Acetaminophen considered safe and effective

You recently wrote an article on the risk of heart disease with aspirin and anti-inflammatory drugs. What about acetaminophen (Tylenol)? I have been taking this for many years of pain following spinal surgeries. — C.S.

DEAR READER >> There have been some studies that have shown a mild increase in risk of heart disease among chronic heavy users of acetaminophen. However, most of the data have shown that among people who use it every other day or less (on average), if there is a risk, it probably is small. Heavy users of anti-inflammatory medicines such as naproxen probably are at a higher-thanaverage risk for heart disease as well. Acetaminophen is considered to be one of the safest medications for pain relief, but all medicines have the potential for side effects.

DEAR DR. ROACH >> I have had psoriasis for some time. It doesn’t cause pain or itching; it’s just unsightly. My dermatologist has a new treatment by laser. My insurance covers it 100 percent. Could you comment on the success and side effects of this treatment? — F.W.B.

DEAR READER >> I think you are talking about a particular type of laser, a 308 nm excimer laser. It is high-powered and is directed only at the plaques. In a preliminary study using 10 treatments, 84 percent of subjects had at least 75 percent clearing of their psoriasis plaques. The major side effects were redness and blisters, but none of the subjects stopped the treatment due to side effects. Based on preliminary data, I think that this particular laser therapy is a potentially valuable new treatment for psoriasis, and it has the advantage of much less exposure to normal skin and faster response. Insurance coverage has been a problem for many, so you are fortunate to have coverage.

DEAR DR. ROACH >> I’m a 67-year-old man in fairly good health, but I was diagnosed with celiac sprue over 10 years ago by a blood test. I maintain a gluten-free diet the best I can, but I’m sure occasionally I get some gluten. How close are we to a cure or some type of medicine that one can take to break down gluten? Are there different levels of gluten intolerance? I have eaten food containing gluten with no side effects. — R.F.

DEAR READER >> Celiac disease, also called “celiac sprue” or “gluten-sensitive enteropathy,” is an immune disorder triggered by gliadin, a component of gluten, which is found in wheat, rye and barley, and in some other grains. The definitive treatment is meticulous, strict compliance with a completely glutenfree diet, as minuscule amounts (as little as 30 mg) of gliadin can trigger a reaction in the gut. This leads to the inability to absorb nutrients, and possibly predisposes one to development of lymphoma and gastrointestinal cancer.

However, you are right that some people are more tolerant than others and can tolerate amounts of gluten that would cause symptoms in others. Nonetheless, I recommend a strict gluten-free diet for people with celiac disease.

A new medication, larazotide, is being developed not to break down gliadin, but to reduce the body’s response to gliadin. It is in late-stage clinical trials.