Celiac And Alt Therapies Flashcards
Define food intolerance.
Lacks enzyme to digest or more nutrients than enzyme. Not immune mediated
Lactose intolerance or FODMAPs
Define food sensitivity.
Variety of reactions when eating the food.
Usually not immune mediated response to nutrient.
No permanent damage.
Gluten sensitivity
Define food allergy.
Specific IgE mediated immune response rx to protein
Respond min-hrs after exposure
Usually 1st yr of life
Milk allergy wheat allergy
What does the body specifically react to from the cereals? What does it cause?
Prolamins-storage protein
Causes chronic inflammation, flat villi (Villous atrophy), malabsorption
What genes are specific to CD?
HLA-DQ2 and HLA-DQ8
Classic S/S of CD?
N/V, abd cramping, gas, bloating, chronic diarrhea to constipation, steatorrhea, dehydration, folate deficiency anemia, wt loss, dermatitis herpetiformis (lesions on GI tract and skin)
Specific cereal triggers and the proteins in them?
Wheat (gliadin)
Rye (secalin)
Barley (hordein)
What makes up the prolamin of wheat (storage protein)?
Gliadin and glutenin.
Steps of cellular and humoral response with gluten exposure?
High cellular TH1 makes INF gamma
Lymphocytes into epith makes humoral response then IgA, IgA, IgM
Gliadin upregulates zonulin to raise permeability
Proteins into circulation
What is zonulin? What does it regulate?
Intestinal permeability regulator. It is expressed after gliadin binds CXCR3 on outside of cell. Upregulation leads to leaky gut.
What 5 conditions being present mean to screen for CD?
Infertility Osteoporosis Lupus DM1 Thyroid diseases
Why is osteoporosis common with CD?
Less Ca and Vit D b/c think lactose intolerant
Thyroid probs- Ca comes out of bones
Prednisone- use to manage pain
No exercise or wt bearing activity -tired
Malabsorption fat so SOAP form with Ca Zn Mg
What is DH?
Dermatitis herpetiformis
85% people with this have CD. Only 10% people with CD have DH.
Watery itchy blisters. IgA deposited under top layer of skin.
How is CD usually Dx?
Detect serum IgA anti-tTG antibodies (sensitive to CD)
Gold standard: intestinal mucosal biopsy (need to be eating gluten still!)
Good names to know with CD?
A. Fasano (zonulin)
Michelle Pitzack
High risk groups for developing CD?
Down's UC Asthma Eczema Fibromyalgia Autoimmune (T1DM, thyroid, lupus, RA)
What is silent CD?
Not clinically harming until secondary effects (T1DM, Lupus, RA, osteoporosis, CA)
Just patchy small intestine involvement
MNT for CD.
Possible wt gain (eat more and increase absorption) Monitor fiber intake Avoid BROW Allow CRAP (corn, rice, arrowroot, potatoes)
What are other forms of wheat?
Triticale, spelt, couscous, durum, semolina, farina, Farro
What does CELIAC stand for in MNT?
Consultation, education, lifelong GF diet, identify deficiencies, access advocacy group, continuous follow-up
What is FDA GF definition? Gluten Intolerance Group definition?
GF label must have
Avoid/monitor these foods on GF diet.
Malt anything, beer, miso (barely)
HVP, plastic bags, soy sauce (wheat berry), roux/cheese spreads, binder in meds, hygiene products
Distilled alcohol=ok!
What is non-responsive CD?
S/s despite Dx and Tx
10% of pts
Usually from: gluten expose (more edu), IBS, di/mono deficiency
What is NCGS?
Non-celiac Gluten sensitivity
No intestinal damage but s/s after gluten exposure
No Dx for sure (no CD for sure, no wheat allergy, maybe have bio markers)
50% of these people have HLA genes
Define CD and avg Dx time.
Gluten-sensitive enteropathy or celiac sprue
Inherited, autoimmune, immune response to gluten (environmental)
Was 11 years but now 6 years for Dx.
What are the 5 no’s of paleo? Risks with the diet?
No grains, sugars, dairy, processed foods, or beans (no PB)
Osteoperosis, ketosis,
What is SCD?
Specific Carbohydrate Diet
Di and poly poorly absorbed= yeast overgrowth, thick mucus, and malabsorption
Can only eat monosaccharides, F/V but no pot/yam, no chick or soy, no milk, no grains, ok honey
What are night shades?
2000 plant species
Solanaceae plant family
Believed to cause inflammation in joints
Bell peppers, tomatoes, eggplant, potato, paprika, Goji berries)
What is diverticulitis? What are 2 types of conditions?
Inflammation in the colon
Diverticulosis and diverticulitis
Define diverticulosis
Out pockets and pouches on SI or colon.
Asymtomatic, unknown cause, maybe LT constipation, obesity or low PA
Increases with age.
Possible: mild bleeding or different BM habits
Define diverticulitis.
Acute inflammation of the diverticula that leads to infection
Caused by: lodged stool in pocket, tear pocket, lodged food, rupture diverticululum then colon contents infect body!
33% end up in hospital
S/S with diverticulitis.
Not a lot of specific one
All common GI problem s/s
Most specific: pain in one specific quadrant
3 main complications with diverticulitis.
Obstruction
Sepsis
Fistula
MNT for diverticulosis.
High fiber diet ( insoluble- bulking)
Exercise
Fluids, avoid constipation from meds, no greasy food or popcorn.
MNT for diverticulitis.
If burst- antibiotic therapy.
NPO, maybe TPN, clear liquid, low fiber, BRAT diet, low fat diet
What is IBS? 3 types?
Irritable Bowel Syndrome; Abd pain associated with altered BM for 3 months. Biopsy finds nothing. No obstructions.
IBS-D, IBS-C, IBS-M
What is SIBO?
Small intestinal bacterial overgrowth.
Thinks its main cause of IBS.
Focus on Candida albicans (white flour, sugar, yeast, cheese) may improve with FODMAP diet
MNT for IBS?
Eliminate triggers, get reg eat pattern
Smaller meals, less lactose, fat, polyols, fructose, sucrose, gas producing foods (beans, peas, broccoli, cabbage, bran)
Sources of fructose?
Honey, agave, HFCS
Dates, watermelon, pear, oranges, apples, melon, cherries
What is lactose maldigestion and how Dx?
Can co exist with IBS.
Hydrogen breath test or monitored diet hx or eliminate lactose for 1-2 weeks and see
What does FODMAP diet avoid? Why?
To avoid fermentation/osmotic effect of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.
Started in 2001
What ingredient should you look for in bars if stomach hurts?
Inulin anything
3 main skills to teach pts with GI problems.
Label reading
Meal planning
Recipe modification
What is FPIES?
Food protein induced enterocolitis syndrome
Severe food allergy
