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MULTIPLE SCLEROSIS
The management of multiple sclerosis (MS) involves changing one’s diet and lifestyle and also taking specific supplements. This regime can help someone with MS improve, rather than get worse. Evening primrose oil is a very important nutritional supplement in the management of MS.
In particular, the kind of fat which someone eats seems to have a strong bearing on MS.
The geographical distribution of MS
One of the most marked features of MS is its geographical distribution. MS is a disease of temperate zones, and is virtually non-existent in the tropics. One of the key differences between areas of high and low incidence of MS seems to be the food that people eat.
In those places where MS is commonest, people eat a lot of dairy produce. In those places where MS occurrence is lowest, people eat more fish and vegetable oils. The difference between an area of high MS and low MS can be as little as a few miles. So some of the starkest contrasts in MS distribution are in Norway where MS is high in inland areas where dairy farming is practiced and low in coastal areas where people eat a lot of fish. Similarly in some Scottish islands, the rates of MS can fluctuate from very high to very low according to the main diet of the local people – high in areas of dairy farming and low in fishing areas.
One of the first doctors to look at the world map of MS was Professor Roy Swank, now based in Portland, Oregon, USA.
He first developed his famous Swank Low Fat Diet in 1948. Swank noticed several important clues. First, the amount of saturated fat in the typical American diet was rising dramatically. And as the consumption of saturated fat increased, so did the incidence of certain diseases – particularly MS, heart disease and stroke.
There were further clues for any medical detectives on the look-out during World War II. It was noticed that young American soldiers who had died of heart attacks during training and battle showed a greater degree of hardening of the arteries than their Oriental counterparts who ate mostly vegetables and rice.
In occupied Norway, fat consumption fell by 50% during food shortages. At the same time, there were significant reductions in death rates from heart attacks, and the rate of MS dropped too.
In the UK today, 40% of our diet is saturated fat. Around the world, tipping the balance of saturated/unsaturated fat in favour of saturated fats has coincided with an increase not just in MS, but also in cardiovascular (heart and stroke) diseases.
The amount of sugar we eat has increased enormously in the same period of time. Some nutritionists believe that humans were not designed to thrive on a high saturated fat plus high sugar diet. The rise in chronic disease coincides with these radical changes in diet in the western world.
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PROTEINS AND AMINO ACIDS: CLINICAL PROBLEMS
Protein deficiency is not common in the United States. Under certain circumstances an individual might be in negative nitrogen balance. This means that his body is breaking down protein tissues faster than they are being replaced. Thus the excretions contain more nitrogen than is being supplied by the diet. Just as overdrawing a bank account is not a good thing, so the excess removal of nitrogen from the tissue is also harmful. When negative nitrogen balance exists, the individual is less able to resist infections, he may withstand the stress of injury or surgery poorly, and his general health will deteriorate.
Negative nitrogen balance can exist when an individual does not eat enough protein-containing foods, or eats protein foods of poor quality, or obtains insufficient calories. Some persons use crash diets for reducing and thus have a very low protein intake. Many elderly persons are unable to chew well, or don’t like milk, or believe they don’t need protein foods such as meat or eggs. Injury, infections, and surgery increase the protein need but patients in these situations often have a poor appetite. Nurses and dietitians should be particularly alert to the possibility of protein malnutrition in patients with poor appetites. They should take steps to improve food intake before serious problems arise.
Protein-calorie malnutrition
Two forms of protein-calorie malnutrition (PCM), kwashiorkor marasmus, are seen in infants and young children in Africa, Central and Latin America, and parts of the Orient. Although rare in the United States, these conditions are sometimes seen in conditions of severe poverty, or as a result of parental ignorance regarding infant feeding, or in child neglect.
Kwashiorkor usually appears after the child is weaned from the mother’s breast. Usually the infant obtains enough calories, but the high-carbohydrate foods do not supply enough protein. The infants fail to grow, the appetite is poor, the skin and hair change in texture and color, diarrhea follows, the tissues hold water (edema), and death sometimes follows if there is no treatment.
Marasmus occurs in infants who are weaned very early and who are fed diets that are low in calories as well as protein. These infants are emaciated in appearance. Because the severe malnutrition has occurred very early in life, the brain cells have had less opportunity to develop. If the infant survives, there is the possibility of mental retardation taking place.
Protein-calorie malnutrition can be prevented or treated with inexpensive sources of protein-rich foods. Dry milk supplied through UNICEF to many infants and children has been highly effective. Many countries have developed protein-rich foods by combining locally available plant foods. Incaparina, the best known of these, is a food powder that can be mixed with water for child feeding. It is made from corn, cottonseed, sorghum, and mineral-vitamin supplements. Soybean protein, peanut protein, and others have been used in various mixtures.
Some fallacies and facts
1. Fallacy. Athletes need more protein than non-athletes.
Fact. The protein requirement of the adult depends on the body size and not on the amount of exercise.
2. Fallacy. Older people need less protein than young adults.
Fact. The need for replacing the protein of tissues continues throughout life. Older people need the same amount of protein as the young adult of the same body size.
3. Fallacy. Gelatin is an excellent source of protein.
Fact. Dry gelatin is about 90 per cent protein, but the average gelatin dessert would furnish about 2 gm protein. Gelatin lacks some of the essential amino acids; as a sole source of protein it cannot maintain life or support growth.
4. Fallacy. Protein foods should not be eaten in the same meal as starches.
Fact. There is no reason to separate protein foods and starches. In fact, many common foods contain both protein and carbohydrate. The digestive tract efficiently digests protein, carbohydrate, and fat components of the diet at the same time. Each meal should contain one fourth to one third of the day’s protein so that the amino acids will be most efficiently used for tissue synthesis.
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BURNING FEET
This stubborn and infuriating condition afflicts many men and women in their fifth and sixth decades of life. Accounts of burning feet appeared in The War Diary of Weary Dunlop, who cared for Australian prisoners of war in Japanese concentration camps. The prisoners burning feet related more to Berri Berri and the absence of Vitamin 1, than it did to the paucity of calories.
Thiamine deficiency in contemporary Australia occurs frequently in alcoholics who drink an appropriate quantity of calories; but insufficient vitamins. Burning feet and loss of power in the lower legs of alcoholics are clear signs of thiamine deficiency that is reversible by the prescription of Vitamin 1.
Burning feet without an excess of alcohol may still relate to unbalanced nutrition. More often it can be a sign of arthritis or disc degeneration in the lower spine. In such cases arthritic joints pinch the nerve roots running to the feet, frequently at the lower levels of the lumbar spine.
Home Remedies
The consumption of Vitamin 1 is mandatory for all persons drinking more than two pots of beer a day. Non drinkers or drinkers with burning feet and without excess alcohol consumption still find Vitamin B1 useful; and for unknown reasons some gain relief from Vitamin B6. Attention to posture and lumbar support when sleeping or lying will sometimes improve the burning in those who suffer nerve root irritation consequent to a degenerative disorder of the lumbar spine.
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PARKINSON’S DISEASE: RESEARCHES AND TREATMENT
The latest research indicates that with Parkinson’s disease, cells die in that part of the brain which governs movement (the substantia nigra, literally black area) in the brain stem (base of the brain between the ears); these dying cells form small masses called Lewy bodies – named after the man who discovered them. They are very hard to see under the microscope but are always found in the brain stem in Parkinson’s disease. New techniques now mean that they can be seen more easily and they have been discovered in the main part of the brain (the cortex) in people who have Parkinson’s disease and chronic confusion. The researchers feel this is a new form of dementia and have called it Cortical Lewy Body disease.
The cause of Parkinson’s disease is not known. We do know that all the movement problems, and the tremor, etc., are secondary to the loss of a chemical in one part of the brain and this chemical is used to transmit the messages to the nerve and then the muscle cells. The chemical is called dopamine and is made and stored in a tiny part of the brain called the substantia nigra. We don’t know what causes the chemical to disappear but symptoms don’t start until, at least 90 per cent of it has gone, and this probably takes many years. A picture very similar to Parkinson’s disease can be caused by numerous small strokes, drugs and even Alzheimer’s disease; this condition is called Parkinsonism.
The treatment of Parkinson’s disease involves many different factors. Initially a lot of improvement can be gained from physiotherapy. As the disease progresses, however, it is usual for drug therapy to be used. The most commonly used drug is levodopa (contained in Sinemet and Madopar). This treatment aims to put back the missing chemical. It has revolutionized the treatment of the condition but it does not cure it; it helps control the symptoms but the disease is usually progressing underneath it all.
A comparatively new drug Selegeline (Eldepryl) appears to be valuable in treatment. It appears to enhance and protect existing levels of dopamine and is now being used early in the diagnosis of the condition. Many other drugs are used to try and control the symptoms. They all have side-effects and one of the most important is that all the drugs used to treat the condition can cause confusional states. If a person with Parkinson’s disease develops confusion, the drugs they are on must always be considered as the cause.
There is no doubt that as sufferers live longer they are becoming resistant to drug treatment and physiotherapy alone, and are becoming very handicapped. Recently we have seen the exciting use of brain implantation to treat the condition. In a few centers around the world, including the UK, either foetal cells or a person’s own adrenal tissue are being placed via a thin needle into the brain, hopefully to ‘take’ and begin producing their own dopamine. The results are eagerly awaited by doctors, sufferers and their carers, and the indications are that any benefit may take years but in some cases can be dramatic.
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Other names: Eldepryl
SLEEPING DISORDERS: TAKING PILLS
Most experts advise avoiding sleeping pills except for those emergencies when you cannot get to sleep and you must be rested for some important reason the next day. Taking pills long-term leads your system to tolerate them – they stop having an effect.
Besides being a bad habit, insomnia has many causes, including serious illness. If Dr. Bootzin’s do’s and don’ts are no help, go to a sleep center.
At the other end of the scale, 300,000 Americans have narcolepsy – they fall asleep without warning at any time, in any place. Says Joe Piscopo, a computer executive, “I slept through just about all of college and barely graduated in 1965 from the University of Illinois with a degree in computer science. From ages 16 to 25,1 was in 15 car accidents – I fell asleep at the wheel. It was sheer luck that no one was hurt.”
In 1969, doctors at the Mayo Clinic in Rochester, Minnesota, diagnosed his narcolepsy. They gave Mr. Piscopo a strong stimulant, which he still takes. It enabled him to found a successful software company and retire at age 42. He is chairman of the American Narcolepsy Association, which helps narcoleptics learn about their disease and find help.
Scientists have made rapid progress in helping the nation’s 3 million or so night-shift workers, who must get their sleep during the day. Many arrive on the job at midnight and spend the next 8 hours trying to work while fighting sleep.
They can’t synchronize the wall clock with their biological clock. This is dangerous and inefficient.
Dr. Charles A. Czeisler and others at Brigham and Women’s Hospital in Boston have scored a major triumph: In just 4 days, using sun-bright light therapy, they actually shifted workers’ biological clocks, allowing them peaceful sleep during the day and productive work at night. Light therapy possibly could solve night-shift problems forever, reducing accidents and poor work.
In 1993, Dr. Al Lewy and colleagues at the Oregon Health Sciences University in Portland achieved similar effects on volunteers by giving them capsules with an artificial form of melatonin, a chemical produced naturally in the brain’s pineal gland.
It long has been known that the gland produces melatonin only in the dark at night, but when the artificial chemical was given to humans at night, it seemed to create no reaction. When Dr. Lewy’s team gave it to the volunteers during the day, however, the chemical shifted their internal clocks.
Dr. Lewy says melatonin can help jet lag. It also may aid those who need to sleep in the day and stay up at night, or go to bed very early and rise at or before dawn. Once tested, melatonin also might help those with delayed- or advanced-sleep problems or those who get “winter depression” from waking up in darkness. Dr. Lewy says when melatonin is taken in the afternoon, the body behaves as if it had wakened to a bright dawn.
Because melatonin can be classified as a dietary supplement, it has hit the so-called health food stores in a big way. It’s OK for Dr. Lewy to do experiments, it’s another thing to offer it to the public before extensive testing has been done.
If you think melatonin may help you, you may want to ask a sleep expert before you start popping pills.
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CHOOSING THE EYE CARE PROFESSIONAL
When a person seeking eye-care treatment walks into a professional office, he is only concerned about getting the best possible servicing of his problem. But the patient would have to be an astute pupil of politics to understand the forces now at work shaping the future of the eye-care industry.
The truth is that with all of the diagnostic advances the improved quality of eye care, and the many breakthroughs we are describing here, the competition grows among health care professionals administering to patients with vision problems. Consumers may become confused by the lobbying and heated discussions among the three groups of specialists: ophthalmologists, optometrists, and opticians. There is a basic economic conflict on various levels among the three groups, and there tends to be financial pressure from one group to downgrade the others. These various pressures, along with medical and professional concerns, account for much of the competition.
One problem that confuses consumers is choosing an eye care professional to visit regularly. An ophthalmologist (pronounced off/THAL/mol/ogist) is an eye physician and surgeon with an M.D. degree, who also is known as an oculist. This medical doctor specializes in the total care of the eyes. He or she is the only practitioner medically trained and qualified to diagnose and treat all eye and visual system problems as well as general diseases of the body. By looking within your eye, an ophthalmologist can see the signs of many systemic diseases which require immediate treatment, including diabetes, high blood pressure, and cancer.
With an instrument called a tonometer and ophthalmologist can determine a patient’s eye pressure, the force with which the fluids of the eye press against the optic nerve. High eye pressure, like high blood pressure, is a serious matter. It may indicate the presence of glaucoma.
“You have to think of the eyes in terms of the entire body”, said the former president of the American Association of Ophthalmology, Alfonse Cinotti, M.D. “Prescribing corrective glasses and contact lenses is only a part of total eye care. A medical eye examination by an ophthalmologist can reveal subtle changes in your eyes which often signal the beginning of such sight-threatening conditions as glaucoma or cataract. In most cases early treatment of eye disease can prevent impairment of vision and even blindness.”
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MILD ASTHMA ATTACK IN CHILDHOOD
I asked Simon to describe to me how he felt during an asthma attack:
I always seem to get them before I go back to school – or at least my Mum and Dad say I do. I remember waking up in the night and I suddenly found I was itching. At first I didn’t know what was making me itchy but suddenly I noticed a lot of white and red spots all over my body. When I was itching I really caught one and it hurt a lot. I felt very hot as if I was in a train boiler. I felt very weak and tired and then I started to cough. I couldn’t stop and my Mum came in and shouted, ‘Stop that coughing, you’ll waken everyone else.’ I tried to hold my breath so as I wouldn’t cough but I found that my breathing was worse than usual. I needed the toilet but when I got out of bed and tried to walk I found I couldn’t breathe. I felt very depressed and started to cry. My Mum came then and said that I was having an asthma attack and needed my inhaler. I took two puffs of my inhaler and soon I felt a lot better although my hands wouldn’t stop shaking. I couldn’t sleep so my Mum stayed with me the rest of the night.
This describes one of Simon’s early attacks, and now he is well able to recognize when his wheezing is going to start. At the time I was treating him with a standard Ventolin pressurized inhaler, which was effective at relieving the wheezing but gave Simon the irritating side-effect of shaking characteristic of Ventolin. His parents were very worried by it, so I changed him to a Bricanyl inhaler. Next time I saw him at the asthma clinic he commented that the Bricanyl made him seem very weak and he always had to lie down after it. He had also found that if he used it at school he was unable to concentrate on his lessons. I had not heard of this previously with Bricanyl so wondered if it was really a facet of the asthma rather than the treatment. However, at his next appointment Simon still complained of tiredness and said he much preferred the shaking with the Ventolin – it only bothered his parents, not him. Often in illnesses children seem to know naturally what is right for them, so I changed Simon back to the Ventolin. Although he developed the shakes again he was quite happy and not tired or lethargic.
Simon was a classic example of how important it is to monitor asthma with a peak flow meter. When he was perfectly well and had been free of any wheezing for a few weeks his peak flow measurement was around the 450 mark. When I saw him after school one day when he had developed asthma following a run, his peak flow was down to 330, indicating a reasonable degree of constriction of the airways. Ten minutes after taking two puffs on his inhaler it had risen to 390. Simon was very happy with this and felt much better, but really he still had some way to go to a full return to normal.
I checked Simon’s inhaler technique and there was no doubt he was rushing the process and not allowing the medication sufficient time to be absorbed into his lungs before breathing out. I told him to breathe slower and this time his peak flow rose to 420, better, but still 30 short of his maximum.
One of Simon’s friends at school had shown him his diskhaler, which Simon thought looked good fun and I then wondered if inhaling a powder would improve his peak flow. Sure enough, with one single measured dose, roughly equivalent to the two puffs he had been taking, the peak flow reading returned to its normal of 450. Simon went away very pleased with his new toy and looking forward to showing it off at school.
Only by measuring Simon’s peak flow could we tell that his lungs were not functioning normally. I cannot stress enough the use of the peak flow meter in the treatment of both mild and severe asthma, as it shows quite objectively whether the situation is improving or becoming worse. As the child becomes older the readings can be used to gain valuable time in treatment and also to assess how severe the attack is likely to be.
*45/211/5*