DEAR DR. DONOHUE: My 13-year-old niece just found out that she has celiac disease. We are all very confused about it. Please take time to explain this horrible disease. We have a hard time finding foods that she likes and is allowed to eat. – M.M.

ANSWER:
Once considered a rarity, celiac disease has become almost a household name. Millions of North Americans have it, and probably millions more have it without knowing they do.

A misfiring immune system is responsible for this disorder. The immune system has declared war on gluten, and the small intestine, the place where food is absorbed, is collateral damage in that war. Gluten is a protein found in wheat, barley and rye. When a person with celiac disease eats these grains, the small intestine suffers, and the passage of nutrients from the small intestine into the blood comes to a halt.

Celiac disease causes weight loss. Nausea, crampy abdominal pain and diarrhea are other symptoms. Since minerals are not absorbed, iron-deficiency anemia is common, as is osteoporosis because of faulty calcium absorption.

Treatment is a vigilant avoidance of all foods with gluten. This is no easy task, since gluten is in so many foods and in foods one would not think have it. It is a filler in some vitamins and medicines. It can be found in some canned soups, salad dressings, sausages and ice cream. A celiac patient must become a careful reader of food labels.

Your niece has powerful allies that she needs to contact, as do you and your sister. The Celiac Disease Foundation has a Web site, www.celiac.org, and its address is 13251 Ventura Blvd., Suite 1, Studio City, CA 91604. You can also contact the Celiac Sprue Association at www.csaceliacs.org, or Box 31700, Omaha, NE 68131. Both organizations supply valuable information.

DEAR DR. DONOHUE: I am extremely troubled by Raynaud’s disease. Even though I live in the South, it bothers me. I get some relief by running hot water over my hands. Kindly comment on it. – J.C.

ANSWER:
Whenever the fingers (or toes) are exposed to cold, blood vessels servicing them clamp down to conserve body heat. Blood flowing close to the body surface loses heat.

With Raynaud’s (ray-NOSE), this vessel constriction is exaggerated in the extreme. Vessels are so tightly clamped that no blood reaches the fingers. They turn white. In a short while, blood trapped in the vessels prior to their constriction gives up all its oxygen, and the fingers turn blue. When the constriction finally relaxes, blood rushes into the fingers, and they turn red.

In a few instances, Raynaud’s is associated with another illness. Scleroderma, the condition where skin hardens and becomes taut, and lupus, the disorder that features joint and skin problems, are two examples.

Don’t smoke. Nicotine constricts blood vessels, and that is the last thing a person with Raynaud’s needs. If you anticipate having to plunge your hands into the cold, like retrieving food from the freezer, wear mittens. Calcium-channel blockers like nifedipine can often keep blood vessels opened. Nitroglycerin, the medicine used to treat angina chest pain, is another medicine that benefits some with Raynaud’s.

DEAR DR. DONOHUE: I have a patch of unbearably itchy skin. I have scratched it so much and so hard that it is now covered with scabs. My mother says it’s eczema. What can I do for it? – V.K.

ANSWER:
Wash only with tepid water and use a mild soap such as Dove or Neutrogena. Pat the skin with a towel lightly so that a moist film stays on it. Then cover the involved skin with a moisturizer. If no progress is made, use a cortisone cream or ointment. A few people find that citrus fruits, tomatoes, chocolate, ice cream, wine and beer aggravate eczema. Give them up for a time to see if that helps. If still there is no progress, you must see a doctor for prescription medicines and for a proper diagnosis. Dr. Mom might be wrong.

DEAR DR. DONOHUE: My husband and I just had our cholesterol checked. My husband’s total cholesterol is 181 mg/dL (4.7 mmol/L), but his HDL cholesterol is only 36 (0.93). Which is better: having a low total cholesterol or a high HDL cholesterol? How do you raise the HDL cholesterol? – C.F.

ANSWER:
The many varieties of cholesterol have people reeling from dizziness. The normal value for total cholesterol is 200 or less. On that score, your husband gets an A. The HDL cholesterol should be 40 (1.0) or higher. On that score, you husband gets a C-.

HDL (high-density lipoprotein) is the kind of cholesterol that protects people from heart attacks and strokes. It siphons cholesterol off artery walls and takes it to the liver for disposal. You can’t have too much of this kind of cholesterol. Although a value of 40 (1.0) is considered OK, values of 60 (1.55) or higher afford a person protection from a heart attack or stroke.

Most attention has been focused on lowering total cholesterol and LDL cholesterol. The LDL (low-density lipoprotein) clings to artery walls and eventually obstructs blood flow through the artery. When that happens in a heart artery, the result is a heart attack; in a brain artery, it’s a stroke. HDL cholesterol, therefore, was not given a position on the first string of risk factors. Now, that has changed. A low HDL cholesterol is considered a risk factor for heart disease and stroke.

How to raise the HDL cholesterol is a problem. Exercise can do it. That means 30 or more minutes of walking or similar exercise on most, if not all, days of the week. If your husband drinks, then alcohol can elevate it. For men, the limit is two drinks a day; for women, one drink. The use of alcohol is suggested only for those who can drink it in moderation.

Omega-3 fatty acids boost HDL. They are found in fish and fish oils. Unsaturated oils such as olive oils also elevate the HDL level. If the family doctor thinks it’s a pressing issue, drugs like niacin, statins, Lopid and Tricor can be prescribed.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.



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