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How to build up calcium stores without dairy products, the latest research on Crohn's disease and a bee venom balm for joint pain, by Dr Sarah Brewer

DEAR DOCTOR - I have to follow a milk-free, yeast-free diet and am worried about getting enough calcium. I've been told to eat tinned fish (including the bones) plus leafy green vegetables, but how much is enough? Any other suggestions?

Ideally, you need to obtain at least 800mg calcium a day from your diet - those at risk of osteoporosis may need almost twice as much. The calcium content of green vegetables varies and, per 100g, raw broccoli provides an average of 56mg calcium, curly kale 130mg, okra 160mg, spinach and watercress 170mg, and spring greens 210mg. Canned salmon provides 93mg calcium per 100g, but as at least two thirds is locked up in fish bones, it's unclear how much can be absorbed. Other good sources of calcium include nuts, seeds (especially sesame seeds, providing 670mg calcium/100g), pulses, eggs and fortified foods.

Usually, only 30-40 per cent of dietary calcium is absorbed. High-fibre diets reduce calcium absorption, while phytates found in unleavened bread (such as chapatti) bind calcium in the bowel to form an insoluble salt. A calcium supplement will act as a nutritional safety net.

Adding calcium supplements to the diet of elderly people, for example, has been shown to reduce their risk of a vertebral fracture by 20 per cent, while giving them both calcium and vitamin D supplements may reduce their risk of non-vertebral and hip fracture by about 40 per cent. The most absorbable salts seem to be calcium lactate (the form found in milk), calcium gluconate and calcium citrate.

Calcium tablets are best taken with meals, and preferably your evening meal, as calcium flux is greatest in the body at night, when growth hormone is secreted. Taking calcium supplements together with essential fatty acid supplements (such as evening primrose or fish oils) increases calcium absorption from the gut, and its retention in bones.

Dear Doctor - I was diagnosed with Crohn's disease 10 years ago. Medication has had little or no effect and I suffer severe bouts of vomiting, pain and diarrhoea. Reducing dairy produce has helped a little. Can you suggest anything else?

Crohn's disease is a chronic inflammatory disease of the bowel whose aetiology is unknown. Some researchers believe it is an abnormal allergic reaction - possibly to dietary components or an as-yet unidentified bacterial, viral or parasitic infection. Particular foods often exacerbate symptoms and should be avoided to help reduce symptoms or maintain clinical remission.

Unfortunately, it is not always easy to identify the culprits. In one study, the foods most commonly implicated were corn, wheat, milk, yeast, egg, potato, rye, tea, coffee, apples, mushrooms, oats and chocolate. A 19-year epidemiological study in Japan found that the strongest independent dietary risk factor for Crohn's was an increased intake of animal protein.

Malabsorption in Crohn's disease can lead to a variety of vitamin and mineral deficiencies, especially zinc, selenium, B12 and folic acid, and a high-vitamin, low-fibre, low-sugar diet is often recommended. Several studies have found that fish oils are beneficial. In one, enteric-coated fish oil capsules supplying 1.8g of eicosapentaenoic acid (EPA) and 0.9g of docosahexaenoic acid (DHA) daily were taken for one year. Only 28 per cent of the 39 patients taking fish oils relapsed to active disease compared with 69 per cent of 39 patients receiving a placebo.

Aloe vera gel, probiotic supplements containing healthy digestive bacteria (such as lactobacilli) and herbal supplements with a natural antimicrobial action such as grapefruit seed extract, golden seal or garlic are often helpful. Further information and advice is available from the National Association for Colitis and Crohn's Disease, 4 Beaumont House, Sutton Road, St Albans AL1 5HH; helpline 01727 844296; www.nacc.org.uk

Dear Doctor - I was interested to read about bee venom balm. For the past 10 years, I have taken a tablet called Apitoxina which is dissolved under the tongue whenever I cannot sleep because of joint pains. These tablets, from Uruguay, really worked for me. It would be helpful to know if there is anything like this available in Britain.

This sounds very like a homoeopathic remedy or combination based on honey bee venom. A homoeopathic remedy based on whole honey bee, including the sting, is available in Britain called Apis mellifica (may be labelled Apis or Apis mel). Its indications include conditions that affect the linings of joints, such as arthritis, but after 10 years, another remedy may suit you better as your symptoms, personality, likes and dislikes - which are all taken into account when selecting a homoeopathic remedy - may have changed. It's therefore a good idea to consult a homoeopath for an individually prescribed treatment. To request a list of registered homoeopaths, phone the British Homoeopathic Association, tel: 0207 566 7800; www.trusthomeopathy.org

Dear Doctor - Is it advisable to buy a diabetes test kit to measure my blood glucose level? I am 70 and, although I don't think I'm diabetic, have read that one million people in Britain with diabetes are unaware of it.

It is a good idea to have blood glucose levels checked every year or so, especially if diabetes runs in your family. However, there is no need to buy a test kit. Your doctor or practice nurse will be happy either to test a sample of urine for you as a simple screening test, or to measure your blood glucose levels if indicated.

Dear Doctor - What could I use to reduce liver spots on the back of my hands?

Liver or age spots are the result of a lifetime's accumulation of sun damage. Photodamage may be treated with a cream containing the vitamin A derivative, tretinoin, which is available on private prescription from your doctor (you pay the full cost of treatment yourself). This stimulates skin collagen production and oxygenation to fade pigmented age spots. In a clinical trial involving almost 300 people, 57 per cent noticed improvement in fine wrinkling, 63 per cent reported decreased mottling and 42 per cent noticed a lessening in skin roughness after six months. Alternatively, over-the-counter fade creams may help. For prevention, selenium supplements and topical creams containing co-enzyme Q10 are thought to prevent many of the detrimental effects of photoageing.

If readers have trouble obtaining nutritional supplements featured here, the Nutri Centre in London will supply them by mail order at a 15 per cent discount. Please call 020 7436 5122.

Letters should be sent to Dr Sarah Brewer, Features Department, The Daily Telegraph, Canada Square, Canary Wharf, London E14 5DT; fax 020 7513 2508. Letters cannot be answered personally. Before following any advice, please consult your GP. No responsibility can be taken for advice given in this column. Questions can also be sent by email to: drsarah@bizonline.co.uk

-- Anonymous, March 28, 2001

Answers

Response to HLTH - Calcium on milk-free diet; Crohn's disease; bee venom balm for joints

Thanks for posting the information.

-- Anonymous, March 28, 2001

Response to HLTH - Calcium on milk-free diet; Crohn's disease; bee venom balm for joints

Re: Crohn's disease

Fair Use, for educational purposes only

From Kennebec Journal, Augusta, Maine, 3.29.01

http://www.centralmaine.com/news/stories/010329crohnsdi.sht ml

Thursday, March 29, 2001

Mainer to get a test transplant

Copyright © 2001 Blethen Maine Newspapers Inc. BANGOR — A woman who has struggled with pain severe enough to require morphine because of Crohn's disease will become the first patient in the nation to receive an experimental stem-cell transplant.

Joy Weiss, 21, of Mariaville, has struggled through repeated hospital visits but now holds out hope of a cure at a hospital in Chicago. She wishes others could be offered the same ray of hope.

"I still can't believe that of all the people in the United States, I'm going," Weiss said. "I'm sick with Crohn's, but other people are dying. I could last another couple of years if I had to."

Crohn's, like lupus and multiple sclerosis, is an autoimmune disorder in which the sufferer's immune system is programmed to attack the body itself.

Crohn's disease tells the body's white blood cells to rally against the digestive tract, which irritates the tissues, causing pain and impeding the body's ability to absorb nutrients from food.

Weiss' illness began with stomach pains that her pediatrician first diagnosed as food allergies or a bacterial infection. Nothing helped and her doctor finally diagnosed Crohn's.

More than 50,000 Americans have the disease, according to a national research foundation. Some can control the disease simply by limiting their diet.

For Weiss, it meant no dairy or fried foods, no seeds, nuts, or salads and nothing with citric acid.

Eventually, her doctor prescribed Prednisone, a powerful drug that reduced the inflammation, but with nasty side effects.

"The drug is a two-edged sword," said Barbara Weiss, Weiss' mother, who is a registered nurse. While Prednisone is effective as an anti-inflammatory, it weakens tissues throughout the body, she said.

As a little girl, Joy Weiss ruptured her spleen, which had been weakened by the drug, in a minor fall from her horse. And one of her lungs collapsed during surgery, so a port implanted in her chest so medications could be delivered directly to a large vein at the top of the heart.

Weiss now suffers from osteoporosis, but her body cannot absorb the calcium supplements prescribed to slow its progression. She is chronically anemic because she cannot absorb vitamins and minerals from her food.

Despite the medication and surgeries to remove badly damaged sections of her colon and intestine, until Weiss was 19, she could not absorb enough sustenance from her food to exceed a weight of 80 pounds.

"We've been in and out of the hospital so many times, it's a blur," said Barbara Weiss.

Despite the challenges, Weiss graduated from Ellsworth High School in 1998.

But continuous pain in recent weeks led Weiss' doctors to suggest a colostomy, an operation that would open her colon and force her to use an external waste bag for the rest of her life.

"Physically, I needed it, but mentally and emotionally I just wasn't ready," Weiss said. Seeking any alternative, Weiss' doctor, pediatric surgeon Thomas McGill, learned of an experimental stem cell transplant proposed by Dr. Richard Burt at Northwestern University.

Weiss traveled to Chicago last month to meet Burt and to undergo a series of tests, which indicated that she was a perfect candidate for the world's first stem cell transplant for Crohn's. The stem cells will come from her own body.

The treatment will kill Weiss' defective immunity, then build her a new immune system using stem cells from her own bone marrow.

Stem-cell transplants have been used successfully for decades to rebuild cancer patients' natural immunity after intense radiation or chemotherapy treatments. For a dozen years, Burt has been performing stem-cell transplants to build new immune systems for other autoimmune diseases such as lupus, multiple sclerosis and rheumatoid arthritis with promising results.

Copyright © Blethen Maine Newspapers Inc.

-- Anonymous, March 29, 2001