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Dietary Intolerances. Peanut Allergy Claims Life of 15-Year-Old Girl after Kissing Boyfriend Who Had Eaten Peanut Butter Sandwich. Celiac Intolerance. Mrs. M. was excited. Finally, somebody found out what was wrong with her. A mother of 3 children she had been feeling

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dietary intolerances

Dietary Intolerances

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

celiac intolerance
Celiac Intolerance

Mrs. 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 taking

naps in the afternoon. It was all she could do to keep up with

her family. She had been seen by her family physician several

times over the past year was told she was anemic. She was

given a prescription for iron pills and told to get lots of rest. She

saw no improvement. She was very frustrated and began to think

it was all in her head. Finally she was sent to a gastrointerologist

who finally diagnosed with Celiac Sprue or Gluten Intolerance.

gluten intolerance celiac disease
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
Gluten Intolerance
  • The disease primarily affects the mucosa of the jejunum or ileum.
gluten intolerance celiac disease5
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 disease6
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
  • Nutritional care includes complete withdrawal of gliadin from the diet.
  • Gluten is found in wheat, barley and rye.
  • OatsHold the Oats for Celiac Disease?
  • Corn, rice, soy, arrowroot, tapioca and potato flours may be substituted for wheat flour.
nutritional care8
Nutritional Care
  • A gliadin-free diet requires careful of labels of all packaged 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 care9
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 care10
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
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 quality12
Nutritional Care - Suggestions to Improve Quality
  • The amount of leavening needs to be increased. For each cup of 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 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 deficiency14
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 deficiency15
Lactase Deficiency
  • The result is bloating, flatulence, cramps and diarrhea.
  • Lactase activity declines at weaning..
lactase deficiency16
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
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 care18
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 care19
Nutritional Care
  • Milk and milk products treated with lactase enzyme (Lactaid™) are well tolerated.
lactose content of foods
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
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 allergies22
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
    • Adults: 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 allergies24
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 allergies25
Food Allergies
  • Symptoms : severe reaction
  • Extreme versions of previous rx.
  • Constriction of the airways
  • Shock
  • Rapid pulse
  • Dizziness.
food allergies26
Food Allergies
  • Diagnosis
    • Skin prick test
    • Blood tests
    • Challenge test