By Matt McMillen
What to do if joint pain turns out to be RA.
For a few years, Andrew Ellis tried to tough out the pain, which started in his thumb. A boxer and football player in college, Ellis, 58, was used to aches and pains. He’d even broken his thumb once, so he told himself the new pain was from the old break. Then his other thumb began to hurt. Soon, he had pain in his toes and the balls of his feet. When his neck began to hurt, he finally admitted to himself that it was time to see a doctor.
“I said to myself, ‘There’s something wrong,” recalls Ellis, who retired after 28 years in the military and now lives in Bel Air, Md.
He was right. Ellis learned that he had rheumatoid arthritis.
For a man, that’s a rather uncommon diagnosis. Of the estimated 1.3 million people with the disease in the U.S., women outnumber men by as much as three to one.
It’s not known why the condition is so much more common among women, though there’s evidence to suggest that hormonal differences might explain at least some of the disparity in numbers. In fact, other rheumatic diseases, such as lupus and fibromyalgia, also affect many more women than men.
Good News and Bad News for Men with RA
Rheumatoid arthritis is an autoimmune disease. It causes the body’s immune system to attack the lining of joints. This leads to painful inflammation, swelling, and stiffness. In advanced stages, the damage caused by such inflammation can be quite debilitating.
RA symptoms can last anywhere from a few months to a lifetime. For some people, it flares up on occasion, then temporarily goes into remission; for others, it can be a constant, painful presence.
For men with the disease, there may be some good news. According to rheumatologist Grant Louie, MD, an arthritis specialist at The Johns Hopkins Hospital in Baltimore, men may have a less severe disease course than women. Men may also be more likely to have their disease go into remission, especially if it is caught and treated early.
Diagnosing and treating the disease early is important for other reasons, as well. Joint damage often happens during the first two years of having RA, according to the Arthritis Foundation.
Many men, though, are much less likely than women to see a doctor, for arthritis or anything else. Ellis is a perfect example. He put up with his pain for three to four years before consulting with a physician.
“Men are often diagnosed later because they tend to downplay their symptoms,” says Louie, who is treating Ellis' RA. “They may not recognize that it is something that they need treatment for.”
Louie adds that men also may have fewer functional disabilities than women do. But the reason may be that men are underreporting the extent of the difficulties that the disease is causing. This also comes up when diagnosing RA.
One of the standard diagnostic tests involves probing joints for tenderness. As the doctor does this, the patient ranks the amount of discomfort he experiences.
“A man may be reluctant to say, ‘This hurts,’ because it would reveal weakness, which could make it more difficult to evaluate the disease,” Louie says. “The good news is there are also objective measures.”
Blood tests, for example, will reveal the presence of particular antibodies associated with RA, as well as measure indicators of inflammation, such as C-reactive protein levels. So the arthritis can be diagnosed even if the man won’t admit to feeling the pain.
But the first order of business, says Louie, is getting men to admit that they are experiencing pain and then to see a doctor.
“We need to advise men so that they are aware that their symptoms may be rheumatoid arthritis,” Louie says. “The chances for successful treatment are higher the earlier we can catch it.”
Stick with Your Treatment
Many different medications are used to control RA. They range from analgesics for pain relief to non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation to a class of medications known as disease-modifying antirheumatic drugs (DMARDs), which can slow down the progression of rheumatoid arthritis.
For his arthritis, Ellis takes an NSAID, as well as methotrexate, a DMARD that Louie calls the “mainstay” of arthritis treatment. Taking the drugs, which Ellis says has not caused any noticeable side effects, has eased his pain and stiffness considerably. The balls of his feet no longer trouble him, and he is now able to go running again each weekend.
The drugs, says Louie, can be extremely helpful, and men and women do equally well when taking them. But men, he says, are less likely than women to stick with their prescribed treatment. “Once they are being treated and start to feel better, they often say, ‘I’ll see if I can take less of the medication,’” Louie says.
Ellis was no exception. “I said to myself, ‘I don’t want to take all these drugs.’ So he stopped taking the NSAID. "Then I had more pain, and I went back on it," he recalls.
Keeping Active Helps
“Everyone needs exercise, but especially patients with RA,” says Louie. “RA patients who adhere to an active lifestyle appear to have less severe disease activity than those with more of a sedentary lifestyle.”
That’s true for men and women. But “participation in physical therapy and adherence to recommended exercise programs appear to be lower in men,” Louie says.
Not Ellis. He is a lifelong exerciser. And that seems to have helped keep his arthritis under control. Although he wakes up achy and stiff, he says that doesn’t last past his morning routine of pushups, sit ups, and leg lifts coupled with a cardio workout, either on his elliptical trainer or, on weekends, running.
“Whatever type of exercise, I’m out and doing something,” he says, adding that the medications he takes help make that possible. “The methotrexate subdues the pain and lets me do those things.”
Thursday, May 24, 2012
Guide to Gluten-Free Flours
What to know about gluten-free flours, including nutritional information.
By Elizabeth M. Ward, MS, RD
Are you on a gluten-free diet? Regular breads, bagels, muffins, and many other store-bought baked goods are not allowed on gluten-free eating plans.
Here's what you need to know before you buy gluten-free grain products or bake them at home.
What Is Gluten?
Gluten is a protein present in wheat flour, which is widely used in commercial and homemade baked goods. Gluten is also found in flour made from barley, rye, spelt, and triticale, a cross between wheat and rye. Gluten helps dough to rise and lends shape and a chewy texture to baked goods.
"Baking without gluten can be challenging because gluten contributes important properties to baked products like cookies, cakes, pastries, and breads," says Carol Fenster, PhD, author of 10 gluten-free cookbooks, including 1,000 Gluten-Free Recipes, and her most recent, 125 Gluten-Free Vegetarian Recipes.
That's why, in addition to seeing gluten-free flours such as white rice flour listed in the ingredient list, you may also notice xanthan gum and guar gum. "These gums work with other ingredients, such as yeast, baking soda, and baking powder, to help the dough or batter rise," Fenster says.
Read the Label
For the estimated 3 million Americans with celiac disease, avoiding gluten is a must for good health. Others avoid gluten because they feel sensitive to it.
Among some people with celiac disease and gluten intolerance, gluten-free goods may have a "health halo." That is, they're considered more nutritionally valuable for what they contain -- or don't contain, in the case of gluten.
Gluten-free bread, bagels, and muffins may taste better now than when they first hit store shelves years ago, but they haven't improved much nutritionally. The store-bought gluten-free baked goods you eat on a regular basis, such as bread and bagels, are not created equal to regular varieties made with wheat flour.
Wheat flour is typically enriched with vitamins and minerals, including iron, folic acid, and other B vitamins, and whole wheat flour supplies fiber. You can't count on gluten-free flours to provide the same nutrient profile.
It's important to read the Nutrient Facts panels carefully to help avoid certain nutrient shortfalls on a gluten-free eating plan.
"Purchase gluten-free products with added vitamins and minerals, and look for items made with whole grain flour or bean flour to help you get the nutrients you need," says Shelley Case, RD, nutrition consultant and author of Gluten-Free Diet: A Comprehensive Resource Guide.
Although there's no shortage of refined carbohydrates in most commercial gluten-free baked goods, most are lower in fiber, Case says.
"When there's no gluten in a recipe, it takes far more gluten-free ingredients to produce a tasty product," Case explains.
The refined carbohydrates typically used in gluten-free products and mixes, including white rice flour and tapioca, produce baked goods that are much higher in calories and total carbohydrates than regular versions.
Simply swapping regular bread, muffins, and other baked items for gluten-free products without any regard for calories can easily lead to weight gain. Case warns that gluten-free baked goods won't necessarily help you with weight control, and they may hinder weight control efforts.
Gluten-free or not, it always pays to be aware of your personal calorie budget for weight control. Check the calories and serving sizes of store-bought baked goods, and make sure all the foods you eat, including gluten-free cookies, cake, and brownies, fit into your daily calorie allowance for weight maintenance or weight loss.
Gluten-Free Home Baking
When you're baking at home, it's impossible to simply substitute gluten-free flours for those with gluten and get the same results. However, home baking allows you to use an array of gluten-free flours with more nutrition than what's often found in commercially baked goods.
In supermarkets and online, you'll find a variety of gluten-free flours, including those made from:
•Brown rice
•Fava beans
•White beans
•Amaranth
•Potato
•Oats (make sure oats are certified gluten-free)
•Avoid buying gluten-free flours from bulk bins. You never know if someone accidentally used the whole-wheat flour scoop in a gluten-free flour bin.
When you first start baking gluten-free, it may be easier to stick with a simple multi-purpose flour blend before experimenting further.
Fenster suggests relying on a pre-mixed homemade flour blend to use in a variety of baked goods, including bread, pizza dough, and pancakes. Having a flour mix on hand is a time saver that makes gluten-free baking that much easier.
"A good flour blend uses a main or protein-laden flour such as brown rice or sorghum or beans, for example, blended with a starchy flour such as potato starch or cornstarch," Fenster says. "The protein in flour lends structure and stability, while the starchy flours add lightness and airiness."
Recipe: Gluten-Free Flour Blend
Here is Fenster's recipe for a gluten-free flour blend:
1.5 cups sorghum or brown rice flour
1.5 potato starch or cornstarch
1 cup tapioca flour
Whisk together thoroughly and store in a dark, dry place.
When substituting this blend for wheat flour in recipes, measure it as though it were wheat flour.
Fenster says the sorghum version works well for most baked goods. She relies on the brown rice version for light and delicate baked goods, such as cake. When making muffins or yeast breads, you can substitute amaranth, buckwheat, quinoa, or teff flour for sorghum or brown rice flour. (Teff is a tiny grain commonly used in Ethiopian cuisine.)
By Elizabeth M. Ward, MS, RD
Are you on a gluten-free diet? Regular breads, bagels, muffins, and many other store-bought baked goods are not allowed on gluten-free eating plans.
Here's what you need to know before you buy gluten-free grain products or bake them at home.
What Is Gluten?
Gluten is a protein present in wheat flour, which is widely used in commercial and homemade baked goods. Gluten is also found in flour made from barley, rye, spelt, and triticale, a cross between wheat and rye. Gluten helps dough to rise and lends shape and a chewy texture to baked goods.
"Baking without gluten can be challenging because gluten contributes important properties to baked products like cookies, cakes, pastries, and breads," says Carol Fenster, PhD, author of 10 gluten-free cookbooks, including 1,000 Gluten-Free Recipes, and her most recent, 125 Gluten-Free Vegetarian Recipes.
That's why, in addition to seeing gluten-free flours such as white rice flour listed in the ingredient list, you may also notice xanthan gum and guar gum. "These gums work with other ingredients, such as yeast, baking soda, and baking powder, to help the dough or batter rise," Fenster says.
Read the Label
For the estimated 3 million Americans with celiac disease, avoiding gluten is a must for good health. Others avoid gluten because they feel sensitive to it.
Among some people with celiac disease and gluten intolerance, gluten-free goods may have a "health halo." That is, they're considered more nutritionally valuable for what they contain -- or don't contain, in the case of gluten.
Gluten-free bread, bagels, and muffins may taste better now than when they first hit store shelves years ago, but they haven't improved much nutritionally. The store-bought gluten-free baked goods you eat on a regular basis, such as bread and bagels, are not created equal to regular varieties made with wheat flour.
Wheat flour is typically enriched with vitamins and minerals, including iron, folic acid, and other B vitamins, and whole wheat flour supplies fiber. You can't count on gluten-free flours to provide the same nutrient profile.
It's important to read the Nutrient Facts panels carefully to help avoid certain nutrient shortfalls on a gluten-free eating plan.
"Purchase gluten-free products with added vitamins and minerals, and look for items made with whole grain flour or bean flour to help you get the nutrients you need," says Shelley Case, RD, nutrition consultant and author of Gluten-Free Diet: A Comprehensive Resource Guide.
Although there's no shortage of refined carbohydrates in most commercial gluten-free baked goods, most are lower in fiber, Case says.
"When there's no gluten in a recipe, it takes far more gluten-free ingredients to produce a tasty product," Case explains.
The refined carbohydrates typically used in gluten-free products and mixes, including white rice flour and tapioca, produce baked goods that are much higher in calories and total carbohydrates than regular versions.
Simply swapping regular bread, muffins, and other baked items for gluten-free products without any regard for calories can easily lead to weight gain. Case warns that gluten-free baked goods won't necessarily help you with weight control, and they may hinder weight control efforts.
Gluten-free or not, it always pays to be aware of your personal calorie budget for weight control. Check the calories and serving sizes of store-bought baked goods, and make sure all the foods you eat, including gluten-free cookies, cake, and brownies, fit into your daily calorie allowance for weight maintenance or weight loss.
Gluten-Free Home Baking
When you're baking at home, it's impossible to simply substitute gluten-free flours for those with gluten and get the same results. However, home baking allows you to use an array of gluten-free flours with more nutrition than what's often found in commercially baked goods.
In supermarkets and online, you'll find a variety of gluten-free flours, including those made from:
•Brown rice
•Fava beans
•White beans
•Amaranth
•Potato
•Oats (make sure oats are certified gluten-free)
•Avoid buying gluten-free flours from bulk bins. You never know if someone accidentally used the whole-wheat flour scoop in a gluten-free flour bin.
When you first start baking gluten-free, it may be easier to stick with a simple multi-purpose flour blend before experimenting further.
Fenster suggests relying on a pre-mixed homemade flour blend to use in a variety of baked goods, including bread, pizza dough, and pancakes. Having a flour mix on hand is a time saver that makes gluten-free baking that much easier.
"A good flour blend uses a main or protein-laden flour such as brown rice or sorghum or beans, for example, blended with a starchy flour such as potato starch or cornstarch," Fenster says. "The protein in flour lends structure and stability, while the starchy flours add lightness and airiness."
Recipe: Gluten-Free Flour Blend
Here is Fenster's recipe for a gluten-free flour blend:
1.5 cups sorghum or brown rice flour
1.5 potato starch or cornstarch
1 cup tapioca flour
Whisk together thoroughly and store in a dark, dry place.
When substituting this blend for wheat flour in recipes, measure it as though it were wheat flour.
Fenster says the sorghum version works well for most baked goods. She relies on the brown rice version for light and delicate baked goods, such as cake. When making muffins or yeast breads, you can substitute amaranth, buckwheat, quinoa, or teff flour for sorghum or brown rice flour. (Teff is a tiny grain commonly used in Ethiopian cuisine.)
What Are Immune System Disorders?
Immune system disorders cause abnormally low activity or overactivity of the immune system. In cases of immune system overactivity, the body attacks and damages its own tissues (autoimmune diseases). Immune deficiency diseases decrease the body's ability to fight invaders, causing vulnerability to infections.
Allergies and Asthma
Allergies result from the immune system's overreaction to a non-threatening foreign substance. Foods and inhaled particles like pollen and pet dander are the most common allergens (substances causing allergic reactions). When the immune system senses an allergen, it stimulates the release of chemicals such as histamine.
Symptoms of the resulting allergic reaction can include breathing problems, eye irritation, rash, nasal congestion, or nausea and vomiting. Antihistamine medications can reduce symptoms, but avoiding allergen exposure is the best preventive treatment for allergies.
Asthma is a condition in which the immune system becomes overactive in the airways (bronchi) in the lungs. People with asthma suffer periodic episodes of constriction of their airways (bronchospasm), making it harder to breathe. Most people with asthma also have ongoing inflammation in their airways. Asthma treatment sometimes includes a daily inhaled corticosteroid, which reduces immune system overactivity and inflammation.
Autoimmune Diseases
In response to an unknown trigger, the immune system may begin producing antibodies that instead of fighting infections, attack the body's own tissues. Treatment for autoimmune diseases generally focuses on reducing immune system activity. Examples of autoimmune diseases include:
Rheumatoid arthritis . The immune system produces antibodies that attach to the linings of joints. Immune system cells then attack the joints, causing inflammation, swelling, and pain. If untreated, rheumatoid arthritis causes gradually causes permanent joint damage. Treatments for rheumatoid arthritis can include various oral or injectable medications that reduce immune system overactivity.
Systemic lupus erythematosus (lupus). People with lupus develop autoimmune antibodies that can attach to tissues throughout the body. The joints, lungs, blood cells, nerves, and kidneys are commonly affected in lupus. Treatment often requires daily oral prednisone, a steroid that reduces immune system function.
Inflammatory bowel disease (IBD). The immune system attacks the lining of the intestines, causing episodes of diarrhea, rectal bleeding, urgent bowel movements, abdominal pain, fever, and weight loss. Ulcerative colitis and Crohn's disease are the two major forms of IBD. Oral and injected immune-suppressing medicines can treat IBD.
Multiple sclerosis (MS). The immune system attacks nerve cells, causing symptoms that can include pain, blindness, weakness, poor coordination, and muscle spasms. Various medicines that suppress the immune system can be used to treat multiple sclerosis.
Type 1 diabetes mellitus. Immune system antibodies attack and destroy insulin-producing cells in the pancreas. By young adulthood, people with type 1 diabetes require insulin injections to survive.
Guillain-Barre syndrome. The immune system attacks the nerves controlling muscles in the legs and sometimes the arms and upper body. Weakness results, which can sometimes be severe. Filtering the blood with a procedure called plasmapheresis is the main treatment for Guillain-Barre syndrome.
Psoriasis. In psoriasis, overactive immune system blood cells called T-cells collect in the skin. The immune system activity stimulates skin cells to reproduce rapidly, producing silvery, scaly plaques on the skin.
Graves' disease . The immune system produces antibodies that stimulate the thyroid gland to release excess amounts of thyroid hormone into the blood (hyperthyroidism). Symptoms of Graves' disease can include bulging eyes as well as weight loss, nervousness, irritability, rapid heart rate, weakness, and brittle hair. Destruction or removal of the thyroid gland, using medicines or surgery, is usually required to treat Graves' disease.
Hashimoto's thyroiditis . Antibodies produced by the immune system attack the thyroid gland, slowly destroying the cells that produce thyroid hormone. Low levels of thyroid hormone develop (hypothyroidism), usually over months to years. Symptoms include fatigue, constipation, weight gain, depression, dry skin, and sensitivity to cold. Taking a daily oral synthetic thyroid hormone pill restores normal body functions.
Myasthenia gravis. Antibodies bind to nerves and make them unable to stimulate muscles properly. Weakness that gets worse with activity is the main symptom of myasthenia gravis. Mestinon (pyridostigmine) is the main medicine used to treat myasthenia gravis.
Vasculitis. The immune system attacks and damages blood vessels in this group of autoimmune diseases. Vasculitis can affect any organ, so symptoms vary widely and can occur almost anywhere in the body. Treatment includes reducing immune system activity, usually with prednisone or another corticosteroid.
Immune Deficiency Diseases
The immune system may be suppressed by medications or illness. Immune deficiency can also be present from birth as a genetic disorder (primary immune deficiency). Immune deficiency diseases result in higher vulnerability to infections. Examples of immune deficiency diseases include:
Severe combined immune deficiency (SCID). A genetic condition causing severe impairment in multiple areas of the immune system. Babies with SCID die from overwhelming infections, usually before reaching age 1. Bone marrow transplant can cure some cases of SCID.
Common variable immune deficiency (CVID). Due to a genetic defect, the immune system produces too few antibodies to effectively fight infections. Children with CVID typically have frequent infections of the ears, lungs, nose, eyes, and other organs. Treatment includes replacing the missing antibodies with regular injections of antibodies, called immunoglobulins.
Human immunodeficiency virus / acquired immune deficiency syndrome (HIV/AIDS). HIV infects and destroys immune system cells that normally fight infections. As the number of immune system cells declines, a person's vulnerability to infections rises steadily.
Drug-induced immune deficiency. Medicines that suppress the immune system result in an increased chance of infection. People taking immune-suppressing drugs for long periods require careful monitoring to detect and treat any infections that occur.
Graft versus host syndrome. After bone marrow transplant, the donor's immune system cells may attack the tissues of the person receiving the transplant. Prednisone and other immune-suppressing medicines are used to prevent excessive organ damage caused by the donor's immune cells
Allergies and Asthma
Allergies result from the immune system's overreaction to a non-threatening foreign substance. Foods and inhaled particles like pollen and pet dander are the most common allergens (substances causing allergic reactions). When the immune system senses an allergen, it stimulates the release of chemicals such as histamine.
Symptoms of the resulting allergic reaction can include breathing problems, eye irritation, rash, nasal congestion, or nausea and vomiting. Antihistamine medications can reduce symptoms, but avoiding allergen exposure is the best preventive treatment for allergies.
Asthma is a condition in which the immune system becomes overactive in the airways (bronchi) in the lungs. People with asthma suffer periodic episodes of constriction of their airways (bronchospasm), making it harder to breathe. Most people with asthma also have ongoing inflammation in their airways. Asthma treatment sometimes includes a daily inhaled corticosteroid, which reduces immune system overactivity and inflammation.
Autoimmune Diseases
In response to an unknown trigger, the immune system may begin producing antibodies that instead of fighting infections, attack the body's own tissues. Treatment for autoimmune diseases generally focuses on reducing immune system activity. Examples of autoimmune diseases include:
Rheumatoid arthritis . The immune system produces antibodies that attach to the linings of joints. Immune system cells then attack the joints, causing inflammation, swelling, and pain. If untreated, rheumatoid arthritis causes gradually causes permanent joint damage. Treatments for rheumatoid arthritis can include various oral or injectable medications that reduce immune system overactivity.
Systemic lupus erythematosus (lupus). People with lupus develop autoimmune antibodies that can attach to tissues throughout the body. The joints, lungs, blood cells, nerves, and kidneys are commonly affected in lupus. Treatment often requires daily oral prednisone, a steroid that reduces immune system function.
Inflammatory bowel disease (IBD). The immune system attacks the lining of the intestines, causing episodes of diarrhea, rectal bleeding, urgent bowel movements, abdominal pain, fever, and weight loss. Ulcerative colitis and Crohn's disease are the two major forms of IBD. Oral and injected immune-suppressing medicines can treat IBD.
Multiple sclerosis (MS). The immune system attacks nerve cells, causing symptoms that can include pain, blindness, weakness, poor coordination, and muscle spasms. Various medicines that suppress the immune system can be used to treat multiple sclerosis.
Type 1 diabetes mellitus. Immune system antibodies attack and destroy insulin-producing cells in the pancreas. By young adulthood, people with type 1 diabetes require insulin injections to survive.
Guillain-Barre syndrome. The immune system attacks the nerves controlling muscles in the legs and sometimes the arms and upper body. Weakness results, which can sometimes be severe. Filtering the blood with a procedure called plasmapheresis is the main treatment for Guillain-Barre syndrome.
Psoriasis. In psoriasis, overactive immune system blood cells called T-cells collect in the skin. The immune system activity stimulates skin cells to reproduce rapidly, producing silvery, scaly plaques on the skin.
Graves' disease . The immune system produces antibodies that stimulate the thyroid gland to release excess amounts of thyroid hormone into the blood (hyperthyroidism). Symptoms of Graves' disease can include bulging eyes as well as weight loss, nervousness, irritability, rapid heart rate, weakness, and brittle hair. Destruction or removal of the thyroid gland, using medicines or surgery, is usually required to treat Graves' disease.
Hashimoto's thyroiditis . Antibodies produced by the immune system attack the thyroid gland, slowly destroying the cells that produce thyroid hormone. Low levels of thyroid hormone develop (hypothyroidism), usually over months to years. Symptoms include fatigue, constipation, weight gain, depression, dry skin, and sensitivity to cold. Taking a daily oral synthetic thyroid hormone pill restores normal body functions.
Myasthenia gravis. Antibodies bind to nerves and make them unable to stimulate muscles properly. Weakness that gets worse with activity is the main symptom of myasthenia gravis. Mestinon (pyridostigmine) is the main medicine used to treat myasthenia gravis.
Vasculitis. The immune system attacks and damages blood vessels in this group of autoimmune diseases. Vasculitis can affect any organ, so symptoms vary widely and can occur almost anywhere in the body. Treatment includes reducing immune system activity, usually with prednisone or another corticosteroid.
Immune Deficiency Diseases
The immune system may be suppressed by medications or illness. Immune deficiency can also be present from birth as a genetic disorder (primary immune deficiency). Immune deficiency diseases result in higher vulnerability to infections. Examples of immune deficiency diseases include:
Severe combined immune deficiency (SCID). A genetic condition causing severe impairment in multiple areas of the immune system. Babies with SCID die from overwhelming infections, usually before reaching age 1. Bone marrow transplant can cure some cases of SCID.
Common variable immune deficiency (CVID). Due to a genetic defect, the immune system produces too few antibodies to effectively fight infections. Children with CVID typically have frequent infections of the ears, lungs, nose, eyes, and other organs. Treatment includes replacing the missing antibodies with regular injections of antibodies, called immunoglobulins.
Human immunodeficiency virus / acquired immune deficiency syndrome (HIV/AIDS). HIV infects and destroys immune system cells that normally fight infections. As the number of immune system cells declines, a person's vulnerability to infections rises steadily.
Drug-induced immune deficiency. Medicines that suppress the immune system result in an increased chance of infection. People taking immune-suppressing drugs for long periods require careful monitoring to detect and treat any infections that occur.
Graft versus host syndrome. After bone marrow transplant, the donor's immune system cells may attack the tissues of the person receiving the transplant. Prednisone and other immune-suppressing medicines are used to prevent excessive organ damage caused by the donor's immune cells
Wednesday, May 23, 2012
7 Signs Your Child May Have Food Intolerances
Written by: Pamela Bond
In recent years, pediatrician William Sears, MD, has seen a lot more cases of asthma and eczema in his San Clemente, Calif., office. Dairy and wheat are still the biggest culprits, but experts believe new factors may be contributing to the rise in food sensitivities, including synthetic additives such as partially hydrogenated oils and artificial colors, flavors, and sweeteners, as well as genetically modified ingredients.
If you think your child may be reacting to something in his or her diet, the first step is to look for clues. “A lot of parents already suspect the answer,” says Kelly Dorfman, LND, author of What’s Eating Your Child? (Workman, 2011). Become a “nutrition detective,” she suggests, noting when and how possible symptoms arise. Here’s a guide to assessing the evidence and finding solutions.
1. Spitting up
Possible culprit: Intolerance to casein, a dairy protein. Casein in dairy products—which is different from the casein in human milk—that gets into breast milk or is in formula can irritate an infant’s gut lining, causing gastroesophageal reflux disease (GERD). Later, the symptoms may morph into chronic ear infections or constipation, says Dorfman.
Action plan: Remove dairy from the baby’s and nursing mom’s diet for at least a week. (It takes four to five days for dairy to clear from breast milk.) For formula-fed infants, choose a brand made with predigested casein or whey. To heal baby’s damaged intestinal lining, give 10 billion CFU daily of probiotic bacteria mixed in a bottle or sprinkled on solid food.
2. Chronic diarrhea
Possible culprit: Intolerance to gluten (a protein in wheat and other grains) or lactose (dairy sugar). Diarrhea is the gastrointestinal tract’s way of getting rid of problematic substances. Therefore, the most common symptoms of both gluten and lactose intolerance are diarrhea, gas, and bloating.
Lactose intolerance is usually the root cause because the enzyme that digests lactose (lactase) is easily inactivated when the gut is irritated. When you’re gluten sensitive, digesting gluten irritates the gut, so almost everyone with gluten intolerance also cannot tolerate lactose, Dorfman says. Thankfully, fermented dairy products such as cheese and yogurt have low lactose levels, so consuming them is often safe.
Action plan: Get a blood test to rule out celiac disease; then eliminate gluten for at least a month. Although the diarrhea could resolve within a week, it may take a few weeks to get a clear picture with school-aged children. “The birthday parties, the grandma visit—there’s often something that causes accidental cheating,” Dorfman says. “You need a longer period to see a trend.
3. Chronic ear infections
Possible culprit: Dairy intolerance and, for some, soy sensitivity. Some research has shown that 90 percent of kids with recurring ear infections or ear fluid have food reactions, a statistic Dorfman says her current patients corroborate. The usual suspect: dairy products. However, about half of people who react to dairy also react to soy, according to Dorfman.
Action plan: Quit dairy and soy for several months. Because children don’t suffer ear infections every week, it can take longer to verify a correlation. Dorfman recommends eliminating soy milk, soy yogurt, and tofu, but adds that ultrasensitive individuals may need to avoid processed foods, most of which contain soy byproducts.
4. Eczema or itchy skin rash
Possible culprit: Reaction to a combination of gluten, casein (in dairy products), eggs and what Dorfman calls “extended” citrus (oranges, grapefruit, tangerines, lemons, strawberries and pineapple).
Action plan: Ask an allergist to conduct an IgE radioallergosorbent (RAST) blood test on your child. Because an itchy rash suggests a histamine response, blood tests can be more accurate here than they can be in detecting food sensitivities.
5. Hyperactivity
Possible culprit: Sensitivity to artificial colors, or even sugar. According to Sears, children’s underdeveloped blood-brain barrier makes them more vulnerable to the neurotoxic effects of chemical food additives, such as artificial colors and monosodium glutamate (MSG).
A 2007 British study linked six food colors with possible hyperactivity in children. As a result, the European Union now requires most foods containing artificial food dyes to carry a warning label. Thus far, the FDA has not issued a similar ban or required additional product labeling. Also watch sugar intake; some kids are literally hypersensitive to the sweet stuff
Action plan: Buy organic; by definition, organic products are certified to contain no artificial colors. If organic options aren’t available, scrutinize food labels for the nine petroleum-based synthetic dyes currently approved for food use in the United States: Blue 1 and 2, Citrus Red 2, Green 3, Orange B, Red 3 and 40, Yellow 5 and 6. To avoid added sugars, look beyond the Nutrition Facts panel, which combines natural and added sugars for a total amount, to the ingredients list. Words like high-fructose corn syrup, sucrose, glucose, fructose, cane sugar, and syrup indicate added sugars.
6. Crankiness
Possible culprit: Gluten intolerance. Gluten sensitivity is traditionally associated exclusively with digestive disturbances, but some studies have recently linked it to neurological symptoms, which can range from moodiness and chronic headaches to ADHD and coordination loss.
Action plan: Eliminate gluten for a month to assess a connection between mood and food. Other reasons may account for kids’ agitation; however, if food is the culprit, says Dorfman, children will often want to eat the problem food excessively.
7. Small stature or picky palate
Possible culprit: Gluten sensitivity or zinc deficiency. Because gluten intolerance interferes with nutrient absorption, suffering kids often fail to thrive. “Small size—height or weight—is a classic symptom of celiac disease,” Dorfman says.
Zinc could be another factor: The mineral normalizes appetite and, through its relationship with growth hormones, helps the body develop. If levels are low enough, a child’s growth will be stunted, perhaps in the fifth percentile or lower for weight and height on the standard growth charts. In this case, a child may rarely be hungry, be a picky eater, or complain that food smells or tastes “funny,” Dorfman says.
Action plan: Eliminate gluten from the diet for a month. Ask your pediatrician for a blood test to determine serum zinc levels, or buy a zinc sulfate taste test online. After sipping a bit of zinc sulfate solution, your child will report tasting nothing (which indicates deficiency) or a bad flavor (no deficiency). Zinc-rich foods include beef, chicken, beans, pumpkin seeds, cashews, and chickpeas. If there’s a deficiency, ask your health care provider about an adequate supplement dose based on your child’s age.
In recent years, pediatrician William Sears, MD, has seen a lot more cases of asthma and eczema in his San Clemente, Calif., office. Dairy and wheat are still the biggest culprits, but experts believe new factors may be contributing to the rise in food sensitivities, including synthetic additives such as partially hydrogenated oils and artificial colors, flavors, and sweeteners, as well as genetically modified ingredients.
If you think your child may be reacting to something in his or her diet, the first step is to look for clues. “A lot of parents already suspect the answer,” says Kelly Dorfman, LND, author of What’s Eating Your Child? (Workman, 2011). Become a “nutrition detective,” she suggests, noting when and how possible symptoms arise. Here’s a guide to assessing the evidence and finding solutions.
1. Spitting up
Possible culprit: Intolerance to casein, a dairy protein. Casein in dairy products—which is different from the casein in human milk—that gets into breast milk or is in formula can irritate an infant’s gut lining, causing gastroesophageal reflux disease (GERD). Later, the symptoms may morph into chronic ear infections or constipation, says Dorfman.
Action plan: Remove dairy from the baby’s and nursing mom’s diet for at least a week. (It takes four to five days for dairy to clear from breast milk.) For formula-fed infants, choose a brand made with predigested casein or whey. To heal baby’s damaged intestinal lining, give 10 billion CFU daily of probiotic bacteria mixed in a bottle or sprinkled on solid food.
2. Chronic diarrhea
Possible culprit: Intolerance to gluten (a protein in wheat and other grains) or lactose (dairy sugar). Diarrhea is the gastrointestinal tract’s way of getting rid of problematic substances. Therefore, the most common symptoms of both gluten and lactose intolerance are diarrhea, gas, and bloating.
Lactose intolerance is usually the root cause because the enzyme that digests lactose (lactase) is easily inactivated when the gut is irritated. When you’re gluten sensitive, digesting gluten irritates the gut, so almost everyone with gluten intolerance also cannot tolerate lactose, Dorfman says. Thankfully, fermented dairy products such as cheese and yogurt have low lactose levels, so consuming them is often safe.
Action plan: Get a blood test to rule out celiac disease; then eliminate gluten for at least a month. Although the diarrhea could resolve within a week, it may take a few weeks to get a clear picture with school-aged children. “The birthday parties, the grandma visit—there’s often something that causes accidental cheating,” Dorfman says. “You need a longer period to see a trend.
3. Chronic ear infections
Possible culprit: Dairy intolerance and, for some, soy sensitivity. Some research has shown that 90 percent of kids with recurring ear infections or ear fluid have food reactions, a statistic Dorfman says her current patients corroborate. The usual suspect: dairy products. However, about half of people who react to dairy also react to soy, according to Dorfman.
Action plan: Quit dairy and soy for several months. Because children don’t suffer ear infections every week, it can take longer to verify a correlation. Dorfman recommends eliminating soy milk, soy yogurt, and tofu, but adds that ultrasensitive individuals may need to avoid processed foods, most of which contain soy byproducts.
4. Eczema or itchy skin rash
Possible culprit: Reaction to a combination of gluten, casein (in dairy products), eggs and what Dorfman calls “extended” citrus (oranges, grapefruit, tangerines, lemons, strawberries and pineapple).
Action plan: Ask an allergist to conduct an IgE radioallergosorbent (RAST) blood test on your child. Because an itchy rash suggests a histamine response, blood tests can be more accurate here than they can be in detecting food sensitivities.
5. Hyperactivity
Possible culprit: Sensitivity to artificial colors, or even sugar. According to Sears, children’s underdeveloped blood-brain barrier makes them more vulnerable to the neurotoxic effects of chemical food additives, such as artificial colors and monosodium glutamate (MSG).
A 2007 British study linked six food colors with possible hyperactivity in children. As a result, the European Union now requires most foods containing artificial food dyes to carry a warning label. Thus far, the FDA has not issued a similar ban or required additional product labeling. Also watch sugar intake; some kids are literally hypersensitive to the sweet stuff
Action plan: Buy organic; by definition, organic products are certified to contain no artificial colors. If organic options aren’t available, scrutinize food labels for the nine petroleum-based synthetic dyes currently approved for food use in the United States: Blue 1 and 2, Citrus Red 2, Green 3, Orange B, Red 3 and 40, Yellow 5 and 6. To avoid added sugars, look beyond the Nutrition Facts panel, which combines natural and added sugars for a total amount, to the ingredients list. Words like high-fructose corn syrup, sucrose, glucose, fructose, cane sugar, and syrup indicate added sugars.
6. Crankiness
Possible culprit: Gluten intolerance. Gluten sensitivity is traditionally associated exclusively with digestive disturbances, but some studies have recently linked it to neurological symptoms, which can range from moodiness and chronic headaches to ADHD and coordination loss.
Action plan: Eliminate gluten for a month to assess a connection between mood and food. Other reasons may account for kids’ agitation; however, if food is the culprit, says Dorfman, children will often want to eat the problem food excessively.
7. Small stature or picky palate
Possible culprit: Gluten sensitivity or zinc deficiency. Because gluten intolerance interferes with nutrient absorption, suffering kids often fail to thrive. “Small size—height or weight—is a classic symptom of celiac disease,” Dorfman says.
Zinc could be another factor: The mineral normalizes appetite and, through its relationship with growth hormones, helps the body develop. If levels are low enough, a child’s growth will be stunted, perhaps in the fifth percentile or lower for weight and height on the standard growth charts. In this case, a child may rarely be hungry, be a picky eater, or complain that food smells or tastes “funny,” Dorfman says.
Action plan: Eliminate gluten from the diet for a month. Ask your pediatrician for a blood test to determine serum zinc levels, or buy a zinc sulfate taste test online. After sipping a bit of zinc sulfate solution, your child will report tasting nothing (which indicates deficiency) or a bad flavor (no deficiency). Zinc-rich foods include beef, chicken, beans, pumpkin seeds, cashews, and chickpeas. If there’s a deficiency, ask your health care provider about an adequate supplement dose based on your child’s age.
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