Flourish –Your Guide to Health, Beauty & Fitness 01.12.2024 by Brentwood Press & Publishing

January 12, 2024

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Your Guide to Health, Beauty & Fitness

THE PRESS Dry January Benefits of a break from alcohol Your Guide to Health, Beauty & Fitness

Red Light Therapy A new pain relief treatment

Going Gluten Free Understanding gluten and its dietary role

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A primer on celiac disease, gluten sensitivity

eliac disease symptoms and gluten sensitivity symptoms can be the same*. What is the

difference between these two conditions if the symptoms are similar? Awareness of “gluten-free” has increased, but understanding the difference

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BURKHART no information about CD and GS. This has to change. Because there is little training on celiac disease and gluten sensitivity in medical schools, little information is relayed to patients. Providers and patients must self-educate on the topics. I hope this article helps in that process. Celiac disease is common. ♦ A groundbreaking study found the incidence of CD in people donating blood to be 1/133. More recent information shows the number is now closer to 1/100. ♦ If someone is symptomatic or has a celiacrelated disorder such as anemia, diabetes, osteoporosis, short stature, infertility, or Down’s syndrome, the incidence of CD increases to 1/25. ♦ If there is a first-degree relative with CD, the incidence increases further to 1/22, irrespective of whether or not the relative showed any symptoms. CD is an autoimmune, genetic, lifelong condition that can present at any age. It causes damage to the villi of the intestinal mucosa because of an abnormal immune reaction to gluten. Gluten is a protein found in wheat, barley, and rye. With continued ingestion of gluten, a person with CD develops malabsorption and subsequent complications. Long-term complications of celiac disease include (but are not exclusive to): anemia, vitamin deficiencies, heart disease, osteoporosis, infertility, and neurologic symptoms. Celiac disease is a multi-organ system disorder that can affect the thyroid, liver, heart, and reproductive organs and the musculoskeletal system and brain. The risk of long-term complications

decreases with adherence to a gluten-free diet. Only 30%-40% of celiac patients actually have GI symptoms at diagnosis Celiac disease symptoms are not what you may think. The presenting symptoms ( primary symptoms at diagnosis) of celiac disease have changed dramatically over the last decade. This disease is a chameleon and celiac disease symptoms vary from person to person. Once thought to be a “wasting” disease, we now know that 40% of CD patients are overweight or obese at diagnosis. Another common misconception is that gastrointestinal symptoms are required to initiate a diagnostic evaluation. However, gastrointestinal symptoms only occur in 30–40% of celiac patients at diagnosis. Their absence should not preclude an assessment. “Atypical” celiac disease symptoms are now common, including factors such as anxiety, depression, anemia, fatigue, osteopenia, rashes, dental enamel defects, and aphthous ulcers. One or more of these may qualify as the presenting symptom. I want to reemphasize that only 30-40% of patients actually have GI symptoms at diagnosis. For example, I have frequently seen newly diagnosed celiac patients with only anxiety or only joint pain. They have no other symptoms – emphasis on no other symptoms. These were their “glutenreaction” symptoms. Also changed is the belief that CD is found primarily in Northern European Caucasians. The ethnic boundaries of CD are now blurred, as the disease appears to be equally common in other ethnic groups. Someone must be eating gluten for tests to be accurate. Basic screening for celiac disease includes a serum TTG IgA and total serum IgA. Total serum IgA needs to be done to rule out IgA deficiency which occurs in about 10% of celiac patients. If IgA deficiency is present, the TTG IgG must be used but is less accurate. Further testing may be needed in those situations. Some labs include a DGP-IGA and EMA in their celiac screen/panel or do these tests as a reflex. The confirmatory test is an endoscopic biopsy. The biopsy is indicated if tests are posisee Gluten page 4B

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Editor’s note: The following is a statement/question-and-answer presentation from Dr. Amy Burkhart of Napa, a medical doctor and registered dietician, on celiac disease, gluten sensitivity and gluten intolerance. The answers are printed verbatim from her website with her permission. CD is celiac disease, GS is gluten sensitivity and GI is gluten intolerant.

between gluten sensitivity and celiac disease is lagging. As we all live online more and more, the influence of the internet plays a more critical role. Confusion and misinformation about celiac disease and non-celiac gluten sensitivity are still widespread. Healthcare providers have the opportunity to correct misperceptions and identify patients with these common and underdiagnosed conditions. Providers must respond to patient questions with accurate information and a well-informed diagnostic plan. I have many patients in my practice with celiac disease (CD) or non-celiac gluten sensitivity (GS). The disparity in diagnosis and treatment from other providers is astounding. There is confusion on countless fronts. Celiac symptoms are often missed. Misinformation stems, in part, from internet lore and wellmeaning friends. These are variables that are difficult to control. However, I also see many people whose providers have given them misinformation or

What doctors know – and don’t know

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Red-light therapy can relieve pain HEMANANTHANI SIVANANDAM

Red-light therapy, also known as photobiomodulation or low-level light therapy, may help improve several skin and health conditions.

or more than a decade, Jennifer Ogden of Brentwood suffered from severe chronic

pain and tried various ways to find relief. But nothing helped until she stumbled upon a book about red -light therapy a few years ago. She tried it, and she said is now free of pain. Ogden, 61, explored red-light therapy and said she experienced immediate relief during three treatments. Motivated by her personal experience, she transitioned from being a nanny to launching her own business and extending her newfound knowledge of red-light therapy at Sawa Spa. Ogden said she was impressed by the results of the treatments she went for and mentioned it to the pain management consultant who had treated her. The consultant offered to train Ogden. After her training, Ogden reached out to the Sawa Spa director, who was happy to offer red-light therapy as part of their services. “That is how I started my own busi-

ness and now I am treating clients at Sawa Spa,” she said. “I live pain-free now and I’m helping others live pain-free without prescription or over-the-counter medications,” said Ogden, who is now a pain management consultant. According to health.com, red-light therapy, also known as photobiomodulation or low-level light therapy, may help improve several skin and health conditions such as acne, fine lines, wrinkles, and alopecia, among others. It uses low-level light to penetrate the skin and strengthen the mitochondria. Ogden said she uses red-light therapy for pain management, such as inflammation, joint pain, stiffness, and arthritis, among others. She recommends those suffering from pain come for at least three sessions. The results, however, will vary depending on several factors such as the kind of pain, its

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duration, diet, and medication taken. “For these reasons, I offer a 30-minute consultation before I treat so we can look at all the factors to determine the optimal care plan,” she said. “Oftentimes, when a client has dealt with chronic pain for years, they may want to purchase a (Food and Drug Administration-approved) pad and use them at home for continued relief,” Ogden said. Ogden said her sessions at Sawa Spa at 1700 Trilogy Parkway in Brentwood adopt a holistic approach that focuses on the mind, body, and spirit, adding there are four parts to the program. Each session encompasses treating the entire neck and spine with red light, followed by targeted treatment of the areas that hurt with the application of a light pad. Clients are provided noise-canceling headphones to

listen to guided meditation and use bluelight glasses to wear. “While you close your eyes the blue lights flash and sync to the binaural sounds of the background of the meditation. “The listener is gently guided into the relaxed state of brainwave Theta, which results in the reduction of the hormone adrenaline,” she said. “Once in that state, the listener can more easily let go of negative thoughts, feelings, and beliefs, allowing the body to heal faster.” The final step is the use of VibePlate for a whole-body vibration, which forces muscles to contract and relax. For more information, visit www.thebrights.care or call 925-809-7171. Editor’s note: People should consult their doctors and use devices approved by the Food and Drug Administration because not all devices are cleared by FDA.

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Gluten from page 2B tive and are required for diagnosis. Of note, many celiac centers and practitioners follow a more extensive evaluation process involving screening antibodies, genetic testing, clinical response to a gluten-free diet, and endoscopy. The only treatment for CD is a strict, lifelong gluten-free diet—100% of the time Pharmaceutical treatments currently in clinical trials may aid in the digestion of gluten or in decreasing intestinal permeability seen with celiac disease. None are currently on the market but Larazotide is in Phase 3 clinical trials (i.e. getting close). Larazotide is aimed at decreasing celiac disease symptoms that

occur when someone is accidentally exposed to gluten. It will not cure celiac disease or allow someone to eat a regular diet. Current over-the-counter digestive enzymes marketed for digesting gluten are not appropriate for people with CD. Some of the most promising pharmaceuticals under investigation are aimed at decreasing the symptoms that occur from cross-contamination, such as when dining out. They will not be a cure, but their development will be helpful in addressing the social and psychological issues surrounding CD. The social aspect of celiac disease is not commonly discussed in the medical community. The use of nanoparticle technology is currently being evaluated as a treatment for

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celiac disease. Early results are promising. Diagnosis of gluten sensitivity There is no validated test to diagnose GS. Some online labs offer blood, saliva, or stool tests for gluten sensitivity, but they are invalidated and not recommended. It is impossible to develop a test when the mechanism of gluten sensitivity has not been determined. Diagnosis is made by ruling out CD and wheat allergy while the patient is on a gluten-containing diet. Once both are ruled out, a gluten elimination diet is prescribed. If symptoms improve, the patient is deemed to have gluten sensitivity. Using a response to initiation of a gluten-free diet as a prognostic indicator will give inaccurate results, as both celiac and GS can have similar responses to a gluten-free diet. Treatment of gluten sensitivity At this point, a gluten-free diet may not be the starting point for gluten sensitivity patients. Many cases of GS are due to FODMAP intolerance. Once an evaluation is done to assure no other conditions are responsible for symptoms, a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet may be indicated. Referral to a dietitian familiar with the Low FODMAP diet is recommended. Once studies clarify what gluten sensitivity truly is, more targeted and individualized therapies will be developed. It is not clear how strict the gluten-free diet needs to be or what the long-term complications are. These are both areas currently under investigation. Why you must test and not just start a gluten-free diet? The blood tests and biopsy used to test for CD require a patient to be eating gluten to obtain accurate results. If a patient is started on a gluten-free diet without evaluating celiac disease, it becomes challenging to appropriately diagnose celiac disease. Patients who experience clinical improvement on a gluten-free diet will rarely restart a gluten-containing diet to get an appropriate diagnosis. They finally feel well, and returning to being sick is just not an option. The importance of testing cannot be overemphasized. Consider these factors: ♦ CD is lifelong. We don’t know about GS. It is wrong to subject someone to a lifelong, strict gluten-free diet if they don’t need it. The social and psychological implications can be vast.

CD requires a strict gluten-free diet. A gluten-free diet may not treat those with GS. They may require a low FODMAP diet. This difference in utilizing the proper diet can be life-changing to some patients. ♦ CD is genetic. If you miss a CD diagnosis, you may also miss or delay diagnosis in their child, sibling, or parent. ♦ CD has long-term risks and complications. These parameters may be different for GS. We simply don’t know yet. Appropriate diagnosis is necessary for proper follow-up care of celiac patients and those with gluten sensitivity. Insurance reimbursement can be more challenging without a diagnosis. You and your patients are more likely to get insurance reimbursement for a diagnosis of CD that would otherwise be missed if never tested for. Summary of the difference between celiac disease and gluten sensitivity 1. Celiac is a genetic autoimmune condition. Gluten sensitivity does not appear to be genetic or autoimmune. 2. Testing for celiac disease must be done when someone is eating gluten to have valid test results. There is currently no valid test for gluten sensitivity. 3. We know many other conditions are associated with celiac disease, we are not sure of all conditions associated with gluten sensitivity. 4. Gluten sensitivity may be several different disorders, including FODMAP intolerance, ATI intolerance, and intolerances to other components of wheat besides gluten. 5. Celiac Disease is lifelong. The tolerance to gluten in someone with celiac disease does not ever improve or go away. Gluten sensitivity may be lifelong or temporary and can become less severe over time. 6. The diet for celiac disease is a strict, lifelong gluten-free diet. The diet for gluten sensitivity is typically a Low FODMAP diet or a less strict version of the glutenfree diet. 7. For people with celiac disease, the glutenfree diet is their treatment, i.e., “medication .” There is not a time when they should or can eat gluten. For people with gluten sensitivity many can eat gluten occasionally. For more information, visit https:// theceliacmd.com/ ♦

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‘Dry January’ can be a huge help to recovery from ‘wet’ holidays N I C KO L AU S H AY E S

rinking during the holiday season is commonplace. Social drinking is widely

accepted, it lightens moods and brings people together. However, many people see their drinking habits change and find themselves consuming more alcohol than usual. The holidays are a complex time of year; even the weeks leading up to it can be challenging. Dry January is an opportunity to abstain from alcohol for the entirety of the first month of the year and reset your mind and body. If you need a reason, ask yourself if you are using alcohol to cope with stress, if you find yourself stressed without alcohol, or if your drinking has hurt your relationships or your professional life. If you are answering ‘yes,’ Dry January will be of significant benefit. Even giving up alcohol for just one month, you will notice a benefit. You’ll see you have more energy, sleep better, lose weight, have clearer skin, have more money, lower blood pressure, and lower cholesterol. Your mental sharpness and well-being significantly improve. Statistically, California sees the highest

HAYES

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Taking a break from drinking in January is an opportunity for people to reassess their relationship with alcohol. number of alcohol-related deaths. There is an annual average of over 15,000 deaths in the state attributed to excessive alcohol use. Binge-drinking Californians binge a median of 1.6 times monthly. While abstaining from alcohol significantly improves health and contributes to reducing alcohol-related deaths, it is also the backbone of drunk driving prevention. Overall, there are more benefits associated with a Dry January than not. It can seem challenging, especially if alcohol has taken up a significant spot in your life. But there are practical tips you can use to make Dry January a success.

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Initially, create a supporting environment in which you know you will succeed. Thoroughly purge all the booze around you; either dump it, hide it, or give it away. Moreover, find a suitable non-alcoholic drink for social situations. Recruit a friend or family member to participate and help avoid temptations. Not only will you support one another, but you can also plan activities that do not involve alcohol, and you can speak about the successes and challenges of abstaining from alcohol. Stay busy and active, and take this time to focus on your mental and physical wellbeing; take advantage of having more energy

and sleeping better. Use Dry January apps that will help you track your progress and find practical ways to hold yourself accountable. Ideally, this can be optimal to reflect on your drinking habits. During the month, you will begin to lose alcohol cravings, and you may realize alcohol does not need to take up such ample space in your life. If the benefits make you feel great physically and mentally, consider continuing for another 30 days. Embrace your new attitude to alcohol use. Nickolaus Hayes is a healthcare professional in the field of substance use and addiction recovery and is part of the editorial team at DRS (Drug Rehab Services). His primary focus is spreading awareness by educating individuals on the topics surrounding substance use.

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people likely associate colds

with winter. Colds tend to spread more easily in winter, when people typically spend more time indoors with

White tea

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at any time of year, but most

Many people have their own remedies when it comes to treating colds, and those strategies may include a daily glass of tea. Tea has been a beloved beverage for quite some time. According to the UK Tea & Infusions Association, tea can be traced all the way back to 2737 B.C. in China. As the legend has it, Chinese Emperor Shen Nung was sitting beneath a tree when some leaves blew into some boiled drinking water his servant had been preparing for him. The emperor tried the concoction and the rest is history. Since tea was first (accidentally) consumed, it has become an integral part of many people’s daily lives. That’s even more so when people feel a little under the weather, which might prompt some to wonder if tea actually boasts any medicinal properties or if it’s all just legend. According to Penn Medicine, various types of tea do, in fact, provide some notable health benefits.

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A comparative study published in the Journal of Food Science in 2010 found that white tea might be the most effective cancer-fighting tea thanks to its robust antioxidant content. Penn Medicine also notes white tea is a source of fluoride, catechins and tannins, which means it could help to strengthen teeth and fight plaque.

Herbal tea

Harvard Medical School notes the curious distinction that herbal teas are not technically tea, as they typically lack the leaves or leaf buds of tea plants. Herbal teas are in fact made from tisanes, which are blends or infusions of dried fruits, flowers, spices, or herbs. Harvard Medical School advises speaking with a physician prior to drinking herbal teas, as they can cause problems among individuals with certain medical conditions. If a doctor gives the green light for herbal teas, people may be happy to learn that they’ve been linked to a host of health benefits, including improved sleep, reduced stress and lower blood pressure, among others.

Green tea

Penn Medicine notes that green tea is high in flavonoids, which are a type of metabolite found in plants. Flavonoids have been linked to improved heart health because they can help to lower levels of bad cholesterol and reduce blood clotting. In addition, a 2014 study published in the European Journal of Nutrition concluded that green tea and its catechins can help to improve blood pressure.

Should certain teas be avoided?

Though white tea, herbal tea, green tea, and other forms of the popular beverage have been linked to various health benefits, Penn Medicine notes other types of tea are best avoided. For example, detox teas, which Penn Medicine notes are often laced with laxatives, can be harmful to overall health. Bubble teas also tend to be high in sugar and calories. In general, it’s best to discuss tea with a physician before making it a part of your daily routine. – Courtesy of Metro Creative

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Exercise guidelines for adults of all ages

physically active lifestyle has been linked to a host of health benefits, including a

reduced risk for various chronic diseases and a longer, healthier life. The U.S. Department of Health and Human Services notes that moving more and sitting less benefits people regardless of their age, sex, race, ethnicity, or even current fitness levels. Whether they’re adapting to a more physically active lifestyle, already physically active or somewhere in between, individuals can benefit from recognizing the latest physical activity federal guidelines.

Adults

Substantial health benefits can be gained when adults do between 150 and 300 minutes of moderate-intensity aerobic activity each week or 75-150 minutes of vigorous aerobic activity each week. HHS notes that aerobic activity, which can

include walking, running, cycling, and hiking, among other activities, should be spread out over the course of the week. In addition to aerobic activity, HHS urges adults to do muscle-strengthening activities of moderate or greater intensity on two or more days per week.

Older adults

HHS recommends that older adults adhere to the same guidelines as younger adults but take additional steps as well. Older adults are urged to incorporate multicomponent physical activity that includes balance training into their fitness regimens. HHS also advises older adults to determine their level of effort for physical activity relative to their fitness level. It’s also recommended that older adults with chronic conditions discuss their ability to engage safely in regular physical activity with their physicians. Vigorous- and even moderateintensity exercise may not be possible for some older adults with existing conditions. Routine physical activity can help adults and older adults live longer, healthier lives. Adults of all ages are urged to speak with their physicians about safe ways to become more physically active.

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