NMT150 Nut Week 10 Spotlight PDF

Functional GI Disorders (IBS) and Food Sensitivity ABDOMINAL PAIN, DIARRHEA, CONSTIPATION, BLOATING AUTHOR: DR. MARYAM YAVARI, MD, PH.D., ND NMT150 2023 LEARNING OBJECTIVES Considerations for providing nutritional guidance for patients with IBS: Role of microbiome Food...

Functional GI Disorders (IBS) and Food Sensitivity ABDOMINAL PAIN, DIARRHEA, CONSTIPATION, BLOATING AUTHOR: DR. MARYAM YAVARI, MD, PH.D., ND NMT150 2023 LEARNING OBJECTIVES Considerations for providing nutritional guidance for patients with IBS: Role of microbiome Food additives IBS food pyramid Review on food sensitivity and allergy Food sensitivity testing ROLE OF PROBIOTICS Systematic review and meta-analysis of 35 randomized controlled trials: Probiotics may improve global IBS symptoms and abdominal pain, particularly in people with diarrhea-predominant IBS. Not all studies have found a significant benefit of probiotics for IBS. Ford AC, Quigley EM, Lacy BE, et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta- analysis. Am J Gastroenterol. 2014;109(10):1547-1561.  Food Additives Ginger Turmeric  IBS FOOD PYRAMID Cozma-Petruţ A, Loghin F, Miere D, Dumitraşcu DL. Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients! World J Gastroenterol. 2017 Jun 7;23(21):3771-3783. doi: 10.3748/wjg.v23.i21.3771. PMID: 28638217; PMCID: PMC5467063.  Digestion and Food Sensitivities, Intolerance, Allergy  Major Immunoglobulin- Mediated Food Reactions IgE – Type I hypersensitivity reaction (Immediate) IgG – Type III hypersensitivity reaction (Delayed) IgA – Mucosal damage (Delayed)  Consideration Immunoglobulin E Immunoglobulin G Onset of reaction Comparing Rapid IgEDelayed and IgG Duration of reaction Brief (hours) Prolonged (days to weeks) Circulating immune complexes Origin of response Mast cells (CICs) macrophage overload Food that trigger Any food Commonly consumed foods Small amount of food can Dose dependent - more reactive Food quantity trigger response food means bigger reaction Subject usually aware of Subjects usually unaware of food Patient awareness food trigger trigger Reactions may persist for Symptoms may occur for Persistence life or resolve months after elimination of spontaneously reactive foods AdapAdapted from Nutr Clin Pract. 2010;25(2):192-98 ted from Nutr Clin Pract. 2010;25(2):192-98  Non-Immune Reactions Enzyme Deficiencies Eg: lactose intolerance is a deficiency of lactase Food Additive Sensitivity Food dyes, preservatives, emulsifiers, flavouring agents, fillers. e.g. MSG, sulphites Naturally Occurring Chemicals In Food Histamine, tyramine, phenylethylamine, salicylates, glutamate  Food Allergy Food Intolerance Immune System Activated Yes No Exposure Required to Elicit Tiny quantity Normal size portion Symptoms Timeframe for Reaction Immediate – 1 or 2 hrs 30 min – 48 hrs After Exposure Food avoidance, medicines Food limitation or complete Treatment (antihistamines, epinephrine avoidance, depending on shot) severity https://badgut.org/information-centre/health-nutrition/food-allergy-vs-intolerance/ In Canada, the most common allergens in food – otherwise known as the priority allergens – are: ▪ Eggs ▪ Soy ▪ Milk ▪ Sulphites ▪ Mustard ▪ Tree Nuts (almonds, ▪ Peanuts Brazil nuts, cashews, hazelnuts, macadamia ▪ Crustaceans and nuts, pecans, pine nuts, molluscs pistachios and walnuts) ▪ Fish ▪ Wheat and triticale ▪ Sesame seeds Common Food Allergens Eggs, fish, shellfish, nuts, peanuts are most common immediate hypersensitivity foods. While dairy, chocolate, wheat, citrus, food colorings are most common delayed hypersensitivity foods.  Food Intolerance In contrast to food allergy, food intolerance does not involve the body’s immune system. Symptoms of a food intolerance include: Abdominal pain. Diarrhea. Gas and bloating. Headaches or migraines. Heartburn. Nausea. Upset stomach. 1. National Institute of Allergy and Infectious Diseases. Food Allergy, Intolerance, and Sensitivity. https://www.niaid.nih.gov/diseases-conditions/food-allergy Accessed February 28, 2023. 2. Mayo Clinic. Food Intolerance. https://www.mayoclinic.org/diseases-conditions/food-intolerance/symptoms-causes/syc-20355095. Accessed February 28, 2023. 3. American Academy of Allergy, Asthma & Immunology. Food Intolerance. https://www.aaaai.org/conditions-and-treatments/library/allergy-library/food-intolerance. Accessed February 28, 2023. 4. National Health Service (UK). Food Intolerance. https://www.nhs.uk/conditions/food-intolerance/. Accessed February 28, 2023. 5. European Food Safety Authority. Food Intolerance. https://www.efsa.europa.eu/en/topics. Accessed February 28, 2023.  Food Intolerance Lactose Intolerance: ▪ Up to 70% of the world’s population has lactose malabsorption. ▪ Undigested lactose lingers in the intestine and ferments, causing abdominal pain, bloating, diarrhea, and flatulence. Non-Celiac Gluten Intolerance: ▪ In one double-blind, randomized, placebo-controlled trial, patients reported that gluten induced symptoms of bloating, dissatisfaction with stool consistency, abdominal pain, and tiredness. ▪ There is no evidence that non-celiac gluten intolerance causes damage to the small intestine. National Institute of Allergy and Infectious Diseases. Food Allergy, Intolerance, and Sensitivity. https://www.niaid.nih.gov/diseases-conditions/food-allergy Accessed February 28, 2023. Mayo Clinic. Food Intolerance. https://www.mayoclinic.org/diseases-conditions/food-intolerance/symptoms-causes/syc-20355095. Accessed February 28, 2023. American Academy of Allergy, Asthma & Immunology. Food Intolerance. https://www.aaaai.org/conditions-and-treatments/library/allergy-library/food-intolerance. Accessed February 28, 2023.. National Health Service (UK). Food Intolerance. https://www.nhs.uk/conditions/food-intolerance/. Accessed February 28, 2023. European Food Safety Authority. Food Intolerance. https://www.efsa.europa.eu/en/topics. Accessed February 28, 2023.  Up to 25% of adults surveyed in a study, reported food intolerance symptoms, while another study published in 2018 suggested that up to 89% of participants reported experiencing adverse reactions to food at some point in their lives. These findings suggest that food sensitivities may be more prevalent than many people realize, but it's important to note that more research is needed to fully understand the scope of this issue. 1.Skypala IJ, Williams M, Reeves L, Meyer R, Venter C. Sensitivity to food additives, vaso-active amines and salicylates: a review of the evidence. Clin Transl Allergy. 2015 Dec 23;5:34. doi: 10.1186/s13601-015-0074-y. PMID: 26719752; PMCID: PMC4686050. 2.https://pubmed.ncbi.nlm.nih.gov/26434966/  Symptoms suggested to be associated with IgG food reactions ▪ Obesity ▪ Recurrent Infections ▪ Increased inflammation ▪ Enuresis ▪ Fatigue ▪ Nephrotic Syndrome ▪ Migraines ▪ ADHD ▪ Irritable Bowel Dis ▪ Epilepsy ▪ Gallbladder Disease ▪ Eczema ▪ Asthma ▪ Psoriasis ▪ Rhinitis  Food Component: Lectins Can be toxic, inflammatory, and/or allergenic: ▪ Stimulate release of histamine by gastric mast cells ▪ May enhance intestinal permeability and translocation of pathogenic antigens ▪ Highest in starchy foods (lower in Paleolithic diets) ▪ Implicated in autoimmunity? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1115436/  Food Component: Lectins Can be toxic, inflammatory, and/or allergenic: Stimulate release of histamine by gastric mast cells Wheat gliadin contains lectin-like substance that binds mucosa and is implicated in celiac disease. Rubber latex allergy caused by lectin Resistant to cooking and digestive enzymes Highest in starchy foods (lower in Paleolithic diets) Exposed by neuraminidase (elaborated by influenza virus, streptococcus, etc.) https://ketontrack.com/lectins-in-a-healthy-diet/  Sulphites ▪ Sulphites are added to some processed foods to maintain colour, prolong shelf life and prevent the growth of microorganisms. Added sulphites can trigger allergic-type symptoms in sensitive individuals. ▪ They must be declared as an ingredient or component of an ingredient except in situations where regulatory exemptions apply and their total amount is less than 10 parts per million. https://www.canada.ca/en/health-canada/services/food-allergies-intolerances/avoiding-allergens-food/allergen-labelling.html  Gluten ▪ Barley ▪ Oats ▪ Rye ▪ Triticale ▪ Wheat Gluten can be present in yeast extract and malt flavoring or malt extract Ingredients used in various foods such as soups, sauces, seasoned chips, baked goods, cereals and some beverages. https://www.canada.ca/en/health-canada/services/food-allergies-intolerances/avoiding-allergens-food/allergen-labelling.html  Laboratory Assessment Testing Food Allergies Testing Food Sensitivities Barrie, S., Pizzorno, J. Food Allergy Testing. Textbook of Natural Medicine, 2008. Allergen Cross-Reactivity A legume Other legume 5–10% A tree nut Other tree nut 40% A fish Other fish 50% A shellfish Other shellfish 50–75% A grain Other grains 20% Egg Chicken 5% Cow’s milk Beef 10% Cow’s milk Goat’s milk > 90% Cow’s milk Mare’s milk 4% Allergen Cross-Reactivity Pollen Fruits/veggies 50% Melon Other fruit 90% Latex Fruits 35% High Association: banana, avocado, kiwi, and chestnut. Moderate Association: potato, tomato, apple, carrot, apricot, celery, melon, watermelon, grape, papaya. Low Association: Apricot, buckwheat, castor bean, cayenne pepper cherry chic pea citrus fruits dill fig pepper, cherry, chic pea, citrus fruits, dill, fig. Elimination Diet Exclude all foods that contain: Refined sugar Wheat Dairy products Corn Eggs Citrus fruits Known or suspect allergens (including IgE) A Any foods they eat 3 or more times a week. Andalso coffee, tea, alcohol, and food additives other than vitamins. Also exclude soy, yeast and nightshades  Reintroduction 1 food every 3rd day Eat sufficient amount of the challenged food OBSERVE Food that causes symptoms is avoided Once symptoms resolve the next food can be challenged  IRRITABLE BOWEL SYNDROME A double-blind 2004 British study randomized 150 patients to receive either a sham diet or true diet. The true diet group eliminated all IgG reactive foods, and the sham diet group excluded the same number of foods as showed up reactive, but not the actual reactive foods. The true diet group had significantly reduced severity of IBS symptoms and overall symptoms compared to the sham diet group. Atkinson W, Sheldon TA, Shaath N, Whorwell PJ. Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial. Gut. 2004 Oct;53(10):1459-64. doi: 10.1136/gut.2003.037697. PMID: 15361495; PMCID: PMC1774232.  MIGRAINE 61 people were tested via IgG ELISA for 113 foods. About 90% of participants eliminated some or all of the reactive foods from their diet. At 1 month, 30% reported marked improvement, and at 2 months 40% reported benefit. Reintroduction of the reactive foods into the diet resulted in return of migraine for 60% of these patients. A 2010 randomized, double-blind, crossover trial showed a statistically significant drop in the number of headache days, and the number of headaches during the six week period when IgG reactive foods were eliminated from the diet. Alpay K, Ertas M, Orhan EK, Ustay DK, Lieners C, Baykan B. Diet restriction in migraine, based on IgG against foods: a clinical double-blind, randomized, cross-over trial. Cephalalgia. 2010 Jul;30(7):829-37. Alpay K, Ertas M, Orhan EK, Ustay DK, Lieners C, Baykan B. Diet restriction in migraine, based on IgG against foods: a clinical double-blind, randomized, cross-over trial. Cephalalgia. 2010 Jul;30(7):829-37. doi: 10.1177/0333102410361404. Epub 2010 Mar 11. PMID: 20224819.  WEIGHT GAIN / ATHEROSCLEROSIS A study reported that obese children have significantly higher IgG antibodies to food antigens than normal weight children. They also found that antifood IgG antibody concentrations are strongly associated with low-grade systemic inflammation and with increased intima-media thickness of the common carotid arteries. The study concluded that: “These findings raise the possibility that anti-food IgG is pathogenically involved in the development of obesity and atherosclerosis.” Wilders-Truschnig M, Mangge H, Lieners C, Gruber H, Mayer C, März W. IgG antibodies against food antigens are correlated with inflammation and intima media thickness in obese juveniles. Exp Clin Endocrinol Diabetes. 2008 Apr;116(4):241-5.  ATOPY Individuals who are allergic or have atopy experienced a 70% decrease in symptoms by removing foods that trigger an IgG response. Atopic children had elevated IgG levels to particular foods compared to non-atopic children. Even among children without eczema, increased IgG levels were still significantly linked to atopy, with the highest levels of IgG reactivity observed to egg white, orange, and cow's milk. Van der Brempt X, Van der Werf JF, Legros JJ, Pauwels RA. Prevalence and clinical significance of IgG antibodies to inhalant allergens in allergic patients. Clin Exp Allergy. 1991 Oct;21(5):577-83.  RHEUMATOID ARTHRITIS Some rheumatoid arthritis patients have shown improvement in symptoms when reactive foods were eliminated from the diet. Darlington LG, Ramsey NW. Review article: searching for the cause of rheumatoid arthritis--could the intestinal microbiota be the culprit?. Aliment Pharmacol Ther. 2006 Aug 1;24(3):423-31.  ADHD In children, a few studies have shown improvement in attentiveness and temperament when common food allergens (e.g. wheat, dairy, oranges) were eliminated. Pelsser LM, Frankena K, Toorman J, Savelkoul HF, Dubois AE, Pereira RR, Haagen TA, Rommelse NN, Buitelaar JK. 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