10/29/12 The Role of Food Allergies and Intolerances in Chronic - - PDF document

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JENNIFER JEWELL-LARSEN, ND

MEDICA MEDICAL DIRECT L DIRECTOR, OR, NA NATUR TUROP OPATH THIC F IC FAMIL MILY H Y HEA EALTH TH

INF INFO@NF-HEAL O@NF-HEALTH.COM TH.COM

The Role of Food Allergies and Intolerances in Chronic Conditions

Naturopathic Medicine

 Unique and distinct system emphasizing prevention

and natural therapeutics

 Trained to serve as primary care general practitioners  4 year medical training

 Comprehensive study of conventional medical sciences  Training in variety of natural therapies

Naturopathic Medicine Principles

• 1. Do no Harm
• 2. The Healing Power of Nature
• 3. Find the Cause
• 4. Treat the Whole Person
• 5. Preventive Medicine
• 6. Doctor as Teacher

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Naturopathic Medicine

 Patient-centered approach  Integration with conventional medicine  NDs are currently licensed in

 16 states: Alaska, Arizona, California, Connecticut, Hawaii, Idaho, Kansas, Maine,

Minnesota, Montana, New Hampshire, North Dakota, Oregon, Utah, Vermont, Washington

 The District of Columbia  US territories: Puerto Rico and US Virgin Island  5 Canadian provinces

 Infrastructure includes accredited educational institutions, professional

licensing, national standards of practice, peer review and commitment to scientific research

Detecting and eliminating specific antagonistic foods, and designing a nutritionally sound diet to ensure the optimum health of the food-sensitive person, is the ultimate aim in food sensitivity management. This process is often tedious and time consuming, and requires tremendous knowledge, skill, commitment and dedication…However, when a person who has been chronically sick suddenly feels well for the first time in many years, as so often happens, the rewards for both practitioner and [patient] more than justify the time and effort

• f the endeavor.
• J.V. Joneja

Dietary Management of Food Allergy and Intolerance. 2nd ed. Vancouver, BC, Hall Publishing Group, 1998.

Adverse Food Reactions Related Conditions and Symptoms

 Eczema  Chronic otitis media  Chronic LRTIs and

sinusitis

 Acne  GERD  IBS  Migraines  ADHD  Arthritis  Autistic specturm

disorders

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Classification of Adverse Food Reactions

Int Intole leranc nce C Category y De Description n Food A Alle llergy y

Immune mediated, mainly IgE Symptoms in minutes – hours Typically rash, angioedema, anaphylaxis GI symptoms possible with histamine release

Celi liac Di Disease

Gliadin (a portion of gluten present in wheat, rye, barely, spelt, kamut, semolina, triticale and malt) triggers chronic inflammation through reactive CD4+ T cells for people with HLA DQ2 or DQ8 May affect multiple organ systems 10-23% may develop neurological symptoms such as idiopathic ataxia and paresthesias

Cross-a

• alle

llergy y

Triggered by foods with similarities to an environmental allergy Often characterized by oral tingling

Pseudo-a

• alle

llergies

Foods trigger mast cell degranulation without involving IgE antibodies

Eosino nophi hili lic esopha hagogastroent nteritis

Accumulation of eosinophils in any or all layers of the digestive tract Serum eosinophils may be elevated with no other explanation

Phys ysiolo logic r reactions ns

Gas production or dyspepsia due to foods relaxing the lower esophageal sphincter

Classification of Adverse Food Reactions, Cont’d

Int Intole leranc nce C Category y De Description n Ig IgG-r

• rela

lated i int ntole leranc nce

Intolerances develop slowly hours – days after exposure May cause increased small intestinal permeability Wide variety of symptoms

Pha harma macolo logic r reactions ns

Drug-like effect triggered by some foods

Toxin me n mediated

Symptoms triggered by specific toxins present in a food such as food poisoning, mycotoxins, herbicides and pesticides

Enz nzyma ymatic

Poor digestion of certain foods due to deficiency of an enzyme such as lactase and less commonly fructose, sorbitol, mannitol and xylitol

Structural l

Underlying pathologic process, such as inflammatory bowel disease, , pancreatitis, achalasia, strictures, etc. leads to intolerance of different foods

Inf Infectious

Chronic infections predispose to adverse food reactions

Psycho hogeni nic

Somatoform disorders, eating disorders or the discouragement tied to food intolerance itself may lead to food reactions. Stress can cause intolerance from elevating norepiephrine levels and triggering histamine release

Othe her c causes

Mastocytosis, carcinod and other neuroendocrine tumors, GI neoplasms by lead to symptoms

Identifying the Cause

 Elimination diet  IgE: skin and serum tests for foods and environmental

allergies

 IgG: serum tests for foods  HLA typing for celiac disease  Enzymatic: Hydrogen and methane breath test  Endoscopy, colonoscopy

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Treatment Plan Goals

• 1. Identify potential problem food(s)
• 2. Remove the problem food(s)
• 3. Calm and repair:

 Reduce histamine release  Decrease inflammation  Repair the intestinal tract

• 4. Reintroduce the trigger food(s) slowly and systematically
• 5. Create long term plan

Common Food Culprits

Food Allergy Citrus, dairy, eggs, fish, peanuts, soy, gluten (barley, oats, rye, wheat, semolina, triticale), shellfish, tree nuts (almonds, pecans, walnuts) Food Intolerance All foods listed for food allergy, plus: Beef, corn, food additives (antioxidants: butylated dyrdoxyanisole, butylated hydroxytoluene; aspartame; flavor enhancers (msg); food colors (tartrazine, various other dyes derived from coal tar); nitrates and nitrites (preserved meats); thickeners/stabilizers: tragacanth, agar- agar; biogenic amines: histamine, tyramine, octapamine, phenylethylamine; disaccharides: lactose; foods high in nickel and salicylates; refined sugars

Natural Tools

 Reduce histamine release

 Vitamin C  Nettles  Quercetin (derived from citrus peel)

 Decrease Inflammation

 Bromelain (derived from pineapple)  Omega fatty acids  Aloe juice  Slippery elm bark

 GI repair

 Probiotics  Glutamine  N-acetyl glucosamine  Deglycyrrhizinated licorice

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Eczema

 Common triggers in pediatric population:

 Dairy  Eggs  Gluten  Soy

 Other considerations:

 Artificial colors, benzoates, sulfites  Berries, citrus, currants, tomatoes  Fish, beef, chicken, pork  Legumes  Pollen-related foods (fruits, nuts, vegetables) more common in

adults

Chronic Otitis Media, Sinusitis and Respiratory Infections

 Common triggers in pediatric population

 Dairy  Gluten

Acne

 Common triggers in pediatric population

 Dairy  Sugar  Fatty foods

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GERD

 Common triggers in pediatric populations

 Dairy  Fatty foods  Mint, chocolate, citrus  Carbonated beverages, coffee  Infants: Dairy, soy

Migraines

 Common triggers

 Beef, eggs  Chocolate, coffee, tea  Corn  Oranges  Sugar  Yeast  Aspartame  Histamine: fish, cheese, wine, beer  MSG: mushrooms, kelp, scallops, preserved meats, Chinese food  Nitrates: processed meats  Tyramine: aged cheeses, some red wines

Irritable Bowel Syndrome

 Common triggers

 Dairy, eggs, gluten  Rule out lactose and alcohol sugar intolerance  Rule out celiac disease

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ADHD

 Common triggers:

 Apples, oranges, tomatoes  Corn  Dairy products  Caffeine  Peanuts  Aspartame  Artificial colors, tartrazine (yellow dye #5)  Glutamate  Butylated hydroxyanisole, butylated hydroxytoluene (in packaged cereals)  Benzonates (chewing gum, margarine, pickles, prunes, tea, raspberries, cinnamon,

anise, nutmeg)

 Nitrates and nitrites (preserved meats like bacon, hot dogs, pepperoni),  Propyl gallate  Sulfites (dried fruits, mushrooms, potatoes, baked goods, canned fish, pickles,

relishes)

Autistic Spectrum Disorders

 Common aggravating foods:

 Gluten  Casein (milk protein)  Food additives  Artificial colors

Arthritis

 Common triggers

 Corn  Dairy  Gluten  Nightshade vegetables (bell peppers, eggplant, potatoes,

tomatoes)

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Elimination Diet

• 1. Planning phase
• 2. Avoidance phase
• 3. Challenge phase
• 4. Long term nutrition plan

Level 1

Simple Diet

Foods A Allo llowed Foods E Eli limi mina nated Animal proteins Beef, chicken, lamb, pork, turkey Dairy Eggs Grains and starches Arrowroot, buckwheat, corn, millet, oats (GF), rice, rye, sweet potato, tapioca, white potatoes, yams Gluten grains: wheat, rye, barley, kamut, spelt, semolina, triticale Fruits, vegetables, legumes All whole fruits, vegetables allowed except refined corn products All legumes except soy Corn syrup, high fructose corn syrup All forms of soy: tofu, soy beans, soy milk, soy sauce Other Salt, spices sugar

Level 2

Stricter Elimination

Foods A Allo llowed Foods E Eli limi mina nated

Animal proteins Lamb All others including dairy and milk Vegetable proteins None Beans, bean sprouts, lentils, peanuts, soy, all

• ther nuts

Grains and starches Arrowroot, buckwheat, corn, rice, sweet potato, tapioca, white potato, yams Wheat, barley, millet, oats, kamut, spelt, rye, wheat, semolina, triticale Vegetables Most allowed Peas Fruits Most allowed Citrus, strawberries, tomatoes Sweeteners Beet sugar, maple syrup Any others, including aspartame, cane sugar, corn syrup Oils Coconut, olive, safflower sesame Animal fats (lard), butter, corn, margarine, shortening, soy, peanut, other vegetable oils Other Salt, pepper All other spices including vanilla and cinnamon Chocolate, coffee, tea, soft drinks, alcohol

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Level 3

Few Foods Diet

 Foods allowed:

 Apples  Apricots  Asparagus  Beets  Beet sugar  Carrots  Chicken  Honey  Lamb  Lettuce  Olive oil  Peaches  Pears  Rice (including rice cakes and

cereal)

 Safflower oil  Salt  Sweet potatoes  White vinegar

References



Rakel, D.: Integrative Medicine. 3rd ed., Madison, Wisconsin, Elsevier Saunders, 2012.



Joneja J.V.: Dietary Management of Food Allergy and Intolerance. 2nd ed., Vancouver, BC, Hall Publishing Group, 1998



Baenkler H.W., Silbermann A.: The differential diagnosis of food intolerance. Dtsch Arztebl. 2009; 106:359-370



Effect of probiotic Lactobacillus strains in children with atopic dermatitis. J Allergy Clin Immunol. 2003 Feb;111(2):389-95.



Bjarnason I., MacPherson A., Hollander D.: Intestinal permeability: an overview. Gastroenterology. 1995; 108:1566-1581.



Hollander D.: Intestinal permeability, leaky gut, and intestinal disorders. Curr Gastroenterol Rep. 1999; 1:410-416.



Patriarca G., Schiavino D., Pecora V.: Food allergy and food intolernace: diagnosis and treatment. Intern Emerg Med. 2009; 4:11-24



Mahan, L.K., Escot-Stump, S. Krause’s Food Nutrition and Diet Therapy. 11th ed. Philadelphia, Saunders, 2004.



Effect of probiotics on gastrointestinal symptoms and small intestinal permeability in children with atopic dermatitis. J Pediatr. 2004 Nov;145(5):612-6.



Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled

• trial. Lancet. 2003 May 31;361(9372):1869-71.



Vitamin C in breast milk may reduce the risk of atopy in the infant. Eur J Clin Nutr. 2005 Jan;59(1): 123-8.