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Sleep Well
Thursday, October 14, 2010

Are You Gluten-Free and Sleep-Free?

Being gluten-sensitive or gluten-intolerant has gained a lot of attention in recent years, no doubt spurred by celebs like The View’s Elisabeth Hasselbeck who has written a book about living a “G-free life.” Also called celiac disease, this condition is caused by an allergic reaction within the inner lining of the small intestine to proteins (gluten) that are present in wheat, rye, barley and, to a lesser extent, oats. The body’s immune response causes inflammation that destroys the lining of the small intestine, which then reduces the absorption of dietary nutrients and can lead to uncomfortable symptoms and signs of nutritional, vitamin and mineral deficiencies.

You wouldn’t think being sensitive to gluten would have any effect on sleep, but there is, in fact, a strong connection. A team of researchers recently found that people with this condition — even those following a gluten-free diet –В commonly suffer from sleep disorders that are related to depression, anxiety and fatigue. It is, to put it mildly, a vicious cycle:

  • When you’re tired and down, you’re not likely to sleep well, which can then play into digestive issues.
  • Add to that a sensitivity to an ingredient as ubiquitous as gluten and there’s bound to be trouble.
  • The reverse holds true as well: when your eating life is challenged by celiac, you run a higher risk of having physical ailments that hinder restful sleep.

Since anxiety and depression both occur at higher rates in people with celiac disease than in the general population, the researchers were curious to see how celiac disease might affect quality of sleep.

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In addition to finding that sleep disorders commonly affect people with celiac disease, regardless of gluten-free status, they also found that sleep disorders are less common in celiacs who score higher on quality-of-life scales, while those with low quality-of-life scores suffer at higher rates.

This may seem like an expected observation, but it further proves the complex challenges people face when their health is not 100 percent, or they suffer from a condition that can lower their quality of life. Just about any disease or illness can cut sleep short and increase one’s risk for consequences linked to sleep deprivation. Fatigue, depression and anxiety are really just common denominators to myriad other conditions; in other words, they happen as a side effect to enduring or living with other health problems.

Here’s some advice: If you or someone you love has celiac disease, be prepared to address sleep issues, and do everything possible to ensure a good night’s rest. That means:

  • Avoiding digestive irritants, especially if you’re sensitive to gluten.
  • Keeping a regular bedtime routine.
  • Watching your consumption of stimulants, from caffeine to watching CSI at night.
  • Managingstress better in your life and being mindful of your mood.
  • Getting the sleep your body deserves.

For celiacs, living a G-free life doesn’t mean you have to be sleep-free too. The more restful sleep you achieve, the easier it will be to manage your condition and enjoy a vibrant, well-rested life.

Michael J. Breus, PhD

The Sleep Doctorв„ў

The opinions expressed in WebMD Second Opinion are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. Second Opinion are. Expand

The opinions expressed in WebMD Second Opinion are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD Second Opinion are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.

Do not consider Second Opinion as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately.

Prostate Cancer

I felt I was better off in a City of Hope environment, where it’s a cancer treatment specialty hospital. This is what they do.” Ralph Richardson, prostate cancer patient

If you have been recently diagnosed with prostate cancer, talk to the experts at City of Hope. Our integrated team of specialists will guide you and your loved ones through each step of the journey, from diagnosis to treatment to recovery and survivorship.

We will answer your questions, calm your concerns and design a personalized treatment plan to give you the best possible outcome.

If you have been diagnosed with prostate cancer or are looking for a second opinion consultation about your treatment, you may request an appointment online or contact us at 800-826-4673 (HOPE).

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Please visit Making Your First Appointment for more information.

Our Expertise

As a founding member of the National Comprehensive Cancer Network, our doctors also help develop and improve evidence-based prostate cancer treatment guidelines for patients throughout the country.

Highlights of our prostate cancer program include:

  • Our leadership and experience in robotic prostate surgery, the largest program of its kind in the western United States with over a decade of experience and more than 7,000 operations performed
  • Our surgeons’ expertise in minimally invasive and nerve-sparing prostatectomies, which reduces discomfort and recovery time while preserving urinary and sexual function
  • Highly precise radiation therapy delivery that can target the cancer while avoiding nearby healthy tissue, preserving bladder and bowel control functions
  • A wide portfolio of drugs that can fight cancer better with fewer side effects
  • A dedicated continence recovery program to help men regain urinary function after treatment
  • Sophisticated active surveillance monitoring for men with low-risk, slow-growing prostate cancer who do not want immediate treatment
  • Ongoing research and clinical trials of promising new therapies
  • Long-term survivorship and follow-up program focused on minimizing recurrence risk and improving quality of life


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What is prostate cancer?

Prostate cancer is a disease in which cells in the prostate start growing abnormally and uncontrollably.

The prostate is a walnut-shaped organ that contributes fluid to semen and helps expel semen during ejaculation.

Almost all prostate cancers are adenocarcinomas (which originates from the glandular cells of the prostate) and most are slow growing. However, they may cause symptoms that require timely interventions, such as restricting urine flow or sexual function.

What increases your risk of prostate cancer?

Factors that can elevate risk prostate cancer include:

  • A family history of prostate cancer
  • Inherited genetic mutations, such as BRCA1/BRCA2 genes and Lynch syndrome (also known as hereditary nonpolyposis colorectal cancer or HNPCC)
  • Conditions such as prostatitis, inflammation of the prostate, and benign prostatic hyperplasia or BPH, a noncancerous enlargement of the prostate gland
  • A diet high in red meats and high-fat dairy and low in fruits and vegetables
  • Obesity
  • Age: approximately 60 percent of cases are diagnosed in men older than 65
  • Race and ethnicity: African-American men and Caribbean men of African ancestry are more likely to be diagnosed with prostate cancer

Research has also shown that a healthy lifestyle, including a well-balanced diet and maintaining a healthy weight, may reduce prostate cancer risk.

What are the signs and symptoms of prostate cancer?

Because the prostate lies below the bladder and surrounds the urethra, most prostate cancer signs are tied to urinary symptoms, including:

  • Weak or interrupted flow of urine
  • Frequent and sudden urge to urinate, especially at night
  • Difficulty starting urination
  • Trouble emptying the bladder completely
  • Painful or burning sensations while urinating
  • Blood in urine or semen

Prostate cancer may also cause more generalized symptoms, such as:

  • Pain in the lower back or pelvic area
  • Weakness or numbness in the legs or feet
  • Dizziness
  • Fatigue

Although these symptoms can be caused by other conditions, you should check with a doctor – preferably a urologist – so they can make a definitive diagnosis.

Sources: National Cancer Institute and American Cancer Society

Diagnosing prostate cancer

Precise prostate cancer tests are crucial for treatment planning, and City of Hope is equipped with state-of-the-art technologies and specialized staff to ensure an accurate, comprehensive diagnosis of prostate cancer.

Highlights of our screening and diagnosis services include:

  • Advanced imaging technologies to detect and locate prostate tumors
  • MRI-guided biopsies to increase precision and accuracy
  • An experienced pathology staff specializing in prostate cancer diagnosis
  • Genomic testing of cancer cells to find the most effective treatments available

How is prostate cancer detected?

Once you notice symptoms, or as part of a routine examination, your doctor may use the following tests to look for prostate cancer:

  • Physical exam
  • Prostate specific antigen (PSA) test: This test measures PSA levels in your blood.

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    Levels higher than normal range (4 nanograms per milliliter of blood) may indicate prostate cancer or other conditions, such as prostate inflammation or BPH, an enlarged, noncancerous prostate.

  • Digital rectal exam: A doctor or nurse inserts a lubricated, gloved finger into the rectum to feel for prostate abnormalities.
  • Biopsy: Surgical removal of suspicious tissues for further examination
  • Transrectal ultrasound: A small probe is inserted into the rectum to take images of the prostate using high energy sound waves. A biopsy may be taken if the images show any abnormalities. This procedure typically takes less than 10 minutes and the area may be numbed to reduce discomfort.
  • Transrectal magnetic resonance imaging (MRI): This procedure images the prostate using a powerful magnet, radio waves and a computer; a radio wave-emitting probe is inserted into the rectum and the MRI machine takes a series of detailed images of the prostate and its surrounding regions. A biopsy may be taken at the same time if the images show any abnormalities.

If cancer is found, additional tests are performed to determine the type and stage of disease. These diagnostic tests include:

  • Lymph node biopsy: Removal and examination of lymph nodes in the pelvic region to see if the cancer has spread
  • Seminal vesicle biopsy: Removal of fluid from seminal vesicles (glands that produce semen) to detect prostate cancer spread
  • ProstaScint scan: A test that uses a small amount of radioactive material, which binds selectively to prostate cancer cells. After the material is injected into the bloodstream, a scanner is used to detect prostate cancer spread, which shows up as bright spots due to concentration of the material.
  • Computed tomography (CT or CAT) scan: This test involves taking a series of X-ray images at different angles to form a computer-generated image, which determines tumor size, location and number. Special dyes may be used to enhance this scan.
  • Bone scan: A procedure using a small amount of radioactive material to determine if prostate cancer cells have spread to the bones.
  • Genomic testing: The cancerous tissue is tested to see if it exhibits certain genetic mutations, which can be used to determine better treatments.

Based on the results of these tests, the prostate cancer is then staged according to its size, number of lymph nodes affected and whether it has spread to nearby or distant organs.

What are the current screening guidelines for prostate cancer?

The American Cancer Society currently recommends men discuss with their health care provider the routine screening options available for prostate cancer. The discussion should take place at:

  • Age 50 for men of average risk
  • Age 45 for men at high risk, including African-American men and those with a first-degree relative (father or brother) who was diagnosed with prostate cancer before the age of 65
  • Age 40 for men at highest risk, including those with two or more first-degree relatives who had prostate cancer at an early age

Based on your discussion, your provider may screen you with a prostate specific antigen (PSA) test and possibly a digital rectal examination. Depending on the initial screening results and other risk factors, the screening may be repeated annually or once every two years.


Prostate cancer treatment options

Patients . can rest assured that we have more experience than anyone else in the region for robotic surgery for straightforward and complex cases.” Clayton Lau, M.D., director, Prostate Cancer Program

Your prostate cancer is every bit as unique as you are, and that is why prostate cancer treatment at City of Hope is focused around you and your loved ones.

This means our physicians will personally consult with you about your disease, treatment options and desired outcomes.

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Afterward, our multidisciplinary team of specialists will work together to discuss, design and deliver an individual treatment plan to best meet those goals.

The innovative treatments we use to treat prostate cancer include:

Surgery is a common treatment option for most prostate cancer patients, particularly early-stage prostate cancer that has not spread beyond the glands.

The most common prostate cancer surgery is a radical prostatectomy, an operation that removes the prostate gland, seminal vesicles and surrounding tissues. When possible, nearby nerves and blood vessels will be spared to preserve urinary and sexual function.

Nearby lymph nodes may also be removed and examined to determine if the cancer has spread.

City of Hope is a leader in minimally invasive, robotically-assisted prostatectomies, with over a decade of experience and 7,000 surgeries performed — the most in Western United States. This procedure uses a surgical robot and smaller incisions to remove the prostate and surrounding tissue.

Compared to an open surgical approach, robotic prostatectomies offer several benefits:

  • Less pain and discomfort
  • Reduced blood loss
  • Shorter recovery time
  • Faster return to normal activities or follow-up treatments

City of Hope also has an extensive recovery and follow-up program after the procedure to help patients monitor for complications, manage side effects, restore urinary/sexual function and resume normal activities as soon as possible.

Radiation Therapy

Radiation therapy uses high-energy X-rays or other forms of radiation to kill cancer cells. It may delivered externally using focused beams of energy, or internally with a radiation-emitting substance placed in or near the tumor site.

Depending on the cancer, the patient’s health and desired outcomes – radiation therapy may be offered on its own, or in conjunction with surgery and drug therapy. Radiation may also be used to relieve symptoms associated with prostate cancer.

City of Hope offers a wide variety of leading-edge radiation therapy options to treat prostate cancer. These methods include:

  • Image-guided external radiation systems, including TomoTherapy and TrueBeam: These systems combine detailed imaging and radiation delivery technologies, allowing our care team to “sculpt” radiation beams to the tumor site while avoiding nearby healthy tissue. This maximizes radiation’s prostate cancer fighting ability while minimizing exposure to the bladder, rectum and other nearby organs.
  • MRI-guided focused ultrasound: This nonradiation technology uses magnetic resonance imaging (MRI) to detail images of the prostate area, followed by highly focused ultrasound to heat up and destroy cancerous tissue.
  • Brachytherapy: This therapy involves the placement of radioactive material next to or within the tumor site. Depending on the disease, patient health and treatment goals, the radioactive material may be low-dose and permanently placed (low dose rate / LDR brachytherapy) or high-dose and placed for only a few minutes (high dose rate / HDR brachytherapy).

Patients also have access to our recovery program to address and treat symptoms and issues that may arise from radiation therapy – such as urinary and sexual dysfunction.

Drug Therapy

Drug therapy may be given to patients to fight prostate cancer cells throughout the body by killing them or stopping their growth and spread. These drugs include:

  • Hormone therapy, which blocks production or activity of hormones – particularly testosterone and dihydrotestosterone, or DHT – which fuels most prostate cancer growth
  • Chemotherapy, which targets all rapidly-dividing cells, including prostate cancer cells
  • Targeted therapy, which selectively attacks prostate cancer cells based on specific characteristics – such as a gene mutation
  • Immunotherapy, which stimulates the patient’s immune system to attack cancer cells

Drugs may also be prescribed to treat conditions related to prostate cancer, such as weakened bones and sexual dysfunction – common side effects of hormone therapy – or bone loss from metastasized prostate cancer.

The drug or drug combination used depends on the type and stage of prostate cancer, previous treatments used, the patient’s health and overall treatment goals.

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This personalized medicine approach may be further enhanced by molecular or genetic testing of your cancer, which can help identify treatments that are more effective and with fewer side effects.

City of Hope has a wide portfolio of cancer-fighting drugs available in its on-site pharmacy, allowing our medical oncologists to plan and prescribe a drug regimen that can best fight prostate cancer while minimizing side effects.

In addition to standard drug treatments, patients may also be eligible for new, promising drugs through our clinical trials program.

Active Surveillance

For men with early-stage, slow-growing prostate cancer, active surveillance may be considered an option, since the benefit of immediate treatment may not outweigh its risk. This approach includes regular monitoring of prostate-specific antigen, or PSA, levels and digital rectal examinations of the prostate. As soon as abnormalities arise or symptoms begin to display, the doctor and patient can opt for the treating the cancer.

When performed regularly and on-schedule, active surveillance typically catches prostate cancer in its earliest stages of progression, when it is still very treatable with surgery, radiation and/or drug therapy.

City of Hope’s renowned physicians and researchers utilize the latest in technology and innovation to treat prostate cancer, coupled with our enduring belief in providing unparalleled compassionate care.