Adverse Food Reactions

A Seminar by Robert Buist PhD

Copyright © 2012 International Academy of Nutrition

Malabsorption in Malabsorption in Coeliac Disease (CD) Coeliac Disease (CD)

Malabsorption of iron, folate, calcium and fat soluble vitamins results in iron deficiency, folate deficiency and reduced bone density

INFANT PRESENTATIONSINFANT PRESENTATIONS

Infants and young children present with diarrhoea, abdominal distension and FAILURE TO THRIVE

Mechanism underlyingMechanism underlying osteoporosis in CD osteoporosis in CD

Calcium malabsorption Vitamin D malabsorption Secondary hyperparathyroidism Failure of peak bone density as child Reduced gonadal function in men Autoimmunity

CD is associated with:CD is associated with:

Delayed menarche Premature menopause Amenorrhoea recurrent miscarriages Infertility & low birthweight babies Increased perinatal mortality

Autoimmune Diseases & GlutenAutoimmune Diseases & Gluten

Coeliac Disease Diabetes Mellitus Autoimmune Thyroid Disease / MS Rheumatoid Arthritis / Psoriasis Glomerulonephritis

Antibodies disappear on a gluten free diet

Common MisdiagnosesCommon Misdiagnoses

Anaemia

Allergies

Thyroid Disease

Lactose Intolerance

IBS, CFS

Autoimmune Disorders Autoimmune Disorders tenten times times more common in CD more common in CD

IDDM Thyroid disease Sjogrens

Disease Renal Disease

Addisons Disease

Cardiomyopathy Neurological

disorders Autoimmune

liver disease

Serological Tests for CDSerological Tests for CD Antibodies against gliadin

(IgA-AGA, IgG-AGA) Endomysial antibody (IgA-EMA) Tissue transglutaminase antibody

(IgA-tTG) Total IgA

Cancer and CDCancer and CD

Malignant diseases are more frequent in coeliacs

Small bowel CA Oesophageal & oropharangeal CA Non-Hogkins lymphoma

Exorphins & BehaviourExorphins & Behaviour Autistic children respond to gluten-free,casein-free diet

Improved speech, social behaviour, sleeping habits

Food peptides affect ADHD

Depression & morphine-like exorphins

Oats are not toxic to patients with Coeliac Disease or Dermatitis Herpetiformis

Candida & CoeliacCandida & Coeliac Disease Disease

Genetic link (HLA-DQ2 and HLA-DQ8) in patients with coeliac disease

Alpha-gliadin has immunoreactve peptides

Hyphal wall protein (HWP 1) in C. albicans. Similar epitopes in gliadin

Transglutaminases elevated Transglutaminases elevated in CD in CD Yeasts adhere to gut via transglutaminases

Gliadin deamidated via transglutaminases

Yeast & gluten provide T-cell epitopes (reactive peptides which trigger antibodies)

Autoreactive antibodies form against tissue transglutaminases and endomysium peptides

Affect of AntibioticsAffect of Antibiotics

Increased candida overgrowth Damage to gut Increased exposure of transglutaminases Increased binding of candida HWP 1 Tissue transaminases (autoantigen)

recognised by autoreactive antibodies

Breast Feeding ProtectsBreast Feeding Protects against CD against CD

Introduce gluten while breast feeding Small quantities of gluten only Keep breast feeding after gluten exposure Breast feeding at exposure increases oral

tolerance Breast feeding protects against Diabetes

type 1, IBS and Leukaemia

Adverse Reactions to MilkAdverse Reactions to Milk

Milk Allergy

Milk Intolerance

Uncommon,

Small amounts trigger

IgE mediated

Reactions sudden

Common

Normal amounts trigger

Not IgE mediated

Skin tests Negative

Reactions delayed (4-26 days)

Milk IntolerancesMilk Intolerances

Masking- Remove dust, mould, dogs etc

Glue ear- Are parents atopic?

IBS- Milk & wheat increase rectal PG’s

Asthma- Look for milk addiction

Eczema- >2 allergens (related to asthma)

Periorbital swelling due to milkPeriorbital swelling due to milk

Katherine’s writing age at sixKatherine’s writing age at six

Fat consumption Fat consumption & Heart Disease (IHD) & Heart Disease (IHD)

Total Fat (% total energy)

No IHD IHDFramington 38.8 40.0Puerto Rico (urban) 36.6 37.7Puerto Rico (rural) 32.2 32.0Honolulu 33.3 35.2London 40.5 40.0Zutphen 41.7 41.8Ireland/Boston 38.5 39.4Caerphilly 40.1 40.9

Dietary LactoseDietary Lactose

Glucose-Galactose (disaccharide) 12g per 250ml milk Reduced in yogurt/fermented milk Absent in hard cheese Intolerance when lactase deficient

Lactose - A possible Lactose - A possible Coronary Risk Factor Coronary Risk Factor

Examination of 23,207 sets of coronary arteries and aortas revealed severity of atherosclerosis was related to:

Highest daily milk consumptionThose with highest lactase activity

Milk consumption & Milk consumption & Lactase Activity Lactase Activity

Correlation of Milk Intake with Persistent HighCorrelation of Milk Intake with Persistent High Lactase Activity (PHLA) in 14 countries Lactase Activity (PHLA) in 14 countries

Category Milk (Category Milk (cals/daycals/day) *PHLA (%)) *PHLA (%) 1 399 871 399 87 2 259 302 259 30 3 100 553 100 55

4 117 37 4 117 37 5 119 29 5 119 29

*A precondition for drinking lots of milk*A precondition for drinking lots of milk

IHD in France and FinlandIHD in France and Finland

Men 55-64 yrs had the same cholesterol and sat. fat intake (1950-1980) but IHD mortality was highest in Finland. Why?

(Wine and ethanol intake was the same)

The Finns drank 3.4 times more milk

Milk verses CheeseMilk verses Cheese

During 1972-92 there was a dramatic decline in IHD in Finland as milk consumption declined.

Cheese intake increased 3 times during this period

Countries with low IHD Countries with low IHD

Japan,China, Greenland Eskimos (heavy smokers, low wine intake)

Masai of East Africa (drink fermented milk low in lactose)

South African Blacks, Afro-Carribeans, Prima Indians, Shri Lankans (low milk, low lactose)

North Indians, Pakistanis and British have elevated IHD, high milk intake and high lactase levels

Why French have lowerWhy French have lower IHD mortality IHD mortality

Milk intake - 66% less than UKFat intake - 33% more than UKCheese intake 300% more than fresh milk

Lactase activity: Northern France - 50% less than Europe Southern France - 25% less than Europe

Lactose increasesLactose increases LDL oxidation LDL oxidation

Galactose (and Fructose) preferentially glycate proteins especially LDL.

This makes LDL more susceptible to oxidation and thus atherosclerosis

Foods & IHD mortality Foods & IHD mortality Correlation between foods Correlation between foods & IHD mortality rates in 43 countries& IHD mortality rates in 43 countries

Dietary Item rDietary Item r Total Milk 0.75Total Milk 0.75 Energy 0.72Energy 0.72 Meat 0.65Meat 0.65 Fats & oil 0.62Fats & oil 0.62 Protein 0.62Protein 0.62 Total sugar 0.57Total sugar 0.57

Is high lactose consumption merely

a marker for -casein intake?

“The rate of -Casein A1 consumption (excluding cheese) is a more accurate predictor of heart disease…. Than that reported for traditional risk factors”

Conventional Risk Conventional Risk Factors for CVD queried Factors for CVD queried

CHOLESTEROL BLOOD PRESSURE SATURATED FATS OBESITYVaried in relative contribution to illness

A survey of 39 centres in 26 countries

Incidence of Diabetes by Incidence of Diabetes by Milk Consumption Milk Consumption in Finland in Finland

0

100

200

300

400

500

600

Relative Indidence of

Diabetes

Low MilkDiet

High MilkDiet

Myocardial Infarcts in UlcerMyocardial Infarcts in Ulcer Patients who took Milk Patients who took Milk

Ulcer withSippy

Ulcer with no Sippy

No Ulcer

0

5

10

15

20

25

30

35

40

% Relative

Incidence of Myocardial

Infarct

USA Britain

Comparison of A1 CaseinComparison of A1 Casein consumption & Heart Attack consumption & Heart Attack Mortality Mortality

A1 CHD

A1

0

0.5

1

1.5

2

2.5

3

3.5

Relative Incidence of

Heart Disease

Toulouse Belfast

CHD

CHEESE CASEIN IS DIFFERENT CHEESE CASEIN IS DIFFERENT TO THAT FOUND IN MILK TO THAT FOUND IN MILK

Rennet and subsequent enzymatic action as cheese ages causes alterations to

the cheese protein structure causing cross-linking of casein molecules.

Casomorphin-7 is absent in most cheeses

Adverse effects of CaseinAdverse effects of Casein

Casein causes heart disease in animals Casein accelerates hypercholesterolaemia and atherosclerosis in animals Apo E deficient atherosclerosis prone mice

get more lesions Longevity in animals decreased by casein (compared with soy and whey) Pigs fed casein have elevated homocysteine

Casein in FoodsCasein in Foods Bakery products Ammonium caseinateBakery products Ammonium caseinate Creamed cheese Calcium caseinateCreamed cheese Calcium caseinate Frozen dessertsFrozen desserts Custard, ice cream Potassium caseinateCustard, ice cream Potassium caseinate Fruit sherbetsFruit sherbets Coffee whiteners Sodium caseinateCoffee whiteners Sodium caseinate Cottage cheeseCottage cheese YogurtYogurt��Also in fortified cereals, infant formulas, nutrition bars,Also in fortified cereals, infant formulas, nutrition bars, bakery glazes, salad dressings, sauces, whipped toppingsbakery glazes, salad dressings, sauces, whipped toppings