Living with an illness that limits the foods she can eat renders journalist Debbie Galant an expert on Crohn’s, the chronic inflammatory bowel disease that sends her to the hospital periodically to clear out an obstruction. She’s like any of your customers seeking to spread these emergency visits as far apart as possible while enjoying a high quality of life.
“The main thing is I can’t eat anything hard,” Galant says. “So, no popcorn, raw carrots, raw celery or nuts. I’m really not supposed to eat cooked corn either — but sometimes I do. I find if I eat too much, I can get a bowel obstruction. My bowel resection surgery was a little more than 30 years ago, and the scar tissue from that is like a pipe that’s corroded. It’s basic plumbing.
“I wish I could eat nuts,” she adds. “Instead, I scoop a spoon of various nut butters: peanut, cashew, almond or sunbutter.”
Each Person Is Different
Crohn’s is considered an Inflammatory Bowel Disease (IBD) and what triggers a flare up varies from person to person. With Crohn’s, inflammation can develop anywhere in the GI tract — from the mouth to the anus — although it most commonly occurs at the end of the small intestine.
According to the Crohn’s & Colitis Foundation of America (CCFA), about 67% of people with Crohn’s in remission will suffer at least one recurrence within five years (1).
Another IBD is ulcerative colitis (UC), which is limited to the large intestine — the rectum and colon. Some of the main foods doctors advise people with UC to stay away from are caffeine, alcohol, dairy, carbonated beverages, and foods high in fiber. Some people with IBD can eat onions, while others cannot.
About 30% of people in remission will experience a relapse in the next year, CCFA estimates (1).
Neither Crohn’s nor UC is curable, but eating the right foods and avoiding others can help stem repeat hospital visits.
Meanwhile, Irritable Bowel Syndrome, which goes by the name IBS, is something that can be managed with diet. Having IBS symptoms once doesn’t mean they will happen again. IBS can be caused by stress, foods or hormones. The role of food in certain allergies or intolerances is not yet fully understood, but among the foods implicated for IBS are chocolate, spices, fats, fruits, beans, cabbage, cauliflower, broccoli, milk, carbonated beverages and alcohol (2).
Celiac disease is an autoimmune disorder where ingestion of gluten damages the small intestine. According to the Celiac Disease Foundation, “When people with celiac disease eat gluten (a protein found in wheat, rye and barley), their body mounts an immune response that attacks the small intestine. These attacks lead to damage on the villi, small fingerlike projections that line the small intestine, that promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body” (3).
Celiac disease is hereditary, meaning that it runs in families. People with a first-degree relative with celiac disease (parent, child, sibling) have a 1 in 10 risk of developing celiac disease (3). People living gluten-free must avoid foods with wheat, rye and barley, such as bread and beer. Ingesting the tiniest amounts of gluten, like crumbs from a cutting board or toaster, can trigger the immune response.
People affected with an IBD will typically sort out what bothers them by using a food and symptom journal when first diagnosed. A food that didn’t affect them before may start to bother them down the road.
Food sensitivities can develop at any age, and some can be reversed if the right steps are taken, says WholeFoods columnist and nutrition expert Jaqui Karr, CGP, CSN, CVD. While the words “sensitivity” and “allergy” are often used interchangeably, that’s a mistake. Sensitivity usually relates to the digestive system while allergy relates to the immune system.
“The body is designed for variety,” Karr says. “Don’t eat the same food every day. That’s one way allergies develop.”
“People with food sensitivities usually try to avoid foods that cause discomfort but may ‘cheat’ once in a while knowing they may experience some issues,” says Dave Rosenberg, food category manager, NOW Foods, Bloomingdale, IL. “On the other hand, people with a food disease or food intolerance such as a celiac, who have an autoimmune reaction when gluten is consumed, need to avoid specific foods or the repercussions can be more serious. Depending on the severity of their intolerance, they may experience dramatic allergic reactions, abdominal pain, nausea, diarrhea, constipation or even life-threatening reactions.”
“A food allergy triggers an immune response, meaning your immune system mistakes the food for something harmful and attacks it,” says Anne Laraway, senior VP of business development and innovation at Happy Family, New York. “It usually happens every time you eat the food, comes on suddenly and can be life threatening.”
“There are no absolutes for universally safe foods for sensitive digestive systems because once the system is disrupted, there can be several things going on that need a reset,” Karr says. “Fresh fruits and vegetables are generally the safest foods across the board.”
The weaker the immune system is, the more foods and chemicals (like pesticides, sulphites, preservatives) will cause a reaction. Karr recommends using a coach or doctor specializing in allergies because this is not regular nutrition.
“Depending on what stage of damage the person is in,” says Karr, “the list of foods they should and shouldn’t eat will change. How they eat them will also make a difference. For example, raw cruciferous vegetables can be tough on a damaged digestive system. Cooking them until the system is restored is an easy solution as long as someone advises the person to do that.”
Yogurt might be an option for those who are lactose intolerant and labels should contain “active cultures” or “pro-biotic.” Foods rich in magnesium such as spinach, soybean, avocado, nuts and seeds can help cut down on hydrochloric acid secretion to keep the stomach in check.
The eight common allergens include wheat, dairy, soy, tree nuts, peanuts, eggs, fish and shellfish, says Rosenberg.
FODMAP is an acronym that stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols.
These are a group of carbohydrates that are poorly absorbed in the small intestine, cause excessive water to be drawn into the intestine and can become rapidly fermented by bacteria residing in the colon, which results in gas. The end result is water and gas buildup leading to bloating, cramps, diarrhea and constipation.
Reducing FODMAPs can sometimes minimize these digestive symptoms.
The Low FODMAP diet has been clinically shown to reduce GI symptoms in 70% of people with IBS (4). FODMAP Friendly is the only registered certification trademark worldwide certifying FODMAP levels in packaged food.
High-FODMAP ingredients include high fructose corn syrup, fructose, honey, mushrooms, garlic, onions, chicory root, inulin, wheat, rye, barley, polydextrose, fructo-oligosaccharides, nonfat milk, cream, erythritol, sorbitol and mannitol.
Role of Supplements
Supplements can be a make-or-break factor in many cases, Karr says.
“The key is to know exactly what we’re dealing with and create a custom plan accordingly,” Karr says. “You can’t just pop a multi-vitamin and assume it’s going to restore health.”
Some common supplements that are good across the board include vitamin D, B complex, curcumin, magnesium and glutathione. A quarter of people with celiac disease (which is irreversible once triggered) are vitamin K deficient and often anemic, Karr says, so K as well as iron might be advisable.
“If there’s gut damage, then a damage control protocol is needed,” says Karr. “Pre- and probiotics are helpful. Choose as many high-quality brands as possible and rotate between them as each bottle is finished in order to have as many different strains as possible.”
Karr’s power tip: Buy jars with only a 30-day supply each so there is a constant rotation.
“The trends that interest us most are those that blend foodie-ism with food sensitive ingredient requirements,” says Amy Lotker, owner/president, Better For You Foods in Delray Beach, FL. “One example is gluten-free foods made with ancient grains (such as quinoa, buckwheat and chia). Ancient grains offer hearty flavors to baked foods, while providing benefits for individuals who are sensitive or allergic to gluten. Likewise, we favor the continuing trend toward zesty Mediterranean foods — many of which are naturally dairy-, gluten-, egg-, soy-, and corn-free.”
Ancient grains, as well as sprouted grains, are considered whole grains. Whole grains are defined by the Boston, MA-based Whole Grain Council (WGC) as a grain that retains its three original parts; the bran, germ and endosperm. Many grains can fall under the banner of ancient grains including einkorn, emmer/farro, Kamut, spelt, sorghum, teff, millet, quinoa and amaranth. Heirloom varieties of more common grains can also fall under the banner such as black barley, red and black rice and blue corn, says WGC (5).
Other grains like Kamut, which is a brand name for a strain of wheat called khorasan, has scientific research behind its health benefits. In tests on rats, the khorasan wheat did not create inflammation in control rats and protected against oxidative stress and inflammation in experimental rats (5).
Many whole grains are naturally gluten free, including quinoa, millet, teff, amaranth, buckwheat, wild rice, brown rice, and corn (5).
“The one-meal-fits-all strategy of food planning is slowly fading away as people realize that everyone’s body is different,” says Rosenberg. “It will become more important to identify the right foods for one’s body type and find foods that are easily digestible, offer the proper nutrition, and even reduce inflammation. Personalized food analysis and menu planning will become more common as part of a broad customization trend.”
What do retailers need to know to serve their customers with food sensitivities?
“The big issue is avoiding cross contamination,” Karr says. “There’s a risk from raw ingredient, to packaging, to transport, to prep, and then finally, serving. Every single step carries a risk with it and requires stringent processes and unprecedented attention to detail.”
Formally trained staff is non-optional because it’s where the majority of mistakes happen in retail kitchens, she adds. The kitchen also needs to be meticulously, methodically organized.
“There’s a gap between legally gluten free and actually gluten free, so the person purchasing ingredients needs to understand gluten at medical /scientific grade to ensure they’re buying naturally gluten-free products,” Karr adds. “These factors should be taken into consideration at R&D and recipe development stage. Having an expert on retainer to double check can mean tremendous cost savings down the road by avoiding the expensive road of changing recipes.”
The Gluten-Free Certification Organization (GFCO) is the leading third-party certification agent and uses a more exacting standard than that of the FDA. To carry the GF circle, a product’s gluten content must test at no more than 10 parts per million. The FDA, by contrast, requires only 20 parts per million.
More than 40,000 products around the world have been tested by GFCO. Demand is increasing rapidly, says Chris Rich, VP of development for the Gluten Intolerance Group, parent of the GFCO program.
“Some people have a very high sensitivity and we’re that symbol of trust,” Rich says. GFCO auditors conduct on-site inspections to ensure no cross-contamination and periodic spot checks.
“Gluten-free is not a trend. It’s not like Atkins,” he says, noting that for people with celiac disease this is their only option for treatment right now. WF
- “Understanding Crohn’s Disease.” https://www.crohnsandcolitis.com/crohns?cid=ppc_ppd_ggl_cd_da_crohn%27s_Phrase_64Z1867745
- “Irritable Bowel Syndrome.” http://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/basics/causes/con-20024578
- “What is Celiac Disease.” https://celiac.org/celiac-disease/understanding-celiac-disease-2/what-is-celiac-disease/
- Halmos, EP, et al. “A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome.” 2014. http://www.wholefoodsmagazine.com/grocery/features-grocery/healthy-harvest/
Published in WholeFoods Magazine September 2017