Monday, March 10, 2008

Celiac Disease: Not as rare as most doctors think

Celiac disease is a chronic illness that affects 1 in 133 Americans. It is a condition where the body is allergic to gluten, a protein found in wheat, rye and barley (and also in cross-contaminated oats). The immune system thinks that gluten is an invader like a virus or bacteria and develops antibodies against it, attacking it and consequently damaging the lining of the small intestine, the part of the intestine which absorbs nutrients from the foods we consume. As long as the person afflicted with this condition continues to consume gluten or gluten-containing foods, the attack will never relent, with damage and inflammation only getting worse over time.

There are tiny finger-like projections in the small intestine which are designed to absorb nutrients and fats from the foods we eat. In the person with Celiac Disease, these finger-like projections become progressively damaged due to the immune system's attack as it tries to "get rid of" gluten. Eventually the small intestine becomes so inflamed and damaged that it can no longer absorb vitamins, minerals, fats and other nutrients properly. Instead, these just pass on through and out of the body, resulting in diarrhea, possible weight loss and malnutrition.

Symptoms aren't the same from person to person. Some people are diagnosed when they are young due to poor growth and low weight. It was thought, only until recently, that only children had Celiac Disease and that the incidence was quite low - only 1 in 5000. However, doctors are now beginning to realize that this condition afflicts up to 1 in 133 people in the United States. Symptoms may not become apparent until adulthood and they may be mild, instead of severe.

There is no cure for Celiac Disease, but there is an effective way to test for and treat this condition. There is a simple antibody test that you can ask for from your physician, along with a recommended colonoscopy to check for inflammation and damage caused by the disease.

The treatment is a lifelong, strict adherence to a gluten-free diet. This means not eating most processed foods and being very careful where you eat when you do eat out at restaurants. I have Celiac Disease and eat only whole foods. This way I can be assured that nothing I eat contains gluten. Medications should also be checked for any excipients or fillers which may contain gluten. Most medications don't contain gluten, but be sure to call your pharmacy or the pharmaceutical company which manufactures your medication just to be sure.

Even tiny amounts of gluten can trigger an inflammatory response and if left untreated, folks with Celiac Disease will face a 1 in 10 chance of contracting lymphoma, a type of cancer that affect the lymph nodes. Failing to adhere to the gluten-free diet can also lead to depression and anxiety because tryptophan cannot be absorbed properly. Tryptophan is an amino acid that is converted to the mood-elevating neurotransmitter serotonin in the brain but must be absorbed through the small intestine first.

After beginning a gluten-free diet, you will feel better, with less acid reflux, no more diarrhea and perhaps even less anxiety and depression as the small intestine begins to heal itself. I've been on the gluten-free diet for more than a year and feel a world of difference.

Although awareness is increasing of this condition, a lot of physicians are still in the dark and misdiagnosis is common, with symptoms being blamed on a "spastic colon" (Irritable Bowel Syndrome), GERD (gastroesophageal reflux disease), lactose intolerance or anxiety.

Gluten is a very hard to digest protein and whole foods are much more healthy for you anyway, so I recommend a diet rich in fresh fruits and vegetables rather than a diet that contains pasta, breads or other sources of wheat.

You'll most likely feel better on a gluten-free diet even if you don't have Celiac Disease, so please do give whole foods a try. Your body will thank you.

Saturday, March 8, 2008

"Economy class syndrome": What you need to know

Economy class syndrome has been all over the newspaper and TV headlines for the past several years, with little insight given to this problem other than press releases by the major airline carriers, who are in denial over fear of numerous lawsuits, should they discuss in any detail. We are told it is just something that happens to folks who are immobile for long times in the economy class section of the aircraft.

Let's focus on what Economy Class Syndrome really is and what it is not. First of all, Economy Class Syndrome is a misnomer as it also occurs in first class and among flight attendants and even pilots. It refers to DVT, or deep vein thrombosis, where the blood pools in the deep veins of the legs and then clots. Sometimes these clots can break off and travel to the lungs or heart, causing a pulmonary embolism or myocardial infarction, also known as a heart attack. Risk factors include clotting factor abnormalities which are inherited, smoking (nicotine promotes blood clots), illness with cancer, dehydration and prolonged immobility.

Blood travels quickly through arteries, which actively pump the blood to all parts of the body. Veins, on the other hand, are passive and blood flow relies on a one-way valve system. Whenever the muscles are flexed or arms or legs moved, it causes the muscles to squeeze the veins, causing blood to flow back to the heart. If there is prolonged immobility, then the blood can clot. Usually these clots, if they are in the deep veins of the lower legs (behind the calf), will dissolve on their own, but sometimes they will break free and can then travel to the lungs and cut off the blood supply there. That is a pulmonary embolism and is often fatal without immediate medical treatment using "clot-busting" (thrombolytic) medication.

The advice given by the airlines and most general practitioners is to wiggle your toes from time to time and do other in-seat exercises to keep blood flowing. Getting up to walk around the cabin is also recommended every hour or so. Drink plenty of fluids and avoid alcohol or caffeinated beverages as these have a diuretic effect, further dehydrating you. Blood is much more sticky when one is dehydrated.

Now, we go on to examine why folks in business class and flight attendants, who are neither in cramped conditions nor immobile (in the latter case) still get deep vein thrombosis (DVT), or the so-called "Economy Class Syndrome".

A few articles appeared on the web a number of years ago, written by a few doctors and a pilot, stating that the cause is due to rapid compression and decompression, especially the rapid decompression experienced on takeoff. Most airlines pressurize their cabin to be the equivalent of 8000 feet above sea level because it is just not possible to keep the plane pressurized to sea level at the high altitudes they fly. The plane's body, or fuselage, simply isn't strong enough.

I know, you're thinking, "8000 feet? That's like living up in the mountains!". You're right. The amount of oxygenation _and_ pressurization is equivalent to living up in the mountains at a high elevation of 8000 feet. Oxygen content is far less than it is on the ground, although most folks in good health can tolerate this. Folks with heart ailments may be wise to avoid flying altogether or use supplementary oxygen while onboard the flight.

Low oxygen, dry air, immobility and low air pressure all contribute to the increased risk of DVT. In fact, there was a study done where some patients sat in a crowded theater for 8 hours. Examinations were done to look for blood clots. None were found. However, on an airplane flight, it is quite different. One in 10 passengers form clots, but almost all of these dissolve on their own without further complications. This lends more fuel to the fire that there's something about being on an airplane that triggers clots, or causes preexisting clots to dislodge and travel to the lungs or heart.

With all factors analyzed, the only thing that sticks out is low air pressure and sudden decompression and recompression. The airlines don't want you to know this, because I'm sure they know and to admit any fault would mean endless lawsuits or one heck of a class action against them.

The rapid decompression of flying is somewhat like a diver coming out of the water. Divers can experience blood clots if they surface too quickly or fail to undergo proper decompression shortly after surfacing. The same concept applies to flying. Surely it can trigger blood clots and usually these clots don't break off until there is recompression upon landing and deplaning.

In conclusion, it is most likely the rapid decompression on takeoff - a decompression from sea level to 8000 feet in a matter of seconds - that triggers clots and this explains why flight attendants and other active members of the cabin experience the same problem as the rest of us. It is not just long haul flights either. Now it is known that several short flights seem to be just as risky. This is likely due to the compression/decompression at work on producing and loosening up clots.

What is the best prevention? Wear compression stockings. Your doctor will be familiar with those and can recommend to you the right size and compression. Drinking just 4 ounces of tomato juice also has a potent blood-thinning effect (e.g. there is a brand called Cardioflow), along with drinking plenty of water and getting up every hour to walk around.

I have a feeling the airlines will never come forward with the truth. My friend is a long haul pilot for a major parcel service and knows this, so why not spread the news? It might save your life.

Friday, March 7, 2008

Boost your immune system and zap depression with exercise!

Of course we all know about the cardiovascular benefits of regular exercise. Not much is said about anything else. If the cardiovascular benefits of regular exercise are not enough to motivate us, we need to see what else exercise can do for our health.

Exercise performed every other day for at least 30 minutes strengthens the immune system. The reason for this is due to increased endorphin production, the natural pain killers produced by the human body. Endorphins give you that "glow" and feeling of relaxation and in joggers, the "runner's high", where they feel they can keep on running and running without feeling much in the way of exhaustion or pain.

Well, recent research has shown that the immune system's cells contain endorphin receptors. When these receptors are stimulated with endorphins, the immune system becomes much more robust. Increases in the number of T-cells (CD4) have been observed along with a much more healthy immune response, thus increasing your resistance to various illnesses, including reduction of the risk of cancer.

Endorphins are also good depression busters. Regular exercise helps promote positive changes in brain chemistry and at least one study has shown exercise to be at least as effective as antidepressant drugs in the treatment of depression. Exercise is also beneficial in the treatment outcomes of those suffering from schizophrenia and other mental illnesses.

In the very least, exercise makes us feel better about ourselves, increases our confidence and gives us more energy to enjoy the special things in life such as playing with our children and grandchildren.

As always, please be sure to consult with your physician before beginning any exercise program.

A longer and better quality of life are just around the corner.

Thursday, March 6, 2008

Vitamin E linked to cancer

If you haven't read the latest news about Vitamin E, here it is: Megadoses of Vitamin E are linked to lung cancer, especially in smokers. Sounds scary, doesn't it? Well, it should, considering that, of the people who take vitamins, vitamins A, C and E are most often consumed, often in megadoses, without realizing the potential health dangers. Vitamin E was thought to be safe in large doses, unlike Vitamin A, for example. However, there is evidence that Vitamin E can act as a pro-oxidant instead of an antioxidant in large doses, enhancing and promoting the damage caused by free radicals.

What's the best course of action to take? Well, I believe the best way to get your vitamins is through eating plenty of fresh fruits and vegetables, but if you plan to take vitamin supplements, please don't take more than the Recommended Daily Intake (RDI), also known as the Daily Value (DV).

Please also note that vitamin supplements are not regulated by the Food and Drug Administration (FDA), thus, quality can never be completely assured. That said, if you do buy vitamins, it would be best to choose a major brand name such as Centrum. It contains no more than 100% of the DV for any vitamin listed on its label. I've been taking Centrum daily for 15 years and feel that my health has benefited from this and also from my diet which is rich in vegetables.

In my final closing words, the best way to prevent cancer is to not smoke or to quit smoking if you are a smoker. Smoking is the leading preventable cause of death around the world.