Celiac Disease is an autoimmune disorder of the small intestine that causes digestive problems. It is triggered by consumption of gluten containing products. A person can develop Celiac Disease at any age. It affects roughly 1% of US population. Family history of Celiac disease in first and second degree relatives as well as having other autoimmune disorders such as Type 1 Diabetes, autoimmune thyroid disease increases the risk of developing Celiac disease.
Symptoms of celiac disease
Celiac disease is often undiagnosed or diagnosed later in life due to the nature of vague symptoms.
Unintentional weight loss
Diarrhea
Fatty stool
Flatulence
Abdominal pain
Feeling tired or weak
complications of celiac disease
Untreated celiac disease causes malabsorption of nutrients and therefore can contribute to many other comorbidities.
management of celiac disease
Glutten containing food is the trigger for Celiac disease and its complications. Avoiding Gluten in diet for life long can keep the disease under control and reduce the risks of other comorbidities. General American diet contains a ton of Gluten and therefore it takes serious commitment and lifestyle changes.
Avoid any foods containing Rye, Barley, Oats, Malt, Yeast and Wheat
Distilled alcoholic beverages and wine are safe to drink. However beers, ales and beverages that are not distilled should be avoided.
Many patients with celiac disease can also have lactose intolerance. Monitoring for worsening symptoms with dairy products can help avoid them and control the symptoms.
Following a gluten free diet is not easy. It needs a lot of attention and commitment. Transitioning from a regular diet to gluten free diet can take some time. However following a gluten free diet by a person with Celiac disease can see great improvement in their health. Many of us are not aware of the hidden gluten in some foods. It is important to check the ingredients when purchasing any food, especially the processed food.
Some food items that contain gluten and are often forgotten
Processed food
Broths, Soups, seasoning and sauces
Cereals
Burgers, meatloafs, sausages, deli meat, imitation meat
Flavored coffee and Tea
Speciality cheeses
Oats may be contaminated with wheat
frozen food
Many of the complications from celiac disease are due to nutritional deficiencies. Therefore it is important to replenish the nutrients that are lacking in these patients. Testing and treating Vitamin K, B1, B12, B6, Magnesium, Selenium, Iron , folic acid, since are necessary.
Acid reflux is when the acid that is normally in your stomach backs up into the esophagus (tube that carries food from your mouth to your stomach). It is also known as Gastroesophageal Reflux disease or GERD.
sYMPTOMS OF ACID REFLUX
Burning sensation in the chest (heart burn)
Cough
Burning in the throat or an acid taste in the throat
Stomach pain
Trouble swallowing
sore throat or hoarseness
Recurrent lung infection
Behavioral modifications TO MANAGE Acid Reflux
Avoid certain food and beverages such as caffeine, peppermint, spicy food, greasy food, chocolate, Soda, pepper, citrus food, chewing gum and alcohol
Avoid smoking
If you’re overweight, losing weight can help control acid reflux symptoms
Avoid medications such as ibuprofen (also known as Motrin / Advil), Aspirin
Avoid going to bed soon after eating (avoid going to bed at least 3 hrs. after eating), when going to bed elevate the head of the bed by 6 to 8 inch
Avoid tight fitting clothes
MEDICAL MANAGEMENT OF ACID REFLUX
Over the counter antacids such as Tums can neutralize the stomach acid and provide relief
For persistent symptoms your doctor can prescribe antihistamines such as Zantac or Pepcid or Proton pump inhibitor such as Prilosec / Nexium / Protonix
Proton pump inhibitors are the most effective medications in the treatment of GERD, however they also contain a lot of adverse effects. When taken for a long time it can cause bone loss, it can increase certain infections.
What if symptoms persist despite medication and behavioral modifications?
If the symptoms persist despite medications and behavioral modifications or if you experience unintentional weight loss, feeling of food getting stuck, vomiting blood or blood in stool your doctor will order Endoscopy to rule out more serious medical conditions.
An upper endoscopy is commonly used to evaluate the esophagus. A small, flexible tube is passed into the esophagus, stomach, and small intestine. The tube has a light source and a camera that displays magnified images. Damage to the lining of these structures can be evaluated and a small sample of tissue (biopsy) can be taken to determine the extent of tissue damage.
complications of long term uncontrolled GERD
Ulcer – Ulcers can form in the esophagus as a result of burning from stomach acid.
Stricture – Damage from acid can cause the esophagus to scar and narrow, causing a blockage (stricture) that can cause food or pills to get stuck in the esophagus.
Barret’s Esophagus – During repeated exposure of stomach acid in the esophagus there is a risk of esophagus lining (squamous cells) to change into a different type of cell (intestinal cell). This change has a potential to develop into cancer cells
Goal of pharmacological or non pharmacological management is to reduce the blood pressure to less than 130/80 mm Hg.
RISK FACTORS OF HYPERTENSION
Secondary causes of High Blood Pressure
Some medical conditions can contribute to high blood pressure. when those medical conditions are managed appropriately, blood pressure can be controlled.
Obstructive sleep apnea
Hyperthyroidism
Hyperaldosteronism (Conn’s Syndrome)
Renal Artery Stenosis
Pheochromocytoma
Hypercortisolism
Chronic Kidney Disease
Some medications can increase the blood pressure. In that case upon discontinuing the medication, blood pressure can be normalized.
Some Antidepressants (Venlaflaxine or Effexor, Wellbutyrin or Bupropion)
ADHD medications (Adderall, Ritalin)
Estrogen containing Birth control pills
Why is it important to keep the Blood Pressure Under Control?
Uncontrolled Blood pressure can cause many significant and dangerous health problems and can even lead to death.
Cardiovascular (Heart) Problems : When the blood pressure is high your heart needs to work extra hard to pump blood to the rest of the body. By working extra hard for a long period of time heart goes under tremendous stress and can develop conditions such as Heart Failure and Heart Attack
Neurovascular (Brain) Problems: High Blood pressure reduces blood supply to the brain and therefore can cause Ischemic stroke (part of the brain that gives up functioning due to no blood flow) and Dementia. In addition high blood pressure can also cause hemorrhagic Stroke by causing increase pressure in the vessels leading them to rupture (Think of your blood vessels like a pipeline, if the pressure in the pipe increases it can cause the Pipe to explode and water will start leaking).
Vascular (Blood Vessel)Problem: Long standing high blood pressure can weaken the blood vessel and cause problems such as aneurysm and dissection (blood vessel ruptures causing the blood to leak internally).
Vision (EYE) Problems: Lack of blood supply to the eyes can cause retinopathy and eventually blindness.
Nephropathy (Kidney) Problem : Lack of blood supply due to increase pressure can put alot of stress for the kidneys to function and can cause kidneys to fail and eventually needing Dialysis or kidney transplantation.
Erectile Dysfunction (Sexual dysfunction): Who would have thought High blood pressure can contribute to sexual dysfunction. It is caused by the same concept, and that is high pressure reduces blood supply to the Penis causing it to not function as it should be. This can lead to difficulty maintaining or achieving an erection.
Like any other medical condition if you have 2 or more reading of elevated blood pressure that are not affected by external factors (drinking caffeine before checking the blood pressure etc.) your doctor can diagnose you with Hypertension. There is a common problem called White coat Hypertension in which people have elevated blood pressure every time they come in to the doctor’s office (since no one likes to come to the doctors office and the anxiety or stress cause the blood pressure to falsely be high). In that case your doctor would ask you to check the blood pressure outside of that environment such as home or a pharmacy or etc.
Proper management of Hypertension includes a multidisciplinary approach. Just following one without controlling the others is not going to help you achieve good blood pressure control
Medications
Diet & Exercise
Weight loss
Management of Stress
Management of other medical problems that can contribute to High Blood Pressure
No one likes to be on medications, however if you are diagnosed with Hypertension and if you failed to control your blood pressure by lifestyle changes being on medication is the best option for you. Many people are worried about the side effects of medications. Even though medications do have side effects, having high blood pressure can cause more harm than the side effects of medications. If you look at any medication It would always have a long list of possible side effects, that does not mean everyone is going to experience some or all the side effects. Your doctor would explain you the most common and most dangerous side effects and if you experience any of them you can talk to your doctor and stop or switch the medication immediately. Your doctor will also discuss with you the best blood pressure medication for you depending on your ethnicity, age and comorbidities. Just because you have to start a medication for hypertension does not mean you have to be on it forever. When you work on the other factors that affect your blood pressure and control them your blood pressure will also be under control and eventually you can get off of the medication with your doctors guidance and supervision.
Diet & Exercise
Diet plays a major role in blood pressure control. Recommended diet plan for hypertension is DASH diet. DASH diet includes
Over weight, obese or morbid obesity puts you at high risk of developing hypertension and other complications. Studies have shown that losing approximately 10 lbs will reduce the systolic blood pressure by 5 – 20 mmHg. In addition if you have a secondary cause of hypertension that is related to your body habitus, it can help reduce it even further.
Management of stress
We all go through a lot of stress on a daily basis. From waking up in the morning , then getting stuck in the traffic and finally when you get to work there is more stress. If we do not find a way to handle our stress, stress will take control of our life and health. There is no one way to manage stress, you just have to find what works for you. some of the most common stress relievers are
Aging is a natural process every single one of us have to go through. If the process is inevitable, why not make it a healthy and smooth ride!
Quality of life is more important than living life itself. This article will be focusing mainly on Lifestyle modifications that can improve your quality of life. Lets start to build the path to healthy aging.
What are the lifestyle factors that contributes to a successful aging?
Physical Activity
Healthy Eating
Sleep
Psycho social factors
Substance use
Physical Activity:
Exercise can improve your health significantly by reducing bone loss and preventing osteoporosis, reducing arthritis pain, strengthen and decrease fall and fracture risks, improve sleep and cognitive function as well as contributing to improve medical conditions such as blood pressure, Diabetes, High cholesterol and Depression. Some studies have also showed reduced risk of colon and breast cancer and death by being physically active.
It is recommended for older adults to perform at least 150 min/ week of moderate intensity exercise such as brisk walking or 75 mins/ week of vigorous intensity exercise such as jogging or running. Muscle strengthening exercises involving major muscles such as legs, hips, back , chest, shoulder and arms should be included as part of the physical activity. For those who are not active at all, even low intensity exercise such as sitting less, walking around the house while watching TV or standing more can be beneficial compared to no physical activity at all.
Type of Exercises and its benefits
Aerobic Exercise: Aerobic exercise such as walking, running, swimming, bicycling all provide cardiovascular and muscular benefits. It is always better to increase the duration of the exercise before increasing the intensity of the exercise.
Resistance Training : Resistance training such as use of weights or exercise bands are associated with increase in muscle strength and muscle mass. When you first start, pick a weight which you can lift comfortably atleast 8 times. when you use weights you should start slowly about two to three seconds to lift, hold for one second, and three to four seconds to return back to the starting position.
Flexibility Training : Dance exercises such as Zumba or Yoga improves flexibility and joint range of motion, endurance and muscle strength. You should slowly stretch into the preferred position and hold each stretch for about 10 to 30 seconds.
Balance Training : Balance training such as Tai Chi improves balance and reduces the risk of falls and fractures.
Healthy Eating
Malnutrition is a very common problem older adults encounter. It can be due to multiple reasons such as other medical problems affecting appetite or the ability to eat (poor dentures, etc) or Elderly negligence. Weight loss and decreased food intake is associated with increased harm and mortality in elderly. A healthy BMI in older adults is between 23- 32 kg/m2. Eating a healthy diet rich in protein, dairy, vegetables, fruits and reduced fat has shown to improve the quality of life in elderly.
Dietary supplements with vitamins are not required unless there is deficiency. Calcium and Vitamin D supplement may help with the bone health and prevent Osteoporosis. Vitamin D supplement with calcium have shown to reduce falls in people who are deficient in vitamin D, however if your vitamin D is within normal limits supplementing vitamin D will not benefit you.
SLEEP
As we get older our duration and quality of sleep gets compromised. It is recommended to get 7- 8 hrs of sleep for adults older than 65, however 80% of older adults does not get the required amount and quality of sleep. When you do not get good sleep, your thinking, mood and functional abilities are compromised. It is important to try good sleep hygiene if you experience sleeping problems prior to trying medications, since sleeping pills have many side effects including drowsiness causing falls, affecting the breathing pattern and can even make you get addicted to them.
What is a good sleep hygiene ?
Use your bed only for sleep and sex. Do not eat or do work in bed
Make your bed comfortable to sleep by using the appropriate linen and pillows that make you comfortable and setting up the temperature to best suit you.
Go to bed only when you are sleepy and if you cannot fall asleep for 15 – 20 mins, get up and do some light activity and then try to go back to sleep again
Avoid drinking caffeinated beverages in the evening and even eat your dinner early
If you have to wake up multiple times in the middle of the night to urinate, avoid drinking a lot of water late at night.
Avoid smoking or alcohol at night
Increase day time activity and reduce or avoid day time naps.
Try relaxation techniques such as meditation
If none of the sleep hygiene techniques help you get the sleep you need and if you have to start sleeping medication, talk to your doctor about the risks, side effects and addiction potential of each and every sleeping pills prior to making a decision.
Substance Use :
Smoking is associated with reduced quality of life as well as increased mortality in older adult. Smoking can affect every single part of your body from your skin to your brain. In addition to causing multiple cancers including skin, Lungs, bladder etc and causing heart attacks and stroke , it can also affect your immune system and make you more prone to catch infections. As we get older the ability for our body to fight infections reduce and this leads to multiple hospitalizations and poor quality of life. Quitting smoking reduces the risk of death despite the age.
Older adults with alcohol use disorder have higher rates of death due to liver failure, falls and injuries and cancer. In addition they also have poor quality of life due to the trauma and poor wound healing, increased risk of developing dementia and stroke. It is common for older adults to be on multiple medications due to other medical problems and alcohol can interact with them and affect alcohol level or drug levels causing toxicity and even death.
Older individuals sometimes use medications that are not prescribed to them or take extra dose of medications (intentionally to increase the benefit of the medication or unintentionally due to memory problems). Due to the physiological changes that happens with aging, prescription, over the counter medications or herbal supplements tend to cause more harm in elderly when taken without a physician’s recommendation. A lot of medications and supplements are listed as a safety concern by FDA in elderly. Talk to your doctor before taking any medications or supplements.
PSYCHO-social Factors :
Despite the medical advances and awareness there is still a stigma about depression and mental health. Older adults are at higher risk of developing major depression or depressive symptoms, however it is also most commonly missed due to contributing the symptoms to other medical problems.
Older adults have multiple risk factors to develop depression including loss of independence due to frailty or medical problems and complications from multiple medical problems. Elderly negligence or abuse is another common reason for impaired mental health.
Older men who are single have higher rates of completed suicide. Good social support, being married , being religious are some of the factors that shows protective factor against suicide attempts.
For those with mild depressive symptoms, improving your diet, sleep , physical and pleasure activity and social support can significantly help with depressive symptoms. If symptoms are severe your doctor can help you chose an antidepressant that is safe for you.
Mediculous 