Q: In the last few months, I've started having quite severe reactions to bread, pasta and pastry - all of which I love. Could it be coeliac disease? I'm 53 and haven't had any major problems before this year.
It could be coeliac disease but it could also be wheat allergy or wheat intolerance. You do not say what your reaction is; coeliac disease classically causes pale diarrhoea associated with weight loss, anaemia, abdominal bloating and discomfort. In the past few decades we have realised that many adult patients have symptoms which are more subtle: perhaps mild anaemia and fatigue, or even no symptoms at all with the disease being identified on blood tests.
Coeliac disease is an immune reaction to the presence of gluten in food. It causes damage to the internal surface of the small intestine so that essential foods are very poorly absorbed. Gluten is a protein present in wheat grains (plus barley and rye) and the condition is cured by strict adherence to a gluten-free diet. There are blood tests which can confirm whether you have coeliac disease, so discuss these with your GP. If you do have it, you’ll need more tests.
Wheat allergies and intolerances are caused by reactions to a much wider range of proteins present in wheat. The only way of determining if you have this problem is to withdraw wheat completely from your diet (not just gluten-free) to see if the symptoms go away. If they do then start eating wheat-containing foods again to see if they come back. More severe wheat allergies can cause allergic reactions such as skin rashes, asthma, vomiting and diarrhoea; in these circumstances the diagnosis is usually obvious.
Q: My mother is desperate to visit my sister and her family in Australia, and I'm willing to go with her but I'm worried if the flight would be safe for her. She's 79 and has arthritis, is rather overweight but has no other real health worries.
It is good to hear that your mother has no illnesses which might increase the potential risk of such a long journey. From what you say, the main concern would be of a deep vein thrombosis (DVT); this is more common after long-haul flights and enforced immobility. Being overweight and having arthritis can make it more difficult to move around easily, so she will have to make a real effort to stay mobile during the flight, with regular small walks or leg exercises, particularly of the calves, if walking is not possible. Good hydration and avoiding alcohol are also important and she should wear special flight socks’ (available from pharmacies) for the duration of the flight. In any case, it would be sensible for your mother to have a chat with her GP about her plans just to make sure she does not face any other potential risks which may be less obvious. With these precautions the risks are reduced considerably and many people of your mother’s age fly regularly with no ill effects.
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