Directory of health resources for healthcare professionals.

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).

*79\186\4*

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.

*69\83\2*

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.

*10\83\2*

A sprain is the tearing of the ligaments, fibrous structures which support the joints. The most common sprains occur on the limbs, such as sprained ankles, wrists and thumbs, but can affect almost any joint if the ligaments are suddenly or excessively stretched beyond the normal range of movement. ‘Whiplash’, for example is the spraining of the ligaments between the vertabrae of the neck. The joint will swell and often bruise and will be extremely painful.

Initially, sprains should be treated much the same way as bruises. Much of the pain of sprains arises from the swelling and the bleeding in the tissues. Immediately apply ice to the area and elevate the affected limb. Rest as much as possible. Apply arnica as a cream or tincture, or a compress of either arnica or comfrey root, directly on the swelling. Under medical supervision only, arnica can be taken in tablet form to help limit the bruising and Vitamin C and the herb horsetail aid the healing of muscle tissue. Initially, the joint may be strapped firmly to provide support, limit swelling and ease the pain. Soon, however, gentle massage and movement is required to prevent the ligament tissues shortening and tightening as they heal. To begin with, a physiotherapist will only stroke the affected area firmly, progressing to deeper tissue massage with fingers and thumbs only when the injury is healing. Hydrotherapy can also help the patient maintain movement and build up strength in the joint. Note that sprains take longer to heal than fractures do, up to six or eight weeks, and that a joint which has been sprained may be permanently weakened and more prone to dislocation, requiring special care and strapping with elastic bandage when exercising.

Rather than arising from one single over extension of the joints, strains result from the overuse of muscles, through careless exercise or even because of poor work practices. Strained muscles can result in temporary discomfort or the development of more serious nerve and muscle conditions.

*57\69\2*

When Greta, a 69-year-old woman referred to Professor Volz by her GP, was asked what was troubling her, depression was the furthest condition from her mind. Instead she complained of many physical ailments – headache, stomach ache, tiredness and an unpleasant taste in her mouth. Her GP had been unable to find any physical explanation for these symptoms and the only abnormality he could detect was a slight problem with cardiac conduction, as measured by EKG. She had complained of sleep difficulties, for which she had been treated with sleeping pills with some success.

When Dr Volz questioned her, it became apparent that her difficulties had begun about two years before, shortly after her husband died unexpectedly of a heart attack. Despite having enough money and a close relationship with her son, who lived in the same town and visited her twice a week, Greta complained of sadness and hopelessness but, she hastened to add, ‘only when I am alone’. Dr Volz tried to explain to her that her symptoms might be due to depression, but she vehemently objected to such an explanation. When he suggested that she might benefit from a drug such as Prozac, she refused to take any synthetic antidepressants, insisting ‘that’s all chemical stuff.’ After two further visits with Dr Volz, he suggested that she might try St John’s Wort. To his astonishment, she immediately agreed to take this because ‘herbs are not dangerous.’

Dr Volz started Greta on St John’s Wort at a dosage of 900 mg per day. He noticed no improvement until she had been on the herbal remedy for six weeks, and it took another 10 weeks before Greta’s symptoms were reduced to a significant degree. Greta remains convinced that the improvement she has enjoyed on St John’s Wort has nothing to do with relief from depression but rather to ‘non-specific’ effects of the herb. Dr Volz feels no need to challenge this belief. She is no longer depressed and her mood has been stable without any adverse effects whatsoever – reward enough for a caring doctor.

*32\75\2*

One characteristic of the brain-fag problem is an acute loss of memory. Norma Tolliver came to me for this problem. A year earlier, she had been pursuing a promising career as a buyer for a large manufacturing concern. Her forte was her outstanding memory. She knew the sizes, colors, weights, and other specifications of the company’s products, as well as the names and phone numbers of the shipping lines, manufacturers, and other colleagues by heart. Her employers called her the “walking encyclopedia” and relied upon her to have information at the tips of her fingers.

She never failed to supply the information they sought. Then, without warning, her memory began to fade. A succession of doctors analyzed her problem as psychological in origin and offered a number of imaginative explanations. Tolliver tried desperately to hold onto her position, surrounding herself with thick notebooks filled with data of all sorts. This was a transparent device, and her employers became disillusioned, suspecting her of having tricked them all along. Eventually, she was fired.

Testing in a hospital setting revealed serious susceptibility to corn and wheat. Ingestion of these two foods had led to mental cloudiness, memory impairment, and other signs of brain-fag.

Her reaction to the oat test was most dramatic, however. This was her last food test in the hospital, made necessary by the fact (initially overlooked) that she ate oats in some form almost every day: oatmeal porridge, oatmeal cookies, and so forth. After twenty minutes, the test seemed to be negative, and I left the hospital. Miss Tolliver, however, went into a severe reaction to the oats, as was revealed when a nurse’s assistant came into her room and made an innocent comment. Miss Tolliver misinterpreted the comment and became very annoyed; she insisted that the nurse apologize and angrily started calling all over the hospital, demanding to be discharged and cursing out the administrators. It was only in retrospect that she realized that her reaction was, indeed, a cerebral reaction to a common food eaten with addictive regularity—the oats. In fact, this sort of violent moodiness was familiar to her from previous reactions. Avoidance of her incriminated foods, particularly the three grains mentioned, led to an increase in her mental acuity. She eventually found and kept another job.

When brain-fag was first diagnosed, it was believed that food allergy was the sole cause. After 1950, clinical ecologists became aware of the importance of the chemical environment to health. Cases began to be seen which were primarily caused by exposure to common environmental chemicals.

*83\110\2*

In the preceding section, the basic concepts of food and chemical susceptibility were presented. In this section, we shall examine how such reactions actually affect patients with a variety of illnesses which are rarely helped by conventional medicine.

The chapters in this section are rather arbitrarily organized around particular diseases. This is, of course, the way conventional medicine, and most patients, think of their ailments. In actuality, however, most susceptible patients have a constellation of diseases, with few clear-cut distinctions between them. The headache patient, if questioned, may turn out to have many localized problems, on the one hand, and a tendency toward depression on the other. Or he may vacillate between periods of exuberance and energy and subsequent “hangovers.”

It is the orthodox, overly analytical medical system which insists on pigeonholing patients into disease categories, and, particularly, separating physical from “mental” or “emotional” problems. Whatever the practical benefits of such a scheme, it fails to describe these various complaints as part of an overall continuum of ill-health in the life of each individual patient.

What is meant by “headache” or “arthritis” below, then, is a stage of illness in which arthritis or headache is the principal, but rarely the sole, complaint. These levels of reaction were first described in 1956.1

The bulk of the cases presented here fall either into the plus-two, the minus-two, or the minus-three categories. In other words, they are intermediate between the least and the most extreme cases of both stimulation and withdrawal. The reasons for my emphasis on these conditions are as follows.

*53\110\2*

Funnel chest is a condition in which the breastbone is depressed or sunken in. The breastbone (sternum) connects the front end of the ribs. The diaphragm (a band of muscle separating the chest and abdominal cavities) attaches in front to the lower ribs and to the bottom of the breastbone. In children, the ribs are made of tough elastic tissue called cartilage; this cartilage gradually hardens into bone as the child grows. Since cartilage is not as strong as bone, the ribs of a baby are delicate, but the diaphragm is relatively strong. When some babies breathe in, the diaphragm pulls in the lower half of the breastbone, causing a hollow in the center of the chest. This hollow is exaggerated when the child makes a greater effort to breathe, as with bronchitis, pneumonia, and choking. This condition, called retracting, is a sign of breathing difficulty. If retracting occurs only when the child has difficulty breathing, it is not considered to be a true funnel chest.

A true funnel chest exists if the breastbone is depressed when the child breathes out, even while the child is at rest and is having no difficulty breathing. If mild or moderate, a funnel chest will cause no harm and will gradually correct itself over the years as the child’s ribs grow heavier and stronger. If funnel chest is severe, it may not correct itself and may interfere with breathing. Rarely is it severe enough to affect the position or functioning of the heart.

Signs and symptoms

A funnel chest can be seen by observing the chest of a well child. The breastbone appears to be sunken in, forming a hollow in the center of the chest. If this hollow appears whenever the child breathes out, this may be a sign of true funnel chest.

If a child has not previously shown signs of a funnel chest, retractions of the lower breastbone are an important sign of breathing difficulty.

Home care

A fixed deformity (true funnel chest) cannot be treated at home. Bring it to the attention of your doctor.

If retractions of the breastbone begin in a child with no earlier signs of funnel chest, look for other signs of breathing difficulty. Then treat the disease that is causing the breathing problems.

Precautions

• Don’t be alarmed by persistent mild to moderate depression of the breastbone in an infant or young child.

• Do not restrict your child’s activities.

Medical treatment

The doctor will determine if the child has a true funnel chest or if the child is having temporary difficulty breathing. In marked cases of funnel chest, the severity and effect on heart and lungs is judged by X ray and other test results.

If funnel chest is severe and persists without gradual improvement, the condition may require surgery. Surgery may be performed if there are signs of limited heart or lung function or for cosmetic reasons. Your doctor may order X rays, an electrocardiogram, and measurements of the lung capacity.

*78/84/5*

Cancer: In every study done on rodents, statins have caused cancer. A review published in the Journal of the American Medical Association states that “All members of the two most popular classes of lipid-lowering drugs (the fibrates and the statins) cause cancer in rodents, in some cases at levels of animal exposure close to those prescribed to humans.” Studies done on humans have not produced such dramatic results because cancer is a disease that takes a long time to develop, and most clinical trials done on statins have not gone on for more than two or three years. This same study made the following final statement: “the results of experiments in animals and humans suggest that lipid-lowering drug treatment, especially with the fibrates and statins, should be avoided except in patients at high short-term risk of coronary heart disease.” These studies have been conveniently forgotten, because millions of patients around the world are being put on cholesterol lowering drugs even if they have very few risk factors. Statins are also a drug that must be taken for life. One study done on humans, called the CARE trial found that breast cancer rates in those taking statins went up 1500 percent. Statins may get your cholesterol down, but at what price?

Heart Failure: The world has experienced an enormous increase in the incidence of congestive heart failure. The incidence of heart attacks has gone down slightly, but heart failure rates are going up. In Australia there are approximately 300 000 people currently living with heart failure, with 30 000 people being newly diagnosed each year. Congestive heart failure occurs when the heart becomes weaker and cannot pump blood around the body as well as it should. Over time the heart becomes enlarged, thickened, and continues to get weaker. It becomes much less efficient at pumping blood.

Statins deplete the body of Co Enzyme Q10; the heart is a muscle, and heavily relies on Co Q 10 for energy. Without Co Q10, the mitochondria in the cells making up the heart cannot produce enough energy, leading to muscle weakness. The higher your dose of statins, and the longer you take them, the more likely you are to end up with heart failure. Ironically, virtually all patients with heart failure are placed on statins, supposedly to protect them against heart attacks, even if their cholesterol is normal.

*23/53/5*

Vaginal spermicides (foams, jellies, creams, film)

These substances kill sperms on their way to meet an egg and must be put into the vagina before intercourse. They are unsafe as a sole method of contraception and should be used along with a sheath or a diaphragm. Follow the instructions for the brand you intend to use. Most are active for only 1-3 hours.

Advantages

• Easy to use.

• Can be bought without a prescription.

• Work well if used together with a barrier method.

Disadvantages

• Not reliable except when combined with a barrier method.

• Can be messy as they melt and run out of the vagina.

• Put some men off oral sex. If this is a problem insert the spermicide just before intercourse.

• May have medical side-effects.

Research shows that liver function is altered and blood pressure lowered in some women using spermicides. They are absorbed from the vagina, especially if left in place for long periods.

• You can’t bath or have a wash on a bidet for six hours after sex.

The cap (diaphragm)

This is a dome-shaped barrier made of latex rather like a sheath. It has to be used with a spermicide to be safe. It is a good method for many women but it has to be supplied by a doctor, who will measure the woman for the correct size. For best results it must be used properly.

Advantages

• It is cheap and easy to use.

• It is nearly as safe as the Pill.

• There are no medical or health side-effects.

• It can be used to hold back menstrual flow to make for more pleasant love-making during a period.

Disadvantages

• It is not suitable for the woman who dislikes handling her genitals.

• It interferes with sensation in some women, especially those who enjoy the front wall of their vagina (around the G-spot) being stimulated during intercourse.

• It has to be put in well before sex and this removes the spontaneity for many women who find such ‘premeditated’ preparation un-sexy.

• It is easy to forget that it is in place for a day or two.

• It has to be supplied by a trained person in the first place.

• It should ideally be checked every six months by a trained person to see that the fit has not changed. This is especially important soon after a baby.

• It is easy for small holes, invisible to the naked eye, to develop which render the barrier ineffective.

• It interferes with sensation in those men who like to feel their partner’s cervix hitting against the tip of the penis.

How to use it

Place 3 or 4 inches of spermicidal jelly on the inside of the cap and spread some around the rim too. Insert the cap in the way that you have been taught and do so well in advance of intercourse. If you don’t have sex within 3 hours use more spermicide in the vagina. Don’t remove the cap for at least six hours after intercourse. If you have sex more than once during this six hours use more spermicide without removing the cap.

Look after the cap well. Remove it gently after intercourse ensuring that you don’t damage the dome with your nails. Wash it with plain, warm water and leave it out to dry. Never use perfumed soap or detergent to wash it. Never use Vaseline or disinfectant or you will spoil it. Hold it up to a good light every month and look for obvious holes. If there is any sign of damage, get a new one. Never wear a cap for more than twenty-four hours without removing and washing it.

The sponge

This is a disc of spermicide-impregnated sponge that the woman places in the vagina before intercourse.

Advantages

• Fairly easy to use.

• A good, non-permanent, barrier method.

Disadvantages

• All the disadvantages of absorbing spermicides into the bloodstream.

• Must be left in place for six hours after intercourse.

• It has to be thrown away after a single use and so is expensive.

• It can be felt in the vagina by the man’s penis or fingers.

• It is rather unreliable (75-85 per cent effective only) and so is really only suitable for couples who want to space their children rather than those who want to be absolutely sure about fertility control.

*12/72/5*