Adverse
Food
Reactions
A Seminar by Robert Buist PhD
Copyright © 2012 International Academy of Nutrition
Malabsorption in
Coeliac Disease (CD)
Malabsorption of iron, folate,
calcium and fat soluble vitamins
results in iron deficiency, folate
deficiency and reduced bone
density
INFANT PRESENTATIONS
Infants and young children
present with diarrhoea,
abdominal distension and
FAILURE TO THRIVE
Mechanism underlying
osteoporosis in CD
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Calcium malabsorption
Vitamin D malabsorption
Secondary hyperparathyroidism
Failure of peak bone density as child
Reduced gonadal function in men
Autoimmunity
CD is associated with:
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Delayed menarche
Premature menopause
Amenorrhoea
recurrent miscarriages
Infertility & low birthweight babies
Increased perinatal mortality
Autoimmune Diseases & Gluten
 Coeliac Disease
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Diabetes Mellitus
Autoimmune Thyroid Disease / MS
Rheumatoid Arthritis / Psoriasis
Glomerulonephritis
Antibodies disappear on a gluten free diet
Common Misdiagnoses
Anaemia
Allergies
Thyroid Disease
Lactose Intolerance
IBS, CFS
Autoimmune Disorders ten
times more common in CD
 Addisons
Disease
 Thyroid disease
 Cardiomyopathy
 Sjogrens
D isease
 Neurological
disorders
 Renal Disease
 Autoimmune
liver disease
 IDDM
Serological Tests for CD
 Antibodies against gliadin
(IgA-AGA, IgG-AGA)
 Endomysial antibody (IgA-EMA)
 Tissue transglutaminase antibody
(IgA-tTG)
 Total IgA
Cancer and CD
Malignant diseases are more
frequent in coeliacs
 Small bowel CA
 Oesophageal & oropharangeal CA
 Non-Hogkins lymphoma
Exorphins & Behaviour
 Autistic children respond to
gluten-free,casein-free diet
 Improved speech, social behaviour,
sleeping habits
 Food peptides affect ADHD
 Depression & morphine-like
exorphins
Oats are not toxic to
patients with Coeliac
Disease or Dermatitis
Herpetiformis
Candida & Coeliac
Disease

Genetic link (HLA-DQ2 and HLA-DQ8)
in patients with coeliac disease
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Alpha-gliadin has immunoreactve
peptides
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Hyphal wall protein (HWP 1) in
C. albicans. Similar epitopes in gliadin
Transglutaminases elevated
in CD
 Yeasts adhere to gut via transglutaminases
 Gliadin deamidated via transglutaminases
 Yeast & gluten provide T-cell epitopes
(reactive peptides which trigger antibodies)

Autoreactive antibodies form against tissue
transglutaminases and endomysium peptides
Affect of Antibiotics
 Increased candida overgrowth
 Damage to gut
 Increased exposure of transglutaminases
 Increased binding of candida HWP 1
 Tissue transaminases (autoantigen)
recognised by autoreactive antibodies
Breast Feeding Protects
against CD
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Introduce gluten while breast feeding
Small quantities of gluten only
Keep breast feeding after gluten exposure
Breast feeding at exposure increases oral
tolerance
 Breast feeding protects against Diabetes
type 1, IBS and Leukaemia
Adverse Reactions to Milk
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Milk Allergy
Milk
Intolerance
Uncommon,
Small amounts trigger
IgE mediated
Reactions sudden
Common
Normal amounts trigger
Not IgE mediated
Skin tests Negative
Reactions delayed (4-26 days)
Milk Intolerances
 Masking- Remove dust, mould, dogs etc
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Glue ear- Are parents atopic?
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IBS- Milk & wheat increase rectal PG’s
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Asthma- Look for milk addiction
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Eczema- >2 allergens (related to asthma)
Periorbital swelling due to milk
Katherine’s writing age at six
Fat consumption
& Heart Disease (IHD)
Total Fat (% total energy)
No IHD
Framington
Puerto Rico (urban)
Puerto Rico (rural)
Honolulu
London
Zutphen
Ireland/Boston
Caerphilly
38.8
36.6
32.2
33.3
40.5
41.7
38.5
40.1
IHD
40.0
37.7
32.0
35.2
40.0
41.8
39.4
40.9
Dietary Lactose
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Glucose-Galactose (disaccharide)
12g per 250ml milk
Reduced in yogurt/fermented milk
Absent in hard cheese
Intolerance when lactase deficient
Lactose - A possible
Coronary Risk Factor
Examination of 23,207 sets of coronary
arteries and aortas revealed severity of
atherosclerosis was related to:
 Highest daily milk consumption
Those with highest lactase activity
Milk consumption &
Lactase Activity
Correlation of Milk Intake with Persistent High
Lactase Activity (PHLA) in 14 countries
Category
1
2
3
4
5
Milk (cals/day) *PHLA (%)
399
87
259
30
100
55
117
37
119
29
*A precondition for drinking lots of milk
IHD in France and Finland
Men 55-64 yrs had the same
cholesterol and sat. fat intake
(1950-1980) but IHD mortality
was highest in Finland. Why?
(Wine and ethanol intake was the same)
The Finns drank 3.4 times
more milk
Milk verses Cheese
During 1972-92 there was a
dramatic decline in IHD in
Finland as milk consumption
declined.

Cheese intake increased 3
times during this period
Countries with low IHD

Japan,China, Greenland Eskimos
(heavy smokers, low wine intake)
 Masai of East Africa (drink fermented
milk low in lactose)
 South African Blacks, Afro-Carribeans,
Prima Indians, Shri Lankans (low
milk, low lactose)
North Indians, Pakistanis and British have elevated
IHD, high milk intake and high lactase levels
Why French have lower
IHD mortality
Milk intake - 66% less than UK
Fat intake - 33% more than UK
Cheese intake 300% more than fresh milk
Lactase activity:
Northern France - 50% less than Europe
Southern France - 25% less than Europe
Lactose increases
LDL oxidation
Galactose (and Fructose)
preferentially glycate proteins
especially LDL.
This makes LDL more susceptible
to oxidation and thus
atherosclerosis
Foods & IHD mortality
Correlation between foods
& IHD mortality rates in 43 countries
Dietary Item
r
Total Milk
Energy
Meat
Fats & oil
Protein
Total sugar
0.75
0.72
0.65
0.62
0.62
0.57
Is high lactose
consumption merely
a marker for -casein
intake?
“The rate of -Casein A1
consumption (excluding
cheese) is a more accurate
predictor of heart disease….
Than that reported for
traditional risk factors”
Conventional Risk
Factors for CVD queried
A survey of 39 centres in 26 countries
CHOLESTEROL
 BLOOD PRESSURE
 SATURATED FATS
 OBESITY
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Varied in relative contribution to illness
Incidence of Diabetes by
Milk Consumption
in Finland
600
500
400
Relative
Indidence of 300
Diabetes
200
100
0
Low Milk
Diet
High Milk
Diet
Myocardial Infarcts in Ulcer
Patients who took Milk
40
35
Ulcer with
Sippy
30
%
25
Relative
Incidence of 20
Myocardial
15
Infarct
10
Ulcer with no
Sippy
No Ulcer
5
0
USA
Britain
Comparison of A1 Casein
consumption & Heart Attack
Mortality
3.5
3
A1
2.5
Relative
2
Incidence of
Heart Disease 1.5
A1
CHD
CHD
1
0.5
0
Toulouse
Belfast
CHEESE CASEIN IS DIFFERENT
TO THAT FOUND IN MILK
Rennet and subsequent
enzymatic action as cheese
ages causes alterations to
the cheese protein structure
causing cross-linking of
casein molecules.
Casomorphin-7 is absent in most cheeses
Adverse effects of Casein
 Casein causes heart disease in animals
 Casein accelerates hypercholesterolaemia
and atherosclerosis in animals
 Apo E deficient atherosclerosis prone mice
get more lesions
 Longevity in animals decreased by casein
(compared with soy and whey)
 Pigs fed casein have elevated homocysteine
Casein in Foods
 Bakery products
 Creamed cheese
Frozen desserts
 Custard, ice cream
Fruit sherbets
 Coffee whiteners
Cottage cheese
Yogurt
Ammonium caseinate
Calcium caseinate
Potassium caseinate
Sodium caseinate
�Also in fortified cereals, infant formulas, nutrition bars,
bakery glazes, salad dressings, sauces, whipped toppings