Ask the Dr

Got milk? An increasing number of people are getting a funny feeling after cheesecake on Shavuos or having a queasy sensation when drinking the before-davening coffee or late-night chocolate. Others just have a hard time with the aftereffects of eating dairy products.

There’s a name for it. Lactose intolerance is the inability many people have digesting the sugars of milk, or lactose.

What is lactose and where is it found? Lactose is a type of sugar found in milk and other dairy products. Like other sugars, it requires a special enzyme to be digested. While there are many enzymes used to digest sugars, lactose is digested by lactase, a unique enzyme made in the small intestines. Unfortunately, many people do not have adequate amounts of lactase, leading to lactose intolerance. In fact, three-quarters of all Jews cannot digest this milk sugar, and this deficiency is primarily common amongst Ashkenazim.

How do you know if you are lactose intolerant? If you know you know! People with lactose intolerance do not feel well about an hour after eating dairy. They will experience nausea, cramps, stomach pain, gas, bloating or diarrhea. Children may have watery, frothy or bulky stools. Because the lactose is not properly digested in the small intestine, it ends up in the large intestine and gets digested by the bacteria that live there. This leads to all of the uncomfortable symptoms that lactose intolerant people have after that Shavuos cheesecake.

What tests diagnose lactose intolerance? The good news is that most lactose intolerance is diagnosed by personal history alone. If someone is experiencing consistent symptoms after eating dairy, the diagnosis is made. If the symptoms are severe, inconsistent, unclear if it appears only after dairy, or associated with any significant weight loss, a doctor may require some testing to rule out other causes. This may include bloodwork, a special breath test (called the hydrogen breath test) or, depending on the symptoms, even an endoscopy or colonoscopy.

I think I have lactose intolerance, now what? An easy way to test this is to take a break from eating dairy. If your symptoms improve, you have your answer. While avoiding dairy is challenging, it’s not impossible and there are many dairy substitutes for parve and fleishige meals. However, it’s also important to supplement some vital minerals which milk provides, particularly calcium and vitamin D. You may want to consider a multivitamin that has both. If you’re really missing that summer sundae, commercially available lactase enzyme preparations may be worth a try. While they don’t work for everyone, taking a Lactaid (or similar product) immediately prior to digesting dairy may help decrease symptoms in individuals with mild lactose intolerance.

There’s no use crying over spilled milk. There’s always soy.

Zeidy remains a spry senior well into old age, enjoying the eineklach and slower lifestyle well past his biological golden years. For many families, the break between crusty vibrancy and a life of doctor appointments and pills is a fall.

Bones which once withstood a kinetic clash with the hardest rocks and survived dozens of scrapes and bruises now cannot endure soft contact with the ground.

Welcome to the grim world of osteoporosis, a disease which can easily be prevented with some foresight in the younger years.

Osteoporosis is a disease that causes weak bones. People with the disease can break their bones too easily, for example breaking a hip after falling down at home.

These fractures can be serious, especially if the bone is in the hip. People who break a hip sometimes lose the ability to walk on their own and may require a long recovery.

Osteoporosis is a silent sickness in that it creeps up suddenly on the person. There are no symptoms until there is a fracture. However, doctors can evaluate bone strength or density using a "DXA test." If the test shows lower than expected bone density, doctors may choose to treat this with additional calcium and vitamin D.

DXA is a special kind of X-ray that gives off very little radiation and gives reliable measures of bone density in different parts of the body, such as the spine, hip, and wrist. 

Who should get tested for osteoporosis?

As people age, their bones weaken. Women age 65 and older should have bone density testing at least once. The exam might also be appropriate for some men who are older than 70. Doctors will also sometimes check bone density in younger individuals who may be on medication or have underlying medical conditions which have an increased risk of osteoporosis.

 Things that increase your risk of breaking a bone include:

●Having already broken a bone as an adult

●Taking medicines called steroids for a long time

●Weighing less than 127 pounds

●Having rheumatoid arthritis

●Having a parent who broke a hip after a minor injury

Oftentimes, people learn that they have osteoporosis for the first time when they break a bone during a fall or a mild impact. This is called a "fragility fracture," because people with healthy bones should not break a bone that easily.

While there are treatment options for osteoporosis, remember that the best treatment is prevention.

To keep your bones healthy you can:

●Eat foods with a lot of calcium, such as milk, yogurt, and green leafy vegetables

●Eat foods with a lot of vitamin D, such as milk fortified with vitamin, and fish from the ocean

●Take calcium and vitamin D pills

●Be active for at least 30 minutes on most days of the week

●Avoid smoking

●Limit the amount of alcohol you drink to 1 to 2 drinks a day

In addition, you can increase the safety of your home by:

●Make sure all your rugs have a no-slip backing to keep them in place

●Tuck away any electrical cords, so they are not in your way

●Light all walkways well

●Watch out for slippery floors

●Wear sturdy, comfortable shoes with rubber soles

The sense of vision in a human being does not become fully developed until their early 20s. From then on, most people find their vision and eye health generally remain stable throughout their mid-20s and 30s, with the occasional exception of women during pregnancy.

At this stage of life, it is important to establish good eye health habits for a lifetime of healthy vision. For example, people with diabetes or pre-diabetes need to have regular eye exams to make sure they don’t develop diabetic eye disease. A big part of diabetic eye-care is working with your doctors to control weight and blood sugar, as well as blood pressure and cholesterol.

Adults under the age of 40 with good eye health should have a complete exam by an ophthalmologist every five to 10 years. People at this age who wear glasses or contacts should be seen more frequently.

Between the ages of 40 and 65, our eyes can go through significant changes.

The most common change most people notice is the need to hold reading materials farther away from their eyes. Called presbyopia, nearly everyone experiences this increasing farsightedness that usually begins in their late-30s to mid-40s. Most people need reading glasses or another vision correction strategy to deal with farsightedness. If left uncorrected, this may cause headaches and eye fatigue.

Farsightedness usually starts in the early 40s and can increase with age. Even people who see well and who don’t have age-related eye diseases may have vision changes that might not be obvious. For instance, it may gradually become harder to distinguish an object from its background when they are the same color, such as result notching a white coffee cup sitting on a white table. This is called loss of “contrast sensitivity.”

For seniors, the ability to see well in different lighting may change. When going from a well-lit area to one with poor light, or vice versa, the eyes may take longer to adjust and focus, or they don’t adjust very well.

Problems adjusting to light and dark can make driving more difficult, especially at night or in the rain. Driving can be even more challenging when eye diseases affect the peripheral (side) vision or increase a sensitivity to glare.

It’s important to have a complete eye exam with your ophthalmologist every year or two after age 65.

Keeping up with regular eye exams allows the ophthalmologist to catch problems early on. The sooner a problem is detected, the more likely it is that treatment will be successful.

So much in life begins by taking a look at it. Keeping the eyes healthy well into old age is not a far-fetched dream but a doable idea which begins in childhood.

Infants have a mostly blurry vision, which progresses into a fully developed vision by the time they are about three years old. Newborns are typically evaluated for a “red reflex,” in which pediatricians look at the blink and pupil response. If a baby is born prematurely, they may sometimes require a specialist to examine the eyes since these babies are prone to vision complications.

Between six and twelve months, babies are screened for proper eye alignments and lazy eyes. When they reach school-age, children undergo screenings to check their vision and may be referred to a specialist if there is a concern.

It is important to note that while spending time looking at a screen or computer does not necessarily worsen eyesight, it can lead to dry eyes, itchy eyes, blurry vision and headaches. To help prevent this, consider the “BLINK 20-20-20” strategy. It’s good for kids — and adult! — during screen time:

B - BLINK: Blinking helps moisturize the eyes. Set a 20-minute timer and, when it goes off, look at an object 20 feet away for 20 seconds while blinking and relaxing the shoulders and neck muscles. This will force the eyes to reset, refocus and relax.

L - LUBRICATE: Lubricate your eyes with artificial tears or ointment throughout the day. If you wear contact lenses, try wearing glasses while using electronic devices to reduce dryness. If your house is dry, consider using a humidifier.

I - INCHES AWAY: Keep the computer or screen an arm’s length away and at a slight downward angle from the face. Adjust the computer screen's settings, including contrast and brightness, so that it is comfortable. Avoid using screens outside or in brightly lit areas, where the glare on the screen can cause strain. Also, maintain good posture while using a screen. Poor posture can contribute to muscle tightness and headaches associated with eye strain.

N - NEAR DEVICE BREAKS: Encourage children to utilize breaks from online learning or computer use to go outside or to play. Pre-mark books with a paperclip every few chapters to remind your child to look up. On an e-book, use the “bookmark” function for the same effect.

K - KNOW YOUR SOURCES: Rely on eye health information from trusted sources, including your child’s pediatrician or pediatric ophthalmologist. For example, there is no scientific evidence that the light coming from computer screens is damaging to the eyes. Because of this, blue light glasses or any special eyewear for computer use are not recommended.

While children with learning disabilities may have vision problems, learning disabilities are not caused by vision problems. Therefore, things like special diets, vitamins, sugar restriction, or special glasses do not help or “cure” learning disabilities. There is also no scientific evidence that eye exercises, which are sometimes recommended for children who are having difficulty learning to read or write, work. These exercises are often called vision training or vision therapy.

Having a good vision is not only an apt metaphor for life but also a literal goal to aim for!

Between burning the chometz, Lag Baomer bonfires, summer cookouts, chanukah menorahs, not to mention the weekly Shabbos blech, fire is an important part of Jewish life.

So is fire safety. While a cottage industry has sprung up around fire safety, which the community largely adheres to, every fire is one too many and one which is avoidable.

House fires are a common cause of death and injury in the United States. Each year, more than 3,000 Americans die in fires. Alarmingly, at least one child dies every day from a fire inside a home. Fortunately, there are many steps that can be taken to protect yourself and your family

One of the most important steps is to install smoke alarms and keep them in good working order. These can be purchased at most hardware stores at a usual cost of $10 or less. In some places, fire departments give out and install free smoke alarms.

Smoke alarms should be installed in every bedroom or area where someone sleeps. There should be one alarm for every level of your home. Consider installing them in playrooms and basements as well.

Alarms should be tested monthly and come equipped with a test button to help do this. It is best to use smoke alarms that have long-life batteries, but if you do not, change the batteries at least once a year such as Sukkos and Pesach. Alarms should be completely replaced every 10 years.

Pesach and Sukkos are also good times to practice family fire drills. Have an escape plan and practice it with your family. If a fire occurs, there will be no time for planning an escape. The plan should include two ways how to exit any room, as well as identifying any staircases that may need to be used in an apartment building. Agree on a meeting place. Choose a spot outside your home where everyone can meet after escaping, such as near a certain tree, street corner or fence. Teach your children that the sound of a smoke alarm means to go outside right away to the chosen place.

Everyone should know the way to call the fire department. This is not a time to call Hatzalah, since seconds can make a big difference in getting the fire extinguished and getting everyone to safety. Teach your children that firefighters are there to help and they should never hide from them.

Of course, even the most excellent plans are useless if they are not practiced. Set up realistic scenarios, block certain exits, and get everyone used to getting out of the home quickly and calmly. The more prepared your family is, the better your chances of surviving a fire. Tailor the plan to meet the needs of the family. Families with babies, toddlers or children with special needs should plan accordingly and designate an adult or older child to help with rescue.

Prevention of fires and fire safety education is an incredibly important step in protecting your home, your family and yourself.

What to Do if a Fire Breaks Out

While prevention is key, and practicing fire drills is important, knowing what to do in case of a fire can also be lifesaving

Just like Bubby said, eat healthy and stay active to ward diabetes away. Chicken soup, too — well, it can’t hurt, can it?

Diabetes is one of the fastest growing illnesses to affect people’s health and quality of life. Nearly 40 million American adults have it, and one out of five of them are not diagnosed on time. It is one of the top 10 causes of death in the United States and is the number one cause of kidney failure, leg amputations and adult blindness.

Most concerning, the number of adults diagnosed with diabetes has more than doubled since the turn of the century.

There are three main types of diabetes — Type 1, Type 2 and gestational.

Type 1 Diabetes is responsible for close to 10 percent of total diabetes diagnoses. People with type 1 diabetes have minimal or no ability to produce insulin, the hormone which directs the body’s sugar to the blood cells to be converted into energy. The result is that blood sugar levels rise after eating. While typically diagnosed in childhood, it can manifest for the first time in young and even late adulthood. While there is no cure and no known prevention, it has many different treatment options.

Type 2 Diabetes is responsible for the majority of diabetes diagnoses. Although it is typically diagnosed in adulthood, it is increasingly being recognized and diagnosed earlier. People with type 2 diabetes don’t use insulin well, causing their blood sugars to rise. It has a strong genetic component, but healthy eating, carrying a healthy weight and being physically active can prevent it.

Gestational Diabetes develops during pregnancy. Gestational diabetes increases the risk of the baby having health problems. While it usually goes away after the baby is born, it may increase the mother’s risk for type 2 diabetes later in life.

People with diabetes need to monitor their blood sugar frequently and often need to take medicine that duplicates insulin to help keep their sugars within normal range. It is important to realize that while type 2 diabetics have many different treatment options, there are ways of preventing it in the first place. Talk to your primary care provider about early diabetes screening which usually involves some bloodwork. If picked up early, the prediabetic stage can be reversed with lifestyle changes and can avoid developing a chronic medical condition.

Individuals with Type 1 and Type 2 need regular vision screening, as well as evaluation of their feet to make sure that sensation has remained intact. Unfortunately, diabetes can lead to serious issues like heart and kidney disease as well as blindness and nerve damage.

Eating healthy, moving your body and encouraging your kids to do the same are all fantastic steps to prevent type 2 diabetes and the complications that come with it.

The golden years should be devoted to einiklach, muffins and shiurim, not battling one of society’s most preventable cancers. All it takes is a doctor’s visit once or twice a decade to cut in half the odds of colorectal cancer, the third most common cancer in men and women not counting some kinds of skin cancer.

Screening for colorectal cancer, also called colon cancer, is recommended to begin at age 45 for those without any risk factors, and even younger for those with a family history of colon cancer or abnormal polyps.

What are screening tools?

The best way to take advantage of screening options is by going for a stool-based test every one to three years. The benefits of this are that they are less invasive than colonoscopies. However, if anything abnormal is found it may require further screening with a colonoscopy.

A direct visualization tests via a colonoscopy is recommended every five to ten years, depending on family history, test results or overall health. These tests require some prep at home to clean out the colon. The procedure then uses a camera to visualize the gastrointestinal system from the inside.

Who is at risk?

Anyone with a history of colorectal cancer, defined as having a first-degree relative with the cancer, may need to start screening at age 40, and retake the test every five or ten years, depending on results. If there are two or more first degree relatives with colon cancer, a colonoscopy is recommended every five years starting at age 40, or 10 years before the youngest case in the family was diagnosed, whichever comes first.

If a colonoscopy discovers polyps or adenomas, the doctor may recommend more frequent screenings, depending on the size, number and type of polyps.

Those with ulcerative colitis or Crohn’s colitis may need more frequent and earlier screening.

Why screen?

Early detection of colon cancer can be the difference between a treatable and non-treatable cancer. In addition, identifying and removing pre-cancerous polyps can be life-saving and prevent an individual from even developing cancer later on.

It is a medical miracle that a simple screening can slash the odds of getting one of cancer world’s most fearsome creatures. But only if you take advantage of it.

Challos on Shabbos, rye bread on Wednesday and honey-nut babke on Friday. Don’t forget cheesecake on Shavuos and hamantashen on Purim. The heimishe diet has a love-hate relationship with gluten, but it may lead to the autoimmune celiac disease.

Celiac disease is often confused with gluten allergy or sensitivity. In fact, true celiac disease occurs in only about 1 percent of the general population, though it is more common among Ashkenazi Jews. For this reason it’s important to recognize symptoms and consider celiac disease when noticing an intolerance to gluten.

Celiac is an autoimmune disease, which means the body recognizes something internal and tries to attack itself in an attempt at self-defense. When a person with celiac disease eats gluten, the immune system begins to attack villi, which are small, fingerlike projections in the intestines that absorb nutrients. Damaged villi prevent nutrients from being absorbed. This can lead to anemia, weight loss, diarrhea and ultimately, malnutrition.

The first symptom in children of celiac disease is poor growth. Some other common symptoms in both adults and kids include diarrhea, fatigue, anemia, headaches or dermatitis herpetiformis, a type of itchy rash. Symptoms can be vague, mild or non-existent in the beginning.

The first step to managing the medical issue is getting diagnosed. The doctor will usually take a blood test to look for antibodies to gluten. If the results are positive for celiac disease, you may be referred to a gastroenterologist, a type of doctor more familiar with celiac disease, to discuss an endoscopy and biopsy to confirm the result. Note: It is important to remain on a normal diet which includes gluten products before and while being tested for celiac disease. Going gluten-free prior to diagnosis may affect test results.

Once the diagnosis is confirmed, it is time to manage it. There is no cure for celiac disease; the patient will instead be treated by a lifelong gluten free diet. This means no foods which contain wheat, barley, rye and the derivatives of these grains, including malt and brewer’s yeast. Other grains like quinoa, rice, corn and oats are fine by themselves, though they often contain cross-contamination with gluten.

One common error people have is mistaking a gluten sensitivity with the celiac disease. There need not be any other reason to avoid gluten other than celiac. There is no such thing as gluten allergy, although people with a gluten sensitivity may have bloating and other abdominal discomforts, even if they do not have a formal celiac diagnosis. These people will repeatedly test negative for celiac disease and respond well to a gluten-free diet. Before eliminating any type of food, it is important to check with your primary health care provider as some elimination diets can be dangerous and unnecessary.

If celiac disease runs in your family or you have other medical conditions such as type 1 diabetes, thyroid disease or other autoimmune conditions, consider asking your primary care provider about screening for celiac.

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Ask the Dr.
Ask the Dr.
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Boro Park Jewish Community Council 
1310 46th St 
Brooklyn, NY 11219 
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