Nutrition.png
 

At BFAC, we understand the unique dietary challenges patients with food related disorders are facing everyday

“Is this dish contaminated with my food trigger(s)?”

“Did the chef/server remember that I cannot eat sesame and nuts?”

“Am I getting all the nutrition I need with my restrictive diet?”

“Maybe I will skip dinner tonight, because I don't want my GI symptoms to get into the way of hanging with my friends. “

Food related disorders (FRD) are a diverse group of medical conditions caused by consumption of a specific food item or food group. Examples include IgE-mediated food allergy (such as nut allergy), celiac disease, eosinophilic esophagitis, food protein induced enterocolitis syndrome (FPIES), lactose intolerance and hypersensitivity to foods resulted from various underlying mast cell activation disorders. Many of these conditions can present with similar symptoms, and may cause confusion and questions such as:

  • I have a food allergy or an intolerance? Do I have a GI problem?

  • Should I be evaluated by a GI doctor, an allergist, or a dietitian? Or all three?

Case Studies

 To help patients with food related disorders , Dr. Leung established BFAC in 2013 with the goal to treat these conditions using a multidisciplinary approach:

GI + allergy + nutrition

Having fellowship-trained in both allergy and gastroenterology subspecialties, Dr. Leung has unique knowledge and experience to evaluate patients from the perspectives of both an allergist and a gastroenterologist in the same setting. A broad range of differential diagnoses from both disciplines are considered, and tools available to both specialties can be used to narrow down and pinpoint the diagnosis. Once a diagnosis is confirmed and if the patient needs dietary treatment, our dietitian will work with the medical team to formulate an individualized plan.

 
 

For example, patients with eosinophilic esophagitis (EoE) often avoid cow’s milk and/or wheat as these are common triggers for the disease. A patient’s dietary preference (such as vegetarianism) may potentially increase the risk of nutritional deficiency. We have designed customized disease-specific laboratory panel to screen for potential micronutrient deficiency in patients on various elimination diets. We modified these panels further to factor in patients’ dietary preferences.

 

Given the increasing complexity of medical elimination diets and individual dietary preferences, we established the Quantitative Nutrition Treatment Center (QNTC) in 2019 to address the growing need of patients who suffer from nutritional deficiency due to restrictive dietary treatment for food related disorders. In addition to qualitative dietary recall and analysis techniques, we obtain a customized disease-specific laboratory panel, based on best available literature, to quantitatively identify potential nutrition gaps in at-risk patients.

 
image.jpg
 

In the example mentioned, the patient will obtain a comprehensive panel that screens for all potential micronutrients deficiency due to (1) milk-restrictive diet, (2) wheat-restrictive diet and (3) plant-based diet. This allow us to determine the exact micronutrient(s) that are deficient and precisely to what degree. A personalized diet plan can then be formulated and prescribed. Our nutrition prescription focuses on the use of natural food sources to replenish the deficiencies. Oral or IV supplements can also be given in refractory or severe cases when indicated.

Diets at a Glance

Created by: Zoe Tabakin & Yijie (Claire) Cheng

Dietetic Interns at Tufts Medical Center

Friedman School of Nutrition Science and Policy