Celiac Disease, a great masquerader

Celiac disease is an inherited digestive disorder of unknown cause that affects the small intestine. Other names for this condition are celiac sprue, nontropical sprue, and gluten-sensitive enteropathy. If someone in your immediate family has it, chances are about 10 percent that you may have it too. Once thought rare, celiac disease has recently been estimated to affect 1 of every 141 Americans.  Those who have celiac disease cannot tolerate a protein called gluten, which is present in wheat, rye, and barley. When a person with celiac disease eats foods containing gluten, an immune reaction occurs in the small intestine, resulting in damage to the surface of the small intestine and an inability to absorb certain nutrients from food.  Eventually, decreased absorption of nutrients can cause vitamin deficiencies which can lead to other illnesses affecting a number of organs.
 

Celiac disease symptoms may start in childhood or adulthood, with onset and severity influenced by the amount of gluten that is eaten.  Some of the ways that celiac disease can present include:

• An infant may have abdominal pain and diarrhea (even bloody diarrhea), and may fail to grow and gain weight.
• A young child may have abdominal pain with nausea and lack of appetite, anemia (not enough iron in the blood), mouth sores and allergic dermatitis (skin rash).
• Teenagers may hit puberty late and be short.
• Adults typically have abdominal pain, chronic diarrhea, weight loss and pale, foul-smelling stools.

Celiac disease may also present itself in less obvious ways, including irritability or depression, stomach upset, anemia, joint pain, muscle cramps, skin rash (dermatitis herpetiformis), mouth sores, osteoporosis, and tingling in the legs and feet (neuropathy).

Celiac disease appears to be an under-diagnosed condition and can be confused with other gastrointestinal problems such as irritable bowel syndrome, gastric ulcers, lactose intolerance, and parasite infections.  When suspected, a blood test (tTG-IgA test) can be performed to detect high
levels of antibodies responsible for the immune reaction.  If blood test results suggest celiac disease, a biopsy of the small intestine, performed during a procedure called upper GI endoscopy, can confirm the diagnosis.

There is no specific medicine or surgery to treat celiac disease. Instead it is "managed" through complete avoidance of gluten. Gluten-containing foods that must be avoided include:

• Breads or baked goods prepared from wheat, barley, or rye
• Cereals made from wheat, rye, or barley
• Pasta prepared from wheat, rye, barley, or semolina
• Salad dressings, gravies, sauces, and soups prepared with gluten-containing ingredients

Other less obvious sources of gluten include pre-packaged foods, lip balms, toothpastes, vitamin and nutrient supplements, and, rarely medications.

Following a gluten-free diet is a lifetime requirement for individuals with celiac disease. A gluten-free diet will stop symptoms and allow for healing of the intestinal damage. Gluten-free flour, bread, pasta, and other products are available, which makes this diet more tolerable. Improvements after starting a gluten-free diet may be especially dramatic in children.

It is very important to recognize celiac disease since, if left untreated, it can result in a number of serious conditions including malnutrition, osteoporosis, and nerve damage. Celiac disease has even been associated with a higher risk of developing colon cancer and intestinal lymphoma.

Sources for article: 
Celiac Disease from the The National Institute of Diabetes and Digestive and Kidney Diseases
What is Celiac Disease? from the Celiac Disease Foundation

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Kent Davidson MD - Health Tip Content Editor

Cardio Exercise vs. Weight Lifting - Which is better for my health?

Back in the early 70's, Kenneth Cooper, M.D popularized the term "aerobics", which referred to the types of exercise that focused on cardiorespiratory fitness. This spurred on the jogging, cycling and walking craze which continues today. Aerobic exercise, also known as "cardiovascular" or "cardio" exercise, utilizes major muscles such as those in the arms and legs walking while increasing heart and respiratory rate. Examples of this type of exercise include jogging, aerobic dancing, rowing and bicycling. Since then Dr. Cooper's Aerobics Center and numerous other researchers have confirmed the health benefits of aerobic exercise which range from increased longevity to reduction in the risk of developing certain types of cancer and heart disease.  At the outset of the aerobics boom, resistance training or weight lifting was thought of as a means to building muscle mass, increasing strength or enhancing sports performance, but it took a back seat in terms of promoting general health. Over the past several years, this previously held perception is being reevaluated, with clear benefits being reported with resistance training in the literature.  This has led to a great deal of confusion among many people who want to do what is best for their health.   Additionally, for those with busy schedules, it is important to be able to get the "most bang for the buck" in terms of their time commitment to exercise.  In today's health tip, I'll try to point out some of the confirmed benefits of aerobic (cardio) and resistance exercise and also dispel some of myths surrounding each.


Effect on hypertension
Studies have shown that regular cardio exercise can reduce systolic blood pressure (the top number) anywhere from 4 to 9 mm (points).  The greatest benefit appears to come from a moderate-intensity exercise as compared to higher intensity workouts.  Some studies have also shown sustained improvement, although not as great as with cardio activity, in people participating in a resistance training program.  When lifting weights, systolic and diastolic blood pressures can actually increase temporarily, indicating the need for caution among individuals with uncontrolled hypertension or heart disease.  Resistance training does not, however, lead to the development of hypertension.

Effect on blood lipids
For some time it has been known that cardio exercise can increase the level of "good cholesterol" (HDL cholesterol) and lower blood triglycerides in those with elevated levels.  More recently it has been found that resistance training can bring about similar results.  It appears that the resistance programs that use lower weights with higher repetitions are the ones that are best at improving lipid profiles.  Combining aerobics with resistance training appears to be the optimal way to address elevated blood lipids.

Effect of oxygen uptake
In numerous studies, aerobic exercise has been confirmed to improve maximum oxygen uptake (VO2 max).  In sedentary persons, an improvement in VO2 max of 10-20% will occur with a minimum of 20 minutes of moderate-intensity aerobic exercise done at least 3 days a week.  Exercising at higher intensities will improve VO2 max even more. Typical resistance training programs that utilize "sets" of weight lifting with rest periods between have not demonstrated this same degree of improvement in VO2 max.  "Circuit training" programs, however, in which the individual moves rapidly between resistance exercises with minimal rest, have been shown to produce modest improvement in VO2 max.  These programs may be performed with exercise machines, hand-held weights, elastic resistance, calisthenics or any combination.

Effect on calorie burning
Exercise is an essential component of an effective weight loss program.  Aerobic activity alone, keeping caloric intake at the same level, causes weight loss primarily by "burning" body fat.  With diet alone, reduction in weight may occur, but this can be at the expense of lean body tissue (muscle).  A number off studies have shown that sustained weight loss is more likely when a reduced calorie diet is coupled with a regular exercise program. Resistance training programs (particularly those using circuit methods) have shown improvements in body weight and fat mass comparable to aerobic programs.

Effect on strength
This is one area where resistance training clearly stands out.  By pitting muscles against resistance, such as  a barbell or weight machine, the muscle cells eventually become larger and stronger.  When beginning resistance training, the initial increase in strength is due to a phenomenon called "neural adaptation." This means that the nerves servicing the muscles "fire" more frequently and more muscle fibers are recruited to perform the contraction.  Through neural adaptation, you become stronger, but the muscles remain the same size. With continued resistance training, the muscle cells eventually increase in size (hypertrophy).  While aerobic exercise does work the larger muscles of the arms and legs, its primary benefit is to improve heart and lung function.
 
Final thoughts
This Health Tip only touches on the many benefits of these two types of exercise.  The "take home" message is that there are clear and undeniable reasons to incorporate exercise into your life.  An ideal program should include elements of each type.  The American College of Sports Medicine recommends that all Americans should try to receive "30-60 minutes of moderate-intensity exercise (five days per week) or 20-60 minutes of vigorous-intensity exercise (three days per week) and perform strength training on two non-consecutive days each week."  From the above discussion, it is clear that there are complimentary benefits from participation in both types of exercise.

Sources for article:
Hypertension and weight training: secrets for success from The Cooper Institute
Exercises to Control Your Cholesterol from WebMD
How much am I burning? From Mayo Clinic
ACSM Issues New Recommendations on Quantity and Quality of Exercise from the American College of Sports Medicine

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Along Came a Spider...

Black widow spider (Latrodectus mactans)   The female black widow spider is a shiny, inky black spider that measures (including its legs) anywhere from one-half to one inch in length.  The male is much smaller and does not cause envenomation in humans.  The most distinguishing characteristic is a red to orange-colored marking on the underside of its abdomen in the shape of an hourglass.  Black widow spiders are found throughout the U.S. and prefer to live in undisturbed areas such as woodpiles, sheds, crawl spaces, basements and garages.  The venom of a black widow is a type of neurotoxin, meaning it attacks the nervous system. The bite is said to feel like a pinprick and sometimes the two fang marks can be seen.  Within a few hours, though, intense pain at the site of the bite begins. Systemic (affecting the entire body) symptoms of black widow envenomation include nausea, restlessness, sweating, increased blood pressure, severe abdominal pain, muscle spasms and fever. 

Brown recluse spider (Loxosceles reclusa) The brown recluse is named for its habit of hiding in dark locations such as attics, closets, and woodpiles.  Their range is primarily in the Midwest and South Central United States.  They are sometimes called "fiddle back" spiders due to a violin-shaped marking on their backs (cephalothorax).  This spider is golden brown in color and its size ranges from one-quarter to three-quarters inches in length. The bite produces a mild stinging, followed by local redness and intense pain within eight hours. The wound may take on a bull's-eye appearance, with a center blister surrounded by an angry-looking red ring and then a blanched (white) ring. Tissue at the site of the bite and the surrounding area dies and eventually sheds. Systemic symptoms include fever, chills, nausea, vomiting, and muscle aches.

What to do if bitten by a spider.  If it can be done safely, identification or collection of the spider can assist the doctor in managing the bite. First-aid measures for black widow or brown recluse bites include cleaning the wound, applying cool compresses and taking a mild pain reliever, such as acetaminophen (Tylenol).  Since the extent or seriousness of the envenomation may not be apparent shortly after the bite, it is a good idea to seek medical attention.  Development of systemic symptoms clearly warrants medical evaluation.
Most black widow spider bites do not cause serious complications and can be managed with pain medications, benzodiazepines (e.g. Valium) for muscle spasms and, administration of tetanus prophylaxis.

For more severe symptoms, such as increasingly severe pain, dangerously high blood pressure, and generalized muscle spasms, black widow antivenom is available. This should only be administered under the careful supervision of a physician since severe allergic reactions, including anaphylaxis, have occurred.
Rather than being toxic to the nervous system, the venom of the brown recluse primarily causes tissue destruction at the site of the bite.  With careful wound care, sometimes including treatment with antibiotics, most of these bites heal without complications. Often, weeks of treatment are necessary until the skin is completely healed.  Occasionally, because of severe tissue damage, surgical debridement or skin grafting may be required.

In spite of the general perception that spiders are dangerous, they are actually quite beneficial in controlling insects.  Most envenomations occur as a defensive measure when humans encroach upon the spider's habitat.  Spider-related fatalities are rare, usually only occurring in small children, the severely ill, or in the elderly. In fact, most people who go to the doctor because of a "spider bite" actually have some other skin problem.  Particularly in the areas of the country that venomous spiders are not known to live, a more likely explanation for a "spider bite" is a methicillin-resistant Staphylococcus aureus (MRSA) skin infection.

Sources for article:

Black widow spider from Medline Plus
Spider bites: First aid from Mayo Foundation for Medical Education and Research
Black Widow Spider Bite from WebMD
Brown Recluse Spider Bite from eMedicineHealth

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