No scientific evidence that electric blanket has impact on Afib
Hello, dear readers, and welcome to our first regular letters column of spring. With the longer days and the gradually warming weather, many of us are spending more time outdoors. Whether it’s with sunscreen or protective clothing (or, better yet, with both), please remember to gear up against the UV rays. And now, onward to the mail. nwe recently wrote about atrial fibrillation, an irregular and often abnormally rapid heart rhythm in which the upper chambers of the heart fail to sync up with the lower chambers. The topic prompted a question from a reader living with that condition. “Is there any research that shows that atrial fibrillation is adversely impacted by sleeping with an electric blanket?” they asked. The short answer is no, there is no scientific evidence that using an electric blanket will have an effect on atrial fibrillation. However, becoming overheated can stress the heart, which might conceivably trigger an episode. If you do use an electric blanket, be sure to use it on a safe and appropriate setting. Alternatively, you might consider using it just to preheat the bed. nin answering a question about valley fever, a potentially serious infection caused by the fungus Coccidioides, we shared recent findings that drought is contributing to its spread. A reader wrote to say she found this confusing. “How can this be, when fungi thrive in moist environments?” Coccidioides is found in the soil of certain arid regions, including throughout the southwestern United States. It grows during cycles of rainfall, which, as you point out, provides the moist environment fungi need to reproduce. However, the spores of Coccidioides are able to withstand dry conditions. They lie dormant in the soil, then spread easily in hot, dry and windy conditions. If inhaled into the moist environment of the lungs or somehow entrapped in flesh, infection is possible.
—A column about resistant starch, which is a carbohydrate that resists digestion, is getting a lot of mail. Because resistant starches skip the small intestine, they both contribute to glucose control and help feed the gut microbiome. Some high-carb foods, such as potatoes and pastas, develop resistant starch when cooled after cooking. This led a reader to ask for more specifics. “Do high-carb foods that are reheated after being chilled still maintain their benefits?” they asked. “Sounds like a great new benefit from leftovers!” Researchers have looked into that question and found that, for the most part, yes, the resistant starch persists, even after reheating. As the reader suspected, there is indeed a decrease in resistant starch upon reheating. However, the net result is a significant gain in the percentage of resistant starch.
Thank you, as always, for taking the time to write. We love hearing from you. The most recent batch of mail included some very kind thoughts and encouragement, which we appreciate. For newer readers, a reminder: We are not able to give a diagnosis, offer a second opinion, look at personal medical information or photographs or comment on specific treatment plans.
Gastroparesos caused by damaged nerves delaying digestion
Dear Doctors: Is there a standard treatment for gastroparesis? I have a mild case of it, along with Type 2 diabetes, and I am unsure how to proceed. One of my doctors prescribed erythromycin, but another one said that only changing my diet will help. How do I know who is right?
Dear Reader: Gastroparesis is a condition in which damage to the nerves that activate the stomach muscles causes a delay in digestion. Specifically, it prevents the contents of the stomach from moving into the small intestine in a timely manner. In normal digestion, food spends an hour or two in the stomach, mixing with and being broken down by digestive juices. The resulting slurry, known as chyme, is then moved into the small intestine by a series of wavelike muscle contractions known as peristalsis.
When someone has gastroparesis, the peristaltic action of the stomach muscles is impaired. This makes it difficult for food to leave the stomach. Symptoms of the condition include belching, gas, bloating, nausea, vomiting, loss of appetite, heartburn and pain. This type of stalled digestion sets the stage for the growth of bacteria. In some cases, it leads to the formation of a coagulated mass called a bezoar, which can cause a blockage.
It is estimated that onethird of cases of gastroparesis are linked to diabetes, a disease that can cause nerve damage. It adds to the health risks of people living with diabetes because the digestive delay can impair blood glucose control. Gastroparesis can also be caused by viral stomach infections, surgical injury, an underactive thyroid and certain neurological or autoimmune conditions. Although rare, gastroparesis can arise as a side effect of medications that affect digestion, such as opioids, calcium channel blockers and antihistamines.
The erythromycin that you have been prescribed is sometimes used to stimulate the stomach muscles in gastroparesis and other types of gastric disorders. Although common, this is an off-label use of the antibiotic. Diet is also an important part of managing the condition. People living with gastroparesis are asked to eat small, nutrient-dense meals made up of soft, well-cooked foods. High-fat foods, which delay gastric emptying, are to be avoided. So are highly processed foods and those with added sugars, both of which can wreak havoc on glucose control.
Foods that are high in fiber can be difficult to
digest. For that reason, patients are asked to limit their use. For many types of foods, cooking can overcome this restriction. A carrot or an apple in raw form would be difficult for someone with gastroparesis to digest. But if the carrot is cooked or the apple presented in the form of applesauce, each can be included in the diet. Because nutrition and glucose control present challenges to people living with gastroparesis, working with a registered dietitian can be beneficial.
When it comes to the mixed treatment messages you are receiving from your doctors, your best bet is to ask them for clarifications. You can also ask them to consult with each other. If their approaches continue to diverge, you may want to seek a new opinion.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla. edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.