March 2021 Diet & Digestive Health (DDHChat) Twitter Chat with IFFGD, and Raquel Durban MS, RD, LDN

2021 March DDHChat: Food Intolerance and Food Allergies

IFFGD – introductory tweets and remarks:

The views and experiences shared by our participant are their own and do not reflect the official positions of IFFGD. Each patient is different. Always consult with your health care provider or a registered dietitian (RD) on a diet treatment plan that is right for you. Information and resources shared during today’s chat should not replace medical care that you are receiving. And reminder, be sure to include #DDHChat in each of your tweets.

IFFGD – welcomes everyone to the chat and introduces co-host Raquel Durban MS, RD, LDN:

Welcome to our March #DDHChat on Food Intolerances and Food Allergies with lead host Raquel Durban, MS, RD, LDN. Understanding the differences between food allergies and food intolerances can be challenging for many people with gastrointestinal disorders. For those with food intolerances, you may be able to eat small amounts of offending foods without any trouble at all. The symptoms of both food allergies and intolerances are often similar to those of irritable bowel syndrome (IBS), including diarrhea and abdominal pain. When you notice changes in your symptoms, it is important to communicate these changes with your healthcare provider.

We’re joined today by registered dietitian (#RD) Raquel Durban MS, RD, LDN to share her unique insights on Food Allergies and Food Intolerances.

IFFGD and Raquel Durban MS, RD, LDN Q&A:

Q1: Thank you, Raquel Durban, MS, RD, LDN, for joining us today. Can you briefly explain the differences between food allergies and food intolerances? #DDHChat

Raquel Durban, MS, RD, LDNGreat place for us to dive in! Let’s look at the food allergy guidelines for this answer. A food allergy is an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food. Food allergens are the parts of food or ingredients within food (usually proteins) that are recognized by immune cells. When an immune cell binds to a food allergen, a reaction occurs that causes the symptoms of food allergy.  Food intolerances are adverse health effects caused by foods. They do not involve the immune system. For example, if you are lactose intolerant, you are missing the enzyme to break down lactose, a sugar found in milk. This does not involve the immune system https://www.niaid.nih.gov/sites/default/files/faguidelinespatient.pdf page 8. #DDHChat

Q2: Food allergies come in MANY different forms. Can you share with us what the different types of food allergies are? #DDHChat

Raquel Durban, MS, RD, LDN: The food allergy most of us think of is one that causes anaphylaxis requiring epinephrine for treatment. This type of food allergy is caused by IgE. Immunoglobulin E (IgE) are antibodies produced by the immune system. If you have an allergy, your immune system overreacts to an allergen by producing antibodies called  IgE. These antibodies travel to cells that release chemicals, causing an allergic reaction @AAAAI. There is non-IgE mediated food allergy too! The two I types I work with most are Eosinophilic Gastrointestinal Disorders (EGIDs) @AFPEDorg @CUREDfoundation and Food protein induced enterocolitis syndrome (FPIES) @IFPIES. Some people may have both IgE and non-IgE food allergy!Collaboration of a board certified allergist and a registered dietitian will help you stay safe, healthy and happy while managing food allergy! #DDHChat

Q3: For those living with food allergies, symptoms can range from mild to severe. What are some common food allergy symptoms? #DDHChat

Raquel Durban, MS, RD, LDN: For IgE allergies, @AAAAI has a wonderful education page, a portion posted below of symptoms and @FARE provides a printable action plan to schools and caregivers. Anaphylaxis typically occurs immediately or within 2 hours of ingestion of the food allergen. Red rash with hives/welts, that is usually itchy (It is possible to have a severe allergic reaction without skin symptoms.) Swollen throat or swollen areas of the body (It is possible to have a severe allergic reaction without skin symptoms). Wheezing,passing out, chest tightness, trouble breathing, cough, hoarse voice, trouble swallowing, vomiting, diarrhea,stomach cramping, pale or red color to the face and body, feeling of impending doom. However, EGIDs symptoms are often delayed and vary by age and may include vomiting, reflux, chest/abdominal pain, dysphagia, failure to thrive. FPIES is typically a diagnosis of infancy and results in profuse vomiting, lethargy, pallor 1-4 hours after ingestion #DDHChat

Q4:Living with any chronic illness can be extremely debilitating and life-altering. How can food allergies impact an individual’s quality of life, especially for children and parents? #DDHChat

Raquel Durban, MS, RD, LDN: There are many publications that have looked at this because food allergy is so impactful on quality of life (QoL). Think of food allergy diagnosis as an opportunity to bloom rather than wilt!  Focus on safe foods that you CAN have rather than the cannot.  Learn a new recipe or adapt a favorite with a few substitutions Budget for specialty items and call the grocer before you go to check stock of your speciality needs. Online retailers are a great option too! Speaking of budget, some speciality substitution foods are more expensive, so consider this when planning your food expenses! Instead of the speciality substitution for egg could you use apple sauce? Or banana? This goes back to the tried and true rule of shopping the perimeter! Let’s say you get to the dairy and bread section to be reminded that milk and wheat need to be avoided. Don’t despair! Allergen replacement foods have come so far with innovation that you wouldn’t believe how yummy your options may be! So now that you’ve shopped and cooked, pack those “just in case” snacks and head out for a sunny day adventure with your emergency meds and action plans! If you cooked a little extra, can you freeze it for your batch cooking needs?  Send these extras for lunch or save for those days when you’re in a hurry!  Plan for social events by keeping shelf stable substitutions handy to help ensure inclusion in the festivities. #DDHChat

Q5: Reading packaged food labels can be challenging when you aren’t sure what the ingredients are. What should people look for when reading FDA labels? #DDHChat 

Raquel Durban, MS, RD, LDN: The FDA has an awesome resource on labeling laws as it related to food allergies. https://www.fda.gov/food/food-labeling-nutrition/food-allergies. In 2004, congress passed the Food Allergen Labeling and Consumer Protection Act (FALCPA) of 2004. This law requires the top 8 allergens or “major food allergens” as at the time of the law passing these 8 foods made up 90% of food allergens.  These major food allergens are: milk, egg, wheat, soy, peanut, tree nut, fish and shellfish. They must be labeled in plain language on a label in one of two ways.  In parentheses following the name of the ingredient. Examples: “lecithin (soy),” “flour (wheat),” and “whey (milk)”  Immediately after or next to the list of ingredients in a “contains” statement. Example: “Contains wheat, milk, and soy.” Precautionary allergen labels (PAL) such as “may contain” or “manufactured on the same equipment as…” are not regulated by FALCPA. Language on PAL does not indicate risk. Sesame is under consideration to be added to FALCPA. 

FALCPA does not apple to foods that are placed in a wrapper or container (such as paper or a box for a sandwich) following a customer’s order at the point of purchase. FALCPA does not include meat, poultry or egg products. The USDA regulates these. #DDHChat

Q6: Finding staple food items suited for people with food allergies can be tough. What tips or advice do you have for people when they go grocery shopping? #DDHchat

Raquel Durban, MS, RD, LDN: Plan ahead by reading the grocer’s weekly ads for sales. Considering splitting safe bulk items with another food allergic family. Shop the perimeter for single ingredient options such as fruits and vegetables. Innovation has lead to numerous alternatives. Check out brands online before you shop. Many companies have an FAQ or customer service contact to answer your food allergy related questions #DDHChat

Q7: Elimination diets are used to identify food sensitivities and allergies, but can you explain why having a diverse diet is important, especially for young children? #DDHChat

Raquel Durban, MS, RD, LDN: When the diet is not diverse, it can be unbalanced and this may impact growth or lead to malnutrition. Diet diversity also lends to exposure of various textures, temperatures, colors, smells, flavors, etc to engage children AND adults. Complementary feeding is the offering of solids to complement the breastfed or formula fed infants’ nutritional needs. Each food lends a unique combination of nutrition as well as aids in meeting developmental feeding milestones. Diversity in the diet is important at all ages! Select a few options from each food group and consider various preparations. Once you’ve mastered those, think about how to combine these options or build on them. The choices are endless! Don’t let an elimination block your creativity.  Focus on “What can I eat?” rather than “What do I need to avoid?” #DDHChat

Q8: Dining out with friends and family does not have to be off-limits for a person living with food allergies. What tips can you provide patients who have food allergies but want to enjoy dining out again? #DDHChat

Raquel Durban, MS, RD, LDN: Check out Allergic Living. They are a wealth of resources on dining out. Food Allergy Research and Education (FARE) has wonderful chef cards too in various languages if you’re globe trotting! https://www.foodallergy.org/resources/food-allergy-chef-cards. Call the restaurant before you arrive to ask how they handle food allergies and the options they may have for your needs. Let them know what time you plan to arrive. When you arrive, speak up and don’t feel embarrassed! You’re ensuring your safety. Check out this resource from FARE for the 101 on dining out: https://www.foodallergy.org/resources/dining-out #DDHChat

Q9: On average, what is the cost of food allergy, what impacts might this have on family members and/or caregivers, and why do you feel it is important to raise awareness? #DDHChat

Raquel Durban, MS, RD, LDN: FARE recently published this data: https://www.prnewswire.com/news-releases/new-research-shows-one-in-four-american-consumers-do-not-purchase-products-containing-the-top-9-food-allergens-301081016.html.  cost of food allergy extent is beyond food, copays for appointments, testing, oral food challenges. What about missed work, mileage to appointments or speciality grocers? When parents are missing work, children also missing school. What resources and time is needed to make up this work? The cost of food accommodations in the cafeteria for the food allergic child. These children deserve and are mandated to be offered a safe option, but these safe options may cost more for the school to obtain these foods. The language we use around the cost of food allergen is most important. It is not the burden of the food allergic person, but the entire community to ban together for support to ensure these associated costs do not prevent other necessities from being unmet. FARE and @APFEDorg have lobbying opportunities if you would like to get involved #DDHChat

Q10: What is batched cooking, and how might this help an individual with food allergies save money? #DDHChat

Raquel Durban, MS, RD, LDN: Batch cooking is an awesome way to save time and money! Batch cooking is a way to meal prep when you cook more food, less often. Think of only having to cook once or twice a week! This also means, less frequent trips for food shopping. And if you are like me and toss items in the cart that are not are your list, this might save you money too! And batch cooking doesn’t mean food has to be boring or repetitive. You can spread the meals out based on their frozen food safety recommendations found here: https://www.foodsafety.gov/food-safety-charts/cold-food-storage-charts. And you might make a meal that you can add a different sauce or side to jazz it up! #DDHChat

Q11: What other tips or words of encouragement do you have for those living with food allergies? #DDHChat

Raquel Durban, MS, RD, LDN: Food allergy is an opportunity to increase self confidence! Believe in your worth and speak up for yourself in situations where food safety may be a concern #DDHChat

IFFGD – final tweets and remarks:

Remember that food allergies are common and you are not alone in this quest to find the right foods for you. To learn more about this topic from Raquel Durban, MS, RD, LDN, visit https://www.carolinaasthma.com/

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