Dietary Intolerances

Peanut Allergy Claims Life of 15-Year-Old Girl after Kissing Boyfriend Who Had Eaten Peanut Butter Sandwich

Celiac IntoleranceMrs. M. was excited. Finally, somebody found out what was wrong with her. A mother of 3 children she had been feeling more and more tired in 18 months. She found herself takingnaps in the afternoon. It was all she could do to keep up withher family. She had been seen by her family physician severaltimes over the past year was told she was anemic. She wasgiven a prescription for iron pills and told to get lots of rest. She saw no improvement. She was very frustrated and began to thinkit was all in her head. Finally she was sent to a gastrointerologistwho finally diagnosed with Celiac Sprue or Gluten Intolerance.

Gluten Intolerance- Celiac Disease Celiac disease is caused by a reaction to

gliadin, the alcohol-soluble component of gluten.

Results in damage to the villi of the intestinal mucosa and malabsorption of virtually all nutrients.

Gluten Intolerance

The disease primarily affects the mucosa of the jejunum or ileum.

Gluten Intolerance- Celiac Disease The mechanism by which gliadin damages

the bowel is unknown, but it appears to have genetic and immune components.

Diagnostic procedures consists of IgA and IgG blood tests and mucosal biopsy.

Gluten Intolerance- Celiac Disease

Symptoms in children: diarrhea, growth failure in children, projectile vomiting. Stool frequency can be in excess of 10/day.

Adults may have: increased appetite, weight loss, weakness, fatigue and

anemia. Diarrhea may or may not be present. Bowel movements

usually are large, putty colored, and foul-smelling.

Nutritional Care Nutritional care includes complete complete

withdrawal of gliadin from the diet. Gluten is found in wheat, barley and rye. Oats Hold the Oats for Celiac Disease? Corn, rice, soy, arrowroot, tapioca and

potato flours may be substituted for wheat flour.

Nutritional Care A gliadin-free diet requires careful of labels of all labels of all

packaged foodspackaged foods: Hydrolyzed vegetable protein flour cereal products vegetable protein malt, malt flavoring modified starch, modified food starch vegetable gum, soy sauce, or soy sauce solids.

See Words That May Indicate Gluten – pg. 521

Nutritional Care Lactose intolerance sometimes appears

secondary to celiac disease. If the disease is severe, vitamin and

mineral supplementation may be required. Anemia may be treated with iron, folic

acid, and vitamin B12.

Nutritional Care The following may be substituted for wheat

flour in recipes: 1 cup corn flour 3/4 cup coarse corn meal 1 scant cup fine corn meal 5/8 cup potato flour 7/8 cup rice flour

Nutritional Care - Suggestions to Improve Quality Soy flour should always be used with other

flours. Longer and slower baking is usually

required.

Nutritional Care - Suggestions to Improve Quality The amount of leavening needs to be

increased. For each cup of coarse coarse flour, use 2 1/2 tsp of baking powder.

Dryness is a characteristic of cakes made with other flours.

Moisture may be preserved by using frosting and storing in closed container.

Lactase Deficiency Lactase in a enzyme located in the brush

border of the small intestine which digests lactose to glucose and galactose.

Lactose intolerance is the most common carbohydrate intolerance and affects person of all age groups.

Lactase Deficiency Lactose that is not hydrolyzed into

galactose and glucose remains in the gut and acts to osmotically draw water into the intestines.

Bacteria ferment the undigested lactose, creating lactic acid, other organic acids, CO2 and hydrogen gas.

Lactase Deficiency The result is bloating, flatulence, cramps

and diarrhea. Lactase activity declines at weaning..

Lactase Deficiency Asians and Native Americans tend to be

most lactose intolerant. ~75% of African-Americans, 50% of

Hispanics and 20% of Caucasian have varying degrees of lactose intolerance.

Lactose intolerance can also develop secondary to an infection of the small intestine or destruction of mucosal cells by other causes.

Lactose Intolerance Diagnosis is based on

a oral dose of lactose equivalent to 1 quart of milk.

In lactose intolerance blood glucose increases less than 25 mg/dl and GI symptoms develop.

Nutritional Care Most adults with lactose-intolerance

can consume some lactose without symptoms.

Lactose is better tolerated as part of a meal than when taken separately.

Some milk products such as aged cheese are usually tolerated because the lactose content is low.

Nutritional Care Milk and milk

products treated with lactase enzyme (Lactaid™) are well tolerated.

Lactose Content of Foods Milk - 1 cup 10-12 gm goats Milk - 1 cup 9 gm Sour Cream 1/2 C 4 gm Cottage Cheese 1/2 C 2-3 gm Yogurt - 1 cup 5 gm Cheese - 1 oz 1 -2 gm Ice cream - 1/2 C 6-9 gm

Food Allergies Sulfites Used to prevent certain foods from browning,

such as light-colored fruits, dried fruits and vegetables

5-50% population sulfites may pose risk Symptoms: wheezing, diarrhea, stomach ache,

hives or swelling See page 532 – Where Might You find

Sulfites

Food Allergies 2 – 2/12 percent of adults (6 million), 4-6 percent of infants and 1-2 % of children are

diagnosed with food allergies. Most Common Food Allergies

AdultsAdults: peanuts, crustacea (crab, crawfish, lobster, shrimp), tree nuts (almonds, Brazil nuts, hazel nuts, pecans, walnuts), fish

Children: milk, eggs, peanuts, soybeans, tree nuts, wheat, fish, shell fish

Food Allergies Symptoms of true food allergy Skin reactions

Swelling, itchy eyes, hives, hash

Respiratory tract reactions Itchy and/or tightness in throat, shortness of breath,

dry or raspy cough, runny nose, wheezing

Digestive tract reactions Abdominal pain, nausea, vomiting, diarrhea

Food Allergies Symptoms : severe reaction Extreme versions of previous rx. Constriction of the airways Shock Rapid pulse Dizziness.

Food Allergies Diagnosis

Skin prick test Blood tests Challenge test