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clearly\tlisted\tif\tit\tis\tan\tingredient\tin\ta\tvitamin,\tmineral,\tor\therbal\tsupplement.\n•\t\nCommunion\twafers:\tGF\talternatives\tare\tavailable\n•\t\nToothpaste,\tmouthwash,\tand\tcosmetics,\tespecially\tshampoo\tand\tlipstick\n•\t\nChildren’s\tmodeling\tdough\nCross-contamination\nBelow\tare\tsome\tof\tthe\tmost\tcommon\n\tsources\tof\tgluten\tcontamination.\tA\tfew\tcrumbs\tthat\tmay
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not\teven\tbe\tseen\tcan\tcause\tdamage\tto\tthe\tintestine,\tso\tit\tis\tbest\tto\tavoid\tthese\tsituations:\n•\t\nToasters\tused\tfor\tgluten-containing\tfoods\nKeep\ttwo\ttoasters\tat\thome\tand\tdesignate\tone\tas\tGF.\tAlternatively,\tthere\tare\tnow\tbags\navailable\tthat\tare\tdesigned\tto\thold\ta\tpiece\tof\tbread\tin\tthe\ttoaster.\n•\t\nBulk\tbins.\tPrepackaged\tfood\tis\ta\tsafer\n\tbet.\n•
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•\t\nBulk\tbins.\tPrepackaged\tfood\tis\ta\tsafer\n\tbet.\n•\t\nCondiment\tjars\t(peanut\tbutter,\tjam,\tmayonnaise,\tetc.)\nIt\tis\tbest\tto\tkeep\ta\tseparate\tGF\tjar\tfor\tcommonly\tused\titems\tand\tbe\tsure\tto\tlabel\tit\nclearly.\tAt\tthe\tvery\tleast,\tmake\tsure\teveryone\tin\tthe\thouse\tknows\tnot\tto\t“double-dip.”\n•\t\nBuffet\tlines
|
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•\t\nBuffet\tlines\nOther\tcustomers\tmay\tuse\tone\tserving\tutensil\tfor\tmultiple\titems.\tFood\tfrom\tone\tarea\tmay\nbe\tspilled\tinto\tanother\tfood\tcontainer.\tIt\tmay\tbe\n\tsafer\tto\torder\tfrom\tthe\tmenu.\n•\t\nDeep-fried\tfoods\nOil\tis\ttypically\tused\tover\tand\tover\tto\tfry\tfoods.\tIt\tis\thighly\tlikely\tthat\tFrench\tfries\t(or
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other\tGF\tfoods)\tare\tfried\tin\tthe\tsame\toil\tas\tbattered\tand\tbreaded\tfoods\tsuch\tas\tfried\nchicken.\n•\t\nStrainers/colanders\nColanders\tused\tto\tdrain\tgluten-containing\tpasta\tmay\thold\tonto\tresidual\tgluten\tproteins,\nas\tthey\tare\tvery\tdifficult\tto\tthoroughly\n\tclean.\nGF\n,\tGluten\tfree.\t\nAdapted\tfrom\tParrish\tCR\tet\tal:
|
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] |
clean.\nGF\n,\tGluten\tfree.\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.\nTo\tavoid\tmisinterpretation\tof\tinformation,\tnewly\tdiagnosed\tpatients\tshould\tbe\tstarted\twith\tan\tin-
|
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] |
depth\tinstruction\tfrom\ta\tregistered\tdietitian\tnutritionist\t(RDN)\ton\tthe\tGF\tdiet,\talong\n\twith\treliable\nresources\tfor\tfurther\tguidance\tand\tsupport.\tPersons\twith\tCD\tusually\trequire\tseveral\teducational\tor\ncounseling\tsessions\tand\toften\tbenefit\tfrom\ta\tsupport\tgroup\t(American\tGastroenterological\nAssociation\t[AGA],\t2015)\t(see\t\nBox\t27.9\n\tfor\tCD\tresources).
|
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] |
Association\t[AGA],\t2015)\t(see\t\nBox\t27.9\n\tfor\tCD\tresources).\nBOX\t27.9\nCeliac\tDisease\tResources\nSupport\tGroups\nGluten\tIntolerance\tGroup\nPhone:\t206-246-6652\nEmail:\t\[email protected]\nWebsite:\t\nhttps://www.gluten.org\nMedical\tCenters\nBeth\tIsrael\tDeaconess\tCeliac\tCenter\nBoston,\tMassachusetts\nhttps://www.bidmc.org/centers-and-departments/digestive-disease-
|
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https://www.bidmc.org/centers-and-departments/digestive-disease-\ncenter/services-and-programs/celiac-center\nUniversity\tof\tMaryland\tCenter\tfor\tCeliac\nResearch\nBaltimore,\tMaryland\nhttps://www.massgeneral.org/children/services/treatmentprograms\n.aspx?id=1723\nCeliac\tDisease\tCenter\tat\nColumbia\n\tUniversity\nNew\tYork,\tNew\tYork\nwww.celiacdiseasecenter.c
|
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] |
Columbia\n\tUniversity\nNew\tYork,\tNew\tYork\nwww.celiacdiseasecenter.c\nolumbia.edu\nUniversity\tof\tChicago\nCeliac\nDisease\tProgram\nChicago,\tIllinois\nhttp://www.cureceliacdise\nase.org\nOther\tCeliac\tOrganizations/Resources\nBeyond\tCeliac\nwww.beyondceliac.org\nGluten-Free\tRestaurant\tAwareness\tProgram\nwww.glutenfreerestaurants.org\nCeliac\tDisease\tFoundation
|
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www.glutenfreerestaurants.org\nCeliac\tDisease\tFoundation\nwww.celiac.org\nCeliac\tDisease\tand\tGluten-\nfree\tSupport\n\tCenter\nwww.celiac.com\nCanadian\tCeliac\nAssociation\nwww.celiac.ca\nNational\tCeliac\tAssociation\nwww.nationalceliac.org\nTropical\tsprue\nTropical\tsprue\n\tis\tan\tacquired\tdiarrheal\tsyndrome\twith\tmalabsorption\tthat\toccurs\tin\tmany\ttropical
|
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] |
areas.\tIn\taddition\tto\tdiarrhea\tand\tmalabsorption,\tanorexia,\tabdominal\tdistention,\tand\tnutritional\ndeficiency\tas\tevidenced\tby\tnight\tblindness,\tglossitis,\n\tstomatitis,\tcheilosis,\tpallor,\tand\tedema\tcan\noccur.\tAnemia\tmay\tresult\tfrom\tiron,\tfolic\tacid,\tand\tvitamin\tB\n12\n\tdeficiencies.\nPathophysiology
|
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] |
Identified\tintestinal\torganisms\tmay\tdiffer\nfrom\tone\tregion\tof\tthe\ttropics\tto\tthe\tnext.\tAs\tin\tCD,\tthe\tintestinal\tvilli\tmay\tbe\tabnormal,\tbut\tthe\nsurface\tcell\talterations\tare\tmuch\tless\tsevere.\tThe\tgastric\tmucosa\tis\tatrophied\tand\tinflamed,\twith\ndiminished\tsecretion\tof\thydrochloric\tacid\tand\tintrinsic\tfactor\t(\nLangenberg\tet\tal,\t2014\n).
|
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] |
Langenberg\tet\tal,\t2014\n).\nMedical\ttreatment\nTreatment\tof\ttropical\tsprue\ttypically\tincludes\n\tuse\tof\tbroad-spectrum\tantibiotics,\tfolate,\tvitamin\tB\n12\n,\nfluid,\tand\telectrolytes.\nMedical\tnutrition\ttherapy\nNutrition\tmanagement\tincludes\trestoration\tand\tmaintenance\tof\tfluids,\telectrolytes,\tmacronutrients,
|
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] |
and\tmicronutrients,\tand\tintroduction\tof\ta\tdiet\tthat\tis\tappropriate\tfor\tthe\textent\tof\tmalabsorption\n(see\t\nDiarrhea\n\tearlier\tin\tthis\tchapter).\tAlong\twith\tother\tnutrients,\tB\n12\n\tand\tfolate\tsupplementation\nmay\tbe\tneeded\tif\tdeficiency\tis\tidentified.\tNutritional\tdeficiency\tincreases\tsusceptibility\tto\tinfectious\nagents,\tfurther\taggravating\tthe\tcondition.
|
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agents,\tfurther\taggravating\tthe\tcondition.\nIntestinal\tbrush-border\tenzyme\tdeficiencies\nIntestinal\tenzyme\tdeficiency\tstates\tinvolve\tdeficiencies\tof\tthe\tbrush-border\tdisaccharidases\tthat\nhydrolyze\tdisaccharides\tat\tthe\tmucosal\tcell\tmembrane.\tDisaccharidase\tdeficiencies\tmay\toccur\tas\t(1)\nrare
|
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rare\n\tcongenital\tdefects\tsuch\tas\tthe\tsucrase,\tisomaltase,\tor\tlactase\tdeficiencies\tseen\tin\tthe\tnewborn;\n(2)\tgeneralized\tforms\tsecondary\tto\tdiseases\tthat\tdamage\tthe\tintestinal\tepithelium\t(e.g.,\tCrohn’s\ndisease\tor\tCD);\tor,\tmost\tcommonly,\t(3)\ta\tgenetically\tacquired\tform\t(e.g.,\tlactase\tdeficiency)\tthat
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] |
usually\tappears\tafter\tchildhood\tbut\tcan\tappear\tas\tearly\tas\t2\tyears\tof\tage.\tFor\tthis\tchapter,\tonly\nlactose\n\tmalabsorption\tis\tdescribed\tin\tdetail\t(see\t\nChapter\t42\n\tfor\ta\tdiscussion\tof\tinborn\tmetabolic\ndisorders).\nLactose\tintolerance\nLactose\tintolerance\n\tis\tthe\tsyndrome\tof\tdiarrhea,\tabdominal\tpain,\tflatulence,\tor\tbloating\toccurring
|
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] |
after\tlactose\tconsumption.\tSecondary\tlactose\tintolerance\tcan\tdevelop\tas\ta\tconsequence\tof\tinfection\nof\tthe\tsmall\tintestine,\tgastrointestinal\tsurgeries,\tinflammatory\tdisorders,\n\tHIV,\tor\tmalnutrition.\tIn\nchildren\tit\tis\ttypically\tsecondary\tto\tviral\tor\tbacterial\tinfections.\tLactose\tmalabsorption\tis\tcommonly
|
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associated\twith\tother\tGI\tdisorders,\tsuch\tas\tIBS.\nEtiology\nHigh\tconcentrations\tof\tthe\tbrush-border\tenzyme,\tlactase,\tis\tpresent\tin\tthe\tsmall\tbowel\tof\tall\nnewborn\tmammals.\tAfter\tweaning,\tabout\t75%\tof\tthe\tworld’s\tpopulation\tdramatically\tdecreases\tthe\nsynthesis\tof\tthis\n\tenzyme\tdespite\tcontinued\texposure\tto\tlactose\t(\nLevitt\tet\tal,\t2013
|
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] |
enzyme\tdespite\tcontinued\texposure\tto\tlactose\t(\nLevitt\tet\tal,\t2013\n).\tThese\tpeople\tare\ntermed\tto\tbe\tlactase\tnonpersistent.\tThe\tmajority\tof\tadults\tof\tAsian,\tAfrican,\tLatino,\tand\tNative\nAmerican\tdescent\tare\tlactase\tnonpersistent,\twhereas\tthe\tmajority\tof\tCaucasians\tare\tlactase
|
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] |
persistent.\tLactose\tmalabsorption\tor\tintolerance\thas\tbeen\treported\tto\tbe\tlow\tin\tchildren\tyounger\nthan\tage\t6\tbut\tincreases\tthroughout\n\tchildhood,\tpeaking\tat\tage\t10\tto\t16\tyears.\nWhile\tevidence\tindicates\tthat\tlactose\tintolerance\tincreases\tslightly\twith\tincreasing\tadult\tage\tor
|
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varies\tby\trace\tor\tgender,\tthe\tdifference\tmay\tbe\tmore\tclosely\taligned\twith\ta\tdose\tspecific\teffect,\tbody\nsize,\tand\tgenetic\tdifferences\tversus\tlactose\tintolerance\t(\nLapides\tand\tSavaiano,\t2018\n).\tHowever,\teven\nin\tadults\twho\tretain\ta\thigh\tlevel\tof\tlactase\tlevels\n\twith\tage\t(75%\tto\t85%\tof\twhite\tadults\tof\tWestern
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0.02453821897506714,
0.06827033311128616,
0.0696093738079071,
0.07339631021022797,
-0.04783130809664726
] |
with\tage\t(75%\tto\t85%\tof\twhite\tadults\tof\tWestern\nEuropean\theritage),\tthe\tquantity\tof\tlactase\tis\tabout\thalf\tthat\tof\tother\tsaccharidases\tsuch\tas\tsucrase,\nalpha-dextrinase,\tor\tglucoamylase.\tThe\tdecline\tof\tlactase\tis\tknown\tas\t\nhypolactasia\n\t(see\t\nFocus\tOn:\nLactose\tIntolerance:\tNOT\tan\tUncommon\tAnomaly).\n\t\nFocus\tOn\nLactose\tIntolerance:
|
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] |
Focus\tOn\nLactose\tIntolerance:\n\tNOT\tan\tUncommon\tAnomaly\nWhen\tlactose\tintolerance\twas\tfirst\tdescribed\tin\t1963,\tit\tappeared\tto\tbe\tan\tinfrequent\toccurrence,\narising\tonly\toccasionally\tin\tthe\twhite\tpopulation.\tBecause\tthe\tcapacity\tto\tdigest\tlactose\twas\nmeasured\tin\tpeople\tfrom\ta\twide\tvariety\tof\tethnic\tand\tracial\tbackgrounds,\tit\tsoon\tbecame
|
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apparent\tthat\tdisappearance\tof\tthe\tlactase\tenzyme\tshortly\tafter\tweaning,\tor\tat\tleast\tduring\n\tearly\nchildhood,\twas\tactually\tthe\tpredominant\t(normal)\tcondition\tin\tmost\tof\tthe\tworld’s\tpopulation.\nWith\ta\tfew\texceptions,\tthe\tintestinal\ttracts\tof\tadult\tmammals\tproduce\tlittle,\tif\tany,\tlactase\tafter
|
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weaning\t(the\tmilks\tof\tpinnipeds—seals,\twalruses,\tand\tsea\tlions—do\tnot\tcontain\tlactose).\nThe\texception\tof\tlactose\ttolerance\thas\tattracted\tthe\tinterest\tof\tgeographers\tand\tothers\nconcerned\twith\tthe\n\tevolution\tof\tthe\tworld’s\tpopulation.\tA\tgenetic\tmutation\tfavoring\tlactose
|
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tolerance\tappears\tto\thave\tarisen\tapproximately\t10,000\tyears\tago,\twhen\tdairy\tfarming\twas\tfirst\nintroduced.\tPresumably,\tit\twould\thave\toccurred\tin\tplaces\twhere\tmilk\tconsumption\twas\nencouraged\tbecause\tof\tsome\tdegree\tof\tdietary\tdeprivation\tand\tin\tgroups\tin\twhich\tmilk\twas\tnot\nfermented\tbefore\tconsumption\t(fermentation\tbreaks\tdown\tmuch
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] |
fermented\tbefore\tconsumption\t(fermentation\tbreaks\tdown\tmuch\n\tof\tthe\tlactose\tinto\nmonosaccharides).\tThe\tmutation\twould\thave\tselectively\tendured,\tbecause\tit\twould\tpromote\ngreater\thealth,\tsurvival,\tand\treproduction\tof\tthose\twho\tcarried\tthe\tgene.\nIt\tis\tproposed\tthat\tthe\tmutation\toccurred\tin\tmore\tthan\tone\tlocation\tand\tthen\taccompanied
|
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] |
migrations\tof\tpopulations\tthroughout\tthe\tworld.\tIt\tcontinues\tprimarily\tamong\twhites\tfrom\nnorthern\tEurope\tand\tin\tethnic\tgroups\n\tin\tIndia,\tAfrica,\tand\tMongolia.\tThe\thighest\tfrequency\t(97%)
|
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D\tproduced\tby\tskin\texposure\tto\tsunlight.\nDairy\n\tfarming\twas\tunknown\tin\tNorth\tAmerica\tuntil\tthe\tarrival\tof\tEuropeans,\tbut\tthe\tnative\npeoples\tof\tNorth\tAmerica\tdid\thave\ta\tsource\tof\tdairy\tin\ttheir\tdiets.\tThus\tNative\tAmericans\tand\nthose\tof\tnon-European\tdescent\tare\tamong\tthe\t65%\tof\tthe\tworld’s\tpopulation\twho\ttolerate\tmilk\npoorly,\tif\tat\tall\t(
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poorly,\tif\tat\tall\t(\nSilberman\tand\tJin,\t2019\n).\tThis\thas\tpractical\timplications\twith\trespect\tto\tgroup\nfeeding\tprograms\tsuch\tas\tschool\n\tbreakfasts\tand\tlunches.\tHowever,\tmany\tlactose-intolerant\npeople\tare\table\tto\tdigest\tmilk\tin\tsmall\tto\tmoderate\tamounts\t(\nShaukat\tet\tal,\t2010\n).\nPathophysiology
|
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] |
Shaukat\tet\tal,\t2010\n).\nPathophysiology\nWhen\tlarge\tamounts\tof\tlactose\tare\tconsumed,\tespecially\tby\tpersons\twho\thave\tlittle\tremaining\nlactase\tenzyme\tor\twith\tconcurrent\tGI\tproblems,\tloose\tstools\tor\tdiarrhea\tcan\toccur.\tAs\tis\tthe\tcase\nwith\tany\tmalabsorbed\tsugar,\tlactose\tmay\tact\n\tosmotically\tand\tincrease\tfecal\twater,\tas\twell\tas\tprovide
|
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] |
osmotically\tand\tincrease\tfecal\twater,\tas\twell\tas\tprovide\na\tsubstrate\tfor\trapid\tfermentation\tby\tintestinal\tbacteria,\twhich\tmay\tresult\tin\tbloating,\tflatulence,\nand\tcramps.\tMalabsorption\tof\tlactose\tis\tdue\tto\ta\tdeficiency\tof\tlactase,\tthe\tenzyme\tthat\tdigests\tthe
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sugar\tin\tmilk.\tLactose\tthat\tis\tnot\thydrolyzed\tinto\tgalactose\tand\tglucose\tin\tthe\tupper\tsmall\tintestine\npasses\tinto\tthe\tcolon,\twhere\tbacteria\n\tferment\tit\tto\tSCFAs,\tcarbon\tdioxide,\tand\thydrogen\tgas.\nMedical\ttreatment\nLactose\tmalabsorption\tis\tdiagnosed\tby\t(1)\tan\tabnormal\thydrogen\tbreath\ttest\tor\t(2)\tan\tabnormal
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] |
lactose\ttolerance\ttest.\tDuring\ta\thydrogen\tbreath\ttest,\tthe\tpatient\tis\tgiven\ta\tstandard\tdose\tof\tlactose\nafter\tfasting,\tand\tbreath\thydrogen\tis\tmeasured.\tIf\tlactose\tis\tnot\tdigested\tin\tthe\tsmall\tintestine,\tit\npasses\tinto\tthe\tcolon,\n\twhere\tit\tis\tfermented\tby\tthe\tgut\tmicrobiota\tto\tSCFAs,\tCO\n2\n,\tand\thydrogen.
|
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] |
2\n,\tand\thydrogen.\nHydrogen\tis\tabsorbed\tinto\tthe\tbloodstream\tand\tis\texhaled\tthrough\tthe\tlungs.\tThe\tbreath\thydrogen\ntest\tshows\tincreased\tlevels\t60\tto\t90\tminutes\tafter\tlactose\tingestion.\nDuring\ta\tlactose\ttolerance\ttest,\ta\tdose\tof\tlactose\tis\tgiven,\tand\tif\tthe\tindividual\thas\tsufficient\nlactase\tenzyme,\tblood\tsugar\trises,\treflecting\tthe\tdigestion
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lactase\tenzyme,\tblood\tsugar\trises,\treflecting\tthe\tdigestion\n\tof\tlactose\tto\tgalactose\tand\tglucose.\tIf\tthe\nindividual\tis\tlactose\tintolerant\t(lactase\tdeficient),\tblood\tsugar\twill\tnot\trise\tbecause\tthe\tlactose\tis\tnot\nabsorbed;\tit\tpasses\tinto\tthe\tcolon\tand\tGI\tsymptoms\tmay\tappear.\tThe\tlactose\ttolerance\ttest\twas
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0.06675858050584793,
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0.08381606638431549,
0.029822492972016335,
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0.06056549400091171,
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0.0030516290571540594,
-0.024748899042606354,
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0.07524258643388748,
0.02787717990577221,
0.00019338171114213765,
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0.11833789199590683,
0.09625296294689178,
0.12800240516662598,
-0.08239427953958511
] |
based\toriginally\ton\tan\toral\tdose\tof\tlactose\tequivalent\tto\tthe\tamount\tin\t1\tquart\tof\tmilk\t(50\tg).\nRecently\tdoses\tlower\tthan\t50\tg\tof\tlactose\thave\tbeen\tused\n\tto\tapproximate\tmore\tclosely\tthe\tusual\nconsumption\tof\tlactose\tfrom\tmilk\tproducts.\nDemonstrated\tlactose\tmalabsorption\tdoes\tnot\talways\tindicate\ta\tperson\twill\tbe\tsymptomatic.\tMany
|
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] |
factors\tplay\ta\trole,\tincluding\tthe\tamount\tof\tlactose\tingested,\tthe\tresidual\tlactase\tactivity,\tthe\ningestion\tof\tfood\tin\taddition\tto\tlactose,\tthe\tability\tof\tthe\tgut\tmicrobiota\tto\tferment\tlactose,\tand\tthe\nsensitivity\tof\tthe\n\tindividual\tto\tthe\tlactose\tfermentation\tproducts\t(\nMisselwitz\tet\tal,\t2013\n).
|
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] |
Misselwitz\tet\tal,\t2013\n).\nConsumption\tof\tsmall\tamounts\tshould\tbe\tof\tlittle\tconsequence\tbecause\tthe\tSCFAs\tare\treadily\nabsorbed\tand\tthe\tgases\tcan\tbe\tabsorbed\tor\tpassed.\tLarger\tamounts,\tusually\tgreater\tthan\t12\tg/day,\nconsumed\tin\ta\tsingle\tfood\t(the\tamount\ttypically\tfound\tin\ta\tcup\tor\t240\tmL\tof\tmilk)\tmay\tresult\tin\tmore\nsubstrate\tentering\tthe\tcolon\tthan
|
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] |
substrate\tentering\tthe\tcolon\tthan\n\tcan\tbe\tdisposed\tof\tby\tnormal\tprocesses.\tBecause\tserving\tsizes\tof\nmilk\tdrinks\tare\tincreasing\tand\tmore\tthan\tone\tsource\tof\tlactose\tmay\tbe\tconsumed\tin\tthe\tsame\tmeal,\nthe\tamounts\tof\tlactose\tconsumed\tmay\tbe\tmore\timportant\tthan\tin\tyears\tpast\t(\nMisselwitz\tet\tal,\t2013\n).\nMedical\tnutrition\ttherapy
|
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] |
Misselwitz\tet\tal,\t2013\n).\nMedical\tnutrition\ttherapy\nManagement\tof\tlactose\tintolerance\trequires\tdietary\tchange.\tThe\tsymptoms\tare\talleviated\tby\nreduced\tconsumption\n\tof\tlactose-containing\tfoods\t(see\t\nTable\t27.3\n\tfor\tcommon\tfoods\tcontaining\nlactose).\tThose\twho\tavoid\tdairy\tproducts\tmay\tneed\tcalcium\tand\tvitamin\tD\tsupplementation\tunless
|
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they\tare\tdiligent\tabout\tincluding\tnondairy\tsources\tof\tthese\tnutrients.\tA\tcompletely\tlactose-free\tdiet\nis\tnot\tnecessary\tin\tlactase-deficient\tpersons.\tMost\tlactose\tmaldigesters\tcan\tconsume\tsome\tlactose\n(up\tto\t12\tg/day)\twithout\tmajor\n\tsymptoms,\tespecially\twhen\ttaken\twith\tmeals\tor\tin\tthe\tform\tof\tcheeses\nor\tfermented\tdairy\tproducts\t(
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or\tfermented\tdairy\tproducts\t(\nMisselwitz\tet\tal,\t2013\n).
|
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] |
TABLE\t27.3\nLactose\tContent\tof\tCommon\tFoods\nProduct\nServing\nSize\nApproximate\tLactose\tContent\n(grams)\nMilk\t(nonfat,\t1%,\t2%,\twhole),\tchocolate\tmilk,\tacidophilus\nmilk,\tbuttermilk\n1\tcup\n10-12\nButter,\tmargarine\n1\ttsp\ntrace\nCheese\n1\tounce\n0-2\nCheddar,\tsharp\n1\tounce\n0\nAmerican,\tSwiss,\tParmesan\n1\tounce\n1\nBleu\tcheese\n1\tounce\n2\nCottage\tcheese\n½\tcup\n2-3
|
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] |
1\tounce\n1\nBleu\tcheese\n1\tounce\n2\nCottage\tcheese\n½\tcup\n2-3\nCream\t(heavy),\twhipped\tcream\n½\tcup\n3-4\nCream\tcheese\n1\tounce\n1\nEvaporated\tmilk\n1\tcup\n24\nHalf-and-half\n½\tcup\n5\nIce\tcream\n½\tcup\n6\nIce\tmilk\n½\tcup\n9\nNonfat\tdry\tmilk\tpowder\t(unreconstituted)\n1\tcup\n62\nSherbet,\torange\n½\tcup\n2\nSour\tcream\n½\tcup\n4\nSweetened\tcondensed\tmilk,\tundiluted\n1\tcup\n40\nYogurt,
|
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] |
½\tcup\n4\nSweetened\tcondensed\tmilk,\tundiluted\n1\tcup\n40\nYogurt,\n\tcultured,\tlow-fat\n*\n1\tcup\n5-10\n*\nNote:\tAlthough\tmost\tyogurt\tdoes\tcontain\tlactose,\tyogurt\twith\tlive\tcultures\tis\tgenerally\twell\ttolerated\tby\tthose\twith\tlactose\tintolerance.\nMany\tadults\twith\tintolerance\tto\tmoderate\tamounts\tof\tmilk\teventually\tadapt\tto\tand\ttolerate\t12\tg\tor
|
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] |
more\tof\tlactose\tin\tmilk\t(equivalent\tto\tone\tcup\tof\tfull-lactose\tmilk)\twhen\tintroduced\tgradually,\tin\nincrements,\tover\tseveral\n\tweeks.\tIncremental\tor\tcontinuous\texposure\tto\tincreasing\tquantities\tof\nfermentable\tsugar\tcan\tlead\tto\timproved\ttolerance,\tnot\tas\ta\tconsequence\tof\tincreased\tlactase
|
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] |
enzyme\tproduction\tbut\tby\taltered\tgut\tmicrobiota\tcomposition.\tThis\thas\tbeen\tshown\twith\tlactulose,\ta\nnonabsorbed\tcarbohydrate\tthat\tis\tbiochemically\tsimilar\tto\tlactose\t(\nLomer,\t2015\n).\tIndividual\ndifferences\tin\ttolerance\tmay\trelate\tto\tthe\n\tstate\tof\tcolonic\tadaptation.\tRegular\tconsumption\tof\tmilk
|
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state\tof\tcolonic\tadaptation.\tRegular\tconsumption\tof\tmilk\nby\tlactase-deficient\tindividuals\tmay\tincrease\tthe\tthreshold\tat\twhich\tdiarrhea\toccurs.\nLactase\tenzyme\tin\ttablets\tor\tliquid\tor\tin\tmilk\tproducts\ttreated\twith\tlactase\tenzyme\t(e.g.,\tLactaid)\nare\tavailable\tfor\tlactose\tmaldigesters\twho\thave\tdiscomfort\twith\tmilk\tingestion.\tCommercial\tlactase
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preparations\tmay\tdiffer\tin\ttheir\teffectiveness.\tFermented\n\tmilk\tproducts,\tsuch\tas\taged\tcheeses\tand\nyogurts,\tare\twell\ttolerated\tbecause\ttheir\tlactose\tcontent\tis\tlow.\tTolerance\tof\tyogurt\tmay\tbe\tthe\nresult\tof\ta\tmicrobial\tgalactosidase\tin\tthe\tbacterial\tculture\tthat\tfacilitates\tlactose\tdigestion\tin\tthe
|
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] |
intestine.\tThe\tpresence\tof\tgalactosidase\tdepends\ton\tthe\tbrand\tand\tprocessing\tmethod.\tBecause\tthis\nmicrobial\tenzyme\tis\tsensitive\tto\tfreezing,\tfrozen\tyogurt\n\tmay\tnot\tbe\tas\twell\ttolerated.\tAlthough\tthe\naddition\tof\tprobiotics\tmay\tchange\tthis,\tevidence\tis\tlacking\t(\nMorelli,\t2014\n).\tLactose-free\tor\treduced
|
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] |
Morelli,\t2014\n).\tLactose-free\tor\treduced\nlactose\tenteral\tnutrition\tformulas\tare\twidely\tavailable\tfor\thospitalized\tand\tlong-term\tfeeding\ttube\npatients\t(see\t\nChapter\t12\n\tand\t\nAppendix\t16\n).\nFructose\tmalabsorption\nDietary\tfructose\texists\tin\tthree\tforms:\t(1)\tthe\tmonosaccharide,\t(2)\tsucrose,\ta\tdisaccharide\n\tof
|
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of\nfructose\tand\tglucose,\tand\t(3)\tin\tchains\tas\tfructans.\tConsumption\tof\tfructose\tin\tthe\tUnited\tStates,\nespecially\tfrom\tfruit\tjuices,\tfruit\tdrinks,\tand\thigh-fructose\tcorn\tsyrup\t(HFCS)\tin\tsoft\tdrinks\tand\nconfections,\thas\tincreased\tsignificantly\tin\trecent\tyears.\tThe\thuman\tsmall\tintestine\thas\ta\tlimited
|
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ability\tto\tabsorb\tfructose,\tcompared\twith\tthe\tability\tto\tabsorb\tglucose\trapidly\tand\tcompletely.\nEtiology\nAlthough\t\nfructose\tmalabsorption\n\tis\tcommon\tin\thealthy\tpeople,\tits\tappearance\tdepends\ton\tthe\namount\tof\tfructose\tingested.\tAbsorption\tof\tfructose\tis\timproved\twhen\tit\tis\tingested\twith\tglucose
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incompletely\tabsorb\ta\nlarge\tquantity\tof\tfructose\t(50\tg)\ttaken\talone\t(Putkonen\tet\tal,\t2013).\nFructose\tcoexists\tin\tfood\twith\tother\tpoorly\tabsorbed\tcarbohydrates,\twhich\thave\tbeen\tgiven\tthe
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] |
umbrella\tterm\tFODMAPs.\tIn\tone\trecent\tstudy,\trestricting\tFODMAPs\tin\tthe\tdiet\tdemonstrated\tglobal\nsymptom\trelief\tin\tthose\twith\tfructose\tor\tlactose\tintolerance,\twith\tthe\tbenefit\tindicating\tpossible\nrelationship\tto\n\tchanges\tin\tintestinal\thost\tor\tmicrobiome\tmetabolism\t(\nWilder-Smith\tet\tal,\t2017\n).\nMedical\tnutrition\ttherapy
|
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] |
Wilder-Smith\tet\tal,\t2017\n).\nMedical\tnutrition\ttherapy\nPeople\twith\tfructose\tmalabsorption\tand\tthose\tpatients\twith\tGI\tconditions\tthat\texperience\tsymptoms\nof\tfructose\tmalabsorption\tmay\tnot\thave\tproblems\twith\tfoods\tcontaining\tbalanced\tamounts\tof\tglucose\nand\tfructose\tbut\tmay\tneed\tto\tlimit\tor\tavoid\tfoods\tcontaining\tlarge\tamounts\tof\tfree\tfructose.\n\tPear,
|
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] |
opposed\tto\tsucrose)\tare\talso\tmore\tlikely\tto\tcause\tsymptoms.\tThe\tdegree\tof\tfructose\tintolerance\tand\ntolerance\tto\tthe\tsymptoms\tof\tfructose\tmalabsorption\tare\tso\tvariable\tthat\tintake\tof\tthese\tfoods\tmust\ngenerally\tbe\tindividualized\twith\teach\tpatient\t(see\t\nTable\t27.7\n\tfor\ta\tlist\tof\tfoods\thigh\tin\tfructose\ncontent).\nInflammatory\tbowel\tdisease
|
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] |
content).\nInflammatory\tbowel\tdisease\nInflammatory\tbowel\tdisease\t(IBD)\n\tis\ta\tchronic\tand\trelapsing\tdisorder\tof\tthe\tgastrointestinal\ntract.\tIt\tis\tcharacterized\tby\tchronic\tintestinal\tinflammation\n\tand\tis\tcategorized\tinto\ttwo\tmajor\tforms\nas\teither\t\nCrohn’s\tdisease\n\tor\t\nulcerative\tcolitis\t(UC)\n.\tCrohn’s\tdisease\tand\tUC\tare\trelatively\trare
|
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] |
ulcerative\tcolitis\t(UC)\n.\tCrohn’s\tdisease\tand\tUC\tare\trelatively\trare\ndisorders,\tbut\tthey\tresult\tin\tfrequent\tuse\tof\thealth\tcare\tresources.\tThe\tprevalence\tand\tincidence\tis\nincreasing\tas\tIBD\temerges\tas\ta\tglobal\tdisease,\tthough\tit\tremains\tmost\tprominent\tin\tindustrialized\nnations\t(\nLewis\tet\tal,\t2017\n).\tIt\tis\talso\tbecoming\tmore\tprevalent
|
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] |
nations\t(\nLewis\tet\tal,\t2017\n).\tIt\tis\talso\tbecoming\tmore\tprevalent\n\tin\tolder\tadults\t(\nYe\tet\tal,\t2015\n).\nContrary\tto\tolder\tdata\tused\tin\testimates\tfrom\t1999,\tin\t2015\tthe\tCDC\tfound\tthat\t3.1\tmillion\t(1.3%)\nof\tadults\tin\tthe\tUnited\tStates\thad\tever\tbeen\tgiven\ta\tdiagnosis\tof\tIBD.\tOf\tthese,\tthere\twere\ta\thigher
|
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] |
percentage\tof\tindividuals\tat\tages\t45\tto\t64\t(1.5%)\tand\t≥65\t(1.7%)\tcompared\twith\tyounger\tage\ngroups.\tHispanics\tand\tnon-Hispanic\twhites\thad\ta\thigher\tprevalence\tthan\n\tnon-Hispanic\tblacks.\tLevel\nof\teducation,\temployment,\tand\tsocioeconomic\tstatus\twere\talso\tcorrelated\twith\tthose\twho\thad\nreceived\tan\tIBD\tdiagnosis\t(\nDahlhamer\tet\tal,\t2016\n).
|
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] |
received\tan\tIBD\tdiagnosis\t(\nDahlhamer\tet\tal,\t2016\n).\nWhile\tthe\tonset\tof\tIBD\toccurs\tmost\toften\tin\tpatients\t15\tto\t30\tyears\tof\tage,\tfor\tsome\tit\toccurs\tlater\nin\tadulthood.\tIBD\toccurs\tmore\tcommonly\tin\tdeveloped\tareas\tof\tthe\tworld,\tbut\tin\tthe\tUnited\tStates\tit\nis\tmore\tprevalent\tin\tthose
|
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] |
is\tmore\tprevalent\tin\tthose\n\tliving\tin\tpoverty\t(incomes\t<100%\tvs.\t≥400%\tof\tthe\tfederal\tpoverty\tlevel).\nThe\tdisease\thas\ta\thigher\tprevalence\tfor\tthose\tliving\toutside\tthe\tcentral\tcity\tof\ta\tmetropolitan\nstatistical\tarea.\tFactors\thaving\tno\timpact\ton\tprevalence\tincluded\tregion\tof\tresidence,\tsex,\tcurrent\nmarital\tstatus,\tor\thealth\tinsurance\tcoverage\ttype\t(
|
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] |
marital\tstatus,\tor\thealth\tinsurance\tcoverage\ttype\t(\nDahlhamer\tet\tal,\t2016\n).\tReasons\tfor\tthe\tvaried\nprevalence\tof\tIBD\tare\tnot\tentirely\n\tclear\tbut\temerging\tresearch\tis\tinvestigating\tmany\taspects\tof\tthe\nincreased\tinflammatory\tand\tproliferative\tstate,\tincluding\tetiology,\tepidemiology,\tand\tnutritional\nfactors.
|
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0.06081373989582062,
0.06931675225496292,
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] |
factors.\nCrohn’s\tdisease\tand\tUC\tshare\tsome\tclinical\tcharacteristics,\tincluding\tdiarrhea,\tfever,\tweight\tloss,\nanemia,\tfood\tintolerances,\tmalnutrition,\tgrowth\tfailure,\tand\textraintestinal\tmanifestations\t(arthritic,\ndermatologic,\tand\thepatic).\n\tIn\tboth\tforms\tof\tIBD,\tthe\trisk\tof\tmalignancy\tincreases\twith\tthe\tduration
|
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0.048723623156547546,
0.10679100453853607,
0.10276544094085693,
0.015866044908761978
] |
of\tthe\tdisease.\tAlthough\tmalnutrition\tcan\toccur\tin\tboth\tforms\tof\tIBD,\tit\tis\tmore\tof\ta\tlifelong\tconcern\nin\tpatients\twith\tCrohn’s\tdisease\tthan\twith\tUC.\tThe\tfeatures\tthat\tdistinguish\tthe\tforms\tof\tthe\tdisease\nin\tterms\tof\tgenetic\tcharacteristics,\tclinical\tpresentation,\tand\ttreatment\tare\tdiscussed\tin\t\nTable\t27.4\n.
|
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] |
TABLE\t27.4\nUlcerative\tColitis\tversus\tCrohn’s\tDisease\nUlcerative\tColitis\nCrohn’s\tDisease\nPresentation\nBloody\tdiarrhea\nPerianal\tdisease,\tabdominal\tpain\t(65%),\nmass\tin\tabdomen\nGross\tpathology\nRectum\talways\tinvolved\nRectum\tmay\tnot\tbe\tinvolved\nMoves\tcontinuously,\tproximally\nfrom\trectum\nCan\toccur\tanywhere\talong\ngastrointestinal\ttract
|
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] |
from\trectum\nCan\toccur\tanywhere\talong\ngastrointestinal\ttract\nNot\tcontinuous:\t“skip\tlesions”\nThin\twall\nThick\twall\nFew\tstrictures\nStrictures\tcommon\nDiffuse\tulceration\nCobblestone\tappearance\nHistopathology\nNo\tgranulomas\nGranulomas\nLow\tinflammation\nMore\tinflammation\nDeeper\tulcers\t(hence\tnamed\nulcerative)\nShallow\tulcers\nPseudopolyps\nAbscesses\tin\tcrypts
|
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] |
ulcerative)\nShallow\tulcers\nPseudopolyps\nAbscesses\tin\tcrypts\nFibrosis\nExtraintestinal\nmanifestations\nSclerosing\tcholangitis\nErythema\tnodosum\nPyoderma\tgangrenosum\nMigratory\tpolyarthritis\tGallstones\nComplications\nToxic\tmegacolon\nMalabsorption\nCancer\nCancer\nStrictures\tand\tfistulas\tare\tvery\nrare\nStrictures\tor\tfistulas\nPerianal\tdisease\nEtiology
|
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rare\nStrictures\tor\tfistulas\nPerianal\tdisease\nEtiology\nThe\tcause\tof\tIBD\tis\tnot\tcompletely\tunderstood\tand\tthere\tis\tno\tknown\tcure,\tbut\tthe\tmost\twidely\naccepted\tpathogenesis\tinvolves\tcomplex\tinteraction\tof\tthe\tGI\timmunologic\tsystem\tof\tthe\thost,\tand\ngenetic\tand\tenvironmental\tfactors.\tEmerging\n\tresearch\tis\talso\tinvestigating\tthe\trole\tof\tthe\tmicrobiota
|
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] |
research\tis\talso\tinvestigating\tthe\trole\tof\tthe\tmicrobiota\nand\tits\tpotential\trole\tin\tthe\tdisease\t(\nNishida\tet\tal,\t2018\n).\tGenetic\tsusceptibility\tis\tnow\trecognized\tto\nbe\tdiverse,\twith\ta\tnumber\tof\tpossible\tgene\tmutations\tthat\taffect\trisk\tand\tcharacteristics\tof\tthe
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disease.\tThe\tdiversity\tin\tthe\tgenetic\talterations\tamong\tindividuals\tmay\thelp\texplain\tdifferences\tin\nthe\tonset,\taggressiveness,\tcomplications,\n\tlocation,\tand\tresponsiveness\tto\tdifferent\ttherapies\tas\tseen\nin\tthe\tclinical\tsetting.\tThe\tmajor\tenvironmental\tfactors\tinclude\tresident\tand\ttransient\nmicroorganisms\tin\tthe\tGI\ttract\tand\tdietary\tcomponents.
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microorganisms\tin\tthe\tGI\ttract\tand\tdietary\tcomponents.\nThe\tgenes\taffected\t(e.g.,\tC677T\tmutation\trelated\tto\tmethylene-tetrahydrofolate\treductase)\nnormally\tplay\ta\trole\tin\tthe\treactivity\tof\tthe\thost\tGI\timmune\tsystem\tto\tluminal\tantigens\tsuch\tas\tthose\nprovided\tby\tintestinal\tflora\tand\tthe\tdiet.\tIn\tanimal\tmodels,\tinflammatory\tdisease\tdoes\tnot\toccur\tin
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] |
the\tabsence\tof\tgut\tmicrobiota.\tNormally,\twhen\tan\tantigenic\tchallenge\tor\ttrauma\toccurs,\tthe\timmune\nresponse\tis\tinitiated;\tit\tis\tthen\tturned\toff\tand\tcontinues\tto\tbe\theld\tin\tcheck\tafter\tthe\tchallenge\nresolves.\tIn\tIBD\thowever,\tincreased\tantigen\texposure,\tdecreased\thost\tdefense\tmechanisms,\tand/or\ndecreased
|
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0.04803876578807831,
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0.08094442635774612,
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bacterial\tsensing,\tinvasion,\tand\telimination.\tFailure\tof\tthese\tgenes\tto\tcome\ttogether\tcan\tlead\tto\nimpaired\tautophagy\tand\n\tpersistence\tof\tbacteria,\tresulting\tin\tabnormal\timmune\tresponses\t(\nBossuyt\nand\tVermeire,\t2016\n).\nThe\tWestern\tdiet\tmay\talso\tbe\ta\tcontributing\tfactor\tfor\tdevelopment\tof\tIBD\t(\nLewis\tet\tal,\t2017\n).\tIn
|
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] |
Lewis\tet\tal,\t2017\n).\tIn\nepidemiologic\tstudies,\tfactors\tassociated\twith\tof\tthe\tdevelopment\tof\tIBD\tinclude\tincreased\tsucrose\nintake,\tlack\tof\tfruits\tand\tvegetables,\ta\tlow\tintake\tof\tdietary\tfiber,\tincreased\tconsumption\tof\tred\tmeat\nand\talcohol,\taltered\tomega-6/omega-3\tfatty\tacid\tratios\tand\tinsufficient\tvitamin\tD\tintake\t(\nHlavaty\tet\nal,\t2015
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] |
Hlavaty\tet\nal,\t2015\n).\tDietary\tinterventions\tto\tmodify\tthese\tfactors\tduring\tIBD\tflares\tare\tstill\tunder\tinvestigation\n(\nOwczarek\tet\tal,\t2016\n).\nPathophysiology\nCrohn’s\tdisease.\nChrohn’s\tdisease\tmay\tinvolve\tany\tpart\tof\tthe\tGI\ttract,\tbut\tapproximately\t50%\tto\t60%\tof\tcases\ninvolve\tthe\tdistal\tileum\tand\tthe\tcolon.
|
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] |
involve\tthe\tdistal\tileum\tand\tthe\tcolon.\n\tOnly\tthe\tsmall\tintestine\tor\tonly\tthe\tcolon\tis\tinvolved\tin\t15%\tto\n25%\tof\tcases.\tSome\tunique\tfeatures\tof\tCrohn’s\tdisease\tinclude\tsegments\tof\tinflamed\tbowel\tthat\tmay\nbe\tseparated\tby\thealthy\tsegments,\tand\ttransmural\tmucosal\tinvolvement\tthat\taffects\tall\tlayers\tof\tthe
|
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mucosa.\tCrohn’s\tdisease\tis\talso\tcharacterized\tby\tabscesses,\tfistulas,\tfibrosis,\tsubmucosal\tthickening,\nlocalized\tstrictures,\tnarrowed\n\tsegments\tof\tbowel,\tand\tpartial\tor\tcomplete\tobstruction\tof\tthe\nintestinal\tlumen.\nUlcerative\tcolitis.\nUlcerative\tcolitis\tdisease\tactivity\tis\tlimited\tto\tonly\tthe\tlarge\tintestine\tand\trectum.\tThe\tdisease
|
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] |
process\tis\tcontinuous\tand\tis\tnormally\tlimited\tto\tthe\tmucosa.\tBleeding\tis\tmore\tcommon\tin\tUC\tas\twell.\nSee\t\nFig.\t27.5\n\t(A–C)\tand\tTable\t27.4\tto\tcompare\tand\tcontrast\tfurther.\nFIG.\t27.5\nA,\n\tNormal\tcolon.\t\nB,\n\tUlcerative\tcolitis.\t\nC,\n\tCrohn’s\tdisease.\n\t\nSource:\n\t(\nA,\n\tFrom\tFireman\tZ,\tKopelman\tY:\tThe\ncolon—the\tlatest\tterrain\tfor\tcapsule\tendoscopy.
|
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] |
colon—the\tlatest\tterrain\tfor\tcapsule\tendoscopy.\t\nDig\tLiver\tDis\n\t39[10]:895-899,\t2007.\t\nB,\n\tFrom\tBlack\tJM,\tHawks\tJH:\t\nMedical\tsurgical\nnursing:\tclinical\tmanagement\tfor\tpositive\toutcomes\n,\ted\t8,\tSt\tLouis,\t2009,\tSaunders.\t\nC,\n\tFrom\tMcGowan\tCE,\tLagares-Garcia\tJA,\nBhattacharya\tB:\tRetained\tcapsule
|
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] |
From\tMcGowan\tCE,\tLagares-Garcia\tJA,\nBhattacharya\tB:\tRetained\tcapsule\n\tendoscope\tleading\tto\tthe\tidentification\tof\tsmall\tbowel\tadenocarcinoma\tin\ta\tpatient\twith\nundiagnosed\tCrohn’s\tdisease,\t\nAnn\tDiagn\tPathol\n\t13[6]:390-393,\t2009.)\nThe\tinflammatory\tresponse\t(e.g.,\tincreased\tcytokines\tand\tacute-phase\tproteins,\tincreased\tGI
|
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permeability,\tincreased\tproteases,\tand\tincreased\toxygen\tradicals\tand\tleukotrienes)\tresults\tin\tGI\ntissue\tdamage.\tIn\tIBD\teither\tthe\tregulatory\tmechanisms\n\tare\tdefective\tor\tthe\tfactors\tperpetuating\nthe\timmune\tand\tacute-phase\tresponses\tare\tenhanced,\tleading\tto\ttissue\tfibrosis\tand\tdestruction.\tThe
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clinical\tcourse\tof\tthe\tdisease\tmay\tbe\tmild\tand\tepisodic\tor\tsevere\tand\tunremitting\t(see\nPathophysiology\tand\tCare\tManagement\tAlgorithm:\n\tInflammatory\tBowel\tDisease\n).
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Diet\tis\tan\tenvironmental\tfactor\tthat\tmay\ttrigger\trelapses\tof\tIBD.\tFoods,\tmicrobes,\tindividual\nnutrients,\tand\tincidental\tcontaminants\tprovide\ta\thuge\tnumber\tof\tpotential\tantigens,\tespecially\nconsidering\tthe\tcomplexity\tand\tdiversity\tof\tthe\tmodern\tdiet.\tMalnutrition\tcan\taffect\tthe\tfunction\tand
|
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effectiveness\tof\tthe\tmucosal,\tcellular,\tand\timmune\tbarriers;\tdiet\talso\tcan\taffect\tthe\ttype\tand\trelative\ncomposition\tof\tthe\tresident\tmicroflora.\tSeveral\tnutrients,\tsuch\tas\tdietary\tfats\tor\tvitamin\tD,\tcan\naffect\tthe\tintensity\tof\tthe\tinflammatory\tresponse\t(\nHlavaty\tet\tal,\t2015\n;\t\nSadeghian\tet\tal,\t2016\n).
|
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Hlavaty\tet\tal,\t2015\n;\t\nSadeghian\tet\tal,\t2016\n).\nFood\tallergies\tand\tother\timmunologic\treactions\tto\tspecific\tfoods\thave\tbeen\tconsidered\tin\tthe\npathogenesis\tof\tIBD\tand\tits\tsymptoms,\tthough\tthe\tincidence\tof\tdocumented\tfood\tallergies,\tcompared\nwith\tfood\n\tintolerances,\tis\trelatively\tsmall.\tSome\ttheorize\tthat\tintestinal\twall\tpermeability\tto\tfood
|
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0.08362296968698502,
0.0072770193219184875
] |
molecules\tand\tcell\tfragments\tis\tlikely\tincreased\tin\tinflammatory\tstates,\twhich\twould\tallow\tthe\npotential\tfor\tincreased\tinteraction\tof\tantigens\twith\thost\timmune\tsystems\t(\nMichielan\tet\tal,\t2015\n).\nWhile\tdamage\tto\tepithelial\tbarrier\tfunction\tis\ta\tcharacteristic\tfeature\tof\tIBD,\tfurther\tresearch\tis\nneeded\tto\tdetermine
|
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] |
needed\tto\tdetermine\n\twhether\tthis\tplays\ta\tprimary\trole\tin\tdisease\tdevelopment\tor\tas\ta\tsecondary\nresponse\tto\tinflammation\tin\tIBD\t(\nAntoni\tet\tal,\t2014\n).\nFood\tintolerances\toccur\tmore\toften\tin\tpersons\twith\tIBD\tthan\tin\tthe\tpopulation\tat\tlarge,\tbut\tthe\npatterns\tare\tnot\tconsistent\tamong\tindividuals\tor\teven\tbetween\texposures\tfrom\tone\ttime\tto\tthe\tnext.
|
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] |
Reasons\tfor\tspecific\tand\tnonspecific\tfood\tintolerances\tare\tabundant\tand\n\tare\trelated\tto\tthe\tseverity,\nlocation,\tand\tcomplications\tassociated\twith\tthe\tdisease\tprocess.\tPartial\tGI\tobstructions,\nmalabsorption,\tdiarrhea,\taltered\tGI\ttransit,\tincreased\tsecretions,\tfood\taversions,\tand\tassociations
|
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0.10382097959518433,
0.11576157808303833,
0.0881824791431427,
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] |
are\tbut\ta\tfew\tof\tthe\tproblems\texperienced\tby\tpersons\twith\tIBD.\tHowever,\tneither\tfood\tallergies\tnor\nintolerances\tfully\texplain\tthe\tonset\tor\tmanifestations\tin\tall\tpatients\t(see\t\nChapter\t25\n).\nMedical\tmanagement\nThe\tgoals\tof\ttreatment\tin\tIBD\tare\tto\tinduce\tand\tmaintain\tremission\tand\tto\timprove\tnutrition\tstatus.
|
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] |
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