Food Sensitivities and Gut Imbalance

The clinical significance of IgG food testing was illustrated in an early article published by an otolaryngologist who reported that the majority of his patients had substantial health improvements after eliminating foods found positive by IgG food allergy testing. The study demonstrated a 71% success rate for all symptoms, achieving at least a 75% relief. Of particular interest was the group of patients with chronic, disabling symptoms, unresponsive to other intensive treatments. Symptoms most commonly improved (75%-100%) on the elimination diets included asthma, coughing, ringing in the ears, chronic fatigue, headaches, gas, bloating, diarrhea, skin rash and itching, and nasal congestion. The most common IgG food allergies were to cow’s milk, garlic, mustard, egg yolk, tea, and chocolate. A recent study reported that 93% of non-celiac, gluten-sensitive patients showed anti-gliadin IgG antibody disappearance after a six-month adherence to a gluten-free diet. The IgG disappearance was closely related to a significant improvement of both gastrointestinal and extra-intestinal symptoms. High IgG antibody levels have frequently been found in children with diabetes mellitus, Crohn’s disease, celiac disease, and in those considered to be obese. IgG food test results are often used to develop food antibody-guided exclusion/ elimination diets. The implementation of such diets has been shown to alleviate symptoms associated with nonceliac gluten sensitivity and food sensitivity-induced atopic conditions, reduce the frequency of migraine headaches, decrease the occurrence of diarrhea, decrease failure–to-thrive among children with cystic fibrosis, reduce symptoms of irritable bowel syndrome, improve rectal compliance, decrease stool frequency in Crohn’s disease, prevent seizures and hyperkinetic behavior in children with epilepsy, and ameliorate kidney function in glomerulonephritis. Food elimination diets also hold promise for the improvement of behaviors associated with attention-deficit hyperactivity disorder.

MosaicDX offers a more comprehensive measurement of total IgG antibodies to different food-based antigens and Candida, in contrast to many laboratories that only measure IgG4 molecules. IgG4 antibodies account for less than 6% of the total IgG antibodies, and testing for only IgG4 antibodies limits the clinician’s ability to identify foods that could cause significant clinical reactions in their patients.

The objective of IgG-mediated food allergy testing is to identify foods that can trigger multiple adverse reactions. IgG1, IgG2, and IgG3 antibodies can cause inflammation by creating large immune complexes or lattices that activate complement proteins. On the other hand, IgG4 antibodies to food antigens usually do not activate complement and therefore do not typically cause inflammation.

In an article by Kemeny et al., they emphasized the importance of measuring all subtypes of IgG antibodies. Their research found that patients with celiac disease had elevated IgG1 antibodies to gluten, but none had elevated IgG4 antibodies to gluten. However, elevated levels of IgG4 antibodies still indicate the presence of immune reactions against food antigens.

The immune system’s IgG response targets proteins, not lipids. Some individuals may wonder whether they can consume butter if they are sensitive to casein or soy lecithin if they are sensitive to soy. Trace amounts of the corresponding protein have been discovered during the extraction process for these components. However, the protein levels are generally low and not likely to cause issues. The majority of individuals can tolerate these trace amounts, but a few may not. For those uncommon situations, an elimination and reintroduction phase could aid in further examination. 

It can take as long as 6 months after eliminating a food from the diet for the IgG response to that specific food antigen to return to normal levels. If a person is not consuming the food, or has not done so in over 6 months, it is unlikely to trigger a significant immune response and will not appear as elevated on the test. A low reactivity to a particular food does not imply that the person can now tolerate it or that the food can be reintroduced safely. It only indicates that the person has been diligent in avoiding it. Conversely, if a person has avoided consuming a specific food and the test result shows positive, cross-contamination with structurally similar proteins in the diet is likely responsible. 

The following tests provide valuable insight into metabolism, nutrient needs, food sensitivities and metal toxicity.

• IgG Food Map with Candida + Yeast
• Heavy Metals Hair
• Organic Acids Test

Serum samples have a relatively stable nature and can be stored in a refrigerator for up to 30 days and in a freezer for six months. 

Almost all organic acids used for human testing are measured by a combination of gas or liquid chromatography linked with mass spectrometry. Organic acids are most commonly analyzed in urine because they are not extensively reabsorbed in the kidney tubules after glomerular filtration. Thus, organic acids in urine are often present at 100 times their concentration in the blood serum and thus are more readily detected in urine. This is why organic acids are rarely tested in blood or serum. The number of organic acids found in urine is enormous. Over 1,000 different organic acids have been detected in urine since this kind of testing started.

Dried Blood Spot samples have a relatively stable nature and can be stored in a refrigerator for up to 31 days and in a freezer for six months. 

Different samples have different expiration dates. In general, stool and blood (from blood draw) have shorter viability, and we would suggest that you collect those later than some other samples such as urine and Dried Blood Spot (DBS).

Please see list below for guidance on sample viability:

• Hair – No expiration date
• Buccal Swab for DNA Methylation – 2 months
• Saliva for Hormones Test – 2 months (frozen)
• Urine* – 30 days (frozen)
• Dried Blood Spot (DBS) – 21 days
• Stool – 5 days after day 2 collection
• Blood Draw (all types) – Ship immediately on the same day

*Urine – Porphyrins Test is viable for 14 days (frozen)

Please refer to your test’s specific Test Preparation and Instructions for more information regarding the potential effects of medications, foods, and supplements on this test. 

You make also consult your healthcare provider prior to making any changes to your medications.

The OAT or MOAT is typically not affected by antibiotics or antifungal medications, unless they contain certain fruits like apples, grapes, pears, or cranberries. However, it’s important for both the patient and practitioner to consider the purpose of the test when deciding whether to avoid these medications. For instance, if the practitioner is interested in evaluating the effectiveness of a particular therapy, it may be acceptable for the patient to continue taking the medication during the test. On the other hand, if the patient wants to determine their metabolic condition without any influence from medication, it’s advisable to discontinue the antibiotics or antifungals for a period of 1-2 weeks before the test. 

The ordering process for MosaicDX tests starts with your healthcare practitioner assessing your symptoms and recommending the most appropriate test.

Once a test has been recommended, collection kits can be conveniently ordered and delivered straight to your doorstep. If you already have a collection kit, you can register your test and begin the process at your convenience.

It is important to carefully follow the collection instructions and include all required information about yourself and your specimens when registering your test. When your specimens are collected, you can use the prepaid shipping materials provided in your kit to ship them to MosaicDX. Your results will be accessible online via the MosaicDX portal. We recommend scheduling an appointment with your healthcare practitioner to discuss your results and develop a plan for your healthcare

If you are located outside of the U.S., our customer service team can assist you in finding a distributor in your country. In countries where a distributor is not required, you can place an order through our international patient ordering site. Please note that all international shipping costs must be paid prior to shipping the kit.  

Different states have regulations that define the scope of practice for practitioners. It is the practitioner’s responsibility to abide by these rules. Check with your state board of health to determine any restrictions related to laboratory testing. Please note, Mosaic Diagnostics does not offer testing in New York. 

Once you have opened your account, you have the options of ordering kits to stock in your office or drop-ship kits directly to your patients through your MosaicDX portal.   

Watch our short tutorial videos on how to conveniently  

• Order kit for your inventory  
• Drop-ship a kit to your patient  
• Re-order a follow-up test for your patient.    

Already have a kit? Watch this video on how to place an order for your patient using a kit from your inventory.   

Visit the payment information page for an overview of payment options and procedures along with insurance coverage overview.

NOTE: Insurance coverage for testing is based on several factors such as the type of procedure, diagnosis, and insurance policy guidelines. Patients are encouraged to contact their insurance company to check for coverage and to provide the procedure codes (CPT codes) and diagnostic codes (ICD-10 codes). The CPT codes can be found on the billing information page, while ICD-10 codes are provided by the practitioner.

1. Visit AnyLabTest Now to find a location near you.
   1. Schedule an appointment online, call for assistance, or just show up for your lab test — no appointment necessary.
   2. Bring the following to your appointment:
      1. Payment for specimen collection and processing fee.
      2. Test collection kit
      3. Included gel pack (freeze ahead of time)
      4. Collection instructions
      5. Test Requisition Form with doctor’s signature
      6. UPS return bag (included in the test kit)
2. Alpha Phlebotomy Group offers three options
   1. In Home Collections – where the phlebotomist comes to you. Fees include per collection rates and mileage.
   2. Collection Draw Site Locations – where APG provides you with a location that is familiar with MosaicDX orders. Prices for collections vary by phlebotomist.
   3. Mobile Event Collections for Groups – Have a group of 20 blood collections? Create a blood draw corporate or wellness event. Events require a minimum of 6 draws per hour otherwise additional hourly fees may apply along with specific pricing per participant.
3. Los Angeles and Orange County Areas: Contact Mobile Phlebotomy Service
   1. They will complete the blood draw directly from your home. Call 909-985-5562 to make an appointment. Standard hours of operation are 6:00 a.m. to 3:00 p.m.
4. Kansas City Metro Areas: Contact Test Smartly Labs.
   1. Collection hours are Monday through Friday 9:00 a.m. to 5:00 p.m. at all four of the TSL Kansas City area locations. Call 816-800-9699 to set up your appointment.

Use of organic acids to provide insight into functional metabolic imbalances has evolved from historic diagnostic testing to investigate inborn errors of metabolism (IEM).

While the OAT is not designed specifically to diagnose classically defined IEMs, persistent marked elevations in OAs noted on the profile may indicate an undiagnosed underlying metabolic pathway defect. As such, further clinical investigation via an individual patient’s clinical presentation and the results of complementary laboratory tests may be warranted to guide more specific testing.

IEM are a class of inborn errors of metabolic pathways that are marked by accumulation (and usually toxic) organic acid metabolites in blood (i.e., organic acidemias) and increased excretion of organic acids in urine (i.e., organic acidurias). While individual IEMs are rare that typically become apparent clinically during the newborn period or early infancy, though milder – and even asymptomatic – forms may emerge in adolescence and adulthood.

Because of the life-threatening metabolic disturbances (acidosis and ketosis) that are associated with IEMs, an entire field of preconception and postnatal screening has arisen. Current newborn screening includes assessment of 34 core conditions which allows for early treatment intervention should a positive finding result.

The Organic Acids Test by Mosaic Diagnostics evaluates levels of oxalates in urine. Oxalate (and its acid form, oxalic acid), is an organic acid that is primarily derived from three sources: the diet, fungus (such as Aspergillus and Penicillium), possibly Candida, and also human metabolism. Oxalic acid is the most acidic organic acid in body fluids and is used commercially to remove rust from car radiators. Antifreeze (ethylene glycol) is toxic primarily because it is converted to oxalate in the body. Two different types of genetic diseases are known in which oxalates are high in the urine, hyperoxalurias type I and type II, which can also be determined from the Organic Acids Test. 

Foods especially high in oxalates are often foods thought to be otherwise healthy, including spinach, beets, chocolate, peanuts, wheat bran, tea, cashews, pecans, almonds, berries, and many others. People now frequently consume “green smoothies” in an effort to eat “clean” and get healthy, however, they may actually be sabotaging their health. The most common components of green smoothies are spinach, kale, Swiss chard, and arugula, all of which are loaded with oxalates. These smoothies also often contain berries or almonds, which have high amounts of oxalates as well. Oxalates are not found in meat or fish at significant concentrations. Daily adult oxalate intake is usually 80-120 mg/d. A single green smoothie with two cups of spinach contains about 1,500 mg of oxalate, a potentially lethal dose. 

High Oxalate Food List

External sources of oxalates include ethylene glycol, the main component of antifreeze. Antifreeze is toxic mainly because of the oxalates formed from it. In addition, some foods also contain small amounts of ethylene glycol. Vitamin C (ascorbic acid or ascorbate) can be converted to oxalates but the biochemical conversion system is saturated at low levels of vitamin C so that no additional oxalate is formed until very large doses (greater than 4 g per day) are consumed. The high correlation between arabinose and oxalates indicate that intestinal yeast/fungal overgrowth is likely the main cause for elevated oxalates in the autistic spectrum population. The deposition of oxalates in critical tissues such as brain and blood vessels, the oxidative damage caused by oxalate salts, and the deposition of oxalate mercury complexes in the tissues.

•Organic acidic products of cellular metabolism that are excreted in urine (in mammals)

oProduced by living organisms including humans, bacteria, and fungi

oEvaluation of these downstream products of metabolic pathways provides insight into potential nutrient deficiencies, inflammation, toxicity, and other imbalances that could be contributing to clinical complaints

•Origins of Organic Acid Testing

oTo rule out rare Inborn Errors of Metabolism (IEM)- usually in infancy

oElevations of these organic acids (OA) reflect dysfunction in specific metabolic pathways

§Accumulation of these toxic metabolites can by life-threatening

§Symptoms observed in the newborn period include poor feeding and weight gain; nausea and vomiting; neuromuscular issues (e.g., poor tone, seizures); and susceptibility to infection

•Use of OAs have evolved from investigating IEM to providing insight into functional metabolic imbalances.