Mark McEwen, former TV weatherman for The Early Show on CBS, found out during a flight to Orlando in 2005. He had been dozing, then woke up, feeling odd. “It was like being underwater and trying to swim to the surface,” says McEwen, now 55. “You’re just trying to survive, to make sense of something that is senseless.” He had no clue it was a stroke. Nor apparently did the attendant who helped him off the plane—or the skycap who left McEwen sitting curbside in a wheelchair. McEwen could barely talk, but he did manage to ring his wife’s cell phone and convey a basic message. “Help me. Not good.”

If someone near you, like McEwen, were having a stroke, would you recognize it? Would you know what to do? Stroke is the third leading cause of death in this country—and every 40 seconds on average, someone in the United States suffers one. About 30 percent of strokes 
are mild, resulting in no disability. But the 20 percent that are severe, yet survivable, can be crippling.

“A major stroke can change everything—the ability to speak, to move, to work,” says Dr. Walter Kernan, professor of medicine at Yale University School of Medicine. “It may seem to rob a person of his life without actually taking it.” Fortunately, new therapies are in the works that may help improve outcomes.

Striking Out Against Stroke

The most significant advance is the clot-busting drug, known as tissue plasminogen activator, or tPA, which can help the 85 percent of patients whose strokes are caused by clots in the brain. “Sadly,” says Dr. Ralph Sacco, a neurologist and president-elect of the American Heart Association (of which the American Stroke Association is a division), “only about 5 percent of patients actually get it because they don’t reach the hospital in time or they don’t go to a [hospital certified as a] primary stroke center, which can give it rapidly.” Administered intravenously, it takes time to dissolve a clot, particularly a large one and as neurologists say, “time is brain.” Last year, the AHA revised its guidelines, saying that tPA could be given up to four hours and 30 minutes after the onset of stroke—a significant increase over the previous three-hour window. But sooner remains better.

“The best outcomes are still in patients with small clots who receive tPA in less than 90 minutes,” says Dr. Rishi Gupta of Vanderbilt University Medical Center.

Other technologies are already available at comprehensive stroke centers (a notch above primary stroke centers, which are mainly geared to giving tPA). At the Cleveland Clinic, doctors are using stents to prop open blocked blood vessels during a stroke, as well as two FDA-approved devices to help remove clots. One, the Merci Retriever, works like a miniature corkscrew to pull the clot out. The other, the Penumbra, breaks up a clot with microjets of water, then suctions out the pieces. Both devices require highly skilled specialists, and not every patient is a candidate. “You have to image the brain first to see if functional tissue remains that could benefit from restored blood flow,” says Dr. Irene Katzan, medical director of the stroke program at the Cleveland Clinic.

Refining Recovery

Acute treatment is only the first step in stroke recovery. Fortunately, therapists are getting better results with post-stroke rehabilitation than ever. “We used to say to patients, ‘you have three to six months to improve, and after that you can’t expect a whole lot,’ ” says Dr. Richard Zorowitz, chair of physical medicine and rehabilitation at Johns Hopkins Bayview Medical Center. Now, knowledge about the brain’s ability to rewire itself—a concept called neuroplasticity—has encouraged therapists (and patients) to try longer and harder.

“Thanks to the neuroplasticity of the brain—the ability of the brain cells to rearrange their connections, our brain has more capacity than we ever imagined to rewire itself for greater levels of recovery,” says researcher and stroke survivor Dr. Jill Bolte Taylor (read “Life After Stroke”).

Dr. Steven C. Cramer at the University of California, Irvine, is working with robotic therapy to help restore function as well as investigating two hormones that may encourage stem cells to develop into new neurons, key cells that transmit nerve signals to and from the brain. So far, early results look promising. Meanwhile, Dr. David Simpson at Mount Sinai School of Medicine in New York is using botulinum toxin (Botox) to help reduce the spasms that lead to twisted limbs and abnormal gaits, a frequent result of stroke.

For the most part, rehab consists of hard work—and lots of it. Three hours a day is the rule of thumb. But technologies like Nintendo’s Wii video game console keeps exercises interesting—engaging stroke patients in games such as bowling or tennis to improve balance and shifting of weight.

As for McEwen, he’s back on his feet after 14 months of rehab. Today the former weatherman, who described his experiences in his 2008 book Change in the Weather, is a motivational speaker and spokesperson for the American Stroke Association. The organization’s latest campaign (PowerToEndStroke.org) is directed at people with risk factors for stroke—high blood pressure, diabetes, excess weight, and a history of heart disease. “There are lots of things you can do to lower your risk for stroke,” says McEwen. “Knowledge
 is power.” And it could just save your life.

The Post Investigates: Stroke Advances The Saturday Evening Post

Gut Reactions

Kupper’s condition turned out to be an autoimmune disorder known as celiac disease, a severe reaction to gluten, the protein in many grains, including wheat, rye, and barley.

When the immune system launches an attack against gluten, the result isn’t merely irritation of the gut (though there’s plenty of that, too, chronic diarrhea being a major symptom). The repeated attacks also end up flattening the finger-like projections in the small intestine through which nutrients are absorbed into the bloodstream. The resulting nutrient deficiencies can lead to a number of problems, from anemia to osteoporosis (caused, respectively, by a lack of iron and calcium). In children, celiac disease can lead to short stature and a general “failure to thrive.”

But celiac disease is more complicated than a digestive complaint or food allergy. As part of the immune system’s assault on gluten, the body generates antibodies to one of its own enzymes called tTG (tissue transglutaminase). This enzyme is an innocent bystander that only gets targeted because it binds to gluten in the lining of the intestines. If tTG were found only in the gut, there would be damage enough. But tTG is also found in the skin, heart, thyroid, bones, and nervous system. Antibodies against tTG can direct fire at any of these organs, too. The results may range from blistering, itchy rashes to thyroid disorders and neurological problems. “Name an organ, and it can be affected,” says Dr. Peter Green, director of the Celiac Disease Center at Columbia University’s College of Physicians and Surgeons.

As recently as a decade ago, celiac disease was considered rare. Now almost everyone seems to know someone who has it. That’s not just the result of better diagnosis, which today involves blood testing and confirmatory intestinal biopsy. Recent studies suggest that celiac disease is becoming more common. One 2009 study in the journal Gastroenterology compared banked blood samples from the early 1950s with recent samples and, using the blood tests for celiac disease, found a fourfold increase in the last 50 years.

Celiac disease is now thought to affect one in 100 people of all ages and races. Unfortunately, it often takes years before the disease is correctly identified, according to the National Institutes of Health.

Search for the Cause

Gluten was first identified as the trigger in celiac disease after a Dutch doctor noted the precipitous drop in cases during the bread shortages of World War II—and the rebound of the disease once bread became available again.

But scientists believe that it’s more than just bread, crackers, cookies, pasta, and other wheat-filled foods that are responsible for the increase in celiac disease. In order to develop the ailment, a person must eat gluten, and also carry genes that predispose her to gluten sensitivity. “But our genes haven’t changed in the last 50 years,” points out Dr. Green. He cites a Finnish study that compared a high-celiac population in Finland to those across the border in Russian Karelia with low rates of the disease. “The two have similar genes. That means there must be some other environmental factor that helps initiate the immune response.”

Life is easier for Cynthia Kupper, who feels "much, much better" after going gluten free.
Photo by Duane Hamamura

One possible explanation focuses on the “hygiene hypothesis,” already suspect in the rising tide of allergies and asthma. According to this theory, humans today grow up in more sterile environments than our ancestors did. When infants and young children fail to encounter historic levels of household and farm germs, their immune systems—which evolved to fight these bugs—go looking for other foreign invaders. They end up targeting things like pollen, peanuts, or gluten. Perhaps Grandma was right when she advised, “You have to eat a peck of dirt before you die.”

Improved hygiene, however, is not the only shift in Western society. Researchers are investigating the potential impact of a half-century of changes in how we live, what we eat, and how medications affect the workings of the gut. We take different drugs and more of them, from potent antibiotics to acid blockers. These pills affect the populations of bacteria that naturally inhabit the gut. Some researchers suggest that dietary changes, too—including more fiber-poor, sugar-rich foods, and consumption of sulfites found in cooked and processed foods as well as in wine and beer—can affect intestinal flora. Exactly how these might contribute to celiac disease is unclear, but one possibility might be increasing the permeability of the gut, which disrupts the way the digestive system functions. “When the tight junctions between cells in the intestinal lining come apart, gluten seeps into the underlying tissue and incites the immune system,” says Dr. Alessio Fasano, director of the Center for Celiac Research at the University of Maryland School of Medicine.

Meeting the Need

Whatever the fundamental cause, the solution is simple in concept, if difficult in practice—eliminate gluten from the diet. Fortunately, 
food manufacturers accepted the challenge of providing gluten-free fare (though not cheaply), and pharmaceutical companies are exploring potential drug treatments.

They can hardly come too soon. A decade ago, there were few gluten-free baked goods, and those products “tasted like cardboard-Styrofoam combinations,” says Kupper, who now enjoys renewed energy and good health after embracing the gluten-free life, adding, “I’m really doing well.”

Today, celiac sufferers can find a burgeoning array of gluten-free offerings that are actually tasty, even if pricey. The Celiac Disease Center at Columbia University found that the cost tends to run twice as high for gluten-free products as for normal versions of bread, pasta, cookies, cakes, and crackers. (A cheaper and super-healthy approach is to eat a diet that’s naturally free of gluten—including vegetables, fruits, fish, nuts, lean meat, rice, and potatoes.)

Experts advise celiac consumers to carefully examine food labels for hidden gluten: Its presence is not always obvious. For example, frozen or canned fruits and vegetables, processed cheese spreads, and flavored yogurts, even lotion, toothpaste, and shampoo, may contain gluten.

Drugs are still years away. But Alvine Pharmaceuticals in California is conducting a trial testing digestive enzymes for gluten. These would help break down indigestible gluten fragments into individual amino acids that the immune system would not recognize as threatening. Another company in Australia is working on a vaccine. Also in Australia, a third group has launched a clinical trial giving participants hookworm infections, which appear to alter the immune response of celiac patients in beneficial ways.

With all these lines of research, it seems likely that at least one of these approaches to drug therapy will eventually pan out. When that day comes, scientists will be able to boast that, for the first time, celiac sufferers can have their gluten-laden cake. And eat it, too.

Celiac Disease: The Great Pretender The Saturday Evening Post

Vitamin D deficiencies — both mild and severe — are rampant in this country. A national sample of nearly 19,000 individuals found that between 1988 and 2004, the proportion of Americans with adequate levels of vitamin D in their blood fell from 45 percent to 23 percent. Among blacks, those with sufficient levels plummeted from 12 percent to just 3 percent.

And that could spell trouble for a large portion of the U.S. population. Traditionally, scientists have thought of vitamin D as necessary mainly for bone health, because it helps the body absorb calcium. But recent research shows that vitamin D performs a multitude of other functions. And though much work remains to be done, one thing is clear: Vitamin D does far more than doctors realized even a decade ago.

“We should test for vitamin D as routinely as cholesterol,” says Dr. Daniel Nadeau, medical director of the Diabetes, Endocrine, and Nutrition Center at Exeter Hospital in
New Hampshire. Dr. Nadeau tests about 70 percent of his patients — and finds that almost all have suboptimal levels.

Deficiencies are being linked to some of the most serious chronic diseases. In 1997, epidemiologists Frank and Cedric Garland found that people with blood levels below 30 had three times the risk of colon cancer. Last year the famous Framingham heart study linked levels below 15 with a 60 percent greater likelihood of a heart attack.

Other studies have drawn tentative links between low D and elevated risks for multiple sclerosis, rheumatoid arthritis, asthma, and depression. In fact, if you drew a chart of the human body with arrows pointing to each organ affected by vitamin D, it would start to resemble a painting of Saint Sebastian, the martyr who met his end in a hail of arrows.

Beyond Bone Health

Researchers who gave people 800 to 2,000 units of vitamin D a day have found that those who received the supplements had lower risks for a variety of ailments — 80 percent lower for type 1 diabetes, 72 percent lower for falls in nursing homes, and 60 percent lower for multiple cancers. More studies are needed, but the results so far point pretty consistently in the same direction. “Vitamin D is not a magic pill, but it’s as close as you’ll ever get,” says Dr. John Cannell, president of the Vitamin D Council.

How can one substance affect so much? Dr. Michael Holick, professor of medicine, physiology, and biophysics at Boston University Medical Center and author of The Vitamin D Solution, slated for release next spring, offers an explanation.

“Virtually every tissue in the body has vitamin D receptors,” he says. “They have to be there for a reason.”

And that reason seems to be that vitamin D helps regulate genes throughout the body — genes that help control blood pressure, cell proliferation, and inflammation, among other things. They even rev up the immune system — not the antibodies that target specific germs, but the general-purpose cells that attack any foreign invader. For this reason, Dr. Cannell speculates that vitamin D could be a huge help in battling viral infections, including the H1N1 (swine) flu. “You should still get the vaccine,” he says. “But I wouldn’t dream of letting my family face H1N1 this winter with blood levels under 50.” In principle, few problems are easier to fix than vitamin D deficiency.

D-Fining Sources

There are three sources of vitamin D — sunshine, supplements, and foods.

Foods naturally high in vitamin D include fish, such as salmon, mackerel, sardines, and tuna. Milk, breakfast cereals, and some brands of orange juice are fortified with vitamin D. Those rays of golden sun — specifically UV-B radiation — stimulate the synthesis of the vitamin in the skin. That distinguishes it from other vitamins, which can only be obtained through food or pills. Dr. Holick recommends venturing into the sun with bare arms and legs daily without sunblock, but only for five to 10 minutes.

“Moderation is the word,” he says.

That leaves daily supplements. Currently, the recommended level of supplemental vitamin D is 200 international units (IUs) for individuals 19-50; 400 IUs for those 51-70; and 600 IUs for 71-plus. The Institute of Medicine, however, is expected to issue revised recommendations in 2010.

Some researchers are already taking more.

At a meeting at the Centers for Disease Control and Prevention this year, Dr. Robert Heaney of Creighton University passed out slips of paper to the other vitamin D researchers and asked them to jot down how much they take. He takes 3,000 units a day. “The average among my peers was more than 5,000,” he says. That sounds breathtakingly high compared to the current guidelines, but it’s not. “People with high sun exposures get 15,000 to 20,000 IUs a day from the sun with no sign of vitamin D toxicity,” says Dr. Edward Giovannucci, professor of nutrition and epidemiology at Harvard School of Public Health.

That said, there will never be a one-size-fits-all recommendation for vitamin D intake. There are too many variables. The obese need more than the thin because of their larger body size. The elderly need more than the young because they are less efficient at synthesizing it. Those who live at northern latitudes need more than those near the equator, where sunshine is more abundant year-round. Even individuals have different requirements at different times of the year.

As for me, I finally got the results of my vitamin D test: My level was 34 — just barely acceptable, but at least in the ballpark. “Increase your supplementation and get tested again in six months,” my doctor advised. Mind you, I was already taking 1,200 IUs a day and probably getting a couple hundred more from food. And despite wearing sunblock, sun-protective clothing, and floppy hats, my supersensitive skin is probably still synthesizing vitamin D during my
45-minute daily walks.

Even though I had an acceptable level, Dr. Nadeau said it may be “because you got tested in the summer.” Come winter, he hinted, I might slip into inadequate territory — but nothing I couldn’t fix with a few more supplements.

Vitamin D Dilemma The Saturday Evening Post