SCIENTIFIC THINKING ABOUT WEIGHT CONTROL

May 8th, 2009

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 OF ENDOMETRIOSIS

May 8th, 2009

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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WHAT IS ENDOMETRIOSIS: HOW LONG HAS ENDOMETRIOSIS EXISTED

May 8th, 2009

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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SORE THROAT AND TONSILLITIS

April 29th, 2009

Most common in children, the often acute inflammation of the tonsil tissue at the very back of the mouth is caused by either streptococcus bacteria or viral infections. Like the lymph glands, tonsils are designed to destroy germs but, if overwhelmed, they will themselves become infected.

In an attack of tonsillitis, the throat may become so swollen, that the patient will have difficulty swallowing. In extreme cases, breathing can be obstructed and, if distress of this kind is evident, you should seek professional advice immediately. Fever, headache, vomiting and a cough commonly accompany the swelling of the tonsils.

Normally the acute symptoms last just a couple of days. Gargle a mixture of sage, thyme or myrrh, drink plenty of fluids and take garlic capsules to fight the infection. A tonic containing golden seal will help to reduce the inflammation of the membranes in the throat and a tincture of golden seal can be sprayed directly on the glands. Avoid mucous rich foods such as dairy foods and, if eating is difficult, take fruit and vegetable juices until the worst symptoms have eased.

Recurrent tonsillitis can indicate poor nutrition or reduced immunity. Boost your intake of Vitamins B and C and zinc.

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ST JOHN’S WORT IN THE ELDERLY

April 29th, 2009

Anti-depressant effects of hypericum have been confirmed in several clinical studies that have compared this compound to placebo as well as to standard anti-depressants … One of the most important features is that side-effects occur rarely. This benign side-effect profile may make hypericum a particularly attractive choice for treating mild-to-moderate depression in our elderly patients.

Michael Jenike, MD, editor,

Journal of Geriatric Psychiatry and Neurology, 1994

One result of the success of modern medicine in conquering the diseases of childhood and middle life is the ageing of our population and the progressive increase in those of us who can be regarded as elderly, regardless of how we define that term. Depression is very common among the elderly and major depression has been estimated to affect approximately one in seven individuals over age 65 in community settings, and as many as one in four individuals in nursing homes. An index of the severity of this problem is the fact that the highest suicide rates occur among our elderly citizens. The elderly have many reasons to be depressed, including physical ailments, isolation from family, the loss of friends, and financial difficulties, to name just a few. This leads to the common misconception even among healthcare workers that depression may be a natural and justifiable response to an elderly person’s life circumstances. Regardless of how adverse a person’s life circumstances may be, wherever depression is encountered, including among the elderly, it is certainly worth treating. This will often result in a markedly improved quality of life even though it will not necessarily change the realistic basis for a person’s sorrows.

Because St John’s Wort has only recently come to the attention of clinicians, doctors have very little experience with its use in older patients with depression. Yet, as Michael Jenike points out in the editorial quoted above, St John’s Wort would seem like a very reasonable anti-depressant for those elderly patients who are depressed. As our population ages, medications that are suited to older people will surely become increasingly important and, considering the widespread prevalence of depression in the elderly, it is a particular blessing that Nature’s own apothecary appears to have yielded so excellent a remedy for this group of people in the form of St John’s Wort.

Perhaps the person with the most experience in treating elderly patients with St John’s Wort is Dr Hans-Peter Volz, Chief of the Department of Psychiatry in Jena, Germany. He estimates that he has treated approximately 70 depressed patients over age 65 with St John’s Wort in dosages of up to 900 mg per day. He is comfortable with recommending it as a first-line treatment in mildly depressed elderly patients, though he is still inclined to use conventional anti-depressants for those who are moderately or severely depressed. He acknowledges, however, that his practice of not using St John’s Wort as a first-line treatment in more seriously depressed cases is not based on any direct experience of its ineffectiveness for such people, but rather on the absence of sufficient controlled study data on St John’s Wort in severely affected individuals.

Volz reports excellent anti-depressant effects in the elderly people he has treated with St John’s Wort, with very few side-effects. In addition, he has noted no adverse interactions between St John’s Wort and the many drugs that elderly people often need to take for ailments accumulated over a lifetime. He emphasizes the need to wait six to eight weeks before passing judgement as to whether the herbal remedy is working or not. Here are two cases from Professor Volz’s clinical files.

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CASE STUDY: BRAIN-FAG WITH HEADACHE AND RHINITIS

April 28th, 2009

Joseph Robinson was a businessman in his forties, whose position in his company was threatened by increasing ill health. He traced the onset of his sickness to a tonsillectomy. Soon after this operation, persistent nasal stuffiness and a postnasal drip developed, which did not respond to any medication.

A busy person, Robinson paid little attention to these symptoms. A few years later, he began to get headaches in the front of his forehead. These usually came on an hour or two after the evening meal and persisted for the evening. They were often accompanied by bouts of fatigue, “laziness,” and mental exhaustion, which kept him pinned to the living-room couch, unable to move.

At first these problems were restricted to the evening hours and were easily attributed to the difficulty and tension of Robinson’s job. Soon, however, the fatigue and mental exhaustion began to creep into his daytime hours as well. He would start to go home early, or rest his head on the desk when he was supposed to be working. His job was in jeopardy when he was first examined for ecologic illness.

A variety of the foods which he ate most commonly, including wheat, milk, eggs, coffee, citrus fruit, legumes, chocolates, various meats, and nuts were eliminated for a week or so. To his amazement, he felt much better, experiencing far less fatigue and no headaches. One by one, these foods were returned to his diet. All of them were tolerated with no return of symptoms except for beef and milk (which are closely related). On the third day of eating beef products, he developed a severe headache which lasted ten hours. He developed a headache half an hour after eating his fourth milk-containing meal. Chocolate also made him feel tired.

With the complete avoidance of beef, milk, and chocolate, all of his symptoms of fatigue, headache, and brain-fag disappeared. As a final test, one month later, he treated himself to a glass of milk. A sharp headache rapidly developed. After about six months, however, he regained tolerance for milk, beef, and their by-products. He was then able to reintroduce them into his diet, provided that he did not have any of them more often than once every four days. He had successfully solved the problem that was ruining his career. In fact, his position in the company improved, and he gained a promotion.

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THE BASIC CONCEPTS OF ALLERGIES: CASE OF CHEMICAL SUSCEPTIBILITY (WEED KILLERS)

April 28th, 2009

In June, 1972, the Johnson family lay sleeping in their rustic house, built alongside a brook in a Western state. At around 6:30 a.m., without prior warning, a helicopter came in low over their rooftop and began discharging a heavy white fog along the power company’s right-of-way, which adjoined the house. Four times it swooped down to release a toxic plume of herbicide, in order to kill all vegetation growing beneath the high steel towers of the company.

Although the wind was only three miles per hour that morning, the powerful downdraft of the helicopter’s blades propelled the chemicals in the direction of the sleeping household.

Awakened by the sound of the chopper, Mr. Johnson aroused the family, whose members gulped down a hasty breakfast and left the house. As soon as they emerged from the door, however, they were enveloped in a cloud of Tordon 100, a herbicide which contains Pictoran and 2,4-D.

The worst affected was Johnson’s teenage daughter, Lydia. She felt nauseated and dizzy and had persistent headaches for weeks following this incident. Her eyes were dry, with a burning sensation, and she suffered from shortness of breath and coughing, even when the family moved to Johnson’s mother’s house, miles away. Many bizarre symptoms followed this exposure. All that summer the children were tired almost all the time and slept for long hours at a stretch, although they were normally active and energetic. In September, they returned to their home for the first time since the spraying.

The helicopter had left a wide swath of destruction in its path. From the powerlines, over and past their house, and up the hill behind them, the vegetation and plants were either dead, dying, or deformed. A beautiful fig tree which had stood in their yard was leafless and barren.

Not long after this, Johnson was hospitalized with a mysterious “lung problem.” By June of the next year, Lydia’s eyes no longer focussed properly, and she could not take final exams. Her lips were swollen, and her eyelids were sometimes so enlarged that she could not see out of them. Doctors at a local hospital refused to treat her, however, claiming that her problems were all “psychosomatic” and “hysterical.”

By December, 1973, Lydia had trouble walking. She could not maintain her balance and moved in a wobbly fashion, like a drunkard. She had to support herself by hanging onto furniture or clinging to the balustrade when she walked downstairs. Her local general practitioner referred her to a neurologist, who suggested that she was “trying to get attention” by feigning symptoms. He prescribed tranquilizers. Although not particularly susceptible to chemicals before being “abated,” Lydia now became susceptible to many substances, including tobacco smoke, perfumes, deodorants, motor exhausts, gasoline, and so forth. Although her worst symptoms decreased with time, she contracted severe headaches and difficulty in breathing whenever exposed to various chemicals. When she was tested in my hospital Ecology Unit, she was found to have allergies to wheat, corn, and a number of other foods. More dramatic, however, were her reactions to chemicals commonly encountered in daily life. After having avoided chemical exposure for many days, she was given a feeding of commercial apples, a food which she tolerated in their unsprayed form. The first feeding was followed by repeated clearing of the throat, coughing, and dizziness on sudden change of position. The second feeding of commercial tomato and tomato juice was followed by a sensation of burning in her mouth. A third meal of commercially canned chicken was followed by a headache at ten minutes, which rapidly increased in intensity and was soon accompanied by canker sores in the mouth, aching joints, aching leg muscles, and insomnia that night.

A feeding of commercially canned cherries brought on aching legs, while commercial lettuce caused a stomachache and shaking, quivering, and depression. These symptoms became severe about an hour and a half later, and she also cried and sobbed.

Finally, commercial frozen cauliflower brought on severe depression and crying after fifteen minutes, as well as residual shaking and numbness of the lower limbs on the following morning. It is noteworthy that this numbness was identical in feeling to that which followed the original spraying incident, although it was less severe than that experienced in 1972.

Despite the undemonstrable theories of her neurologists, Lydia Johnson was suffering from the chemical-susceptibility problem, brought on in her case by a massive exposure to herbicide months before. This initial exposure was maintained, albeit at a lower level, by daily exposure to common environmental chemicals, such as residues found in commercial food.

Air pollution from herbicides is becoming more common. Because of the use of similar defoliants during the Vietnam War, some of these effects are becoming better known. One of the chemicals to which Lydia Johnson was exposed, 2,4-D, is also an ingredient in the now infamous Agent Orange. Reports of Vietnam veterans sound remarkably like the symptoms reported by Lydia Johnson. According to one report on such veterans, published in the New York Times:

They say it is a poison that fell from the sky, a herbicide that was supposed to kill only unwanted plants. Instead, they insist, it has made them sick and changed their lives, and even though many years have passed since their exposure to it, they fear it still. They fear it has started processes within them that will make them sick again and perhaps kill them. No more eloquent—and frightening—condemnation could be made of the virtually unrestrained chemical contamination of our environment.

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MORE ABOUT FREQUENT ILLNESSES IN CHILDREN

April 28th, 2009

Signs and symptoms

The first step is to decide whether a child is actually ill more often than most other children. Some reports show that the average, normal child between one and 12 years of age may have as many as eight illnesses per year. Other figures show that a first child will seldom be ill during the first year; then the child will have increasingly frequent sicknesses as he or she begins to play with other children and attend school. An infant with older brothers or sisters will be sick the first year as often as the other children are. To decide if your child is ill too frequently, compare the number and seriousness of the illnesses with those of the child’s brothers, sisters, and friends.

Home care

How much your child is exposed to illnesses depends somewhat on you and your circumstances. Over-protectiveness and isolation from other children can lead to emotional problems that could be harder to treat than physical problems. On the other hand, overexposure to other children who may be ill can lead to almost constant minor illnesses, especially in very young children. Keep older children who are ill – yours and the neighbor’s-away from infants. Isolate any ill child from your other children as much as is practical.

Precautions

• Frequent illnesses that could interfere with normal growth must be investigated. If the child stops gaining height or weight or begins to lose weight, see your doctor.

• Repeated pneumonia in the same part of a lung must be evaluated by your doctor.

• Frequent lower respiratory infections with a prolonged cough can be a sign of cystic fibrosis or asthma.

Medical treatment

Your doctor will help you decide whether your child is ill more often than others of the same age and under similar circumstances. If so, your doctor will seek the cause through a variety of tests. These tests may include a sweat test, measurement of immune globulins, blood count, sedimentation rate, chest X ray, sinus X rays, nose and throat cultures, and allergy tests. You and your child may be referred to an ear, nose, and throat specialist, to an allergist, or to a medical center for thorough investigation of all immune mechanisms.

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CHOLESTEROL: NEUROPATHY AS A POTENTIAL SIDE EFFECT OF STATIN DRUGS

April 23rd, 2009

Statins can cause nerve damage resulting in symptoms such as tingling, pain, numbness and weakness in the hands and feet. Some people even experience difficulty walking because of this. Researchers studied 500, 000 residents of Denmark and found that taking statins for one year raised the risk of nerve damage by 15 percent. People who took statins for two or more years were 26 percent more likely to get nerve damage. Cholesterol is a major component of the myelin sheath, which insulates our nerves and facilitates nerve transmissions.

Anne in NSW had been taking 40mg of Lipex (simvastatin) for 18 months before she noticed any side effects. Her cholesterol had been 6.3mmol/L and she couldn’t get it down any lower with diet and exercise, so her doctor decided to put her on Lipex. The fact that Anne is a type 2 diabetic made her an even more suitable candidate for statin therapy according to her doctor. Anne has got a fatty liver, and her liver enzymes were elevated even before she started taking Lipex, yet her doctor still recommended she take it. Anne suffers with high blood pressure and takes Avapro 300, and has an under active thyroid, and takes Oroxine for this.

The first unusual symptoms Anne noticed were a feeling of nausea and what she described as “dead legs”; her legs felt extremely weak and heavy. She started sweating, developed pins and needles and felt overpoweringly ill. Anne assumed that she had come down with a virus.

A week later her legs became even weaker and she noticed that her arms were trembling. The nerves in her arms and legs tingled and she felt like she was on the verge of suffering an anxiety attack, even though she had never experienced that before. Anne commented that her hands trembled as though she had Parkinson’s disease.

Anne accidentally forgot to take Lipex for the next few days and started feeling better. She resumed the drug and the next morning felt incredibly weak, was trembling, shaking and sweating. The next thing she noticed, she could hardly stand. That was when Anne was taken to hospital. She underwent numerous tests which came up with nothing specific. Anne did not have an infection and her liver enzymes were still raised as previously. She was taken off Lipex, and then resumed it one last time, only to have all these symptoms return. Her doctors concluded that the only possible explanation for all of these symptoms was an adverse reaction to Lipex.

Anne was permanently taken off Lipex and the dose of her blood pressure tablet was reduced. It has now been one month since Anne discontinued Lipex, and she is slowly getting better. She used to walk 20 kilometers each week for exercise but cannot manage anything near this now; even going shopping is a strain on her legs. Anne still notices the occasional tremors in her hands.

The information leaflet inside a box of Lipex recommends it be used in people with diabetes, a history of stroke, or other blood vessel disease, regardless of their cholesterol level, in order to prolong their life. It is recommended that you do not take Lipex if you have a liver disease; Anne had a fatty liver yet she was still prescribed this medication. Paraesthesia is listed as a possible side effect of Lipex, this is a nervous system disorder whereby people experience burning, prickling or stinging sensations. Anne experienced an extreme case of an adverse drug reaction. She has now been placed on an appropriate eating plan with nutritional supplements, and day by day she is slowly recovering her health.

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INFECTIONS AFFECTING BOTH MALE AND FEMALE FERTILITY

April 23rd, 2009

Many people don’t realize there are a number of infections that can damage fertility. Some can cause infertility in both men and women, some can stop the embryo implanting once fertilisation has taken place, and some can cause miscarriages.

In men, infections in the seminal vesicles or the prostate gland can affect the sperm in several ways. Pus cells will reduce the sperm’s swimming ability and certain infections may kill off the sperm. Some infections can cause blockages in the male reproductive system, stopping the effective transport of the sperm. Cytomegalovirus (CMV), which is caused by a herpes virus, has been linked with low sperm count and inflammation of the testes.

Chlamydia

Chlamydia may sound like an exotic flower but it is actually a sexually transmitted bacteria which can lead to infertility in women without causing any symptoms. It is effectively an infertility time-bomb, which is claiming growing numbers of victims (particularly teenage girls). The Royal College of Physicians’ Committee on Genito-urinary Medicine estimates that it is the most common sexually transmitted disease in our society.

A number of countries, such as Sweden, routinely screen for chlamydia trachomatis and the fall in the number of clilamydia cases there has been dramatic. But there is no routine screening in the UK. It is known as the ’silent illness’ because only a small number of women experience actual symptoms such as a discharge. Men can also get chlamydia. They feel a burning sensation on passing urine. If men do not get the symptoms investigated then they will infect their partners, and possibly damage their own fertility.

In a woman the chlamydia bacteria can lie dormant for many months before passing through the cervix, and from there unnoticed into the womb and up the fallopian tubes where it causes the majority of pelvic inflammatory diseases (PID). If untreated, it can damage the fallopian tubes, resulting in blocked or scarred tubes which can mean infertility or increased risk of an ectopic pregnancy (where the fertilised egg implants into the fallopian tube instead of in the womb). In men it can cause inflammation of the testes and the tubes surrounding the testes.

Women can be screened for chlamydia with a cervical swab and/or a urine test and men can have a urine test. If caught early it can be treated successfully with antibiotics.

Mycoplasma and Ureaplasma

Mycoplasma hominis and Ureaplasma urealyticum are very common organisms that can infect the genito-urinary tracts of men and women. These organisms don’t always cause infertility, but:

• According to a study in the 1970s, there seems to be a higher frequency of these organisms in the ejaculates and cervical secretions of couples with unexplained infertility problems. And when the couples were treated, pregnancy rates increased.

• In men, this type of infection can decrease the sperm count, reduce motility and increase the number of abnormal sperm.

• These organisms have also been linked with an increased risk of miscarriage.

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