Health Blog

A routine visit to the doctor totally changed Tammy Munson’s life.

Tammy, a 33-year-old resident of Jamestown, New York, admits that she knew very little about good nutrition when she was younger. Even though she routinely ate high-fat foods such as Buffalo wings, pepperoni pizza, and french fries, she couldn’t understand why she kept packing on the pounds. “I just didn’t know any better,” she says. By age 21, she weighed 253 pounds.

Then, during a routine checkup, Tammy found out that she had alarmingly high blood pressure. The news jolted Tammy into action. Determined to slim down, she began paying more attention to her diet. She switched from 2 percent milk and regular sodas to skim milk and diet sodas—and lost 30 pounds. She had never considered how her beverage choices contributed to calorie intake. This surprised her so much that she decided to learn everything she could about healthy eating.

“I went to the library and signed out every nutrition book I could find,” she says. “I was determined to make better food choices so that I could lose more weight.” She also read dozens of cook-books and discovered how to turn fat-laden recipes into nutritious meals with a few simple ingredient substitutions.

All of that reading transformed Tammy’s eating habits. Within about a year, she lost a total of 147 pounds. And she has stayed at era’

106 pounds ever since, thanks to 12 years of healthy eating. ”

WINNING ACTION

Find out what you’re really eating. For one day, write down everything that you eat and drink, along with the fat and calorie content of each item. At the end of the day, add up your numbers. Surprise! You’re probably eating more than you realized.

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Could the minute amounts of pesticide that we eat with our food ever be injurious to health ? The answer to this question really depends on how dangerous those pesticides are – and this is something that cannot easily be answered. All new pesticides are tested very rigorously, and the risk posed by eating small amounts are assessed. Unfortunately, many of the pesticides that are widely used today were developed before adequate testing procedures were introduced, and there is concern that some of these may be toxic or carcinogenic, even in minute doses. A government programme is underway to retest such pesticides, but there are only four scientists involved in the testing, and at the present rate of progress it will be at least 50 years before all those now in use have been properly tested.

Even with the newer pesticides, there is some cause for concern. Some were tested by the discredited commercial laboratory mentioned on p306, in connection with food additives. Despite the doubts that this casts over their safety, these are still in use. More seriously, pesticides are never tested in combination, for any possible ‘cocktail effects’. Such effects are not unlikely. It is known that some insecticides affect

the liver, for example, making it less able to detoxify other chemicals. The safety data on pesticides, like that on food additives, are not open to public inspection because they are covered by the Official Secrets Act. After many years of assuring the public that pesticide residues were insignificant and harmless, the Ministry of Agriculture has recently admitted that there are serious problems. A confidential report, leaked to the press in August 1988 states ‘ consumers may be exposed to higher dosages of these chemicals than has hitherto been suspected. These residues could present a health hazard to man and it is plainly desirable that appropriate statutory controls are enacted to limit human exposure to pesticide residues from food.’ The report adds that even the ‘inert substances’ used to dilute the active ingredients of pesticides may be damaging to health.

In addition to pesticide residues, some foods contain hormones and antibiotics that are routinely fed to farm animals. Meat, poultry, milk, cheese and eggs are the main sources of these chemicals, but fish from fish farms may also contain some antibiotics. Some individuals are allergic to minute amounts of certain antibiotics, and they may react to traces of antibiotic in food.

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Test wheat before other cereals. Do not test it as bread, because this contains various other ingredients as well. Certain breakfast cereals are pure wheat, notably Puffed Wheat and Shredded Wheat, and these are good for testing – they can be moistened with fruit juice if you are not able to have milk. Alternatively, use bulgur wheat, or pasta (checking first for other ingredients), or mix flour into a pancake batter with eggs (assuming you have tested eggs already and they are safe). If using flour, start with wholemeal flour, preferably untreated and organically grown, as you can be sure that it contains no other ingredients. You can test white flour later. Some people are intolerant of the part of the wheatgrain that is lost during the production of white flour, so they only react to wholemeal flour and bread. Others are sensitive to white flour only, probably because of the additives in white flour, or the chemical processes, such as bleaching, that are used in its production.

If you react to wheat, allow at least a week to pass before testing any more cereals – test something else in the meantime. Rye can be tested as rye crisp-bread, but make sure it is pure rye, because some contain wheat bran. (Also bear in mind that some people who react to yeast also react to malt, which is a common ingredient in crispbreads and cereals.) Oats can be tested as porridge, and maize as sweetcorn or cornflour. Barley can be tested by eating pearl barley – boil about two or three tablespoons of it in plain water or homemade stock. It may seem rather pointless testing a food such as barley if you never eat it normally, but you could have become sensitive to it if you drink beer regularly, or if you are sensitive to wheat. Rye, barley and oats are all quite closely related to wheat and cross-reactions are not uncommon.

Other items to be tested are: eggs, beef, chicken and anything else that you decided to avoid, such as rice or peanuts.

The reintroduction phase should take about seven or eight weeks. If it takes any longer than this, there is a risk of lost sensitivity: the food-intolerant person becomes less reactive after avoiding the culprit food for a time. For some people, it may take many months or years to lose their intolerance, but for others the process can happen within two to three months.

If you have still not tested all foods eight weeks after starting the exclusion phase, then you should reintroduce all those which you have not yet tested. Eat all of them (in normal portions) every day for a week. If, after a week, there is no reaction, then you can consider them all safe. If there is a reaction, cut them all out again, and avoid them for five days, or until your symptoms clear up, if this takes longer. Then retest each of those foods in turn, using the same procedure as before.

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Because food molecules pass into breast milk, it is important for the mother to watch what she eats while breast-feeding. She should avoid eggs, cow’s milk, peanuts and fish, and should restrict her alcohol intake, especially of red wine. Calcium gluconate tablets can be prescribed to make up for the lack of calcium in a milk-free diet – or she can try goat’s or sheep’s milk, in limited quantities. If any previous children are highly allergic to specific foods then these too should be excluded from her diet, and should not be given to the new baby in its first year.

Ironically, the most difficult place to ensure that a baby is given nothing but breast milk may be in a maternity ward. The practice of giving supplementary or ‘complementary’ feeds is still common in some hospitals, and can be very damaging in the first few weeks of life. These feeds contain infant formulas based on cow’s milk, which are likely to be allergenic for the susceptible child. At this early stage in life the baby is very vulnerable to sensitization by foreign proteins.

Giving supplementary feeds can also have more insidious effects that may lead to the baby having to be entirely bottle-fed. Extra feeds from bottles upset the subtle balance of demand-and-supply that is established between a breastfeeding mother and her child. A rubber teat works differently from a real one, and babies that are given bottles do not always suck properly at the breast. Their appetite is also diminished, so they suck less hard, and the mother therefore produces less milk. This sets up a vicious circle, which may end with the mother being told that she ‘does not have enough milk’ and must therefore bottle-feed.

Where there is a hospital policy of not putting babies to the breast during the night, breast milk can be ‘expressed’ and stored, to be given from a bottle by a nurse. This method can also be used at home, for times when breastfeeding is not a practical proposition.

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If a child or adult lacks the ability to deal with lactose, the sugar passes through into the intestine, where it provides a bonanza for waiting bacteria. They consume the sugar, giving off gas and toxic products as they grow and multiply. These toxins then cause unpleasant symptoms such as pain and diarrhoea. They may be at the root of colic, which is why lactose intolerance is important here.

Following a bout of diarrhoea – due to an infection or whatever other cause – the digestive processes in our intestines take a little while to get back to normal. During this recovery period, there is often far less lactase produced by the gut lining than there is normally. This is something that happens in both children and adults, and it may cause a continuation of the diarrhoea if milk is consumed after an infection. Formula feeds without lactose are available, and your doctor may be able to prescribe one for you for a time, if your baby has had gastroenteritis and continues to have colic or diarrhoea afterwards. In the case of breast-fed babies, it is probably better, on balance, to continue breastfeeding, even though breast milk contains lactose. In general, children and adults should not be given too much milk to drink if they are recovering from a stomach upset. Yoghurt and cheese (but not cottage cheese) are usually tolerated because they contain far less lactose. Soya milk is lactose-free.

It is also possible that some small babies have insufficient lactase to cope with very large feeds – they can digest small feeds, but if their morning feed is larger than usual, the extra lactose overwhelms their capacity to cope with it. This could explain why some babies only have colic in the evening, when the morning feed reaches the intestines and the bacteria that live there begin to feed on the undigested lactose. This theory has recently been investigated scientifically, and the results suggest that it could well be correct.

In the past, it was often assumed that all babies who could not tolerate milk were lactase-deficient, and this idea is still current in some quarters. It is now known that most children who are sensitive to cow’s milk are actually reacting to the proteins it contains. But the diarrhoea produced by this reaction may, in turn, cause lactase deficiency. Doctors refer to this as secondary lactase deficiency. There are readily available tests for lactase deficiency, but these do not distinguish between true lactase deficiency (or primary lactase deficiency) and secondary lactase deficiency. More complicated tests can distinguish the two, and these show that primary lactase deficiency is actually very rare. So if you are told that your baby is lactase deficient after some routine tests, you should be prepared to question the diagnosis and ask your doctor to help you investigate the possibility of food sensitivity, as described in the following section.

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Both nuts and fruits have a major problem to contend with, despite these cunning strategems. There are a great many other living things that would like to eat them without providing any service in return. These range from small animals, that might nibble away at the fruit without dispersing it, to bacteria and fungi that would rot the nut as it lies in the soil.

A range of chemicals are present to keep these creatures at bay, many of them being selective toxins that affect one type of creature but not another. The ‘poisonous berries’ of many wild plants are poisonous only to mammals -birds relish them, and are of far more use to the plant in dispersal. The chemicals that stop bacteria and fungi from spoiling the fruit or nut are not always so specific. Although their main effect will be on microscopic life-forms, they may have minor untoward effects on larger animals as well – including human beings.

Clearly, there is a massive chemical arsenal in wild food, even in the foods that want to be eaten. In the course of our evolution, we have adapted to the challenge of eating these chemicals.

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Hypothyroidism is easily corrected by taking a daily tablet of T4 (from which the body can make T3). This treatment, taken indefinitely, can be prescribed by your regular doctor.

Most people with hypothyroidism feel well after two to three months of taking the pills.

Your doctor will probably start you on a low dose of thyroid hormone and check your TSH levels every few weeks until the proper dosage is found.

Dosing requirements can change, so have your TSH levels checked about once a year.

caution: Thyroid pills should not be taken with iron supplements. Iron blocks the absorption of thyroid hormone.

Low levels of TSH generally mean hyperthyroidism. This condition can occasionally be caused by inflammation of the gland or too much iodine in the diet. But the most common cause is a hereditary condition known as Graves’ disease.

Graves’ usually strikes between age 20 and 40. Signs include swelling of the thyroid, weight loss, anxiety, hair loss, muscle weakness and a rapid heartbeat.

If you’re diagnosed with Graves’, your doctor will probably refer you to an endocrinologist for additional testing and treatment.

About one of every 25 people has one or more small nodules in their thyroid gland.

If a nodule is detected, your doctor should evaluate it further. Tests may include a TSH level, imaging studies (an ultrasound or a radioactive thyroid scan) and a thyroid biopsy. ‘

Nodules that prove to be cancerous should be surgically removed. Surgery is often combined with radioactive iodine, thyroid supplements and X rays or chemotherapy. Most cases of thyroid cancer can be cured via these means.

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This game may seem drastic or childish. One of my patients, to whom I suggested a variation of it, replied skeptically, “But that’s playing games!” What he meant of course is that it was a kind of manipulation entailing “tit for tat” behavior. It seemed excessive and revengeful to him. “If I have to do something like that to get her to want me, then it wouldn’t be real; it would be contrived.” There is an element of truth to this complaint, I told him—but I make a distinction between playing a game simply to gain revenge and playing a game designed to end a stalemate and achieve closeness. The former I call a subjective form of acting-out, while the latter constitutes objective acting-out. The rationale of objective acting-out is to oppose subjective acting-out (the wife’s headache maneuver) in the only way that will truly reach her—by acting out back to her. Sometimes you have to go to another person’s level of game-playing before you can transcend it and reach more-authentic relating!

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Players: Depressed spouse and nondepressed spouse. Activists: Both. Setting: Home.

Aim: To join and mirror the depressed spouse’s defensive posture in order to facilitate him or her in developing more insight.

Game Plan: The depressed spouse has been rejecting all sexual overtures for some time. Let us say that in this case the depressed spouse is the husband. The wife now tries a different approach. She asks the husband to play this game with her.

They sit facing one another on a bed or rug. She fondles him to get him aroused. He fondles her too, although indifferently.

“It’s hopeless,” she says. “Everything’s hopeless,” he says. “Sex is hopeless,” she says. “Why bother?” he says. “I’m too depressed,” she says. “I’m too depressed, too,” he says. “It’s all so hopeless,” she says. “Why bother?” he says.

“What’s the use?” she says.

“I won’t get an erection,” he says.

“I won’t get wet,” she says.

“I’ll come too quickly,” he says.

“I’ll end up frustrated,” she says.

“Why bother?” he says.

“Yes, it’s hopeless,” she says.

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(If he does not know how beforehand, he can consult a “how-to” book.) When he finishes, he asks, “There, how do you feel now?”

“Wonderful.”

“What can I do for you now?”

“I don’t believe you.”

“What don’t you believe?”

“Why are you doing this?”

“Because I love you. What can I do now?”

“I can’t think of anything. I’m too shocked.”

“Well, if you do, let me know. I’m at your disposal.”

“And you don’t want sex?”

“I want it, but I know you have a headache and you’re not in the mood. I understand.” “You do?”

“Yes. I mean, I love you and I love making love to you, but I don’t want to make love to you unless you really want me. I don’t want you to do it out of duty or because I browbeat you into it. All these years I’ve just been thinking about myself, about my own selfish sexual needs, and I haven’t been thinking about you. So I thought that for once in my life I’d think about you.”

“I can’t believe my ears.”

“Believe it. It’s true.”

“So you really don’t expect sex?”

“No. I want it, but I don’t expect it. When you feel ready to give to me in that way, I’ll appreciate it from the bottom of my heart and loins. Until then, I’ll just be patient.”

“You know, that tie is kind of cute.” She reaches out to touch the bow.

“Don’t,” he says, pulling back.

“Why not?”

“You can’t remove the tie until we have sex.”

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