MACRONUTRIENT BALANCE

There is some inter-conversion between nutrients such as protein being converted to glucose (gluconeogenesis) for release into the bloodstream, but under normal conditions, the capacity to convert one nutrient into another for storage is very limited. Also, humans have little capacity to ‘waste’ extra energy by burning it off. This process, which has been termed luxuskonsumption, is common in animals such as rats but is very limited in humans. Therefore, the examination of each macronutrient as a separate entity is necessary and is summarised below.

Carbohydrate. Carbohydrate stores (glycogen) are very small and tightly controlled in the body. Only relatively small increases in glycogen storage capacity can be gained, for example by the carbohydrate loading techniques employed by endurance athletes, which may increase stores by up to 2,5 times the normal amounts. Carbohydrate calories from the diet keep this small storage space topped up but are mainly used for current energy needs and displace fat as an energy source. Carbohydrate is, therefore, a second priority fuel for energy use, after alcohol. Unlike alcohol and fat, carbohydrate and protein are the main regulators of appetite by satisfying hunger and producing satiety. While the exact mechanisms for this are not known, parts of the complex cascade of responses are being discovered and they appear to involve stretch nerve fibres in the stomach, hormones released from the gut, increases and decreases of certain nutrients in the blood, and a whole series of neurochemical responses in the brain. The final target for appetite control is in the hypothalamus in the brain. Carbohydrate, like protein therefore, is ‘fully balanced’ by influencing both its own burning and satiety mechanisms.

Myth-information. ‘Fat metabolisers’, which are generally forms of amino acids, are often claimed to ‘convert fat to body fuel’. However, scientific assessment shows they are substances which are easily synthesised by the body and have no effect on body fat.

*53\186\4*

BABY AND CHILDHOOD RESPIRATORY DISORDERS: HAY FEVER (ALLERGIC RHINITIS)

Hay fever may occur in the first year of life but is more common after one or two years. It commonly occurs at certain seasons when the child breathes in certain particles (usually pollens from grasses and trees) to which he or she is sensitive. At other times the child may be constantly allergic to other material regularly present in the air (such as house dust).

The common symptoms are an itch of the eyes, nose, throat and ear lobes. There may be coughing, sneezing, probably wheezing. This may be accompanied by heat of the affected parts. Attacks may come on suddenly, in certain seasons, or at certain times of the day. Headaches, nosebleed, recurrent sore ears may occur. Often there is a nasal discharge, and frequently the eyes smart and water.

Treatment

It is another form of allergic reaction, and avoiding as much as possible the known troublemakers is the best idea. Keep away from house dust (if known to cause symptoms); avoid venturing outdoors as much as possible on dusty windy days, particularly when pollens to which the child is sensitive are in the air. Spring and summer, and maybe autumn, are often trouble times—it depends largely when the offending pollens are in the atmosphere in the greatest quantities. Frequently pollens may come from grassing areas many hundreds of kilometres away; these may be carried to city areas by prevailing winds and upper air currents in an amazing manner.

Give the child plenty of fluids to drink. They tend to dilute or wash away histamine from the system, the chemical that is liberated by the allergens and the basic cause of the adverse reactions.

Cold packs to affected areas can often give relief. Icy cold packs to the eyes, ears, skin and itchy irritating areas may assist. Applying anti-itch creams and lotions can also bring relief—for example, Eurax cream, Calistaflex, or Liniment calamine containing benzocaine 3 per cent (be sure to keep it away from eyes).

Antihistamine tablets or liquids for younger children often neutralize the histamine and reduce symptoms. But this often makes the child drowsy, so care in avoiding accidents is essential afterwards. Often a good long sleep will follow, which in itself may be beneficial.

In recent years, excellent preventive measures have become available. As with asthma, sodium cromoglycate capsules placed in an insufflator (a rubber bulb) enable the powder to be inhaled into the nose. Long-term use (at the critical times when symptoms most commonly appear) may often reduce their frequency and severity.

More recently, beclomethasone dipropionate (Beconase inhaler) may similarly reduce the severity when inhaled. It takes up to 14 days for these preventive measures to exert their full benefit. They will not give immediate relief from an attack, and they are not designed to. They are to be used as a preventive measure.

Ephedrine was often used in the past, and may still be used by some doctors for mild cases. Various synthetic derivatives are now often used instead of ephedrine itself.

Some doctors find that discovering the allergen by performing allergy tests and then desensitizing the patient is a successful way in which to increase the body’s inbuilt immunity to future attacks. In the main, however, this system is not popular, for it involves regular weekly or bi-weekly visits to the doctor for injections—not a popular pastime for children of any age, as most parents would agree.

*77\87\2*

BABY AND CHILDHOOD ILLNESSES: LEARNING DIFFICULTIES (INCLUDING HYPERACTIVITY AND DYSLEXIA)

All children are born with a basic urge to learn. What happens is governed both by inherited capability and by local, external influences. A person’s intellect grows and it is a cumulative process. Early stimulation is vital, and ideally the child is exposed to a variety of stimulating experiences from birth. Education starts at home, and the years before school commences are probably the most important in the entire life of the child.

The most frequent cause of serious delay and difficulty in learning is mental subnormality. But another important cause is a slowness in maturation. Some children learn to acquire some skills much quicker than other skills, and much more rapidly than other children. Children with a late puberty are often slower at learning.

Sometimes learning difficulty may be associated with a condition called minimal cerebral dysfunction, claimed to be a consequence of inadequate oxygen reaching the brain at birth. This may result in the so-called hyperkinetic syndrome (commonly known as hyperactivity). The child is often restless, on the move all the time, has a short attention span, is impulsive and clumsy and emotionally unstable. He or she rejects discipline and finds ordinary duties irksome. Often it is very difficult to cope with these fellows at school. (See below under Hyperactivity)

Some children have difficulty with words. Many normal persons have been through a stage of stammering (but have ultimately done all right), simply because for them piecing words together was difficult—just as other children were perhaps slow in learning to walk or to control their urine or to ride a bike. Sometimes the stuttering persists, and in certain cases it may represent a mild degree of brain damage.

Dyslexia means difficulty in reading; dysphasia is difficulty in learning how to speak; dysgraphia is difficulty in writing. There are all manner of variations to these disorders.

Treatment

It is essential that any speech difficulty be carefully checked by a doctor to establish whether there is any neurological disability. Then an assessment by an educational psychologist who can manage the child is essential. There are many problems and difficulties, but a reasonable outcome is often possible.

*28\87\2*

OSTEOPOROSIS

Osteoporosis or ‘brittle bone disease’ is caused by calcium leaching from our bones, leaving them weak and prone to fractures. It can occur in both men and women but women are much more vulnerable to it, partly because they tend to have less bone mass in the first place but mostly because the female hormone oestrogen plays in an important role in the body’s ability to use and retain calcium. Loss of calcium from the bones begins around 30 years of age and increases dramatically when the body stops producing oestrogen after menopause.

You are most at risk if you are white, slim and small-boned; if your menopause is early; or if your mother or grandmother suffered from the disease. Rheumatoid arthritis, diabetes, thyroid problems and certain asthma drugs are other risk factors, and caffeine, nicotine and alcohol all accelerate loss of bone mass.

Because it replaces the oestrogen in the body after menopause, hormone replacement therapy can protect you against osteoporosis.

But prevention is better than cure. It is important to make sure you include plenty of calcium in your diet throughout life, not just at menopause, along with vitamin D to aid absorption. 700-1000mg of calcium daily is recommended before menopause and 1000-1500mg after.

Recently, it is been proposed that Vitamin K may play a role in preventing osteoporosis, and it may be a good idea to include foods rich in this vitamin in your diet — turnips, greens, broccoli, cabbage, liver and cereals. The trace element boron may also help the body avoid loss of bone mass; it is found in apples, pears, grapes, leafy vegetables, pulses and nuts.

A high intake of protein, particularly animal protein, may make the problem worse, so cutting down on meat after menopause at the same time as eating more vegetables and cereals is probably wise.

Gentle weight-bearing exercise will help strengthen and thicken your bones; you don’t have to run or jog — just walking will do, and T’ai chi is another possibility. Exercising throughout your life is the most effective strategy, but it’s never too late to start. One study of women aged 65 to 69 found that those who exercised for half an hour a day three times a week over three years increased the bone mass of their arms by 4.3%, compared with a 2.5% loss in a control group. Before you start a new exercise regimen, it’s a good idea to consult a health practitioner, especially if you already suffer from osteoporosis or heart problems.

*27\69\2*

ST JOHN’S WORT AT WORK: ADELE’S STORY

Adele is a woman of approximately 50, whom I have treated for the past eight years. Although extremely intelligent, she has had learning difficulties since childhood – although she has mastered these sufficiently to complete university and graduate school successfully and become an educator herself, teaching others how to teach. Despite the many good things in her life – a loving husband, children of whom she is proud, good looks and physical health – Adele has suffered long stretches of time during which she has felt tired, tearful and, above all, anxious. During these times she loses interest and initiative, has trouble sleeping, is unable to concentrate on her work and devalues herself.

These episodes of depression and anxiety would come and go over the years, sometimes apparently with the seasons, sometimes in response to stress, and sometimes for no good discernible reason at all. And over the years I have treated Adele with a series of anti-depressants, all of which have created problems that, sooner or later, would come to a head so that she would elect to discontinue the medications rather than suffer the side-effects. Prozac caused her to itch unbearably. Wellbutrin made her edgy and irritable. Lustral stripped her of her sex-drive and ability to have orgasms. Light therapy in winter was of some help but not sufficient in itself. Psychotherapy helped her to deal with some of her life issues, many of which were the result of childhood sorrows and traumas, but didn’t resolve the symptoms of her underlying depression – fatigue to the point of exhaustion, sadness and, always in the background, all-encompassing anxiety.

After my experience with Malcolm’s self-treatment, I finally began to take the European literature on St John’s Wort more seriously. I was eager for Adele to try the herb, as her depressive symptoms seemed to fit the profile of those who had most frequently benefited from the drug. I gave her some samples of

Jarsin, the type of St John’s Wort used in most of the European research literature and now available under the brand name of Kira™, with instructions based on the advice of my German colleagues. Neither of us could have hoped for a happier outcome. On St John’s Wort (300 mg twice a day) Adele began to feel more confident, content and optimistic. Her anxiety disappeared and, best of all, she experienced no side-effects. The return of sexual feelings and the ability to express and enjoy them were extremely welcome developments. Although her job had been a longstanding source of conflict for her, suddenly she felt that it offered her new opportunities which she had not previously appreciated. As far as Adele is concerned, St John’s Wort has opened up a whole new world of possibilities for someone who has fought a long and painful battle with depression and anxiety.

Since my work with Adele I have treated numerous patients successfully with St John’s Wort and have answered their many questions about the herb. The herb is now widely available to the public and many want to use it but lack the latest information on how to go about doing so. This book is written for all who may be interested in trying the new herbal remedy in the hope that it may lift the clouds of depression and bring joy back into their lives again.

*3\75\2*

ALLERGIES: HYPERACTIVITY (PLUS-TWO REACTION)

One of the major forms of plus-two reactions is hyperactivity. This is also sometimes called hyperkinesis. Far more common in males than females, it is marked by distractability, inappropriate responses, and irritability. Supercharged and jittery behavior can occur at any age but is particularly common among children. It is often accompanied by aggressive actions, temper tantrums, poor schoolwork, and sometimes by overweight. This was first described in 1947.This sort of behavior has become increasingly common among children, and many theories have been advanced to account for it, ranging from Freudian interpretations of family life to the incrimination of television violence. Often, however, the problem is an allergic/addictive response to some food eaten in a compulsive fashion or to some chemical encountered in the course of everyday life. Removal of these substances and overall environmental control can often help such children in a dramatic way.

*56\110\2*

THE BASIC CONCEPTS OF ALLERGIES: THE WATER SUPPLY

Water is something we all take in, every day. It is obvious that the quality of that water will have a bearing on health and well-being. To prevent the spread of infectious diseases, such as typhoid fever, our cities began adding the chemical chlorine to the drinking water in 1912.

Chlorine was admirably effective in stopping the spread of infection. But, as a historian of this topic notes, “In discovering that drinking water could be purified by different filters, and made doubly safe through chlorination, interest in pollution declined.”6 Thus, there was very little reaction when two allergists, S. H. Watson and C. S. Kibler, showed, in 1934, that chlorinated drinking water could cause asthma in certain susceptible individuals.7

Chlorine is, in fact, a common cause of symptoms in individuals who are generally susceptible to chemicals. For this reason, in my special diagnosis and treatment facility, the Ecology Unit (Chap. 17), patients are given spring water to drink and treat chlorinated tap water as a “suspect” beverage. Some patients also react to swimming in chlorinated pools or even breathing their vapors. Some people are made sick by standing over a tub of steaming water in a closed bathroom. The contribution of fluoridation to this problem has simply not been studied adequately to permit us to make any definite statements about it.

In some parts of the country, the water is very “hard” (that is, saturated with mineral salts) and difficult to use in washing. There is a tendency in these areas to soften all water entering the kitchen or the laundry room with chemical water softeners. This is one of the built-in hazards of present-day home construction. If the softened water is drunk, it is apparently tolerated by many but a minority may become highly susceptible and be made ill by it.

The solution is to use softened water for all other purposes, but only unsoftened water for drinking and cooking. This requires having an extra tap in the kitchen. Some patients have a separate tap of unsoftened and filtered water, which is the only kind they use for internal consumption.

Even a “safe” source of water can easily become polluted. Certain wells, known to have been approved for use by chemically susceptible persons at one time, have since become chemically contaminated, as judged by several patients with this type of problem who are no longer able to use waters from such sources. The same holds true for several recently diagnosed patients.

Ideally, drinking waters should be rotated in the same way as foods. Of the recently hospitalized patients whom we have tested, approximately 70 percent reacted to one or several of the seven different waters which we routinely employed in testing. As with foods, a currently tolerated water may eventually become the source of individual reactions at some later time, especially if it is abused. Unfortunately, water rotation often is not practicable, since many locations lack an adequate variety of water supplies.

It should be said in summary that, as with other aspects of the food and chemical susceptibility problem, no two patients are found to have exactly the same water problem. For instance, there is no readily available water which seems to agree with all chemically susceptible patients, and a water which is agreeable to one person may be a major cause of symptoms in another. In short, the water problem remains not only highly individualized, but is also a common cause of persistent unexplained symptoms in otherwise controlled patients.

*26\110\2*

CHILDREN’S HEALTH: DISLOCATED ELBOW

A dislocated elbow (Malgaigne’s subluxation) is a condition in which the bones are out of their proper place in the joint. Actually, a dislocated elbow is not completely out of place. Therefore, it is more properly called a “subluxation” (partial dislocation). It is also known as “nursemaid’s elbow.” It is the only common dislocation in young children. It frequently occurs between one and three years of age; it is rare beyond age four.

The elbow contains two separate joints. The larger is a hinge joint that allows the forearm to bend and to straighten in relation to the upper arm. The smaller, less obvious joint of the elbow is between the upper ends of the two bones of the forearm (radius and ulna). This smaller joint allows the forearm to rotate, to turn the palm up and down. It is this smaller joint (radioulnar joint) that is partially dislocated when there is a sudden yank on the child’s hand or wrist. It may occur when a parent tries to save the child from a stumble or fall. It may also occur when a child is swung around by the wrists in a game or when the child tries to grab a handhold to prevent falling.

Signs and symptoms

When an accident causes a dislocated elbow, there is immediate pain. The pain may be felt anywhere from the elbow to the wrist. The child refuses to use the affected arm, clutching it against the side with the good arm. The child holds the affected arm with the palm of the hand facing back. Attempts to turn the palm forward cause pain. Swelling of the wrist and hand develops several hours later. If you know that the arm has been yanked and the child holds the arm with palm facing back, a dislocated elbow is a likely cause. However, if you do not know that the arm has been pulled, you may not realize the cause of the problem. A dislocated elbow is commonly mistaken to be an injured wrist.

Home care

The first time you suspect your child has a dislocated elbow, have a doctor treat it.

A dislocated elbow tends to occur again, however. There is a simple procedure for correcting a dislocated elbow, which parents can frequently do themselves. Your doctor may teach you the procedure if the elbow becomes dislocated often. If this manoeuvre is done within a few hours of the accident, a sharp snap or click is heard and actually felt near the elbow. The child is immediately relieved of pain and can use the arm freely.

Caution: Do not attempt to correct a dislocated elbow unless you have been taught the correct procedure by a doctor.

Precautions

• Do not use the procedure for correcting a dislocated elbow unless the symptoms exactly fit the description and you are sure the arm has been yanked. A fracture (break) of a forearm bone can produce similar symptoms. • A dislocated elbow should be treated as soon as possible. If the elbow is dislocated for more than a few hours, correcting it may be more difficult because of the swelling; then for one to two days after correction, the arm may still be sore and not fully usable. • After an elbow is dislocated, the joint remains susceptible to another dislocation for three to four weeks. Be careful.

• Make a habit of lifting your child by the upper arms or under the armpits. Do not lift a child by pulling on hands, wrists, or forearms.

Medical treatment

Your doctor will determine if the elbow is dislocated and may request an X ray to be sure there are no broken bones. (Sometimes, positioning the arm for the X ray returns the dislocated bone to its proper place.) After the diagnosis is certain, your doctor will correct the dislocation using the standard procedure mentioned.

*51/84/5*

LAUGHTER THERAPY FOR LONG LIFE

Richard Haude, Ph.D., professor emeritus of psychology, and his colleagues speculated that “it is possible that a jocular nature and an ongoing appreciation of humor may facilitate successful survival into older adulthood.” In other words, they figured a good punch line could add to your life line.

To test their hypothesis, Dr. Haude and his colleagues asked 33 older adults with a mean age of 72.3 to rate themselves and a deceased sibling (mean age at death was 64.6) on a scale that evaluates one’s sense of humor. The results showed that the surviving siblings had a better sense of humor than their dead relatives. Though he admits the data are limited, Dr. Haude says the study shows that “if you appreciate humor to a greater extent than somebody else, you’re likely to live a little longer.”

Now this is all well and good for a person who is a natural-born comedian, but what about the person who cannot make others laugh? Is there hope for the humor-impaired? Michelle Gayle Newman, Ph.D., assistant professor of psychology at Pennsylvania State University in University Park, thinks so. In a study she conducted, she found that two groups of people-one that tended to use humor to cope with stress and another group that didn’t-both benefited positively from using humor during exposure to a stressful film. In this study, all participants, even those who didn’t have a sense of humor, demonstrated fewer stress reactions to the film when they used humor coping than participants who did not use humor coping. As a result of her study, Dr. Newman now believes that “humor can be learned.”

So keep practicing those punch lines.

You may never make it to the open mike night at your local comedy club, but you could still be standing to hear the next generation of stand-up comedians.

*58/36/5*

SURGERY FOR BREAST DISEASES: BIOPSY, ADAIR’S OPERATION AND MICRODOCHECTOMY

Biopsy of the breast

Some years ago surgeons were taught that if a woman had a lump in her breast, the diagnosis should always be confirmed by excision of the lump and examination of it under a microscope. This procedure has now been almost entirely replaced by the use of fine needle aspiration biopsies or of a wider Tru-Cut needle to remove a core of breast tissue when a more substantive biopsy is required.

Although some women would prefer to have a local anesthetic for an open breast biopsy, this is not usually possible. It is surprisingly difficult, once a small incision has been made in the breast following a local anesthetic injection, for the surgeon to locate a breast lump, and this is more easily done if the patient has had a general anesthetic. Not only is it disconcerting for a surgeon not to be able to find a breast lump which has been hidden by the injection of the local anesthetic, but the surgeon’s concern about the difficulties might also be transferred to the patient.

Adair’s operation

Also known as Hadfield’s operation, this is performed for duct ectasia.

A general anesthetic is used, and a peri-areolar incision is made around the upper or lower half of the nipple. A piece of tissue containing the central breast ducts is then removed. The excised tissue is about the same size as a 50p piece; it is always sent to the pathology laboratory to be looked at under the microscope.

The skin is then closed with a cosmetic subcuticular stitch, i.e. a stitch beneath the surface of the skin. The suture is made using either a non-absorbable material such as Prolene, which is rather like Nylon and must be taken out after 7 to 8 days, or an absorbable material which does not need to be removed. There is a tendency for wounds to leak more if closed with the absorbable material, although there is no associated increased risk of infection.

The most common problem after an Adair’s operation is bruising. There may also be a 10 to 15 per cent risk of recurrence of the previous disease.

Microdochectomy

Occasionally, a small warty growth or a very early cancer can appear in the ducts just underneath the nipple and cause a bloody nipple discharge. If the offending duct can be identified, it is possible to use X-ray mammography to locate the growth. A small cannula is placed into the duct and dye is then injected through it, so that the small warty lesion or papilloma within the duct becomes clearly visible.

The operation to remove the duct is known as microdochectomy, and involves the use of a general anesthetic. A probe is put into the affected duct and then removed through a radial incision made from the tip of the nipple. The probe takes with it the duct containing the lesion and the skin is then closed as described above.

If the warty lesion turns out to be entirely benign, which is usually the case, the operation is complete. If, as happens rarely, an intraductal cancer which is showing some sign of invasion is found, the operation may need to be followed up by more radical surgery.

*37/39/5*