DEAR DR. ROACH: What can you tell me about Fahr disease? I had an MRI, and I read the term on the report and was concerned because I hadn't been told about it. I asked my provider about it, and he told me that it usually is diagnosed when someone is young. I am soon to be 80 years old. His advice was that if it had not shown up before now, it will not now that I am older. -- B.P.
ANSWER: Fahr disease, also called "idiopathic basal ganglia calcification," is a rare disease of the brain, with symptoms similar to Parkinson's disease. It also can cause other types of movement disorders. Symptoms can come on any time from adolescence to age 60 or so. One way the diagnosis is made is when people have symptoms suggestive of the disease and an MRI scan shows calcium deposits in a part of the brain called the "basal ganglia," which is responsible for coordination of movement.
However, about 1 percent of people have similar findings on their brain scan (when obtained for another reason, as I think yours must have been) but have none of the symptoms of Fahr disease. In fact, a study from Germany in the 1990s showed that basal ganglia calcifications did not put people at risk for other neurological conditions. So, I think that this is an example of medicine learning that imaging studies, especially MRI, show conditions that we thought were likely to cause specific problems but in fact may be found in people with no problems and who will never get those specific problems.
I agree with the good advice your provider gave you.
DEAR DR. ROACH: Does stomach acid kill the live cultures in yogurt and kefir before they can enter the gut? If so, would drinking kefir immediately after waking in the morning, when stomach acid is nil, and following it with a cup of water work? Are enteric-coated probiotic capsules effective? What is your opinion on the value of yogurt and kefir, and the importance of well-balanced gut flora? -- R.L.
ANSWER: Stomach acid does kill the majority of the healthy live bacteria found in some yogurts and kefirs (kefir is a fermented milk drink). However, there are a lot of bacteria (hundreds of millions in a cup of yogurt), and some make it through the stomach, as proven by a study that showed the yogurt bacteria can make it all the way out through the other side of the gastrointestinal tract.
Interestingly, stomach acid is highest during fasting times, so the stomach is very acidic first thing in the morning. However, food dilutes the stomach acid quickly. From the standpoint of chemistry and physiology, I'd probably recommend something like toast or cereal with plenty of fluid, followed quickly by the source of healthy bacteria: kefir, yogurt or probiotic capsules. The last, however, are designed to dissolve in the intestine, allowing the majority of the probiotic (just a name for healthy bacteria) to be delivered to the small and large intestines where they work.
There is no question that a healthy gut flora is essential to digestive health, and probably to many other aspects of health. However, it's not yet proven that probiotics are of value to healthy people. In people with irritable bowel syndrome, and some with inflammatory bowel disease with symptoms, probiotics may be of value. I don't recommend them for healthy people with no symptoms.
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