New Hampshire Nursing News - June 2022

June, July, August 2022 New Hampshire Nursing News • Page 17
Do We Really Know What is In Our
Food? The Connection Between
Dietary Mycotoxin Exposure and
Pediatric Crohn’s Disease
Susan Gonya, MA, RD, RN, CCRN
Upper Valley Community Nursing Project has some exciting news. We have
changed our name to Community Nurse Connection. Kristin Barnum, RN, BSN,
MBA is our new Executive Director and Jill M. Lord, RN, MS is our new Board
Chair.
Our aim is to unite, strengthen and support regional Community Nursing
Programs.
Our beliefs are based on a holistic philosophy of nursing, which dates
back to the mid 19th century—a time when nurses focused on the health of
individuals, families, and groups within a community.
Our focus is on the health people drawn together by such commonalities as
location, religious affiliation, social connections, or fraternal association.
We believe every community deserves access to a community nurse.
Please visit our website: communitynurseconnection.org or email
kristin@communitynurseconnection to learn more about connecting more
communities with nurses.
NHNA Supports MCED Legislation
Pamela P. DiNapoli, PhD, RN, CNL
Executive Director, NHNA
Unity in politics, we hear all too often, is something more honored in the breach
than the observance. But it does happen, and it should be celebrated when it
occurs—especially if it helps to save lives.
Congress has a number of urgent priorities, but the fact remains that cancer
will take the lives of more than 600,000 Americans this year alone. Recently, I
am happy to note, the entire New Hampshire delegation to Congress signed the
Medicare Multi-Cancer Early Detection Screening Act (https://www.congress.
gov/bill/117th-congress/house-bill/1946/all-info?r=6&s=1), legislation that will,
ultimately, enable millions of Americans to detect cancer in its earlier, more
treatable stages. As an exemplar of unity in politics, it does not get much better
than this.
As registered nurses, patient care and interactions place us in the front row to the
emotional and physical cost cancer patients, and their families, endure. Therefore,
as a the executive director of New Hampshire Nurses Association, a membership
organization that values caring and the health of the NH population, I am happy
to see that our Congressional Delegation took notice and acted with patients in
mind. Here in New Hampshire, cancer is the leading cause of death. There were
an estimated 2800 deaths from cancer this year with an estimated 9,340 more of
our citizens diagnosed with the disease this year alone. Cancer remains the second
leading cause of death in America and early diagnosis and treatment are our best
weapons in the battle against cancer.
There is no doubt that the right thing to do is to take advantage of all available
cancer screenings. Tests like pap smears, mammograms and colonoscopies save
lives with early diagnosis. Identification of cancer in its earliest stages yields a fiveyear
survival rate of 89%.
Sadly, there is a lack of early screening for most cancer types. At present, we only
have the ability to test for five of the more than 100 common cancers. There is
hope on the horizon. Multi-cancer early detection (“MCED”) technologies,
currently in front of the Food and Drug Administration, will allow healthcare
professionals to test for dozens of cancer types with a single cancer. The Medicare
Multi-Cancer Early Detection Screening Coverage Act, supported by our NH
delegation, would create a pathway for Medicare to cover these potentially
lifesaving innovations upon approval by the FDA with a single screening.
President Joe Biden announced a challenge to his own administration and those
that follow to: reduce the cancer mortality rate by 50% over the next quarter
century. He dubbed this the “Cancer Moonshot,” something akin to the challenge
President John F. Kennedy posed to Americans that resulted in our landing on the
moon. A crucial component of this moonshot, President Biden noted, would be
“a call to action for cancer screening and early detection.” Additionally, President
Biden spoke to the promise of new multicancer technologies.
As the president then exclaimed, “When we work together in America, there is
nothing — nothing beyond our capacity. Nothing. So, let’s show the world what’s
possible. Let’s show the world that we’re committed.”
Abstract
BACKGROUND: The incidence of pediatric Crohn’s disease (CD) has increased
over the past few decades. The etiology of CD has not yet been elucidated. Still,
researchers have identified variables associated with the disease process, including
genetic predisposition, environmental triggers like a poor-quality diet, air pollution,
water pollution, and a dysbiotic microbiome with increased fungal diversity as
predisposing factors. Fungal mycotoxin contamination in the food supply from
toxicants like Deoxynivalenol (DON), a highly prevalent gastrointestinal irritant,
has largely been ignored as a potential factor influencing the fungal dysbiosis
and symptoms associated with the disease process. It is hypothesized that global
and intermittent exposure to mycotoxins like DON may negatively affect the
gastrointestinal health of pediatric CD patients.
OBJECTIVE: The objective of this two-part thesis project was to search the literature
for evidence of widespread mycotoxin contamination in the food supply. Then, to test
local food commodities for mycotoxins to assess the need to develop a low-mycotoxin
diet as a potential treatment modality for pediatric CD.
METHODS: An integrative review of studies measuring global DON prevalence was
conducted and presented in table and narrative format. With evidence that wheat and
corn crops are routinely contaminated with mycotoxins, these flours were directly
tested for DON using lateral flow screening technology. Wheat bread and pasta
samples were also analyzed and sent to Trilogy laboratory for liquid chromatography,
mass spectrometry-mass spectrometry mycotoxin testing. Descriptive statistics were
used to quantify chemical testing results.
RESULTS: Results showed that globally, wheat, corn, bakery products, pasta, and
mothers’ milk were routinely contaminated with DON. There was sufficient evidence
to suggest that other grain-based crops, soy, coffee, tea, dried spices, nuts, certain
seed oils, animal milk, and various water reservoirs are intermittently contaminated.
Direct measurement of foods in a typical child’s diet, such as pasta, bread, and
raw ingredients such as wheat- and corn-based flours, also demonstrated routine
contamination with DON. Some pasta samples were also contaminated with HT-2
toxin. Contamination rates were significantly higher in 2021 than in 2019, showing the
problem may be escalating.
DISCUSSION AND CONCLUSIONS: Universally, children appear to be at risk
for higher exposures to DON than adults due to their increased intake of cerealbased
foods relative to their lower body weight. This study suggests that mycotoxin
contamination in the food supply is common. The cumulative effects of multiple
mycotoxin exposures by pediatric CD patients may pose serious health risks.
Further investigation into the role mycotoxin contamination plays in the disease
process, microbial perturbations, and fungal dysbiosis inherent in CD is needed. The
information obtained here demonstrates a need to develop a “Low Mycotoxin Diet”
for pediatric CD patients to help mitigate the common occurrence of these biohazards.
KEYWORDS: Crohn’s disease, Pediatrics, Deoxynivalenol, Diet, and Mycotoxin
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Thank you to our NH delegation for support on this important legislation and the
promise for advances in early detection and treatment leading to increases survival
rates.