READ: Part 1 and Part 2
A curious aspect of non-coeliac gluten sensitivity (NCGS) is that this syndrome is usually acquired after childhood. It is odd because statistically, adults have a smaller percentage of allergy sufferers than children – one presumes childhood allergens are better tolerated as one grows older and develops a more rounded (or stronger) immune system.
It might be suggested that NCGS is akin to lactose intolerance, which develops after the body stops producing the enzyme lactase. The difference is the human body is innately unable to produce the enzymes to digest many complex carbohydrates at any age – it needs bacteria in the human gastrointestinal microbiota (HGM) to do this, and one supposes adults have a larger range of bacterial fauna than children.
To be clear, humans do produce enzymes to digest some common carbohydrates, especially starches (made up of amylose and amylopectin) and sugars – but most other carbohydrates need digestive help from the HGM. This is why FODMAPs may be allergens behind NCGS if the HGM is defective in some way. FODMAP stands for Fermentable, Oligo-, Di-, Mono-saccharides And Polyols, and are varieties of carbohydrates which humans cannot digest natively via enzymes – and they are often found in food where gluten is present, and also in foods where there is no gluten.
Old wheat vs new wheat?
As modern wheat is a hybrid derived from various grasses, it is worth determining if some change in wheat genes is a cause of NCGS. This was investigated by the University of Reading in 2017. Analysis of various ancient strains established differences in various compounds compared to modern wheat, in particular carotenoid lutein, a colourant mostly bred out of modern wheat (as people prefer white wheat flour). There were also minor differences in plant phytochemicals and dietary fibre content. Curiously, the profiles of FODMAPs are remarkably similar in both ancient and modern wheats. So if FODMAPs are a root cause of NCGS, then people have been suffering for thousands of years.
One mildly interesting outcome is there seems a lesser reaction to FODMAPs from a strain of khorasan wheat called kamut (also known as “mummy wheat” as it allegedly came from wheat grains found in Egyptian tombs). Symptoms of NCGS and irritable bowel syndrome (IBS) appear to be reduced with kamut wheat, and analysis of faecal samples suggested that kamut wheat has a different impact on HGM than normal bread wheat. However, the studies were on small groups and therefore not conclusive – also complicating matters is the fact that nutrition profiles of kamut grown in various countries have wide differences which may or may not be significant.
Gluten, FODMAPs and baking
Next was a look into the impact of modern processing of wheat flour, especially in commercial bakeries and food processing plants. Research in 2015 in Britain suggests that bread gluten becomes less digestible after baking (possibly due to structural changes) – in particular, baked gluten is even more indigestible in people deficient in producing the enzyme amylase (used for digesting amylose).
Furthermore, a 2014 Flinders University study researched the impact of baking on two major prebiotics in bread wheat flour: arabinoxylans (AX) and fructans – prebiotics are non-digestible food compounds which feed the HGM, and are also FODMAPs.
The study found slight variations in AX content after various stages of baking – which implies AX is not hugely affected by processing. More interesting is the impact on fructans; in particular, the use of yeast to ferment and leaven bread flour before baking can reduce fructan content in bread by 60% (though it is important to also note the baseline content and types of fructans vary widely depending on the source of the flour).
This is significant because most commercial bakeries do not proof (ferment with yeast) breads as it takes too long – instead they often use chemicals (eg. sodium bicarbonate, sodium aluminium phosphate, etc) to raise bread quickly in commercial ovens, and therefore the fructan content is significantly higher than for leavened breads.
Fructans are oligosaccharides (complex sugars consisting of polymers or chains of fructose-based molecules). There are several categories of fructans, delineated by different hydroxyl (radical –OH) bonds in their structure and the most well-known types are inulin and levan. They are interesting because a 2017 study at Oslo University claimed that fructans is a possible cause of NCGS. Although the study was small, it was a well-done double-blind exercise, though it is odd that the test fructans (inulin derived from chicory roots) are also sold as prebiotics to promote HGM health.
When test subjects did not know what they were eating, 22% reported intestinal issues with gluten while 46% reported the LEAST problems when ingesting gluten. With fructans, 41% recorded issues, almost double the number for subjects troubled by gluten. Moreover, the study suggested that issues with fructans may be dose-dependent – doubling the amount of fructans normally eaten provoked negative reactions which were absent with less consumption.
There are some considerations. The fructans used in the study were derived from chicory roots – which are different from fructans in wheat and other foods. The same fructans used are also sold commercially as prebiotic supplements to promote HGM health – presumably there are not many people reacting negatively to such supplements or else it would not be a business.
The gluten is based on the 19 most allergenic gliadins (out of around 890 types of known gliadins) – these proteins are 33-mer peptides, and as such not all the gliadins in a normal diet are covered.
It should therefore be noted that not all combinations of fructan and gluten compounds in normal diets were tested.
As an aside, durum wheat (found in good spaghetti and pasta) lacks the gene to produce 33-mer peptides so if you have a reaction to bread wheats, you might try eating some pasta instead to see if it helps.
In 1965, Bronstein’s research into the digestion of wheat gliadins indicated the resulting acidic peptides are a cause of coeliac disease (CD) as sufferers lack an enzyme to digest such peptides, which then circulate around the digestive tract. In response, the body produces antibodies to counter these peptides which are perceived as foreign pathogens. Later in 2000, Fassano showed that intestines also increase production of zonulin in such situations – this protein loosens the tight cellular linkages in the intestines, causing “leaky gut syndrome” where digestive substances permeate into the blood stream, provoking more severe reactions.
Then a 2015 US paper researched the effect of pre-digested wheat gliadins on intestinal tissues extracted from people with CD, NCGS and controls with no gluten sensitivity. The outcome was sobering – ALL tissue samples demonstrated increased permeability reactions to pre-digested gliadins. In addition, it was found that the controls produced significantly more of a protein called cytokine IL-10, which is an anti-inflammatory factor.
It should be noted that tests on tissue extracts with chemically pre-digested gliadins may not accurately reflect conditions in the body. Or it can be suggested gliadins in wheat gluten consistently provoke intestinal inflammatory issues and people who produce enough cytokine IL-10 do not feel the effects of such inflammation.
The probability that humans are reacting to chemical food additives used in modern processed foods also cannot be ignored. This is a long complex subject, covered in the six-part series, “How to count on food”.
If you’re not confused by now, you’re not paying attention
A summary is now in order.
Gluten (especially wheat gliadins) and FODMAPs are broad, complex groups of food substances which vary widely in quantity and types. Due to idiosyncratic differences in humans, it is difficult to pin-point exactly which compound or combinations in one or both groups cause NCGS.
FODMAPs are indigestible food compounds which need the HGM to help with digestion. As they can promote fermentation in the gut, some FODMAPs are associated with gas and distended bellies. They are not necessarily bad – but they do need a compatible, robust HGM to process them.
Ironically, a lot of commercial gluten-free food is bulked up with FODMAPs and often contain industrially-processed oils and added sugars – in short, gluten-free foods are not always inherently healthy.
Fructans are fructose-based FODMAPs which can trigger NCGS, though the reasons why are not known – maybe it is related to HGM. Fructan content varies widely by source and also by certain food processing steps, such as yeast fermentation.
Gliadins in bread wheat gluten, particularly 33-mer peptides, have been linked with intestinal permeability.
Food additives can trigger NCGS, though relevant impact analysis data is currently not available due to the wide range of additives in modern food processing.
Back to Taiwan
Based on the above, my incident in Taiwan in Part 1 of this series was likely due to over-consuming wheat flour in noodles and buns, pushing gliadin and FODMAP consumption past levels which overwhelmed the body’s anti-inflammatory response.
The same issue may apply for commercial breads using unleavened dough with high fructan content and textured with industrial additives.
Subjectively, although problems develop after consuming certain compounds (eg. gliadins, FODMAPs, additives) past a tolerance threshold, it does not mean I have NCGS – in the same way getting drunk does not mean an alcohol allergy.
So if you still consider NCGS a problem issue, you now have all the (currently known) facts before deciding to pay premium prices for gluten-free foods.
If your child has food allergies, his paediatrician may recommend that he be placed on a food elimination diet.
What it means is that you will need to temporarily eliminate specific foods from his diet, and possibly your diet as well, if you are still breastfeeding him. It should last around two to four weeks.
This method is normally combined with skin or blood tests, and its purpose is to help identify specific foods that are triggering his food allergies.
By avoiding the suspected food trigger, both you and the paediatrician can monitor his symptoms, which should disappear if the foods that trigger his allergy are excluded.
As an additional step to help determine the exact offending food, his paediatrician may ask for it to be reintroduced to his diet gradually. Any return of his symptoms would signify that he is likely allergic to the food that was reintroduced.
Allergy vs intolerance
Food allergies are a result of the immune system mistakenly identifying specific foods to be harmful, thus reacting by creating immunoglobulin E (IgE) antibodies to combat the perceived threat.
This often results in fairly immediate symptoms (within minutes) that could present as gut-related (abdominal pain, vomiting or diarrhoea), skin reactions (rashes, itching or swelling), respiratory (runny nose, sneezing or difficulty breathing), or even headaches in older children.
Food intolerance, on the other hand, is a purely gut-related problem that is caused by difficulty in digesting certain foods – the immune system is not reacting in any way.
Symptoms such as bloating, tummy aches or diarrhoea, do not normally appear immediately and can take a while before presenting.
The eight most common allergenic foods listed by the US Food and Drug Administration (FDA) are milk, eggs, fish (bass, flounder, cod), crustacean shellfish (crab, lobster, shrimp), tree nuts (almonds, walnuts, pecans), peanuts, wheat and soybeans.
Preparing fresh foods with raw ingredients may be the best solution, but this may not always be possible.
Do exercise extra care whenever you buy processed foods.
It is imperative that you read the product labels carefully before buying and serving them to your child. This will help ensure that the processed foods do not contain any of the foods that are in his food elimination diet.
As an example, if soy is part of the foods to be eliminated, buying processed foods that contain soy (commonly labelled as lecithin) would most likely skew the results, particularly if your child is allergic to it.
The eight most common allergenic foods listed by the US FDA are milk, eggs, fish (bass, flounder, cod), crustacean shellfish (crab, lobster, shrimp), tree nuts (almonds, walnuts, pecans), peanuts, wheat and soybeans.
Other common ingredients to be aware of include flour, which is often listed as wheat, and whey, which is often listed as milk.
If you are unsure about the processed food, it would be better to err on the side of caution and avoid it.
Keeping a food diary in conjunction with the food elimination diet is a good habit, as it could potentially be useful in identifying problem foods.
Make it a point to accurately record all symptoms (including number of times and duration) and everything that your child ate or drank.
In addition to food and drinks taken during main meals, you should also include prescribed medicines, supplements, and any sweets or snacks he takes. Yes, even taking a taste from someone else’s plate or cup counts!
Start with a fresh page every day. Remember to bring it, along with any food packaging or labels, during consultation sessions with your child’s allergist, in order to give him a complete picture to help in his analysis.
Tips for success
By this point, it should be apparent that going on a food elimination diet can be quite complex.
It is important to plan it and ensure that you take careful note throughout the course of the elimination diet. Here are things you can do to help yourself:
Preparation is key: Spend a little time doing some research prior to starting the elimination diet.
Do a search for elimination diet-friendly recipes beforehand.
You may also want to search for suitable processed foods ahead of time.
Stock up before starting: In addition to getting recipes, you should also ensure that you have all the necessary ingredients ahead of time.
Be sure to also stock up on snacks or light foods that are elimination diet-friendly. This will help increase your chances of following the elimination diet, especially on days when your child is hungry or just wants something to nibble on.
Clean out the clutter: Take some time to go through your kitchen and other parts of your house to look for foods that are not elimination diet-friendly.
Make sure that you either hide them well, discard them (if they are almost expired) or give them away. By removing non-elimination diet-friendly foods, you also remove any temptation for your child.
This will pre-empt situations where your child may see his favourite snack (that is part of the eliminated food) in plain sight and demands to have some.
Keep all caregivers in the loop: Be sure to involve all caregivers in this exercise as they will help ensure that your child adheres to his elimination diet. This includes the people who will care for him in daycare, kindergarten or school.
For school-going children, it is important that you discuss this in detail with him in order to ensure his cooperation.
You may need to prepare meals for him, unless you are 100% sure that the canteen foods can comply with his elimination diet.
It may also be necessary to inform family members and parents of friends in order to avoid accidentally sharing/giving food.
Lastly, do note that the elimination diet may not yield conclusive results, in which case your child’s allergist may recommend an oral food challenge in order to check any inconclusive results.
However, it is very important that any elimination diet be taken ONLY under the supervision of an experienced medical professional, in order to avoid possible problems such as malnutrition.
Dr Amir Hamzah Abdul Latiff is a consultant paediatrician and consultant clinical immunologist/allergist. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. For further information, please e-mail firstname.lastname@example.org or visit www.mypositiveparenting.org. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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Open your tissue, if you dare. The color of your snot can reveal a lot about your health.
The nose is lined with mucus membranes that secrete snot to help keep tissues healthy and trap dirt, cleaning the air we breathe on its way to our lungs. The nasal discharge they produce repels infections, lubricates the skin, and keeps viruses from entering our bodies.
The color of the snot in your nasal passages is often determined by how many white blood cells are circulating in the nostrils. That’s why taking a look (as gross as it sounds) can reveal useful information about how healthy we are.
Of course, the color of your snot isn’t an absolute diagnostic test. Most of the colorful clues our noses give us are not reason enough, on their own, to call a doctor, yet the rainbow of options can serve as a first hint about what’s going on inside our bodies.
Given that we produce and swallow about 1 1/2 quarts of nasal mucus every day, we are filled with a lot of sticky data to draw from.
Take a look at what the color of your mucus may indicate:
Clear snot is generally a good thing, but too much of it can be a warning that something is brewing.
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White snot signals that things are clogged up.
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Yellow snot is a sign your body is fighting to keep you healthy.
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Green snot is probably an indication that something isn’t right.
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Red snot doesn’t mean you’re sick.
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Brown snot can be a sign of irritation or pollution.
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Black snot may be a reason to call the doctor. Or it could just mean you’ve been breathing in smoke.
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Julia Calderone wrote an earlier version of this post.
As most of us know by now, this Chinese New Year marks the beginning of the Year of the Earth Dog in the Chinese zodiac.
In celebration of man’s best friend, we round up how your furry friend could give your health a boost in the coming year.
Reduced risk of allergies
Various studies have now found a link between owning a dog and a lower risk of allergies, especially in children.
Research presented in 2017 at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting detailed how children of mothers who had been in daily contact with a dog while pregnant had a lower risk of eczema by age two, and that pet dogs could also have a protective effect against asthma symptoms.
Swedish researchers also found, after looking at more than one million Swedish children, that those who grew up with dogs had a 15% lower risk of asthma.
A small American study found that despite a dog’s snoring, sleeping with your pooch could actually help you get a better night’s sleep.
After recruiting 40 adults and their pets for the study, researchers at the Mayo Clinic in the United States found that regardless of the size of the dog, sleeping with a furry friend in the room helped some people sleep better.
However, having a dog on the bed didn’t have the same effect, with the team finding that those who let their canines get too cozy, did it at the expense of a good night’s sleep.
“Most people assume having pets in the bedroom is a disruption.
“We found that many people actually find comfort and a sense of security from sleeping with their pets,” commented the study’s author Dr Lois Krahn.
Improved mental health
After looking at 17 research papers, a British review published just this week found that having a pet could have a positive effect on managing long-term mental health conditions.
Owning a dog, or other animal such as a cat, goldfish or hamster, was found to be beneficial by helping to distract owners from the stress of having a mental health problem and helping to alleviate feelings of loneliness.
Dogs also had the added benefit of helping owners increase their level of physical activity through walking, which in turn can also help improve mental health and encourage social interaction with other dog owners.
Pet dogs have also been found to help support children when they are stressed, while a 2015 American study found that children who have a dog at home also have a lower level of anxiety than those who do not.
It can be hard to find the motivation to get moving sometimes, but most dog owners will tell you, you don’t have much choice if your dog is asking for walks.
Many recent studies have also found that those with a dog do indeed get more exercise, with a dog being especially beneficial for helping seniors to get out of the house and get moving.
A British study published in 2017 found that seniors who walk their dogs clock up around 30 minutes more physical activity a day than non-dog owners, even during the colder, wetter months, with an Australian study also finding that dog walkers achieved at least 30 minutes of physical activity on more days per week than non-dog walkers, helping them to meet the 150 minutes of physical activity per week currently recommended for good health. – AFP Relaxnews
- The symptoms of a cold and the flu can often look similar, but there are some key differences.
- Seasonal allergies are a third variable to consider.
- The only way to get properly diagnosed is with a doctor’s visit. Knowing what you have can help determine the best treatment.
It can start with a sniffle. But before your symptoms turn into full-blown illness, you want to know: is it a cold or the flu?
Both illnesses can share a variety of symptoms. They’re also both caused by viruses. And, of course, there’s a third potential culprit to consider: allergies.
Most diagnostic detective work is best left to a doctor. But in the meantime, there are a few variables to consider that can help you narrow in on the cause of your illness.
The chief symptom of a cold is a stuffy or runny nose
If your nose feels stuffed or runny – but not itchy – and you don’t have a fever, it’s likely that you’ve been hit by a cold. Paying attention to the time of year is helpful, too. During the fall, roughly 75% of all circulating viruses are rhinoviruses, the most common cause of colds.
Here’s the good news: most colds only last three to seven days, though symptoms can linger for another week or so.
To start feeling better, avoid stocking up on vitamin C supplements, which studies suggest won’t do much for your symptoms. Instead, try a zinc lozenge – some research indicates zinc may help shorten the duration of a cold by interfering with the way rhinoviruses replicate.
If it’s allergies, you’ll probably be itchy and sneezy
Seasonal allergies, which typically crop up in the spring and summer, are also accompanied by nasal symptoms, but they differ in several key ways from those that characterize a cold, according to the National Institutes of Health. You’ll usually have an itchy – as opposed to a runny – nose, and your eyes will likely feel scratchy too. You’ll also probably be sneezing.
Your doctor can tell you if you suffer from an allergy and prescribe the right treatment for you. If you’re suffering from allergies, symptoms can last as long as whatever allergen triggering them remains in the air, which can be more than a month.
The flu is the worst of the three
Flu season strikes from late fall to late winter, typically peaking in February. The first thing you should do if you suspect you’ve come down with the flu is to take your temperature. Most flu cases are accompanied by a fever of more than 100 degrees Fahrenheit. Flu sufferers also typically experience body aches, coughs, and extreme tiredness, according to the Centers for Disease Control and Prevention. In people who are especially vulnerable, like older people, children, and individuals with weakened immune systems, the virus can also cause serious complications like pneumonia.
The flu can stick around in your system for longer than a cold, with symptoms like fatigue persisting up to three weeks. Individuals infected with the flu can pass it to anyone within 6 feet, and only stop being contagious once they’ve been fever-free for a full 24 hours (without the help of medication).
If you’re already sick with the flu, make sure you rest, since sleep is key to a properly functioning immune system, and keep an eye on your symptoms to be sure you don’t develop more severe complications.
If you’re not sick yet, the best defense against the virus is the flu shot. Getting vaccinated can also make the flu less miserable if you do get it.
Lauren Friedman wrote a previous version of this story.