Directory of health resources for healthcare professionals.

We are all ridden with various anxieties and tensions of differing degree. These may be likened to a pot of simmering soup which may quite easily boil over; such ‘boiling over’ may result in various skin disorders. It is therefore essential that we develop or improve our faculties for reducing these tensions or anxieties, so that we may live within the capabilities of our own particular skin. Those of us who have problems with the skin will have noticed how the condition of our skin is rather like a barometer, signifying very clearly how calm or otherwise our internal milieu is.

However an individual with anxiety or tension symptoms may have a skin disorder that is unrelated to his stresses. Moreover, some disorders may occur more frequently in neurotic people yet not be caused by their neurosis, just as atopic eczema occurs in people with a tendency for allergies although eczema is rarely allergic. Likewise the flaring up of a skin lesion following an emotional upset is not necessarily proof of psychogenic origin. Psychic factors often ‘trigger’ an eruption which can be easily misinterpreted as a psychogenic disease. For instance, an attack of herpes simplex may be precipitated by emotion, but it is not psychogenic—rather the causative factor is a virus.

The reverse of this situation is the crediting of a therapeutic result to some physical therapy—such as creams, tablets, X-rays etc.—when in reality unrecognized psychological components in the therapy are responsible. When one doctor gets good results by dietary means, another by allergic management, another by eradicating foci of infection, and when the practitioner of one school is unable to repeat the results of the other, there is a strong liklihood that the factor common to all is psychological. Large doses of the doctor himself are often the curative agent.

On the surface the doctor-patient relationship is one in which a sick person requests help from an individual trained in medical science. There is however an emotional substratum, often not recognized by either party, having to do with one of the oldest relationships in human life: that between parent and child. Even in these sophisticated and perhaps sceptical days, the patient unconsciously fits the doctor into the prototype of the wise, omnipotent, loving, giving, parent, and much of the benefit of any type of treatment derives from this transference. It must, however, be remembered that many general physicians and specialists are extremely stress-ridden themselves— indicated by frequency of heart attacks, suicide etc.—and this may be one of the reasons many of their patients are turning to less conventional methods of stress relief.

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

Popcorn (G.I. of 55) • A surprisingly low G.I. for a processed product The type of starch or changes to its structure in the popping and cooling of the popcorn may be the cause of the lower G.I. Popcorn is a high fibre snack food.

Porridge • Published G.I. factors range from a low 42 up to 66 for ‘one minute oats’. The additional catting of rolled oats to produce quick cooking oats probably increases the rate of digestion causing a higher G.I.

Pumpernickel bread (G.I. of 41) • Also known as rye kernel bread because the dough it is made from contains 80 to 90 per cent whole rye kernels. It has a strong flavour and is usually sold thinly sliced. Because it is not made with fine flour, its G.I. is much lower than ordinary bread. Available in supermarkets and delicatessens.

Quick-cooking wheat (G.I. of 54) • Whole wheat grains which have been physically treated to allow short cooking times, it Is most often used as a substitute for rice. The whole grain structure also acts as a barrier and so reduces its digestibility and hence lowers the G.I.

Rice bran (G.I. of 19) • Rich in fibre (25 per cent by weight) and oil (20 per cent by weight), rice bran has an extremely low G.I. It is available in the cereal section of supermarkets as Sunfarm Rice Bran from Sunrice Australia.

Spaghetti (G.I. of 41) • While both fresh and dried pastas have a low G.I. this is not the case for canned spaghetti. Canned spaghetti is generally made from flour rather than high protein semolina and is very well cooked—two factors which are likely to give it a high G.I.

Sultanas (G.I. of 56) • Sultanas are less acidic than grapes and this may account for their slightly higher G.I. since increased acidity is associated with lower G.I. factors.

Sweet corn (G.I. of 55) • Raw, fresh, frozen or canned varieties would be suitable to use. Corn on the cob has a lower G.I. than com chips or cornflakes. The intact whole kernel makes enzymic attack more difficult.

Sweet potato (G.I. of 54) • Belonging to a different plant family to regular potato, sweet potatoes are mainly available either white or yellow/orange in colour. The ‘sweetness’ comes from a high sucrose content. Sweet potato is high in fibre. It has a lower G.I. than regular potato varieties.

Vinegar (G.I. = 0) • All types of vinegars, even in small amounts (1 tablespoon) contain adds which put a break on stomach emptying and slow down digestion in the small intestine. The most effective appear to be red and white wine vinegars.

Yoghurt (G.I. of 33) • A concentrated milk product, soured by the use of specific bacteria. All varieties have a low G.I. including those containing sugar. Artificially sweetened brands have both a lower G.I. factor and contain fewer kilojoules.

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All of the effects of the influencing and moderating factors on body fat stores are mediated through the final common pathway of food, or energy expenditure. In particular, the intake of energy through dietary fat, and the utilisation of fat as energy through physical activity are now known to be the major influences on fat stores. However, as we have stressed the importance of fat in determining total energy, we now concentrate more on the two components of the energy balance equation as fat/energy intake (F/EI), and/or fat/energy expenditure (F/EE).

The most appropriate aspects of physical activity, which is the major modifiable component of EE for fat loss. The important point is the change in thinking about the components of energy

balance from energy intake, to fat intake, and from energy expenditure to fat utilization.

The implications of this on the energy intake side, are that it is much more realistic to aim for a change in the quality of the diet (reducing the fat-carbohydrate ratio) than by asking people to eat less. On the energy expenditure side, the approach places a much greater emphasis on ‘physical activity’, in contrast to ‘exercise’ for fat loss, and is in line with recent research which supports the use of lower duration, moderate intensity activity to achieve metabolic fitness and promote fat loss. It redirects priorities for fat loss and obesity reduction away from a physical fitness orientation towards a strategy based on increasing low-moderate intensity activity (such as walking and ‘incidental’ exercise).

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Helen’s story

After seven months on Duphaston I returned to my doctor and told her how miserable I felt and that I wanted to try some of the alternative treatments. She suggested laser surgery and referred me to a surgeon experienced in the procedure.

I was a little apprehensive after my interview with this surgeon for he rather casually mentioned dividing the utero-sacral ligament as a way of relieving pain. My initial reaction was distrust as I imagined that the uterus would be unsupported. However this isn’t so and he carefully described the procedure explaining that as there were a lot of nerve fibres in the ligament it would give me relief from the pain experienced every time the uterus contracted.

I went home and looked up all the books and articles I owned. I telephoned the Endometriosis Association and received all their latest information as well as the opinions of a few professionals. I then spent a day in the Health Department Library but didn’t find much material. It appeared that there was very little information available because very few surgeons were doing the procedure here in Australia. I hoped that maybe zapping off my spots of endometriosis was all that was necessary to relieve the pain.

I recontacted my original doctor and told her of my concerns and asked her to speak to the surgeon. She relayed the message that he would be conservative but couldn’t really be sure of the best treatment until the laparoscopy. This made sense to me and I decided to trust them.

I awoke from the anaesthetic to hear the good news that all the endometriosis seen had been removed with the argon laser and that one of my utero-sacral ligaments had been cut (a utero-sacral neurectomy). I would not need to follow this surgery up with drug treatment.

Two menstrual cycles were pain free. It is hard to describe the feeling of liberation when you realise that the quality of life you had previously experienced was so compromised.

I hasten to add that I am quite realistic about the nature of endometriosis and know this current euphoria can only be guaranteed for twelve months. But as I am only experiencing a slightly rotten day on the second day of my cycle it all seems worth it. Most importantly I am getting on with my life.

Cathy’s story

One of the most difficult decisions of my life was deciding whether or not to have a hysterectomy. I had been seeing a gynaecologist who was treating me with Duphaston which wasn’t working. I was in severe pain, had no control of my bladder and I had bowel problems. He seemed to think there was not much wrong with me. He had performed a laparotomy on me seven months previously and diagnosed and cleaned up mild endometriosis. He was now suggesting that my only option was Danazol — mainly, to calm me down, I think, as he didn’t feel the endometriosis could have grown back so quickly.

I felt upset and humiliated by his attitude towards me and I felt there must be other alternatives. I knew I was in trouble — I was living on Panadeine Forte every day. Sometimes I couldn’t pass urine and other times I couldn’t retain it. The pain became so severe I couldn’t even drive a car. My family was suffering terribly with me also — I was always irritable and unable to function. Taking Danazol as was suggested worried me as I have a severe allergy condition to the extent that my husband and I had to build a new chemical free house in the hills. I had suffered bad side effects with both Provera and Duphaston.

I decided to get a second opinion a month later. The next gynaecologist said that the disease can grow back quickly and be very aggressive. He said that laser therapy via a laparoscope can control the endometriosis if it was mild and perhaps no drugs would be needed. However, when he gave me a gentle examination he thought he could feel a large cyst and sent me off for an ultrasound which showed a large cyst of four centimetres plus.

I now had to have another laparotomy and lose the right ovary. Drugs would not work on an endometrioma of that size. As I was 37 years old and had two children and didn’t want any more, he suggested I think about having a hysterectomy as my side effects were so severe — by this stage I was also bleeding from the rectum. After two months of agony, both physical and mental (my husband listened patiently for hours and supported me — I felt a failure for needing a hysterectomy), I decided I wanted my life back. I could no longer function — I had given up my work, my study and my social life. I was trapped by endometriosis in all my waking hours and sometimes in my sleep — it never left my thoughts.

So, in July 1990,1 had a hysterectomy during which a bowel surgeon was also present and needed. My right ovary was stuck to the uterus and was enlarged to the size of a tennis ball with endometriosis. There were also other cysts and spots of endometriosis. As I had agreed to a hysterectomy, the surgeon was able to remove the ovary and cyst with the uterus, without spilling the contents of the cyst.

Since the operation I have been feeling significantly better and pain free. I can now enjoy my life again, my husband, my children, study and work. My sex life has also improved remarkably. I never knew one could have intercourse without pain — it is now a wonderful experience for me. I honestly believe I made the right decision to follow my instincts and seek a second opinion. My pain and my disease were very real and very debilitating.

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Endometriosis is the second most common gynaecological condition affecting women in their menstruating years and it is responsible for up to one-quarter of all the abdominal surgery performed by gynaecologists. It is also one of the leading causes of infertility in women over the age of 2 5 and it is thought to affect approximately 30% to 40% of infertile women. It is impossible to determine how common endometriosis is because some women do not have any symptoms and many women with the condition are undiagnosed. Gynaecologists believe that endometriosis probably affects approximately 10% to 15% of women at some stage during their menstruating years.

How does endometriosis develop-The full story of how endometriosis develops is not yet known. However, there are four main theories. Each theory explains how some, but not all, cases develop and it is likely that there is not one single cause of endometriosis, but rather a number.

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