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Kids and lactose intolerance

June 23, 2014

Do you wonder if your child might have “lactose intolerance”?    Have you ever thought of removing dairy from your child’s diet?  If the answer to either of these questions is yes, here are a few things to remember when it comes to lactose intolerance in kids:

  • Lactose is broken down by lactase.

While lactose is the carbohydrate (sugar) found in milk, lactase is the enzyme that digests the sugar. This enzyme is found in the lining of the small intestine, breaks down lactose into simpler molecules that are easier to absorb.  When there isn’t enough lactase, the sugar isn’t properly absorbed, which leads to the symptoms of “intolerance”, which include gas, bloating, pain and diarrhea.

  • True lactose intolerance is rare in young children.

Although children as young as infants can “transiently” have l...

Gluten intolerance or low FODMAPs?

June 18, 2014

Despite test results that show no evidence of their children having neither any detectable allergies to wheat nor any signs of celiac disease, many parents choose to have their children follow a gluten-free diet.  This is because of convincing stories of how gluten (a protein found in wheat and other grains) seems to cause their kids to have belly aches, nausea, bloating and a variety of other symptoms.  

For years, this was hard to explain without a scientific explanation.   Gastroenterologists like me had a hard time supporting families who wanted to follow gluten free diets, without a good “medical reason”.  Then, in 2011, researchers from Australia conducted a double-blind, randomized, placebo-controlled, rechallenge trial in nearly 3 dozen patients (none of whom had celiac disease or wheat allergy), all of whom described worsening symptoms when unkno...

Does your child have a food allergy or food sensitivity?

June 09, 2014

“Every time my child eats, his belly hurts. I think he must have a food allergy. Can you help us?”

Countless times have I heard this from parents of children worried about foods being the cause of their child’s gastrointestinal (GI) complaints. Some families wonder whether their child should start a “gluten-free” or other type of dietary change. More often than not, families have already tried a few diets before meeting with me.

Parents considering these types of elimination diets need to be aware of a few key points:
The difference between “food allergy” and “food sensitivity”:

Sports drinks and energy drinks

June 03, 2014

I recently wrote a short post for the Issaquah Soccer Club on the topic of sports & energy drinks.

What is inflammatory bowel disease (IBD)?

May 21, 2014

Inflammatory bowel disease (IBD) is a chronic (i.e. long-lasting) inflammatory condition of the gastrointestinal system. IBD is often confused with irritable bowel syndrome (IBS) because of their similar acronyms, but the two conditions are not related. IBD affects approximately 1.4 million Americans and is most commonly diagnosed between 15-40 years of age.

IBD can be categorized into ulcerative colitis and Crohn’s disease. Though there are clear differences between the two, they are closely related and sometimes difficult to distinguish.

Ulcerative colitis is a condition where inflammation affects the most superficial layer of the large intestine (colon). It typically starts at the rectum and can involve a varying amount of the colon. In contrast, the inflammation of Crohn’s disease can affect all layers of the intestine and can involve any area of the gastrointestinal tract – from the mouth to the anus. The type of inflammation seen in Crohn’s disease may lead to long-term complications such as strictures or fistulas (abnormal connections to other organs) that are typically not seen in ulcerative colitis.

What is inflammatory bowel disease (IBD)?

May 21, 2014

Inflammatory bowel disease (IBD) is a chronic (i.e. long-lasting) inflammatory condition of the gastrointestinal system. IBD is often confused with irritable bowel syndrome (IBS) because of their similar acronyms, but the two conditions are not related. IBD affects approximately 1.4 million Americans and is most commonly diagnosed between 15-40 years of age.

IBD can be categorized into ulcerative colitis and Crohn’s disease. Though there are clear differences between the two, they are closely related and sometimes difficult to distinguish.

Ulcerative colitis is a condition where inflammation affects the most superficial layer of the large intestine (colon). It typically starts at the rectum and can involve a varying amount of the colon. In contrast, the inflammation of Crohn’s disease can affect all layers of the intestine and can involve any area of the gastrointestinal tract – from the mouth to the anus. The type of inflammation seen in Crohn’s disease may lead to long-term complications such as strictures or fistulas (abnormal connections to other organs) that are typically not seen in ulcerative colitis.

Why aren't my bowel habits normal?

April 21, 2014

Do you have irregular, uncomfortable, or distressing bowel habits? Irritable Bowel Syndrome (IBS) is the most common gastrointestinal condition affecting an estimated 15% of the general population. It is most common among women aged 30 to 49 years old.

IBS is a chronic condition of the digestive system that is not generally associated with more concerning findings of anemia, weight loss, family history of colorectal cancer, inflammatory bowel disease, or celiac disease. Symptoms of IBS include abdominal discomfort, constipation and diarrhea. Despite extensive research, no common cause of IBS has been identified. Some theories include:

Why aren't my bowel habits normal?

April 21, 2014

Do you have irregular, uncomfortable, or distressing bowel habits? Irritable Bowel Syndrome (IBS) is the most common gastrointestinal condition affecting an estimated 15% of the general population. It is most common among women aged 30 to 49 years old.

IBS is a chronic condition of the digestive system that is not generally associated with more concerning findings of anemia, weight loss, family history of colorectal cancer, inflammatory bowel disease, or celiac disease. Symptoms of IBS include abdominal discomfort, constipation and diarrhea. Despite extensive research, no common cause of IBS has been identified. Some theories include:

FDA finally defines gluten free

February 26, 2014
On August 5th, 2013, the U.S. Food and Drug Administration (FDA) at long last published a formal rule regulating the use of the term "gluten free" on foods and beverages.  Even though this came with a big sigh of relief to the millions of people with celiac disease living in the US, consumers should be aware that the law gives manufacturers one year to be in full compliance (and goes into effect August 5, 2014).

As we head into the final months before the law’s final compliance date, I thought I’d highlight a few other key points about this brand new law:

1. No symbols needed.  The law does not require or recommend manufacturers use any particular symbol or food label, but if a label should include any of the following phrases, compliance must be ensured:
  • "Gluten-free"
  • "Free of gluten"

Pivotal time for chronic hepatitis C treatment

February 10, 2014

An estimated 2.7-3.9 million people in the US are chronically infected with hepatitis C.* Patients are often diagnosed incidentally, when they donate blood, get life insurance or get a routine physical exam with blood tests showing normal or abnormal liver enzymes. They may have been diagnosed many years ago with non-A, non-B hepatitis, but forgot about it, never followed up, or did not mention it to their regular health care provider. In 2012, the Centers for Disease Control (CDC) issued additional recommendations to start screening “Baby Boomers,” those born between 1945-1965. Though Baby Boomers account for 3.25% of the US population, they account for 3/4 of the hepatitis C infections.*

Patients may have seen a health care provider in the past and told that there is no treatment, that treatments were not effective, or not worthwhile due to side effects. Patients have been reluctant to seek treatment because they have heard about the terrible side effects associated with treatment, including flu-like symptoms, fatigue, depression, muscle aches, rashes, etc, lasting up to a year.

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