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Parasitophobia. This relates to a morbid fear of being infested with parasites. Sufferers of this condition may also be deluded, believing themselves already infested, and may bring in various pieces of thread, lint, scrapings and debris of all sorts believing them to be the ‘parasites’. The deluded victim often has hallucinations, insisting that he can see and feel the parasites within his skin. Patients with this disorder require psychiatric help, as they frequently ‘need’ the symptom to remain, in other areas of their functioning life, sane.

Dermatitis artefacts. This is a skin disorder which is self-inflicted. Furthermore the patient denies having produced the lesion with his own hands. Chemicals, heat, or other physical and mechanical means may be used to inflict the disorder, and the lesions are therefore of singularly curious patterning, generally not conforming to known disorders and usually in an easily accessible area. A fairly decisive diagnostic indication is the disappearance of the lesion under an occlusive dressing.

Generally speaking two types of patient perpetrate this type of disorder: the hysterical individual, with a rather apathetic appearance, who converts intense anxiety into this symptom; and the malingering individual, who produces the lesion to attain some gain or to explain a lack of success. These patients require definite help, and should certainly not be confronted or accused of self-infliction. Psychiatric referral is very wise.

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This glossary describes of some of the key foods that can form part of a low G.I. diet.

Lemon juice (G.I. = 0). A small amount of lemon juice (1 tablespoon) won’t add any carbohydrate but its acidity has a powerful slowing effect on stomach emptying thereby slowing down the rate of starch degestion. Vinegar has the same effect.

Milk (G.I. of 27) • Lactose, the sugar occurring naturally in milk, is a disaccharide which must be digested into its component sugars before absorption. The two sugars that result, glucose and galactose, compete with each other for absorption. This slows down absorption and lowers the G.I. The presence of protein and fat in milk also lowers the G.I. of milk.

Oat bran (G.I. of 55) Unprocessed oat bran is available in the cereal section of supermarkets, usually loosely packed in plastic bags. Its carbohydrate content is lower than that of oats and it is higher in fibre, particularly soluble fibre, which is probably responsible for its low G.I A soft, bland product, it is useful as a partial substitution for flour in baked goods to lower the G.I.

Oranges (G.I. of 44) • Well known as a good source of vitamin C, most of the sugar content of oranges is sucrose. This, and their high acid content, probably accounts for their low G.I. Parboiled rice (G.I. range: 38 to 87) • Parboiling involves steeping rice in hot water and steaming it prior to drying and milling. Nutrients from the bran layer are retained in the grain and the cooked product has less tendency to be sticky- Some studies have found parboiled rice to have a lower G.I. but studies on Australian rice have found only small differences between parboiled and regular rice. The overriding determinant of the G.L of rice is the type of starch present in the grain.

Pasta (G.I. range: 32 to 64) • Pasta is made from hard wheat semolina with a high protein content, which gives a strong dough. Protein-starch interactions and minimal disruption to the starch granules during processing contribute to the low G.I. There is some evidence that thicker pasta has a lower G.I. than thin types.

Peach (G.I. of 42, fresh; 30, canned) • Most of the sugar in peaches is sucrose (4.7 per cent). Other aspects like their acid and fibre content may account for their low G.I.

Peanuts (G.I. of 14) • A low carbohydrate but high fat food, being 50 per cent fat and 25 per cent protein* which is one reason for the low G.I. value.

Pear (G.I. of 38, fresh; 44, canned) Another fruit with a high fructose (6.7 per cent) content, accounting for the low G.I.

Peas (G.I. of 48) • Peas are high in fibre and also higher in protein than most other vegetables. Protein-starch interactions may contribute to their lower G.I. They also average 3.5 per cent sucrose giving them a sweet flavour.

Pineapple juice (G.I. of 46) • Mainly sucrose (7.9 per cent).

Pita bread (G.I. of 57) Unleavened flat bread was found to have a slightly lower G.I. than regular bread in a Canadian study. Sold in supermarkets in packets of flat rounds.

Ploughman’s Loaf™ Wholegrain (GJ. of 47) • A wholemeal bread with additional whole grains. It is widely available in supermarkets. Other varieties under the Ploughman’s label are probably also low G.I.

Plums (GJ. of 39) • The G.I. for plums comes from a European study. Australian plums containing a fairly equal mixture of glucose, fructose and sucrose. The higher the concentration of sugars, the slower the food is emptied from the stomach and hence the slower the absorption. This may account for the low G.I.

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An alternative paradigm; The ecological model

Any complete understanding of obesity must take account of the differences both within and between individuals and populations, as well as the moderating physiological adjustments which occur as a result of changes in energy balance. This would mean a more ecological approach to the problem which implies a delicate balance between a wide variety of competing forces. There are three main influences on equilibrium levels of body fat—environmental, biological and behavioural—and these are mediated through fat/energy intake (F/EI) and/or fat/energy expenditure (F/EE), but moderated by physiological adjustments to changes in energy balance.

This model adds the biological, environmental and behavioural influences to an equation whose end point is ‘equilibrium stores’ of body fat. This is a dynamic relationship where fat stores ‘settle’, at least temporarily, until there is some change in components of the equation, after which physiological adjustment occurs, or a new equilibrium, or ‘settling point’, is reached. This paradigm discards the notion of a ‘set point’ for body fat, whereby the body works to achieve and maintain a body fat mass of say 75kg. It also modifies the previous notions of energy balance by specifying the initial aspects of food, exercise, the rate of fat intake and the rate of fat utilisation respectively. Finally, the model incorporates the physiological adjustments which occur with body composition changes and which then bring it back into equilibrium. The components of the model are broken into the mediators (i.e. fat intake and expenditure), influences (environment, biology and behaviour) and the moderators (physiological adjustment).

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Combined treatment for endometriosis involves the use of a course of hormonal treatment before or after surgery.

Who is suitable for combined treatment Combined treatment is sometimes used for women with the more severe forms of endometriosis in association with a conservative laparotomy though it may also be used in combination with a hysterectomy. Laparoscopic surgery is often followed by a course of hormonal treatment regardless of the severity of the condition.

What does combined treatment involve

Gynaecologists vary in the way that they use combined treatment. Some believe that the hormonal treatment is best used before surgery and some believe that it is best used after surgery, while others believe that it can be used both before and after surgery.

Those who recommend that the hormonal treatment be taken before surgery believe that it makes the surgery easier to perform by reducing the size and number of the implants that need to be removed and makes them easier to remove. They also believe that it reduces the development of adhesions following surgery.

The practice of using the hormonal therapy after surgery is based on the thinking that surgery can only remove those implants which are visible and accessible. The hormonal therapy is used to eradicate any implants remaining after surgery, including any microscopic implants.

If the hormonal therapy is used before surgery, two to six months of treatment is usually prescribed, whereas if it is used after surgery up to nine months of treatment is generally used.

Effectiveness of combined treatment

There are few statistics on the benefits of combined treatment. Many gynaecologists believe that combined treatment is probably more effective than hormonal or surgical treatment alone.

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Endometriosis is A condition in which endometrium (the lining of the uterus) is found in locations outside the uterus. It can occur in menstruating women at anytime from puberty to menopause. This misplaced endometrium is most commonly found on the ovaries, the ligaments supporting the uterus and the Pouch of Douglas. It can cause a wide range of symptoms including period pain, pelvic pain, painful intercourse, bowel problems and infertility.

How long has endometriosis existed-Endometriosis has probably been around for as long as the human race. The first mention of the characteristic symptoms of endometriosis has been found in ancient Egyptian scrolls which date back to the year 1600 B.C. The first reference to endometriosis in medical literature appeared in 1860. But it was not until 1921 that an American doctor, John Sampson, first gave an accurate description of the disease and named it endometriosis.

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