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DEAR DR. ROACH: I have no health issues, but I’m a cheapskate. I see products labeled as “grain-free” or as “gluten-free,” but they always cost more than the regular product. Are there any health benefits to using these, or are they marketing gimmicks? – L.C.
ANSWER: They are not marketing gimmicks at all. People with celiac disease have a sensitivity to a protein in gluten, called gliadin. Even small amounts of gluten can cause long-lasting damage to the intestines, and many people with celiac disease will be unable to properly absorb nutrients if they are regularly exposed to gluten. This can manifest with severe symptoms, such as weight loss, diarrhea and severe metabolic disturbance. Or it can trigger much milder ones, such as mild abdominal discomfort after eating, skin changes, anemia or joint pains.
Because the symptoms of celiac disease are so varied, a physician must be fairly convinced it’s celiac before making the diagnosis. Biopsy is the gold standard for certainty, but blood testing – if done while consuming a diet containing gluten – is suggestive. I strongly recommend getting a diagnosis before going on a strict gluten-free diet if you suspect celiac disease.
For people with diagnosed celiac disease, strict adherence to a gluten-free diet is essential, and the increasing availability of gluten-free foods has made the lives of people with celiac disease better. Many grains are gluten-free naturally.
Some people with symptoms from gluten-containing foods do not have celiac disease. The term is “non-celiac gluten sensitivity” (NCGS). Some people with this condition are sensitive to components of the food other than the gluten, although there are some people who are sensitive to gluten but do not have celiac disease.
For people without NCGS and without celiac disease, avoiding gluten is not necessary. A diet with many different whole grains has been proven to reduce heart disease risk compared with a more meat-based diet.
DEAR DR. ROACH: Please discuss the problem of the thirst mechanism as it relates to the elderly. I’m 70 years old and in almost perfect physical health. I bicycle every day – 75 miles each week. Even with this enormous physical exercise, I am never thirsty all day and night. Also, I do not perspire. I need to force myself to drink water. Why don’t I feel thirsty? – M.U.
ANSWER: Thirst is a powerful motivation. In people with an intact thirst mechanism, the desire for water can be overpowering; it’s one of the body’s main ways of regulating salt and volume in the body. You are exactly right that as people age, the thirst mechanism becomes less powerful, and that tends to leave older people with a slightly higher amount of salt in the body compared with younger people. Remembering to drink water, especially on hot days, reduces the risk of dehydration.
However, people who drink continually may never trigger the thirst response. There are many social cues to drink, and people who are not losing fluid through exertion and sweat may never trigger a strong thirst response. Drinking too much is as dangerous as not drinking enough: If thirst is really impaired, you need to use other mechanisms to monitor fluid status. For example, needing to urinate every several hours (at least) is one way of staying in the right zone.
Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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