Food Intolerance and Allergy Levels are Growing is Your Business Ready to Grow Too?!
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1 Food Intolerance and Allergy Levels are Growing is Your Business Ready to Grow Too?! Dr Sue Shepherd B.App.Sci. (Health Promotion), M. Nut & Diet., PhD. Advanced Accredited Practising Dietitian
2 Representations and Affiliations
3 A huge opportunity for you Australia has one of the highest adverse reaction to food prevalence rates in the world, and rates are increasing Adverse reactions to food: Allergies Coeliac Disease Food intolerances (IBS, non-coeliac gluten sensitivity) (temporary: toxic reactions, food poisoning) People are looking for foods that they can incorporate into their diet to meet their needs and still give their food sensitivity needs with wide variety of nutritious food choices
4 The gluten free BOOM Time magazine rated the GF movement second on its top 10 list of food trends in Australian GF sales expected to be around $100million in 2015 UK growth up 15% in 2014, now worth 238m USA GF market is worth $2.6 billion - a growth of 36% since 2006 and expected to double in size in next 2 years
5 Learning the lingo Allergy is the term often used to describe any adverse reaction to food eg. I am allergic to onion, I have allergy to mushrooms However, in reality, allergies are the least common adverse reaction to food.
6 Learning the lingo Allergies Allergies involve the immune system, they are not trivial, and can indeed be life-threatening. There is a spectrum of severity of symptoms and sensitivity, however wise to always assume reactions are anaphylactic when involved in food preparation/service to someone with an allergy. Admissions for anaphylaxis due to food allergy in children aged 0 to 4 years have increased 5-fold over the past decade in Australia.
7 Coeliac disease Learning the lingo Coeliac disease involves an activated immune system in genetically susceptible people. It is an auto-immune condition, not an allergy. People need a strict life-long gluten free diet as the only treatment. Non-compliance can lead to cancer, infertility, osteoporosis, etc. Prevalence has increased x 4 over past 50 yrs
8 Learning the lingo Food intolerances Food intolerances do not involve the immune system at all. They are a collec5on of annoying however ul5mately harmless symptoms including abdominal bloa5ng, excess wind, diarrhoea, abdominal pain (eg. IBS symptoms), migraines, sinus irrita5on, etc. The types of foods that trigger symptoms vary, as does severity of symptoms and threshold of tolerance. Dietary management is very individualised. IBS is just as prevalent today as it was in the 1980s, it is just spoken about a lot more!
9 Coeliac Disease Size of the market Affects 1 in 80 males and 1 in 60 females in Australia Prevalence of around 1 in 100 reported around the world Not usually seen in Eastern Asians Non-Coeliac Gluten Sensitivity 0.5-6% of the community Vague definition All ethnicities
10 Low FODMAP Diet Size of the market IBS (1 in 7 = 3.5million Australians) All ages All ethnicities Gluten intolerance (1 in 17 = 1.5m Australians) Coeliac disease with ongoing symptoms despite strict gluten free diet (12,500 Australians) IBD (Crohn s or Ulcerative colitis) with ongoing symptoms despite disease in remission (3,500 Aust)
11 Size of the market Food allergies: Overall 1 in 20 children, 1 in 50 adults Wheat Children: 1 in Adults: 1 in 500 most grow out of it by 3-5yrs of age Dairy (Cow s milk protein): 1-2% children, 0.4% adults Soy Egg: 1-2% children, 0.4% adults Fish: 0.4% Shellfish: 1.2% Peanut: 1.3% Treenut: 0.6% Sesame
12 Size of the market Food allergies: Overall 1 in 20 children, 1 in 50 adults Wheat Children: 1 in Adults: 1 in 500 most grow out of it by 3-5yrs of age Dairy (Cow s milk protein): 1-2% children, 0.4% adults Soy Egg: 1-2% children, 0.4% adults Fish: 0.4% Shellfish: 1.2% Peanut: 1.3% Treenut: 0.6% Sesame
13 Adverse Reaction to Wheat: Complex! Gluten: Non Coeliac Gluten Sensitivity Protein: Wheat Allergy Gluten: Coeliac Disease Fructans (FODMAP): Irritable Bowel Syndrome Image:
14 Common Symptoms from Adverse Reactions to Wheat Coeliac Disease Non-Coeliac Gluten Sensitivity Irritable Bowel Syndrome Wheat Allergy Abdominal Pain Abdo Bloating Excess Wind Diarrhoea Constipation Nausea Fatigue Foggy Head Vitamin Deficiencies Mineral Deficiencies * can be asymptomatic Abdominal Pain Abdo Bloating Excess Wind Diarrhoea Constipation Nausea Fatigue Foggy Head Joint Pain Muscle pain Headaches Abdominal Pain Abdo Bloating Excess Wind Diarrhoea Constipation Nausea Fatigue Foggy Head Diarrhoea Nausea Vomiting Headache Itchy watery eyes Nasal congestion Hives, itchy rash Swelling/itching of mouth or throat Difficulty breathing Anaphylaxis
15 Common Symptoms from Adverse Reactions to Wheat Coeliac Disease Non-Coeliac Gluten Sensitivity Irritable Bowel Syndrome Wheat Allergy Abdominal Pain Abdo Bloating Excess Wind Diarrhoea Constipation Nausea Fatigue Foggy Head Vitamin Deficiencies Mineral Deficiencies * can be asymptomatic Abdominal Pain Abdo Bloating Excess Wind Diarrhoea Constipation Nausea Fatigue Foggy Head Joint Pain Muscle pain Headaches Abdominal Pain Abdo Bloating Excess Wind Diarrhoea Constipation Nausea Fatigue Foggy Head Diarrhoea Nausea Vomiting Headache Itchy watery eyes Nasal congestion Hives, itchy rash Swelling/itching of mouth or throat Difficulty breathing Anaphylaxis
16 Coeliac Disease: Gluten Free Diet
17 What is Coeliac Disease? A medical condition of a permanent intestinal intolerance to dietary gluten. Gluten is the protein component of wheat, rye, barley AND OATS Gluten induces an autoimmune reaction at the lining of the small intestine Coeliac disease is common and increasing Coeliac disease affects < 1 in 70 Australians or more than 250,000 people 75% of those are not currently diagnosed nearly x2 as prevalent as Type 1 diabetes
18 Diagnosis The initial test for coeliac disease is a simple antibody blood test administered by a GP A small bowel biopsy is the gold standard for diagnosis, showing the characteristic changes of coeliac disease including villous atrophy It is important not to start a gluten free diet before testing as this can cause a false test result.
19 Symptoms don t = severity! Symptoms do not relate to severity of disease. All people with coeliac disease require the same, strict, life long diet irrespective of how unwell they are with symptoms. People with no symptoms do not get away with it if they eat small amounts of gluten.
20 Strict life-long gluten free diet required Very small intakes of only 50 mg per day will initiate the inflammatory response. This represents less than one hundredth of a slice of wheat bread. This may not necessarily cause symptoms Cross contamination education important 1/100th portion of bread is enough to cause damage
21 Medications No active ingredient contains gluten Gluten may be present in excipients Gluten free definition for medications is the same as food
22 Gluten in non-food, non-oral medications
23 Gluten in non-food, non-oral medications Gluten is present in cigarettes so people with coeliac disease cannot smoke
24 Gluten in non-food, non-oral medications Gluten is present in cigarettes so people with coeliac disease cannot smoke
25 Gluten in non-food, non-oral medications If wheat-based ingredients are used in skin lotions, hair products, etc, it does not matter in someone with coeliac disease as gluten is an issue only when it is INGESTED
26 Gluten in non-food, non-oral medications If wheat-based ingredients are used in skin lotions, hair products, etc, it does not matter in someone with coeliac disease as gluten is an issue only when it is INGESTED However For Food Allergies, skin contact may trigger a reaction For Food Intolerances, skin contact will NOT trigger a reaction
27 IBS: The low FODMAP diet
28 IBS: The low FODMAP diet FODMAPs are a collection of poorly absorbed short-chain carbohydrates
29 How do FODMAPs trigger symptoms of IBS?
30 Adapted from Barrett, et al 2009 How do FODMAPs trigger symptoms of IBS?
31 Adapted from Barrett, et al 2009 How do FODMAPs trigger symptoms of IBS? Increased water delivery
32 Adapted from Barrett, et al 2009 How do FODMAPs trigger symptoms of IBS? Increased gas production
33 Adapted from Barrett, et al 2009 How do FODMAPs trigger symptoms of IBS? Luminal distension and Altered bowel motility Abdo pain, distension, excess wind, diarrhoea +/- constipation
34 Examples of high FODMAP foods Excess Fructose Apples, pears, mangoes, nashi fruit, boysenberry, watermelon, cherries, asparagus, Jerusalem ar5chokes, sugar snap peas, honey, high fructose corn syrup, agave. Polyols Lactose Fructans Galacto- oligosaccharides Apple, apricot, avocado, blackberry, cherry, nashi fruit, peach, pear, plum, prune, watermelon, cauliflower, mushrooms Milk, ice cream, custard, yoghurt, rico[a cheese, cream cheese, co[age cheese. Custard apple, persimmon, nectarine, watermelon, globe ar5choke, asparagus, garlic, legumes, len5ls, leek, onion, shallot, spring onion (white part), cashew, pistachio, wheat, rye, barley (in large amounts). Legumes, len5ls, chickpeas.
35 Examples of high FODMAP foods Excess Fructose Apples, pears, mangoes, nashi fruit, boysenberry, watermelon, cherries, asparagus, Jerusalem ar5chokes, sugar snap peas, honey, high fructose corn syrup, agave. Polyols Lactose Fructans Galacto- oligosaccharides Apple, apricot, avocado, blackberry, cherry, nashi fruit, peach, pear, plum, prune, watermelon, cauliflower, mushrooms Milk, ice cream, custard, yoghurt, rico[a cheese, cream cheese, co[age cheese. Custard apple, persimmon, nectarine, watermelon, globe ar5choke, asparagus, garlic, legumes, len5ls, leek, onion, shallot, spring onion (white part), cashew, pistachio, wheat, rye, barley (in large amounts). Legumes, len5ls, chickpeas.
36 Wheat, rye and barley foods On the Low FODMAP Diet, only a problem when consumed in large amounts eg. small amount of wafer within a chocolate is suitable on the low FODMAP diet. However On the Gluten Free Diet, must be STRICTLY avoided. Oats must also be avoided. With Wheat Allergy, STRICT avoidance of wheat needed
37 Global uptake of the Low FODMAP Diet not yet as well known as GFD International print media International online media
38 Non Coeliac Gluten Sensitivity (NCGS): Gluten Free Diet or Low FODMAP Diet?
39 Many people with NCGS don t feel better on a gluten free diet! Do you currently feel in control of your symptoms Almost 1 in 4 don t feel in control of symptoms on GFD nonsensical to presume issue is gluten NO (22%) SOMETIMES (7%) MOSTLY (12%) YES (59%) 41% have incomplete resolution of symptoms on GFD Biesiekierski JR, et al 2014
40 Healthier foods please! Surprisingly, up to 50% of survey respondents thought going GF was a healthy option for physical (Djokovic) and mental health, and weight loss GFD is not a magical answer to weight loss removing cakes, pastries, pies and confectionery from our diet and replacing them with fruits and vegetables will of course be helpful Some research suggests that a GFD seems to increase the risk of overweight or obesity Nutritional quality of packaged foods often poor more/added fat and sugar to improve taste/texture Demand for healthy Free From products
41 Safer foods please! The free from boom has changed the landscape moved from a history of limited availability of suitable foods to an explosion of options Packaged food is easily identifiable as being safe gluten free declaration on packaging (<3ppm) Mandatory declaration of allergens Eating away from home at cafes/restaurants/ hospitals/school camps food service space is a risk taking venture. Although GF Nut Free DF may now be dotted throughout many menus, too often they are not suitably prepared there is often no quality control
42 Safer foods please! Three eras in the GF restaurant/café scene: Pre-2002: GFD relatively unknown. Plain grilled chicken with an undressed salad typical. Boring but safe : An emergence of some outlets that invested time and effort into understanding the needs of their GF patrons. Tasty meals (with sauces!) and safe present: So many keen to jump aboard this booming dietary trend, without taking time to understand the requirements of GF food preparation. Lots of tasty options, majority unsafe.
43 Where to for more information Coeliac Australia National phone number is: Website: Branches in each State Professional Membership Application forms available from website Ingredients Lists Smartphone App Coeliac Australia offers guidelines and best practice advice to food service industry Coeliac Australia restaurant endorsement program Massive opportunity for food service
44 Where to for more information Allergies Australasian Society of Clinical Immunologists and Allergists (ASCIA) Helpful information /fact sheets regarding safe food preparation and service
45 Where to for more information FODMAP Reference books Shepherd Works consulting service
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