DEAR DR. DONOHUE: How serious is celiac disease? My oldest daughter recently underwent testing, and the results came back positive for it. She says it is of genetic origination. May I have your comments? – J.G.

ANSWER:
Celiac disease can be quite serious if it goes untreated. Treated, the illness is a controllable condition.

The troublemaker is gluten, a protein found in wheat, barley and rye. Gluten, when eaten by celiac patients, triggers an immune response that disrupts their digestive tracts. Crampy stomach pain, bloating, diarrhea and weight loss are prominent symptoms. The digestive tract can’t absorb nutrients, vitamins or minerals, and the consequences can be many – iron-deficiency anemia, osteoporosis and vitamin deficiencies.

Some people have such mild symptoms that the diagnosis isn’t made until late in life. Others with more prominent symptoms are frequently misdiagnosed. These days, the diagnosis is made more easily, with the many tests now available for antibodies that celiac patients make. When those tests are positive, a biopsy of the small intestine can be obtained from instruments introduced through the mouth. Microscopic examination of the biopsy material shows changes classic for the disease.

Genes are important. The illness is especially prevalent in whites of Northern European extraction. People who inherit the celiac genes are at greater risk of coming down with the illness, but only a minority of them actually do.

Treatment is strict avoidance of gluten. That means no wheat, barley and rye. Oats might be a problem for some. Treatment sounds simple. It isn’t all that simple. These grains are the backbone of our diets, and their products appear in many other guises. Fortunately, celiac patients have two active organizations that can guide patients through the complexities of a no-gluten diet. They are the Celiac Disease Foundation (818-990-2354, www.celiac.org) and the Celiac Sprue Association (877-CSA-4CSA, www.csaceliacs.org).

DEAR DR. DONOHUE: You wrote that the cutoff number for diabetes was a blood sugar of 100 mg/dL (5.55mmol/L). I was always told it was 120. Has Big Pharma changed the parameters, as it did for cholesterol? When my wife retired from the Air Force, her retirement physical indicated that the normal cholesterol could be as high as 278 mg/dL (7.2 mmol/L). Then they invented the statin drugs, so they lowered the threshold. We consumers can’t win. – C.C.

ANSWER:
It wasn’t pharmaceutical companies who changed the norms for diabetes. A panel of diabetes experts did it, and only after much discussion and research.

When I was a medical student, a cholesterol reading of 300 (7.7) was acceptable. Now 200 (5.18) is the target. The change came about with greater knowledge of cholesterol and what it does. Back then, LDL cholesterol (bad cholesterol) and HDL cholesterol (the good stuff) weren’t even discussed.

Changes aren’t made on whimsy. They come about with advancement of knowledge.

DEAR DR. DONOHUE: I am a 75-year-old male. I have leaking heart valves. I don’t have symptoms at this point. I have had all kinds of tests and do take some medicines. I am able to walk 2 miles every day at the gym without problems, and I spend 20 minutes on the treadmill. Should I be thinking of heart valve replacement? – M.O.

ANSWER: Heart valves keep blood moving from one heart chamber to the next without any blood spilling back into the chamber it just left. Many people have small leaks. Your tests (included in the letter) aren’t so bad. Furthermore, your exercise capacity is excellent, and exercise produces no symptoms. At your age, you might never have to face valve replacement. Progression of leaks is often a slow affair.

All you should do right now is follow your doctor’s advice. Periodic checks by your doctor will tell if you ever reach the point where surgery is the answer.

DEAR DR. DONOHUE: Your Lyme article was dreadfully inaccurate. Syphilis is known to cause congenital infection, and Lyme disease and syphilis are spirochetal diseases. The bull’s-eye rash of Lyme does not occur in everyone, and it disappears on its own. Symptoms can be missed in the early stages, when cure is possible. There should be a retraction for this article. – F.J.

DEAR DR. DONOHUE: Your information on Lyme disease leads people to believe they are hysteric over this disease. That’s like telling them it’s in their heads. You imply that after taking antibiotics a person no longer has Lyme disease. Wrong. Lyme is a bacterium, and once you get bitten you do not get rid of the disease. You are better off not writing about Lyme, and our newspaper can help by not putting that information out to the public. – M.M.

ANSWER:
I appreciate both your points of view. However, I stand by what I wrote.

The bacterium causing Lyme disease is Borrelia burgdorferi; the one causing syphilis is Treponema pallidum. Both are in the same order of bacteria, but they are different genera and cause different illnesses. Congenital infection with Borrelia has not been demonstrated. Infection during pregnancy may cause stillbirth or miscarriage, but that “may” should be capitalized. Treatment of Lyme disease results in cure in most cases.

The bull’s-eye rash of Lyme doesn’t occur in all cases, but it occurs in enough to be considered a criterion for the illness.

The original letter writer is the mother of an adult daughter who suffered many years from many symptoms. The daughter consulted a practitioner who, upon laying eyes on her, told her she suffered from Lyme disease, as did her son. That is the hysteria I referred to. Surely you don’t want people misdiagnosed as having an illness without any evidence of it.

I based my answer on the following references, which you are welcome to check: Mayo Clinic Proceedings, Vol. 83, pp 566-571, May, 08; Journal of the American Medical Association, Vol. 23, pp 2617-2627, June 21,07; New England Journal of Medicine, Vol. 357, pp 1422-30, Oct 4, 07; National Institutes of Health Publication No. 03-7045 – Lyme Disease; Mandel, Douglas and Bennett’s Principles and Practice of Infectious Diseases, the premier textbook on infections.

Not that it matters very much, but I have spent a great deal of my adult life studying infectious diseases and am board-certified in infectious diseases. I have a master’s degree in public health and tropical medicine. I do understand Lyme disease.

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. Readers may also order health newsletters from www.rbmamall.com.


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