Celiac disease often mistaken for IBS
DEAR DR. DONOHUE: My husband has celiac disease. We are very much aware of how often it is ignored, misdiagnosed and mistreated by the medical profession. You recently discussed irritable bowel syndrome, which has symptoms similar to celiac disease. Please mention celiac disease so the possibility will be investigated. — R.E.
ANSWER: Hearing about celiac disease as a medical student, I thought I could tuck it away in a back file, since I would never see it. That was a wrong impression. It’s a common disorder that often is misdiagnosed because its symptoms are mistaken for other illnesses, one being irritable bowel syndrome.
Diarrhea, weight loss, fatigue, bloating and crampy abdominal pain are celiac disease’s most conspicuous symptoms. However, many celiac patients don’t have dramatic symptoms. They might see the doctor for osteoporosis, because celiac disease interferes with calcium absorption. Or they might have an iron-deficiency anemia because of that mineral’s malabsorption. Often a celiac patient’s symptoms are those of irritable bowel syndrome, and the patient is given treatment that does nothing for celiac disease.
Many doctors feel that all who are diagnosed with irritable bowel syndrome should have the simple blood test for celiac disease. If that test is positive, further testing with a small bowel biopsy confirms the diagnosis.
Celiac disease is an intolerance to gluten, a protein found in wheat, barley and rye. In intolerant people, gluten activates the immune system, which attacks the digestive tract. Treatment is a gluten-free diet. In the early stages of treatment, oats are often banned because during refinement, they’re frequently contaminated with one of the gluten grains.
A gluten-free diet is somewhat difficult to master and is somewhat constricting in the food choices it allows. However, the Celiac Disease Foundation stands ready to help people master the diet. Contact the foundation at 818-990-2354 or on the Internet at www.celiac.org.
DEAR DR. DONOHUE: My older brother died in a mobile home fire in Alaska. Enclosed is a copy of his autopsy. It states the cause of death as “hypertensive and atherosclerotic cardiovascular disease with smoke inhalation contributing to it.” I find no evidence of heart attack or stroke in the report. The Internet does not indicate that a carbon monoxide level of 34.9 percent is a fatal level (his level). Please explain. — S.C.
ANSWER: Your brother had signs of an old heart attack (lateral wall myocardial infarction). His heart arteries were severely clogged, showing from 90 percent to 99 percent blockages. His heart was twice the normal size, most likely a result of high blood pressure. A heart with such advanced disease and so starved for blood is liable to develop lethal heartbeats from the level of carbon dioxide found in his blood. Smoke, in addition to carbon monoxide, contains other noxious gases that added to the burden of an already overburdened heart.
Carbon monoxide displaces oxygen from red blood cells. The red blood cells grab onto it in preference to oxygen. His heart suffered a great oxygen deficit from the carbon monoxide and from the tremendously reduced blood supply to his heart.
You have my deepest condolences on your brother’s death.
DEAR DR. DONOHUE: Years ago, Carmen Miranda sang to us to not put bananas in the refrigerator. Why? Are we supposed to leave them on the counter to attract fruit flies? Personally, I like a cold banana. What to do? — G.J.
ANSWER: I remember the banana advertisement. It went something like: “Bananas like the climate of the very, very tropical equator, so you should never put bananas in the refrigerator.”
You’ll be happy to know Carmen’s advice no longer holds true and really never did. You can put bananas in the refrigerator. They last longer. Their peels might turn brown, but the bananas themselves stay fresh.
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.