FAD DIETS: IMPLICATIONS

Weight loss diets abound, all with the promise of eagerly sought results. If any formularised eating plan is to be used, those working in fat loss need to:

1. Look to scientific research for the basis of claims, and ensure the eating plan is not actually a danger to health.

2. Sort through the claims and promises for the actual strategies required.

3. Assess if it requires anything special to make it work, including pills, potions or machdnes.

4. Assess its consistency with recommended food selection guides and the use of locally available foods.

5. Assess the promised rate of weight loss.

6. Assess the energy level and macronutrient composition and compare this with national recommendations.

7. Ensure that it is nutritionally adequate in micronutrients, and not reliant on supplements.

8. Assess the cost of the plan, particularly for long-term implementation.

9. Ensure that it is sustainable, incorporating commonsense food selection and regular, appropriately chosen physical activity.

10. Refer to an appropriately qualified health professional if unsure.

11. Reject any diet promoting a specific food or drink as a fat ‘burner’.

12. Consider only those eating plans which are likely to be adhered to for extended periods without alterations to physical nutrient profiles.

13. Be aware that liquid meal replacement diets without an accompanying activity program should only ever be used for the very obese and with appropriate professional supervision.

14. Discourage dieting in favour of healthy eating plans.

15. Keep in mind that diets of less than 1200kcals per day should not be used except under strict professional supervision and only in cases of extreme and life-threatening obesity.

SOME TIPS TO PREVENT FLUID RETENTION

•     Wear elastic stockings if your legs swell.

•     Do the same in pregnancy and in both cases use every opportunity to take the weight off your feet. This greatly helps reduce the swelling.

•     Come off the Pill and use another method of contraception.

•     Prevent allergies by eliminating foods and other allergens from your diet and surroundings.

•     Take vitamin B6. This seems to affect the balance between oestrogen and sodium. Taking 200 mg a day pre-menstrually has been shown to prevent fluid retention. B6 is especially good in pregnancy. Never take more than 200 mg a day.

•     Take vitamin Ñ-it seems to enhance the action of vitamin B6. It also has a diuretic effect of its own.

•     Drink more water – additional 4-6 glasses a day on top of what you currently drink. This increases the excretion efficiency of the kidneys.

•     Take less salt. Some people are exceptionally sensitive to salt and as little as 1 g can produce swelling in them. One large pickled cucumber, for example, contains 2 g salt.

•     Eat only complex carbohydrates (as found in fruit, vegetables and whole grains)-no refined ones. Sugar is a major culprit when it comes to water retention, and we consume quantities of sugar without being aware of its presence. Look for anything with the suffix ‘ose’ on the label (fructose, lactose, dextrose, maltose etc) and avoid it.

•     Include in your diet natural diuretics, such as pineapple, cucumber, parsley, alfalfa, strawberries, apples, grapes, beetroot and chamomile tea.

•     Ensure that you eat plenty of calcium-containing foods, especially if your fluid retention is a part of your pregnancy symptoms, as there is a link between the amount of calcium in the diet and fluid retention during pregnancy.

•    Take more exercise. Any exercise that improves the tone of blood vessels will help.

•    Try to lie down flat at least once a day for twenty minutes or so, as urine production is increased in the horizontal position.

UNDERSTANDING BPH AND HOW IFS DIAGNOSED: WHAT SETS ALL THIS IN MOTION?

There probably isn’t one clear-cut explanation for BPH; it involves too many disparate factors. But we do know that the development of BPH has at least two prerequisites—the testes, and aging. And new research suggests that a third condition, family history, may also be important.

The testes, housed in the scrotum, are the main source of the male hormone, or androgen, called testosterone, which is responsible for secondary sex characteristics, like post-puberty body hair and deepening of the voice, and for fertility. Testosterone acts on the prostate, but it’s not the only thing that makes the prostate grow. In fact, as it turns out, testosterone is not even the primary troublemaker in BPH; it just initiates the process. The trouble starts when testosterone is converted by an enzyme called 5-alpha-reductase to DHT (dihydrotestosterone). DHT is the major androgen, or male hormone, inside the prostate cell. (The thermostat that regulates all this activity is the hypothalamus, located in the brain.)

What are the Benefits of Using Green Tea?

It seems as if a week doesn’t go by before another study showing the health benefits of green tea comes out. The tea, brewed from the leaves of the plant, Camellia sinensis, is proving to be a powerhouse when it comes to health.

Emerging studies suggest green tea has multiple health benefits, including fighting heart disease, lowering cholesterol and blood pressure, increasing metabolism and fat loss, fighting breast cancer, and more. Studies also suggest green tea may be beneficial in preventing diseases of the eye, such as glaucoma.

Green tea is also proving to be quite a potent antibiotic, helping fight bacteria and tooth decay. This isn’t surprising, given that the substance that makes green tea green, chlorophyll, is known to be antimicrobial.

If you’re looking for something to get you going in the morning besides coffee, you might give green tea a try. Coffee does provide energy, but it does so at a price. Many people get the “jitters” after a few cups, and find themselves crashing later.

Green tea contains a little caffeine and L-theanine – a substance that reduces stress while raising alertness and mood. A good term for the feeling green tea gives is “calm energy”.

DO THESE TREATMENTS WORK?

Many articles in dermatology journals state that patients with BDD frequently have a poor response to dermatologic treatment. Of great concern is a study done in two dermatology practices in England, which found that the most frequent causes of patient suicide were acne and BDD. I’ve talked with dermatologists who told me about BDD patients of theirs who committed suicide. One dermatologist said that six of his patients with probable BDD had committed is and how important it is for people with this disorder to get effective psychiatric treatment.

There’s a great need for more studies of this important issue. What’s especially needed are prospective studies, in which patients are followed over time and carefully assessed before and after surgery or dermatologic treatment to see whether their BDD improves, is unchanged, or worsens. Patients should be clearly identified as having BDD, and their outcome after these treatments should be assessed over a long period of time.

Even though BDD appears unlikely to get better with these treatments, some people who initially consult surgeons, dermatologists, or dentists may be reluctant to see a psychiatrist. If this is true for you, keep in mind that as best we know, these treatments usually don’t work. Seeing a psychiatrist or therapist doesn’t mean you’re “crazy.” It simply means that you have a potentially treatable illness that in many ways is no different from heart disease or any other medical illness. Psychiatric treatment is very likely to help you feel a lot better. There’s a good chance it will give you more control over your obsessions, help you get your life back on track, and relieve your mind of worry, anxiety, and depression.

It may be hard for you to accept this advice if you think your defect is real and truly looks bad, as almost all people with BDD do. Most people with BDD have the hope that a physical change in their appearance will solve their problem. But look back at what my patients have told me about how they wish they’d never had surgery. Remember that as best we know, these treatments almost never help. And keep in mind that regardless of what you actually look like, if you’re obsessing about an appearance flaw, and if you’re distressed over it or it’s causing problems in your life, psychiatric treatment is likely to quell your obsessions, alleviate your suffering and distress, and help you function better and start enjoying your life again.

TYPE 1 DIABETES: PATHOGENESIS

As noted in the section on classification of diabetes, type 1 diabetes may be immune-mediated (type 1A) or idiopathic (type 1B). In either case, complete (or almost complete) loss of pancreatic beta cell function results in an absolute need for insulin therapy.

 The pathogenesis of immune-mediated destruction of the pancreatic beta cells has received the most attention, and is better understood than idiopathic loss of beta cell function. Pathologically, it is characterized by degranulated beta cells, an inflammatory infiltrate, and preservation of the other pancreatic islet cells, such as the glucagon-secreting alpha cells or the somatostatin-producing delta cells. The inflammatory infiltrate is composed of lymphocytes (CD4 and CD8 cells), natural killer cells, and macrophages.

 Islet involvement may be variable, and the clinical course of islet destruction may be slow or rapid.
Autoantibodies in the plasma are predictive and diagnostic for type 1A diabetes. Autoantibodies to the pancreatic islets were the first to be described. Subsequently, other autoantibodies have been found, including antibodies to glutamic acid decarboxylase (GAD), insulin, and other islet cell antigens. Type 1 diabetes-associated autoantibodies have been recognized before the onset of clinical disease, and their presence indicates a high risk of developing type 1 diabetes.

 First-phase insulin release is often reduced, and hyperglycemia eventually occurs. Islet cell autoantibodies are present in at least 70-80% of people with newly diagnosed type 1 diabetes, and insulin autoantibodies are present in about 50%. As the disease progresses, titers of autoantibodies fall and may be undetectable with long-standing autoimmune type 1 diabetes. A relatively high incidence of other autoimmune diseases (thyroiditis, celiac disease, pernicious anemia,or Addison’s disease) in people with type 1 diabetes supports the role of autoimmunity in the pathogenesis of the disease.

 The components of the immune system that are primarily responsible for cell destruction are under study. Elaboration of the cytokine interleukin-1 (IL-1) is thought to be of pathogenetic importance. IL-inhibits insulin secretion and may be cytotoxic to the islets. Another cytokine, IL-6, is produced by beta cells and can stimulate the immune response, enhance insulitis, and result in beta cell destruction. In one m it is hypothesized that viral infection of a beta cell increases release cytokines and adhesion of leukocytes. The infected beta cell is susceptible to attack by antiviral cytotoxic CD8 lymphocytes. Macrophages in the islets are stimulated to produce cytokines and free radicals, increasing the cytoxicity to the beta cells.

 Macrophages offer viral antigens to CD4 lymphocytes, which activate B lymphocytes to produce antiviral and anti-beta-cell antibodies. The process is obviously a complicated one with evolving concepts. The end product of virtually complete beta cell destruction leads to an absolute need for insulin therapy.

HOW MUCH SLEEP?

How much sleep is enough? This question is not easy to answer, and is very subjective. Some mink they need at least seven hours, some say ten. In fact this varies from person to person and also with age. It has been shown that babies sleep nearly all day. As they get older, they need less and less sleep. It is well known that the older we are, the less sleep we need. One of the common complaints of the elderly is that they cannot sleep. They hate to be awake and alone at night. They take sleeping pills, as they feel distressed when they cannot sleep.

Sleep is something we have no control over. We cannot close our eyes and give the magic word sleep, as sleep may not follow. In studies of how people fall asleep, it is observed that we are not folly awake one second and asleep the next. We all go through a very brief hypnotic state, which is called the Transitional Hypnotic State or THS.

How much sleep is required to restore, to repair, to recuperate, so that the next day we feel refreshed and satisfied? We will explore this question in two parts:

* Sleep deprivation and how much sleep is enough

* Psychological influence of how much sleep is enough