Mens Health Blog. Medical Blog

You may think that atherosclerosis is just a disease whereby fat accumulates on the inner lining of your arteries. The fatter you eat, the more fat accumulates inside your arteries and the greater your chances of having a heart attack. This was what the medical community believed for many years, and it is still what the majority of the public believes. This is a very simplistic view, and we now know that atherosclerosis is a much more complex process.

Scientists have discovered that inflammation is involved in every stage of atherosclerosis, from the beginning when a fatty streak develops, right through to the end when the fatty plaque breaks off and causes a blood clot which blocks blood flow in an artery, causing a heart attack. Inflammation is the way our body responds to injury. We can usually tell a part of our body is inflamed when it is red, hot, swollen and we can’t move it properly. Think of a stubbed toe or a sprained ankle. Inflammation is present in all “itis” conditions, such as arthritis, hepatitis, bursitis, and many others. It is a normal reaction by our immune system to infection or injury. However, inflammation can also occur inside our body in a much more silent way, where we don’t even know it is happening.

Inflammation can trigger the release of substances into our bloodstream that damage the inner lining of arteries. Cholesterol in the bloodstream can then put a protective coating over this damage. Cholesterol has a healing, protective quality; large amounts of it are present in scar tissue. As the damage to our arteries gets worse, more cholesterol accumulates, the fatty plaque grows and our arteries narrow.

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The sound of air being sucked through partially collapsed airways and the vibration of the soft palate is evidence of obstructed airflow. As snoring becomes more severe, there may be further limitation of airflow with the possibility of complete airway collapse and no movement of air whatsoever. A situation where there is no effective movement of air to ventilate the lungs is termed apnoea and it follows that those who experience collapse of the upper airway with a subsequent loss of ventilation through either the nose or mouth during sleep, despite normal or increased efforts to breathe, are suffering from obstructive sleep apnoea (OSA). It is not uncommon for complete obstruction to occur several hundred times a night in advanced OSA.

Another form of apnoea occurs when no effort is made to breathe; a pause of 10 seconds or longer between breaths is commonly accepted as a significant apnoeic event. The rate at which we breathe and the volume of air taken in during inspiration is driven by the need to maintain a sufficient blood oxygen level. This is coordinated by a part of the brain called the respiratory control centre which, under normal circumstances, receives messages relating to the amount of oxygen in the blood and sends appropriate messages to the lungs to maintain that level. Sometimes there is a breakdown in either the message going to or being sent from the respiratory control centre so that there is no effective attempt to breathe. The pause in respiration resulting from an absent or inadequate message from the brain is called central apnoea. It is possible for snorers to suffer both obstructive and central apnoeas during sleep but we will be dealing mostly with the obstructive component.

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Here are some definitions from various learned sources:

Oxford English Dictionary Soundness of body: that condition in which its function is duly discharged.

Collins Dictionary The state of being bodily and mentally vigorous and free from disease.

World Health Organisation A state of complete physical, mental and social well-being.

Parsons The state of optimum capacity of an individual for the effective performance of valued tasks.

Rossdale The product of a harmonised relationship between man and his ecology.

Dubos A modus vivendi enabling men to achieve a rewarding and not too painful existence while they cope with an imperfect world.

Illich A process of adaptation. It is not the result of instinct, but of an autonomous yet culturally shaped reaction to socially created reality. It designates the ability to adapt to changing environments, to growing up and to ageing, to healing when damaged, to suffering and to the peaceful expectation of death. Health embraces the future as well, and therefore includes anguish and the inner resources to live with it.

It is easy to see how different these approaches are. Some stress an ideal state and others a more practical approach. Some focus on physical conditions and others have the widest possible perspectives.

Various researchers on the subject quite understandably express very different views, but it is increasingly accepted that health involves far more than simply physical and even mental well-being or the absence of disease. Vibrant health and terminal illness are the extremes of the spectrum but modern thinking increasingly stresses the need to be nearer the ‘vibrant health’ end than midway between the two.

This broader view of health sees it as a state in which the individual is energetic, integrated, productive and self-actualized. This begs all kinds of questions though about what a particular person’s ideas of fullness of life are for him or her. Obviously this sort of definition will vary from person to person and will depend on what individuals see as important in their lives. To some, physical wellness will be the most important part of their definition of health and to others psychological, emotional or spiritual factors will be of most value.

To some extent the way each of us defines health for ourselves depends on how we perceive illness. Some see illness as an intrinsic part of being a person-all human beings are destined to be ill in one way or another at some time in their lives-and to others it is only the way that we behave that makes us ill: perfect behaviour produces perfect health. The first group of people see health as a kind of battle and illness as some sort of evil spell that is put on mankind. This sort of thinking has very ancient roots going back to pre-Biblical times but it has been crystallized for Judaeo-Christian societies in the story of Adam and Eve. By going against the will of God, the story goes, they brought eternal suffering and illness on themselves. This line of thinking removes any personal responsibility for health because ill health becomes part of the divine plan for mankind and by definition can’t be influenced.

By now the reader will be able to see how difficult it is to define health and illness but it is essential to be aware of what we mean by these terms or we will not be able to think intelligently about prevention. Health and illness are not just personal matters though-they occur in a social setting and reflect a particular society’s values, traditions and structures. We shall see in the next section how different illnesses are dealt with in different cultures.

Of all the symptoms that people have, only a fraction are mentioned to other members of the family and even fewer are taken outside the family. Only a small proportion of all symptoms are taken to health professionals, so clearly there is a hidden mass of ‘disease’ which, like an iceberg, lies submerged within society. Illness usually starts in the family context and most diagnoses are made by people in their own homes, sometimes helped by family and friends. Often, professional help is sought in order to get reassurance that the diagnosis is correct, or to get a prescription for a drug. The health professional’s response is then relayed to the ‘social-medical advisory system’ of family and friends and action is taken that the person considers appropriate. At this stage the individual with the problem often comes to a different conclusion from that of the health professional-possibly because the individual has different perceptions of the problem and because he or she knows more about him or herself than the doctor does.

A subject that is very little discussed in medical circles but which is very important in this context is what makes an individual decide, on a particular day, to see a doctor, when the symptoms may have been present for some time without this decision being taken. In other words, few people in the illness iceberg see their doctors at the very first sign of illness, so what makes them go for professional help at a particular time? An understanding of this can often enable the doctor to get to the heart of the real problem very quickly.

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Goals can keep you motivated and moving in the right direction— if you set the right ones. But how do you know what goals to set, and how do you make them realistic?

The first rule is to start small. Establish daily or weekly mini-goals to change some aspect of your behavior that’s standing between you and weight-loss success. It can be as simple as eating air-popped popcorn while you watch TV, instead of your usual potato chips. Or walking your kids to school every morning, rather 3 than loading them into the minivan. |

As you start to feel better, you’ll naturally be inspired to set jloftier goals. You may decide to give up potato chips completely or to increase your walking time to a half-hour or even an hour a day. ) It’s good to keep updating your goals as you make progress, but be sure to keep them doable.

The second rute of goal setting is to write down your goals. Seeing them in front of you takes them from the abstract and [ makes them real. I have a friend who writes her goals on Post-It notes and sticks them on her bathroom mirror. They’re the first thing that she sees every morning, and they remind her of her new priorities.

However you choose to do it, keep your goals manageable and visible. Stick with them and watch them work!

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Pastry, pancakes and waffles can be made with rye flour although the results are heavier than with wheat, partly because rye flour is only available in wholemeal form. Putting the rye flour through a fine sieve first improves the quality by removing the larger pieces of husk from the flour, and adding some baking powder helps too. Pancakes can also be made with maize or barley flour, and taste pleasant although they are slightly rubbery – beat plenty of air into the mixture just before frying to improve the texture. Buckwheat flour is fairly protein-rich and makes a good pancake batter, but should be mixed with other flours to dilute the strong taste. Gluten-free mixes for pastry and pancakes can be bought by post and generally give excellent results.

Pasta made with gluten-free flour is obtainable by post. Or you can try rice noodles, obtainable in Chinese groceries, or buckwheat spaghetti, from healthfood stores.

Soya flour, gram flour and lentil flour are rich in protein, as well as carbohydrate. They can be used in baking, combined with other flours (see above under Gluten-free flours) and tend to improve the texture of pastry and pancakes.

Rice flour, potato flour, banana flour, chestnut flour, yam flour and other exotic flours are mostly low in protein. They are useful for making puddings and biscuits, or for thickening sauces (see below). Chestnut flour tastes sweet and nutty and is pleasant in shortbread or in a crumble topping for fruit, although it is rather heavy.

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You are probably suffering from caffeine withdrawal – or it might be the effects of cutting out alcohol. This is ‘cold turkey’ – the same sort of withdrawal symptoms that a heroin addict has, though nothing like as bad. You just have to keep going, in the knowledge that it will pass and you will then feel a great deal better than you did before. Not eating sugar might have similar effects until your body gets used to the idea.

It is most unlikely that you will still feel worse after two or three weeks. If you do, think about any other changes that have occurred. Could they be die cause? Or were you steadily getting worse anyway? If you’re sure it’s due to the diet then consider any new foods you are eating, or foods eaten in greater quantity than before. It may be that you are allergic or intolerant to such foods. Consider them suspect and cut them out in the exclusion phase of Stage 2. Alternatively, if you are eating a lot more fruit and vegetables than before, and if you are sensitive to pesticide residues, then this might explain your deterioration. Read Chapter Nine before going on to Stage 2.

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One discovery about enzyme deficiencies is particularly intriguing, because it may explain the link between hyperactivity in children and food colourings. Hyperactive children appear to be deficient in an enzyme known as phenolsulphotransferase-P or PST-P. This enzyme detoxifies various compounds, including a substance called p-cresol that is produced by bacteria in the gut. No-one has any idea how p-cresol might cause hyperactivity, but it is a phenol, and phenols can be toxic.

What is interesting about PST-P is that it can be inhibited by certain food colourings – in other words, the enzyme no longer works if those food colourings are present. If a normal, healthy child eats colouring of this type in moderation, it will not do any apparent harm because that child’s PST-P is fully active to begin with. But for a child with defective PST-P, the same amount of colouring could reduce the level of PST-P activity to damaging levels.

It is interesting that a high proportion of patients with migraine, who are affected by dietary triggers such as cheese and chocolate, also have a defect in PST-P. Wine, like some food colourings, appears to inhibit PST-P, and this may contribute to the effects of red wine in triggering migraines. It is likely that enzyme defects play a part in migraine, because migraine sufferers tend to be defective for certain enzymes, but exactly what goes wrong is far from clear. The chemicals that are under suspicion of triggering migraine – tyramine and phenylethylamine – are not detoxified by PST-P. Tyramine is detoxified by a related enzyme called PST-M, but this is generally not lacking in migraine sufferers. This is a puzzle that can only be sorted out by more research. For more on enzyme defects in migraine.

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Carbohydrates – the ‘starchy’ substances in foods – are restricted to 80 gm per day. This effectively means no potatoes, bread, flour, rice, breakfast cereals, pasta or other starchy foods, except for one very small portion each day. The incidental carbohydrate in vegetables, nuts and other foods will account for most of your daily allowance. High-carbohydrate vegetables such as sweetcorn, peas, parsnip, lentils and broad beans should be avoided. Nuts can be eaten in moderation, but not cashew nuts as they are rich in carbohydrate. Continue to eat plenty of garlic and fresh, green leafy vegetables.

If the Candida proves resistant to these measures, then drug treatments may be the only answer. The drug most widely used is nystatin. Although this is available in tablet form it is often prescribed as a powder, to be taken mixed with water – this combats Candida in the mouth and throat, as well as in the intestines. Nystatin is not absorbed from the gut and is a remarkably safe drug when taken by mouth. However, there are rare instances of individuals proving sensitive to it, and vomiting and diarrhoea can occur at very high doses.

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The medical controversy about adverse reactions to food is compounded by a long-running dispute over the meaning of allergy. For a word that is scarcely more than 80 years old, it has had a very chequered career. A Viennese doctor, Baron Clemens von Pirquet, first used it in 1906 to mean ‘altered reactivity’. Von Pirquet was a paediatrician and he felt the need for a new medical term to describe certain reactions in his young patients. These changed reactions included the development of immunity to infection, on the one hand, and marked reactions to certain foods, pollen or insect stings, on the other. He was principally concerned with reactions involving the immune system, the set of cells that protect our bodies from infection. But he apparently intended his newly coined word to mean any altered response to the environment. In this context, environment means all the external things that can affect the body, whether in food or water, in the air we breathe, or in things that come into contact with our skin. Von Pirquet also introduced the word allergen to describe the substances that brought about these changed reactions.

At that stage, very little was known about how some of these reactions might arise. The following decades brought greater understanding, and the meaning of allergies was narrowed down – the development of immunity to disease was dropped from the definition, because it was obviously something quite different from adverse reactions to food, pollen or bee stings.

In 1925, the definition of allergy was narrowed down still further. Experiments had shown that many adverse reactions to pollen or food could be transferred from one person to another by injecting a small amount of blood serum into the skin. The area around the injection site became very sensitive to the allergen. This, and other evidence, indicated that the immune system really was at work in these cases, as von Pirquet seems to have suspected. Most of those working in the field decided to limit the definition.

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Players: Husband and wife.

Activists: Both.

Setting: Home or hotel.

Aim: To arouse unconscious, unspoken judgments.

Game Plan: This is a simple game, but its results can be profound. It is for the narcissistic couple who started off in a twin-ship or idealizing transference but have drifted apart. Sometimes, in such cases, either there is little sex or it is rushed and orgasm comes too quickly or not at all. Sometimes one or the other feels disillusioned—even contemptuous toward the mate. Sometimes a quiet (and sometimes a loud) rage is expressed. Sometimes envy or possessiveness gets in the way of effective relating: The wife envies the husband’s job and mobility, and the husband is possessive of the wife.

During a weekend evening or other relaxed occasion, the husband and wife undress and entwine themselves face to face. A good position for this game is for the husband to lie across a bed with his back and head propped on pillows, and the wife to straddle him. After he enters her and they are one, they should gaze into one another’s eyes. Eye contact is important.

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