12/18/2018 1 The Need for Gluten-Free “One Man’s Food is Another Man’s Poison” Sponsor Disclosure: Support for this presentation was provided by the Foodservice Express division of Med-Diet, Inc. The material herein is for educational purposes only. Reproduction or distribution of these materials is prohibited except as expressly provided by Med-Diet, Inc. Copyright 2017 Med-Diet, Inc. All rights reserved. Learning Objectives After completing, the learner will: • Distinguish between celiac disease, non-celiac gluten sensitivity and wheat allergy • Identify the dietary needs for celiac disease, non-celiac gluten/wheat sensitivity and wheat allergy • Recognize the variety of resources that support gluten-free living 2 Prevalence • ~15 million with diagnosed food allergies • 5% of children • 4% of adults • Food Intolerance / Sensitivity • Not quantifiable • 1:3 people claim issues • P.S. That’s 100 million people • <1% of popu. w/diagnosed celiac disease I can’t eat that I’m ‘allergic’ to it ... …I follow a gluten-free diet. Defining an Allergy • Abnormal response to a ‘normal’ food • Triggered by immune system • Body produces antibody IgE • Reaction may be immediate or hours after exposure • Response ranges from mild to severe • Risk is tied to genetics • Proteins in the offending food have survived usual breakdown from cooking, stomach acids and/or digestive enzymes The Allergic Response • Response & timing unique to individual • Protein fragments are introduced and allergic reactions follow: • Itching in mouth; throat discomfort • Abdominal discomfort with digestion • Vomiting, diarrhea, GI pain • Allergens in bloodstream • Drop in blood pressure • Upon reaching the skin → hives, eczema • Reaching the lungs → wheezing 8 Foods cause 90%* of Allergies • Milk • Eggs • Wheat • Soybeans • Peanuts • Tree Nuts • Shellfish • Fish 6 *The other 10% is any number of other foods.
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The Need for Gluten-Free · 12/18/2018 3 Intestinal Villi Dermatitis Herpetiformis Celiac sounds like an Allergy •Allergies (especially wheat) can be outgrown •An allergy doesn’t
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12/18/2018
1
The Need for Gluten-Free“One Man’s Food is Another Man’s Poison”
Sponsor Disclosure: Support for this presentation was provided by the Foodservice Express division of Med-Diet, Inc. The material herein is for educational purposes only.
Reproduction or distribution of these materials is prohibited except as expressly provided by Med-Diet, Inc.
Copyright 2017 Med-Diet, Inc. All rights reserved.
Learning Objectives
After completing, the learner will:
• Distinguish between celiac disease, non-celiac gluten sensitivity and wheat allergy
• Identify the dietary needs for celiac disease, non-celiac gluten/wheat sensitivity and wheat allergy
• Recognize the variety of resources that support gluten-free living
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Prevalence
• ~15 million with diagnosed food allergies• 5% of children
• 4% of adults
• Food Intolerance / Sensitivity• Not quantifiable
• 1:3 people claim issues• P.S. That’s 100 million people
• <1% of popu. w/diagnosed celiac disease
I can’t eat that I’m ‘allergic’ to it ...
…I follow a gluten-free diet.
Defining an Allergy
• Abnormal response to a ‘normal’ food
• Triggered by immune system• Body produces antibody IgE
• Reaction may be immediate or hours after exposure
• Response ranges from mild to severe
• Risk is tied to genetics
• Proteins in the offending food have survived usual breakdown from cooking, stomach acids and/or digestive enzymes
The Allergic Response
• Response & timing unique to individual
• Protein fragments are introduced and allergic reactions follow:• Itching in mouth; throat discomfort
• Abdominal discomfort with digestion• Vomiting, diarrhea, GI pain
• Allergens in bloodstream• Drop in blood pressure
• Upon reaching the skin → hives, eczema
• Reaching the lungs → wheezing
8 Foods cause 90%* of Allergies
• Milk
• Eggs
• Wheat
• Soybeans
• Peanuts
• Tree Nuts
• Shellfish
• Fish
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*The other 10% is any number of other foods.
12/18/2018
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Definition – Intolerance / Sensitivity
• Intolerance / Hypersensitivity - not a true allergy• Non-IgE mediated
• Not linked to genetics
• Abnormal physiological or psychological response to food or food compound
• Varied mechanisms of action:• Metabolic: absence of chemicals/enzymes to digest a food (e.g. lactose)
• GI: Inability to absorb nutrients (e.g. fructose)
• Pharmacologic: natural/artificial food chemical sensitivity (e.g. salicylates, nitrates, caffeine)
• Psychological: extreme dislike for a food
Intolerance/Sensitivity Response• Chronic vs. acute; less obvious
• Available Now (enzymes):• Gluten Manager (Intregrative Therapiutics)
• GlutenAid (CVS)
• Rx currently in Trials:• Repair leaky gut; enzymes to digest the gluten proteins; antibodies and other
novel ideas
Summary of Clinical Trial Phases
PHASE PRIMARY GOAL DOSE PATIENT MONITORTYPICAL NUMBER OF PARTICIPANTS
NUMBER OF PARTICIPANTS NOTES
Preclinical
Testing of drug in non-human subjects, to gather efficacy, toxicity and pharmacokinetic information
unrestrictedA graduate level researcher (Ph.D.)
not applicable (in vitro and in vivo only)
Phase 0
Pharmacokinetics particularly oral bioavailability and half-life of the drug
very small, subtherapeutic
clinical researcher 10 people often skipped for phase I
Phase ITesting of drug on healthy volunteers for dose-ranging
often subtherapeutic, but with ascending doses
clinical researcher 20-100determines whether drug is safe to check for efficacy
Phase IITesting of drug on patients to assess efficacy and safety
therapeutic dose clinical researcher 100-300
determines whether drug can have any efficacy; at this point, the drug is not presumed to have any therapeutic effect whatsoever
Phase III
Testing of drug on patients to assess efficacy, effectiveness and safety
therapeutic doseclinical researcher and personal physician
1000-2000
determines a drug’s therapeutic effect; at this point, the drug is presumed to have some effect
Phase IVPostmarketing surveillance – watching drug use in public
therapeutic dose personal physiciananyone seeking treatment from their physician
watch drug’s long-term effect
Thank you for participating in today’s session!
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This presentation is intended to provide general information about the gluten free diet but is not intended to provide medical advice.
Presentation Author: Debra Zwiefelhofer, RDN, LD
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