About Health & Medicine

Fibre

Food fibre is found in fruits, cereals, beans and vegetables. There are several kinds of fibre and they are not digested in the stomach or bowel, but assist in normal bowel function. They appear to be beneficial in the prevention of certain bowel diseases and particularly help prevent constipation.

There is some evidence that fibre in fruits and cereals and vegetables may help prevent too rapid an absorption of glucose from the carbohydrate in these foods. This is certainly helpful in the control of non-insulin-dependent diabetes, and may also be helpful in the diet of young people with diabetes. Recent evidence shows that a diet rich in fibre leads to better diabetic control.

Water

Fluids, either as water or in some beverage or food, are of course essential to health. Thirst is a good guide to requirements and you should respect a child’s desire to drink by letting him have water freely. Children sometimes drink large quantities of sweet drinks such as cordials and soft drinks and flavoured milk. They may drink these because of their sweet taste rather than their need to have fluids. For this reason sugar containing drinks are not used as part of the diabetic diet and artificially sweetened drinks may need to be rationed to help educate a child not to rely on sweet drinks.

Many solid foods have quite high water content and supply much of a child’s fluid requirements.

Meals provide constant glucose in the bloodstream

A diabetic diet takes into account the need for providing all these foods in proper amounts for good health. However, as well as providing the overall nutritional needs of the body, the regular taking of food ensures that there is a constant supply of glucose being absorbed into the bloodstream throughout the day. Sugars in food (such as fruit or milk) lead to a quick supply of glucose, whereas starches, being more slowly digested, lead to a steadier absorption over a longer period. With snacks at mid-morning, mid-afternoon and supper-time, the glucose supply is given a ‘boost’ which maintains a satisfactory level until the next main meal.

Meal times must be regular

Clearly, if this relatively constant supply of glucose in the blood is to be maintained, meal times have to be as regular as possible. Being late for a meal may mean that the glucose from the previous meal is disappearing from the blood, and too low a level may result. Being too early may lead to too long a gap to the next meal, with the same result.

*23/54/5*

The basis for teenage behaviour lies at least in part in the developmental process of adolescence. As every parent of a teenager knows, adolescence is not just a time of rapid growth and sexual maturation. It is also a period of psychological, emotional and social development. This development is just as important for the teenager as physical growth.

Adolescents have to proceed through a number of emotional developmental changes if they are to become mature adults. In many ways this is similar to the toddler as he passes from baby dependence to the independence of self-feeding, toileting and going off to kindergarten. Adolescents also have to achieve independence from their parents and they can make even more fuss in doing so. Teenagers must also establish their own self-esteem, measuring up with others of their age. They have to work out their own sexual feelings and develop a mature attitude to sex as part of a relationship with someone else. They have to work out where they are going, who they are and what their life career will be. They have to do all these things in a few turbulent teenage years with all the stresses of competitive school life and uncertain employment prospects.

It is no wonder that on top of all this a teenager with diabetes may have little time for sticking to all the rules of diabetic control. No wonder, in sorting out priorities, adolescent development may have a higher rating than exact diet and regular blood tests.

Fortunately for parents, adolescence only lasts a few years, but it is also a rewarding and entertaining time for the family. At this time it is important to set realistic goals for care of the diabetes. Realize that precise compliance probably isn’t possible just yet, but will occur later. Recognize that it is probably more important to be a parent and let your child’s doctor act the part of diabetes watch-dog.

*56/54/5*

How does your child feel about his diet?

It may be up to you to find out how your child feels about these sweet foods. If he has been used to a lot of sweets, and if the family has tended to regard sweets as rewards, then an abrupt denial of them all (particularly if the rest of the family goes on eating them) may be very upsetting for your child. He may even interpret the denial as a sort of punishment. ‘I ate too much sugar and so I got diabetes. Now I am being punished by being forbidden them.’ This is of course nonsense, but it is surprising how many children feel this way.

Diet is not a punishment

He may rebel and take sweets and cakes when no one is looking. He may yield to temptation occasionally and have a taste of some forbidden food (like a heavy smoker who is advised to stop smoking). In either case he will probably feel guilty afterwards, and this feeling of guilt will be made worse if you blame him, or reproach him, or worse still, punish him.

All children will break their diet occasionally

Children may not always seem logical. They may not believe you if you say that you are stopping them having cake for their own good (especially if you say this while you yourself are enjoying a luscious piece of iced cake).

Much explanation is necessary, and much understanding. If he does break his diet, and you find out, you may find that the best way to act is to let him realize that you know and disapprove, but avoid punishment or blame.

Your child has to live in a society where sweet carbohydrate foods are in profusion, and no party is a party without the cake. You cannot prevent him seeing other children enjoying these things, and although you will make some changes in your own home, you cannot perhaps deny all the rest of the family everything sweet. You may be able to help your child develop strengths of self-discipline in relation to food and show that you are also capable of some self-discipline yourself. You must help your child to accept, not only that he cannot freely have sweet things, but that other people can have them.

*48/54/5*

Early warning signs

At the stage when the level of glucose in the blood is falling rapidly, there will usually be warning signs before the level becomes too low. These include hunger, tremulousness, dizziness, headache, shaking, weakness or other odd feelings the child himself learns to recognize. At this stage the child may become pale and sweaty with a rapid pulse rate.

These warning signs are readily corrected by taking sugar.

There may possibly come a time – perhaps because the / warning signs were not recognized or heeded or because they were only present for a few moments, or in some cases they may not have been present at all – when blood glucose may fall to very low levels. When this occurs, it may mean that there is insufficient glucose for the efficient functioning of the brain, which depends on a constant supply of glucose from the blood.

Later signs

So the brain, deprived of sufficient glucose, may act in an unusual fashion and this leads to unusual behaviour of the child. He may become irritable, or cry easily, lose concentration and seem vague or be unreasonable or bad tempered. He may get a headache, or feel dizzy, ‘funny’ or drowsy. He may become weak in some muscles, or develop trembling of his limbs. He may even lose consciousness and some children may have a convulsion although this is very rare.

A hypo reaction may happen quickly

Usually these things develop quite rapidly and at a time when the child has been otherwise well. A normal or even a high blood glucose level earlier in the day does not rule out the possibility that a hypo may occur later, as the blood glucose level may fall quite rapidly from a high to a low level in a few hours.

When may a hypo reaction occur?

Although one child differs from another in his behaviour during a hypo, he tends to have the same sort of reaction each time he has one. Thus he or his parents quickly come to recognize a hypo when it is developing, and treatment can be given at once before more serious signs develop. Hypos tend to occur when sugar produced from a recent meal is largely used up and at its lowest level; often just before the next meal is due. Other times to be on the lookout for hypo reaction are after strenuous exercise or unusual activity. Each type of insulin has its time of maximum effect and at these times there is the most likelihood of an insulin reaction.

Difficulties in recognizing hypo reaction

There will be times in the early stages of your child’s diabetes, and especially if he is a baby or toddler, when you may be uncertain whether unusual behaviour is due to a reaction or not. As you get more experienced, you will learn to recognize reactions quite easily, but if you are in any doubt it is better to regard the unusual behaviour as a reaction and treat it. Note whether there is an improvement after giving treatment; if so it was probably a hypo reaction and if not probably was not. Very occasionally some children ‘put on’ bad behaviour and complain of headache to get the extra sugar you will use to treat the supposed reaction. If you suspect this, do a blood test. A low test will tend to confirm the probability that it is a hypo reaction.

Some symptoms of a hypo – paleness, sweating, shakiness for example, are the result of the body’s reaction when the glucose level in the blood is rapidly falling. This can occur when the glucose is falling from say 6 to 3 mmol/1, so there is a true hypo, but can also occur if, say, the blood glucose falls from 12 to 8 mmol/1. In this case, the child is heading for a hypo but is not actually hypoglycemic. This may explain why the blood test is not always low when symptoms occur.

It also helps to explain why sometimes a child’s blood glucose level may be found to be low but there are no symptoms. In this case, perhaps the blood glucose has been falling slowly, so the body doesn’t recognize the fall and there is no reaction.

*39/54/5*

It is best to use a meter

You can use a meter to measure the blood glucose level. There are a number of different meters for this test and from time to time new meters are introduced or old ones upgraded. It is well worth while looking at each of these and discussing how they work with an expert. Diabetes educators are usually aware of the range of meters available and some specialist pharmacists stock a range and can explain them to you. You can also see the range in diabetes clinics and at Diabetes Australia. All of the meters operate on the same principle: they measure the strength of colour that is developed on the test strip and convert it to a blood glucose value. They have a timing mechanism to make sure that the blood is on the strip for the correct time and that the test is read at the correct time. They tell you the result by a digital readout.

You can estimate the blood glucose value without a meter.

Some test strips (the Boehringer BM Glycemie 20/800, Hypo-guard GA, and the AMES Glucostix) can be used without a meter. You have to time the test yourself accurately with a watch, wiping off the blood exactly on time, and then waiting a further 60 seconds for BM 20/800 or 30 seconds for Glucostix before comparing the colour with blocks printed on the container. This method is convenient to use when you are travelling or camping or if you want to do a check at school or work. It is a useful standby if your meter is being serviced. Some people find it difficult to read the test accurately and it must be done in good light.

Why get a meter if it’s not necessary?

Most people with diabetes and parents of children with diabetes have said they much prefer using a meter. It is more accurate and easier to read, especially at very low and very high ranges. The meter has a timing device and this is valuable as most young people tend to become careless at times and just glance at a watch. Older patients who have trouble with vision, may find strips difficult to read visually, a meter is then very helpful.

The main disadvantage is the price. This may not seem so much if you realize that you should get many years of use and hundreds of tests a year. If you do have difficulty affording a meter, some diabetes clinics can lend you one for a while. Sometimes a service club or other organization will help you purchase one. Some health insurance companies refund part or all of the cost.

*31/54/5*

Memory and concentration problems: Statins may affect your cognitive function. A study done at the University of Pittsburgh in the USA showed that patients who took statins for six months performed much worse in solving complex mazes, memory tests, and had poorer psychomotor skills than patients who took a placebo. Lapses in concentration, and short term memory loss may not be just because you are tired or getting older, it could be the cholesterol lowering drug you are taking. Duane Graveline is a former astronaut and author of the book “Lipitor: Thief of Memory”. In his book Duane describes how he and many others have experienced complete memory loss for varying periods of time; they did not remember where they were and why. These memory blanks can occur suddenly and vanish suddenly. Lipitor (atorvastatin), Zocor and Lipex (simvastatin) are the statins most likely to cause memory loss.

Cognitive decline is not mentioned as a possible side effect of statins in patient leaflets. In fact, some doctors actually recommend that taking statins, and having a low cholesterol level can help to prevent Alzheimer’s disease. However, recent research disputes this. A group of 1026 individuals who were part of the Framingham study were observed. All the participants were free of cardiovascular disease and dementia in 1988-89, and had their cholesterol levels checked twice a year between 1950 and 2000. Between 1992 and 2000, 77 people developed Alzheimer’s disease. The study found that the risk of developing Alzheimer’s disease was in no way related to cholesterol levels.

Depression: Because cholesterol is required for the function of serotonin receptors in our brain, it makes sense that lowering cholesterol may trigger depression in some individuals. This is ironic, as depression is already a major health issue in Australia, and people who are depressed are at greater risk of heart disease.

Mr R. Ñ from Albury in New South Wales experienced significant depression while taking Lipitor. “For the past 15 years I have been in a high stress position dealing with teenagers and young people in a country high school. About 3 years ago I had my cholesterol checked, and my G.P. recommended I go onto Lipitor to lower the level of cholesterol. Over a period of time I began to feel depressed, wishing that there was some way out of the daily grind. I even took long service leave to see if the depression would lift, but it just kept getting stronger and stronger. I hated going to work. Once I was simply working on some landscaping at home when I broke down and cried on the front foot path. I wasn’t even embarrassed about it. I couldn’t care any more. There was no rhyme or reason for this apparent depression. I just felt awful and wanted to end my life.

Twelve months ago I had an appointment with Dr Cabot who asked what current medication I was taking. I listed several including Lipitor (the others were for high blood pressure) and she advised me to immediately stop taking the Lipitor.

The difference was very noticeable. I felt somewhat better during the next day when I didn’t take the Lipitor and within a week I actually looked forward to going to work. Life has become a much happier place for me and I now look forward to a full and rewarding life. AH the things that people do every day without thinking about I can now do with a positive outlook, and I am now living my life to the fullest”.

Please note that we do not recommend you stop taking a cholesterol lowering medication abruptly, unless you have your own doctor’s permission.

*24/53/5*

We live in a society where we are bombarded with chemicals and toxins. All the time we are exposed to chemicals in our food, in the packaging around it, in pesticides, additives and preservatives. In our houses, we can be in contact with chemicals through household cleaners, aerosols, new carpets treated with moth-proofing, and anti-woodworm and wood preservation treatments.

Outside, the environment is equally laden with toxins – traffic fumes, factory pollution, pesticides sprayed on parks and railways. Dangerous chemicals seep out from landfill sites. The list goes on …

All this affects your fertility. Logic tells us that toxins must be one of the main reasons why an increasing number of couples face difficulties conceiving. The fact is that we are living in a ’sea’ of hormones.

Of course it’s difficult to link a specific chemical to a particular medical problem or illness. So much else in our lives may affect our health that it’s often impossible to isolate the real culprits.

But we can learn a lot from the animal world. Infertility in wildlife is known to be linked to substances called xenoestrogens, oestrogen-like chemicals in the environment caused by pollution from pesticides and the manufacturing of plastics.

The power of these xenoestrogens was demonstrated when a group of scientists discovered that alligators which had hatched in Lake Apopka, Florida, had abnormally small penises and altered hormonal levels. In 1980 there had been a massive spill of Kelthane pesticide into the lake – the xenoestrogens from the pesticide were feminizing the alligators and stopping reproduction.

Meanwhile, in the UK, the Department for the Environment found hermaphrodite fish in one river. The fish were part male and part female.

In view of all this it seems very likely that chemicals in regular use are having a damaging impact on our fertility.

Genetically Modified Foods

Fortunately the issue of genetically modified foods has provoked a groundswell of opposition amongst the British public. We were just recovering from the BSE crisis when suddenly our food faced another threat. If the commercial production of GM foods goes ahead in Britain, we could find ourselves sitting on yet another health time-bomb – possibly the most devastating of all.

GM foods are already affecting the fertility of insects that feed on them. For example, ladybirds that ate greenfly fed on genetically modified potatoes had a drastic reduction in fertility, with fewer eggs being produced.

Likewise, when a gene to produce redness was put into a petunia, it produced plants with more roots, hairier leaves and a reduction in fertility. Scientists should know by now that they cannot manipulate nature without consequences.

Household Chemicals

Think about the number of chemicals we have in our houses – all those cleaners and aerosols. There is plenty of evidence that the chemicals they contain can be harmful.

In an American study, published in 1991, women with a history of unexplained infertility and recurrent miscarriages were found to have high levels of two chemicals commonly found in carpets, leather upholstery and wood preservatives.

Leading UK fertility expert Lord Professor Robert Winston believes that chemicals in emulsion paint being used in a closed laboratory over 100 meters away from his clinic affected embryo growth at a vital stage of treatment. No one is allowed to wear perfume or aftershave in Lord Winston’s clinic because he believes it is important to avoid chemicals when trying to maximize fertility. Some chemicals can stop women conceiving, or the egg may fertilise naturally but not be able to grow or develop.

*12/73/5*

Fit in some folic acid and some Bs. Folic acid as well as vitamins B12 and B6 can help reduce levels of an amino acid in the blood called homocysteine that has been found to damage arterial tissue.

“I think there is real promise here,” says Ronald M. Krauss, M.D., head of molecular medicine at Lawrence Berkeley National Laboratory at the University of California in Berkeley and chairman of the Nutrition Committee of the American Heart Association. “Although we do not have direct evidence that reducing homocysteine can reduce the risk for heart disease, we strongly recommend that people ensure adequate intakes of folic acid and  vitamins,” says Dr. Krauss. Folate (the form of folic acid in foods) is found in fruits such as oranges; in vegetables such as asparagus, beans, and Brussels sprouts; and in fortified grains and cereal products. The Daily Value for folic acid is 400 micrograms, and the Daily Value of vitamins B6 and B12 is 2 milligrams and 6 micrograms, respectively, Dr. Krauss says. You may need to take a multivitamin to get that much in a day, however, he adds.

Fill up on fiber. Whether it helps soak up cholesterol or simply prevents you from overeating isn’t clear. But the American Heart Association says that getting 25 to 30 grams of fiber a day can cut your risk for heart disease.

“The reasons why are still elusive, but people who eat more fiber have less heart disease,” says Dr. Ascherio. One simple way to make sure that you get more fiber in your diet is choosing a breakfast cereal that’s high in fiber. Look for brands that provide at least 5 grams of fiber per serving. “Some cereals have surprisingly little fiber, and others are really high. Check the side of the box,” he says.

Check your flax. Research has shown that eating bread made with flaxseed may help reduce cholesterol levels. A natural blood thinner, flaxseed apparently helps combat thickening of the blood as we age, says Tom Watkins, Ph.D., laboratory director of the Kenneth Jordan Heart Research Center in Mont Clair, New Jersey.

“Flaxseed oil is rich in alpha-linoleic acid, and in our own studies that appears to be beneficial,” says Dr. Ascherio. If you don’t have a taste for flaxseed or never bought one of those trendy bread machines, consider munching on a handful of walnuts. “There’s increased evidence that walnuts reduce the risk of heart disease because they’re also high in alpha-linoleic acid,” he says. Found in soybean and corn oil, polyunsaturated fat is much better for your heart than saturated fat.

Trash trans fatty acids. Better living through chemistry? Not always. When food manufacturers wanted to make margarine stiffer and lengthen the shelf life of other products, they created what are called trans fatty acids-a nutritional Frankenstein harder on your heart than even the dreaded saturated fat. “There’s no question that trans fatty acids have the worst effect on blood cholesterol,” says Dr. Ascherio. “Not only do they increase the bad cholesterol, but also they reduce the good cholesterol, or HDL cholesterol.” To purge trans fatty acids from your diet, avoid foods containing partially hydrogenated vegetable oil, suggests Dr. Ascherio. But be vigilant. It’s found in prepared foods from bread to frozen French fries.

*88/36/5*

Which of these views is right? All of them-to an extent. But a complete picture only emerges when experts pool their information and examine the problem from all points of view.

Most anorexics are teenagers, and I believe that for them anorexia represents a way to avoid maturity. By maturity I mean not just physical or sexual development, but psychological and social development as well. A woman can translate her fear of growing up into a loss of body weight. If she can keep the same weight she had at age ten, maybe she can stay ten forever. Achieving thinness lets her turn back the clock and revert to a childlike physical appearance. Even more important, loss of body weight causes the menstrual cycle to shut down. The patient gains control over one of the most powerful-and perhaps frightening-signs of womanhood. (For males, of course, the issue is different, as I’ll explain later.) Thus anorexia can reflect problems in making the transition from childhood to adolescence.

In contrast, bulimia can reflect difficulty growing from adolescence into adulthood. Here the problem isn’t so much one of achieving maturity, but of handling its responsibilities: separating from the family; controlling oneself and others; assuming an identity through marriage or career; defining oneself through relationships with others.

A person with an eating disorder struggles with these deep and troubling issues. The pressures combine and drive her to create an identity based on her ability to control food and eating. Through such control she achieves something that everybody desires, something that society values: the ability to be seen as special.

Everyone wants to be special in some way. It’s a natural human trait. We seek distinction through our talents, achievements, or personalities. Some of us take jobs and provide things that people want. Others express themselves through the arts. Still others devote themselves to the care of their families. Rewards for our efforts come in many forms: a paycheck, applause, a child’s hug.

But victims of an eating disorder look for a different reward. They believe that the only way they can be special is to control their weight and eating habits-to starve themselves if they have to. An anorexic patient might say to me, “I want to be the thinnest person in my school,” or, “the thinnest in the world.”

Of course, many people realize that true self-esteem is based not just on physical appearance, but on other innate qualities. These are the people who answer the question, “Why must we be thin?” by saying, “I don’t have to be.”

As a specialist in eating disorders, I work to convince patients that defining self-worth through abnormal eating is a dangerously unhealthy business. To pursue the “ideal body shape” is to pursue a myth.

I see these myths every day in countless guises. I don’t know how many times I have heard my patients say, “I always felt that if I was thin I would be happy,” or, “If people really loved me then I wouldn’t binge out,” or, “Being fat lets people see me for the loser I am.”

Some people believe that someone with an eating disorder won’t get better unless she wants to. Wrong! For families to embrace this myth is to run the risk that their daughter will starve to death before she gets the help she needs. Many times, families refuse to get help for their daughter because they believe she can get better on her own. “Recovery is just a matter of willpower,” they claim. People who believe this graduated from the “Just snap out of it” school of thinking. An eating-disordered girl can’t “will” herself out of her condition any more than people can “will” themselves out of the flu.

Helping a patient to want to get better is actually part of the first stage of therapy. Once she has learned the importance of changing, she has reached a point where other types of therapy have a chance of succeeding. Patients need sensitive, thoughtful treatment to help them break the vicious cycle of disturbed eating, correct their faulty thinking, improve their eating behavior and resolve their difficulties in relationships with friends and family.

To me, the most frustrating thing about these myths is how deeply rooted they have become. Many people accept them as reality. Thus the first important step in treatment is to uproot these myths and correct them.

No patient is “typical.” Many share certain traits or experiences, but each patient has a different history-and a different future. Keeping that in mind, here are scenarios describing the course of these illnesses.

*19/35/5*

As the owner of an agency that provides makeup artists for stage actors and TV personalities, Juanita Dillard was constantly surrounded by thin, gorgeous women—and free buffets. The ever-present food proved to be too much of a temptation for Juanita, especially in such a high-pressure environment.

“I’d eat all day, then help the caterers clean up just so I could take home the leftovers,” says the 37-year-old Cheverly, Maryland, resident. Before she knew it, she weighed 274 pounds.

It took a souvenir photo from a vacation in the Cayman Islands to persuade Juanita to slim down. “The photo was taken in late 1989. When I saw how I looked, I became determined to lose weight in the new year,” she says. “I was tired of compliments that stopped at my face. There I was, surrounded by gorgeous women. I wanted g to be one, too.”

Juanita stopped cruising the big buffets and instead signed up for Weight Watchers, where she learned about portion control and the importance of filling up on vegetables. But the most valuable lesson she learned was how to journal. When she started writing about her stress instead of feeding it, the weight rolled off. In a year-and-a-half, she lost 137 pounds.

The biggest test of her weight-loss success came when her dog, Nikki, was killed by a car. Distraught, Juanita grabbed a block of American cheese, a box of Saltines, a jar of black-bean salsa, a super-size bag of Tostitos, and a bottle of blueberry wine—all the fixings for a binge. Before long, tears were rolling down her cheeks. The jar of salsa was empty; the bag of tortillas, half-eaten.

By chance, Juanita reached into her purse and felt her journal. She took it out and started writing about how much she missed Nikki. When she was through, she felt better, and her desire to eat was gone.

“Stress was what made me fat before, and I wasn’t going to let it happen again,” she says. “Now, journaling is my zero-calorie stress buster.”

WINNING A C T I O N

Put your feelings on paper. The next time you’re inclined to pick up a fork, grab a pen instead and start writing. Research shows that journaling when you’re tense can help avoid emotional eating.

*76\89\8*