Dr. Curtis McElroy

Category: Health Conditions

  • Metabolic Disorders

    Metabolic Disorders 

    Metabolic disorders come in several types. There are inherited metabolic disorders by the hundreds, which involve an individual lacking an enzyme that metabolizes a certain amino acid or other chemical substrate, resulting in a buildup of toxic chemicals in the system. These are relatively rare disorders affecting one out of every 1000 babies born. Some metabolic disorders are screened for in early infancy at the time the child is born. This is done so that treatment can begin early in life and complications do not develop.

    Common Inherited Metabolic Disorders:

    Inherited metabolic disorders are not that common but, because the treatment can be as simple as giving a child a certain enzyme or avoiding certain foods, they are screened for at the time of neonatal screening to give the child the best chance of survival without complications.

    Some of these metabolic disorders include:

    • Tay-Sachs disease
    • Galactosemia
    • Phenylketonuria
    • Wilson’s disease
    • Hurler syndrome
    • Niemann-Pick disease

    These metabolic disorders affect an individual from the time they are born. If treated early and for the rest of the person’s life, complications can be spared and the person can live a normal life.

    Acquired Metabolic Disorders

    Much more common are acquired metabolic disorders. Common metabolic disorders include diabetes mellitus type 2, hyperthyroidism, hypothyroidism, and metabolic syndrome. These usually affect adults and are either autoimmune diseases or diseases brought on by unhealthy lifestyles.

    Let’s look at these more common diseases:

    • Grave’s Disease. This is a disorder of elevated thyroid hormone production. It is an autoimmune disease in which an individual makes antibodies, which attack the thyroid gland, turning on thyroid function and resulting in the production of too much thyroxine (T4) and triiodothyronine (T3) hormones. People with Grave’s disease have an overactive metabolism and suffer from symptoms like rapid heart rate, elevated temperature, agitation, nervousness, weight loss, and tremor. A typical feature of Grave’s disease is exophthalmos, in which the eyeballs appear to bulge from the eye sockets. The treatment of this particular disorder is to give radioactive iodine to destroy the cells of the thyroid gland, creating a low thyroid condition, which is treated by giving back the right amount of thyroid hormone in pill form. If not treated, Grave’s disease can lead to a potentially life-threatening condition known as thyrotoxicosis in which there is a dangerously elevated metabolism.

    • Hashimoto’s thyroiditis. This is a low thyroid condition in which autoantibodies attack the cells responsible for making thyroid hormones. The thyroid hormones T4 and T3 are responsible for the maximization of cellular metabolism. When the cells cannot metabolize well, they become sluggish and do not function well. Typical symptoms of Hashimoto’s thyroiditis include sluggish mood, depression, weight gain, constipation, dry skin, and dry hair. The cells cannot metabolize food well so that nutrients go to make fat while the cells themselves are starved of nutrition.

    • Type 2 diabetes. This is an extremely common metabolic disorder caused by genetic factors as well as lifestyle factors. The exact role of each of these factors varies from person to person. Certainly, if you have a first degree relative who has diabetes (such as a sibling or parent); you have an elevated risk of developing this disorder. Eating too much, gaining weight, and exercising too little, also contribute to getting type 2 diabetes.

    The main problem in type 2 diabetes is insulin resistance. For whatever reason, the cells do not respond to the amount of insulin in the system. In spite of elevated levels of insulin, the glucose does not enter the cells to be used as fuel for cellular metabolism. Elevated levels of glucose further raise the insulin, which is forced to put away the extra glucose levels as fat. Type 2 diabetics tend to be overweight, with an elevated fat to total body ratio. This means that all cellular processes tend to be less than adequate because the cells have to work harder to get all the fuel they need and, instead of providing the adequate nutrition for the cells, the glucose turns to fat.

    There are often no real symptoms of type 2 diabetes unless it becomes severe. Things like the immune system are affected so that healing is poor, circulation can become compromised, and the type 2 diabetic is prone to typical diabetic complications, including diabetic neuropathy (damaged peripheral nerves), diabetic retinopathy (blindness secondary to vascular disease in the eyes), cardiovascular disease, and kidney failure. This is why screening for diabetes is so important. By the time symptoms are present, there is often end-organ damage, which cannot be reversed.

    • Metabolic syndrome. This is a relatively common, yet serious metabolic disorder affecting men and women alike, and according to the American Heart Association, 47 million Americans have it and many don’t know they do. People with metabolic syndrome are suffering from insulin resistance so that most of them have elevated blood sugars and diabetes. They also tend to have truncal obesity with relatively thinner arms and legs and with most of the fat around the abdomen. The triglycerides can be dangerously high so the individual is at risk for pancreatitis secondary to hypertriglyceridemia. HDL cholesterol levels tend to be low, which means there is an increased risk of cardiovascular complications. High blood pressure is also a common feature of metabolic syndrome.

    The increased risk of cardiovascular complications is what makes metabolic syndrome so dangerous. These people go on to develop a stroke, heart attack, or peripheral vascular disease. The diabetic component of the disease affects the nerves, eyes, and kidneys. The best treatment is to lose weight and to reduce the blood sugar, triglycerides, and blood pressure. Not much is yet known about metabolic syndrome in terms of why some people get it and others do not. Doctors are left with treating symptoms and lab values when the real problem of obesity is not easily addressed.

    For those who are diagnosed with metabolic syndrome, reduction in weight through a low calorie diet and exercise is the best way to prevent the complications of the disorder. This takes a long-term commitment to better health and a healthier lifestyle. Metabolic disease may have a genetic component but most doctors feel that the bulk of the disorder is triggered by poor lifestyle choices, which is something that most people have some control over.

  • Autoimmune Hepatitis

    Autoimmune Hepatitis

    When white blood cells (lymphocytes) erroneously attack liver cells, they cause inflammation and damage to the liver. This results in the condition autoimmune hepatitis. There are two types of autoimmune hepatitis.

    Type 1 autoimmune hepatitis is the most common type of the disease. Although it can affect anyone of any age, it most commonly develops in women aged around 45.

    Type 2 autoimmune hepatitis primarily affects young girls between the ages of two and fourteen, and is much less common than type 1 hepatitis.

    In many cases of autoimmune hepatitis the symptoms develop gradually over weeks or months. Often at the time of diagnosis there are very mild symptoms, or no symptoms at all.

    How Is Autoimmune Hepatitis Diagnosed

    The presence of hepatitis is often discovered when patients are undergoing medical tests for unrelated disorders.

    Blood tests called liver function tests give a general guide as to whether the liver is inflamed and how well it is functioning. These tests are able to confirm the presence of hepatitis, but not the cause of the disease.

    Other tests and a liver biopsy are able to identify the type of cells involved in the inflammation. This can rule out other causes of the hepatitis, and help confirm the diagnosis of autoimmune hepatitis.

    Symptoms Of Autoimmune Hepatitis

    Symptoms can range from minor to severe, and can include fatigue, joint and muscle pain, feeling very unwell, vomiting and for women loss of menstruation. Jaundice can develop if inflammation is severe.

    Persistent untreated inflammation causes liver damage and may lead to scarring of the liver, a condition known as cirrhosis. This can result in serious problems and liver failure in severe cases.

    Complications Of Autoimmune Hepatitis

    Cirrhosis of the liver occurs when liver tissue is damaged, resulting in fibrosis, or scar tissue. In the early stages it rarely exhibits signs or symptoms of the disease, and worsens steadily over time. However as liver function gradually deteriorates , the problem becomes serious.

    Liver failure occurs when the extent of damage to liver cells prevents the liver from functioning adequately. A liver transplant usually becomes necessary.

    Treatment Of autoimmune Hepatitis

    With early and ongoing treatment for autoimmune hepatitis the prognosis is very good, and the disease is manageable if treatment protocols are followed.

    Early treatment helps to control inflammation and reduces the risk of complications. Long-term treatment can stop the disease from escalating and may even reverse some of the damage to the liver.

    Steroid medication (usually prednisolone) is the usual first treatment, as steroids are good at reducing inflammation. A high dose is usually needed for about the first month of treatment. To reduce the risk of side effects , the dose is gradually lowered over the next few months.

    Monitoring will allow the doctor to ultimately determine the lowest effective maintenance dose. Adding an immune system suppressor (azathioprine) also helps to avoid the side effects of prednisolone.

    Most people need to continue medication for one or two years. Even if there are periods of remission, the disease often reappears if the treatment is discontinued. Some people need to remain on medication for life.

    Causes Of Autoimmune Hepatitis

    Evidence suggests that a predisposition to autoimmune disease may run in families. Already having an autoimmune disease such as rheumatoid arthritis, Celiac or Grave’s disease could make you more likely to develop autoimmune hepatitis.

  • Alopecia (Hair Loss)

    Alopecia (Hair Loss)

    Alopecia areata is a skin condition which occurs as a result of our immune system mistakenly attacking our own healthy tissues. This creates a condition called autoimmune disease.

    Autoimmune disease can present itself in different ways, depending on which body part is affected. When the immune system damages the hair follicles the result is hair loss.

    One or more bald patches appear on the scalp. These patches are usually round in shape and the size of a large coin. Occasionally the beard, eyebrows, eyelashes or other body hair are also affected.

    Alopecia areata can occur at any age. However it usually affects children, teenagers and young adults. Research shows that the first attack of this disease usually happens before the age of 30.

    The Effect Of Alopecia Areata

    There is no scarring or physical pain associated with the condition, and the affected hair follicles are not destroyed. Often as one patch is regrowing another patch is appearing. Apart from the bald patches the scalp usually has a healthy appearance.

    Occasionally, there may be a slight redness, and a mild burning or itching feeling. The size of the bald patches and the time they last are variable.
    The condition can be embarrassing and very upsetting. The stress, especially on young boys, unable to hide the condition because of short hair, is severe.

    Surveys have found the suicide rate among these young sufferers higher than would be expected. This is especially tragic, considering the disease affects the appearance rather than physical health.

    Treatment For Alopecia Areata

    When there are only one or two small bald patches, no treatment is the common option. Bald patches in mild cases often regrow hair in a matter of months. When less than half of the scalp Is affected, doctors’ advice is usually to wait and see
    .
    The chances of hair regrowth within one year, without treatment, for this group is 8 out of 10. One or more recurrences of alopecia areata is common for sufferers. This is the case even if full regrowth of hair occurs after the first episode.

    When complete baldness is the result of autoimmune disease, it is called alopecia areata totalis. When the same condition causes the loss of all head hair, together with all body hair, it is called alopecia areata universalis. These types of hair loss tend to be long lasting, even permanent.

    However, with the uncertainty of this disease there is no way of predicting if the hair loss will be temporary or permanent. Regardless of how much hair is lost, follicles remain alive. Hair regrowth may occur, after many years, even without treatment.

    What Causes Alopecia Areata

    Scientists do not know what the trigger is that causes autoimmune disease to start and stop, or why the immune system suddenly disrupts the normal functioning of the hair follicles.

    They believe that heredity plays a part, but is not the only answer. Studies show there is a loose genetic correlation and that 20% of people with this condition have a close family member with the disease.

    Researcher also suggests that viruses, infections, medicines and environmental factors are all possible causes. Stress is also believed to have an impact.

    Scientists keep searching for the elusive trigger. Its discovery will allow sufferers to avoid relapses. However no dietary or lifestyle modification has yet been found.

    Current treatments do not turn alopecia areata off. Although they stimulate the hair follicles and produce hair again, treatments need to be continued until the disease turns itself off.

Copyright @ 2017 DrCurtisMcElroy