PREGNANCY AND EPILEPSY

Posted by admin on 2011-01-16T12:13:18+0000">January 16, 2011 – 12:13 pm

Mary and her husband felt it was time they started a family. Only one thing made them hesitate — Mary s epilepsy. The drug she had to take to control her generalized seizures was sodium valproate and she knew there was a chance that this might damage her baby.
So before trying to get pregnamt, they came to see me. ‘I’ve thought about it very carefully, and I’d like to come off drugs altogether while I’m pregnant,’ Mary told me firmly. ‘I know I’m risking having seizures, but I’m not worried about that. I think it’s more important not to risk damaging my baby. And I know perfectly well that there’s no drug you can give me which is guaranteed to be safe during pregnancy.’
I knew very well how Mary felt. But I had to tell her that it wasn’t quite as simple as that. If Mary did have her usual generalized seizure, this too would put her baby at risk, because during the seizure the baby might be deprived of oxygen. So I suggested a third option, which was to change Mary’s anticonvulsant drug from sodium valproate to Tegretol, a drug which was safer for pregnant women to take. However, this change would mean postponing the pregnancy for another few months, to make sure that the new drug suited Mary and controlled her seizures.
Three months later, her seizures well controlled with Tegretol, Mary became pregnant. And nine months after that, their baby was born — an eight and a half pound, perfectly healthy, baby boy.
If you have epilepsy and want to become pregnant, you need to think ahead, and discuss your plans with your doctor well in advance. Anticonvulsant drugs can sometimes damage the developing foetus, and your doctor will want to make sure that you are taking the safest possible drug before you try to conceive. If he or she feels it is appropriate, they may suggest that you change to another anticonvulsant. Unfortunately no anti-epileptic drug is entirely safe in pregnancy, but carbamazepine (Tegretol) is thought to be the least harmful. The risk is higher if you are taking more than one antiepileptic drug.
The risk of having a baby with a birth defect may also be higher if there is a history of birth defects in the family of either parent. Genetic counselling before you embark on the pregnancy will help you assess what the risk is in your particular case.
No one specific abnormality is associated with antiepileptic drugs, but the commonest problems are:
Cleft lip and/or palate and congenital heart defects (associated with phenytoin);
Spina bifida, malformation of the penis, ‘webbed’ fingers or toes (sodium valproate);
Possibly reduced birth weight and slow development (carbamazepine);
Malformations of the face, for example eyes which are set too wide apart (commonly phenytoin).
So, if no anticonvulsant is entirely safe, you may well feel like asking your doctor if you can discontinue your drugs entirely during your pregnancy. There are two arguments against this course of action. The first thing to realize is that although there is a risk in taking anticonvulsants, it is still only a very small one. In the population as a whole, two or three babies in every hundred are born with some birth defect. Amongst babies born to women with epilepsy who are taking anticonvulsants the rate of birth defects is four to six in every hundred babies. The risk is increased, but it is still not a large risk.
Second, until very recently it was generally accepted that, when a woman had seizures during pregnancy, her baby was at risk because it might be deprived of oxygen during a seizure, particularly if she went into status epilepticus. More recent evidence suggests that this may not be so, though doctores are not yet certain. What is certain, however, is that the woman herself runs a risk if she stops taking anticonvulsants.
So the chances are that your doctor will probably advise you to carry on taking medication. In the end, though, you are the one who has to balance the risks and make the decision. If you do continue taking your drugs, try not to worry. Remember that, despite taking anticonvulsants, nearly all women with epilepsy have normal pregnancies and healthy babies.
All women are advised now to take folic acid for a month before they start trying to become pregnant, and to continue to take it for the first three months of pregnancy. Folic acid supplements have been found to reduce the risk of spina bifida and other nervous-system defects. It is especially important for women with epilepsy to take folic acid supplements, as some anticonvulsant drugs can reduce the levels of folic acid. Folic acid tablets can be bought over the counter without a prescription, and you should take one 0.4 mg tablet a day. Some doctors recommend that women who are taking carbamazepine or sodium valproate should take a higher dose of 4-5 mg daily. This same higher dose is also given to women who have previously given birth to a child with spina bifida.
You will probably also be asked to take vitamin K tablets for the last two weeks of pregnancy as some antiepileptic drugs cause vitamin K deficiency, which can produce a rare blood disorder.
In addition, your baby will be given a dose of vitamin K soon after birth, to protect against this disorder.
UNPLANNED PREGNANCY
If you did not plan to become pregnant but find that you are, without having had a chance to discuss changing your medication with your doctor, what should you do? Do not stop taking your drugs (this may lead to more seizures, which could also damage the baby) but see your doctor as soon as you can. He or she will be able to tell you how great a risk there is of you having a baby with some abnormality (the risks for most drugs are known). Clonazepam is one of the anticonvulsants with the highest risk of foetal abnormality, so if you are taking this drug, it is especially important to see your doctor straight away. Start taking folic acid tablets immediately and make sure you have appropriate screening tests for abnormalities of the baby (see below).
ANTENATAL SCREENING
Many birth defects can be detected by special screening tests during pregnancy. Most hospitals offer ultrasound scanning around 18 weeks and give a blood screening test around the 16th week of pregnancy to assess the risks of congenital disorder in the baby. Higher than normal levels of one chemical, AFP (Alpha Fetoprotein) can indicate a neural tube defect such as spina bifida.
The results of the test will be reported as ‘screen positive’ or ‘screen negative’. But if you are told your test is positive, it does not necessarily mean that your baby has any abnormality. Screening tests can only assess risks. They are not diagnostic; they cannot confirm that a baby does or does not have spina bifida, only that there is a higher than average risk that it may. There are other reasons for a raised level of AFP; — it may simply be that your pregnancy is more advanced than was thought, for example. Most women who test screen positive go on to have perfectly healthy babies. However, a screen positive result does indicate that there is a need for further tests such as an ultrasound scan and possibly an amniocentesis, which can confirm whether or not there is any abnormality.
If it is found that your baby does have a serious defect, you can then decide whether to continue with the pregnancy.
ANXIETIES ABOUT PREGNANCY
Inheriting epilepsy
Inevitably, anyone with epilepsy who is thinking of starting a family is going to worry that their child might develop the condition too. So what is the likelihood that this might happen? The chances that anyone will develop epilepsy during their lifetime are about one in 200. If either you or your partner (but not both) have epilepsy, the chances of your child developing the condition are only about one in 40. If both parents have epilepsy the risk is higher. But even so, it is much more likely that your child will not develop epilepsy than that they will.
Seizures during pregnancy
Women with epilepsy are considered to have high-risk pregnancies, mostly because there is an increased risk of seizures during pregnancy, labour and delivery. About a quarter to a third of women have more seizures than usual during pregnancy, but some women have fewer. Unfortunately there is no way of predicting how any individual woman will react, whether she will have more or fewer seizures during her pregnancy. Neither does the course of one pregnancy make it any easier to predict what will happen in a second.
Doctors also have to take into account the slightly increased risks to the babies of women with epilepsy. Although these risks are small, they do exist. Babies of mothers with epilepsy are more likely to be born prematurely or to be of low birth weight, and rates of stillbirth are also slightly higher for these babies. Because of these risks it is not advisable for you to have a home birth. Your doctor will probably recommend that you have your baby in hospital.
*84\193\2*

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AVOIDING HEART DISEASE: VITAMINS AND SUPPLEMENTS, JUICES, ETC

Posted by admin on 2010-12-26T12:12:26+0000">December 26, 2010 – 12:12 pm

Vitamins and supplements (daily)
E – up to 1,600 IU, depending on age and condition (in case of rheumatic heart disease not more than 175 IU). A doctor must determine the amount of vitamin E for each heart patient, especially in rheumatic heart damage, hypertension, cardiac decompensation or failure.
Magnesium – 500 mg. or more
Lecithin – 2 tbsp.
Calcium – 1,000 mg.
C- 1,000 to 3,000 mg.
Zinc – 30 mg., as zinc gluconate
Niacin – 100 mg.
B6 – 100 mg.
Brewer’s yeast – 3 tbsp.
Flax seed oil – 2 tsp.
Kelp – 1 tsp. of granules, or 3 tablets
Raw, unrefined honey
Wheat germ – only if available absolutely fresh, not older than one week after it is made
Natural multiple-vitamin-mineral formula

Juices
Vegetables: carrot, beet, celery, asparagus, with small amount of garlic and onion juice added to vegetable juice.
Fruits: red grapes, black currants, rose hips, blueberries.

Herbs
Hawthorne berries, motherwort, horsetail, valerian root, black cohosh, mistletoe, melissa, rosemary. An excellent herb tea for heart diseases is made from the woody, interior walls of walnuts. Use the walls from 4 to 5 nuts for each cup. Soak them overnight, then boil them for 15 minutes the next morning. Take three cups a day. This tea alleviates the pressure and the pain in the chest. Tea can be sweetened with raw honey. Cinchona bark (the source of quinine and guanidine) is specific in the treatment of atrial fibrillation, a rhythm disorder of the heart.

Specifics
Vitamins E, C, magnesium, lecithin, flax seed oil, okra, hawthorn berries. Low-protein, low-calorie, low-sodium diet. No smoking, no alcohol. Plenty of regular exercise.

Notes:
It has been demonstrated in several American and Swedish studies that heart attack and stroke victims have often exceptionally high blood viscosity, or so-called thick blood, with larger than normal count of red blood corpuscles. Researchers concluded that a thousand-year old method, extensively used in folk medicine and by ancient doctors to prevent heart attacks – periodic blood-letting – was based on solid scientific grounds. Blood-letting “thins” the blood, lowers its viscosity, or hematocrit, and prevents the development of coronary thrombosis and blood clots. That women are not affected by strokes and heart attacks before the age of menopause to the same extent that men are, may depend on their usually much lower hemoglobin count. Needless to say, only qualified doctors should perform blood-letting, or decide on the advisability of such treatment in each individual case.
I dare to predict that this method of prevention of strokes and heart attacks may become widely used in the future medical practice – after it is given a little more scientific name, of course. By the way, periodic juice fasting also lowers blood viscosity and diminishes the risk of thrombosis and stroke.

*4/103/5*

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COMING OFF DRUGS: A HEALTHY BODY-WOMEN AND HEALTH, SEX AND DRUG-USING

Posted by admin on 2010-12-19T12:11:05+0000">December 19, 2010 – 12:11 pm

Heavy drug users often find that they have ceased to menstruate. When this happens, it may be several months before periods start up again. And when they do return, they may be irregular, scanty or excessive. If you are worried, see your doctor and sort it out with him. But, as a rough guide, it may take your body up to a year to get its gynaecological functions back to normal.
Incidentally, period pains seem much more severe once you are clean and sober. It is difficult to know whether this means they really are worse, or simply that they seem worse. After years of living under drugged sedation, it can be quite a surprise to feel any kind of ordinary pain! Besides, addicts and alcoholics in the early stages of recovery are bad at enduring any kind of pain or discomfort.
Sex and drug-using-Initially, some drugs are sexually stimulating; others tend to decrease sexuality. Drink, as the drunken porter in Macbeth said, ‘provokes the desire, but it takes away the performance’.
Many addicts and alcoholics have lived distorted sex lives under the influence of drugs and alcohol. When they come clean and sober up, it usually takes some time for this side of their life to settle down. Time is needed to heal the emotional wounds and to sort out their sexual lives.
‘Drinking was always associated with sex and I always had rather unsatisfactory, rather torrid relationships. It seemed to me that sex was a parallel appetite to booze,’ says a recovering alcoholic and addict who has been clean and sober for about five years.
In addiction, drugs and drink distort sexual behaviour. Some women are sexually abused while under the influence of drink or drugs. Others turn to a sexually promiscuous lifestyle. Some women addicts or alcoholics turn to prostitution and some male addicts, including those who are heterosexual, turn to homosexual prostitution to support their using. Sexual infections and subsequent visits to VD clinics are a common part of this drugs or drink lifestyle.
Compulsive sex sometimes accompanies compulsive drug-use. Men, too, sometimes participate in sexual acts that they would not have taken part in if they had been clean and sober. When they get clean it is quite common for addicts and alcoholics to feel a lot of guilt and remorse about this part of their drug-using life and to feel very awkward at initiating any kind of relationship. They have to relearn intimacy.

*106\116\2*

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PSYCHIATRY IN CRISIS: GLOBAL APPROACHES TO THE HUMAN BEING

Posted by admin on 2010-12-12T12:07:22+0000">December 12, 2010 – 12:07 pm

Process oriented psychology is a wide spectrum method of perceiving, differentiating and enabling human signals, both close to and far from the personal identity of the doctor and patient, to unfold. The aim of process oriented psychology is to allow these different signals and states to unfold in an individual way which depends upon the client and the therapist, by focusing on the underlying process structures which connect them. In fact, the most able therapist appears to be one who is familiar with all parts of psychology, including dream and body work, meditation, psychosomatic medicine, medical terminology and treatments, relationship and family work, social work, etc. An empirical discovery is that present problems and issues become their own solutions, their own ‘cures,’ if you will.
Though there are many indications that psychology and psychiatry might grow together, the mental health practitioner today generally uses pieces of different psychologies, medicines and psychiatry to help her clients. These various disciplines, based upon different and sometimes contradictory philosophies, have different methods of empirical investigation and treatment, yet they deal with one and the same person. Medicine attempts to enable patients to function like the rest of their environment. However, since medicine alone may not improve the quality of an individual’s life, most therapists frequently add psychological interventions to their practice. Most psychologies today, however, are unable to deal with the gravity of psychiatric situations alone.
While such differences have the advantage of creating individual and global approaches to the human being, they could become even more valuable if the unitary background to the psychological sciences were better understood. A disadvantage to having several different paradigms of mental health is that the competition among them draws energy away from treating the client and may hinder the cooperation and team work necessary for creating a more functional approach to the individual suffering from extreme states.
*3\227\8*

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WHERE TO GET HELP: PRIVATE CARE SCHEMES

Posted by admin on 2010-09-21T17:08:26+0000">September 21, 2010 – 5:08 pm
The last five years has seen an expansion of the private sector in terms of health care of the elderly that few would have predicted. The main reason for this rapid growth had been the government led inducements for elderly people to enter private homes, the government paying a substantial proportion of the bill via DSS board and lodging benefit. As soon as this means of payment was established by the government the huge increase in places began, with many private homes opening almost overnight. It is now big business with large companies becoming involved, as is already the case in the United States. The total cost escalated to astronomical sums (literally billions of pounds). The government’s answer was the 1990 legislation, the NHS Care in the Community Act, which moved the funding decisions from the DSS (which was effectively limitless) to social services – given a yearly sum, 85 per cent of which must be spent in the independent sector. Private homes are in the same two broad groupings as the state sector, that is residential homes (similar to the local authority old people’s homes) and nursing homes; some health districts have state run nursing homes or the nearest equivalent would be long-stay/ continuing care wards in the local geriatric/psychogeriatric hospital.
Private residential homes are often called rest homes and some have gone back to the concept of the old people’s home that was around many years ago. They like to cater for the elderly frail but genteel type of person. Many there are not even frail; they have chosen this type of care for the company and the lessening of worries about house repairs, etc. Standards will vary as will the fees, but as this type of home caters for the more articulate and well-off type of person, the standards and costs are usually high. Any form of mental illness, especially confusion, is likely to be an absolute bar to entry, as are any problems with incontinence.
The number of people wanting the type of home described above is relatively small compared to the total market for care and hence many homes have relaxed their unwritten rules to widen their potential client group. Many work on almost the same rules as State-run old people’s homes, with confusion not being a bar to entry if it is not accompanied by difficult behaviour or wandering. Residents must be fully mobile (a Zimmer frame is acceptable) and continent, and must be able to care for themselves in a minimum way such as dressing and feeding without help.
Problems begin if the resident fulfils the criteria on admission but runs into difficulties later. In the State sector a great deal of effort will be expended to keep the person in the home while at the same time trying to reverse the problem that has arisen. This may involve the help of numerous people, from both health and social services. As we have seen before living in residential accommodation is not easy. In the private sector there is no in-built requirement to try and make a go of it. Some homes will be excellent and use the resources that are available, but some will simply ask the relatives to remove the person as soon as possible. The latter are the homes led by the profit motive who know they will fill the vacancy almost immediately.
Few private homes cater for the elderly mentally infirm exclusively. They too will vary from the superb to the awful. This type of home also tends to be more expensive because of higher staff to resident ratios.
*64/128/5*

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HOW TO SURVIVE YOUR DOCTOR: GASTROENTEROLOGISTS AND GENERAL PRACTITIONERS

Posted by admin on 2010-09-21T17:07:10+0000">September 21, 2010 – 5:07 pm
Gastroenterologists
Gastroenterologists are physicians who have specialized in disorders of the digestive tract. Their interests range from Hepatitis and disorders of the oesophagus to ulcerative conditions of the rectum. The invention of the endoscope allows such wondrous achievements as the simultaneous photography of the colonoscope’s working parts by the working parts of the gastroscope and vice versa as these two instruments meet in the middle of a patient’s gastrointestinal tract. The use of endoscopes by physicians makes further inroads into the responsibilities of the general surgeon. Now gastroenterologists armed with endoscopes are removing colorectal cancers in their infancy before they spread to distant parts of the body.
General Practitioners
Two socio-political events led to a downgrading of the role of general practitioners in Australia over the last decade. Firstly the supply of general practitioners outstripped the demand for their services. Australia now has one doctor per four hundred head of population; whereas the World Health Organization’s recommendation for developed nations is one doctor per six hundred. Secondly medical specialists took control of many procedures and attendances formerly the domain of general practitioners.
This deskilling and oversupply of general practitioners allows the Federal Government to subsidize price cutting in the private health sector and claim responsibility for the provision of available medical services that all Australians can afford. From the point of view of the six thousand general practitioners that the Government plans to drive out of the medical market place within the next six years, the future for general practitioners in Australia doesn’t look all that promising.
Home Remedies
An oversupply of general practitioners means that blood tests are requested and trials of therapy are advised which are weighted in favour of the doctors’ financial interests; rather than the interests of a patient’s good health. Whenever offered, a prescription, an investigation or a return visit to the doctor’s – ask WHY. Such a simple question reduces the frequency of medical interventions by up to 50 per cent.
*63/131/5*

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ENJOYING A HEART-HEALTHY DIET: THE DIETARY FOUNDATION

Posted by admin on 2010-06-02T13:18:13+0000">June 2, 2010 – 1:18 pm
The same dietary modifications that you’ll need for controlling your cholesterol will pay off in additional dividends. Without even thinking about kilojoules, cutting back on fat will help you lose those kilos you’ve been meaning to shed. If you’re diabetic, you’ll find it a lot easier to keep your glucose levels controlled. In the long term, a low-fat, low-cholesterol diet can also provide protection against cancer.
The best news is that the dietary changes necessary for good health don’t mean deprivation. You’ll find yourself eating as much as you want, never feeling hungry, and indulging in tasty treats that you’ll find mouth-wateringly delicious.
Hearing numbers regarding your foods can be bewildering. What does it mean to eat 30 per cent or 20 per cent or 10 per cent of your kilojoules as fat? Some nutritionists and certain publications have tried to illustrate such numbers in terms of teaspoons of fat. But have you ever seen fat listed in teaspoons on a package of food? There’s an easier, far more practical way to deal with all this.
First let’s assume that like most Westerners you now consume about 40 per cent of your kilojoules as fat. That means that an awful lot of your food has a significant amount of fat in it. Compare that with populations in the world who eat much less fat, about 15 per cent, and have virtually no heart disease. The Heart Foundation of Australia has long recommended a 30-per cent-fat diet, but while that may be fine for others, it’s just not effective for those of us who already have heart disease. On the other hand, a diet calling for only 10 per cent fat will be unacceptable for most people to follow for any length of time. While that may be very effective, it’s just not very practical.
I propose a 20 per cent fat diet. This comes close to the levels of fat intake in countries which are nearly free of heart disease. It allows a delicious choice of foods which can be enjoyed not only at home but while dining out in restaurants and at the homes of friends and relatives.
But, again, you won’t see percentages of fat listed on food packages or in magazine recipes. What you will see listed is the amount of fat measured in grams. That’s something we can all get a practical handle on for our own purposes.
Bear with me for the next few paragraphs and you’ll have your personally tailored prescription for gram intake to achieve a 20 per cent fat diet. We’ll start with the kilojoules you need daily.
The average, moderately active man needs about 145 kilojoules to maintain each kilogram of body weight. A very active man may need more kilojoules to maintain his weight. Less active men, and most women, will require fewer kilojoules. A middle-aged, moderately active woman, or a less active man, may need only 110 to 120 kilojoules to keep weight at the current level. Thus to determine your daily kilojoule needs, multiply either 145 or a greater or lesser number by your ideal weight. Notice that I say ideal weight. We’ll discuss that in a moment.
Let’s take an average man who weighs 68 kilos and is moderately active. He walks regularly, plays an occasional round of golf, and engages in leisure activities other than just watching television. He needs 145 kilojoules per kilogram to maintain his weight. Here’s his calculation:
68 X 145 = 9860 kilojoules/day
What if you’d like to weigh 68 kilos, but right now you tip the scales at 77 kilos? By consuming 9860 kilojoules daily you, our reference man, will feed only your ideal 68 kilos. Little by little, but in a very satisfying process, those extra kilos will come off. You’ll feed only your ideal weight; those extra kilos will be starved away.
Now that we know that our male example needs 9860 kilojoules daily, let’s assume that he’s going to get heart-healthy and consume 20 pet cent of those kilojoules as fat. The calculation is simply to multiply the daily kilojoules by 20 per cent.
9860 X .20 = 1972 kilojoules consumed as fat
While carbohydrates and protein supply only 17 kilojoules per gram, fat provides a full 38 kilojoules. Thus to translate those abstract kilojoules into practical grams, we do the next calculation of dividing our kilojoules consumed as fat by 38, the number of kilojoules in each gram.
1972 ^ 38 = 52 grams
There we have it. Out reference male example will want to consume no more than 52 grams of fat daily. That’s something he (and you and 1) can easily keep track of regularly.
Of that total amount of fat, no more than one-third should be saturated. The balance should come from polyunsaturated and mono-unsaturated fats. More about that in the coming paragraphs.
Of course, you’re not yet familiar with the number of grams of fat in foods. Begin by reading the labels on packages. Look at the labels on milk cartons, bread packages, TV dinners and almost every food that’s processed by a manufacturer. Next, familiarise yourself with the number of grams of fat found in commonly eaten foods including meats, fish, cheese and the like which are not processed when you buy them in the supermarket. Take a look at Table 6 (page 320) for a brief overview. For a listing of the fat, cholesterol, kilojoule, sodium, fibre, iron and calcium contents of foods, refer to the book Calorie Counter by Allan Borushek; it’s available in most bookstores or pharmacies.
When I first began to control my own cholesterol by keeping tabs on fat grams, I knew no more about those numbers than you do now. Within a remarkably short period of time, however, this all becomes second nature. You may not know that cheddar cheese packs about 10 grams of fat per 30 grams versus the 7 grams for mozzarella or Edam, but you’ll have a general idea that cheese has a lot of fat and that eating just 30 grams will account for a significant percentage of your daily fat-gram allowance. Pretty soon you’ll be selecting foods throughout the day and zeroing right in on your fat target without even consulting a chart or table. Millions have done it. Trust me.
But not all fat is the same. The difference is in the degree of saturation of the fat molecule. The more hydrogen atoms are attached to the fat molecule, the more saturated it is said to be. The more saturated a fat is, the more it tends to clog arteries. The saturated fats are solid or semi-solid at room temperature. The reason butter is harder to spread than margarine straight out of the refrigerator is that butter has more saturated fat.
Unsaturated fats fall into two categories: polyunsaturated and monounsaturated. The distinction comes, again, from the number of hydrogen atoms involved, or, conversely, how many spaces on the fat molecule are not occupied by a hydrogen atom. At first one might think, therefore, that polyunsaturated fats would be a far better choice than monounsaturated fats, since the former have more spaces unfilled by hydrogen atoms. For years, that was the consensus in the scientific and medical communities.
But there was one flaw in that reasoning. Many populations in the world consume a vast amount of monounsaturated fat in the form of olive oil, yet have very low rates of heart disease. To briefly summarise the many research projects that followed, we now know that monounsaturated fats can lower cholesterol levels as effectively as polyunsaturated fats when used to replace saturated fats in the diet. In fact, the monounsaturated fats may have a slight edge in view of the indication that they tend to reduce the bad LDL cholesterol selectively, leaving the good HDL untouched. Polyunsaturated fats tend to lower all types of cholesterol.
We’ll discuss specific fats and oils in the section of this chapter that deals with shopping and selecting foods. Needless to say, you’ll want to choose those with less saturated fats. But all foods contain a profile of saturated, polyunsaturated and monounsaturated fats. That’s true across the board, for butter as well as for oil. See Table 7 (page 329) for a comparison of fats and oils.
As much as we’ve heard about dietary cholesterol, and food manufacturers have rushed to satisfy consumer’s demands by advertising “Cholesterol-free” this and “No-cholesterol” that, it turns out that saturated fat raises cholesterol levels in the blood more than dietary cholesterol itself. Indeed, much of the advertising is sheer nonsense, since cholesterol comes only from animal foods, never from plant foods. Thus all olive oil and all peanut butter is cholesterol free.
Actually, by leaning towards foods of plant rather than animal origin, one can cut way back on saturated fats and can eliminate cholesterol entirely. There are only a few exceptions. Avocados, olives and nuts are high in fat and must be consumed in moderation. Again, don’t eliminate, but moderate. See Table 6 for specifics. And the so-called tropical oils—coconut oil, palm oil and palm kernel oil—are high in saturated fats. Fortunately, as a result of consumer demands, manufacturers are removing the offending oils from their foods.
Unfortunately, they’re replacing the tropical oils with hydrogenated oils. This has led to something of a controversy. By adding hydrogen atoms to corn oil, soybean oil and so forth, manufacturers prolong the shelf life and consumer acceptance of their food products. But this makes those oils mote saturated, and thus more likely to raise cholesterol levels in the blood and to clog arteries. While the hydrogenated or partially hydrogenated soybean oil in a food is a far cry better than the tropical oil or the lard it replaced, it’s not as good as the pure soybean oil would be.
Some researchers aren’t as concerned about this, however, pointing out that one must be more careful in observing what really happens to those fats during the hydrogenation process. First, some of the polyunsaturated fats may be converted to monounsaturated fats; as we’ve already seen, that’s not at all bad. Second, not all saturated fats are as artery-clogging as others. The one most commonly formed saturated fat during hydrogenation, stearic acid, apparently has little or no effect on raising cholesterol levels in the blood and, it would be expected, has less tendency to block arteries.
But another wrinkle has entered the hydrogenation dilemma. Some researchers are now concerned that such molecular manipulation changed the naturally occurring cis configuration of the molecule to the abnormal trans configuration. Apparently the trans fats are more artery-clogging than the cis types. You can expect to see and hear more about this in the coming months and years, as more research is done. In the meantime, bear in mind that the amount of trans fats fed in experimental diets being quoted is far higher than almost anyone could possibly expect to eat, even on a very high-fat diet.
The bottom line is to keep all fat intake as low as practical and possible. That’s especially true for saturated fats.
But what about cholesterol? A maximum of 300 milligrams should be consumed daily, no more than 100 milligrams per 4200 kilojoules eaten. But even that’s not good enough for someone who needs to lower his or her elevated cholesterol, especially those individuals who have established heart disease. For those of us in that situation, the ceiling should be 100 milligrams daily, certainly no more than 150 milligrams.
Actually that’s not so hard to do. When you get rid of the saturated fat in animal foods, you automatically get rid of the cholesterol. By switching from whole milk to skim milk you go from more than 10 grams of fat to a mere fraction of a gram. At the same time, you drop from 30 milligrams of cholesterol to only a fraction in a 250 ml glass. Choose a cheese substitute over the regular cheddar, and the cholesterol is completely gone.
Take another look at Table 6 and notice the amount of cholesterol in the foods you’re likely to eat. It’s not all that difficult to limit yourself to 100 to 150 milligrams of cholesterol daily.
You’ll be happy to learn that previous listings of cholesterol in shellfish were inaccurate. Clams, oysters, mussels and scallops are actually very low in both fat and cholesterol. Crab and lobster are extremely low in fat, and have a fairly reasonable amount of cholesterol. Only shrimp (prawns) are relatively high; but they’re virtually devoid of fat. Eating 115 grams of shrimp (obviously not deep-fried) will not exceed your cholesterol limit for the day.
The cholesterol-laden foods to avoid or completely eliminate are egg yolks and organ meats. Fortunately there are a number of very acceptable egg substitutes on the market. Remember, too, that egg whites have absolutely no cholesterol and virtually no fat. And very few of us will bemoan the loss of liver and kidneys and brains from the diet!
While discussing cholesterol, it might be worth noting that even though dietary cholesterol does not elevate cholesterol levels in the blood as much as saturated fat does, it might have problems of its own. Dr Jeremiah Stamler of Northwestern University in Chicago has found that cholesterol has an artery-clogging tendency above and beyond raising levels in the blood. He currently believes that cholesterol intake constitutes a separate and independent risk of atherosclerosis. For those of us whose arteries are already blocked, that’s a real consideration, and another reason to stick with the 100- to 150-milligram daily limit.
Since cholesterol is found only in animal foods, when we reduce the saturated fat by cutting back on those foods, we also limit our cholesterol intake. The foods that are particularly high in cholesterol, though relatively low in saturated fat, are egg yolks, shrimp, squid, crayfish and organ meats.
I can just picture the look of doom and gloom on your face by this point. “Damn it, I won’t be able to eat the kinds of foods that I love. Who wants to live like that?” I wish that you could see the way my family and I eat! That would completely change your attitude, and fast. We love meatloaf and mashed potatoes, pizzas, hamburgers, omelettes and all sorts of things that are probably your favourites as well. But we take advantage of the tricks I’ve learned over the past few years, along with the new foods that have hit the market recently. Believe me, my way of eating represents zero deprivation.
After writing The 8-Week Cholesterol Cure, I received hundreds of letters. Many admitted that they were amazed that they could reduce their cholesterol levels so effectively without feeling at all deprived. You can do it also. Maybe you’ll even write me a letter yourself. Send it to me at PO Box 2039, Venice, CA, United States 90294.
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Cardio & Blood/ Cholesterol
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ENJOYING A HEART-HEALTHY DIET: TESTING FOR CHOLESTEROL

Posted by admin on 2010-06-02T13:17:34+0000">June 2, 2010 – 1:17 pm
It’s important to realise that your cholesterol level can vary considerably from day to day and month to month, even if you don’t change a thing in your diet. Unlike an absolute number such as your body temperature at exactly 98.6°F/36.7°C (unless you have a fever), cholesterol levels represent a range from the low end to the high end. Daily variability may range a full five per cent in either direction.
Thus if your cholesterol reading comes in at 5.2, it might mean that it could be 5.4 or 4.9 tomorrow. Or, of course, that number could represent the high or low end of your particular range.
Moreover, a number of things can influence your count. Stress plays an important role. Accountants demonstrate a higher cholesterol level prior to the tax deadline; it drops back down once the deadline passes. Medical students have shown a cholesterol increase just before major examinations. Even world-class athletes concerned about an upcoming event will experience a rise in cholesterol levels.
An illness can cause fluctuation, so it’s best not to have a test done when you’re suffering from the flu. Women will show a variation during their menstrual period. Your level will be higher in the winter than during summer months.
But don’t throw your hands up in despair. All this means that you shouldn’t trust a single number. That’s especially true for those who’ve just had a heart attack or bypass surgery, both of which can result in an abnormally low count. To have an accurate assessment of your cholesterol level, you should consider the average of at least three separate tests. If your cholesterol test comes in at well over 6.5 each of those times, it’s quite certain that you have a problem to contend with.
There’s been a bit of media publicity regarding testing accuracy. So how can you be sure of your own measurements? The most accurate cholesterol tests are performed in hospital laboratories, where the equipment is regularly serviced and calibrated for both accuracy and precision. Fingerprick tests such as you might see at a shopping mall or supermarket are fine as a way to monitor your levels, but you must realise that they will probably not be as accurate as those processed at a fully equipped laboratory. On the other hand, if the equipment is properly maintained and the personnel are well trained, one can expect a quite accurate measurement from a fingerprick test.
Regardless of the site or method of your test, you can take certain steps to ensure accuracy. If your doctor orders a laboratory test, he’ll probably want a full lipid profile; that is, a complete breakdown of total cholesterol, HDL and LDL cholesterol, and triglycerides. Fasting 12 to 14 hours prior to the test ensures an accurate measure of the triglycerides, and that number is used to calculate the level of LDL in your blood. Fasting is not required if only the total and/or HDL cholesterol will be measured.
Foods eaten the day before a cholesterol test will have little effect on the results, as long as the 12- to 14-hour fast is observed. The effect of a high-fat, high-cholesterol meal takes two to three days to show up in the cholesterol count.
If you have a fingerprick test, rest seated for about five minutes prior to blood drawing. Make sure your hands are warm so that the technician will not have to “milk” a drop of blood from your finger. Such milking results in inaccurately low tests. If cold hands are the result of inclement weather, keep your hands in your pockets during your five-minute rest. If they are cold as the result of stress, take those five minutes to do some deep breathing or biofeedback.
How do your cholesterol levels match up with others in the population? Compare yours with the tabulations in Tables 5A-5F (pages 316-18).
Women should note that their HDL levels typically are much higher than those for men. While a high total cholesterol count may be an initial cause for alarm, it may be balanced out by a very high HDL level. It is an unfortunate reality that many women today are being treated aggressively, perhaps even with drugs, for elevated cholesterol measurements when those elevations may be largely due to high levels of the protective HDLs.
Why might your cholesterol level be high? While we’ve heard so much about diet during the past few years, your eating habits may not be the only reason for cholesterol elevations.
Indeed, a significant part of the problem was inherited from your parents and grandparents. Some people are simply more genetically programmed to produce large amounts of cholesterol in their livers. Eating a high-fat, high-cholesterol diet just makes matters worse.
Other medical conditions also play significant roles. Hypothyroidism can result in cholesterol elevations. So can diabetes and menopause. Moreover, certain medications, such as antihypertensive drugs, can raise cholesterol levels. Your doctor will want to take all of these into consideration in diagnosing your own condition. But to effectively control your cholesterol, you have to play the principal role.
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Cardio & Blood/ Cholesterol
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THE SICK BABY AND CHILD: APPARENT LIFE THREATENING EPISODES (ALTE)

Posted by admin on 2009-05-21T07:09:15+0000">May 21, 2009 – 7:09 am

A number of babies have these episodes, which in the past have sometimes been called ‘near miss SIDS’. The baby is found limp, sometimes blue, sometimes unconscious or unresponsive and not breathing. Varying degrees of stimulation seem necessary to revive him, ranging from noise or gentle movement of a limb to full blown resuscitation including mouth to mouth. This is obviously a very frightening event for parents, and these babies are usually admitted to hospital for close monitoring and investigation.

The causes of these episodes are varied and include: convulsions (fits); choking episodes, sometimes due to gastro-oesophageal reflux (food coming up from the stomach and going down the wrong way); cardiac arrhythmias, where the heart loses its rhythm; apnoeic episodes where the baby ‘forgets’ to breathe, which is usually due to an immature central nervous system. Most often, no cause at all is found.

The relationship between ALTE’s and later SIDS is uncertain. If a cause is found for the episode, this is treated. If no cause is found, the parents are assured that it is unlikely to happen again. Sometimes an apnoea alarm is used for a time in case the baby stops breathing again. This is a mat containing wires that sense the movement the baby makes when he breathes. If the movement stops for a predetermined period of time, then an alarm is triggered. However, the use of apnoea alarms is not without its problems. They are not 100% reliable, and great anxiety is engendered in parents, who often say they lie awake at night listening for the alarm to go off.

The whole area of SIDS, ALTE’s and apnoea alarms is complex, and advice about home monitoring and other aspects of prevention of SIDS is best obtained from the local children’s hospital or your doctor.

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PREGNANCY/EVERY DAY LIFE: ANTENATAL CARE AND DIAGNOSIS

Posted by admin on 2009-05-19T06:26:15+0000">May 19, 2009 – 6:26 am

We strongly advise that throughout the course of your pregnancy you have regular antenatal (before birth) check-ups, to monitor that all is going well. These are usually routine and involve physical examination as well as blood and urine tests and ultrasound. The advantage of regular check-ups is that if any problems arise during the pregnancy, they can be diagnosed and treated promptly.

In certain circumstances your doctor may recommend more involved tests, which are used to identify certain congenital or hereditary disorders in the foetus before birth. Before you undergo any of these tests, we strongly advise you to discuss the details with your doctor. You and your partner may experience a lot of stress making decisions about having tests, waiting for their results, and then being confronted with what to do if they reveal an abnormality. Talk about it beforehand, and make sure you both understand the full implications of these tests.

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