Breakfast and Crohn's disease--I

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Hidden food ingredients, chemical food additives and incomplete food labels

Many foods and medications containing hidden ingredients are described; labelling is usually incomplete and often misleading. Patients sensitive to foods and chemicals are advised to read and interpret labels. Consumers, manufacturers, government agencies and allergists should cooperate to ensure an adequate national food supply without unduly jeopardizing an increasingly sensitive population.

Grain dust and the lungs

Grain dust is composed of a large number of materials, including various types of grain and their disintegration products, silica, fungi, insects and mites. The clinical syndromes described in relation to exposure to grain dust are chronic bronchitis, grain dust asthma, extrinsic allergic alveolitis, grain fever and silo-filler's lung. Rhinitis and conjunctivitis are also common in grain workers. While the concentration and the quality of dust influence the frequency and the type of clinical syndrome in grain workers, host factors are also important. Of the latter, smoking is the most important factor influencing the frequency of chronic bronchitis. The role of atopy and of bronchial hyperreactivity in grain dust asthma has yet to be assessed. Several well designed studies are currently being carried out in North America not only to delineate the frequency of the respiratory abnormalities, the pathogenetic mechanisms and the host factors, but also to establish a meaningful threshold limit concentration for grain dust.

Investigations of leg abnormalities in chicks consuming high tannin sorghum grain diets

Studies were conducted into the etiology of leg abnormalities noted in chicks fed high tannin sorghum grain diets. These anomalies were characterized by a bowing of the legs with a swelling of the hock joints. The incidence of these leg problems was found to be markedly higher when the amino acids in the diet provided by soybean meal were replaced by crystalline amino acids. Supplemental vitamins and minerals had no alleviating effect on the leg problem. Bone mineralization was apparently not influenced by tannins as demonstrated by similar bone ash values for chicks fed high or low tannin sorghums. A possible alteration caused by tannin in the organic matrix of bone is discussed. High tannin sorghum depressed chick growth and feed conversion when compared with low tannin sorghum in both sorghum-soybean meal and sorghum-amino acid rations. This growth depression was overcome by supplementing the high tannin sorghum-soybean meal diet with .15% DL-methionine, but no growth response was observed from a similar supplementation of a high tannin sorghum-amino acid diet.

[Clinical aspects, diagnosis and therapy of food hypersensitivity]

Foodstuff allergens may cause, either ingested, inhaled, locally or systemically, a varied pathology related particularily to the skin, the respiratory and the gastrointestinal tract. Due to the bewildering multitude of symptoms and the lack of reliable methodology for the detection of the allergens, no diagnosis is reached frequently. None of the available test methods (not even new in vitro tests such as RAST) can replace a thorough medical history. Between 1970 and 1975, we have ascertained 63 cases of foodstuff allergy in our clinic in Zürich. Many of them presented as bronchial asthma, allergic rhinitis, urticaria and Quinckeedema. Celery, potatoes, milk, egg-white, cheese and cereals were most frequently encountered as allergens. The only wholly effective therapeutic procedure consists in eliminating the allergenfrom food, a measure whose practical realization may prove to be quite difficult. Some results with oral hyposensibilisation are presented.

The role of various cereals in coeliac disease

It is well established that the consumption of wheat gluten will produce the characteristic mucosal lesion of coeliac disease in subjects who are predisposed to it. The role of other cereals in the pathogenesis of this disease is less certain. In the present study, four different cereals (rye, barley, maize and rice) have been tested by feeding them to volunteer coeliac subjects who had shown good mucosal recovery on a gluten free diet and assessing the effect by serial jejunal biopsy. The biopsy specimens obtained before and after challenge were compared in terms of histology and disaccharidase activity. The results indicate that rye and barley are harmful but that maize and rice are harmless.

The diagnosis of hypersensitivity to ingested foods. Reliability of skin prick testing and the radioallergosorbent test with different materials

The diagnostic reliability in food allergy of skin prick tests (SPT) and the radio-allergosorbent test (RAST) was investigated in paediatric patients with respiratory and skin allergies. SPT and RAST were found to be reliable for the diagnosis of allergy to codfish, peas, nuts, peanuts and egg white. Positive SPT and RAST to cereals were common, but were most often without clinical significance or were correlated with respiratory allergy to the inhalation of flour dust. SPT and RAST were only partly reliable with regard to allergy to cow's milk, and were mostly reliable when used together and showing corresponding results. Experimental allergosorbents for RAST with soy beans and white beans were not reliable. The study shows the need to improve the diagnostic materials and to establish the diagnostic reliability of the material and tests used for each food item in question.

Indigestion in young calves. IV. Lesions of ruminal papillae in young calves fed barley and barley plus hay

Fiftysix calves, in 2 similar experiments, were given 1 of 4 diets including a high lactose milk replacer: ground barley (GB), ground barley plus coarse hay (GB + GH), coarse hay (CH) and the liquid diet only (NS) ; the 2 last diets were held as controls. The calves were on the experimental diet from 1–2 weeks of age until slaughtered at 7-8 weeks of age. As observed by stereo-microscopy, the ruminai papillae in calves fed on GB were thickened, mostly finger- or club-shaped and sometimes nodular; nodular papillae were always arranged on prominent mucosal folds. Scattered nodular papillae had white coats. For calves fed on GB + CH the papillae were mostly finger- or tongue-shaped. Histologically papillae in calves fed on GB had hyperplasia of secondary papillae and epithelial layers. Microabscesses associated with penetrating hairs were frequent, and some calves had dyskeratosis with infiltration of polymorphonuclear leucocytes at the apex of papillae, identified as the white coats. For calves given GB+CH, abscesses and apical dyskeratosis were absent and the hyperplasia of epithelial layers milder than in the case of the GB diet. An ameliorative effect of hay on papillary changes caused by barley is indicated.

Fungal antigens as a source of sensitization and respiratory disease in Scottish maltworkers

Mycological and serological studies were carried out as part of a survey of respiratory disease in Scottish maltworkers. 70% of stained sputum smears from 574 workers showed the presence of higher plant cells and/or myclelia, and the spores of common environmental fungi. Penicillium spp. (90%), Rhizopus stolonifer (48%) and yeasts (53%) were the dominant fungi in 699 sputum cultures, and showed a similar proportional distribution in 327 samples of grain, malt, culms and dusts from fifty-six maltings. 57% of 711 men were serologically positive for fungi, 22% for Aspergillus fumigatus, 20% for A. clavatus, 10% for A. niger, 16% for Cladosporium herbarum and over 3% for Rhizopus stolonifer, 6% of 132 men were positive for Penicillium cyclopium. No precipitating antibodies to antigens from Alternaria tenuis, Aureobasidium pullulans, Candida albicans, Geotrichum candidum, Rhodotorula glutinis or Trichoderma viride were detected in tests of forty sera. Sera from the 5.2% of men with symptoms of extrinsic allergic alveolitis showed increased reactivity to mycelial antigens from Aspergillus clavatus. The fungus was cultured from 21% of maltings, 7% of all environmental samples and from the sputa of 8% of maltworkers.

Animal studies concerning the cariogenicity of dry breakfast cereals

Four studies were performed in rats and hamsters concerning the cariogenicity of cereals and the role of sucrose in that process. The findings indicate that sucrose content per se does not necessarily reflect the cariogenic potential. Presweetened cereals were more conducive to the formation of smooth surface caries in the hamster than were nonpresweetened cereals while no major differences between the cereals were observed in occlusal caries in rats.

Pulmonary hypersensitivity to Alternaria and Aspergillus in baker's asthma

In two cases of baker's asthma pulmonary hypersensitivity was found to the fungi Alternaria and Aspergillus. Provocative bronchial challenge revealed a dual response; an immediate and an Arthus type hypersensitivity to Aspergillus in the first case. A primary binding assay revealed high titres of anti-Aspergillus antibody in the serum. In the second case intradermal and bronchial challenge suggested an immediate type I hypersensitivity response to Alternaria. The suspected organisms were present in the room air of the bakeries. It is suggested that an immunological response to these airborne fungi may have contributed to the pathogenesis of baker's asthma.

Breakfast and Crohn's disease

The breakfast habits in adult life of 34 patients with Crohns disease were compared with those of 68 matched controls. Cornflakes were being eaten at least weekly by 23 of the patients (67--6%) at the time that their symptoms began, compared with 17 (25%) of the controls at the corresponding time. Only one of the 34 patients had not eaten cornflakes at all, compared with half of the controls. A significant but weaker association was found between Crohn's disease and the eating of wheat cereals. However, in both patients and controls the taking of cornflakes and of wheat cereals were correlated, and the observed preponderance of wheat eating among the patients was almost entirely ascribable to this association of habits. Eating of rice cereals and of porridge was not associated with Crohn's disease, though it was correlated with eating cornflakes. There was an excess of bran eaters among the propositi, but this, too, was attributable to their being also cornflake eaters. Other breakfast foods were taken with equal frequency, and omission of breakfast was equally common. Six of the 68 controls, but none of the patients, ate cornflakes later in the day but not at breakfast. The results need confirmation. There was no evidence that bias could have caused the correlation found. The association of Crohn's disease with the eating of cornflakes is strong and unlikely to be indirect. Variable digestive secretory behaviour after waking may play a part in determining susceptibility to Crohn's disease.

Variable rachitogenic effects of grain and alleviation by extraction or supplementation with vitamin D, fat and antibiotics

Three experiments were conducted using day-old broiler type chicks to determine the effect of different cereal grains on vitamin D3 utilization and to investigate the effects of rye, corn, wheat and triticale as the cereal grain component of the diets on the development of a rachitic condition in chicks. Rye was submitted to acid treatment and water extraction in an attempt to destroy or isolate the rachitogenic factor. Results showed that with chicks fed a diet containing 200 I.U. of vitamin D3 with corn as the grain, mineralization of their bones was normal. Growth and bone ash were depressed when rye replaced corn in the diet. These effects were partially reversed when either fat or procaine penicillin was added to the diet, and comppletely prevented with a high level of vitamin D3 (2,000 I.U./kg.). In another experiment, triticale depressed bone ash even though it did not affect body growth to the same extent as rye. Our results indicate that the factor responsible for the rachitogenic condition of rye-fed chicks can be removed by water extraction of this grain or partially destroyed by acid autoclaved treatment. A combination of acid autoclaved treatment and penicillin supplementation prevented the depression in bone ash.

An epidemic of veno-occlusive disease of liver in central India

An outbreak of veno-occlusive disease which was probably caused by consumption of cereals mixed with seeds of a plant (Crotalaria sp.) containing pyrrolizidine alkaloids occurred in the Sarguja district of India in November-December 1975. 42% of the 67 recorded cases died.

Oats and barley toxicity in coeliac patients

The effect of addition of oats and barley to the glutenfree diets of a group of patients with coeliac disease has been studied using the oral 5 g xylose excretion test to assess small bowel function before and after these supplementations.

Both oats and barley were found to be potentially harmful to coeliac patients although the toxic effect of barley was more readily produced than that of oats.

On the basis of their results, the authors recommend the exclusion of both barley and oats, in addition to wheat and rye, from the coeliac diet. In view of the well recognized risk of the development of malignancy, such a diet should be followed particularly rigorously in those patients with a persistence of symptoms and of marked villous atrophy.

Extrinsic allergic alveolitis in Scottish maltworkers

In a survey of respiratory disease in the Scottish malting industry 5.2% of employees were found to have symptoms of extrinsic allergic alveolitis. In most cases the disease was mild and not associated with any serious respiratory disability. It was significantly less common where modern mechanical methods of malting were used. Mycological and serological studies suggested that it was usually caused by a type 3 allergic reaction to Aspergillus clavatus.