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Today's Dietitian: FPIES

I am honored to have been able to provide an interview for this national magazine, bringing further recognition and awareness to this allergy and the vital role a nutrition professional plays on the medical team of a child living with FPIES.  

Food Protein–Induced Enterocolitis Syndrome — The Hidden Scourge of GI Food Allergies By Judith C. Thalheimer, RD, LDN  (Today’s Dietitian Vol. 15 No. 11 P. 12).  

Be sure to check it out! 

What is FPIES? FPIES At A Glance

For more information, go to www.fpiesfoundation.org 

Gardening for Your Health

Ok, so what does a garden have to do with FPIES?  Well, when you begin to see everything with "FPIES eyes" (as a fellow FPIES mom recently coined), you can help but see some connections, along various levels to many things pertaining to health, food, farming, agriculture, nutrition, medicine, etc.

Follow along with me, to learn a little about what I have been learning about....

I recently attended a simple community education class taught by a PhD Chemist whose own health challenges led him to the connections of soil and our health. He teaches the class to help raise awareness and educate people in the communities of the biology of the soil and what we can do to fix it by helping us understand soil fertility and plant health.  Because, in fixing the soil, we can fix our food and fixing our food, we can improve our health.  Sounds simple?  Well, it's all biology (and a little chemistry)!

I support his efforts to raise awareness to sustainable farming and returning nutrition to our food supply. I attended for this purpose, because of my interest in "buy local, eat local, know your farm, know your farmer, and produce what you can".  We have done a garden for the past many years, but I want to expand on it but also to assure what I grow is grown healthy and avoids the use of chemicals while still getting a good sized crop that I can freeze/preserve.  While I listened, I couldn't help but think of FPIES and how many families (myself included) and some research has tied it to gut microbes, environmental factors, some families speculate on genetic connections in this context, so I wanted to share my notes from this class.
Disclaimer: as with all articles I 'review/summarize' on this blog, these are simply my notes; I am including some information from the slides to help my notes make sense; however, I apologize ahead of time for my sketchy/incomplete thoughts in my notes- I was writing as fast as I could while listening and processing! 

Gardening for your Health

Douglas Piltingsrude PhD

Human Health (excerpts from some of the slides)
The presentation was started with the summary of “the problem” – how the lack of essential minerals in the human body means decreased functions and faster aging which is a product of a lack of essential minerals in the plant results in incomplete carbohydrates and proteins resulting in diseases and insects which is a product of lack of essential minerals and mineral balance in the soil results in low plant uptake thus poor plant and human health.

He went on to outline, as an example, the connections of human health to Magnesium and plant health to Mg and then soil and Mg.

My notes: (from discussion of these introductory slides):

• Enzymes are the magic of life, minerals are needed for enzymes; however this doesn't mean we should use supplements to increase our mineral intakes because the best absorption is from FOOD, not from supplements. (this made my dietetics side smile, as this is what we are 'trained'- food is medicine). Other reasons are because supplements have additives and are missing co-factors that the plants have for your body to utilize that mineral optimally.  Also, Supplements are a band-aid – although band-aids are important, they are not the solution.
• Minerals in plants are 98% bio-available, where as supplements run 10-20% bioavailability.
• Plant health- need nutrient to interact with enzymes to make other processes, if decreased nutrient = less nutrients are made by the plant. 
• 64 minerals in every cell in your body
• Lack of balance of minerals in soil

Human Health Loss (excerpts from some of the slides)

• Poor Health results from Stress, such as: Lack of Nutrition,  Emotional Strain, Toxicity from food and environment, physical damage. 
• Loss of human health- doesn't happen overnight.  Some stages of decreasing health are: reduced elimination of toxic substances, signs of toxicity (skin rash, bad breath, etc), inflammation to trap the toxins, chronic disease (ulcers, IBS, chronic fatigue, etc), and finally, organ failure.
• A slide covered a page from “Minerals for the GeneticCode” by Charles Walters for examples of how a deficiency in minerals contributes to disease or ill conditions. The presenter said that there is a website for the book, which I can not locate).  He also notes that this book is not an easy read, but can be used as a reference material. 

My notes: (from discussion of slides)

• Loss of health happens in stages, progressing through the stages as the stress to your body continues to build:  

            Reduced elimination (of toxins)

Signs of toxicity

Inflammation (in body) to trap toxins

Chronic Disease

Organ Failure

• When you do health by nutrition, it takes longer but you don’t have side effects of drugs.  Drugs= symptoms, symptoms are from toxins in the body.
• An example given is Dementia.  Dementia is a Yytrium deficiency with an aluminum toxicity.  Silicon is important because silicon binds to aluminum.
• All processed foods have reductions in nutrients.

Plant Health Loss (excerpts from some of the slides)

• Plants that are unhealthy attract insect and disease
• Like Humans, plants that lack nutrients get sick
• Plant genetics are a secondary factor to the basic problem
• Photosynthesis explains the issues (graph of photosynthesis chemical breakdown of plant structures)
• More complex molecules are not insect food – the insects antenna aren’t built to detect frequency put out by more complex molecules. The insects don’t have the digestive enzymes that can digest these more complex molecules.

My notes: (from discussion of slides)

• Unhealthy plants attract insects- insects take up the frequency of a foods signal.  Insects are attracted to the unhealthy plant, healthy plants ferment in their system and they die.
• Plants with a particular make up has a particular frequency and insects read frequency of sugar, polysaccharides, starch, amino acids, and dipeptides (simple carbohydrates and simple proteins).  The more complex the molecule structure (cellulose, lignins, polypeptides), the signal is not right and bugs are not attracted to it.
• The insects digestive enzymes can’t break up complex molecules and ferments in their system and the insect dies.  There may be a few insects on your crop but if it is a healthy crop, insects will not stay because they will be dying.  Healthy soil = few bugs that won’t live.
• **Don’t spray for bugs- fix the soil!!
• Round up – complexes all the +2 minerals (such as Copper, Magnesium, Zinc, Nickel, etc) and now the plant doesn't have the mineral to make enzymes to make the plants immune system.  Plant gets diseased. Effects happen to humans because of the diseased plant.
• Part of the plants immune system = minerals (something we tend to want to buy supplements for) – it starts in a healthy soil.

The next section goes into “the solution” (first part of the class was discussing the problem, as a Scientist, he wanted to find how he could contribute to the solution (for his own health), in so doing he saw a great need to educate people so that people will put the pressure on the market. 

Soil Biology (excerpts from some of the slides)

• First showed a visual of the live organisms in the soil, such as: bacteria’s, actinomycetes, fungi, algae, protozoa, nematodes, earthworms, and arthropods (in order of pounds per acre).
• What microbes do for us: decompose soil contaminates, suppress disease producing organisms, perform nutrient recycling by decomposing organic plant and animal material, form large complex carbon structures that open the soil to air and water, transform minerals and nutrients into plant usable forms.
• Biological focused agriculture: Definition: enhancing the natural soil life cycles to grow more soil and crops.  Components for growing soil and plants: Air, water, sunshine, plants and microbes, minerals. 
• Conventional Agriculture:  -cide farming products (Herbicide, pesticide, fungicide, biocide, algaecide, insecticide).

My notes  (from discussion of slides)

• Top 6” of soil is where 3.5tons of microbes live (per acre).  
• Plant can take up nitrogen directly but everything else requires microbes.
• Worms are a microbe factory
• Microbes are the bridge from mineral to plant- transform minerals and nutrients into usable form for the plant. 
• Fungi feed on bacteria (can’t exist without it)
• -cide= kill (conventional agriculture)
• Gardening, we depend on biology, with farming we manipulate biology and put on band-aids that are toxic to the soil.

Soil Composition (excerpts from some of the slides)

• Optimum soil make up: 45% Minerals, 25% Air, 25% Water, and 5% Organic matter
• 45% Soil Minerals: Calcium, Magnesium, potassium, sodium, phosphorus, nitrogen, sulfur, boron, iron, manganese, copper, zinc, silica
• 5% organic matter: plant residue is not part of the 5%, undecomposed roots and tops of plants and animal remains (Humus).

My notes: (from discussion of slides)

• No oxygen = anaerobic microbes (rotton/sour). Healthy microbe life needs aerobic microbes. Microbes need food to live (carb)
• 5% organic matter is what you have after the microbes break down materials= humus.

Soil Potential (excerpts from some of the slides)

• Factors that set the limit for soil performance: weather, %organic matter/carbon, calcium to magnesium ratio, TEC or CEC. 

My notes:  (from discussion of slides)

• %organic matter/carbon = how much carbon in soil from breakdown 
• Calcium to Mg ratio= loose vs. hard soil
• TEC or CEC = how many clay particles, which translates to how many 'sites' to 'set' minerals on. 
• Annual soil potential- primary nutrients determining the % of the performance reached are: Sodium, Potassium, Nitrogen, Phosphorus. Secondary nutrients or trace minerals are: Boron, Iron, Mn, Copper, Zinc. 

Balancing Soil Minerals (excerpts from some of the slides)

• A visual slide about how minerals are stored on clay particles until used by the plant.  They are insoluble yet plant available. (a critical process).
• Slides included illustrations showing the importance of the balance of plant uptake minerals.
• An illustration of some minerals that "butt heads"(compete for space)
• Imbalanced Soil = Plant problems.  Examples:  Excessive magnesium in the soil causes potassium, phosphorus, calcium and nitrogen deficiency in plants.  Potassium deficiency in the soil causes manganese excesses and zinc deficiency.   Excess sodium, potassium and magnesium in the soil causes calcium deficiency. Boron deficiency in the soil causes calcium deficiency in the plants.
• Included a detailed discussion of soil testing- showing example illustrations, how different types of soil differ and where problems can arise (from the imbalances).
• The real soil test issue is field performance.

My notes: (from discussion of slides)

• "You are only as strong as your weakest link"- If short one nutrient (or have too much of a nutrient), it affects the plants ability. 
• A lot of agronomy is done by trying to get a bigger crop, but not increasing the potential of the crop = problem. 
• Improve quality and yield of soil = raise the potential (change the soil)
• Mineral imbalance- plant has genetics that decides what it needs, has to have a balance in the soil.

Soil test and use Connection  (excerpts from some of the slides)

• Albrecht Soil Test (recommends this test).  Other tests do not show that nutrients are not ranked numerically but by “low-medium-high” values and without any ‘manual’ to know what to DO about the readings.   Instructions are VITAL (no matter the cost).  Albrecht has 80 plus years of research by William Albrecht and then Neal Kinsey.  It is the longest estabilished soil test by the USDA, developed from 200 best crops across 40 countries plus University of MO research, data over 60yrs, in 60 countries on 200 crops. It is a teachable method, affordable, and he recommends it.
• Illustration was for 2 different tractors- both good tractors, both do the same thing, but have different owners manuals, you can’t use the owner manual for the opposite tractor.

My notes: (from discussion of slides)

• All soil tests are different, none are wrong.   The problem comes with the CONNECTION between tests and field performance.  You have to have the information that tells you what to do: soil test does this, do that to get yield.  BUT not all soil tests are the same. 
• Used an analogy of the similarities of you in the grocery store and the plant in the soil- people go to the grocery store, all different genetics, we shop and get different groceries even though we have the same choices/the same store. Plant in the soil, has its own genetics; but like in the grocery store, there needs to be a balance as the plant can choose what it needs based on genetics.
• Biology of the soil adjusts itself to the conditions.   Fix the soil and microbes will come.
• Example given: calcium levels increased causes copper levels to increase, which causes fungi to vanish.

**Soil test- if you don’t know where you are starting, how do you know where you want to go?**

• Two soil test types (different types) – not the same for each lab. Chemistry wise, none are wrong but the instructions for using them are different (cant’ interchange between soil test types, must have instruction manual).
• What is ‘broken’ is the soil tests, without enough connection to the performance (so not valuable).
• Recommends: Albrecht Soil Test, if you can’t do the test (costs ~$50-100) but want to do something, start by putting 500# of composted manure per 1000 square feet  of your garden (in following years, only put 100#- too much manure can cause nitrogen excess)- it won’t fully balance the soil but it is better than doing nothing.

Decompose Contaminates   (excerpts from some of the slides)

• Herbicides, pesticides, fungicides, oil, salts, GMO plant residues and antibiotics can be broken down into basic building blocks for building new molecules.  Bacteria, actinomycetes and fungi are the microbes that perform this task. 
• Establish different soil life: open the soil up by balancing the minerals, inoculate the soil with microbes and enzymes, keep carbon:nitrogen rations balanced and increase plant and animal matter additions to the soil to increase organic matter, raise % organic matter to >3% for maintaining microbe life. 
• "Build a hose and microbes will come"

My notes: (from discussion of slides)

• Eventually microbes can tear them apart and make useful nutrients 
• Microbes feed themselves first, if a lot of residue, microbes use up nutrients to break down the residue, then the plant will get nutrients. 

Monitor Plant Health (excerpts from some of the slides)

• Measure plant mineral balance by plant tissue tests, take Brix readings for nutrient content of plant sap or produce juice, test plant sap pH, and do visual tests. (slides for illustrations of Brix readings). Gave examples of visual tests, such as: Purple colorations= phosphorus deficiency, cupped leaves on tomatoes = calcium deficiency, tapped ends = boron deficiency. 
• Monitoring with Plant Sap pH: plants are healthiest and produce the best crops when their sap pH is 6.4 (note: want soil at this pH as well).  Sap pH is set in the plant by the balance of acidic vs. basic minerals the plant takes in. 

My notes: (from discussion of slides)

• Need mineral balance to solve the problem. 

Summary/take home points:  

• If it is not in the soil, its not in the plant, then we suffer because we don't have it. 
• All types of Agriculture are biological, the difference is a matter of degree
• Conventional Agriculture suppresses biological activity
• Enhanced biological agriculture balances soil for minerals and biology, breaks down contaminates and monitors plant health. Note: can't grow plants without biology. 

References provided for this class: 

1. Hands-on Agronomy by Neal Kinsey
2. Minerals for the Genetic Code by Charles Walters
3. Nutrition Rules by Graeme Sait
4. Soil Biology Primer by Soil and Water Conservation Society
5. Non-Toxic Farming Handbook by Phillip Wheeler & Ronald Ward
6. Science in Agriculture by Arden B. Anderson
7. The Biological Farmer by Gary F. Zimmer

About FPIES

From The FPIES Foundation

About FPIES

Food Protein-Induced Enterocolitis Syndrome (FPIES) is a type of food allergy affecting the gastrointestinal (GI) tract. Classic symptoms of FPIES include profound vomiting, diarrhea, and dehydration. These symptoms can lead to severe lethargy, change in body temperature and blood pressure. Unlike typical food allergies, symptoms may not be immediate and do not show up on standard allergy tests. Furthermore, the negative allergy evaluation may delay the diagnosis and take the focus off the causative food. Nonetheless, FPIES can present with severe symptoms following ingestion of a food trigger.  Read more.....

An individualized treatment plan....

Earlier this week, I read an article released on Medscape as part of a report on Challenging Diagnosis in Allergy and GI.  It features this article: “Recent Advances in the Treatment of Eosinophilic Esophagitis” by Shauna Schroeder, Dan Atkins, and Glenn T. Furuta. ( http://www.medscape.com/viewarticle/731955?src=ptalk ).   The Abstract reads: “First described nearly 20 years ago, eosinophilic esophagitis (EoE) is an inflammatory disease of the esophagus characterized by eosinophilic infiltration of the esophageal epithelium. Over 50% of the current literature on EoE has been published in the last 3 years, signaling both a rising incidence and increased recognition of this disorder. Treatment options available for patients with EoE include dietary management and/or pharmacologic therapy. An individualized approach to treatment is preferred, with an emphasis on patient–parental preference. The objective of this article is to discuss the current and future treatment options for EoE.”

I read this article, and am encouraged by such advances in the understandings of EoE treatments.  My hope is to someday (soon) be reading an article such as this about FPIES.  There has also been increased literature publication on FPIES in the past 3 years.  As advances in EGID’s (Eosinophilic Gastrointestinal Disorders) emerge, it is promising for FPIES research; the more definition behind this gastrointestinal illness brings further delineations in what needs to be researched for definitions to other gastrointestinal disorders, such as FPIES, protein-induced enertopathy, protein-induced colitis and proctocolitis.  The spectrum of these protein induced gastrointestinal disorders will all benefit from these advances.   FPIES reactions themselves can be classic or chronic, there seems to be a spectrum within these for those affected by FPIES and it varies in each child.   FPIES mechanisms are still not fully understood. Fortunately, there is some understandings of the potential mechanisms with advances in cellular research; but one thing that remains a standard in FPIES treatment as it does in EGID’s treatments is “An individualized approach to treatment is preferred, with an emphasis on patient–parental preference.”

A Case of Severe Atypical Food Protein Induced Enterocolitis Syndrome

I recently read this article: A Case of Severe Atypical Food Protein Induced Enterocolitis Syndrome (abstract here).

It is a short article published in Allergy journal in August 2010 about a case of a severe reaction to cow's milk in a 4yr.old boy.  "The article highlights the potential severity of this condition and its capacity to present beyond infancy".

This 4yr.old boy, with a history of developmental delays had been receiving his extensively hydrolyzed cows milk formula via tube feedings since infancy.  He had ongoing eczema and a history of GERD; but otherwise had no other indications of allergy past infancy.   He was given unhydrolyzed cows milk formula in an overnight feed, within 2hours he was showing discomfort and began to have frequent watery stools (every 10-15min), which progressed to bloody stools within 2hrs.,so the feedings were stopped, and he was also having significant shortness of breath so was taken to the ER.

The article goes on to describe how he presented in the ER without fever (actually had low body temp), had low blood pressure and also acidotic and significant shortness of breath.  Further labs also revealed increased methaemoglobin, neutrophils and platelet levels.  He was treated for his symptoms of presumed septicemia and remained in the hospital; although extensive work up could not find a source for his symptoms.  Follow up endoscopy was performed 3 weeks following this episode and biopsy findings revealed gastritis and eosinophlic infiltrate in the colon.  He was resumed on his tube feedings with an elemental formula. 

The conclusion of the article highlights that FPIES is a "complex of vomiting, diarrhea, and systemic inflammatory response because of Non-IgE food allergy". The authors note that this case is outside of the published criteria for typical FPIES but that it illustrates the severity of this type of allergy and that it is possible to have an FPIES response beyond infancy.  The authors conclude the article with a very important message about FPIES, "FPIES is frequently misdiagnosed, and children often have several acute presentations before the diagnosis is established. In view of its potentially fatal clinical course and the recent increase in prevalence suggested by others, it is critical to consider the diagnosis in young children presenting with acute onset of gastrointestinal symptoms or shock".