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

2. 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.

3. 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.

4. Gluten Intolerance The disease primarily affects the mucosa of the jejunum or ileum.

5. 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.

6. 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.

7. Nutritional Care complete Nutritional care includes complete withdrawal of gliadin from the diet. Gluten is found in wheat, barley and rye. Oats Hold the Oats for Celiac Disease?Hold the Oats for Celiac Disease? Corn, rice, soy, arrowroot, tapioca and potato flours may be substituted for wheat flour.

8. Nutritional Care labels of all packaged foods 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

9. 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.

10. 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

11. Nutritional Care - Suggestions to Improve Quality Soy flour should always be used with other flours. Longer and slower baking is usually required.

12. Nutritional Care - Suggestions to Improve Quality coarse 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.

13. 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.

14. 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.

15. Lactase Deficiency The result is bloating, flatulence, cramps and diarrhea. Lactase activity declines at weaning..

16. 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.

17. 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.

18. 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.

19. Nutritional Care Milk and milk products treated with lactase enzyme (Lactaid™) are well tolerated.

20. 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

21. 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

22. 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 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

24. 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

25. Food Allergies Symptoms : severe reaction Extreme versions of previous rx. Constriction of the airways Shock Rapid pulse Dizziness.

26. Food Allergies Diagnosis Skin prick test Blood tests Challenge test

27. Salt Intake and Hypertension

28. Salt Sensitivity Approximately 30 – 50% of hypertensive and 15-20% of normotensive individuals are salt sensitive. Groups most likely to be salt sensitive are: Obese hypertensive individuals African Americans Person with diabetes The elderly