Starches, because of their more compound nature, have been thought to be more slowly digested and therefore to offer great benefits in the treatment of disease such as diabetes and for fat loss. However, recently it has been shown that digestion and metabolism are not that simple. The speed with which carbohydrates are broken down and absorbed is not simply determined by whether they are ‘simple’ or ‘complex’ and another measure has been developed to classify this.

The Glycaemic Index (GI) is a method of classifying the glycaemic (i.e. blood sugar) response to carbohydrate-rich foods. Put another way, it is a measure of how quickly carbohydrate reaches the bloodstream. Foods can be tested and ranked according to a measure of their GI. The GI is calculated by measuring the area under the curve (of glycaemia) versus time, after consuming a food containing 50g of available carbohydrate by comparison with 50g of reference food (either glucose or white bread). Blood glucose testing is carried out every 15-30 minutes for 2-3 hours.

The lower the GI of a food, the flatter the curve of blood glucose response, meaning the slower this is digested and converted to blood sugar.

It does not necessarily follow that all sweet sugary foods will be quickly absorbed and therefore have a high GI. It is much more complex and depends on a number of characteristics of the food consumed, e.g.:

Type of sugar—Glucose (GI = 100) has a higher GI than fructose (GI = 20). Temperate fruits (e.g. apples, pears, oranges) have a higher fructose content and therefore lower GI than tropical fruits (e.g. watermelon, rockmelon, mangoes).

Nature of the starch—The ratio of two types of starches (amylose: amylopectin) can affect the GI of foods. Amylopectin is more easily digested than amylose. Therefore, foods such as legumes, with a high amylose: amylopectin ratio have a lower GI than rice which has a higher amylopectin content.

Processing and particle size—Food particle size is a determinant of GI. This is shown with bread processing. Whole meal bread has a finer texture than rye bread and thus a higher GI.

Cooking methods—Cooking affects the degree of gelatinisation of fruits and thus GI. Stewed fruits have a higher GI than fresh fruits.

Starch-nutrient interactions—Carbohydrate forms molecular complexes with fats and proteins. This happens, for example, in a baked cake where GI will be reduced.

Fat—Large amounts can reduce GI (e.g. in ice cream) and hence high-fat foods may have a desirable GI but still be undesirable in terms of energy content.

Fibre—This depends on type of fibre. Insoluble fibre appears to have no immediate effects. However, soluble fibre (e.g. guar gum) can decrease the rate of absorption of glucose and hence decrease GI. Fibre supplements will not have the same effect because the fibre is not packaged into the food. Resistant starch will also lower the GI of a food.

Taking these properties into account we can see why, in Table 9.3, wholemeal bread has a higher GI than rye bread and a pineapple has a higher GI than an apple. GI is not a simple function of the sugar content of foods and detailed tables showing the GIs of a wide variety of foods are now available.

There are day-to-day variations in GI due to physiological effects, and the GI of component foods can predict the likely effect of a meal. Sydney University studies have shown that low-GI foods may be beneficial for fat loss as they decrease hunger ratings. Due to the slower absorption of low-GI foods, they may result in less rapid fluctuations in blood glucose and appetite changes for some individuals.

Australian researchers are leading the world in GI research. For more information on this evolving topic, please refer to The GI Factor by Sydney University’s Professor Jennie Brand Miller.

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It is usual for the partner to have a sperm test before the woman undergoes any testing.

The reason for this is that a sperm test is a simple procedure and certainly the most convenient of all fertility tests.

A sperm analysis is carried out to see if sperm are present, how many there are, how many are moving (motility) and how many are normal (morphology). The analysis also establishes if there is an infection in the reproductive tract and whether there are any sperm antibodies present. The testing of these factors will give a guide to your partner’s potential for fertility.

The sperm sample must be taken to the testing laboratory within an hour of collection as a delay may harm the specimen. Most infertility experts advise that intercourse should be delayed for at least three days before the sample is taken as a shorter period may affect the volume and sperm numbers.

A recent illness can affect the quality of the sperm, so if your partner has had a cold or flu recently it may be advisable to repeat the sample if the results are not favourable. Your doctor will advise if this is necessary.

Some medications may also affect the quality of sperm so, again, advise your doctor if your partner is on any medication.

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CT scans (computerised tomography) and ordinary X-rays are of no value in the diagnosis and monitoring of endometriosis. Ultrasound can have a role in some situations.

Ultrasound involves the use of high frequency sound waves to create an image or picture of the body on a screen or film. Over the last decade it has been used increasingly in the diagnosis and management of a number of gynaecological and obstetrical conditions, including the detection of ovarian cysts and determining the age and size of a foetus in early pregnancy.

Ultrasound has a limited role in the diagnosis and monitoring of endometriosis. At present, the machines used are not sensitive enough to detect small implants and adhesions. They can only detect cysts greater than two centimetres in diameter and determine their size and location. Ultrasound cannot determine the nature of a cyst nor can it distinguish it from other types of cysts or conditions.

Ultrasound should not be used as a substitute for laparoscopy to diagnose endometriosis. Its use is limited to confirming the existence of a cyst felt during a pelvic examination and determining its size and location prior to surgery. In some circumstances ultrasound may be used to help monitor the change in the size of a cyst after a laparoscopic diagnosis has been made.

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Zinc is one of the most important minerals in our diet and has antioxidant properties. Two hundred enzyme reactions in the body require zinc, some being the production of protein and tissue. This is why it is such an important mineral for growth and healing.

It is important for healing wounds and skin disorders such as acne and herpes, formation of the bones, the health of the immune system, slowing down the aging process, the sexual development of adolescents and the sexual function of men.

Men can lose up to 1 mg of zinc each time they ejaculate. Zinc may help prevent the enlargement of the prostate gland as it is believed to regulate the metabolism of testosterone.

It is also now thought a zinc deficiency may contribute to anorexia nervosa.

There is a deficiency of zinc in Australian soils and so there is a need to both eat foods which are high in zinc and to supplement the diet with zinc up to 15 mg a day. Signs of a deficiency include: white spots under the nails; skin disorders such as acne; slow healing of wounds; retarded growth and slow sexual development in children, loss of appetite, confused sense of taste, smell and sight; low resistance to infections indicating poor immune response and low sex drive which could lead to prostate problems in later life for men.

Diabetics excrete zinc excessively. Alcohol inhibits the absorption of zinc from the gut and alcoholics always have a zinc deficiency. Vegetarians are also prone to zinc deficiency as a result of a high roughage diet and poor absorption of the mineral from the gut.

Zinc is found in eggs, liver, oysters, beef, chicken, fish, wheat, rice, legumes, corn, Brazil nuts, sesame seeds and pumpkin seeds.

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One major difference between sadness and depression is that the latter is often accompanied by changes in biological functioning. These biological changes are among the most reliable tell-tale signs of depression, and when doctors and therapists look for depression they carefully inquire about changes in sleeping, eating, weight and sex drive. You should certainly pay special attention to these important behavioural functions in evaluating whether you are depressed and, if so, how severely depressed you are.

In depression, sleep is often disrupted. Some depressed people have trouble falling asleep; others toss and turn or wake during the night; and early morning waking, often with difficulty returning to sleep, is very common. Sleep doesn’t seem to have its usual renewing properties and people are often left feeling tired during the day and desperate at night for sleep that stubbornly refuses to arrive. Some depressed patients sleep too much, at times for hours each day more than is normal for them and yet, once again, find that no matter how much they sleep, they still don’t end up feeling refreshed.

These two patterns of sleep disruption – insomnia and oversleeping — may signal two distinct types of depression, one representing a state of hypervigilant overarousal and the other a state of torpid underarousal. These patterns may reflect exaggerations of different types of response to stress.

When people (or animals, for that matter) are stressed, a part of the brain known as the hypothalamus activates a stress-response system, which results in release of certain hormones from the adrenal glands, particularly Cortisol. In addition, the fight-and-flight part of the nervous system, known as the sympathetic nervous system, is activated. These changes result in arousal and vigilance, qualities that are necessary for combating stress, and are associated with decreases in sleep and appetite. The type of depression associated with decreased sleep and appetite and weight loss may represent an exaggeration of these arousal responses. Evidence to support this theory is found in the form of elevated Cortisol levels in the circulation and other signs of overactivity of the stress-responsive hormonal system in these depressed patients.

The heightened arousal and vigilance that are part of our normal response to stress should be time-limited in order to be most effective. Ideally, such responses should kick in following a stressful situation, such as the loss of a loved one, a physical challenge or an important deadline, and taper off when the stress has been successfully handled or resolved. In depression, the stress response may be triggered either by a definable stress or by some unknown factor, but whatever its original trigger it then takes on a life of its own, persisting long after the stress is over. Consider, for example, a person susceptible to depression who is told that he has lost a large sum of money on the stockmarket, whereupon he plummets into a deep depression. If that same person is told a week later that his stockbroker has made a mistake and that he has actually made a lot of money instead of losing it, will his depression immediately disappear? Probably not. Such is the nature of depression that once it gets going, it can continue indefinitely. As you can imagine, this wears the system out and the person is left feeling exhausted and depleted.

The second type of depression – the one associated with oversleeping, overeating and weight gain – may represent an exaggeration of the energy-conserving responses seen frequently in animals. The hibernating bear, for example, goes into a state of low activity and torpor designed to conserve its energy and resources. Such shutting down of bodily activities enables the bear to make it through a winter of severe weather and scarce food. Most people with seasonal affective disorder (SAD), many of whom compare themselves to hibernating bears, experience this second type of depression and tend to oversleep, as well as overeat and gain weight, during their winter depressions.

Withdrawal and seclusion often occur in animals as a response to stress or injury as part of the recovery process. An injured lion, for example, will retreat to its lair until its wounds have healed before venturing back out into the savannahs and exposing itself to the dangers of the wild. An infant monkey separated from its mother initially goes into a state where it cries out pitifully, which was termed the stage of protest by John Bowlby, a pioneer in the area of separation and loss. Later the infant goes into another state that Bowlby called detachment, where it withdraws from contact with other animals. It has been suggested that these stages are ways by which the animal adapts to the loss of its mother. Initially, it makes noises, which would have the function of attracting the attention of the mother, who might not be far away. After a while, however, if the mother has not responded, the infant goes into a state of withdrawal at this point and waits until another parental figure might chance to come along. In the course of evolution, it has probably proven far more adaptive for the infant not to carry on crying, which might attract a predator, and instead to go into this detached state. There is a final stage that has been described in such separated infant monkeys – a stage of reattachment, whereby the infant will reattach to such a new parental figure that might arrive on the scene. Over the millennia, certain adaptive behavioural changes to injury and loss have evolved so as to maximize the chance of survival. It has been suggested that some of the behavioural and physical symptoms of depression may represent disturbances of the normal biological systems responsible for mediating such adaptive responses.

When an animal is stressed, the emphasis is on survival, as well it should be. Having sex is the last thing that will be on that animal’s mind. And so it is that with the depressed person, the sex drive diminishes and may shut off completely. Every aspect of sexual functioning may be affected – arousal, enjoyment of sex and the capacity to function. Needless to say, this does not much help the self-esteem of the depressed person, which is already at a very low ebb.

So we see that in depression there may be an exaggeration of some of our very useful responses to the stresses and challenges that life deals us. When these responses – such as hypervigilance or excessive withdrawal – go too far, they hinder rather than help our ability to adapt. They continue for much too long and we are unable to turn them off by an act of will.

If your sleeping, eating, weight control and interest in sex are disturbed and this has been going on for more than a few weeks, consider the possibility that you may be suffering from depression.

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How to heat a home according to sound, ecologic principles is a topic beyond the scope of this book (see “Suggested Reading”). However, certain basic guidelines can be given to those responsible for this area of domestic life. First, it is a good idea to have a heating engineer recheck the efficiency and safety of the heating system periodically. This will minimize undetected leaks or breaks in the system and save money, as well as trips to the doctor.

If a chemically susceptible person has a gas-fired heating system, he has to consider changing it, or changing houses, regardless of the immediate cost. The reason is that it is difficult for a susceptible person to remain in anything resembling good health if he is subjected to the fumes of such a system.

An oil-fired heating system may also present a danger, since the fumes of the oil and its combustion products can often make their way into the living quarters of the house. If the oil is accidentally spilled, it is almost impossible ever to remove it, and fumes and odors will continue to contaminate the vicinity of the burner and beyond.

The ideal solution is to remove the heating unit from the house and locate it in a separate area or building of its own, so that only the hot water pipes enter the house. Installing electric heat, with or without solar heat, is another alternative.

For those in apartment houses who have a choice, it is best to live as far from the boiler room as possible. Steam or hot water radiators, on floors other than the ground level, are fairly good ecologically. It is a good idea to clean the radiators periodically and to give them an especially thorough cleaning in the fall before the heat is turned on.

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Not long ago, a Bulgarian political refugee in London died three days after a mysterious stranger jabbed him in the leg with a sharpened umbrella tip. Autopsy revealed a minute hollow pellet deep in his wound that, it was believed, contained a fatal poison.

From the nature of his slow death, it was determined that this substance was ricin, an intensely toxic substance (more poisonous than snake venom) present in the castor oil bean. It is not present in castor oil but remains in the bean “cake” after the oil has been extracted. The cake can be rendered safe for human consumption by cooking and is used as staple food in several parts of the world, including Mexico.

Mexicans and Caribbean islanders employ the attractive looking castor oil bean to make necklaces and other jewelry for the tourist trade. According to Toxicology, there have been serious reactions and deaths when people have eaten one of these beans or have merely crushed one in their fingers and subsequently put their fingers in their mouths. Ricin causes drastic purging with bloody diarrhea, shivering, fever, violent vomiting, and shock. Even a minute trace in a scratch can be fatal. So, when shopping abroad for trinkets, avoid buying castor oil bean jewelry.

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Signs and symptoms

Heat rash consists of hundreds of tiny pinhead eruptions, each surrounding a skin pore. These eruptions may look like small pink or red bumps or like tiny water blisters. They are moderately itchy and may show scratch marks. If you look at the rash with a magnifying glass in good light, each dot of heat rash can be seen at the mouth of a pore from a sweat gland.

The rash usually appears on the cheeks, neck, or shoulders, in skin creases, and in the nappy area. It frequently appears if the child has been wearing a wet bathing suit. Hot humid conditions, perspiration, and overdressing are further clues that the rash is heat rash.

Home care

Infants and children are safest from heat rash in an air-conditioned environment. Keep a child with heat rash as cool as possible. Cool baths, or baby powder or corn flour applied lightly with a powder puff, help ease the condition. If the heat rash is on your baby’s face, rest the child’s face on an absorbent pad in the crib. During warm weather, using prickly heat powders may give some relief.

Precautions

• Be careful with powder. If a baby inhales a large amount of powder, inflammation of the lungs can occur.

• Detergents and bleaches in clothing and bed linens may aggravate heat rash.

• Bubble baths, water softeners, and oily lotions should be avoided.

• Do not overdress the child. The clothing that’s appropriate to the weather for you is also appropriate for the baby.

Medical treatment

A doctor’s treatment is not necessary. Heat rash can be adequately and safely treated at home.

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It seems like we’ll do anything for kicks. Careen down rocky mountain trails on a bicycle? You bet. Strap skis to our feet and get dragged behind a boat? Sounds like a blast. Surprisingly (and fortunately), as reckless and dangerous as the activities we call sport may sound, they don’t often kill us. More often, they just beat the crap out of us.

Plenty of weekend warriors are injured in sports like basketball, bicycling, football, and Softball. They’re rarely deadly, but collectively, they report astronomical injury rates, which is where the trouble really lies. We hardly have to tell you that, even if injuries don’t kill you, they can sure take their toll on your body over time. And serious injuries, such as those to the head, neck, or back, can cause permanent debilitating problems like brain damage and paralysis.

“That’s why we encourage people to take just a few minor precautions during their recreational activities,” says Dr. Jeffrey Sacks of the National Center for Injury Prevention and Control.

By following a few basic rules, you can put your safest foot forward next time you step out to play.

Put the beer on ice. Alcohol is an enormous factor in recreational injuries, Dr. Sacks says. So don’t be stupid. “When you’re drowning from a waterskiing incident because you’re drunk, that’s no accident. That’s preventable. Save the beer for afterward,” says Dr. Sacks.

Get in gear. “Some men always seem surprised by their concussions, as if you can’t bruise your brain playing backyard football,” Dr. Sacks says. “A helmet is the best protection you can get for riskier activities, especially football, biking, and other wheel sports like inline skating.”

Take charge. We have a whole industry devoted to “adventure travel” where people do relatively risky activities rather safely, says Dr. Alton Thygerson of Brigham Young University and the National Safety Council’s First-Aid Institute. “That’s because the folks in charge know what they’re doing. You can help prevent being another accident statistic by learning the fundamentals of an activity before you start, especially ones that involve some risk like water sports or mountain biking.”

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The discussion of the side-effects of treatments in this section should not be seen as alarmist propaganda. It is important that this point be appreciated because, unfortunately, such techniques are used in some types of sales drives. The purpose of describing these effects in the following discussion is that they have a very important role in medicine. Discussion of; any therapy without including the side-effects involved is completely invalid. There is another reason. This is that one of the parameters which must be used in comparing the value of any therapy with any other is that of the side-effects. p r instance, if two treatments are equal in their effectiveness for treating a particular condition but one of them exhibited undesirable side effects, then the one which did not would obviously be a better treatment, even though it was, overall, no more effective.

As this book will be connected primarily with rheumatoid and osteoarthritis it will be appropriate to reserve the discussion mainly to these two conditions.

Salicylate therapy

Starting with rheumatoid arthritis, it is probably true to say that the most universally preferred therapy by practicing clinicians is salycilate therapy. Put into simpler terms this usually means aspirin, although other forms of the compound are used. An example of another form is sodium salicylate.

Aspirin is the name given to a compound known chemically as acetyl salicylic acid which is now produced by synthetic means. It did, however, originate in the bark of trees, and before methods for synthesizing it were devised, extracts from the bark of the willow tree were, used in the treatment of rheumatic diseases.

Using acetyl salicylic acid as an example of salicylate therapy, it will be convenient to refer to it in the name of aspirin. There are some variations in effect of the various salicylates but this discussion will be of too general a nature to consider these.

Generally speaking, aspirin shows three beneficial effects: it is an anti-inflammatory, anti-pyretic and an analgaesic agent. It is almost certainly the drug in widest use in the treatment of rheumatoid arthritis and has been used in this way since the beginning of this century. With its anti-inflammatory and analgaesic action it eases pain in two ways. One is by direct pain-relieving action on the central nervous system; the other is by reducing inflammation and thus relieving the pain created at the inflammatory site. It is possible that the anti-pyretic (heat or temperature lowering property) may only be applicable in fever conditions. The effects of salicylate therapy tend to be felt quickly, bringing rapid relief. The duration of relief, however, may not be more than a few hours, thus necessitating repeat doses at frequent intervals.

Side-effects of salicylates

Taking a brief look now at the negative side of this particular therapy (the side-effects) it will be found that regular consumption of salicylates, even in small doses, may induce gastric problems. The most common and the most serious problem is gastric hemorrhage and ulceration. A lot of research has been carried out on this topic and it is believed that factors other than the straight consumption of salicylate can influence the degree of severity of this type of damage) For instance it would be fairly obvious to most people that the taking of aspirin on an empty stomach would be more likely to cause gastric upset and damage than if taken ink conjunction with a meal. However, the degree to which stress, such as tiredness, emotion, or perhaps exposure to adverse climatic conditions, may have an adverse effect is not known. The fact that stress conditions, in conjunction with aspirin, can lead to a marked increase in the severity of gastric damage compared with aspirin alone has been demonstrated in laboratory tests on animals.

If large doses of salicylates are being consumed, then in addition to bleeding and ulceration, effects such as nausea, dizziness, kidney problems and partial deafness can occur.

It must be remembered that people differ considerably in their reactions and responses to pain and to drugs, etc. Thus, there is no hard and fast rule as to the effect that a particular person might anticipate from a given amount of drug. As will already have been realized, apart from many external factors, it also depends very much on the individual and the situation involved.

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