Diets for special needs and life stages

Diets for allergies and intolerances

A food allergy occurs when the immune system overreacts to a protein in the food. The immune system makes IgE antibodies in response to the protein. This causes the person to quickly experience allergy symptoms. Symptoms may include itching, hives, nausea and vomiting, diarrhea, difficulty breathing (e.g., tightness in the throat or chest, coughing, wheezing), or anaphylaxis.

With a food intolerance, the body cannot digest, metabolize, or absorb certain nutrients. Lactose and gluten intolerance are the most common types of food intolerances. Food sensitivities are less severe than food intolerance. Typically, people can consume foods they are sensitive to in moderation. Food sensitivities can resolve over time.

Elimination diet and food allergies

Nine of the most common food allergens can be hiding in ingredient lists under other names. Some examples are listed here:

• Milk (e.g., cream, casein, ghee, galactose, lactalbumin, lactose, and whey)
• Eggs (e.g., albumin, eggnog, ovalbumin, and ovomucin)
• Fish (e.g., cod, bass, flounder)
• Crustacean shellfish (e.g., crab, lobster, shrimp)
• Tree nuts (e.g., almonds, cashews, filberts, hazelnuts, marzipan, nut meal)
• Peanuts (e.g., peanut butter, peanut flour)
• Wheat (e.g., emmer, einkorn, durum, Kamut, modified wheat starch, wheat bran, wheat flour, wheat germ)
• Soybeans (e.g., edamame, miso, soya, tempeh, tofu)
• Sesame (a hidden ingredient in “spices” and “natural flavors”)

It is important to realize that parts of these foods are used in other foods. For instance, milk proteins (e.g., whey and casein) and milk sugar (lactose) appear in some surprising foods, medications, and hygiene products. Some examples include chicken broth, deli meats, hot dogs, French fries, shampoos and conditioners, and dry powder medication inhalers (e.g., Advair Diskus, Flovent Diskus, and Serevent Diskus). Reading ingredient lists is critical for those with allergies.

When people suspect a food allergy, the elimination diet can be used. People remove the allergy-potential foods from their diet. They may need to track what they eat and how they feel. Slowly, they may then add the suspicious foods back into their diet, one food at a time. This process helps identify the allergen. In some cases, a cross-reactivity may occur, and the person will have additional food allergies. An allergist can help identify additional food and environmental allergies.

Pollen-food syndrome

Another issue faced by those with food allergies is cross-reactivity. This means that the protein in the allergic food is similar to that in other foods. The person’s immune system cannot tell the proteins apart and thus reacts to similar foods. Cross-reactivity can occur with foods and nonfood items. For instance, a person with a latex allergy could also be allergic to avocados, bananas, chestnuts, and kiwi.

Pollen-food syndrome (also called oral allergy syndrome) is caused by cross-reacting allergens found in pollens, raw foods, and tree nuts. Symptoms include itchy mouth and ears, scratchy throat, and swollen lips, mouth, tongue, and throat. Typically, the symptoms disappear when the food is out of the mouth. Some common cross-reactions include the following:

• Ragweed pollen: Cucumber, banana, melons, potatoes, and zucchini
• Grass pollen: Celery, melons, oranges, peaches, and tomatoes
• Birch pollen: Pitted fruit (e.g., plum, pear, peach, and apple), kiwi, carrot, celery, almond, and hazelnut

Alpha-gal syndrome

Alpha-gal syndrome or allergy is an allergy to the alpha-gal sugar molecule found in mammals (except for people, apes, and monkeys). The alpha-gal sugar molecule can also be found in products made from mammals, including gelatin, some vaccines and medications, cosmetics, and milk products.

It is believed that the Lone Star tick carries this disease from animals to humans. Most cases occur in the southeastern and midwestern United States and infect adults over age 50. Younger adults and children can also have it. Here are some symptoms of alpha-gal syndrome:

• Rash, hives, difficulty breathing, and wheezing
• Swelling of the lips, face, throat, and tongue
• Drop in blood pressure, dizziness, and faintness
• Nausea, vomiting, severe stomach pain

Symptoms can be life threatening and commonly appear 3 to 6 hours after exposure (eating meat or using products). A skin test or a blood test can be used to diagnose alpha-gal syndrome. Treatment consists of avoiding foods and products that cause the reaction.

Celiac disease

People with celiac disease are put on a gluten-free diet. (See Chapter 19 for additional information on celiac disease.) Gluten is a protein found in a number of food sources:

• Barley and malt products (e.g., flavoring and vinegar)
• Rye
• Triticale (wheat and rye crossbred hybrid)
• Wheat (e.g., durum flour, farina, graham flour, spelt, semolina, and Kamut)

Gluten is commonly found in bread, cereals, pasta, cakes, cookies, and other foods. It causes inflammation in the small intestine of people with celiac disease. Removing gluten from the diet helps to control the symptoms.

The FDA regulates the gluten-free food labeling claim. This is a voluntary claim that manufacturers may opt to use. If they use the label, they are accountable for using the claim in a truthful way.

Lactose intolerance diet

Lactose intolerance or lactose sensitivity are not allergies. Lactose is the main sugar found in dairy products. Lactose is broken down by lactase, an enzyme created by the small intestine. If a person’s small intestine does not produce enough lactase, the lactose moves into the large intestine. The bacteria in the large intestine break down the lactose, causing bloating, cramps, diarrhea, nausea, and gas. Treatment for lactose intolerance or sensitivity involves avoiding milk products or using an oral enzyme replacement supplement.

Nutritional needs for various populations

Nutritional needs change throughout life. Our needs for calories, vitamins, minerals, and protein change as we grow and develop. With pregnancy and breastfeeding, the needs increase. With disease conditions, the needs change. We have already discussed different diets and conditions treated with those eating plans.

Pregnancy and lactation

During pregnancy, it is important to eat a healthy diet. The first trimester can be difficult with nutrition. Depending on the mother’s morning sickness, eating a balanced diet can be tricky. Many providers recommend eating small, frequent meals to combat morning sickness. Dry crackers and toast are also encouraged. Eating low-odor protein foods can also help. Avoiding triggers such as spicy foods and certain smells are important in managing morning sickness.

Providers usually recommend a daily prenatal vitamin and mineral supplement to ensure adequate folic acid and prevent spina bifida. Consuming alcohol during pregnancy is not recommended. Despite the saying “eating for two,” the daily caloric intake only needs to increase by 340 calories for the second trimester and about 450 calories for the third trimester.

Women who are pregnant or breastfeeding should avoid eating raw fish or fish high in mercury. Two to three servings of seafood per week are recommended during pregnancy and when breastfeeding. According to the FDA, examples of the best choices of seafood to eat include salmon, cod, tilapia, catfish, haddock, lobster, perch, squid, trout, shrimp, and light canned tuna. Mercury, which can be toxic to the nervous system, can be found in higher levels in marlin, orange roughy, bigeye tuna, swordfish, shark, king mackerel, and tilefish from the Gulf of Mexico. Consumption of locally caught fish and white albacore tuna intake should be limited to no more than 6 ounces per week.

With lactation, or breastfeeding, the mother needs to eat a healthy diet, and a vitamin supplement may be recommended. It is important to get adequate vitamins and minerals, which are passed to the baby in the breast milk. The mother also needs to drink additional water to maintain her milk volume. During the first 6 months of breastfeeding, the mother should consume about 330 extra calories and 400 extra calories during the remaining 6 months of the

first year.

Nutritional needs by age group

Age	Nutritional needs
Infancy to 2 years	Birth to 6 months of age: Breast milk or formula is given. If an infant cannot tolerate milk-based formulas, other types of formulas are available, including soy formula. Some formulas are available by prescription only.
Six months of age	The child is started on soft, pureed solid foods. Usually, infant cereals, fruits, and vegetables are first introduced.
One year of age	The child is transitioned to whole milk, and pureed foods are gradually replaced with easy-to-eat foods. It is important to offer foods from each food group.
2 to 12 years	Children should eat several dairy products, fruits, vegetables, meats, breads, pasta, cereals, and beans. As children grow and develop, more foods can be added to their diet. Portion sizes also grow.
12 to adulthood	Adolescents experience rapid growth periods, which require more energy. Teens may need encouragement to consume dairy products (e.g., milk) instead of soda. The growth spurts require calcium for strong bones. Females who have started menstruating should eat foods high in iron to replace the iron lost in menstrual blood.
Older adults	As a person grows older, the metabolism decreases, and caloric needs also decrease.

Special nutritional concerns of the older adult include the following:

• Difficulty chewing and swallowing, which can be related to poor-fitting dentures
• Decrease in eating due to changes in the senses (e.g., taste, smell)
• Lack of a well-balanced diet (e.g., limited income, loneliness, and lack of initiative to cook for oneself)