University Health System Weblog

Dr. Mary Beth Hogan answers the question: “Is food intolerance the same thing as food allergy?”

Many people have abnormal responses to foods. Food intolerance refers to responses that are not caused by an overreaction of the immune system. For example, lactose intolerant people experience abdominal distension and diarrhea after drinking milk or eating dairy products. These symptoms occur because these people do not produce enough of the enzyme lactase in their intestine and cannot digest milk sugars properly.

Naturally occurring toxic chemicals in foods such as mushrooms, beans, cabbage, tomatoes, avocados, bananas, pineapples, cheeses and wines can also cause food intolerance reactions. These responses are not allergic because they do not involve the immune system.

What is food allergy? True food allergy occurs when the body’s immune system overreacts to the ingestion of a food substance that is usually harmless. The part of the food that causes the reaction, for example, the allergen, is generally the protein part of the food. Food allergy is present in only two to three percent of the pediatric population. Symptoms of food allergy can include any of the following—stomach cramps, vomiting, diarrhea, eczema, hives, facial swelling, throat swelling, wheezing and difficulty breathing. Severe reactions are potentially fatal.

Mary Beth Hogan, M.D. is professor of pediatrics and section chief  of pediatric allergy, immunology and pulmonary medicine at the University of Nevada School of Medicine. Dr. Hogan is based out of Reno, Nevada.

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Dr. Gregory P. Brown answers the question: “Can antidepressants lose effectiveness over time?”

Many antidepressant medications may lose some of their effectiveness over three to five years’ time. The reason for this is not currently known but may be related to chronic changes in deep wave sleep patterns associated with many antidepressant medications.

Changing antidepressant medication classes under the supervision of a physician will often restore effectiveness. Various additional medications can also augment the lagging response to the original antidepressant.

Gregory P. Brown, M.D. is an associate professor of psychiatry at the University of Nevada School of Medicine in Las Vegas. Dr. Brown is board certified in general psychiatry and forensic psychiatry, American Board of Psychiatry and Neurology.

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Dr. Evan Klass answers the question: “Can I use artificial sweetners if I have diabetes?”

Opinions about artificial sweeteners as it relates to diabetes are about as numerous as the stars. There’s no valid scientific evidence to conclude, however, that there’s a health danger to diabetics from using artificial sweeteners. The U.S. Food and Drug Administration allows their use. You might argue that one has more or less of an aftertaste than another but that’s a personal decision.

Sugar alcohols, such as sorbitol and maltitol, may cause intestinal cramps if you eat too much.

The argument that I find most interesting is whether it’s good or bad for people with diabetes to use artificial sweeteners because it allows them to get used to eating sweet things, which may make it harder for them to stick to their diet plan. I take the opposite position—I think it’s a good thing for people with diabetes to enjoy sweets without having to worry about the effects on their blood glucose.

Evan Klass, M.D. is an endocrinologist practicing in Reno, Nevada at University Health System. Dr. Klass completed his fellowship training in endocrinology at George Washington University Medical Center.

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Dr. Shawn Tsuda answers the question: “I’ve heard a lot about minimally invasive surgery. What exactly is it?”

Minimally invasive surgery refers to operations performed with small scars. Typically this can be accomplished laparoscopically, or with the use of a tiny camera and long, narrow instruments. The advantages of minimally invasive surgery include less post-operative pain and quicker recovery. The cosmetic result is also more favorable.

The vast majority of weight loss procedures such as the Roux-en-Y gastric bypass and the adjustable gastric band are performed laparoscopically, along with common procedures like gallbladder removal and hernia repairs.

Recently researchers have been looking into performing “scarless” surgery, also known as natural orifice and transluminal endoscopic surgery (NOTES) or single-incision laparoscopic surgery, through a tiny hole in the belly button. Although these advanced techniques are still in development and not widely performed, it is likely we will continue to see more surgery performed with either reduced scars, one single scar in the belly button, or no scars at all.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.