Q&A: Celiac Disease; Shortness of Breath; Coping with Stress
Q. What’s the difference between gluten intolerance and celiac disease?
A. Gluten, a protein found in some grains, such as wheat, barley, rye, and triticale, can cause gastrointestinal symptoms in people with gluten intolerance similar to those of celiac disease. Symptoms include diarrhea, cramps, nausea, bloating, and constipation. Until now, gluten intolerance has been viewed as a less serious disorder than celiac disease; however, that view is changing: A recent study shows that in people with gluten sensitivity, but who do not have celiac disease, gluten can trigger an immune reaction that can damage cells in the small intestine. Celiac disease is an autoimmune disease in which gluten triggers an attack against the lining of the small intestine. This impairs the intestine’s ability to absorb nutrients, which can raise the risk of osteoporosis, and other autoimmune disorders, such as Type 1 diabetes and multiple sclerosis, and other debilitating symptoms, such as anemia, fatigue, bone and joint pain, skin rash and depression. The only treatment for celiac disease or gluten intolerance is to follow a strict gluten-free diet, for life. The Celiac Disease Foundation estimates that 2.5 million Americans are undiagnosed with celiac disease, putting them at risk for long-term health complications, including infertility, epilepsy, migraines, and intestinal cancers. If you suspect you have celiac disease, ask your healthcare giver for a blood test that checks for certain antibody proteins that can help diagnose celiac disease.
Q. My husband complains of shortness of breath and fatigue, and seems to have low energy. Is it possible he has heart failure? And if so, what treatments are available?
A. Heart failure comes on gradually, due to a weakening or injury to the heart resulting from many underlying causes, such as heart attack, high blood pressure, diabetes, abnormal heart rhythms and other conditions. In addition to shortness of breath and fatigue, symptoms include diminished exercise capacity, high blood pressure, and increased weight brought on by fluid retention. Have your husband see his health care provider as soon as possible; if he is diagnosed with heart failure, he can start treatment immediately to prevent any worsening of his condition.
Treatment options include medications, lifestyle adjustments, and surgery. Heart failure drugs lower blood pressure, stabilize the heart rate and improve the heart’s pumping ability. Your husband may be treated with an angiotensin converting enzyme (ACE) inhibitor, such as Vasotec, or an angiotensin receptor blocker (ARB), such as Atacand, both of which also improve exercise capacity. They also may help prevent “remodeling,” a side effect of heart failure in which the left ventricle enlarges, increasing the heart’s demand for oxygen, and stretching the walls of the heart muscle so they no longer contract effectively. Other drugs include diuretics, which lower blood pressure by eliminating excess fluid and sodium from the body, and beta blockers, which may reverse remodeling and slow the heart rate. Your husband’s doctor also may prescribe statins and anti-arrhythmia drugs to improve functional capacity and quality of life. Lifestyle changes include a heart-healthy diet such as the Dietary Approaches to Stop Hypertension (DASH) or the Mediterranean diet, both of which emphasize fruits, vegetables, whole grains and healthy fats; limiting fluid intake to reduce swelling; and limiting alcohol intake to one drink a day. Continue to exercise, a combination of aerobics, strength training and flexibility, or just walk 30 minutes a day. Surgical procedures include valve repair, angioplasty, or cardiac resynchronization therapy (CRT), a device implanted under the skin that stimulates the heart to beat in a synchronized way.
Q. I’m going through a fairly rough patch in my life—job and relationship stress. Any coping tips for getting through this period?
A. Here are six strategies that may help keep stress from overwhelming you. 1. Avoid distressing thoughts and toxic people—walk away. 2. Focus on optimism—be more grateful. 3. Take action you can control—achievable small steps. 4. Take care of yourself: get plenty of sleep, eat a healthy diet, exercise, and take time to relax. 5. Stay socially active with trusted friends and family members. 6. Practice daily relaxation techniques.
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