Handouts for NEMDA talk 3/11/11
GI Disorders and Inflammation: Inflammatory Effects of Foods and
Food Additives
OBJECTIVES: After this presentation the participant will be able to:
1. Identify and discuss inflammation resulting from GI disorders
2. Discuss the mechanisms behind dietary causes of inflammation and identify
strategies to reduce inflammation
3. Differentiate between IgE allergy and Type 3 and Type 4 Immune responses
and testing used for each
DESCRIPTION:
Health begins with digestion since digestive problems affect nutrient
absorption and wellness in all areas of our lives. A stressed digestive tract is a
primary source of inflammation. GI disorders, allergies, food sensitivities,
parasites, yeast overgrowth, and emotional stress can all inflame the GUT and
affect nutrient absorption. Current research shows inflammation is the underlying
cause of most chronic diseases and inflammation is linked to oxidative stress.
Food sensitivities play a prominent role in triggering many common
inflammatory conditions, such as Irritable Bowel Syndrome, Migraine Headache,
diabetes, obesity and arthritis. However, there remains a lack of understanding of
the various types of adverse food reactions and their role in the inflammatory
process. This presentation will help the RD understand the spectrum of immune
and non-immune food allergy, sensitivity and intolerance and it’s relationship to
the inflammatory process.
GI tract has 2 major roles:
 Digestion and uptake of nutrients
 Maintaining immune homeostasis
GI tract has the largest number of immune cells in the body. Everyday,
several times each day it is exposed to chemicals, proteins, bacteria and
antigens that are trying to cross the gut mucosa and gain access to the body.
The gastro-intestinal associated lymphoid tissue (GALT) is able to discriminate
between harmful and harmless antigens while maintaining homeostasis.
Inflammation is the body’s response to injury, and is common in many
tissues. Cytokines are proteins produced and released by cells in the immune
system to help regulate the immune response to disease and infection.
GI disorders, food allergies, food sensitivities, parasites, yeast overgrowth,
and emotional stress can all inflame the GIT and affect nutrient absorption.
 Malabsorption can affect macronutrients, micronutrients, or both, causing
excessive fecal excretion resulting in nutritional deficiencies.
 Inflammatory bowel disease (IBD), which includes Crohn's disease and
ulcerative colitis (UC), is characterized by chronic inflammation at various
sites in the GI tract.
 Celiac sprue is caused by intolerance to gluten, resulting in mucosal
1


inflammation.
IBS is an inflammatory response with increased levels of cytokines.
Small-bowel bacterial overgrowth can occur from alterations in intestinal
anatomy or GI motility, or lack of gastric acid secretion.
2
Inflammatory processes are initiated by diet. The gut is the seat of immune
responses. There are four dietary causes of inflammation.
1) Toxin exposure includes exotoxins and endotoxins. From a nutritional
standpoint, the GIT is the site for endotoxin production.
2) Dysglycemia can be viewed as both a trigger and a mediator of chronic
inflammation. J Am College of Cardiology, 2008;51:249-255.
3) Oxygen metabolism is linked to the inflammatory process. Inflammation
and You: How Foods From Plants Protect Us From Disease. Daniel H Hwang,
Agricultural Research/April 2009, 6-7
Prior, Ronald L, A Daily Dose of Antioxidants? Agricultural Research/March
2008, 4-5
4) Immune-mediated adverse food reactions: Digestion and absorption of
nutrients in food is compromised by food allergies, food intolerances, food
sensitivities, and reactions to chemicals in foods.
Combating Inflammation:
1. Antioxidants combat free radicals and reduce inflammation.
2. Fat serves important roles: EFAs are precursors of eicosanoids, secondmessenger mediators involved in inflammation.
3. Adiponectin, an adipose tissue secreted cytokine.
Persons with higher levels of adiponectin, a protein that is produced by fat
cells and that has anti-inflammatory and insulin-sensitizing properties, have an
associated lower risk of type 2 diabetes, according to an analysis of previous
studies, reported in the July 8 issue of JAMA. (Embargo expired on 07-Jul-2009
at 16:00 ET) JAMA, 8-Jul-2009 –
4. Fiber: "Effect of high-fiber diet vs a fiber-supplemented diet on C-reactive
protein level". D.E. King, B.M. Egan, R.F. Woolson, A.G. Mainous III, Y. AlSolaiman, A. Jesri. Archives of Internal Medicine. March 12 2007, Volume 167,
Pages 502-506.
There are two categories of adverse food reactions: those that come from the
immune system and those, which are not immune, mediated. Often, patients are
experiencing both types of reactions.
Non-immunologic reactions:
 Malabsorption – fructose
 Food poisoning
 Enzyme deficiencies – lactase
 Medication reactions
 SIBO – Small intestinal bacterial overgrowth
 Candida or Yeast overgrowth
 Direct provocation of the GI tract with lectins or histamines (which is
borderline immunological since it involves mast cells)
3
Immune-mediated adverse food reactions:
Type I reactions (immediate hypersensitivity) are IgE-mediated and can be
detected by skin testing, RAST and MAST testing.
Food sensitivities are different from Food Allergies and are also immunemediated, but involve different mechanisms, different white blood cells, and
different mediators. Food sensitivities are much more common than allergies
(est. 15-20% incidence)
Type II, or antibody-dependent food hypersensitivity, occurs when the
antibody binds to either self-antigen or foreign antigen on cells, and leads to
phagocytosis, killer cell activity or complement-mediated lysis.
Type III food hypersensitivity develops when immune complexes are formed
in large quantities, or cannot be cleared adequately by the reticuloendothelial
system.
Type IV, a non-IgE reaction, or cell-mediated delayed hypersensitivity, is most
seriously manifested when antigens are trapped in a macrophage and cannot be
cleared.
The loss of oral tolerance and subsequent food reactivity triggers a large
component of the symptoms of Diarrhea-IBS, migraine and other inflammatory
conditions.
4
5
6