10/29/12 ¡ The Role of Food Allergies and Intolerances in Chronic Conditions JENNIFER JEWELL-LARSEN, ND MEDICA MEDICAL DIRECT L DIRECTOR, OR, NA NATUR TUROP OPATH THIC F IC FAMIL MILY H Y HEA EALTH TH INFO@NF-HEAL INF O@NF-HEALTH.COM TH.COM 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 1 ¡
10/29/12 ¡ 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 Adverse Food Reactions 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 of the endeavor. - J.V. Joneja Dietary Management of Food Allergy and Intolerance. 2 nd ed. Vancouver, BC, Hall Publishing Group, 1998. Related Conditions and Symptoms Eczema Migraines Chronic otitis media ADHD Chronic LRTIs and Arthritis sinusitis Autistic specturm Acne disorders GERD IBS 2 ¡
10/29/12 ¡ 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 Accumulation of eosinophils in any or all layers of the digestive tract Serum eosinophils may be elevated with no other explanation esopha hagogastroent nteritis 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 Intole Int 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 Drug-like effect triggered by some foods Pha harma macolo logic r reactions ns 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 3 ¡
10/29/12 ¡ 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 4 ¡
10/29/12 ¡ 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 5 ¡
10/29/12 ¡ 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 6 ¡
10/29/12 ¡ 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) 7 ¡
10/29/12 ¡ 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, Dairy turkey Eggs Grains and starches Arrowroot, buckwheat, Gluten grains: wheat, rye, corn, millet, oats (GF), rice, barley, kamut, spelt, rye, sweet potato, tapioca, semolina, triticale white potatoes, yams Fruits, vegetables, legumes All whole fruits, vegetables Corn syrup, high fructose allowed except refined corn corn syrup products All forms of soy: tofu, soy All legumes except 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 other nuts Grains and starches Arrowroot, buckwheat, corn, Wheat, barley, millet, oats, kamut, spelt, rye, rice, sweet potato, tapioca, wheat, semolina, triticale white potato, yams 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 Animal fats (lard), butter, corn, margarine, sesame shortening, soy, peanut, other vegetable oils Other Salt, pepper All other spices including vanilla and cinnamon Chocolate, coffee, tea, soft drinks, alcohol 8 ¡
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