Diet and Health Guidelines for Food Intolerances

Presented by Janice Hermann, PhD, RD/LD

OCES Adult and Older Adult Nutrition Specialist

Food AllergyA food allergy is an adverse reaction to a food

or food component that involves the immune system

A food allergen is the part of a food to which a person is allergicOften an incompletely digested protein

What Happens With A Food AllergyWhen someone eats a food they are allergic

to, the food allergen stimulates the immune system to release antibodies

The antibodies cause body cells to release other substances, which cause allergic reactions

Food IntolerancesSome people have adverse reactions to foods

that do not involve the immune systemThese are referred to as "food intolerances“

they are not food allergies

Causes of Food IntolerancesFood intolerances may be caused by:

Enzyme deficienciesReactions to chemicals in foodsSulfurDigestive diseases

Metabolic IntolerancesA metabolic intolerance is when the body

cannot adequately digest a portion or component of a food

For example lactose intolerance and gluten intolerance

Lactose IntolerancePeople with lactose intolerance cannot digest

(breakdown) lactose in milk Lactose is a disaccharide (sugar) in milkLactose is digested by the enzyme lactase

into two monosaccharides, glucose and galactose, which can be absorbed by the small intestine

Lactose IntoleranceIf there is not enough lactase, the lactose is

goes undigested the intact lactose moves into the large intestine and is fermented by normal bacteria found in the large intestine

The amount of lactase produced tends to decrease in adulthood

Incidence of lactose intolerance varies for different populations.

Symptoms Of Lactose IntoleranceSymptoms include cramps, bloating,

intestinal gas, diarrhea and nauseaSeverity of symptoms varies with the

amount of lactose consumed and degree of intolerance

Symptoms appear from 15 minutes to several hours after eating foods or beverages containing lactose

Is Lactose Intolerance A Milk Allergy?A milk allergy is an allergic reaction to the

protein components in milk, not the lactose in milk

People with milk allergy usually must avoid all milk products. People with lactose intolerance can use certain dairy products that are low in lactose

How Much LactoseAmount of lactose allowed depends on the

degree of lactose toleranceMany can tolerate 6 grams lactose (1/2 C milk)Many can tolerate fermented products such as

yogurt and acidophilus milkHard cheeses and cottage cheese may be

tolerated because most of the lactose is removed with whey

How Much LactoseMany foods contain small amounts of

lactose, for example breads, dry cereals, cold cuts, cream soups, salad dressings, candy, cookies, drink mixes, and sugar substitutes

Most people can handle the small amount of lactose in these foods

How Much LactoseVery sensitive people need to check food labels

carefully for:MilkWheyLactoseNonfat milk solidsDry milk solidsCurds

CheeseMargarineSweet or sour cream

LactobacilusMany people can use commercially prepared

milk products that have been treated with an enzyme (lactobacilus) that breaks down lactose

Alternatively, people can take enzyme tables with meals or add enzyme drops to their milkExample: Lact-aid, Dairy-ease, Lactinex

Gluten IntoleranceGluten is a protein found in wheat, rye, and

barley or derivatives of these grains such as malt

Some individuals cannot tolerate the gliadin fraction in gluten

Gluten IntoleranceGluten intolerance is also referred to as celiac

disease, celiac-sprue, nontropical sprue or gluten sensitive enteropathy

Individuals do not outgrow gluten intolerance

Symptoms Of Gluten IntoleranceAs a result of gliadin intolerance the

intestinal lining is flattened which results in reduced food absorption, diarrhea, steatorrhea (fat in the stool), bloating, loss of appetite, muscle wasting, weight loss and can lead to progressive malnutrition

Symptoms Of Gluten Intolerance

Lactose intolerance may temporarily occur secondarily to gluten intolerance

However, lactose containing foods can be returned to the diet within a short time

Gluten IntoleranceGluten containing grains

WheatRyeBarley

OatsAlthough oats is gluten-free, the use of oats is

controversial due to contamination with wheat during processing

A limited intake of oats (40 to 60 g/day) is currently considered acceptable

Gluten IntoleranceNon-gluten containing grains

TapiocaCorn flourCorn starchRice floursPotato starchPotato flourSoy flour

Gluten-Free Flour SubstituteGluten-free flour mix

Rice flour 6 cupsPotato starch 2 cupsTapioca flour 1 cup

Food Additive IntolerancesAlthough most individuals consume a wide

variety of food additives each day, only a small number have been associated with intolerances to food additives

Yellow No. 5 or Tartrazine Sensitivity

Yellow No. 5 is a food color additiveAlthough rare, yellow dye No. 5 may cause

hives in some individualsWhenever Yellow No. 5 is added to a food, it

should be listed on the product food label

Carmine SensitivityCarmine is an extract of the cochineal insect

used as a bright red dye in a number of products

Occasional reactions to carmine used as a food coloring have been reported

If carmine is added to a food it should be listed on the product food label

Monosodium glutamate (MSG)MSG is a flavor enhancerMSG is the sodium salt of glutamic acid, an

amino acid found naturally in all proteinA few people report mild and short-lived

reactions after eating MSGIf MSG is added to a food it is listed on the

label as monosodium glutamate

SulfitesSulfites are used to preserve color of foods

and inhibit microorganism growthSome people develop shortness of breath or

fatal shock shortly after exposure to sulfitesSulfites can produce severe asthma attacks in

sulfite-sensitive asthmatics

SulfitesFDA banned the use of sulfites on fresh fruits

and vegetables (except potatoes) intended to be sold to consumers raw

Sulfites added to all packaged and processed foods must be listed on the product label

AspartameSome people have complained of adverse

reactions to aspartameHowever, in clinical studies aspartame has

not shown allergic reactionsFDA concluded there is no evidence of a

cause and effect between aspartame and sensitivities reported