Celiac Disease Symptoms and Gluten-Free Diet Information

Living Gluten Free

Living Gluten Free

A beginners guide that will reveal how living "G" free can help you lose weight today! This is not a fad diet, or short term weight loss program that sometimes makes you worse off than before you started. This is a necessity for some people and is prescribed to 1 out of every 100 people on earth by doctors and health professionals.

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Gluten Free Low Glycemic Cookbook

Fun With Gluten-Free, Low-Glycemic Food Cookbook is an ebook cookbook by Debbie Johnson, former owner and executive chef of The Golden Chalice Restaurant & Gallery, a 100% gluten-free, sugar-free, low-glycemic, organic, allergy-friendly establishment. This is the first Cook-Book of its kind! Every Recipe is Completely Gluten-Free, Sugar-Free (except fruit), Digestion-Friendly, Allergy-Friendly and Low Glycemic with Meat, Poultry, Fish meals and Tree-Nut-Free, Dairy-Free, Vegan and Vegetarian Options for most recipes. The recipes in this ebook have been helpful for people with everything from celiac disease and diabetes to Ibs (irritable bowel syndrome). Also, every recipe in this book contains healing food of some type. This is according to the many books written by doctors who are experts in the field of nutrition.

Gluten Free Low Glycemic Cookbook Summary


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Nonresponsive Celiac Disease

Whilst most patients with celiac disease respond appropriately to a gluten-free diet, usually with responses to symptoms occurring within days to weeks of institution of the diet, a small proportion of patients (approximately 5 ) do not have the expected complete response to a gluten-free diet or they have a relapse of symptoms while apparently on a gluten-free diet. This scenario termed 'nonre-sponsive celiac disease' is multifactorial in nature. The single most common cause of continued or relapsing symptoms in patients with celiac disease is that of inadvertent gluten ingestion. There are many ways in which gluten can get into the diet, and in one series the most common source was commercial cereal in which minor ingredients were derived from the offending grains. However, other sources such as communion wafers and environmental contamination with flour, particularly of baked goods, are also possible. In patients whose serologic tests have returned to normal and where a careful...

Gluten Free Bread Sensory Physicochemical and Nutritional Aspects

List of Abbreviations 161 Introduction 161 An Emerging Need for New Gluten-Free Products 162 Ingredients for the Formulation of Gluten-Free Breads Physiochemical and Sensory Aspects 162 Frozen Gluten-Free Breads Iron-Fortified Gluten-Free Bakery Products 165 Technological Issues 168 Summary Points 168 References 168

Frozen Glutenfree Breads

Frozen storage can be used for the production of gluten-free products with extended shelf life. Par-baking bread production has great market potential in gluten-free cereal processing because a fresh product can be produced with a simple bake-off stage (Kelly et al., 2008). Most of the gluten-free bread and rolls available on the market are par-baked, but there are no publications in this area (Keller etal., 2008). Figure 15.1 shows gluten-free bread frozen stored. 165 As expected, the structure of such products is different from that of a wheat bread. Pore size and number differ usually, the produced sample has larger pores and a lower volume than wheat bread. Frozen storage can be successfully used for the production of gluten-free breads. The sensory characteristics of wheat breads containing gluten and gluten-free breads preserved by using either microwave treatment or frozen storage are presented in Figure 15.3 (Liassi and Mandala, 2007). According to the sensory characteristics...

Ironfortified Glutenfree Bakery Products

The immunologically toxic reaction that is induced by gluten in susceptible individuals results in damage to the mucosal surface of the small intestine (Rubio-Tapia and Murray, 2010). This interferes with the absorption of nutrients, including iron. Thus, the importance of celiac disease as a possible cause of iron deficiency anemia is increasingly being recognized. It is estimated that celiac disease may account for 3 5 of the prevalence of iron deficiency anemia (Grisolano et al., 2004). Moreover, the gluten-free products are often low in micro-nutrients, increasing the risk of deficiencies (Thompson, 2000). Fortified or enriched gluten-free products are rare, but it has been suggested that the development of such products would improve the quality of the diet (Kupper, 2005). Fortification is an effective approach to increase dietary iron intake, provided that certain conditions apply (Hurrell et al., 2004). (A) control gluten-containing breads and (B) gluten-free breads stored in...

Management of coeliac disease

The management of coeliac disease involves a permanent gluten-free diet, and the vast majority of patients show a marked improvement following dietary change. As gluten is present in wheat, rye, barley and oats this imposes severe dietary restrictions on the patient, which must be fully explained. Rice and potatoes are satisfactory sources of complex carbohydrate. Initially, frequent dietary counselling is required to make sure the diet is being observed, as the most common reason for failure to improve with dietary treatment is accidental or unrecognised gluten ingestion. In addition to diet, supportive therapy may include iron supplements, vitamin B12 and folic acid. In rare cases patients are refractory to standard treatment and require corticosteroids to induce remission. Ideally, patients should undergo repeat jejunal biopsy after six months of gluten-free diet to ensure that the small bowel lesion has returned to normal, but this may not be necessary in the majority of patients...

Glutenfree Potato Bread

The incidence of celiac disease or other allergic reactions intolerances to gluten is increasing. Worldwide, the number of people who suffer from celiac disease has been predicted to increase by a factor of 10 during the next few years, resulting in a growing market for gluten-free products (Gallagher et al., 2005). The replacement of gluten, particularly in a bread formulation, presents a major technological challenge because it is an essential structure-building protein that is necessary for formulating high-quality breads. Potato and potato products such as potato flour and potato starch have been found to be useful in preparing gluten-free bread formulation. A formulation based on rice and potato starch supplemented with fish surimi (as a structure enhancer) at the 10 level produced loaves with higher volumes and a softer crust and crumb texture than those of the control (Gallagher et al., 2005). A survey conducted in Alberta, Canada, showed that potato flour along with rice flour...

Nonmalignant Complications of Celiac Disease

Nonmalignant complications of celiac disease include ulcers and structuring within the intestine that occasionally may present with small bowel obstruction and or bleeding, and recurrent acute pancreatitis as the result of inflammation, probably of the sphincter of Oddi. Nongastrointestinal complications are usually the consequence of malnutrition or specific deficiencies. However, others such as neurological problems including ataxia, peripheral neuropathy, or dementia are of uncertain mechanism and perhaps autoimmune in nature. Other consequences of celiac disease have been discussed in the section on atypical or nongastrointestinal presentations (Table 1). Many, but not all, of these nonmalignant complications of celiac disease will respond to a gluten-free diet.

Epidemiology of Celiac Disease

Celiac disease is one of the most common, chronic genetic gastrointestinal conditions affecting just under 1 of Caucasian individuals. Whilst it was initially recognized in Northern Europeans, celiac disease will affect Caucasians wherever they live. It can affect people of mixed ethnic background. It is apparently rare in Southeast Asia and sub-Saharan Africa. While celiac disease was once considered primarily a childhood disease, in many geographic locations, celiac disease is more commonly diagnosed in adulthood. The median age in one study in the US was 50 years of age. Even in childhood, the age at diagnosis is now increased from early infancy to later in childhood or adolescence. The spectrum of disease has also changed with an increasing proportion of patients being diagnosed with mono-symptomatic or less severe celiac disease. Many of these patients would not have been diagnosed in the past, but their symptoms described as functional disorders. It is not uncommon to diagnose...

Malignant Complications of Celiac Disease

The complications of celiac disease can be divided into malignant and nonmalignant complications. In addition, the malignant complications of celiac disease are most commonly that of non-Hodgkin's lymphoma of a T cell variety. This particular tumor occurs in patients who have not been compliant with the diet or within 3 years of diagnosis. The risk of lymphoma or other malignancies appears to drop once a gluten-free diet has been instituted. While the relative risk of malignancy in celiac disease is greatly increased for specific diseases, the actual absolute risk is relatively small. The presentation of lymphomas in the small intestine can be acute with a surgical emergency such as obstruction, perforation, and bleeding, or gradual with insidious return or progress of severe malabsorptive symptoms, often associated with hypoalbuminemia and severe weight loss and malnutrition. The treatment for lymphoma is often unsuccessful. Those patients presenting acutely and managed surgically...

Ingredients For The Formulation Of Glutenfree Breads Physiochemical And Sensory Aspects

Maize and rice are the main ingredients used for preparing gluten-free bakery products. Maize and rice products are similar in taste, thus offering the consumer limited choice. Rice flour is one of the most suitable cereal flours for preparing gluten-free products because it is natural, hypoallergenic, and has a bland taste. It provides a high amount of digested carbohydrates but a low amount of proteins (prolamins), thus indicating the need for other components to reinforce the batter matrix and the nutritional content of the final product. There has been increasing interest in new gluten-free breads, whose formulations mainly involve the incorporation of starches of different origin, other non-gluten proteins such as dairy proteins, gums, and their combinations (Mariotti et al. ,200'). These ingredients can mimic the viscoelastic properties of gluten and result in improved structure, mouthfeel, acceptability, and shelf life of these products (Gallagher et al., 2004). The successful...

Adaptive Immune Response to Gluten

Celiac disease is characterized by an immune response to the storage proteins of wheat, rye, and barley, with wheat as the most immunogenic. Wheat gluten is composed of glutenin and gliadin, and evidence suggests that the gliadin fraction induces disease. Information gathered from T cell clones derived from chronic lesions of the small intestines of celiac patients with established disease demonstrate that gliadin peptides are presented by HLA class II molecules to CD4+ T cells. Several studies have suggested that unaltered native gliadin peptides were antigenic but lacked the negatively charged amino acids needed to bind to the recognition sites of the DQ2 or DQ8 molecules. It has since been recognized that the gliadin peptides are made more antigenic by tissue transglutaminase, and it is these altered (deamidated) peptides that either perpetuate or cause gluten sensitivity in celiac disease. inflamed celiac gut also results in a strong autoimmune response to tissue transglutaminase...

An Emerging Need For New Glutenfree Products

The unequivocal need for the development of new gluten-free products is emerging for several reasons. First, the daily dietary requirements for essential nutrients of celiac disease patients are not fully covered by existing products. Products of the gluten-free group, compared with their gluten-containing counterparts, are lower in protein, vitamins, minerals, and dietary fiber (Anton and Artfield, 2007 Thompson, 2000). Moreover, gluten intolerance is frequently associated with low absorption of nutrients. Consequently, celiac patients face several nutrition-related problems, such as weight loss, iron deficiency anemia, osteoporosis, fatigue syndrome, and diabetes. In addition to nutrient content, gluten-free products based on starch are less tasty than the gluten-containing counterparts. In the case of bread, there is also a high staling tendency due to the absence of gluten (Gallagher et al., 2003). Second, the target group of gluten-free products is currently expanding to include,...

Clinical presentation of coeliac disease

The clinical presentation of coeliac disease is highly variable, depending on the severity and extent of small bowel involvement. Symptoms include recurrent attacks of diarrhoea, steatorrhoea, abdominal distension, flatulence and stomach cramps. Coeliac disease is associated with autoimmune disorders (thyroid disease, insulin-dependent diabetes mellitus, IgA deficiency, Down's syndrome and inflammatory bowel disease). The pathology of coeliac disease also varies considerably in severe cases the mucosa looks flat with complete loss of surface villi. Histology shows 'subtotal villous atrophy', accompanied by crypt hyperplasia and an accumulation of plasma cells and lymphocytes in the lamina propria. In cases with less severe atrophy the changes are milder and a few patients may show only partial villous with an increase in the intraepithelial lymphocyte count.

The Gluten Free Diet

The term 'gluten' as it is used in the context of celiac disease refers to the storage proteins of wheat (glia-dins and glutenin) and of barley (prolamines), and rye (hordeins), and oats (avedins). Gluten is defined in the setting of celiac disease as any protein-containing derivative of the offending grains or their derivatives. Grains that should be avoided are as follows To achieve healing and maintain health, a well-balanced, interesting dietary life style that avoids gluten should be adopted. However, it is not enough to simply avoid gluten patients need to be enabled to explore dietary alternatives and strategies that minimize impact on their life style. The role of oat toxicity in celiac disease is still controversial. Several recent, well-constructed studies have demonstrated no ill effects when a moderate amount of oat products have been included in the diet of either newly diagnosed or already treated celiac patients. These recent studies have clearly demonstrated that oats...

Coeliac disease

Coeliac disease is a condition which affects the mucosa of the small bowel due to an abnormal reaction to gluten, a protein found in wheat, oats, rye and barley. The presence of gluten causes malabsorption in the proximal small bowel due to atrophy of the villi and a decrease in the activity and amount of enzymes present in the surface epithelium. Injury to the intestinal villi appears to be due to an abnormal immune response to gliadin, a component of gluten. The exact cause of coeliac disease remains unknown but it is thought to result from a combination of genetic predisposition and environmental factors. Although the disease may present at any age, it is most commonly seen between 30 and 40. Coeliac disease occurs worldwide but is commoner in northern Europe. The prevalence in the UK is 1 in 2000-8000 but reaches 1 in 300 of the population in parts of Ireland (Jewell 2000). Many mild cases are probably undiagnosed and screening studies of asymptomatic populations suggest a...

Celiac Disease

Celiac disease (CD) can be considered as an autoimmune-like systemic disorder in genetically susceptible persons perpetuated by gluten-containing cereals, wheat, rye, barley and possibly oats. Intestinal mucosal damage in CD is dependent on dietary exposure to prolamins. There is a genetic predisposition to CD related to the HLA-DQ2 and HLA-DQ8 molecules. These molecules stimulate proliferation of T cells and excretion of inflammatory cytokines. There is evidence to show an increase in intestinal permeability in CD, which seems to relate to gluten intake. There is also evidence of increased intestinal permeability in unaffected relatives of celiac patients compared to nonrelated controls. Cummins et al. 24 have shown that improvement in intestinal permeability precedes by many months the recovery in intestinal morphology.

The Basic Ingredients Of Focaccia Flour

According to the voluntary Italian wheat grading standard, superior bread-making wheat, suitable for the production of focaccia by prolonged process, is defined by (1) protein content comprised between 13.5 and 14.5 dry matter, (2) tenacity extensibility ratio (alveograph P L) lower than 0.6, (3) gluten strength (alveograph W) higher than 220 x 10 4 J, and (4) farinographic stability from 10 to 15 min. Protein content between 11.5 and 13.5 , W values within the range of 160 200 x 10 4 J, and stability from 5 to 10 min are sufficient for ordinary bread making (Pagani et al., 2006). Alveograph curve of durum wheat re-milled semolina used in the production of Bari-style focaccia. The curve shows the values of gluten strength and the tenacity extensibility ratio for durum wheat re-milled semolina commonly used in focaccia making in the Apulia region. Alveograph curve of durum wheat re-milled semolina used in the production of Bari-style focaccia. The curve shows the values of gluten...

Future Direction Of Research

Wheat is the most widely grown crop and has traditionally been selected for its technological functionality, resulting in the selection of hard bread wheat (T aestivum L.) cultivars with a high level of strong gluten proteins or of durum wheat (T turgidum ssp. durum) with the yellow-colored pasta products. However, little interest has been devoted to the nutritional and favorable health properties of grains and improvement through breeding programs (Leenhardt et al, 2006). Table 7.1 compares the whole grain flour composition of four groups of wheat emmer, durum, and bread (hard and soft) wheat based on the means of the tested genotypes within each group. Despite the great interspecific variations observed for the nutritional values of the grain in Triticum spp., large intraspecific variations are also observed for the traits in this genus. Evidence from clinical and epidemiological studies implies that a diet high in whole grains may have a protective role in reducing the risk of...

Cardiovascular Disease

In a randomised, double-blind placebo-controlled trial, the effects of oral l-carnitine (2 g day) for 28 days were assessed in patients with suspected acute Ml. Total cardiac events, including cardiac deaths and non-fatal infarction, were 1 5.6 in the carnitine group and 26.0 in the placebo group. Angina pectoris (17.6 vs 36.0 ), New York Heart Association class III or IV heart failure plus left ventricular enlargement (23.4 vs 36.0 ) and total arrhythmias (13.7 vs 28.0 ) were significantly less in the carnitine group compared with placebo (Singh et al 1996). Cardiomyopathy Cardiomyopathy appears to cause leakage of carnitine from heart stores, which may make cardiac tissue vulnerable to damage however, it is unclear whether carnitine leakage is a cause or effect of cardiomyopathy (Baker et al 2005). Long-term placebo-controlled studies (10-54 months) using an oral dose of 2 g day l-carnitine for treatment of heart failure caused by cardiomyopathy found a statistically significant...

Technological Issues

The diversity in composition among different amaranth genotypes necessitates in-depth characterization of biochemical constituents for its specific applications in the food industry. The smaller size granules in amaranth starch, which are similar to the size of fat globules of cow's milk, can be exploited to mimic fat in a number of food products. Some of the genotypes have higher polyphenols with higher antioxidant activity, which could also be utilized in the development of new products. Amaranth grain has the potential to be used in the development of various food products for people suffering from celiac disease, a disorder that makes the body intolerant to gluten proteins.

Adverse Immune Responses

Many natural products, including cereals and other common foodstuffs, induce allergic responses in susceptible individuals. In such cases, after appropriate diagnosis, the individual should avoid the foodstuff responsible. Celiac disease (gluten enteropathy) is a condition characterized by a severe adverse immu-nological gastrointestinal reaction to gliadin, which is a component of gluten, the viscoelastic protein found in wheat and other cereals. Celiac disease is prevalent in all regions where wheat is commonly consumed, and its incidence may reach 0.5 of the population. Celiac patients must exclude gluten from their diets. Thus, products containing wheat, rye, barley, and triticale are not permitted. Although oats were originally proscribed, it is now becoming increasingly clear that they are safe for celiac patients.

Innate Immune Response

Many of the studies on gut responses to gluten have been performed in the established chronic lesion. Little is known of innate responses that can elicit effects within minutes to hours of exposure to gluten. In vitro studies demonstrated an increase in the expression of HLA antigen on the cells in the surface layers of the intestinal mucosa occurring within 2-4 h after exposure to gluten. Gluten also causes the production of the proinflammatory cytokine IL-15 at the surface epithelium. IL-15 expressed by the surface enterocytes activates NK-like T cells to recognize gluten presented by MHC class 1a molecules in the context of the NKG-2D receptor. The NK-like T cell may be a key player in both the damage to the surface epithelium and be a proin-flammatory influence on adaptive response that occurs in the underlying lamina propria. This induction of innate immune responses by gluten may have important consequences. Since the gluten peptides enter into the epithelial compartment and...

Clinical Presentation

Celiac disease may present in a wide variety of ways (Table 1). In children, the onset of celiac disease is classically described as occurring within the first to seventh year of life with the introduction of cereals to the diet. Symptoms may vary with the age of the child at onset of disease. Young children may develop chronic diarrhea, failure to thrive, muscle wasting, abdominal distension, vomiting, and abdominal pain. Older children may present with anemia, rickets, behavioral disturbances, or poor performance in school. In some children constipation, pseudo-obstruction, and intussusception may be seen. It has been estimated that 2-8 of children with unexplained short stature may have celiac disease. Dental enamel defects involving secondary dentition as well as Table 1 Presentations of celiac disease Gastrointestinal presentations neurological syndrome and epilepsy with intracra-nial calcification have also been reported in children with celiac disease. In adults, celiac disease...

Bread making technology

As explained previously, a problem with making good-quality gluten-free breads from sorghum and other grains is that expensive additives such as hydrocolloids are required. This is especially disadvantageous in countries with developing economies in the tropics, where sorghum is a major crop and should be utilized in bread making. As explained previously, the kafirin proteins are not functional in terms of providing the required viscoelastic characteristics to the dough. However, research (e.g., Oom et al., 2008) has shown that if kafirin or zein, the very similar prolamin protein of maize, are mixed with solvent at elevated temperature (75 C), the resulting dough has viscoelastic properties. This is due to the fact that the temperature of 75 C is higher than the glass transition temperature of the kafirin and zein proteins. This finding offers the possibility of developing a process to produce good-quality breads from sorghum or maize flour without using expensive additives.

And Make Bread for Yourself

Corn syrup, sugar, hydrogenated fats, and colors sabotage normal bodily function. I have encouraged patients with tremors, digestive disturbances, sleep apnea, and pain syndromes to limit wheat bread and see miraculous results. The protein in wheat bread, called gluten, literally glues the villi in your intestine together diminishing absorption.

Contraindications And Precautions

As saponins may cause irritation to the gastric mucosa and skin, A. hippocastanum should be taken with food, should not be applied topically to broken or ulcerated skin and should be avoided by people with infectious or inflammatory conditions of the gastrointestinal tract, including coeliac disease and malabsorption disorders.

Chemical Components

Beta-glucan (soluble fibre), triterpenoid saponins (including avenacosides A and B), phenolic compounds (avenanthramides A, B, C), alkaloids (including indole alkaloid, gramine, trigonelline, avenine), sterol (avenasterol), flavonoids, starch, phytates, protein (including gluten) and coumarins.

Technological Issues And Production Of Breads Fortified With Dha And u3 OILS

Sponge dough breads were manufactured to obtain commercial loaves for sensory and texture analyses throughout 14 days of storage at room temperature. Sponges were produced from 604 g flour (14 mb), 356 ml water, and 14 g dry yeast. Sponges were fermented for 4.5 h in a proof cabinet set at 29oC and 85 relative humidity. Resulting sponges were mixed with the dough-stage ingredients (326 g flour, 56 g sugar, 28 g shortening, 28 g nonfat dry milk, 18.6 g salt, 9.3 g vital gluten, 1.86 g diastatic malt, 1.86 g lecithin, 0.94 g sodium stearoyl-2-lactylate (SSL), 55.8 mg sodium ascorbate, and 18.6 mg potassium bromate) and 258 ml of water until optimum dough development was obtained. Resulting doughs were weighed and cut into two identical parts before punching, final proofing, baking (28 min at 225oC), cooling, and slicing. One slice per loaf from 16 different loaves was submitted for determination of its full FA profile using a gas chromatograph flame ionization detector. According to the...

Primary Gastrointestinal Lymphoma

Patients suffering from coeliac disease are predisposed to developing small intestinal lymphomas. It is often associated with small bowel ulceration. Some patients may not have previous documented history of coeliac disease as 'latency' is a recognised feature. The cancer cells express pan-T markers. It has been suggested that a gluten free diet may protect against the development of lymphoma (120). The prognosis is poor in most cases.

Quality Of Chempedak Seed Flour Bread

Loaf volume was an important indicator for identifying bread characteristics because it provided quantitative measurement of baking performance (Hathorn et al, 2007). Bread samples at higher chempedak seed flour substitution levels elicited lower loaf volume compared to the control (Figure 33.3). A pronounced decrease (p 0.05) of loaf volume (49.1 ) was exhibited in 30 chempedak seed flour bread, followed by 20 chempedak seed flour bread (22.3 ) and 20 chempedak seed flour bread (8.1 ), compared to the control. The significant decrease in loaf volume at higher chempedak seed flour substitution levels was attributed to the gluten dilution effect (Krishnan et al, 1987), which was associated with the low protein quality network in the dough (Rosell et al, 2001) and indicated weak interaction between starch and gluten of flour (Oates, 2001). Substitution of chempedak seed flour with wheat flour subsequently weakened coherence and continuity of the protein matrix in the dough due to the...

Starch Use In Bakery Applications

Starch and starch products are used in many food and non-food industries and also as chemical raw materials for many other purposes, such as in plastics and tanning of leather. However, the food industry is the largest consumer of starch and starch products. Starch is a major component in bread making and plays an important role in texture and quality of dough and bread, and bread making depends to a large extent on the selection of flour with the proper gluten and starch characteristics. As reported by Miyazaki et al. (2006), starch competes with other components for available water in the system. Thus, starch determines the structure of the dough system and contributes to the texture of the final baked products. It is used in biscuit making to increase volume and crispness. Moreover, exogenous starch and modified starches are also used in many types of candies. Innovative new starch-derived specialities from Interaction of starch of gluten-free flours with gums influences the food...

Microbial Reduction Of Allergen And Antinutritional Compounds

In addition to carbohydrate and peptide utilization, organic acid production, and flavor formation, sourdough LAB and yeasts possess numerous metabolic activities that can be of interest during sourdough fermentation (Ganzle et a ., 2007). For instance, controlled proteolysis of gluten can result in bread suited for celiac patients (Gobbetti et a ., 2007 Katina et a ., 2005). Biodegradation of phytate, an antinutritional factor that retains certain minerals and hence does not make them bioavailable, has been reported to be activated by endogenous cereal phytase activity through sourdough fermentation (Katina et a ., 2005 Lopez et a ., 2001). Lopez et a . showed that prefermentation of bran with lactic acid bacteria improved phytate breakdown (up to 90 ) and increased magnesium and phosphorus solubility.

Rheological Characteristics

Farinograph water absorption increased from 60.1 to 70.6 (Figure 36.3) when apple pomace was incorporated at 0 and 15 (Sudha et al, 2007). Chen, Rubenthaler, and Schanu (1988) reported an increase in water absorption determined using 10-g mixograph from 66.5 to 72.5 when apple pomace was incorporated at 0 and 12 . The farinograph water absorption of blends containing 30-mesh apple pomace increased from 59.1 to 69.4 with an increase in pomace content from 0 to 11 . With reduction in particle size (50 and 60 mesh), the water absorption also increased to 70.2 upon increase in the addition of pomace content in the blend. The increase in water absorption was attributed to the increase in surface area of pomace, which would hold more water (Masoodi et al, 2001). Dough development time, which indicates the rate of hydration and development of gluten, increased from 1.5 to 3.5 min with an increase in pomace content from 0 to 15 . The increase was predominant in blends containing pomace of...

Adverse Effects And Reactions Allergies And Toxicity

No reports are available on allergies and toxicity resulting from purple wheat products. However, it can be speculated that adverse effects and reactions associated with common wheat may also be applicable to purple wheat. Indeed, the peptides derived from gluten proteins present in wheat are known to be responsible for celiac disease, an intestinal disorder caused by T-cell responses to these peptides (Spaenij-Dekking et al., 2005). Secondary intolerances including viral hepatitis and intestinal infections may also occur in predisposed individuals. However, there is potential for selection of non-toxic varieties for celiac-disease patients. High levels of wheat-specific immunoglobulin E (IgE) have been reported in patients with anaphylaxis (Pourpak et al., 2004).

RLS and Iron deficiency

In patients with low serum ferritin levels. This is discussed in greater depth in the treatment section of this chapter. Consistent with these observations, there has been an increased prevalence of RLS in patients with celiac disease, a disorder with associated abnormal iron absorption (Moccia M, et al, 2010) and as mentioned previously in this chapter, many instances of secondary RLS appear to be also associated with anemia or low iron status. There have been several studies assessing prevalence of RLS in regular blood donors. A large Swedish study of 946 consecutive blood donors, aged 18-64, who were evaluated for RLS, found a gender difference in prevalence. In male blood donors 14.7 met RLS criteria, in female donors the frequency increased to 24.7 . Further, in patients with laboratory evidence consistent with iron-deficiency, the frequency of RLS increased to 37.5 . The authors conclude RLS to be common amongst female blood donors (Ulfberg J, et al, 2004). Conversely, in an...

Malignant Tumors of the Small Intestine

Intestinal lymphomas are another interesting example of disease originating from the interplay between the intestinal mucosa and the intestinal flora. In the stomach, MALT lymphoma is closely related to Helicobacter pylori colonization and may be cured by H. pylori's eradication. IPSID may be responsive to antibiotics, also suggesting a relationship with small intestinal flora. EATL results from chronic malabsorption, most commonly celiac disease, and occurs mainly in the jejunum. It usually involves multiple segments of the small bowel and may therefore be difficult to resect surgically.

Michael J Devlin Stephen A Wonderlich B Timothy Walsh and James E Mitchell

(Markowitz and Weissman) 157 Caucasians age and BED 18 body mass index in 18, 21 comorbidity in women 16 factors influencing development of BED 18, 19 gender differences in BED 17 loss of control eating in children and adolescents 45 obesity in 5, 200 overweight 200 prevalence of BED 6, 15 relationship between BED and obesity 20 risk factors for BED 222 shape and weight concern in 21 Celiac disease 207, 208 chain analysis in dialectical behavior

South Indian Parotta An Unleavened Flat Bread


Oxidizing agents 30 Reducing agents 31 Dry gluten 31 Enzymes 32 a-Amylase 32 amount of salt from 0 to 1.5 decreases the water binding capacity of wheat flour and increases dough stability. Galal et al. (1978) reported that salt decreases water absorption and increases the time until optimum development and stability of the dough as measured by farinograph. Use of sugar up to 1.5 does not alter the dough properties measured using farinograph and extensograph. The addition of increasing amounts of egg from 0 to 15 decreases the water absorption capacity, increases the strength, and modifies the elastic and extensible properties of the dough. When oil is added to the dough, it decreases the water binding capacity of flour, extends the time required for gluten hydration, increases dough development, resists the mixing action, and shows an increase in farinograph stability. The dough with oil lacks elasticity and strength however, it exhibits higher extensibility. It is reported that the...

Physical characteristics and sensory quality of composite baked goods

The physical characteristics of composite baked goods influence their sensory quality and acceptability by consumers. Of interest are characteristics such as crust and crumb color, loaf volume, loaf height, biscuit width, and spread factor. Generally, on incorporation of a legume, the composite baked product tends to become darker as a result of Maillard reactions due to the relatively higher levels of lysine. Composite breads also tend to have lower volume and height and denser, more compact structure due to the reduction in levels of gluten. Hallen et al. (2004) reported that wheat cowpea composite breads became progressively darker (lower L values) with an increasing proportion of cowpea flour. Increasing proportion of cowpea in the composite appeared to somewhat decrease the specific volume of the bread due to a reduction in the wheat structure-forming proteins accompanied by a decrease in the ability of the dough to incorporate air. Increasing proportion of cowpea in the...

Rheological properties of composite doughs

For the preparation of baked goods, rheological properties of the dough are of importance. Wheat, the main ingredient in most baked foods, contains viscoelastic gluten, which confers specific rheological properties to the dough, and this in turn influences the final quality of the baked product. Therefore, it would be expected that during preparation of composite flours and doughs, partial replacement of wheat with another component that may be devoid of gluten would influence rheological properties of the resultant dough. Various rheological parameters are of interest in this regard, including water absorption, dough development time, dough strength, and mixing tolerance. Generally, the major effect on dough rheological properties arises from dilution of the gluten content on partially replacing the wheat component. Composite doughs of wheat with legumes tend to have higher water absorption and lower strength and stability. In a study on the production of Egyptian Balady bread using...

Protein Malabsorption

Mucosal disorders, including inflammatory bowel disease, allergic diseases, and celiac disease, are additional examples of disorders causing protein malabsorption. Once intestinal inflammation is reduced with appropriate medical or nutritional therapy, absorption of protein is usually improved. In Shigella infections, some studies have demonstrated improved nutritional outcomes with a high-protein diet during recovery from the acute symptoms of diarrhea.

Bread Fortification With Okra Flour

In Egypt, the nutritive value of bread produced using composite flour that contained maize was increased by supplementing it with okra flour. The resulting bread was satisfactory and comparable to wheat-based bread because okra contains sticky gluten. Although bitter taste was observed after the consumption of bread that was produced from composite flour that included fenugreek seeds as supplement, which restricted its use because of consumer acceptability constraints, there are no such restrictions for bread that includes okra flour as supplement. Young rats were used as experimental animals, and it was found that maize meal containing okra flour supplement produced the highest growth in the rats (77 g) compared to other diets with fenugreek (72 g) and cottonseed flour (48 g). The protein content in the base okra flour for the bread production was determined to be 18 (Taha, 1947). The associated benefits of okra flour in bread fortification include its slippery characteristics, which...

Adverse Effects Of Soy Protein Fortification On Rheological Properties Of Dough And Bread Quality

The addition of SPI and purified b-conglycinin to foods can increase soy protein consumption and help achieve a physiologically beneficial intake. Fortification of bread with soy protein has a long history due to the relatively high amounts of lysine and valine in soy, which are the limiting amino acids of wheat proteins. Although the nutritive value of the bread rises with the percentage of SPI (Mizrahi et al, 1967), SPI reduces bread quality. SPI-containing bread was judged to be firmer, drier, grainier, less tender, and gummier compared to the ideal bread (Elgedaily et al, 1982). In addition, SPI-containing bread exhibited a strong beany flavor, which curtailed its overall acceptability (Ranhotra and Loewe, 1974). Bread loaf volume also decreased, and bread crumb firmness and firming rate increased proportionally with the level of SPI fortification (Chen and Rasper, 1982 Mizrahi et al, 1967 Ribotta, Arnulphi, et al, 2005). An inverse relationship was shown between bread loaf volume...

Drug and Disease Candidates for Colonic Delivery

Disease states can affect the environment and cellular mechanisms in the colon. This can affect how drugs are metabolized or absorbed. Colonic permeability is increased in patients with IBD 44 , celiac disease, and other conditions 45 . Enzyme levels are also affected in disease, for example, the CYP3A4 metabolism may be higher in inflamed gut tissue of colitis patients than in healthy volunteers 46 . Similarly, MDR1 expression can change in inflammatory conditions of the bowel 47 and P-gp expression and BCRP expression were shown to be reduced in individuals with active inflammation of ulcerative colitis 47, 48 . Enzyme levels may differ from normal levels in tumor tissue, although the evidence to date has been conflicting 49, 50 . Influx transporters are also susceptible to disease states the solute carrier family is downregulated during Vibrio cholerae infection 51 .

Caveats Relating To The Use Of Cholecystokinincholescintigraphy

Cholecystokinin Disease

It is important to recognize that the finding of a low GBEF is not specific for functional gallbladder disorder and may occur in asymptomatic, healthy individuals, in patients with various medical conditions including diabetes, celiac disease, or irritable bowel syndrome,37 and as a result of a number of medications such as opioid analgesics, calcium channel blockers, oral contraceptive agents, histamine-2 receptor antagonists, and benzodiazepines.38 It also must be recognized that the gallbladder may not be responsible for a decreased GBEF as, occasionally, outflow obstruction from abnormalities of the cystic duct or sphincter of Oddi may be responsible.39 Therefore, this test should be considered only when there is a high index of suspicion

Possible Applications Of Macadamia Flour In Baked Goods Nutritional aspects

Enhanced proteins and dietary fibers may be formulated from the composite flours, vital wheat gluten, and lipid emulsifier. Additional studies are warranted to determine appropriate formulas of the macadamia-containing composite flours as well as to evaluate their applications in baked goods.

Flour And Bread Fortification With Emmer

Emmer flour does produce a satisfactory loaf of bread, the quality is not as good as that of bread made with common wheat. Galterio et al. (1994) reported a high lysine content (3.1 ) for emmer grains. In contrast, it is known that common wheat protein is deficient in lysine. The poor gluten quality of emmer is confirmed by its low gluten index value (Cubadda and Marconi, 1996 Galterio et al., 1994). Konvalina et al. (2008) reported that emmer has a high grain protein content, whereas the quality of its gluten is inferior to that of bread wheat as determined by the gluten index and the Zeleny test. It is assumed that the poor gluten quality of emmer is due to its storage protein composition, which is dominated by high concentrations of the intermediate-molecular-weight glutenin group (78 50 kDa), poor synthesis of low-molecular-weight glutenin subunits (45 30 kDa), and the absence of gliadin fractions g-42 and g-45 (Galterio et al., 1994, 2000). The potential use of emmer flour in...


The disease may result in intestinal inflammation and is associated with celiac disease, refractory sprue, and Crohns' disease. Stool cultures for bacteria, ova, and parasites together with duodenal aspirates may be needed. Duodenal biopsies show loss of plasma cells in the lamina propria. Patients may be treated with metro-nidazole for giardiasis or bacterial overgrowth and with gluten-free diet for celiac disease.

Healthy Properties Of Sourdough Bread

Reading And Reflecting Texts

The production of organic acids is also quite important in reducing the postprandial glycemic response in human blood. Starch bread is usually rapidly digested and absorbed, leading to hyperglycemia in people suffering from insulin-resistance syndrome. Organic acids produced in sourdough are responsible for a reduction of the glycemic index this seems to be associated with a delay in gastric empting in the case of acetic acid, whereas lactic acid induces interactions between starch and gluten during dough baking and reduces starch availability (Bjorck and Liljeberg Elmstahl, 2003). Cereals are widely used in human diets throughout the world. Prolamin proteins of cereals are responsible for an autoimmune disorder known as celiac disease or gluten intolerance, which is activated by the intake of prolamin-containing foods. Although numerous studies are under way to find a pharmacological treatment, the only solution at the moment is a diet free of gluten from wheat, rye, barley, and...

The Gastroenterologist

One specialist that may be called on is a gastroenterologist (a specialist in the digestive system and its disorders), also commonly known as a GI doctor. A gastroenterologist may be helpful for people with GI distress such as irritable bowel syndrome that does not respond to traditional therapies. Ideally, the gastroenterologist would screen for other GI conditions such as inflammatory bowel disease or celiac disease (autoimmune disorders that are often genetic), symptomatic diverticulitis (inflamed areas in the intestinal lining), and peptic ulcer disease (caused by erosions to the lining of the digestive system). Many patients who are diagnosed by a gastroenterologist with irritable bowel syndrome find it reassuring that their GI distress is not caused by a malignancy like cancer or any other progressive illness.

Applications To Health Promotion And Disease Prevention Adverse Effects And Reactions

Seeds from sweet almonds are a valuable food source. They contain very low levels of carbohydrates, and may therefore be made into flour for low-carbohydrate diets or for patients suffering from diabetes mellitus or any other form of glycosuria. Almond flour is gluten-free, and is therefore a popular ingredient in cookery in place of wheat flour for gluten-sensitive people, and people with wheat allergies and celiac disease. In addition, almonds are a rich source of riboflavin, magnesium, manganese, and, especially, vitamin E (alpha tocopherol), containing 24 mg 100 g (USDA, 2008). They are also rich in monounsaturated fatty acids, and

Related Autoimmune Diseases

Several genetic loci are shown to be involved in the etiology of multiple autoimmune diseases in humans and support sharing of underlying disease mechanisms across related phenotypes. Associations of certain HLA loci with autoimmune diseases has been reported extensively in SS, SLE, RA, ankylosing spondylitis, psoriasis, multiple sclerosis, and type 1 diabetes.22 A growing list of non-HLA genes also has been implicated in multiple autoimmune diseases. Examples include associations of cytotoxic T-lymphocyte-associated antigen 4 (CTLA4) with AITD, type 1 diabetes mellitus (T1D), celiac disease, Wegener's granulomatosis, SLE, vitiligo, Addison's disease, and RA 23-30 Programmed Death 1(PD-1) with RA, T1D, and SLE 31 and protein tyrosine phosphatase nonreceptor type 22 (PTPN22) with SLE, RA, T1D, Graves' disease, and Hashimoto's thyroiditis.32-37 Interferon regulatory factor 5 (IRF5) and signal transducer and activator of transcription 4 (STAT4) are genes strongly associated with SLE for...

Abnormal Immune Response

Celiac Disease CD is complex autoimmune enteropathy caused by a permanent sensitivity to gluten in genetically predisposed individuals. European and US studies indicate the prevalence of CD in children between 2.5 and 15 years is approximately 3-13 per 1,000 children 13 . Previously considered rare in children in developing countries, more recent evidence challenges this view 14 . In some ways, CD also represents an important form of food-allergic enteropathy. Small bowel damage occurs following mucosal exposure to ingested wheat gluten and similar grains, most notably rye and barely. Unlike other food-allergic enteropathies, CD susceptibility is determined in part by a common HLA association, namely the major histocompatibility complex class II antigens HLA-DQ2 (86-100 patients) and HLA-DQ8 (5 patients) haplotypes. Gliadin, the main wheat protein, presented by HLA-DQ2 and or HLA-DQ8 molecules to T cells stimulates production of proinflammatory cytokines that damage intestinal mucosa...

Immunological Inflammatory Diarrheal Disorders

Regulator Cell Activation

Occurrence of protein-losing enteropathy. Biological exams help to make the diagnosis if IgE levels are enhanced with specific RASTs. However, food allergies are frequently related to delayed type 4 hypersensitivity reactions and show no biological or immunological abnormalities. Skin patch tests most often are not helpful in the diagnosis. Food allergy can share the clinical picture of celiac disease, which has to be ruled out combining serological and if necessary histological evaluations.

Other Seed Allergies Sunflower Mustard Quinoa Buckwheat

Allergy to buckwheat has been recorded since 1961, and was first described in Japan. Buckwheat is a common seed in Asia and Russia, and its consumption is now increasing in Europe and the USA, where it is used in pasta, sandwiches, and pancakes. It has good nutritional values, and is used as a substitute for wheat flour for celiacs, as it does not contain gluten. Buckwheat is known to induce a respiratory allergic reaction in some patients, with rhinitis and asthma. However, these symptoms are rare, and might be seen in patients using a buckwheat pillow, or in those exposed to the seed when working in pancake restaurants or noodle factories.

Comments on Protein Quality for Adults

In the published meta-analysis of nitrogen balance studies by Rand and coworkers (2003), there were no significant differences in the intakes of dietary nitrogen required to meet nitrogen equilibrium between those studies that supplied dietary protein predominantly from animal, vegetable, or mixed protein sources. It is important to realize however, that this aggregate analysis does not suggest that dietary protein quality is of no importance in adult protein nutrition. The examined and aggregated studies included an analysis of those that were designed to compare good quality soy protein (Istfan et al., 1983 Young et al., 1984) as well as one that involved comparison of whole-wheat proteins (Young et al., 1975a) with animal proteins sources using parallel experimental diet groups. The results of these studies showed clearly that the quality of well-processed soy proteins was equivalent to animal protein in the adults evaluated (which would be predicted from the amino acid reference...

The Registered Dietitian RD

The RD is helpful in FM because many people's quality of life will improve through dietary change. The RD can help people learn not only what foods to avoid or minimize but how to introduce new foods into the diet and how to really enjoy those new foods. In FM, obesity is often a problem, especially due to the sporadic nature of FM flare cycles and the resulting disruption of an exercise routine. The RD can individualize an eating plan based on each patient's food preferences. In general, they discourage diets and emphasize healthier eating for the long run. They also try to strip away moral value from food by discouraging naming certain foods good or bad. Instead, they focus on which foods to eat often and which foods to enjoy less frequently or in smaller amounts. Another role of the RD is to help people with concurrent celiac disease since gluten and its related products are so prevalent in the food supply. Lactose intolerance is a bit easier to negotiate, but an RD will have tips...

Pathophysiology and Symptoms

The most common cause of protein malabsorption is so-called protein-losing enteropathy. Etiologies include diffuse mucosal disease such as celiac disease or Crohn's disease, elevated right heart pressure with resultant dilatation of lymphatics and leakage of lymph into the lumen, and colitides such as Shigella or Salmonella infections. Since protein is a relatively minor component of dietary energy compared with carbohydrate and fat, symptoms of protein malabsorption can sometimes be minimal. However, infectious colitis or exacerbations of inflammatory bowel disease often present with frequent loose stools, which may be bloody. Rare, congenital etiologies of protein malabsorption include enterokinase and trypsinogen deficiencies (Table 1).

L Carnitine Infusion Versus Oral Supplementation Mitochondrial Myopathy

Int J Clin Pharmacol Res 13(2) (1993) 87-91. Costa M et al. L-carnitine in idiopathic asthenozoospermia a multicentre study. Andrologia 26 (1994) 155-9. Curione M et al. Carnitine deficiency in patients with coeliac disease and idiopathic dilated cardiomyopathy. with gluten enteropathy. Clin Neurol Neurosurg 2005 Epub ahead of print . Carnitine lV r

Dietary Fiber In Bread Making Technology

Traditionally, bread is considered a nutritious food rich with carbohydrates, protein, dietary fiber, and vitamins and essential components of the daily diet. To provide more variety in functional breads, different sources of dietary fiber have often been used in recipes, such as wheat bran, barley, oat, rye, and rice brans (Katina et al., 2006 Rakha et al., 2010 Sudha et al., 2007 Wang et al., 2002). Fiber-supplemented breads show a pronounced decrease in quality parameters, and there is a significant effect on mixing and viscoelastic properties and fermentation behavior during bread preparation. Dietary fiber addition increases water absorption (Sudha et al., 2007), decreases loaf volume (Katina et al., 2006), and affects fari-nograph parameters and shelf life (Katina et al., 2006). Arabinoxylans are the major high-molecular polymers of cell walls and components contributing to the dietary fiber value in breads. Biliaderis et al. (1995) studied the functional role of various amounts...

Serological Screening Tests

Serological tests are helpful in detecting celiac disease in individuals with nongastrointestinal symptoms, and high-risk groups who may or may not have signs of disease. The clinicians often use the serological results to triage those who need small bowel biopsy. The high-risk groups include first-degree relatives of confirmed cases of celiac disease, those with type 1 diabetes mellitus, Down's syndrome, Turner's syndrome and unexplained dental enamel deficits, and children with unexplained short stature. Serological tests are also used to monitor progress after diagnosis as well as in prevalence studies in unselected populations. The ser-ological tests utilized in current clinical practice include the endomysial antibody, tissue transgluta-minase antibody, and the anti-gliadin antibodies (IgA and IgG). disease. Their role in diagnosis is limited because of moderate sensitivity and specificity. The antiglia-din antibodies are found in intestinal secretions as well as in serum of...

Enteropathy Caused by Food Hypersensitivity

Celiac Disease The incidence of celiac disease (CD) is increasing worldwide, with a prevalence as high as 1 300 and even 1 80 children 9 . One of the major reasons for the increase in prevalence is improved serological screening in subjects without overt gastrointestinal complaints. However, regional differences are emerging. The incidence of histological abnormalities suggestive of CD is lower than 1 250 children undergoing upper endoscopy for various indications (pers. data). Wheat, rye and barley are the predominant grains containing gluten peptides, very rich in proline and glutamine and resistant to digestive enzymes, known to cause CD. Variability exists in the age of onset of symptoms, in extraintestinal and autoimmune manifestations, in serological positivity, and in severity of histological involvement and no clear explanation has emerged despite major advances in the identification of toxic peptides, immune cascade and genetic susceptibility. The incidence of CD in mothers...

Triggers for Loss of Tolerance

Celiac disease only develops in a minority of DQ2+ individuals. How the consumption of gluten generates an inflammatory state in these individuals can be theorized as follows. First, there may be a trigger of the innate immune response, such as a viral infection or physical injury (surgery) that initiates inflammation and later permeability. Enough triggers repeated over time will alter the immune milieu of the mucosal compartment and perturb gut homeos-tasis, potentially altering the levels of the regulatory cytokines IL-10 and TGF-0 and increasing the levels of inflammatory cytokines like IFN-7 and ILNA. Determining which factors lead to the loss of tolerance to gluten in DQ2+ individuals who later develop celiac disease will be crucial in understanding the pathogenesis of celiac disease. Possible factors that may lead to the loss of tolerance are recurring gastrointestinal infections, surgery, or pregnancy. The way in which children are first exposed to gluten may also affect...

Salt in Food Technology

In baking, salt enhances other flavors in the product it also controls the rate of fermentation of yeast-leavened products and prevents the development of undesirable 'wild' types of yeast, which would lead to uncontrolled fermentation rates and variable products. Salt also strengthens the gluten in bread doughs, thus helping to ensure good dough handling and reducing the rate of water absorption. Sodium acid pyrophosphates are used in many industrial baking powders for specialty products. Salting of canned vegetables is primarily for flavor, but it can be used to separate mature, starchy green beans or peas, which will sink, from the younger, fresher beans, which float.

Potential Adverse Effects

Cereals do not have any intrinsic non-specific toxins. However, acrylamide, a carcinogen and potential neuro-toxin, has recently been found at levels up to 120 mg 100 g_1 in baked and fried foods, including breads and processed cereals. Research is ongoing, but the early indications are that acrylamide from these sources is unlikely to increase cancer risk. Detrimental effects may be caused by antinutrients in cereals and, in susceptible individuals, by adverse immune responses (celiac disease, food allergies). Cereals may also be a source of toxins of fungal origin (mycotoxins) or of toxic environmental, agricultural, or industrial contaminants.

Human Zinc Deficiency

In addition to dietary inadequacy, there are several routes that lead to zinc deficiency. Acrodermatitis enteropathica, the genetic disorder of zinc malabsorption, has already been mentioned. Other, more generalized, malabsorption syndromes (e.g., coeliac disease) can also lead to zinc deficiency. Deficiency has also resulted from inappropriate intravenous feeding and the use of chelation therapy. Children are likely to be particularly at risk of zinc deficiency, because of its involvement in growth.

The Child Who Hurts All Over

One of the greatest difficulties for families and physicians is that some children with widespread complaints do not look ill. Routine physical examination of the heart, lungs, and abdomen will not reveal what is causing the child so much distress, for these will not provide evidence of muscle pain, weakness, or tender joints. Some conditions such as celiac disease or mild variants of the mucopolysaccharidoses and other genetic diseases will be diagnosed only if they are tested for routine testing will not reveal them. You may need to insist on blood tests, X-rays, or a specialist referral.

The interaction of insulin resistance and Bcell function

It is possible that nonautoimmune and autoimmune destruction of ( -cells could coexist, but the current classification considers two subtypes. In type 1a there is evidence suggesting an autoimmune origin of ( -cell destruction, mostly determined by the presence of circulating antibodies against islet cells insulin antibodies in the absence of exposure to exogenous insulin or antibodies to glutamic acid decarboxylase, and or islet cell-associated phosphatase. This autoimmune entity also is associated with certain HLAs. Patients with type 1a are also more likely to have other concomitant autoimmune disorders, such as autoimmune thyroiditis, Addison's disease, and celiac disease.

Biological Availability

The fat-soluble vitamins (A, D, E, and K) are absorbed dissolved in lipid micelles, and, therefore, absorption will be impaired when the meal is low in fat. Gastrointestinal pathology that results in impaired fat absorption and steattorhea (e.g., untreated celiac disease) will also impair the absorption of fat-soluble vitamins, because they remain dissolved in the unabsorbed lipid in the intestinal lumen. Lipase inhibitors used for the treatment of obesity and fat replacers (e.g., sucrose polyesters such as OlestraTM) will similarly impair the absorption of fat-soluble vitamins.

Secondary Lactase Deficiency

Been implicated as contributing to lactose maldigestion. An additional infection resulting in an interference with lactose digestion is Ascaris lumbricoides. Severe protein malnutrition is frequently associated with lactose maldigestion. Other disease conditions that give rise to secondary lactose maldigestion are celiac disease, gluten-induced enteropathy, and tropical and nontropical sprue. The mucosal brush border of the small intestine is severely damaged in each case.

Apple Pomace As A Dietary Fortificant

Pomace of varying particle size at different levels showed an increase in viscosity with decreasing particle size. The addition of apple fiber and cellulose on wheat gluten showed that with an increase in the apple fiber concentration, the WHC did not increase linearly, indicating that there may be an interaction between fibrous materials and gluten (Chen, Rubenthaler, and Schanu, 1988). The water sorption isotherms of spray-dried apple, wheat, and oat brans showed that apple fiber was more hygroscopic, which could be due to either the structural difference of cell wall materials between bran of grain and fruit fiber or the lower fiber content in cereal brans, or the smaller particle size of apple fiber, thus indicating that it can function as a humectant (Chen, Rubenthaler, Leung, et al, 1988).

Eosinonophilc Gastroenteritis

In patients with mucosal layer disease (i.e., no involvement of muscle or serosal layer), food intolerance should be looked for. A trial of sequential elimination of milk, pork, beef, eggs, or gluten may be tried. Enteral elemental diets have been tried in some patients with success. Patients with mucosal layer disease who do not respond to dietary measures or patients with deeper layer involvement should try a course of steroids. Any patient who has traveled to the tropics should be considered for antihelminth therapy. See also Celiac Disease. Colon Disorders Nutritional Management of Disorders. Lactose Intolerance. Small Intestine Structure and Function. Stomach Disorders.

General Health Benefits

When administered in the form of syrup for 30 days, spirulina increased the mean blood hemoglobin levels by 11.65 in young anemic adult girls. However, when given as part of a wheat preparation, it brought about significantly less elevation in hemoglobin levels. This reduction in efficacy was attributed to the presence of oxalates and phytates in the grain that interfere with iron absorption (13). In another study, spirulina alone and in combination with wheat gluten resulted in higher hemoglobin content and higher iron storage (14). Supplementation of a university cafetaria diet of young healthy adults in Spain with Provital, a commercial preparation of spirulina, resulted in no significant changes in anthropometric indicators but an increase in total antioxidant capacity with increases in a-tocopherol and h-carotene levels observed only in women volunteers (15).

Defining Chronic Enteropathy

For the present discussion, chronic enteropathy is defined as chronic functional derangement of the small bowel. The primary consequence of chronic enteropathy is persistent diarrhea which is loose or watery stools at least 3 times per day of more than 14 days' duration, with change in stool consistency more meaningful than stool frequency. Depending on the specific pathophysiology, other symptoms may dominate the clinical picture for example, Crohn's disease may present with bloody stool or the child with celiac disease (CD) who, able to partially compensate for reduced absorptive capacity by increasing dietary intake, may present with stunting.

The Reverse Paradigm Underlying Pathology Revealed by Detection of Abnormal Nutrition

Classically, in type 2 diabetes, unexplained weight loss is a presenting complaint when polyuria is mild or absent. Moreover, with common forms of childhood gastrointestinal disorders, such as celiac sprue or Crohn's disease, arrested linear growth is often the first clue that something is clinically awry. It provokes the diagnostic inquiry that leads to the recognition of the bowel lesions. In milder presentations of cystic fibrosis, a similar growth failure occurring in infancy, can indicate an underlying pathological disorder.

Principles of Management

The management issues are simplified. For instance, if a person is dehydrated because of hyperglycemic diuresis in uncontrolled diabetes mellitus, the short-term management involves administration of exogenous intravenous fluids to restore normal hydration however, restoring adequate diabetic control to the patient would be the long-term and definitive solution. The undernutrition and growth failure due to undetected celiac disease is easily eliminated by institution of a gluten-free diet. With deficient nutrition in cystic fibrosis, adequate management of pulmonary problems and digestive-enzyme should allow patients to recover and maintain normal nutrition on a balanced oral diet. Thus, medical or surgical address of the underlying disorder, where possible, is the primary tool for management of secondary undernutrition.

Pathophysiology Of The Small Bowel

Important pathological conditions of the small intestine that will be considered in this section include duodenal ulcer disease, bacterial and viral infections, Crohn's disease, vitamin B12 deficiency, small bowel carcinomas and malabsorptive conditions, including coeliac disease.

Effect Of Cereal Fermentation On Health Properties

Traditionally, sourdough is used in baking applications to acidify and leaven bread dough. The various traditional sourdough fermentations were prevalently replaced by the use of baker's yeast in the twentieth century (Ganzle et al, 2007). As observed by Ganzle et al, the current renaissance of sourdough applications in bread making is motivated by the beneficial effect of sourdough on the flavor, texture, shelf life, and nutritional properties of bread and other baked goods. According to Batifoulier et al. (2005), due to the reduction in bread consumption and of whole cereal flours, a significant percentage of the European population is marginally deficient for dietary riboflavin and other B vitamins. Due to the heterogeneity of the ecological determinants (e.g., flour composition, temperature, pH and redox potential, dough yield, number of refreshments, and baker's yeast addition), mature commercial sourdoughs differ in microbial species complexity and metabolic activity (Ganzle et...

Health and nutritional benefits of plantains

Because of the low lipid and high energy values, bananas are recommended for obese and geriatric patients. Bananas are useful for people with peptic ulcers, for treatment of infant diarrhea, and for celiac disease and colitis. The potential of dried unripe plantain or banana pulp powder in the treatment of ulcers has been noted (Dunjic et al., 1993). Plantains contain vitamin A and thus can act as an aid to digestion. The juice from the male bud provides an apparent remedy for stomach problems in many people. The ripe fruit has also been noted for use in the treatment of asthma and bronchitis.

Adverse Reactions

Wheat is a major diet constituent for much of humankind, but wheat consumption often leads to fastidious or even life-threatening problems. Two different types of adverse reactions are linked to wheat consumption allergies and celiac disease. Celiac disease is an inflammatory immunomediated condition triggered by the gluten prolamins of several cereals (including Triticum spp.) in predisposed individuals. The main causal agent is the gliadin fraction of gluten. All three structural types of gliadins (a b, g, and u) are active nevertheless, glutenin components can exacerbate celiac disease. Two different pathological effects can be distinguished a rapid cytotoxic effect on the intestinal epithelium and an immune response involving T cells that recognize specific prolamin epitopes. toxicity of T. monococcum, which lacks a highly immunoreactive a -gliadin peptide (LQLQPFPQPQLPYPQPQLPYPQPQLPYPQPQPF) encoded by genes located on chromosome 6D (M0lberg et al., 2005) Genome D is absent in...

Treatment for Autism

The field of autism treatment, both behavioral and medical, has been subject to many treatment fads, all claiming high levels of success that are either invalidated or simply not supported by subsequent controlled studies. On the behavioral side, such putative cures include facilitated communication, holding therapy, auditory integration therapy, and sensory-integration therapy. Putative cures on the medical side include treatment with megavitamins, B vitamins, dimethylglycene, secretin, and elimination diets for gluten and casein. Most families, at least initially, undertake multiple treatments including trials of some unproven treatments, which over time, tend to be tailored by perceived or measurable positive responses.

Wet milling

Throughout the world, large quantities of corn are wet milled to produce starch and other valuable by-products, such as gluten, germ, and bran. The first step in the wet milling of corn is steeping in water (30 40 h at 50 C) in the presence of SO2 (0.02 ) under carefully controlled conditions to soften the kernels. SO2 prevents fermentation and facilitates the separation of starch from protein. After steeping, the steep water is drained, and grains are coarsely ground to free the germ from endosperm and hull. The germ portion is then separated, dried, and expelled for oil extraction. The fiber and starch suspension is then fine milled and separated by screening, centrifugation, and washing. The starch is dried and converted into a number of valuable products, such as dextrose, fructose syrups, dextrins, modified starches, and sorbitol, by chemical and or enzymatic processes. a-Amylase, b-amylase, glucoamylase, and pullulanase enzymes from bacterial and fungal sources are used for...


Dietary fat does not affect calcium absorption except in individuals with diseases that impair fat malabsorption (e.g., short bowel syndrome, celiac disease, and pancreatitis). In these conditions, the calcium forms an insoluble and unabsorbable 'soap' with the unabsorbed fat in the alkaline lumen of the small intestine, potentially resulting in impaired bone mineralization. In addition, the luminal calcium is not available to precipitate the oxalates, meaning that the free oxalates will be hyperabsorbed leading to increased risk for renal oxalate stones. Neither dietary phosphorus nor a wide range of phosphorus-to-calcium ratios affect intestinal calcium absorption in very low-birth-weight infants and adults.

Food Applications

The small starch granule size and composition have been suggested to be responsible for unique gelatinization and freeze thaw characteristics that could be exploited by the food industry to develop various products (Becker et al., 1981). Amaranth starch can be used in many food preparations, such as custards, pastes, and salads, and nonfood applications, such as cosmetics, biodegradable films, paper coatings, and laundry starch. Amaranth flour is used as a thickener in gravies, soups, and stews. Sprouted amaranth is used in salads. The cooking of amaranth improves its digestibility and absorption of nutrients. Amaranth flour lacks gluten proteins present in wheat hence, it is not suitable for bread making. It is blended with wheatmeal flour in the preparation of unleavened flat bread known as chapattis in India and tortillas in Latin America. Amaranth flour is also used in the preparation of biscuits, muffins, pancakes, pastas, flat breads, extruded products, etc. In India, the grains...

Side Effects

Celiac disease A condition in which the small intestine cannot absorb and digest food, caused by gluten sensitivity. Although an estimated one in 4,700 Americans have been diagnosed with this disease, a study from the Red Cross suggests it may be far more common one in every 250 Americans. For those who cannot tolerate gluten, the substance damages the lining of the intestines and flattens the villi small hair-like projections that normally protrude from the intestinal surfaces that help absorb nutrients. Permanent intolerance to gluten that damages the small intestine can be reversed by avoiding gluten in the diet. As the villi become damaged, they are unable to absorb water and nutrients, which causes the child to be susceptible to a variety of other conditions related to malabsorption. Celiac disease is hereditary and primarily affects whites of northwestern European ancestry, rarely affecting blacks, Jews, Asians, or people of Mediterranean ancestry. It affects twice as many girls...


Established celiac disease is characterized by an inflammatory response in the proximal small intestine. This inflammation consists of increased numbers of lymphocytes, plasma cells, and macrophages in the lamina propria and increased lymphocytes in the surface layer of the epithelium, called intra-epithelial lymphocytes. The surface enterocytes are shorter and wider than normal and have poorly ordered nuclei. The normally tall thin villi are shortened and flattened. The cryptal layer is increased in depth. These changes may be patchy and affect variable lengths of the proximal small intestine ( Figure 1). the actual pathology of the lesion, and clones derived from such cells have been used to characterize the response to gliadin. Lymphocytes in the intraepithelial layer are also increased in number in untreated celiac disease, many of which bear the 7S TCR. These cells slowly decrease when gluten is removed. An early event in the pathology is an increased expression of class II HLA...

Associated Disorders

Dermatitis herpetiformis This is characterized by an extremely pruritic papulovesicular eruption, which usually occurs symmetrically on the elbows, knees, buttocks, and back. About 80 of patients with dermatitis herpetiformis have small intestine histology indistinguishable from celiac sprue. The diagnosis is established by skin biopsy demonstrating granular IgA deposits in areas of normal appearing skin. A majority of patients with the skin lesion who undergo small bowel biopsy have intestinal mucosal changes of celiac disease. The skin lesions, as well as small bowel histology, improve on a gluten-free diet. Dapsone is an effective short-term treatment for dermatitis herpetiformis however, it does not have any impact on management of small bowel enteropathy. Also, those with dermatitis her-petiformis who are not compliant with the gluten-free diet are at higher risk for malignancy, as are those with celiac disease. Celiac disease has also been associated with other autoimmune as...


Small bowel biopsy remains the gold standard for diagnosis of celiac disease. Over the past decade the diagnostic criteria for celiac sprue have changed. Based on the 1990 revised criteria of the European Society of Paediatric Gastroenterology and Nutrition, the diagnosis of celiac sprue can be made with a diagnostic small bowel biopsy in a patient with highly suggestive clinical symptoms, followed by an objective clinical response to a gluten-free diet. Endoscopic biopsies from the distal duodenum are preferable because the presence of Brunner glands in the duodenal bulb and proximal second portion of the duodenum may affect histologic interpretation. The original criteria requiring a series of three biopsies, i.e., first to confirm the diagnosis, second for demonstration of response to a gluten-free diet and the third for deterioration after gluten challenge, are only required in those few patients in which there is still some diagnostic uncertainty. Endoscopic features observed in...

Bone Metabolism

Osteomalacia is a well-recognized, although uncommon, complication of celiac disease, with bone pain and pseudofractures as features. It is associated with elevated alkaline phosphotase and often normal levels of calcium and phosphate. It usually responds well to a gluten-free diet and calcium and vitamin D supplementation. Osteoporosis, which is common in adults with celiac disease, affects both men and women, and the exact mechanisms are not clear. The prevalence of osteoporosis is even higher in refractory sprue compared to gluten-free-diet-responsive patients. Diagnosis depends on bone mineral density testing with a T-score less than 2.5 SD below mean peak value in young adults. The primary treatment for the osteoporosis in a celiac is the strict gluten-free diet with adequate calcium (1500mgday_1 and vitamin D). Other measures directed at preserving or building bone density may be necessary if the boss mineral loss has been substantial or does not recover with a gluten-free diet.

Modern products

The production of good-quality non-wheat bread with a light, airy texture is a skilled craft. A number of different techniques are used. However, the scientific reasons for most of them remain a matter of conjecture. The general principle of successful non-wheat bread making is that the solute molecules in the dough, mainly starch, have substitute for the gas-holding, viscoelastic properties of the wheat gluten molecules. Specifically, the solute molecules have to interact together and with the water molecules to hold the gas produced during yeast fermentation, allowing the dough to expand during fermentation and to set into a firm cellular structure during baking. In this context, sorghum has no special characteristics compared to other gluten-free cereals such as maize or rice. However, the more bland taste of white, tan-plant sorghum cultivars compared to other cereals and other sorghum types seems to be preferred in bread and cakes. Hydrocolloids such as xanthan gum and...

Small bowel tumours

Lymphomas of the gastrointestinal tract may be primary, with or without involvement of the adjacent nodes, or secondary, having spread from elsewhere. Non-Hodgkin's lymphoma may involve the gastrointestinal tract as part of more generalised disease or may rarely arise in the gut, with the small intestine being most commonly affected. Lymphomas occur with increased frequency in patients with coeliac disease, AIDS and other immuno-deficiency states. Colicky abdominal pain, obstruction and weight loss are the usual presenting features and perforation is also occasionally seen.


Absorption through prolonging gastric emptying and by acting as a barrier to diffusion in the small intestine. Starch-protein interactions (as seen with gluten in wheat products) and starch-fat interactions have been shown to reduce the rate of digestion, and fat is known to slow gastric emptying. A number of the so-called 'antinutrients' present in foods, notably lectins, phytates, and tannins, have been shown to reduce the digestibility of foods. For example, it is considered that phytate, by binding calcium ions that catalyse starch digestion by amy-lase, reduces the rate of small-intestinal starch digestion.


It is well-known that polysaccharides in barley affect the baking quality of breads (Holtekj0len, Olsen, et al, 2008 Izydorczyk and Dexter, 2008). However, there are few studies dealing with possible technological properties of the naturally occurring phenolics within the raw material (barley flours) and their impacts on bread quality. Phenolics have been studied for changes occurring during bread making (Hansen et al, 2002). Certain phenolic compounds, such as FA, have also been added in pure form to study their possible technological impact. Adding FA to the dough has been shown to increase the rate of dough breakdown and simultaneously make it more sticky (Okada et al, 1987). Ferulic acids are also important because they crosslink pentosans, thereby affecting viscosity, or directly link to the gluten, affecting the gluten network. Such interactions are assumed to contribute to a decrease in gluten and hence dough extensibility (Wang et al, 2004a,b).


Psoriasis is an acceleration in the growth of skin cells that results in patches of dry scaly itchy skin. The cause is unknown although it tends to run in families. Stress is often a trigger and gluten in foods or alcohol can precipitate the condition in some individuals. A sluggish liver may also be a factor. Getting sunlight is a common and effective remedy to alleviate symptoms. Antioxidants neutralize free radicals that play a role in inflammatory diseases like psoriasis.

Functional Tests

Vitamin B6 functional tests are the erythrocyte aspartate aminotransferase activation coefficient test and the tryptophan load test. Erythrocyte aspartate aminotransferase activity is measured spectrophotometrically in erythrocyte hemolysate without PLP addition (basal) and with PLP addition (stimulated). The activation coefficient is given by the ratio of stimulated to basal activity. Automation of this test is available. Confounding effects of renal and liver diseases, cancer, celiac disease, high protein diet, thiamin status, alcohol intake, stress, and drugs are reported. The tryptophan load test was used in the past because vitamin B6-dependent enzymes are involved in the conversion of trypto-phan to niacin. After an appropriate loading dose of tryptophan and under controlled conditions, vitamin B6-deficient subjects excrete tryptophan metabolites (kynurenine, kynurenic acid, and xanturenic acid) in urine measured spectrophotome-trically after thin-layer or ion exchange...

Amy Pershing

Clinicians may have similar concerns about patients who struggle with conditions such as Celiac disease, diabetes, or other food allergies or intolerances. IEM elegantly addresses these issues by using the body's natural systems of alert and warning. In the author's 20 years of clinical experience, people with diabetes or Celiac disease, for example, often come to be very aware of their body's response to sugar or gluten. They have typically known it all along. When we forbid a food, we want it all the more. This becomes the evidence that the body cannot be trusted. In fact, when patients finally tune in, they find their body has not wanted toxins all along. Forbidding is anathema to recovery.

The formula provides

Folic Acid 150 micrograms - Folic acid is water-soluble, part of the B Complex group of vitamins, found in leafy green vegetables, citrus fruits, eggs, organ meats, whole grains, seeds and nuts but often destroyed by overcooking. Required for protein synthesis, works with B12 in the formation of red blood cells and is also vital for rapidly dividing cells and the developing foetus. It is needed to make RNA and DNA and therefore essential for the repair and manufacture of all cells. Needed for proper growth, brain activity, normal nervous function. Recent research indicates that folic acid may play a protective role against heart disease due to its ability to lower homocysteine levels along with B6 and B12 it reduces the risk of heart attacks. It also helps to regulate histamine levels in the body. As with B12, anaemia will result when folic acid is low. 400 micrograms is needed prior to and during pregnancy to prevent spina bifida or other neural tube defects. It is adversely affected...


Kafirins have low nutritional quality because they are poor in essential amino acids, particularly lysine (Taylor and Schussler, 1986). They are poorly digestible, especially when cooked in water, as occurs during most food preparation processes (Duodu et al., 2003). However, an important positive health issue with respect to the kafirins is that because they are so different in structure from the wheat gliadin and glutenin storage proteins (see Table 12.2), it has been conclusively shown that sorghum does not elicit morphometric or immunomediated alteration of duodenal explants from patients suffering from celiac disease (Ciacci et al., 2007). Celiac disease, a syndrome characterized by damage to the mucosa of the small intestine, is caused by ingestion of wheat gluten and similar proteins (Catassi and Fasano, 2008). It is 130 becoming recognized that celiac disease is a major health problem in Western countries, However, a major challenge in using sorghum in bread baking is the very...


Absorption of iron in heme from meat is more efficient than as inorganic ferrous or ferric iron. Thus, vegetarian diets present increased risk of iron deficiency. However, most diets, even in affluent westernized countries, are marginal in the amount of iron in relation to population needs. All children are at risk of developing iron deficiency with minor disturbances in dietary quality, iron absorption and metabolism, or with blood loss. Iron absorption takes place in the jejunum and upper ileum so conditions such as gluten-sensitive enteropathy (celiac syndrome), where the brunt of intestinal damage is in the jejunum and upper ileum, may present as severe iron deficiency. Reduced iron absorption during pyrexial illness contributes to iron deficiency in children who suffer frequent infections.


Barley, whole, also known as Scotch barley, is nutritious and chewy and can be eaten alone or combined with brown rice or beans, or as a base for soup. Pearl barley is refined losing fiber and nutrient content. Basmati is a long grain Himalayan rice with a nutty, buttery flavor. White basmati lacks the fiber and nutrient value of brown basmati. Texmati and calmati are basmati hybrids. Buckwheat is gluten-free and suitable