1. Diet and Health Guidelines for Food Intolerances Presented by Janice Hermann, PhD, RD/LD OCES Adult and Older Adult Nutrition Specialist

2. Food Allergy A 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 allergic Often an incompletely digested protein

3. What Happens With A Food Allergy When 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

4. Food Intolerances Some people have adverse reactions to foods that do not involve the immune system These are referred to as "food intolerances“ they are not food allergies

5. Causes of Food Intolerances Food intolerances may be caused by: Enzyme deficiencies Reactions to chemicals in foods Sulfur Digestive diseases

6. Metabolic Intolerances A metabolic intolerance is when the body cannot adequately digest a portion or component of a food For example lactose intolerance and gluten intolerance

7. Lactose Intolerance People with lactose intolerance cannot digest (breakdown) lactose in milk Lactose is a disaccharide (sugar) in milk Lactose is digested by the enzyme lactase into two monosaccharides, glucose and galactose, which can be absorbed by the small intestine

8. Lactose Intolerance If 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.

9. Symptoms Of Lactose Intolerance Symptoms include cramps, bloating, intestinal gas, diarrhea and nausea Severity 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

10. 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

11. How Much Lactose Amount of lactose allowed depends on the degree of lactose tolerance Many can tolerate 6 grams lactose (1/2 C milk) Many can tolerate fermented products such as yogurt and acidophilus milk Hard cheeses and cottage cheese may be tolerated because most of the lactose is removed with whey

12. How Much Lactose Many 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

13. How Much Lactose Very sensitive people need to check food labels carefully for: Milk Whey Lactose Nonfat milk solids Dry milk solids Curds Cheese Margarine Sweet or sour cream

14. Lactobacilus Many 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 milk Example: Lact-aid, Dairy-ease, Lactinex

15. Gluten Intolerance Gluten 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

16. Gluten Intolerance Gluten intolerance is also referred to as celiac disease, celiac-sprue, nontropical sprue or gluten sensitive enteropathy Individuals do not outgrow gluten intolerance

17. Symptoms Of Gluten Intolerance As 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

18. 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

19. Gluten Intolerance Gluten containing grains Wheat Rye Barley Oats Although 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

20. Gluten Intolerance Non-gluten containing grains Tapioca Corn flour Corn starch Rice flours Potato starch Potato flour Soy flour

21. Gluten-Free Flour Substitute Gluten-free flour mix Rice flour 6 cups Potato starch2 cups Tapioca flour 1 cup

22. Food Additive Intolerances Although most individuals consume a wide variety of food additives each day, only a small number have been associated with intolerances to food additives

23. Yellow No. 5 or Tartrazine Sensitivity Yellow No. 5 is a food color additive Although rare, yellow dye No. 5 may cause hives in some individuals Whenever Yellow No. 5 is added to a food, it should be listed on the product food label

24. Carmine Sensitivity Carmine 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

25. Monosodium glutamate (MSG) MSG is a flavor enhancer MSG is the sodium salt of glutamic acid, an amino acid found naturally in all protein A few people report mild and short-lived reactions after eating MSG If MSG is added to a food it is listed on the label as monosodium glutamate

26. Sulfites Sulfites are used to preserve color of foods and inhibit microorganism growth Some people develop shortness of breath or fatal shock shortly after exposure to sulfites Sulfites can produce severe asthma attacks in sulfite-sensitive asthmatics

27. Sulfites FDA 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

28. Aspartame Some people have complained of adverse reactions to aspartame However, in clinical studies aspartame has not shown allergic reactions FDA concluded there is no evidence of a cause and effect between aspartame and sensitivities reported