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recommend\ta\tnew\tlower\tosmolality\tsolution\tat\t245\tmOsm/L\twith\tdecreased\tconcentrations\tof\tboth\nglucose\t(13.5\tg/L)\tand\tsodium\t(75\tmEq/L),\tas\tit\twas\tshown\tto\tresult\tin\tgreater\twater\tabsorption\tin\nchildren\twith\tnoncholera\tdiarrhea\t(\nSuh\tet\tal,\t2010\n;\t\nWHO\t2002\n;\t\nWHO\t2006\n).\nOverall,\twhen\treduced-osmolarity\tORS\tis\tused\tfor
|
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;\t\nWHO\t2006\n).\nOverall,\twhen\treduced-osmolarity\tORS\tis\tused\tfor\n\tchildren\twith\tacute\tdiarrhea,\tit\tresults\tin\ndecreased\tneed\tfor\tintravenous\ttherapy,\tsignificant\treduction\tin\tstool\toutput,\tand\tdecreased\nvomiting\tcompared\twith\tstandard\tWHO-recommended\tORS\t(\nAtia\tand\tBuchman,\t2009\n).\tCommercial
|
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] |
Atia\tand\tBuchman,\t2009\n).\tCommercial\nsolutions\tsuch\tas\tPedialyte,\tInfalyte,\tLytren,\tEqualyte,\tand\tRehydralyte\ttypically\tcontain\tless\tglucose\nand\tslightly\tless\tsalt\tthan\tthe\tWHO-ORS\tformulation\tand\tare\tavailable\n\tin\tpharmacies,\toften\twithout\na\tprescription.\tOral\trehydration\ttherapy\tis\tless\tinvasive\tand\tless\texpensive\tthan\tintravenous
|
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] |
rehydration\tand,\twhen\tused\twith\tchildren,\tallows\tparents\tto\tassist\twith\ttheir\tchildren’s\trecovery.\nHowever,\tclose\tattention\tmust\tbe\tpaid\tto\tthe\tactual\telectrolyte\tcontent,\tas\tmany\tso-called\tORS\tare\nnot\tuseful\tfor\trehydration.\tSee\t\nTable\t27.2\n\tfor\tORS\trecipes\tthat\tcan\tbe\tused\n\tto\tcreate\tthe\tformula\tat
|
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] |
for\tORS\trecipes\tthat\tcan\tbe\tused\n\tto\tcreate\tthe\tformula\tat\nhome.\tCommercial\tsports\tdrinks\t(i.e.,\tGatorade)\twithout\tthe\tadded\tsalt\tare\tnot\trecommended.\nTABLE\t27.2\nOral\tRehydration\tSolution\t(ORS)\tRecipes\n*\n2\tcups\tGatorade,\t2\tcups\twater,\t¾\ttsp\tsalt\n28\tg\tglucose,\t82\tmEq\tNa,\t1.5\tmEq\tK\nor\n1\tquart\twater,\t¾\ttsp\tsalt,\t6\ttsp\tsugar
|
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or\n1\tquart\twater,\t¾\ttsp\tsalt,\t6\ttsp\tsugar\n24\tg\tglucose,\t76\tmEq\tNa,\t0\tmEq\tK\n*\nEach\tmakes\t1\tliter\tand\tshould\tbe\tmade\tfresh\tevery\t24\thours.\nData\tfrom\tKrenitsky\tJ,\tMcCray\tS:\t\nUniversity\tof\tVirginia\tHealth\tSystem\tNutrition\tSupport\tTraineeship\tSyllabus,\n\tCharlottesville,\tVA,\t2010,\tUniversity\tof
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Charlottesville,\tVA,\t2010,\tUniversity\tof\nVirginia\tHealth\tSystem;\tRecipes\tfrom\tParrish\tCR:\tThe\tclinician’s\tguide\tto\tshort\tbowel\tsyndrome,\t\nPract\tGastroenterol\n\t29:67,\t2005.\nA\tsubstantial\tproportion\tof\tchildren\t9\tto\t20\tmonths\tof\tage\tcan\tmaintain\tadequate\tintake\twhen\noffered\teither\ta\tliquid
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offered\teither\ta\tliquid\n\tor\ta\tsemisolid\tdiet\tcontinuously\tduring\tbouts\tof\tacute\tdiarrhea.\tEven\tduring\nacute\tdiarrhea,\tthe\tintestine\tcan\tabsorb\tup\tto\t60%\tof\tthe\tfood\teaten.\tSome\tpractitioners\thave\tbeen\nslow\tto\tadopt\tthe\tpractice\tof\tearly\trefeeding\tafter\tsevere\tdiarrhea\tin\tinfants\tdespite\tevidence\tthat\n“resting\tthe\tgut”\tis\tactually\tmore\tdamaging.
|
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0.012847603298723698
] |
“resting\tthe\tgut”\tis\tactually\tmore\tdamaging.\nGastrointestinal\tstrictures\tand\tobstruction\nPathophysiology\nPatients\n\twith\tgastroparesis,\tadhesions,\thernias,\tmetastatic\tcancers,\tdysmotility,\tor\tvolvulus\tare\nprone\tto\tobstruction,\twhich\tcan\tresult\tin\tpartial\tor\tcomplete\tblockage\tof\tmovement\tof\tfood\tor\tstool
|
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through\tthe\tintestines.\tObstructions\tmay\tbe\tpartial\tor\tcomplete\tand\tmay\toccur\tin\tthe\tstomach\n(gastric\toutlet\tobstruction),\tsmall\tintestine,\tor\tlarge\tintestine.\tSymptoms\tinclude\tbloating,\tabdominal\ndistention\tand\n\tpain,\tnausea,\tand\tvomiting.\nObstructions\tare\tnot\tusually\tcaused\tby\tfoods\tin\tan\totherwise\thealthy\tindividual,\tand\tresearchers
|
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have\tnot\tfound\tthat\teating,\tdiet,\tand\tnutrition\tplay\ta\trole\tin\tcausing\tor\tpreventing\tthe\tfrequency\tof\nobstructive\tsymptoms\tin\tthis\tpopulation.\tHowever,\twhen\tsections\tof\tthe\tGI\ttract\tare\tpartially\nobstructed\tor\tnot\tmoving\tnormally,\tfoods\tmay\tcontribute\tto\tobstruction.\tIn\n\tthese\tindividuals\twith\ta
|
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these\tindividuals\twith\ta\ncompromised\tGI\ttract,\tit\tis\tbelieved\tthat\tfibrous\tplant\tfoods\tcan\tcontribute\tto\tobstruction\tbecause\nthe\tfiber\tin\tthe\tfoods\tmay\tnot\tbe\tcompletely\tchewed\tto\tpass\tthrough\tnarrowed\tsegments\tof\tthe\tGI\ntract.\nMedical\tnutrition\ttherapy
|
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tract.\nMedical\tnutrition\ttherapy\nMost\tclinicians\twould\trecommend\tpatients\tprone\tto\tobstructions\tto\tchew\tfood\tthoroughly\tand\tavoid\nexcessive\tfiber\tintake,\tlimiting\tintake\tto\n\tfoods\twith\tless\tthan\t3\tgrams\tof\tfiber\tper\tserving\tor\tno\tmore\nthan\t10\tgrams\tper\tday.\tA\tpatient\twith\ta\tpartial\tbowel\tobstruction\tmay\tbe\table\tto\ttolerate\ta
|
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restricted-fiber\tdiet\tand\tliquids,\tdepending\ton\tthe\tlocation\tof\tthe\tstricture\tor\tobstruction\tin\tthe\tGI
|
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] |
tract.\tA\tmore\tproximal\t(closer\tto\tthe\tmouth)\tblockage\tmay\trequire\ta\tsemisolid\tor\tliquid\tdiet.\nHowever,\tthe\tmore\tdistal\t(closer\tto\tthe\tanus)\tthe\n\tblockage,\tthe\tless\tlikely\taltering\tthe\tconsistency\tof\nthe\tdiet\twill\thelp.\tSymptoms\tare\tmore\tsevere\tduring\tcomplete\tobstruction.\tPatients\tmay\tbe
|
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intolerant\tof\toral\tintake\tand\tof\ttheir\town\tsecretions\tleading\tto\tprogressive\tdehydration,\telectrolyte\nimbalance,\tand\tsystemic\ttoxicity.\tInitial\ttreatment\tconsists\tof\taggressive\tfluid\tresuscitation,\nnasogastric\tdecompression,\tand\tadministration\tof\tanalgesics\n\tand\tantiemetics.
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0.02500748820602894,
0.05923395976424217,
0.04872104525566101,
0.010151023976504803
] |
and\tantiemetics.\nPatients\twith\tcomplete\tbowel\tobstruction\tmay\trequire\tsurgical\tintervention.\tIn\tsome\tcases,\tenteral\nfeeding\tbeyond\tthe\tpoint\tof\tobstruction\tmay\tbe\tfeasible,\tbut\tif\tenteral\tfeeding\tis\tnot\tpossible\tfor\ta\nprolonged\tperiod,\tPN\tmay\tbe\tneeded.\tWorking\twith\tthe\tpatient\tand\tphysician\tis\tnecessary\tto
|
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] |
determine\tthe\tnature,\tsite,\tand\tduration\tof\tthe\tobstruction\tso\tthat\tnutrition\ttherapy\n\tcan\tbe\nindividualized.\nDiseases\tof\tthe\tsmall\tintestine\nCeliac\tdisease\t(gluten-sensitive\tenteropathy)\nThe\tprevalence\tof\t\nceliac\tdisease\t(CD)\n\thas\tbeen\tunderestimated\tin\tthe\tpast\tand\tnow\tis\tconsidered
|
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] |
has\tbeen\tunderestimated\tin\tthe\tpast\tand\tnow\tis\tconsidered\nto\taffect\t0.3%\tto\t0.9%\tof\tthe\tpopulation\tin\tthe\tUnited\tStates\tand\tvaries\tby\trace\tand\tethnicity,\twith\ta\nmarked\tpredominance\tamong\tnon-Hispanic\twhites.\tWorldwide\tincidence\tof\tCD\tis\tabout\t1%\t(\nLeonard\net\tal,\t2017
|
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] |
Leonard\net\tal,\t2017\n).\tThe\tonset\tand\tfirst\toccurrence\tof\tsymptoms\tmay\tappear\tany\ttime\tfrom\tinfancy\tto\nadulthood.\tThe\tdisease\tmay\tbecome\tapparent\twhen\tan\tinfant\tbegins\teating\tgluten-containing\ncereals.\tIn\tsome,\tit\tmay\tnot\tappear\tuntil\tadulthood,\twhen\tit\tmay\tbe\ttriggered\tor\tunmasked\tduring\tGI
|
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surgery,\tstress,\tpregnancy,\tor\tviral\tinfection.\tIt\tmay\tbe\tdiscovered\tas\ta\tresult\tof\tevaluation\tfor\nanother\tsuspected\n\tproblem\t(such\tas\tconstipation,\tabdominal\tpain,\tunexplained\tanemia).\nEtiology\nThe\tpresentation\tin\tyoung\tchildren\tis\tlikely\tto\tinclude\tthe\tmore\t“classic”\tGI\tsymptoms\tof\tdiarrhea,
|
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steatorrhea,\tmalodorous\tstools,\tabdominal\tbloating,\tfatigue,\tand\tpoor\tweight\tgain.\tAn\tincreasing\nnumber\tof\tpatients\tare\tbeing\tdiagnosed\twith\textraintestinal\tsymptoms\t(such\tas\theadache,\tbrain\n“fog,”\tanemia,\treduced\tbone-mineral\n\tdensity,\tchronic\tfatigue,\tdental\tenamel\thypoplasia,\televated
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density,\tchronic\tfatigue,\tdental\tenamel\thypoplasia,\televated\nliver\tenzymes).\tA\trecent\tstudy\tfound\tthat\tonly\t34%\tof\tpediatric\tpatients\tpresented\twith\tclassic\nsymptoms\tof\tCD\tand\t43%\tof\tpatients\thad\tnonclassic\tsymptoms\t(\nAlmallouhi\tet\tal,\t2017\n).\tCD\nfrequently\tis\tmisdiagnosed\tas\tIBS,\tlactase\tdeficiency,\tgallbladder\tdisease,\tor\tother\tdisorders\tnot
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necessarily\tinvolving\tthe\tGI\ttract,\tbecause\tthe\tpresentation\n\tand\tonset\tof\tsymptoms\tvary\tso\tgreatly.\nPatients\tmay\tpresent\twith\tone\tor\tmore\tof\ta\thost\tof\tconditions\tassociated\twith\tCD:\tanemias,\ngeneralized\tfatigue,\tweight\tloss\tor\tfailure\tto\tthrive,\tosteoporosis,\tvitamin\tor\tmineral\tdeficiencies,\nand\t(although\trare)\tGI\tmalignancy.
|
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0.10284875333309174,
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0.09159616380929947,
0.08743227273225784,
0.08096683770418167,
-0.03822416812181473
] |
and\t(although\trare)\tGI\tmalignancy.\t\nDermatitis\therpetiformis\n,\tyet\tanother\tmanifestation\tof\tCD,\npresents\tas\tan\titchy\tskin\trash;\tits\tpresence\tis\tdiagnostic\tof\tCD.\t\nBox\t27.6\n\tlists\tconditions\tassociated\nwith\tCD.\tPersons\twho\tare\tdiagnosed\tlate\tin\tlife,\twho\tcannot\tor\twill\tnot\tcomply\twith\tthe\tdiet,\tor\twho
|
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0.0037233098410069942
] |
were\tdiagnosed\tas\tchildren\tbut\ttold\tthey\twould\tgrow\tout\tof\tit,\tare\tat\ta\thigher\trisk\tfor\texperiencing\nlong-term\tcomplications\tfrom\tCD\t(\nNachman\tet\tal,\t2010\n).\nBOX\t27.6\nSymptoms\tand\tConditions\tAssociated\tWith\tCeliac\tDisease\nNutritional\nAnemia\t(iron\tor\tfolate,\n\trarely\tB\n12\n)
|
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] |
Nutritional\nAnemia\t(iron\tor\tfolate,\n\trarely\tB\n12\n)\nOsteomalacia,\tosteopenia,\tfractures\t(vitamin\tD\tdeficiency,\tinadequate\tcalcium\tabsorption)\nCoagulopathies\t(vitamin\tK\tdeficiency)\nDental\tenamel\thypoplasia\nDelayed\tgrowth,\tdelayed\tpuberty,\tunderweight\nLactase\tdeficiency\nExtraintestinal\nFatigue,\tmalaise\t(sometimes\tdespite\tlack\tof\tanemia)
|
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] |
Extraintestinal\nFatigue,\tmalaise\t(sometimes\tdespite\tlack\tof\tanemia)\nArthritis,\tarthralgia\nDermatitis\therpetiformis\nInfertility,\tincreased\trisk\tof\tmiscarriage\nHepatic\tsteatosis,\thepatitis\nNeurologic\tsymptoms\t(ataxia,\tpolyneuropathy,\tseizures);\tmay\tbe\tpartly\tnutrition\trelated\nPsychiatric\tsyndromes\nAssociated\tdisorders
|
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Psychiatric\tsyndromes\nAssociated\tdisorders\nAutoimmune\tdiseases:\ttype\t1\tdiabetes,\tthyroiditis,\thepatitis,\tcollagen\tvascular\tdisease\nGastrointestinal\tmalignancy\nIgA\tdeficiency\nIgA\n,\tImmunoglobulin\tA.
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] |
Kupfer\tSS,\tJabri\tB:\tPathophysiology\tof\tceliac\tdisease,\t\nGastrointest\n\tEndosc\tClin\tN\tAm\n\t22:639,\t2012.\nPathophysiology\nCD,\tor\t\ngluten-sensitive\tenteropathy\n,\tis\tcharacterized\tby\ta\tcombination\tof\tfour\tfactors:\t(1)\tgenetic\nsusceptibility,\t(2)\texposure\tto\tgluten,\t(3)\tan\tenvironmental\t“trigger,”\tand\t(4)\tan\tautoimmune\nresponse.\t\nGluten
|
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] |
response.\t\nGluten\n\trefers\tto\tspecific\tpeptide\tfractions\tof\tproteins\t(prolamins)\tfound\tin\twheat\t(glutenin\nand\tgliadin),\trye\t(secalin),\tand\tbarley\n\t(hordein).\tA\tsmall\tnumber\tof\tthose\twith\tCD\tmay\talso\treact\tto\nthe\tavenin\tprotein\tin\toats\t(\nPinto-Sanchez\tet\tal,\t2017\n).\tThese\tpeptides\tare\tgenerally\tmore\tresistant\tto
|
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] |
).\tThese\tpeptides\tare\tgenerally\tmore\tresistant\tto\ncomplete\tdigestion\tby\tGI\tenzymes\tand\tmay\treach\tthe\tsmall\tintestine\tintact.\tIn\ta\tnormal,\thealthy\nintestine,\tthese\tpeptides\tare\tharmless,\tas\tthe\tintestinal\tbarrier\tis\tintact\tand\tprevents\ttranslocation\nfrom\tthe\tintestine.\tHowever,\tin\tpersons\n\twith\tCD\tthese\tpeptides\ttravel\tfrom\tthe\tintestinal\tlumen,
|
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0.06703885644674301,
0.047429393976926804,
0.11513181030750275,
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] |
with\tCD\tthese\tpeptides\ttravel\tfrom\tthe\tintestinal\tlumen,\nacross\tthe\tintestinal\tepithelium,\tand\tinto\tthe\tlamina\tpropria,\twhere\tthey\tcan\ttrigger\tan\tinflammatory\nresponse\tthat\tresults\tin\tflattening\tof\tintestinal\tvilli\tand\telongation\tof\tthe\tcrypt\tcells\t(secretory\tcells),\nalong\twith\ta\tmore\tgeneral\tsystemic\timmune\tresponse\t(\nSams\tand\tHawks,\t2014\n)\t(
|
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] |
Sams\tand\tHawks,\t2014\n)\t(\nFig.\t27.4\n).\tThe\n“triggers”\tthat\tcause\ta\tgenetically\tpredisposed\n\tindividual\tto\tdevelop\tCD\tare\tnot\twell\tunderstood,\tbut\nstressors\t(e.g.,\tillness,\tinflammation)\tare\tthought\tto\tplay\ta\trole.\nFIG.\t27.4\nCD\t(gluten-sensitive\tenteropathy).\t\nA,\n\tPeroral\tjejunal\tbiopsy\tspecimen\tof\tdiseased\tmucosa\tshows
|
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] |
A,\n\tPeroral\tjejunal\tbiopsy\tspecimen\tof\tdiseased\tmucosa\tshows\nsevere\tatrophy\tand\tblunting\tof\tvilli,\twith\ta\tchronic\tinflammatory\tinfiltrate\tof\tthe\tlamina\tpropria.\t\nB,\n\tNormal\nmucosal\tbiopsy.\n\t\nSource:\n\t(From\tKumar\tV\tet\tal:\t\nRobbins\tand\tCotran\tpathologic\tbasis\tof\tdisease\n,\ted\t7,\tPhiladelphia,\t2005,\nSaunders.)
|
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] |
,\ted\t7,\tPhiladelphia,\t2005,\nSaunders.)\nWhen\tCD\tremains\tuntreated,\tthe\timmune\tand\tinflammatory\n\tresponse\teventually\tresults\tin\tatrophy\nand\tflattening\tof\tvilli.\tOver\ttime,\tthe\tprocess\tcan\tcause\tenough\tdamage\tto\tthe\tintestinal\tmucosa\tto\ncompromise\tnormal\tsecretory,\tdigestive,\tand\tabsorptive\tfunctions,\tleading\tto\timpaired\tmicronutrient
|
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and\tmacronutrient\tabsorption\t(\nKupfer\tand\tJabri,\t2012\n).\tCells\tof\tthe\tvilli\tbecome\tdeficient\tin\tthe\ndisaccharidases\tand\tpeptidases\tneeded\tfor\tdigestion\tand\talso\n\tin\tthe\tcarriers\tneeded\tto\ttransport\nnutrients\tinto\tthe\tbloodstream.\tThe\tdisease\tprimarily\taffects\tthe\tproximal\tand\tmiddle\tsections\tof\tthe
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] |
small\tbowel,\talthough\tthe\tmore\tdistal\tsegments\talso\tmay\tbe\tinvolved\t(\nSams\tand\tHawks,\t2014\n).\nThe\tterm\t\ngluten\tsensitivity\n\tis\tused\tcommonly\tto\tdescribe\tpersons\twith\tnonspecific\tsymptoms,\nwithout\tthe\timmune\tresponse\tcharacteristic\tof\tCD\tor\tthe\tconsequential\tintestinal\n\tdamage.\t\nGluten\nintolerance
|
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] |
damage.\t\nGluten\nintolerance\n,\talso\tcalled\tnonceliac\tgluten\tsensitivity,\tdescribes\tindividuals\twho\thave\tsymptoms\tafter\ningesting\tgluten-containing\tfoods.\tSymptoms\tmay\tbe\tisolated\tin\tthe\tgastrointestinal\ttract\tsuch\tas\nnausea,\tabdominal\tcramps,\tor\tdiarrhea;\tor\tmay\tbe\textraintestinal\tin\tnature\tsuch\tas\tbrain\tfog\tor
|
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underlying\tmedical\tcondition\tfor\twhich\ta\tGF\tdiet\tis\tnot\tthe\ttreatment,\tand\t(3)\ta\tGF\tdiet\tcan\tbe\nexpensive\tand\trestrictive.\tNon-celiac\tgluten-sensitivity\tor\twheat\tsensitivity\tincludes\ta\treaction\n\tto\ngluten\tas\twell\tas\tother\tcomponents\tof\twheat\tsuch\tas\tfructan\t(a\tFODMAP)\t(\nGibson,\t2017b\n).\nAssessment
|
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history\tmay\tindicate\tCD.\tIf\tserology\tis\tpositive,\ta\tbiopsy\tof\tthe\tsmall\tintestine\tis\tthe\tgold\tstandard\nfor\tconfirming\tdiagnosis\tof\tCD.\tAn\tintestinal\tbiopsy\tpositive\tfor\tCD\tgenerally\tshows\tvillous\tatrophy,\nincreased\tintraepithelial\tlymphocytes,\tand\tcrypt\tcell\thyperplasia.\tHowever,\tbiopsy\tis\tnot\tused\tfor
|
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] |
initial\tscreening\tbecause\tof\tits\tcost\tand\tinvasiveness.\nElevated\tblood\tlevels\tof\tcertain\tautoantibodies\n\tare\tfound\tin\tpeople\twith\tCD.\tTo\tscreen\tfor\tCD\nseveral\tserologic\ttests\tare\tevaluated.\tThese\ttests\tevaluate\tlevels\tof\tserum\timmunoglobin\tA\t(IgA)\nantibodies\tto\ttissue\ttransglutaminase\t(tTG\tIgA),\twhich\thas\ta\tsensitivity\tof\t73.9%\tto\t100%\tand
|
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] |
specificity\tof\t77.8%\tto\t100%\t(\nLeonard\tet\tal,\t2017\n).\tThere\tis\ta\thigher\tincidence\tof\tIgA\tdeficiency\tin\npatients\twith\tCD;\tthus\tphysicians\toften\tmeasure\ttotal\tIgA\n\tlevels\twhen\tserologic\tfindings\tare\tnormal,\nbut\tthe\toverall\tclinical\tpicture\tsuggests\tCD\t(see\t\nClinical\tInsight:\n\tAntibody\tTesting\tfor\tCeliac\tDisease\nand\tGluten\tSensitivity
|
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Antibody\tTesting\tfor\tCeliac\tDisease\nand\tGluten\tSensitivity\n).\tBecause\tdietary\tchange\talters\tdiagnostic\tresults,\tinitial\tevaluation\tshould\tbe\ndone\t\nbefore\n\tthe\tperson\thas\teliminated\tgluten-containing\tfoods\tfrom\this\tor\ther\tdiet.\tSerologic\ttests\nalso\tmay\tbe\tused\tto\tmonitor\tthe\tresponse\tof\ta\n\tnewly\tdiagnosed\tpatient\ttreated\twith\ta\tGF\tdiet.
|
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positive\tfor\tHLA\tDQ2,\tbut\tless\tthan\t5%\tof\tthese\tpeople\n\tdevelop\tCD\t(\nMay-Ling\tTjon\tet\tal,\t2010\n).\nCLINICAL\tINSIGHT\nAntibody\tTesting\tfor\tCeliac\tDisease\tand\tGluten\tSensitivity\nThere\tare\ttwo\tdifferent\ttypes\tof\tantibodies\tconsidered\tin\tceliac\tdisease\tdiagnosis:\tthose\twhich
|
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0.07763214409351349,
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] |
are\t“antigluten,”\tand\tthose\twhich\tare\t“antiself”\t(auto-immune).\t“Antigluten”\tantibodies\tare\tthe\nantigliadin\timmunoglobulin\tG\t(IgG)\tand\timmunoglobulin\tA\t(IgA).\tIg\tstands\tfor\t“immunoglobulin”\nor\t“antibody.”\tIn\tceliac\tdisease,\tthe\tautoimmune\tantibodies\tare\tantiendomysial\tIgA\tand\tantitissue\ntransglutaminase\tIgA\t(tTG\tIgA).
|
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] |
transglutaminase\tIgA\t(tTG\tIgA).\nThe\ttTG\tIgA\ttest\tis\thighly\tsensitive\tand\tspecific.\tIt\tcorrelates\twell\twith\tbiopsy,\tis\tinexpensive,\nnot\tsubjective,\tand\tcan\tbe\tperformed\ton\ta\tsingle\tdrop\tof\tblood.\tHowever,\tit\tcan\tbe\tfalsely\tpositive\nin\ta\tpatient\twho\thas\tother\tautoimmune\tconditions,\tsuch\tas\ttype\t1\tdiabetes.\n\tFor\tthose\twith\ta
|
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] |
For\tthose\twith\ta\nnegative\ttTG\tIgA\ttest,\tIgA\tdeficiency\tshould\tbe\tconsidered.\nAntigliadin\tantibodies\tIgG\tand\tIgA\trecognize\ta\tsmall\tpiece\tof\tthe\tgluten\tprotein\tcalled\tgliadin.\nAntigliadin\tIgG\thas\tgood\tsensitivity,\twhile\tantigliadin\tIgA\thas\tgood\tspecificity.\tTheir\tcombined\tuse
|
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] |
provides\ta\tscreening\ttest\tfor\tceliac\tdisease.\tMany\tnormal\tindividuals\twithout\tceliac\tdisease\twill\nhave\tan\televated\tantigliadin\n\tIgG.\tIt\tis\testimated\tthat\t0.2%\tto\t0.4%\tof\tthe\tgeneral\tpopulation\thas\nselective\tIgA\tdeficiency,\twhile\t2%\tto\t3%\tor\tmore\tof\tpeople\twith\tceliac\tdisease\tare\tIgA\tdeficient.
|
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If\ta\tceliac\tpanel\tis\tonly\tpositive\tfor\tantigliadin\tIgG,\tthis\tis\tnot\thighly\tsuggestive\tfor\tceliac\ndisease\tif\tthe\tpatient\thas\ta\tnormal\ttotal\tIgA\tlevel.\tAn\tantigliadin\tIgG\tlevel\tthree\tto\tfour\ttimes\tthe\nupper\tlimit\tof\tnormal\tfor\tthat\n\tlaboratory\tis\thighly\tsuggestive\tof\ta\tcondition\twhere\tthe\tgut\tis
|
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] |
laboratory\tis\thighly\tsuggestive\tof\ta\tcondition\twhere\tthe\tgut\tis\nabnormally\tpermeable\t(“leaky”)\tto\tgluten.\tThis\tcan\thappen\twith\tfood\tallergies,\tcystic\tfibrosis,\nparasitic\tinfections,\tCrohn’s\tdisease,\tand\tother\ttypes\tof\tautoimmune\tgastrointestinal\t(GI)\ndiseases.\tThese\tantibodies\tmay\talso\tbe\tslightly\televated\tin\tindividuals\twith\tno\tobvious\tdisease\n(
|
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] |
(\nKelly\tet\tal,\t2015\n).\nRuth\tLeyse-Wallace,\tPhD,\tRDN\nLifelong,\tstrict\tadherence\tto\ta\tGF\tdiet\tis\tthe\tonly\tknown\ttreatment\tfor\tCD\t(see\t\nBox\t27.7\n\tfor\ta\tlist\nof\tsafe,\tquestionable,\tand\tunsafe\tchoices\ton\tthe\tGF\tdiet).\tThe\tGF\tdiet\tdiminishes\tthe\tautoimmune
|
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process,\tand\tthe\tintestinal\tmucosa\tusually\treverts\tto\tnormal\tor\tnear\tnormal.\tWithin\t2\tto\t8\tweeks\tof\nstarting\tthe\tGF\tdiet,\tmost\tpatients\treport\tthat\ttheir\tclinical\tsymptoms\thave\tabated.\tHistologic,\nimmunologic,\tand\tfunctional\timprovements\tmay\ttake\tmonths\tto\tyears,\tdepending\ton\tthe\tduration\tof
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the\tdisease,\tage\tof\tthe\tsubject,\tand\tdegree\tof\tdietary\tcompliance.\tWith\tstrict\tdietary\tcontrol,\tlevels\nof\tthe\tspecific\tantibodies\tusually\tbecome\tundetectable\twithin\t6\tto\t12\tmonths\tin\tmost\tpersons.\nMarked\tgut\timprovement\tand\ta\treturn\tto\tnormal\thistologic\tfindings\toccurs\tin\tthe\tmajority\tof\npatients\tafter\n\tan\taverage\tof\t2\tyears\t(
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patients\tafter\n\tan\taverage\tof\t2\tyears\t(\nHutchinson\tet\tal,\t2010\n).\tPatients\twho\tare\table\tto\tfollow\tthe\tGF\ndiet\tclosely\thave\ta\tbetter\toverall\tresponse\t(see\t\nPathophysiology\tand\tCare\tManagement\tAlgorithm:\nCeliac\tDisease\n).\nBOX\t27.7\nThe\tBasic\tGluten-Free\tDiet\nFoods\nSafe\tChoices\nAvoid\nGrains\nand\nflours\nAmaranth,\tarrowroot,\tbean\tflours\t(such\tas
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] |
Avoid\nGrains\nand\nflours\nAmaranth,\tarrowroot,\tbean\tflours\t(such\tas\ngarbanzo\tor\tfava\tbean),\tbuckwheat,\ncorn\t(maize)\tor\tcornstarch,\n\tflax,\tJob’s\ntears,\tmillet,\tpotato,\tquinoa,\tragi,\trice,\nand\twild\trice\tsorghum,\tsoybean\t(soya),\ntapioca,\tteff\nWheat\t(bulgur,\tcouscous,\tdurum,\tfarina,\tgraham,\nkamut,\tsemolina,\tspelt,\ttriticale,\temmer,\tfarro,
|
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] |
kamut,\tsemolina,\tspelt,\ttriticale,\temmer,\tfarro,\nwheat\tgerm),\trye,\tbarley,\toats\t(except\tpure,\nuncontaminated\toats),\tlow-gluten\tflour.\nCaution:\t“wheat\tfree”\tdoes\tnot\tnecessarily\nmean\t“gluten\tfree.”\nCereals\n—hot\nor\nCream\tof\trice,\tcream\tof\n\tbuckwheat,\nhominy,\tgluten-free\tdry\tcereals,\tgrits\nThose\twith\twheat,\trye,\toats\t(except\tgluten-free
|
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Those\twith\twheat,\trye,\toats\t(except\tgluten-free\noats),\tbarley,\tbarley\tmalt,\tmalt\tflavoring,\twheat\ngerm,\tbran
|
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0.004565098322927952,
0.03007448837161064,
0.04903257265686989,
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] |
dry\nPotatoes\n,\trice,\nstarc\nh\nAny\tplain\tpotatoes,\tsweet\tpotatoes\tand\nyams,\tall\ttypes\tof\tplain\trice,\trice\nnoodles,\t100%\tbuckwheat\tsoba\tnoodles,\ngluten-free\tpasta,\tpolenta,\thominy,\tcorn\ntortillas,\tparsnips,\tyucca,\tturnips\nBattered\tor\tdeep-fried\n\tFrench\tfries\t(unless\tno\nother\tfoods\thave\tbeen\tfried\tin\tthe\tsame\toil),
|
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] |
other\tfoods\thave\tbeen\tfried\tin\tthe\tsame\toil),\npasta,\tnoodles,\twheat\tstarch,\tstuffing,\tflour\ntortillas,\tcroutons.\tLabels\tfor\tcommercial\npotato\tor\trice\tproducts\twith\tseasonings\tshould\nbe\treviewed.\nCracker\ns,\nchips\n,\npopc\norn\nRice\twafers\tor\tother\tgluten-free\tcrackers,\nrice\tcakes;\tplain\tcorn\tchips,\tcorn\ntortilla\tchips,\tpotato\tchips,\tand\tother
|
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tortilla\tchips,\tpotato\tchips,\tand\tother\nroot\t(taro,\tbeet,\tsweet\tpotato,\n\tor\nvegetable,\tetc.)\tor\tgrain\t(amaranth,\nquinoa)\tchips,\tplain\tpopcorn\nGluten-free\tcrackers,\tgraham\tcrackers,\trye\ncrisps,\tmatzo,\tcroutons,\tpretzels,\tsome\tchips\nwith\tflavorings\nDesserts\nSorbet,\tpopsicles,\tItalian\tice,\tice\tcreams,\npuddings\twithout\tgluten\tingredients
|
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] |
puddings\twithout\tgluten\tingredients\nIce\tcream\twith\tbits\tof\tcookies,\t“crispies,”\npretzels,\tpie\tcrust,\tcookies,\tcakes,\tice\tcream\ncones,\tand\tpastries\tmade\tfrom\tgluten-\ncontaining\n\tflours\nMilk\nand\nyogu\nrt\nAny\tplain,\tunflavored\tmilk\tor\tyogurt,\nbuttermilk,\tcream,\thalf\tand\thalf\nMalted\tmilk,\tyogurts\twith\tadded\t“crunchies”\tor
|
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] |
Malted\tmilk,\tyogurts\twith\tadded\t“crunchies”\tor\ntoppings.\tSome\tflavored\tmilks\tand\tyogurts.\nCheese\nCheese\t(all\tstyles\tincluding\tblue\tcheese\nand\tGorgonzola),\tprocessed\tcheese\t(i.e.,\nAmerican),\tcottage\tcheese\nSome\tcheese\tspreads\tor\tsauces\nEggs\nAll\ttypes\tof\tplain,\tcooked\teggs\nEggs\tBenedict\t(sauce\tusually\n\tmade\twith\twheat\nflour)\nMeat,\nfish,\nshellf\nish,
|
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made\twith\twheat\nflour)\nMeat,\nfish,\nshellf\nish,\npoult\nry\nAny\tfresh,\tplain\tuntreated\tmeat,\tfish,\nshellfish,\tor\tpoultry;\tfish\tcanned\tin\nbrine,\tvegetable\tbroth,\tor\twater\nBreaded\tor\tbattered\tmeats.\tSome\tcommercially\ntreated,\tpreserved,\tor\tmarinated\tmeats,\nluncheon\tmeats,\tfish,\tshellfish;\tself-basting\tor\ncured\tpoultry\t(check\tlabels)\nBeans\nand\nlegu\nmes
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cured\tpoultry\t(check\tlabels)\nBeans\nand\nlegu\nmes\nAny\tplain\tfrozen,\tfresh,\tdried,\tor\tcanned\n(no\tflavorings\n\tor\tsauces\tadded)\tbeans:\ngarbanzo\tbeans,\tkidney\tbeans,\tlentils,\npinto\tbeans,\tedamame,\tlima,\tblack\nbeans,\tetc.\nThose\twith\tadded\tsauces\nSoy\nprod\nucts\nand\nmeat\nanalo\ngs\tor\nalter\nnativ\nes\nPlain\ttempeh,\ttofu,\tedamame,\tsome\tmiso
|
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] |
analo\ngs\tor\nalter\nnativ\nes\nPlain\ttempeh,\ttofu,\tedamame,\tsome\tmiso\nSeitan;\t3-grain\ttempeh,\ttraditional\tsoy\tsauce\n(contains\twheat),\tmany\tmeat\tanalogs\tand\nimitation\tseafood,\tsome\tmiso\nNuts\nand\nseeds\nAny\tplain\t(salted\tor\tunsalted)\tnuts,\tseeds\nor\n\tnut\tbutters,\tcoconut\nNut\tbutters\twith\tgluten-containing\tingredients\nFruits\nand\njuice\ns
|
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] |
Nut\tbutters\twith\tgluten-containing\tingredients\nFruits\nand\njuice\ns\nAny\tplain\tfresh,\tcanned,\tfrozen\tfruits\tor\njuices,\tplain\tdried\tfruit\nDried\tfruit\tdusted\twith\tflour,\tpie\tfilling\tthickened\nwith\tflour\nVegetab\nles\nAny\tplain,\tfresh,\tcanned\tor\tfrozen\nvegetables\tincluding\tcorn,\tpeas,\tlima\nbeans,\tetc.\nVegetables\tin\tgluten-containing\tsauce\tor\tgravy\nSoups
|
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] |
beans,\tetc.\nVegetables\tin\tgluten-containing\tsauce\tor\tgravy\nSoups\nHomemade\tsoups\twith\tknown\n\tallowed\ningredients\nCheck\tlabels\ton\tall\tcommercial\tsoups\nCondim\nents,\njams,\nand\nsyrup\ns\nKetchup,\tmustard,\tsalsa,\twheat-free\tsoy\nsauce,\tmayonnaise,\tvinegar\t(except\nmalt\tvinegar),\tjam,\tjelly,\thoney,\tpure\nmaple\tsyrup,\tmolasses
|
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malt\tvinegar),\tjam,\tjelly,\thoney,\tpure\nmaple\tsyrup,\tmolasses\nMalt\tvinegar,\tsoy\tsauce,\tmany\tgravies\tand\nsauces,\tmarinades,\tsome\tsalad\tdressings\nSeasoni\nngs\nand\nflavo\nrings\nAny\tplain\therb\tor\tspice;\tsalt;\tpepper;\nbrown\tor\twhite\tsugar;\tor\n\tartificial\nsweetener\t(i.e.,\tEqual,\tSweet-N-Low,\nSplenda)\nSeasoning\tmixes\tand\tbouillon\twith\tgluten\ningredients
|
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] |
Splenda)\nSeasoning\tmixes\tand\tbouillon\twith\tgluten\ningredients\nFats\nButter,\tmargarine,\tall\tpure\tvegetable\toils\n(including\tcanola),\tmayonnaise,\tcream\nSome\tsalad\tdressings\tand\tsandwich\tspreads
|
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] |
Baking\ningre\ndient\ns\nYeast,\tbaking\tsoda,\tbaking\tpowder,\tcream\nof\ttartar,\tregular\tchocolate\tbaking\tchips\nSee\tgrains\tand\tflours;\tCheck\tlabel\ton\tgrain\nsweetened,\n\tcarob\tor\tvegan\tchocolate\tchips\nBeverag\nes\nCoffee,\ttea,\tpure\tcocoa\tpowder,\tsodas,\nsome\tsoy\tor\trice\tmilks\nMalted\tbeverages,\tsome\tflavored\tinstant\tcoffee
|
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some\tsoy\tor\trice\tmilks\nMalted\tbeverages,\tsome\tflavored\tinstant\tcoffee\nmixes,\tsome\therbal\tteas,\tsome\tsoy\tor\trice\nmilks\nAlcohol\nWine,\tall\tdistilled\tliquor,\tincluding\tvodka,\ntequila,\tgin,\trum,\twhiskey,\tand\tpure\nliqueurs,\tgluten-free\tbeers,\thard\tciders\nBeer,\tale,\tlager,\tgluten-removed\tbeers,\tsome\ndrink\tmixes\nCandies\nCheck\tlabels—many\tare\tgluten-free
|
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0.031019439920783043,
0.0702562928199768,
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] |
drink\tmixes\nCandies\nCheck\tlabels—many\tare\tgluten-free\nCandy\tfrom\tbulk\tfood\tbins,\tlicorice\nCD\n,\tCeliac\tdisease.\t\nAdapted\tfrom\tParrish\tCR\tet\tal:\t\nUniversity\tof\tVirginia\tHealth\tSystem\tNutrition\tSupport\tTraineeship\nSyllabus\n,\tCharlottesville,\tVa,\t2010,\tUniversity\tof\tVirginia\tHealth\tSystem.
|
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,\tCharlottesville,\tVa,\t2010,\tUniversity\tof\tVirginia\tHealth\tSystem.\nIn\tsome\tindividuals,\trecovery\tmay\tbe\tslow\tor\tincomplete.\tA\tsmall\tpercentage\tof\tpatients\tare\n“nonresponders”\tto\tdiet\ttherapy.\tInadvertent\tgluten\tintake\tis\tthe\tmost\tcommon\toffender,\tbut\tanother
|
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] |
coexisting\tdisorder\tmay\tbe\tpresent\t(such\tas\tpancreatic\tinsufficiency,\tIBS,\tbacterial\tovergrowth,\nfructose\tintolerance,\tother\tfood\tallergies\tor\tGI\tmaladies,\tor\tunknown\tcauses).\tFor\tnonresponders,\nintensive\n\tinterviewing\tto\tidentify\ta\tsource\tof\tgluten\tcontamination\tor\ttreatment\tof\tanother\nunderlying\tdisease\tmay\tresolve\tthe\tsymptoms.\tDiagnosis\tof
|
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] |
underlying\tdisease\tmay\tresolve\tthe\tsymptoms.\tDiagnosis\tof\t\nrefractory\tceliac\tdisease\n\tis\tmade\twhen\npatients\tdo\tnot\trespond\tor\trespond\tonly\ttemporarily\tto\ta\tGF\tdiet,\tand\tall\texternal\tcauses\thave\tbeen\nruled\tout,\tincluding\tinadvertent\tgluten\tingestion.\tPatients\twith\trefractory\tceliac\tdisease\tmay\nrespond\tto\tsteroids,\tazathioprine,
|
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] |
respond\tto\tsteroids,\tazathioprine,\n\tcyclosporine,\tor\tother\tmedications\tclassically\tused\tto\tsuppress\ninflammatory\tor\timmunologic\treactions.\nSeveral\tnovel\ttreatments\tfor\tCD\tare\tbeing\tstudied\tfor\ttheir\tpotential\tas\talternative\ttherapies.\nResearchers\tseek\tto\ttreat\tCD\tby\treducing\tgluten\texposure\t(by\tdigestion\twith\tadded\tenzymes),
|
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] |
decreasing\tuptake\tof\tgluten\t(by\ttightening\tjunctions\tbetween\tintestinal\tepithelial\tcells),\taltering\tthe\nimmune\tresponse\tto\tgluten,\tor\trepairing\tintestinal\tinjury.\nMedical\tnutrition\ttherapy\nElimination\tof\tgluten\tpeptides\tfrom\tthe\tdiet\tis\tthe\tonly\ttreatment\tfor\tCD\tpresently.\tThe\tdiet\tomits\tall
|
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] |
dietary\tforms\tof\twheat,\trye,\tand\tbarley,\twhich\tare\tthe\tmajor\tsources\tof\tthe\tprolamin\tfractions.\nIn\tgeneral,\tpatients\tshould\tbe\tassessed\tfor\tnutrient\tdeficiencies\tbefore\tsupplementation\tis
|
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] |
initiated.\tIn\n\tall\tnewly\tdiagnosed\tpatients,\tthe\tclinician\tshould\tconsider\tchecking\tlevels\tof\tferritin,\nfolate,\tvitamin\tB\n12\n,\tand\t25-OH\tvitamin\tD.\tIf\tpatients\tpresent\twith\tmore\tsevere\tsymptoms,\tsuch\tas\ndiarrhea,\tweight\tloss,\tmalabsorption,\tor\tsigns\tof\tnutrient\tdeficiencies\t(e.g.,\tnight-blindness,
|
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0.08963146060705185,
0.09689608216285706,
0.0702798068523407,
0.000044953641918255016
] |
neuropathy,\tor\tprolonged\tprothrombin\ttime),\tother\tvitamins\tsuch\tas\tfat-soluble\tvitamins\t(A,\tE,\tK)\nand\tminerals\t(zinc)\n\tshould\tbe\tchecked.\nThe\thealing\tof\tthe\tintestinal\tmucosa\tthat\toccurs\tafter\tinitiation\tof\ta\tGF\tdiet\timproves\tnutrient\nabsorption,\tand\tmany\tpatients\twho\teat\twell-balanced\tGF\tdiets\tdo\tnot\tneed\tnutritional
|
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] |
supplementation.\tHowever,\tmost\tspecialty\tGF\tproducts\tare\tnot\tfortified\twith\tiron,\tfolate,\tand\tother\tB\nvitamins\tlike\tother\tgrain\tproducts,\tso\tthe\tdiet\tmay\tnot\tbe\tas\tcomplete\twithout\tat\tleast\tpartial\nsupplementation.\tAnemia\tshould\tbe\ttreated\twith\tiron,\tfolate,\tor\tvitamin\tB\n12\n,\tdepending\ton\tthe\tnature
|
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] |
12\n,\tdepending\ton\tthe\tnature\nof\tthe\tanemia.\tPatients\twith\tmalabsorption\tmay\tbenefit\tfrom\ta\tbone-density\tscan\tto\tassess\tfor\nosteopenia\tor\tosteoporosis.\tCalcium\tand\tvitamin\tD\tsupplementation\tare\tlikely\tto\tbe\tbeneficial\tin\nthese\tpatients.\tElectrolyte\tand\tfluid\treplacement\tis\tessential\tfor\tthose\tdehydrated\tfrom\tsevere\ndiarrhea.
|
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] |
diarrhea.\nThose\twho\tcontinue\tto\thave\tmalabsorption\tshould\ttake\ta\tgeneral\tvitamin-mineral\tsupplement\tto\tat\nleast\tmeet\tDRI\trecommendations.\tLactose\tand\tfructose\tintolerance\tsometimes\toccur\tsecondary\tto\nCD.\tA\tlow-lactose\tor\tlow-fructose\tdiet\tmay\tbe\tuseful\tin\tcontrolling\tsymptoms,\tat\tleast\tinitially.\tOnce
|
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the\tGI\ttract\treturns\tto\tmore\tnormal\tfunction,\tlactase\tactivity\talso\tmay\treturn,\tand\tthe\tperson\tcan\nincorporate\n\tlactose\tand\tdairy\tproducts\tback\tinto\tthe\tdiet.\nIn\tgeneral,\tmany\tfruits,\tvegetables,\tnon–gluten\tcontaining\tgrains,\tmeats,\tand\tdairy\tproducts\tare
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] |
safe\tto\teat\ton\ta\tGF\tdiet.\tOats\twere\tonce\tthought\tto\tbe\tquestionable\tfor\tpersons\twith\tCD;\thowever,\nextensive\tstudies\thave\tshown\tthat\tthey\tare\tsafe\tin\tthe\tGF\tdiet\tas\tlong\tas\tthey\tare\tpure,\nuncontaminated\toats\t(\nPinto-Sanchez\tet\tal,\t2017\n).\tHowever,\ta\tvery\n\tsmall\tpopulation\tof\tpatients\twith
|
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] |
).\tHowever,\ta\tvery\n\tsmall\tpopulation\tof\tpatients\twith\nCD\tmay\tnot\ttolerate\teven\tGF\toats.\tIn\tgeneral,\tpatients\tdo\tnot\tneed\tto\tbe\tadvised\tagainst\tincluding\nGF\toats\tin\ttheir\tdiet\tunless\tthey\thave\tdemonstrated\tintolerance\tto\tGF\toats.\nFlours\tmade\tfrom\tcorn,\tpotatoes,\trice,\tsoybean,\ttapioca,\tarrowroot,\tsorghum,\tgarbanzo\tbeans,
|
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nuts\t(such\tas\talmond\tflour),\tamaranth,\tquinoa,\tmillet,\tteff,\tand\tbuckwheat\tcan\tbe\tsubstituted\n\tin\nrecipes.\tPatients\tcan\texpect\tdifferences\tin\ttextures\tand\tflavors\tof\tcommon\tfoods\tusing\tthe\tsubstitute\nflours,\tand\tnew\trecipes\tcan\tbe\tpalatable\tonce\tthe\tadjustment\tis\tmade.\tBlends\tof\tmore\tthan\tone\ttype
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of\tGF\tflour\toften\tresults\tin\tthe\tbest\trecipe\toutcome.\tIn\tGF\tbaked\tgoods,\tgums\tsuch\tas\txanthan,\tguar,\nand\tcellulose\t(from\tnongluten\tgrains)\tcan\tbe\tused\tto\tprovide\tthe\telasticity\tneeded\tto\ttrap\tleavening\ngases\tin\tbaked\tgoods.\nA\ttruly\tGF\tdiet\trequires\tcareful\tscrutiny\tof\tthe\tlabels\tof\tall\tbakery\tproducts\tand\tpackaged\tfoods.
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Food\nand\tDrug\tAdministration\tand\tHealth\tand\tHuman\tServices,\t2013\n).\tThis\tlaw\tstates\tthat\tall\tfood\ncarrying\ta\tGF\tclaim\talso\tmust\tcontain\tless\tthat\t20\tppm\tgluten\t(i.e.,\tbelow\t20\tmg\tgluten\tper\tkg\tof\nfood),\tincluding\tfrom\tcross-contact.\tThompson\tdiscusses\tthe\tlaw\tin\tdetail\t(\nThompson,\t2015\n).\tRecent\nstudies\ton\tthe\tgluten\tcontent
|
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Thompson,\t2015\n).\tRecent\nstudies\ton\tthe\tgluten\tcontent\n\tof\tlabeled\tGF\tfood\tin\tthe\tUnited\tStates\tshowed\tthat\t95%\tto\t99%\tof\tthe\nproducts\ttested\tcontained\tless\tthan\t20\tppm\tgluten\t(\nSharma\tet\tal,\t2015\n).\nThe\tdiet\tfor\tthe\tperson\twith\tCD\trequires\ta\tmajor\tlifestyle\tchange\tbecause\tof\tthe\tchange\tfrom
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traditional\tgrains\tin\tthe\tdiet.\tA\ttremendous\tnumber\tof\tfoods\tmade\twith\twheat\t(in\tparticular\tbreads,\ncereals,\tpastas,\tand\tbaked\tgoods)\tare\ta\tcommon\tpart\tof\ta\tWestern\n\tdiet.\tHowever,\tthere\tis\tincreasing\nawareness\tamong\tfood\tcompanies\tand\trestaurants\tof\tthe\texpanding\tdemand\tfor\tGF\tfoods,\tand\tfood
|
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] |
businesses\tare\tresponding.\tThe\tindividual\tand\tfamily\tmembers\tshould\tbe\ttaught\tabout\tlabel\treading,\nsafe\tfood\tadditives,\tfood\tpreparation,\tsources\tof\tcross-contamination\t(such\tas\ttoasters,\tcondiment\njars,\tbulk\tbins,\tand\tbuffets),\tand\thidden\tsources\tof\tgluten\t(such\tas\n\tmedications\tand\tcommunion\nwafers)\tto\tbe\tcompliant\twith\tthe\tdiet.\t\nBox\t27.8
|
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] |
wafers)\tto\tbe\tcompliant\twith\tthe\tdiet.\t\nBox\t27.8\n\tprovides\tsources\tof\thidden\tgluten\tand\tcross-\ncontamination.\tEating\tin\tcafeterias,\trestaurants,\tbuffets,\tpot\tlucks,\tstreet\tmarkets,\tat\tfriends’\thomes,\nand\tat\tsocial\tevents\tcan\tbe\tchallenging,\tespecially\tinitially.\nBOX\t27.8\nHidden\tGluten\tExposure\tand\tCross-Contamination\nHidden\tgluten\texposure
|
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Hidden\tGluten\tExposure\tand\tCross-Contamination\nHidden\tgluten\texposure\nUnfortunately,\tgluten\tis\n\tnot\talways\tobvious.\tReview\tthe\tlist\tbelow\tfor\tsome\t“unsuspected”\nproducts\tthat\tmay\tcontain\tgluten.\n•\t\nOver-the-counter\tand\tprescription\tmedications\nThe\tlabeling\trequirements\tof\tthe\tFood\tAllergen\tand\tConsumer\tProtection\tAct\tof\t2004\n(FALCPA)\t\ndo\tnot
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0.06471288204193115,
0.10144782066345215,
0.039858777076005936,
0.01811215467751026
] |
(FALCPA)\t\ndo\tnot\n\tapply\tto\tmedications\t(see\t\nBox\t25.7\n\tin\t\nChapter\t25\n).\tCheck\twith\tyour\npharmacist\tor\tcall\tthe\tmanufacturer\tto\tdetermine\twhether\tthere\tis\tany\tgluten\n\tin\tyour\nmedications.\nNote:\tDietary\tsupplements\tare\tcovered\tunder\tFALCPA\tregulations,\tso\twheat\tmust\tbe
|
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] |
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