Even ex­ces­sive calorie in­take can’t help reader re­gain weight

The Western Star - - Life - Keith Roach Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual let­ters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health newslette

DEAR DR. ROACH: I am 66 and have al­ways been in good health. I walk four or five times a week and do mild weight train­ing two or three times a week. I eat a very healthy diet.

I have low testos­terone (339). My symp­toms are in­som­nia, low sex drive, erec­tile dys­func­tion, anx­i­ety and weight loss. I can­not main­tain my weight. My nor­mal weight is 175, and I weigh 154 af­ter eat­ing all day. Also, I have rashes on my face and legs. My doc­tor says my testos­terone is nor­mal, and says I should take tra­zodone for sleep­ing, but does not know why I have this rash and says it will go away in time. The doc­tor says I should eat more to gain weight. I eat 4,0005,000 calo­ries a day, in­clud­ing weight-gain shakes, but can­not gain enough to reach my nor­mal weight. What do you think? Can you help? -- D.L.

AN­SWER: There are many is­sues here, but the one that jumps out at me is your in­abil­ity to gain weight de­spite eat­ing a truly enor­mous num­ber of calo­ries. It’s hard for me to be­lieve, but if I take you at your word, then one of three things is go­ing on. You could be un­able to ab­sorb the nu­tri­ents, due to a prob­lem with the in­tes­tine or pan­creas. You could have a revved-up me­tab­o­lism, which usu­ally comes from ex­cess thy­roid hor­mones. Fi­nally, you could be los­ing calo­ries some­where else, the most com­mon cause of which is un­con­trolled di­a­betes.

I think the most likely sce­nario is mal­ab­sorp­tion, the most com­mon cause of which is celiac dis­ease. This also can cause low testos­terone lev­els, as well as rash. One rash, der­mati­tis her­peti­formis, is very closely as­so­ci­ated with celiac dis­ease, but usu­ally is found on the el­bows and knees more of­ten than the face.

In­abil­ity to sleep is clas­si­cally as­so­ci­ated with a high thy­roid level, so I think you need an eval­u­a­tion of your thy­roid (via blood test) to see whether you are, in fact, un­able to ab­sorb nu­tri­ents (a stool test is an easy way to find out), and a blood su­gar test, which is sim­ple to get as well. I wouldn’t think about treat­ing the testos­terone un­til you find out why you lost weight and are un­able to gain it back.

DR. ROACH WRITES: A few weeks ago, M.A. wrote to me about her low blood counts. She kindly wrote me back, and af­ter a bone mar­row biopsy, was di­ag­nosed with a low-grade marginal zone B cell lym­phoma. This par­tic­u­lar type of blood cancer usu­ally starts in the spleen, and the ab­nor­mal cells of­ten can be found in the bone mar­row, which I think is likely the case with M.A.

The bad news about low­grade lym­phomas is that they of­ten are not cur­able. The good news is that they grow very slowly. Half all peo­ple with this type of tu­mor live with this con­di­tion for longer than 10 years. Be­cause the main rea­son M.A. was found to have this con­di­tion was ab­nor­mal blood test re­sults, it may not be nec­es­sary to treat it right now. How­ever, it’s likely that M.A. will re­quire blood trans­fu­sions as the dis­ease pro­gresses.

Newspapers in English

Newspapers from Canada

© PressReader. All rights reserved.