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FOMO: Fear of Missing Out… On Nutrients

Part II: Wheat, Soy, Peanuts, and Tree Nuts

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Welcome to Part II of our FOMO series! Here we’re discussing how to replace nutrients lost from eliminating wheat, soy, peanuts, or tree nuts from your diet. You can find Part I here covering dairy, eggs, fish, and shellfish.

If you’re used to eating toast, cereal, pancakes, or other baked goods for breakfast, avoiding foods that contain wheat will likely be a hard adjustment. Or maybe you fed peanut butter and jelly sandwiches to your first child with no issue and your second child cannot eat peanut butter. It is an adjustment, to say the least! 

As a pediatric nutritionist, my work focuses on making sure kids with special dietary needs are getting the nutrients their growing bodies need. As you can imagine, many of my patients have multiple food allergies and have a fairly limited diet. The silver lining for these patients is that these children tend to have healthier diets because they’re avoiding lots of processed foods! 

I like to start by looking at each food that’s avoided and its corresponding nutrients side by side. As we discussed in Part I, this approach can make it less intimidating to identify other food sources for those lost nutrients.  

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Let’s take a closer look at a few of the nutrients needed when avoiding wheat, soy, peanuts, and tree nuts.

Wheat products in America are fortified with B vitamins, thiamin, riboflavin, and niacin. 

Thiamin is important for maintaining a healthy metabolism and key function of cells. The major thiamin food sources are whole grains, meat, and fish. In the US, breads, cereals, and infant formulas are enriched with thiamin as well as other B vitamins. If you’re avoiding wheat and most breads and cereals, you may want to ensure your wheat-free products are enriched with these key nutrients as well!

Niacin is another B vitamin—B3 to be specific. Niacin helps our bodies use fat, protein, and carbohydrates to create energy. This vitamin is also enriched in processed wheat products and can be found naturally in most meats as well as mushrooms, avocados, and sunflower seeds, to name a few. 

If you’re a meat eater and wheat-avoider, I’m not typically concerned that you’re missing out on B vitamins (thiamin, riboflavin, and niacin) or iron. However, you may want to think about how much fiber is in your diet. Many people substitute rice, potatoes, and corn-based products for wheat. However, these are mostly low in fiber.

Fiber is a carbohydrate that your body does not digest. There are two types of fiber: soluble fiber and insoluble fiber. Soluble fiber dissolves in water and helps to regulate blood cholesterol and glucose levels. Insoluble fiber does not dissolve in water and works to move food through the digestive tract. Many people experience symptoms like constipation after making a change in their diet. In these cases, I tell my patients to increase their fiber intake and add fruits, vegetables, legumes, brown rice, and other whole grains like oatmeal and quinoa. 

If you are not a meat eater, and you’ve eliminated wheat or soy, this next one is for you.

Iron is found in red meat, fish, and poultry, but there are many plant-based sources of iron outside of wheat and soy, including spinach, beans, lentils, nuts, seeds (e.g., pumpkin, chia, sunflower, and hemp), dried fruits, quinoa, and some fortified breakfast cereals. Iron is better absorbed with vitamin C, so I recommend adding an orange alongside your trail mix for your next snack. Calcium inhibits iron absorption, so whether you get your calcium from dairy or a dairy substitute, try to avoid eating them together. 

Avoiding soy is not easy because it is in so many foods. Both peanuts and soy belong to the legume family and contain many of the same nutrients such as B vitamins, protein, magnesium, and phosphorus. 

Magnesium helps normalize blood pressure and keeps our bones strong. Phosphorus also helps to keep our bones strong and helps our bodies make energy and move our muscles. Both of these minerals are found in abundance in beans, seeds, and tree nuts. Phosphorus is also found in dairy, eggs, in meat products, whole grains, potatoes, and dried fruit.

The goal for everyone should be to expand their diet and add more variety! A more diverse diet will lead to greater nutrient intake, and hopefully more delicious meals. If you feel like you’re in a food rut, take a chance and add something new to your routine. Your body (and likely your taste buds) will thank you!   

 

Tara McCarthy is a Registered Dietitian Nutritionist who has a passion for pediatrics. She has worked at Boston Children’s Hospital for over 15 years as well as a private practice and specializes in nutrition for children with special dietary needs such as food allergies, celiac disease, FPIES, EoE, allergic colitis, and sucrose isomaltose deficiency. 

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Food Allergy Awareness Week! Things I’d Like People to Know… And a Little Dr. Seuss

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It’s almost here, food allergy awareness week 2018! The official dates for this year are May 13-19.

I’m currently sitting in my office looking at a recent picture of my daughter and me at our state capitol with the governor to advocate for food allergy awareness. If you’ve followed Allergy Amulet for a while, you know I’m a passionate food allergy mom!

One of the greatest things about food allergy awareness week is that it’s a conversation starter. I LOVE that statistics are being shared left and right to paint the picture of how many people are affected! Heck, even buildings around the country are “turning teal” in recognition!

However, it’s important that the conversation not just be about how MANY people are affected, but HOW they are affected. So in the spirit of awareness and conversation, I wanted to share 10 things I’d like other parents to understand about food allergies!

1.    Food allergies are not a choice. We don’t know why our family has food allergies, and we have to manage them diligently every day. Please don’t feel sorry for us, help advocate for us!

2.    Food allergies can be life threatening and they’re a serious health issue, not simply an inconvenience—trace amounts of a food allergy protein can be deadly.

3.   Food allergies require planning. We can’t often join spur-of-the-moment outings, so please make sure to give us a heads up so we can plan ahead!

4.    If we ask questions about your food multiple times, it’s not because we don’t trust you, it’s because there’s no room for error. It’s not personal, it’s precautionary.

5.   Food allergies can be draining—mentally, emotionally, and financially. We can’t let our guard down and our vigilance level is always in “on” mode. We want to experience the same events and activities as everyone else, but it’s not always easy.

6.   We’re not germ freaks if we ask you to wash your hands after eating, or if you see us wiping down an airplane seat with disinfectant wipes. It’s simply that we are trying to keep the risk of allergen exposure to a minimum.

7.    Activities don’t have to involve food to be fun! If you know that someone with food allergies will be joining an activity or celebration that you’re organizing, try to be mindful of the foods they avoid (and give them a heads up if their allergen will be present so they can plan accordingly)!  

8.    Always feel free to ask questions. We will never get annoyed if you ask us a million questions about our allergies. Education is the first step to understanding!

9.   We’re just parents doing what we have to do to keep our kids safe. Please realize we’re not trying to inconvenience you, and that we’d do the same for your child!

10.  It helps to have a village of support so you don’t feel like you’re isolated on an island—if you are part of someone’s village, THANK YOU. It’s not an easy task!

Lastly, I leave you with some brilliant words from Dr. Seuss’s Horton Hears a Who. It seems appropriate for food allergy awareness week. ☺️

Don’t give up! I believe in you all!

A person’s a person, no matter how small!

And you very small persons will not have to die

If you make yourselves heard! So come on, now, and TRY!

 

The Mayor grabbed a tom-tom. He started to smack it.

And, all over Who-ville, they whooped up a racket.

They rattled tin kettles! They beat on brass pans,

On garbage pail tops and old cranberry cans!

They blew on bazookas and blasted great toots

On clarinets, oom-pahs and boom-pahs and flutes!

Great gusts of loud racket rang high through the air.

They rattled and shook the whole sky!

 

When they got to the top,

The lad cleared his throat and he shouted out, “Yopp!”

And that Yopp...

That one small, extra Yopp put it over!

Finally, at last! From that speck on that clover

Their voices were heard! They rang out clear and clean.

 

And the elephant smiled. “Do you see what I mean?”...

They’ve proved they ARE persons, no matter how small.

And their whole world was saved by the Smallest of ALL!

 

- Meg and the Allergy Amulet Team 

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My Child Doesn’t Have a Food Allergy... But Her Friends Do

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When my family moved to a new neighborhood five years ago, we quickly learned that our new neighbors’ oldest son had a severe peanut allergy. Our children became fast friends, and the kids went back and forth between the two houses all the time. None of our three children have food allergies, so this was very new to us. To ensure that he was safe while under our care, we knew we had to get up to speed on how to keep him out of harm’s way (and well fed!).

Here are the top 10 tips we’ve learned, in case you find yourself in a similar situation:

1)    Ask the Question. Inviting a new friend over for a play date or sharing snacks at the park? Always ask the other parent or caregiver if their child has any food allergies. Allergy parents are often grateful if you bring it up!

2)    Read Labels. Get to know the ingredients of the snack foods you regularly buy. Which granola bars contain tree nuts? Which crackers are made in a facility that processes peanuts? At a minimum, know where to look on the packaging to find allergen info. I’m often surprised when a food I would have considered to be nut-free actually isn’t. We’ve created a cheat sheet for you to learn the rules of label reading!

3)    Keep the Original Packaging. It’s so much easier to check the ingredient list on a box of crackers if it is still in the original packaging. Often, similar products made by different companies have different allergy warnings and ingredients. 

4)    Have Allergen-Free Snacks on Hand. Consider offering fresh fruits, veggies, or cheese for kids who can eat dairy. We’ve found that parents of kids with allergies are happy to make suggestions for healthy and safe snacks that everyone can enjoy. As an added bonus, minimally processed foods are healthier anyway!

5)    Think About Cross-Contact. When you make a PB&J for your child, does the knife go in both jars? If so, that jam may contain peanuts. I try to use two different knives, but if we have a friend over with a peanut allergy, I open a new jar of jam rather than risk an allergic reaction.

6)    Keep Up the Hand Washing. We all know we should have kids wash hands before eating, but what about afterwards? If your kids eat a peanut butter sandwich, be mindful that their hands may have peanut residue on them, which could pose a risk to those with peanut allergies! Post-meal hand washing also helps keep those toys clean! 🙌  

7)    Think Outside the House. When we carpool with the neighbor that has a peanut allergy, I wipe down the car handles and other surfaces that our kids touch, especially since our family often eats in the car! Let’s be honest, don’t we all? 😉

8)    Make Birthday Parties Inclusive. Ask about food allergies on the invitation. For an electronic invite, you can list what you are planning to serve. We have a child in one of my kids’ friend groups with an egg allergy. His mom is always willing to bring alternative snacks and treats, so a heads up is appreciated in case she needs to plan ahead! 

9)    Know and Support Your School’s Rules. Our elementary school has some classrooms that are nut free, so we always pack nut-free snacks. The lunchrooms are generally nut friendly, with designated nut-free tables. If my child wants to eat with a friend who sits at the nut-free table, he also needs a nut-free lunch. It’s important to avoid undermining the school’s allergen policies. There are plenty of delicious food options for your child that will also keep their friends safe!

10)   Make it Easy on Older Kids. Older kids don’t want you hyper-managing their food choices, especially when they aren’t your children. Make it easy for teens and tweens to self-manage their food allergies by offering plenty of safe options and letting them choose. 

With these guidelines in place, we have been able to successfully navigate the food allergy terrain while keeping our children’s friends safe (and bellies full!).

- Susannah and the Allergy Amulet Team

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FOMO: Fear of Missing Out… On Nutrients

Part I: Milk, Eggs, Fish, and Shellfish

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FOMO, or the fear of missing out, is a source of anxiety for many. For some, it means missing out on social engagements with friends. For others (likely many of our Allergy Amulet followers), it means missing out on certain foods. If you’re in the latter category, this post is for you.

There are many reasons people avoid certain foods: elimination diets, food allergies, or food intolerances, to name a few. In these cases, you’re not only removing the food from your diet, you’re also removing important nutrients (especially if we are talking about growing children!). As a pediatric dietitian, my job is to identify the foods that need to be eliminated, and then figure out how to ensure those lost nutrients remain in my client's diet.

This two-part series will focus on the nutrient implications of eliminating one or more of the top eight most common food allergens from your diet. Whether because of a food allergy or intolerance, or for diet or religious reasons, we’ve got you covered. This first part will focus on milk, eggs, fish, and shellfish. Next month, we’ll cover wheat, soy, peanuts, and tree nuts. Let’s get started.

Personally, I find it helpful to first look at each food and its corresponding nutrients side by side. This approach can make it less intimidating to then find other food sources for those lost nutrients.

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As you can see, some of the foods listed above have overlapping nutrients, vitamins, and minerals. For example, if you are eliminating eggs from your diet, you can find substitutes for protein and vitamin B12 in fish and shellfish.

Where can you find these nutrients and how do they affect your health? Let’s take a closer look.

Protein: Is my child getting enough protein? This question comes up frequently in my practice. First, it’s important to keep in mind that the majority of Americans eat plenty of protein! To see how much daily protein you should be consuming, these Dietary Reference Intake standards provide helpful guidelines. On average, a child should consume approximately .8 - 1.2 gram/kg of protein per day, depending on their age. For example, a 4-year-old child who weighs 35 pounds would need about 16 grams of protein per day. For perspective, a glass of soy milk at breakfast and a turkey sandwich at lunch would be about 24 grams.  

Of course, protein doesn’t just come from animals. There are many plant-based sources that can help you meet your daily protein needs. Most non-dairy milks and yogurts are rich in plant-based protein, for example, as well as beans, legumes, seeds, and nuts.

Has anyone noticed the ever-growing number of milk substitutes hitting grocery aisles? I certainly have! If you’re wondering which one might be best for you, the below table shows common milk substitutes and their approximate nutritional values.

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Calcium: Most parents worry about protein, but I find I’m more focused on calcium intake - especially for those that don’t eat dairy! Calcium is important because it helps maintain the strength of our bones and teeth. It also supports our body structure and helps our muscles, heart, and nervous system function properly. Calcium can be found in vegetables like bok choy, broccoli, Chinese cabbage and collards, beans (black, garbanzo, pinto), and almonds. Several milk substitutes and some orange juices and cereals are also fortified with calcium. Calcium needs range from 700mg - 1300mg/day, depending on a person’s age.

Vitamin D: Vitamin D also plays a role in bone health and the absorption of calcium. Your vitamin D intake depends mostly on sunlight exposure. That said, if you’re not getting much sunlight (read: grey winter weather), it helps to supplement your diet with this important nutrient. You may also routinely have your blood checked to determine whether you’re deficient in this vitamin, as you may need more than the recommended daily dose. If you can’t eat dairy or eggs (a major source of vitamin D), you should look to foods enriched with vitamin D as substitutes.

B Vitamins (B12, B2/Riboflavin, and B5/Pantothenic acid): B vitamins are important multitaskers. They are involved in everything from cognitive function and mood, to energy production and heart health.

B12: The best sources of vitamin B12 are eggs, milk, meat, fish, and poultry. I most often worry about B12 intake in my patients that are vegetarian or vegan. If you fall in either of those camps, plant-based milk substitutes and fortified beverages are great ways to help you meet your daily B12 needs while avoiding animal products.

B2/Riboflavin: Foods high in riboflavin include eggs, dairy, lean meats, green vegetables, and fortified grains (think cereals and breads).

B5/Pantothenic acid: Vitamin B5 (pantothenic acid in scientific terms) plays an important role in turning carbohydrates, fats, and proteins into energy. It removes strain, or stress on the body. Good sources of B5 include mushrooms, cheese, fish, avocados, eggs, lean meats, sunflower seeds, and sweet potatoes.

Expert tip: focus on the foods that you CAN eat. If certain foods are off limits, create a list of the foods you can safely eat, and separate them into different categories (see below).

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Ultimately, the more variety in your diet, the more likely you are to meet your nutritional needs. Plus, it makes eating that much more interesting! Nobody should have FOMO when it comes to food—even if cutting out certain foods is a necessary part of your diet. The solution, in my opinion, is expanding your palate.

 

Tara McCarthy is a Registered Dietitian Nutritionist who has a passion for pediatrics. She has worked at Boston Children’s Hospital for over 15 years as well as a private practice, and specializes in nutrition for children with special dietary needs such as food allergies, celiac disease, FPIES, EoE, allergic colitis, and sucrose isomaltose deficiency. 

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The Secret is Out: Transparency is In

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Last fall, Kellogg’s acquired a protein bar startup called RXBAR for $600M dollars. The significance of that deal is twofold. First is the story behind the company: two childhood friends built the business out of their kitchen with $5,000 each and no outside funding. Second, their brand was built on transparency and candor: each bar neatly lists a handful of ingredients on the front packaging followed by their signature motto: “No B.S.”

The market took notice.

In an era where food labels list hard-to-pronounce ingredients like “tartrazine” and “disodium inosinate” and include vague statements like “may contain” (which we wrote a separate blog post about), consumers are unsurprisingly gravitating towards products like RXBAR.

But the trend isn’t limited to food. Increasingly, shoppers are looking to company values—including a company’s commitment to transparency—when making purchase decisions. More consumers are looking beyond price tag and factoring in product origin, reputation, and quality and ethical standards. The rise of fair trade, organic, and Certified B Corporations (“B Corps”) is a testament to shifting consumer preferences. Consumers are also looking at where companies donate politically: with a new app from startup Goods Unite Us, consumers can run political background checks on products to see what political party their purchase indirectly supports.

Corporate candor is a hot commodity right now. That much is clear.

A Label Insight study looking at consumer behavior around food and personal care products found that nearly 40% of consumers would switch from their preferred brand to one that offered more product transparency. A quarter of respondents indicated that transparency was the leading reason they remained loyal to brands.

We live in a digital age where consumers have access to unprecedented levels of information. In turn, they are using that information to scrutinize company decision-making and hold companies accountable for those decisions. The businesses that are quickest to adapt will likely outperform and outlive their peers.

Investors see the appeal.

Investors routinely evaluate the risk of any potential deal or transaction. Transparency helps mitigate these risks by identifying blind spots, which can in turn reduce reputational, compliance, and financial risk. Transparency also fosters trust: the foundation of any business relationship.

The metrics of business success do not always account for intangibles like transparency and trust—but they should. Facebook is learning that the hard way this month, as user numbers drop and #DeleteFacebook becomes a trending hashtag.

Trust is hard to earn, difficult to quantify, and easily lost. For these reasons, trust is arguably the most valuable commodity a company holds. The precursor to trust is transparency.

- Abi and the Allergy Amulet Team

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Invest In Women

 Female leadership at Allergy Amulet from left to right: Susannah Gustafson (VP of Operations), Abi Barnes (CEO), and Meg Nohe (CMO).

Female leadership at Allergy Amulet from left to right: Susannah Gustafson (VP of Operations), Abi Barnes (CEO), and Meg Nohe (CMO).

While the Chinese zodiac sign for 2018 is the dog, a more appropriate symbol for this year is the woman.

Across the US, women are running for office in record numbers. France announced that it will begin imposing fines on companies that fail to eliminate unjustified gender pay gaps within the next three years. And in the US, movements like #MeToo and #TimesUp have forced our nation to address gender inequality, misogyny, and harassment.

One area where the gender disparity is particularly stark is the startup and venture capital space. In 2017, only 2% of all venture capital was invested in women-led startups, even though women own nearly 40% of the nation's businesses. That same year, the average financing round for women-led companies was less than half that of their male counterparts.

Why the glaring gender gap? While there’s no clear answer, many blame “mirrorocracy”: the idea that the VC community, lacking in diversity, tends to invest in individuals that look like them. Indeed, only ~8% of partners at the top 100 VC firms are women. A recent Harvard study further revealed bias in the line of questioning venture capitalists pose to female and male entrepreneurs. The study found that women were generally asked about the potential for losses, or what the study called “prevention” questions, whereas men were asked about the potential for gains, or “promotion” questions. For every additional prevention question posed to an entrepreneur, the startup raised an average $3.8M less.

Looking back at our own company’s fundraising trajectory, these figures are unsurprising. It took Allergy Amulet nearly three years to secure its first investment: a convertible note in 2016. And the vast majority of our current investors are men.

There’s a strong business case for investing in women. According to Credit Suisse, companies with female CEOs generate a 19% higher return on equity and a 10% higher dividend payout. A study by the Peterson Institute for International Economics found that companies with women in at least 33% of senior management roles accounted for higher annualized stock returns. The study also found that Fortune 500 companies with the greatest proportion of female board members significantly outperformed those with the lowest proportion.

We need to invest more in women, and we need more women investors.

Several VC firms are proactively seeking to address the problem. In a two-part series, Forbes identified several investors and VC funds committed to bridging the gender gap either by ensuring female representation among their partners, portfolio companies, or both.

As with any ecosystem, diversity breeds strength. The startup and venture capital worlds are no exception.  

- Abi and the Allergy Amulet Team

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Peter Rabbit: A Tale of Teachable Moments

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On February 9th, Sony Pictures released its long-awaited movie that modernizes the classic tale of Peter Rabbit—the mischievous little bunny that chases about the garden of grumpy old Mr. McGregor.

While this contemporary rendition has generated lots of laughter and merriment nationwide, it’s also making headlines for the upheaval it’s unleashed in the food allergy community.

In case this is news to you, here’s what happens. The young bunny family discovers that grouchy Mr. McGregor is allergic to blackberries. In their attempt to keep him from monopolizing the affection of their beloved Miss Bea, they launch blackberries at him, one of which lands squarely in his mouth. Mr. McGregor starts to experience trouble breathing and promptly injects epinephrine into his thigh. He then swiftly recovers and starts chasing the bunnies, as if nothing happened. Peter Rabbit even goes so far as to say: “Allergic to blackberries! Is that even a thing? Everyone is allergic to everything! Stop using it as a crutch!”

When I heard the news of the blackberry scene, I was frustrated. The food allergy community has made considerable progress in education, awareness, and teaching kids to be sensitive to those with food allergies. For a major motion picture that targets children to portray food allergies so carelessly (and epinephrine inaccurately) felt like a major step backward.

HOWEVER…

I believe there are some huge positives that came out of the film.

First, this movie has catapulted food allergies into major national news. This New York Times article came out three days after the movie’s release. Press around this incident reached a wide audience, which hopefully helped move the needle forward on food allergy education within the general population.

Most importantly, I viewed this film as a great opportunity to create a teachable moment with my food-allergic daughter. Before seeing the movie, we chatted about the blackberry scene and what she would see. We talked about what really happens when you experience an allergic reaction, and most importantly, about the importance of having compassion for others that are different. We use food allergies in our house as a platform to show our children that everyone has attributes that make them unique—and that differences are not a bad thing! Some of their friends may have food allergies, others might wear glasses, and some may sit in a wheelchair, and it’s important to treat others with kindness and consideration, no matter their differences.

By managing expectations and framing the movie in this light we were able to enjoy the film, and even have a follow-up conversation about the scene afterward. So all in all, I’m thankful for the teachable moments Peter Rabbit brought to our house.

- Meg and the Allergy Amulet Team  

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Everything’s Coming Up… Rotten

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Something in our world is changing. Our bodies are rejecting the food we eat. Even the experts don’t really know why.

In January, Netflix debuted an original six-part documentary series titled Rotten. The series travels deep into the heart of the food supply chain to reveal more than a few unsavory truths about what we eat. Of particular interest to the Allergy Amulet team was the second part of the series: The Peanut Problem.

This episode surveys experts across different fields to understand why the US has witnessed a surge in food allergies in recent decades—more specifically, to peanuts.

According to Dr. Ruchi Gupta of Lurie Children’s Hospital, one in four kids with a food allergy is allergic to peanuts, and more than half of those kids have experienced a life-threatening allergic reaction. 

The problem has become so widespread, in fact, that the peanut industry is beginning to take action. Peanut farmers have started pouring millions of dollars into food allergy research to help address the problem. To date, the National Peanut Board has donated approximately $22M to food allergy research. One company is even developing an allergy-free peanut, which could be on the market as early as next year. 

Peanuts are in trouble. In only a few years they have seen their reputation transform.

The Rotten series artfully underscores the risks that dining out presents. Responsible for nearly half of food allergy fatalities, restaurants have emerged as battlegrounds for those managing food allergies. Chefs must routinely navigate these food allergy minefields—and most kitchens are ill-equipped for the job.

We bend over backwards to make sure our food is safe. Bend over backwards because it’s life and death. – Ming Tsai, Head Chef, Blue Dragon

Surprisingly, no one really knows what’s going on. Doctors are still struggling with what seems to be a simple question: why the increase in food allergies? And why now?

According to Dr. Gupta, it’s likely a combination of genetics and our environment, with environmental factors triggering changes to the composition of our microbiome.

Getting your immune system to know this is ok, that in and of itself would be incredible. – Dr. Ruchi Gupta, Lurie Children’s Hospital

Some of the leading theories discussed in this segment, which we also discuss in an earlier post, include:

-       Microbiome changes: how antibiotic usage in infants and other environmental factors have affected our gut bacteria.

-       Clean state: the idea that the modern world is too clean and the lack of early exposure to dirt, bacteria, and animals weakens the immune system.

-       Early avoidance: for the past decade allergists have advised parents to avoid introducing allergenic foods early in life—it turns out early introduction may prevent the onset of food allergies.  

Much remains uncertain as to the reason for the rise in food allergies, and there is not yet a cure on the horizon. In the interim, management tools, standard precautionary measures (always carry epinephrine!), and treatment options like OIT can make living with food allergies a little easier.

We highly recommend carving out some time to watch this series—you won’t be disappointed.  Whether you have a food allergy, care for someone that does, or simply care about the food you eat—this series has something for everyone.

-       Meg and the Allergy Amulet Team

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Get Your Geek On: The Science Behind Food Allergy Testing

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Food testing is serious business. It’s also a large and growing one: the market for food testing kits was valued at $1.58 billion in 2016. That figure is expected to climb to $2.38 billion by 2022.

Since the enactment of the Food Safety Modernization Act (FSMA) of 2011, food manufacturers are increasingly implementing comprehensive food testing procedures. Allergen testing has accordingly taken on a more prominent role in food safety plans. Traditionally, food allergen testing has been confined to the lab; but as new technologies emerge, and old technologies evolve, that’s starting to change.

In this post, we break down the most common food allergen detection technologies. We also discuss emerging technologies and approaches (including ours!) and why changes in food allergen detection are on the horizon. Spoiler alert: prepare for some major geeking out!

Liquid Chromatography-Mass Spectrometry (LC-MS)

As its name implies, liquid chromatography-mass spectrometry (LC-MS) is a two-phase test. During the liquid chromatography phase, a food sample is dissolved in a liquid and funneled through a highly-pressurized chromatography column, which separates molecules based on size and structure.

The mass spectrometer measures the mass of each molecule, as well as the masses of any molecular fragments. A molecule’s mass and fragmentation pattern provide identifying information about the molecule.

Caffeine: Mass Spectrum

   Mass spectrum fingerprint of caffeine.

Mass spectrum fingerprint of caffeine.

Although LC-MS is a highly-selective tool for molecular identification, LC-MS instruments are expensive and large. Even modest instruments can cost tens of thousands of dollars and stand as high and wide as a microwave. Higher-end instruments can be as large as a car! Test times are also relatively long, ranging from 10 to 30 minutes per food sample. Accordingly, these tests are generally confined to lab environments at present.

Ultraviolet, Visible Light, Infrared, and Raman Spectroscopy

These spectroscopic methods rely on light absorption. A molecule’s chemical structure determines which light wavelengths may be absorbed and the degree of absorption. Spectrometers shine a range of wavelengths at a food sample, and a molecule’s relative absorption of those different wavelengths generates an identifying “fingerprint” for that molecule. You can think of spectroscopy as the enLIGHTened approach to molecular detection 😉.

Caffeine: Infrared Spectrum

    Infrared   spectral fingerprint for caffeine. Peaks and dips signify   degree     of molecular light absorption.

Infrared spectral fingerprint for caffeine. Peaks and dips signify degree of molecular light absorption.

Spectral fingerprints are ideal for identifying molecules in samples containing only a few ingredients. Spectra can be generated in a span of seconds, with high-resolution versions taking only one to two minutes. However, identifying molecules in complex mixtures like food samples can present serious challenges for spectroscopic methods, as spectral fingerprints are likely to overlap, making individual molecules difficult or impossible to identify—especially in low quantities. Accordingly, spectroscopy does not currently lend itself to allergen detection in food samples. Moreover, any spectrometer that could potentially afford sufficient selectivity for allergen detection would be large and costly.

Immunoassays & ELISA

Immunoassay tests rely on antibodies. Antibodies are naturally-occurring proteins in the body’s immune system designed to recognize and fight potentially harmful foreign materials. Each antibody is formed to recognize a specific target—usually a protein or protein fragment. Since the 1950’s, scientists have cultivated antibodies to function outside of the body. These antibodies led to tests known as immunoassays. There are many variants of immunoassays, including ELISA (enzyme-linked immunosorbent assay) tests, which many food manufacturers use to test for allergens during the manufacturing process.

In a typical immunoassay, a liquid sample suspected of containing a particular allergenic protein is exposed to a test strip containing antibodies, which are formulated to recognize that specific protein. If the target protein is present, the protein will stick to the antibodies on the test strip and a secondary reaction will stain the bound protein, causing the test strip to change color.

Immunoassays are highly selective, portable, and can produce results in as little as a few minutes. However, culturing and harvesting specific antibodies can be expensive. Moreover, antibodies—like most proteins—are sensitive to harsh conditions like high temperatures or extreme pH levels. The integrity of these tests, therefore, depends on adequate storage conditions. Antibodies are also known to have relatively short shelf lives and typically degrade within one year.

PCR and Molecular Beacons

Another technology in the allergen detection field involves identifying DNA sequences from an allergenic ingredient using a combination of a polymerase chain reaction (PCR) and molecular beacons. Don’t worry, it’s not as complicated as it sounds.

One way to test for an allergenic ingredient is to detect DNA segments unique to that ingredient. DNA is made of two complementary strands, and when one strand finds its complement, they bind. Simple enough. PCR uses the complementary nature of DNA to identify and exponentially replicate target DNA strands. This replication makes the DNA strands easier to detect using what are called molecular beacons: specialized molecular tags that turn fluorescent upon binding to a target DNA strand. These illuminated beacons can then be measured with a fluorescence spectrometer. While PCR-based assays are sensitive and selective, these tests are generally better suited for laboratory environments because they require automated laboratory equipment.

Historically, molecular beacons have been used to detect nucleotide chains like DNA; more recently, molecular beacons are being used to bind and stain proteins–including allergens–instead of DNA sequences. In this approach, PCR is not necessary, as the molecular beacons attach directly to the protein. Notably, molecular beacon tags require a fluorescence spectrometer to measure the target allergenic protein or nucleotide sequences.

Molecularly Imprinted Polymers (Allergy Amulet’s Technology!)

Molecularly imprinted polymer (MIP) sensors are an exciting emerging technology. MIPs are highly-specialized plastic films molded to recognize a single target molecule, such as an allergenic protein or a chemical tracer for an allergenic ingredient. Historically, molecularly imprinted polymers have been used for drug separation and delivery. Only recently have MIPs been adapted for use as molecular recognition elements in electronic sensing devices.

Building an MIP is similar in concept to creating a lock for which the target molecule is the key. Our polymer films contain hundreds of trillions of cavities (locks), which recognize a specific target molecule (key) by size, shape, and complimentary electron charge distribution. The molding procedures used for MIPs mean that they can be designed to target a wide variety of molecular targets. Our Scientific Advisor, Dr. Joseph BelBruno, was the first to develop electronic MIP sensors for detecting nicotine and marijuana. Allergy Amulet is the first to develop MIP sensors for detecting allergenic ingredients.

   
  
   
  
    
  
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      Imprinted cavity molded to bind to a specific target molecule.

Imprinted cavity molded to bind to a specific target molecule.

Because the core ingredient in a MIP-based sensor is a specialized plastic, MIP films are highly durable and affordable to produce. The high specificity of target binding, coupled with a straightforward electrochemical resistance measurement, allows for rapid and portable testing.

That’s it! Now you know the science behind allergen detection methodologies. We hope you enjoyed geeking out with us for a short while. Until next time!

-        The Allergy Amulet Science Team

 

These scientific explanations have been simplified to accommodate our nontechnical readership. 

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A Look Behind the Label: How Food Manufacturers Prevent Allergen Cross-Contact

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In an earlier post, we explored food allergy labeling laws and why many food products include “may contain” statements. To better understand the extent to which these foods may in fact contain allergens, we’re going closer to the source: food manufacturers.

On nearly all matters concerning food safety, including allergen control, FDA-regulated food manufacturers follow the Food Safety Modernization Act (FSMA).

Signed into law in 2011, FSMA introduced significant reforms to the nation’s food safety laws. For the first time, food manufacturers were required to develop and maintain a written “food safety plan.” FSMA also gave the FDA discretionary authority to approve or reject these food safety plans, giving auditors considerable interpretive power over which food safety plans would pass muster.

In 2015, the FDA published a final rule on Preventive Controls for Human Foods. This regulation is one of the key parts of FSMA and mandates that companies perform a Hazard Analysis and develop Risk-Based Preventive Controls (often referred to as “HARPC”).  The regulation requires manufacturers to identify and implement controls for any “reasonably foreseeable” food safety hazard–which includes the top eight most common allergens (tree nuts, peanuts, shellfish, finfish, soy, milk, egg, and wheat). Accordingly, if any of these allergens could end up in the final food product, manufacturers must implement preventive controls, defined as “written procedures the facility must have and implement to control allergen cross-contact.” Notably, allergen testing is currently discretionary, not required.

So how tough are these food safety plans on food allergens?

According to food safety expert Dr. Scott Brooks, pretty tough. “While FSMA is not prescriptive, food safety plans must stand up to scrutiny from FDA inspectors. The FDA has published industry guidance to help ensure FSMA compliance, and those in the industry know that it’s important to follow the FDA’s guidance documents.” While not finalized, the FDA draft guidance document on HARPC advises implementing controls to prevent cross-contact, and other measures including product sequencing and sanitation controls.

Most larger companies invest considerable resources into food allergen management, according to food safety expert Dr. Bert Popping. Indeed, “large manufacturers often test foods for trace allergens and have allergen management controls in place.” Dr. Popping notes however that “a number of typically small and medium-sized companies have no allergen management in place, and accordingly will often issue precautionary statements like ‘may contain’ for legal reasons, without performing any risk assessment.”

Further guidance on HARPC will be important for advancing safety measures around allergen control at food manufacturers. Until then, we may have to settle for “may.”

- Abi and the Allergy Amulet Team

 

This piece was written by the Allergy Amulet team and reviewed by Dr. Bert Popping and Dr. Scott Brooks for accuracy. 

Dr. Bert Popping is the managing director of FOCOS, a food consulting group based in Germany. Dr. Popping has over 20 years of experience in the food industry, and has authored over 50 publications on topics including food authenticity, food analysis, validation, and regulatory assessments.

Dr. Scott Brooks is a food safety consultant and founder of River Run Consulting. He is the former Senior VP of Quality & Food Safety, Scientific and Regulatory Affairs at Kraft Foods, and prior to that was the VP of Global Food Safety, Scientific & Regulatory Affairs, and Quality Policy at PepsiCo.

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