General Precision Point Diagnostics July 3, 2024

Food sensitivities now, could mean dangerous falls when elderly.

We’ve known for quite some time that inflammation is a killer. Acute inflammation from trauma, disease, and allergies can shut down organs or shut off your airway. Chronic, systemic inflammation can often begin in the gut and spread throughout the body through various pathways. This chronic inflammation can be the origin of autoimmune disorders, diabetes, heart disease and cardiac events, and perhaps even various brain afflictions like Parkinson’s and Alzheimer’s. Inflammation triggers oxidative stress, and oxidative stress can also cause inflammation through other pathways. Strong medical and scientific evidence points to oxidative stress as an underlying contributing factor to heart disease, neurodegenerative conditions, cancers, and toxicity. Over half the people who die do so from a chronic inflammatory condition: heart disease, cancer, diabetes, infections, autoimmune diseases, and many other potentially terminal conditions involve inflammation- either as the primary or contributing cause of death. Beyond terminal conditions, inflammation can cause nearly untraceable silent suffering as it causes a myriad of symptoms that can be hard to trace but that can come to dominate a person’s life.

Inflammation doesn’t just affect the organs, but many other systems in the body. If inflammation becomes chronic, it acts insidiously and silently to cause stress on everything from your eyes to your muscles and joints. Since inflammation and oxidative stress go hand in hand, and both have independent channels of action, there are numerous ways that various bodily systems can be affected by inflammation and oxidative stress. Inflammation tends to increase as we age, and we are discovering more and more that many effects of aging are actually effects of inflammation and oxidative stress. One reason is because of how chronic inflammation impacts the immune system. When inflammation becomes chronic, it can confuse the immune system, and in a worst-case scenario, can trigger an autoimmune disease, which is a condition where the body attacks itself. Allergic conditions can trigger autoimmune diseases by causing the body to mount an overly aggressive response to particles that the body senses as invaders. One side effect of immune response is inflammation. The risk is that the inflammation becomes chronic, or even triggers the autoimmune response.

Food allergies (IgE reactions) work the same way. The immune system mounts a response when it senses the presence of foods that are triggers and attacks them, again causing inflammation. If you don’t avoid these foods, over time you risk the inflammation becoming chronic as you train your immune system to overreact. Luckily, with a food allergy, it’s often easy to spot when a food is affecting you. IgE reactions tend to happen very quickly, within 20 minutes, and cause symptoms that are very distinct and noticeable- hives, swelling, difficulty breathing, feeling light-headed. If you eat an oyster, and these symptoms occur, you’re not likely to eat another oyster anytime soon. IgE reactions to food are allergic reactions, which means you have a food allergy. You can also have food sensitivities, which are IgG reactions. 

IgG reactions to foods also are immune responses, but they take far longer than IgE reactions to manifest themselves. An IgG reaction can take up to 72 hours to happen, and since it takes so long it can be very hard to identify which food is causing the reaction. In fact, it’s likely that a patient wouldn’t associate the reaction with a food at all. This is true not only because so much time has passed between consuming the food and the reaction, but because IgG reactions have very different symptoms than IgE reactions. IgG reactions can cause things you might associate with food, like gut cramping, diarrhea, constipation, etc., but they can also cause symptoms that aren’t likely to be associated with trouble from food. These other symptoms include things like headaches, brain fog, disruptions to sleep, tiredness, lack of energy, memory issues, skin conditions, etc. These types of symptoms are often hard to trace, hard to describe to a doctor and can leave patients lost and confused. The P88 DAT from Precision Point Diagnostics tests both IgE and IgG, along with IgG4 and C3d.

Since the symptoms of food sensitivities can go unnoticed as such, they can persist for years if no action is taken. Because of this, food sensitivities are a path to chronic inflammation in the body. When the gut is chronically inflamed, the cells in the intestinal walls can be damaged by this inflammation, which loosens the tight junctions between these cells. The loosening of these tight junctions (known as “leaky gut”), allows food particles, bacteria, and other substances into the bloodstream, triggering inflammation in other parts of the body. This gut inflammation pathway is through the release of zonulin. Zonulin is a protein that increases the permeability of tight junctions between cells of the wall of the digestive tract, meaning that its release perpetuates a leaky gut. When zonulin is released, it changes the permeability of intestinal epithelial cells by regulating the state of tight junctions. Increased intestinal permeability can lead to abnormal activation of intestinal mucosal immune and bacterial translocation, which can  then induce systemic inflammation. In other words, bacteria can spread throughout the body causing inflammation elsewhere, including muscles and other organs. This is why a patient can feel achy and tired, have brain fog, and just feel bad overall from food reactivity. If a patient has high zonulin levels, we know that that patient likely has a leaky gut and therefore may very well have chronic, systemic inflammation. Precision Point Diagnostics offers a test that can assess zonulin levels, and alert the patient to the damage being done before an autoimmune condition is possibly triggered. 

Since many systems of the body are impacted by chronic inflammation, which often stems from the gut, and in which food sensitivities can play a major role, there are systems that are impacted that we may not think much about but can play a critical role in our health, especially as we age. One system impacted by chronic inflammation is the inner ear.

Many patients think of the system that makes up our ears as only necessary for hearing. Aside from this, though, the inner ear is the locus of our balance and sense of orientation to the world. The human labyrinthine system, also known as the vestibular system, is a complex structure located in the inner ear that plays a crucial role in maintaining balance and spatial orientation. It allows us to sense body movement, direction, acceleration and helps us attain and maintain postural equilibrium. The labyrinthine system detects different types of movement through specialized motion-sensitive receptor cells. There are three receptors for head rotation, another for horizontal acceleration, and one for vertical acceleration (or gravity). These receptors are excited when their hair-like projections are pushed in a particular direction by a fluid called endolymph. The brain uses signals from these organs to control our muscles and maintain our posture. Malfunctions of the labyrinthine system can lead to symptoms like jumpy vision with head movements (oscillopsia), chronic imbalance, difficulty recognizing faces during movement or walking, difficulty focusing on objects while quickly turning the head, and the risk of falls

People take for granted just how fundamental the inner ear is for our ability to negotiate the world. So how does inflammation impact the inner ear? “Although this is a new area, research has linked inflammation to multiple vestibular diagnoses including vestibular migraine, benign paroxysmal positional vertigo, Meniere’s Disease, vestibular schwannoma, and persistent postural perceptual dizziness.” (Emily Kostelnik, Ph.D, in a blog for the Vestibular Disorder Association). It’s thought that inflammation can destroy the small hairs in the inner ear that interact with the fluid and that it might also alter the function, quantity, or composition of that fluid. While this inflammation can damage the inner ear and cause such impacts as loss of balance, ability to orient, and migraines, it can also possibly lead to full-blown vestibular disorders like Meniere’s disease. This disease means there is permanent damage to the inner ear to the extent that patients experience vertigo, frequent migraines, spatial dislocation, inability to judge speed and acceleration correctly, and many other symptoms. Experiencing these symptoms can profoundly affect your sense of well-being and ability to function well in the world. Imagine the difficulty is driving, performing complex tasks, sleeping, exercising, or even just getting through the day safely.

It’s thought that as we age we become more prone to vestibular damage: “The world’s age-related health concerns continue to rise. Audio-vestibular disorders, such as hearing loss, tinnitus, and vertigo, are common complaints in the elderly and are associated with social and public health burdens”. In fact, it may very well be that the reason the elderly experience vestibular damage and even some hearing loss is because of long-term chronic inflammation: “Audio-vestibular dysfunction develops and progresses as a result of age-related inflammation and oxidative stress.” This means that anything that can be done to assess and address inflammation and oxidative stress gives you a yardstick that allows you to formulate a plan of action through diet and lifestyle changes. Just as we offer a test to assess zonulin, Precision Point Diagnostics offers a comprehensive test to assess oxidative stress

So what sort of impact beyond the development of full-blown Meniere’s disease can occur with inflammation-induced vestibular disorders? Dizziness, imbalance, spatial confusion, lightheadedness, and mild vertigo, all sometimes accompanied by migraines or other headaches are common. These conditions are found in higher concentrations in the elderly, and again, can stem from impacts to the vestibular system. “Age-related hearing loss (ARHL) and age-related vestibular loss (ARVL) are common conditions that have deleterious consequences on patients’ health and quality of life among the elderly population, and peripheral vestibular dysfunction is one of their most common causes. Age-related vestibular loss, also known as presbyastasis or presbyequilibrium, commonly occurs during the normal aging process; however, in contrast to ARHL, few studies have reported its prevalence. A population-based study in the United States reported that 24% of people over the age of 72 years experienced dizziness.” This is particularly concerning since the elderly are the fastest-growing segment of the population worldwide. By 2030, 20% of the world population will be over 65, and that will be higher in industrialized countries like the United States.

Dizziness can impact the quality of a patient’s life, but can also accelerate the risk for accidental death, particularly amongst the elderly: “Dizziness and imbalance are associated with an elevated risk of accidental falls and injuries. According to the National Institute of Deafness and Other Communication Disorders of the National Institutes of Health, falls account for over 50% of all accidental deaths among the elderly.” The CDC reports that “Falls are the leading cause of injury for adults ages 65 years and older. Over 14 million, or 1 in 4 older adults report falling every yearFalls are the leading cause of fatal and nonfatal injuries among older adults.” That’s a lot of falls, and even if they don’t immediately result in death, an injury such as a broken hip is likely to result in a long stay in the hospital followed by decreased mobility, future falls, or even eventual death- those deaths aren’t counted among accidental deaths. Aside from the injuries themselves, falls lead to psychological impacts amongst the elderly. For some, their first major fall marks the end of their independence and sows doubts in their (and others) minds about their competence. In addition to those who are injured, the CDC reports that In 2021, approximately 38,742 older adults died as a result of unintentional falls in the United States. There is certainly a correlation between vestibular disturbance and falls among the elderly.

Can vestibular disturbance really result from inflammation and oxidative stress? “Aging induces inflammation and oxidative stress and affects microcirculation throughout the body. Chronic inflammation is observed during aging and has been linked to ARHL and ARVL severity. Furthermore, ARHL and ARVL development has also been largely influenced by genetic and environmental factors such as eating habits and lifestyle. Diet has been documented to heavily influence hearing and balance status since it can mediate age-related changes in the inner ear by modulating systemic inflammation.” In other words, there are several things that cause inflammation that affect the inner ear, including normal aging, genetics, and environmental factors- but diet heavily influences that inflammation. Why is that? What is it about the diet that specifically makes a difference? Various diets have been evaluated for their effects on inflammation, and high fat/high cholesterol diets, high carbohydrate diets, high caloric diets, and high sugar diets have all been found to be inflammatory, while a Mediterranean diet was found to be least inflammatory.  No real surprises there. There’s another factor that could have an even more profound effect on inflammation that affects the vestibular system- food sensitivities.

Although this has not been investigated causally yet, there are signs that definitely point in that direction. To start with, we’ve already detailed how food sensitivities can trigger systemic inflammation. In addition, because they are so hard for a patient to accurately spot on their own, unlike allergies, a patient might continue to consume the irritant for years and create chronic inflammation throughout the body that originated in the gut. In addition to that: “A report from the renowned House Ear Institute in Los Angeles compared the prevalence of allergic conditions in their patient population with Mènière’s Disease to those without Mènière’s Disease. In patients with Mènière’s Disease, nearly 60% reported possible airborne allergies, 40% suspected food allergies, and 37% had had positive allergy tests. When the prevalence of these allergic conditions was compared to patients without Mènière’s Disease, allergic conditions were significantly more prevalent in patients with Mènière’s Disease.” Let’s break that down. Remember that Mènière’s Disease is a serious disturbance of the vestibular system. The percentage of patients with the disease who also have a suspected environmental or food allergy is far higher than that in the general population. The number of those with a confirmed allergy is also higher than those in the general population as a percentage. Clearly, environmental allergies are a problem and should be tested- particularly if a patient has any vestibular symptoms. A comprehensive environmental allergy test should be done with a blood draw, rather than with pricks on the back. Although the prick test is immediate, it isn’t as complete.  As for the reported food allergies, it’s certainly true that food allergies themselves can cause inflammation and you should consider testing for them. However, many people conflate food allergies and food sensitivities. They aren’t the same reaction, but since there is a reaction, many people describe food sensitivities as food allergies. Given what we already know about the difficulty in tracing food sensitivities without a test, we should take the word “allergies” with a grain of salt and include food sensitivities in the mix- particularly since we know how they can trigger inflammation systemically. 

If a patient doesn’t already have vestibular disturbances, is it worth doing all of this testing? Yes. Everyone who ages is likely to become more inflamed, The question is to what degree. How one ages has become even more important than will one age. Death rates have generally remained fairly stable for decades (with a few exceptions)- the question is how well you age. Being affected by vestibular disorders, or other systemic impacts of chronic inflammation is not a pleasant way for a patient to spend their twilight years- not to mention the increased risk of accidental risk.

If a patient is already older or has vestibular disorders, including Mènière’s Disease, given everything that is going on, is it worth it to take these tests? Again, yes. The Vestibular Disorder Association states: “A recent review of the evidence connecting allergic conditions and Mènière’s Disease suggested that there is credible data to suggest patients with Mènière’s Disease may have an enhanced allergic response. While the authors could not conclude that there is a causal association between allergies and Mènière’s Disease, they argue that practicing the principles of allergy control is a safe, relatively inexpensive adjunct to typical medical management.”

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