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ENJOYING A HEART-HEALTHY DIET: ANTIOXIDANTS AND CHOLESTEROL

admin — Wed, 02 Jun 2010 13:28:49 +0000

Yes, high levels of cholesterol in the blood increase the risk of heart disease. Yet some people manage to elude heart attacks even when their numbers are high. It could be that the way your body oxidises cholesterol in the blood may point to susceptibility to heart disease.

At the University of Southern California in Los Angeles, Dr Alex Sevanian said “your predisposition to atherosclerosis may depend much more on how much cholesterol oxide your body happens to produce than on the cholesterol levels in your blood”. Ironically, the LDL carrier of cholesterol oxidises more rapidly in the presence of polyunsaturated fats as found in corn and soybean oils. (That’s another reason to start emphasising monounsaturated rather than polyunsaturates in your diet.) So far, Dr Sevanian’s work has been on laboratory animals, but human studies are scheduled in a number of lipid research centres.

At a meeting of the American College of Cardiology in 1989, Dr Thomas Carew of the University of California at San Diego said LDL, the bad cholesterol, may exert its deleterious influence only after it is oxidised and can then be taken up by scavenger cells known as macrophages. When the macrophages become laden with oxidised LDL, they imbed themselves in arterial walls, where they are transformed into foam cells, the first stage in the development of atherosclerosis.

What can one do about cholesterol oxidation? We have preliminary evidence that one can, indeed, limit this destructive process.

Dr Carew, working with noted lipid researcher Dr Daniel Steinberg in San Diego, found that the prescription drug probucol (Lorelco) limits cholesterol oxidation. Probucol has been prescribed for cholesterol reduction, but its use has been limited by the fact that it reduces the good HDL as well as LDL levels.

Working with another eminent lipid researcher, Dr David Blankenhorn, of the University of Southern California, Dr Sevanian has found that a non-drug approach may achieve the same results. He has shown that blood levels of cholesterol oxides can be reduced with vitamin E, which has long been known to be a potent anti-oxidant.

A report of Canadian researchers at the 1990 meeting of the American Heart Association showed the value of vitamin E in protecting patients from adverse effects of bypass surgery. A group of 14 patients received 300 mg of vitamin E daily, while another group of 14 got a placebo for two weeks prior to their operations. Those getting the vitamin E suffered less “metabolic dysfunction” during the procedure.

Scientists at the University of Toronto have been looking for ways to protect bypass patients from the decrease in heart function that occurs after they are taken off the heart-lung machine which keeps blood circulating and oxygenated during surgery. They have found that unstable molecules known as free radicals may be a major factor in the heart’s inability to resume normal metabolic activity after the operation. In addition, surgery depletes the amount of vitamin E normally in the bloodstream.

Dr Terrence Yau said that presurgical supplementation with vitamin E apparently improved the heart’s ability to function, especially during the dangerous five-hour period immediately following the operation.

Much of the initial research into the activities of free radicals has been done in Japan, and scientists there continue to investigate this important area. Now researchers report that free radical-induced oxidation of LDL cholesterol can be suppressed by supplementation with vitamins E and C. They conclude that vitamin C inhibits water-soluble radicals but could not scavenge fat-soluble radicals within LDL, while vitamin E scavenged fat-soluble radicals in order to break the chain reaction of LDL oxidation.

All the researchers involved in such studies point out the need for additional study, and state that they do not currently advocate self-supplementation. However, in private they admit that they themselves take anti-oxidants regularly. Moreover, the doses of supplements used is not excessive, and while the absolute evidence of benefit has not yet been delivered, the risk of taking reasonable doses of those vitamins is virtually absent.

And while we’re on the topic of nutrient supplementation, add chromium to the list. When subjects were given a 200-microgram dose, their cholesterol levels fell by seven per cent. The recommended “safe and adequate” intake for the trace mineral is 50 to 200 micrograms daily; it’s found in oysters, brewer’s yeast and beer as well as in the organ meats which are on the no-no list for those of us cutting dietary cholesterol. A 1991 study showed that 90 per cent of Americans consume less than 50 meg. Daily intake of chromium should be no more than 200 meg, however, since higher levels can lead to adverse reactions including skin rashes, mood changes and anaemia. Take a look at your vitamin/mineral supplement’s formulation to see how much chromium is included. A dosage of between 50 and 200 meg may do some good and won’t do any harm.

Beta-carotene, the precursor of Vitamin A, has also been shown to have advantages in heart disease. A study of beta-carotene was reported at the 1990 meeting of the American Heart Association in Dallas. Of 333 patients with documented coronary heart disease, those taking a beta-carotene tablet every other day suffered half as many cardiovascular events as those getting a placebo.

Charles H. Hennekens, MD, of Brigham and Women’s Hospital and Harvard Medical School, said the data provide the first evidence in humans of the potential efficacy of beta-carotene in protecting the arteries. His research, known at the Physicians’ Health Study, is a national project involving about 22,000 male physicians aged 40 to 84.

The 333 individuals in the beta-carotene study are those physicians who had evidence of cardiovascular disease when they entered the project. In those taking the beta-carotene, there were half the number of strokes, heart attacks, sudden cardiac deaths and bypass surgeries.

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Cardio & Blood/ Cholesterol

ENJOYING A HEART-HEALTHY DIET: BRINGING OUT THE BIG GUNS TO CONTROL CHOLESTEROL

admin — Wed, 02 Jun 2010 13:28:18 +0000

For many, if not most, men and women, a program of diet, exercise and stress control will bring cholesterol levels under control. But some of us need additional help.

The body makes its own cholesterol in the liver and, to a much lesser extent, in the intestine. But some of us make too much, and our bodies don’t dispose of it adequately once it’s made. Excess cholesterol builds up in the bloodstream and, well, you know the rest.

A number of substances can help lower cholesterol levels. Please see chapter 16 for a full discussion of your options regarding medications.

Partial Ileal Bypass. One of the most drastic measures to lower cholesterol levels remains experimental at the time of writing. Partial ileal bypass is a type of surgery of the intestine resulting in a shunting of food so that cholesterol cannot be absorbed by the body. This yields dramatic cholesterol reductions in the blood.

Over a ten-year period, 838 patients who had had a previous heart attack were divided into two groups at the University of Minnesota. One group received usual treatment and dietary recommendations; the other groups got the partial ileal bypass surgery. Researchers found that deaths due to heart disease were cut by 28 per cent in the surgery group. The surgery group experienced 34 per cent fewer heart attacks, and 63 per cent fewer coronary bypass operations and angioplasties.

In the intervening years, according to Dr Henry Buchwald, patients underwent angiograms to directly study their arteries. Each evaluation showed greater progression of the disease in the control group, while that with a greatly reduced cholesterol level demonstrated actual regression of heart disease.

Of course this is very serious intervention. First there is the consideration of such major surgery itself; all surgery comes with its share of complications. Second, there are serious drawbacks. Patients could eat only small meals and had to eat repeatedly throughout the day. Vitamin deficiencies occurred, requiring supplement injections. And many experienced gastrointestinal distress including diarrhoea. Much better to stick with far more pleasant ways to get and keep cholesterol levels down! However, the study does show the unequivocal benefits of cholesterol reduction.

LDL Pheresis. Here we have another experimental means of cholesterol reduction developed for those who have a genetically determined hyperproduction of cholesterol resulting in levels from 13 to 26. Such individuals may not be able to control their levels even with drugs and the strictest diet.

The technique calls for blood to be “washed” in a manner similar to kidney dialysis. Patients must go to a laboratory each week to undergo the three-hour-long process, which can cost thousands of dollars annually. It is a very special treatment for very special patients.

Vegetarianism. Some might smile that I would include vegetarianism along with other “big guns” of cholesterol count. However, not everyone is willing to completely eliminate all animal products and most fats and oils from the diet for the test of his or her life. But there’s no doubt this can be a very effective means of cholesterol control.

Most individuals will find that they can effectively control their cholesterol counts without giving up animal foods entirely. Carefully selected dairy foods, poultry and seafood are extremely low in fat and cholesterol. Moreover, some of the benefits ascribed to vegetarianism may be due more to what people do eat than to what they don’t. That is to say that the vegetarian diet, by definition, is high in whole-grain cereals, fruits, vegetables and dried beans and peas. A number of researchers who have investigated vegetarian diets have theorised that the nutrients in such foods may have a protective value over and above the lowering of dietary fat and cholesterol.

Dried beans and peas are rich sources of soluble fibre, known to directly lower cholesterol levels. Vegetarians rely on dried beans and peas as an excellent protein source in lieu of meat. Many fruits also provide significant amounts of soluble fibre.

And, as we’ll see in the next section of this chapter, certain nutrients including vitamins C and E and beta-carotene may offer protection against heart disease. Fruits and vegetables are the principal sources of those nutrients in the diet. I’ve discussed Dr Dean Ornish’s research with reversing heart disease. His approach, involving a low-fat, near-vegetarian diet, exercise and meditation, is spelled out in his book Dr. Dean Ornish’s Program for Reversing Heart Disease (Random House, 1990). The book contains a nice section on vegetarian cookery, with some of the recipes supplied by Chef Wolfgang Puck, of LA’s famous Spago restaurant. It’s a well thought-out book, and one you should consider adding to your heart-smart library.

If, like me, you prefer not to become a vegetarian, you still would be well advised to increase your daily intake of non-meat foods. A meatless meal once, twice or even three times a week is a good idea. On those days, concentrate on pastas, egg substitutes, fruits and vegetables, dried beans and peas and the low-fat and non-fat cheeses that have recently come on to the market.

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Cardio & Blood/ Cholesterol

COMMON INFECTIONS OF CHILDHOOD: TREATMENT AND PREVENTION

admin — Thu, 21 May 2009 07:10:00 +0000

If the cough is due to asthma, it is treated appropriately with medications, depending on the nature and extent of the symptoms and the age of the child. The commonest cough, the one that follows a cold, does not need any specific treatment.

Antibiotics are not indicated in the great majority of these children because the original infection was due to a virus, and the cough is likely to be due to prolonged irritation irritation of the respiratory tract rather man to ongoing infection, Cough medicines and expectorants have not been shown to make any appreciable difference to cough. Vaporisers and humidifiers similarly have not been demonstrated to relieve coughing, and there are dangers in young children ingesting the vaporiser solution (usually containing menthol or eucalyptus).

Treatment of cough is non-specific, and antibiotics, cough medicines and expectorants, though they may make the parents feel they are doing something, rarely make any difference. Usually the cough will improve with the passage of time irrespective of what sort of treatment is given.

When to see your doctor

If the cough persists for longer than a week or two after a cold, or if there is a sudden onset of cough, or if it is significantly interfering with the child’s sleep or daily function, then your doctor should be consulted to make sure the cough is not due to asthma or an inhaled foreign body. Similarly, if there is any difficulty with breathing, or an associated high fever, then medical advice should be sought. In the majority of children, however, the child is well except for the cough and no medical consultation is usually necessary.

Prevention

If the cough is due to asthma, it can usually be prevented by appropriate treatment. The risk of inhaling foreign bodies can be minimised by not allowing toddlers and infants to eat nuts or play with small objects that can be easily inhaled. The cough that arises following a viral infection cannot be prevented.

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PREGNANCY/EVERYDAY LIFE: GENETIC COUNSELLING

admin — Tue, 19 May 2009 06:27:12 +0000

Genetics is a highly complicated field. If you have a family history of a particular disorder, it is wise to consult someone experienced in genetic counselling, who can explain the details to you. A geneticist or paediatrician can also advise you about the likelihood of any of your children inheriting the problem. If you have already had one child who was born with a genetic problem, genetic counselling can help assess the risk of the problem recurring in future pregnancies. Full physical examination and specific tests may be performed to determine the risk of a certain disorder within the family itself. A careful family history is always taken, and examination and testing of relatives is sometimes also undertaken.

Decisions by parents about terminating a pregnancy, if the foetus is shown to have a serious genetic disorder, are not taken lightly. Genetic counselling can provide you with the information you require to make informed decisions. It is your right, and responsibility, to know what is likely to be in store for both you and your child should you decide to continue with the pregnancy. This includes the treatment methods that are currently available, as well as the kind of support that exists in the community for children with a genetic disorder, and their families.

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YOUR MARITAL HEALTH/THE MOST OFTEN ASKED QUESTION: WHY DOES HE HAVE THIS FETISH FOR DOING IT DOGGY-STYLE?

admin — Mon, 18 May 2009 12:57:06 +0000

“Why does he have this fetish for doing it doggy-style? He wants to get on me from behind. It’s all he ever wants to do. Why is it such a thing with him?”

ANSWER: A rule of super marital sex is no problem is just with him or with her. It will help if we phrase the question a different way. Why do you find yourselves in conflict over the frequency of one posture? This question raises several mini-questions, such as how you both feel physically and emotionally about the posture and about postures that are not used and how and why this one posture became so frequent. One more thing. A posture is never a fetish, and people don’t “have” fetishes. They behave in various sexual ways that involve a range of stimuli. When one stimulus preference gets in the way of mutual enjoyment, there can be a breakdown in intimate communication. Remember that sexual preferences, even very strong preferences, are not fetishes as long as they do not physically or emotionally harm the partner. When a preference for something becomes a substitute for intimacy, professional help may be necessary on an individual basis first before working on the marital relationship. What you describe is not a perversion. It is a temporary mispositioning within your sexual interaction, not within him or you, that is correctable through open communication.

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WHAT DOES RADIATION DO TO HUMAN CELLS?

admin — Mon, 18 May 2009 07:03:26 +0000

Ionising radiation is harmful to all human cells — both normal and cancerous. You will remember that, because cancer cells are simply a ‘disobedient’ form of our own body cells, there is no type

of treatment that can kill them without harming some of our normal cells. Radiation treatment is no exception to this rule.

Thus, it is never possible to destroy cancer deposits with radiation without injuring nearby normal tissues. This means that radiotherapists are faced with the same challenge every time they plan a person’s treatment—how to produce the greatest possible damage to the cancer growths without risking dangerous

or otherwise very serious reactions in the normal tissues. In

Meeting this challenge, they firstly exploit those differences between cancer and normal tissues which make the cancer, on average, more vulnerable to the harmful effects of radiation. Secondly, they plan the treatment so that the cancer cells receive a higher dose than any normal cells and so that tissues which can give rise to dangerous or otherwise serious reactions receive a smaller dose than tissues whose reactions are less troublesome.

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HYPERTENSION – IMPORTANCE OF TREATMENT

admin — Fri, 15 May 2009 09:25:47 +0000

The doctor may combine drugs which act on different areas, increasing the dose of each of one until side affects appear, then adding another drug and increasing that the same way.

Some patients may respond to the first drug used and be hardy enough not to suffer ill-effects, and others may seem to suffer every side effect at a low dose, and the drugs have little benefit for their blood pressure.

These are the patients of whom their doctors despair and they, in turn, despair of them. They frequently abandon either the doctor or the treatment.

One of the great challenges of medical practice is convincing these people to persist with treatment and eventually bringing their blood pressure under control and so prevent the serious consequences of severe hypertension.

Blood pressure may rise during pregnancy, usually due to pre-eclamptic toxaemia. This is a direct result of the pregnancy, although the exact cause is unknown, and may lead to serious problems for both the mother and the child.

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ALLERGIES TO FOOD – CONCLUSION

admin — Fri, 15 May 2009 07:35:40 +0000

Most of the substances are salicylates or their derivatives. Dr Feingold listed 13 groups of additives which contain more than 2500 different chemicals.

One of the most common is called tartrazine and is a yellow dye. It is a salicylate and related to aspirin and is also known by a variety of other names or codes. It is widely used, not only in food, but also to color medicines and tablets.

One of the difficulties of the allergist investigating his patients is that so few foods are labelled with all of the ingredients. This also poses a problem for parents in choosing foods for their allergic children.

At the moment, the most reliable method of determining if a person is allergic to a particular food is to eliminate it from the diet and see if this relieves the allergy. The suspected food should then be re-introduced to see if the allergy recurs. This procedure may need to be repeated on two or more occasions.

Sodium cromoglycate is a drug widely used in allergic asthma and hay fever. It is produced in powder form made up into capsules. The capsule is inserted in a special inhaler, punctured to release the powder which is inhaled into the lungs or the nose.

It does not relieve the acute symptoms but acts to prevent the onset of the allergy by blocking the action of the allergen from acting on cells in the tissues known as mast cells.

The allergen causes these cells to rupture and release histamine-like substances which act on the tissues and produce the allergic response.

Recently, this drug has been used by mouth to block the action of food allergens in the digestive system. Food allergies only go to show that “one man’s meat is another man’s poison”.

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DEMYSTIFYING ENDOMETRIOSIS

admin — Fri, 08 May 2009 14:47:22 +0000

Endometriosis begins with a retrograde flushing of endometrial tissue that backs up into the fallopian tubes and then sprays into the abdominal cavity. The endometrial cells can then implant themselves on any organ—ovaries, fallopian tubes, bladder, bowel—and grow with each monthly cycle. One would guess that the endometrial tissue somehow gravitates toward its source, the uterus, and implants itself only there. This is not true. In a recent study by a team of endocrinologists and infertility specialists, led by Dr. Susan Jenkins at Duke University Medical Center in North Carolina, it was found that the ovaries were the most likely site of endometrial implants (nearly 60 percent of the cases). For unknown reasons, the left ovary was a more common site than the right by 20 percent. The uterus was the host organ in only 11 percent of the cases. The cul-de-sac, the cavity between the uterus and the rectum, also ranked high as a nesting location for these renegade cells. Endometriosis in the cul-de-sac can be responsible for lower back pain during menstruation. Cases are commonly found in which the bladder and kidney are involved. Soil more surprising, but much more rare, has been the discovery of endometriosis in the lung, armpits, and brain. No women in this study were found to have implants on the cervix or in the vagina—in fact, implants in these two sites are nearly unknown.

Imagine now what happens every month when endometrial tissue, existing outside its normal environment, responds according to its nature. The vulnerable endometrial implants outside the uterus react to the surge of estrogen and progesterone. The tissue thickens and bleeds, as if it were growing in the uterus, but, unlike menstrual blood, it has no way to exit the body. The implants can enlarge and then ding to organs.

If the endometrial masses are not located near nerve endings, they may not cause pain. Endometriosis has been found in women who were pain-free and functioning normally, but who were suffering from other problems, such as uterine fibroids or infertility. About 30 percent of women with endometriosis have no oven symptoms and find out only incidentally that they have the disease. If the implants grow near nerve endings, however, a woman life can be made miserable. Seventy percent of endometriosis victims may begin feeling pain about two weeks prior to and continuing into menstruation. Overwhelming damage can be done to organs bound with endometrial masses in both symptomatic and asymptomatic sufferers.

The most frequent complaint that leads me to suspect endometriosis in a patient is dysmenorrhea, or painful menstruation. Many women with endometriosis tell of long histories of menstrual distress, most specifically heavy menstrual flow accompanied by severe cramping. Backache and/or deep abdominal pain on either side of the body may indicate engorgement of blood in exiled endometrial tissue on the bowels or ovaries.

Dyspareunia, or painful intercourse, is yet another serious problem. Endometrial lesions, especially when they are trapped and growing in the cul-de-sac, can push the uterus into a retroverted position. Retroversion is a tilting back of the uterus. When the uterus is thus pulled out of its normal position, deep vaginal penetration during intercourse can be extremely painful.

Rectal bleeding, the need to urinate frequently, or blood in the urine during menstruation can also indicate endometriosis. Furthermore, if a woman feels pain radiating from her buttocks to the outside of her legs, her sciatic nerve may be affected. Vomiting and abdominal swelling may implicate the involvement of the small intestine. Finally, infertility, which may strike up to 75 percent of all women who have endometriosis, is directly linked to this disease.

Because endometriosis is so variable in nature, a small implant may cause greater suffering than a larger mass. In either case, physical pain from endometriosis does not exist in a Vacuum. This physical pain generally results in a life-changing state of emotional distress, a devastating side effect made worse by the belief among others—doctors, family, friends—that the pain does not, in fact, exist.

Pelvic pain can become an overwhelming entity in itself.

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CORTISONE AND THE SKIN

admin — Fri, 08 May 2009 14:16:51 +0000

Before using a corticosteroid preparation, two important factors must be considered. The first and foremost is the diagnosis. It is most important that the diagnosis be correct, as while cortisone may suit one skin condition, it may have an adverse reaction on some very similar condition. Any confusion in this regard could have drastic consequences. The conditions most responsive to topical corticosteroids are: atopic eczema—flexural, discoid, dyshydrotic; contact dermatitis—allergic, irritant; neurodermatitis; varicose eczema; seborrhoeic eczema; psoriasis.

Adverse reactions to the use of topical corticosteroid are seen in the following conditions:

acne—adolescent, rosacea; infections—bacterial, viral, fungal, parasitic; leg ulcers.

The second factor to consider is which preparation to use. Obviously the best principle is to use hydrocortisone (the mildest steroid) where possible, or a stronger fluorinated compound in its lowest effective concentration; the chosen preparation should be applied to the smallest possible area for the shortest period of time.

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