – the gluten
connection
• 10 patients – had headaches.
– MRI
– UBO’s
• 6 – unsteady, 4 gait ataxia
• 90% response rate to gluten free diet.

49. Observant pediatricians and
depressed parents – with celiac dz

50. Corvaglia, et al 1999
• 3 adult patients found with undiagnosed/untreated
celiac disease
• Found by pediatricians who noted family history
when child’s medical history obtained.
• Celiac disease diagnosis was MADE in childhood,
but diet was stopped due to no more GI
symptoms.
• In all three patients, depressive symptoms
improved with gluten free diet.

51. Does it have to be celiac/gluten to
mess up your head?
-Migraine has high prevalence – 18%
-Allergen-specific IgG in serum of patients
REFRACTORY TO TRADITIONAL TREATMENT
examined.
-IgG antibodies obtained to 108 food allergens measured in
56 patients with migraine and a control group.
-Statistically significant differences found between
migraine group and control group in number of food
allergies.
Answer: NO!
-CONCLUSIONS: “ACCORDING TO THE RESULTS
OBTAINED, serum IgG Antibodies to common food
should be investigated in patients with migraine.”

52. What to be looking for…
• Obvious GI problems
• Chiro adjustments don’t
“hold.”
• Atypical presentations
• KNOWN associations
(autism)
• Symptoms varying with diet
• Excess ABX use (candida)
• Lack of normal progression
in treatment

53. Just one more: Joey - 6/28/11
• 11 year old male 5th grader with dx of ADHD and
Speech Apraxia; problems with reading, writing, oral
expressive language, math, sequencing
• Medical:
– Hx of “lazy bowel”
• “He doesn’t go more than once in two weeks.”
• Dietary: likes cheese, chicken nuggets, ice cream, Coke, pizza.
Used to like cottage cheese.
– GI sxs refractory to pediatric interventions
• Dx 1: ADD: 6/9 sxs of inattentiveness ON RX.
• Dx 2:“Probable severe IgG food sensitivity with
obvious stool retention problems”

54. Dairy IgG sensitivity suspected.
Testing/Results:
• Pediatrician ordered IgE RAST = NEGATIVE
• 7/25/11 – no change. 2 BM’s in one month.
– IgG Testing previously ordered. (Mom resistant
and delayed due to cost. Finally done after this
appt). RESULTS:
• Milk – SEVERE
• Mild: green peas, pinto beans, corn, garlic, tomato,
wheat
• 8/15/11 - constipation and fecal retention
totally eliminated.

55. What I learned; what we can learn
• Think about “the matrix” first.
• Functional and immunologic inquiry and
stabilization is a prerequisite for improvement in
some cases.
– (“You can’t tell by looking.”)
• Psychodynamic errors (“blaming the patient”) can
sabotage miraculous progress.
• The human body has marvelous ability to heal
itself naturally if given the breathing room to do so.

56. Diagnostic challenges & IgG food
sensitivities - opportunities exist
• “Tough cases”
• Weird, multiple symptoms
• Headaches
• GI symptoms, food cravings, or both
• ADHD and “bipolar” type symptoms
• Processing issues (no pills available!)
• Headaches resistant to standard
chiropractic and medical tx
• Fatigue, “brain fog”, temper fits

57. $3,000 vs. $5,500 – casket
and funeral included
Don’t be a commodity. Acquaint yourself with
diagnostic testing available to you.

58. Personal collection - Louis B. Cady, M.D.

59. Contact information:
Louis B. Cady, M.D.
www.cadywellness.com
www.indianaTMS-cadywellness.com
Office: 812-429-0772
E-mail: lcady@cadywellness.com
4727 Rosebud Lane – Suite F
Interstate Office Park
Newburgh, IN 47630 (USA)