Doctorweblog. About Health & Medicine

Menstruation — that most intimate part of every woman’s life — is still, despite modern education, often misunderstood.

So let’s consider exactly what this function is, and the parts of the body involved.

The organs concerned with menstruation are the womb, the ovaries, and the fallopian tubes.

The womb, or uterus, is a pearshaped organ roughly 7.6 cm (3 inch) long and 3.8 cm (IVi inch) wide, and it lies low down in the pelvis.

The womb is mostly thick muscle, but it is lined with several layers of cells known as endometrium.

The ovaries are two almond-shaped organs lying either side of the womb about 5 cm (2 inch) away. The fallopian tubes connect to the top of the womb, and their open outer ends lie very close to and partly enclose the ovaries.

The womb thins down to a narrow neck, the cervix, and sits on top of and projects into the vagina.

The beginning of a woman’s menstrual cycle really begins at the end of menstruation, or bleeding.

A hormone, oestrogen, is produced by the ovaries and causes the lining of the womb to thicken, to become soft and spongy.

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Taking care with what you eat is essential if you have diabetes. For some people with type 2 diabetes, this is all they have to do to keep their blood sugar levels in the normal range of between 4 and 8 millimoles per litre. Others also need to take tablets or injections of insulin. People with type 1 diabetes must have insulin injections. But no matter what the treatment, everyone with diabetes must take care with what they eat in order to keep their blood sugar levels under control Keeping the blood sugar near the normal range helps prevent complications of diabetes such as blindness, heart attacks, kidney failure and amputations.

For over a hundred years, people with diabetes have been given advice on what to eat Many diets were based more on unproven (although seemingly logical) theories, rather than actual research. In 1915, for example, the Boston Medical and Surgical Journal advocated that the best dietary treatment for someone with diabetes was ‘limitation of all components of the diet’. This translated into a very low kilojoule diet interspersed with days of fasting. Unfortunately, malnutrition was often the result!

In the 1920s doctors began recommending high fat diets for their patients. Ignorant of the dangers of a high fat diet, they knew that fat, at least, didn’t break down to become blood sugar.

It was not until the 1970s that carbohydrate was considered to be a valuable part of the diabetic diet Researchers found that not only did the nutritional status of patients improve with a higher carbohydrate intake, but their blood sugar levels improved as well.

The only part of food which directly affects blood sugar levels is carbohydrate. When we eat carbohydrate foods, they are broken down into sugar and cause the blood sugar levels to rise. The body responds by releasing insulin into the blood. The insulin clears the sugar from the blood, moving it into the muscles where it is used for energy, so the blood sugar level returns to normal.

Some people think that because carbohydrate raises the blood sugar level, it should not be eaten at all by people who have diabetes. This is not correct. Carbohydrate is a normal part of the diet and at least half of our total daily kilojoules should come from carbohydrate. In fact, the more carbohydrate you eat the better because it automatically reduces the proportion of kilojoules you get from fat.

The secret to the diabetic diet is not so much the quantity but the type of carbohydrate.

Traditionally sugar was excluded from diabetic diets because it was thought to be the worst type of carbohydrate. The simple structure of sugar supposedly made it more rapidly digested and absorbed than other types of carbohydrate, like starch. This assumption was simply not correct. Even in the late 1970s, test meal studies showed that there was a great deal of overlap between the blood sugar responses to sugary and starchy foods. Fifty grams of carbohydrate eaten as potato caused a similar rise in blood sugar as 50 grams of sugar. Ice cream resulted in a lower blood sugar response than potato! Findings like these sparked research into the G.I. factor in an effort to learn more about how the body actually responds to different carbohydrate foods.

The emphasis through the 1970s and for much of the 1980s, was on the quantity of carbohydrate in the diet. ‘Portion’ diets were used to prescribe a set amount of carbohydrate to be eaten at every meal. (A carbohydrate portion* is an amount of carbohydrate-rich food which contains 10 to 15 grams of carbohydrate—depending on which country, or State of Australia—you lived in. So, not only was the portion system complicated, portion sizes varied throughout the world!).

An underlying assumption of the carbohydrate portions theory, was that equivalent amounts of carbohydrate, irrespective of the type, cause an equal change in the blood sugar level. This reasoning had no scientific backing and has since clearly been shown to be incorrect. Fortunately, good quality scientific research supports today’s dietary recommendations for people with diabetes. While the G.I. factor research has not negated the significance of the quantity of carbohydrate in the diet, it has shown us the importance of considering the type of carbohydrate food that we include.

The G.I. factor has shown us that the way to increase the quantity of carbohydrate in the diabetic diet, without increasing the sugar levels in the blood, is to choose carbohydrate foods with a low G.I. factor.

Our research has shown that blood sugar levels in people with diabetes are greatly improved if foods with a low G.I. factor are substituted for high G.I. factor foods.

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The following lists some basic tasks and resources which can be used by the fat loss counsellor in exploring the psychological component of excess body fatness. More detailed therapy should be referred to a qualified professional psychologist.

Current attitudes.

1. Identify current thoughts, feelings and attitudes to fat loss: What for? Why now? How long for? What then? Ensure clients recognise that permanent fat loss means lifestyle change.

2. Clarify expectations of fat loss: What problems are anticipated that it will solve? How else could these problems be dealt with? If any of these expectations are perceived negatively, how else could the problem be managed?

3. Clearly define a lifestyle which is both acceptable and achievable, which will maintain a lower level of both fat intake and body fat level.

History.

1. Explore previous experiences of fat/weight loss: What worked, What didn’t? What lasted? How were relapses dealt with? Understand what went wrong or right and how this time is different.

2. Deal with family leftovers, experience of fatness in the family, food messages, how eating, drinking and exercise played a part in the family life and what impact these still have.

Obstacles.

1. Identify which important aspects of lifestyle keep the client from losing fat: food choices, feelings/experiences which seem associated with inappropriate eating, time pressure, stress, lack of regular exercise, food knowledge?

2. Identify times during the day/week which represent the most difficult times to control eating: Mealtimes? Snack times? Going to work? Going home? Eating out?

Knowledge.

1. How good is the client’s knowledge of what is in food? How is this used? What else is happening at times when fattier food is deliberately chosen?

2. Increase knowledge of low-fat shopping, cooking, recipe modification and food skills associated with developing palatable, low-fat foods.

Stress management.

1. Identify possible connections between perceived stress and eating behaviour.

2. Develop effective stress management techniques which do not involve the use of food, in conjunction with other regularly used ‘self-nourishing’ activities.

3. Plan and use time consistent with lifestyle aims (i.e. incorporating deliberate and incidental exercise, food choices and meal planning).

4. Develop and practice assertiveness, with self and others.

Habit management.

1. ‘Reframe’ eating habits which contribute to overfatness as ‘curious and interesting’ as opposed to ‘immoral or bad’.

2. ‘Stalk’—describe eating, drinking, exercise avoidance habits or routines and develop strategies for interrupting these. Monitor self-talk, identify triggers for over-eating and thinking patterns associated with these. Challenge beliefs about self body image.

3. Evaluate social environment for social support. Develop ways to protect self from ‘high risk’ situations.

Relapse management.

1. Identify and develop a clear strategy for dealing with relapses. This includes strategies for dealing with celebrations and festivities, times of high stress and pressure, times of boredom alone and negative mood states.

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There is some inter-conversion between nutrients such as protein being converted to glucose (gluconeogenesis) for release into the bloodstream, but under normal conditions, the capacity to convert one nutrient into another for storage is very limited. Also, humans have little capacity to ‘waste’ extra energy by burning it off. This process, which has been termed luxuskonsumption, is common in animals such as rats but is very limited in humans. Therefore, the examination of each macronutrient as a separate entity is necessary and is summarised below.

Alcohol. There is an inconsistent relationship between reported alcohol intake and body mass index, with many studies showing that drinkers of large amounts of alcohol have lower body weights. This has led to hypotheses that alcohol calories may be subject to inefficient oxidation, thereby diminishing the impact of alcohol calories on energy balance. In heavy drinkers, there does seem to be an inefficient burning of alcohol because the addition of alcohol to a weight maintenance energy diet does not result in weight gain. Virtually all ingested alcohol is metabolised in the liver and this process produces energy. None of it is converted directly into fat. The main pathway is via the enzyme alcohol dehydrogenase and this should theoretically produce 7kcal/g of alcohol. However, alcohol also appears to induce another series of liver enzymes to burn it and this pathway produces far less energy for use than the usual one.

Alcohol, perhaps because of its toxic potential, is the top priority fuel for burning and, if present, displaces fat and, to a lesser extent, carbohydrate and protein as fuel sources for energy needs. Hence, while alcohol does not directly turn into body fat, it will certainly send any spare fat in the diet into storage. So it appears that the so-called ‘beer gut’ may not be full of beer calories, but rather full of the chips and nuts that accompanied the beer which have been sent to the fat cells for storage. A sobering fact though is that although alcohol does stimulate its own burning, it does not satisfy hunger, and indeed may stimulate appetite. The nature of beer is such that the type of food that is likely to be eaten with it will probably be high in fat (can you imagine beer and fruit rather than beer and nuts?). The sugar which is in the beer, wine and mixes may have an effect on reducing appetite and therefore counter the stimulation of appetite by the alcohol. Overall, we could consider alcohol as ‘half-balanced’ as a form of energy in the body and a potential promoter of weight gain.

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Bronchiectasis means that large infected cavities have developed in the lungs. It is a chronic disease, often starting during childhood and following on from an infection. Whooping cough, measles, bouts of influenza or pneumonia may have been the predisposing infection. Small cavities of the lung are infected, and this usually spreads gradually. Although the general health of the child may originally have been good, a chronic loose cough becomes established. At first it may be apparent only in the mornings or the evenings. When the child runs or exerts himself, there may also be some breathing difficulty. He gets out of breath easily. Gradually, as it develops, he may lose weight and also lose general health and vitality.

Older children tend to develop a cough and bring up large quantities of foul-smelling sputum. Often there is a mild fever which waxes and wanes. In long-standing cases the doctor notices that the fingers become clubbed. (This means the normal ends of the fingers are more rounded.) Many children become anaemic, pale and obviously in deteriorating health.

Treatment

Most doctors believe that bronchiectasis can usually be prevented by adequate treatment of any respiratory disorder. Upper respiratory tract infections, bouts of the flu, coughs and colds, bronchitis, pneumonia, removal of foreign bodies—whatever the cause and nature of the respiratory disorder—if this is treated adequately and completely until a full recovery has taken place, then the risk of this hapless and debilitating chronic disease is not nearly so high. It is salutary advice which parents would do well to follow.

Treatment must be under the proper care of a doctor or hospital where full facilities are available, and where ongoing care and advice can be offered. Lengthy hospitalization is usually not needed, and much of the care can be given at home by the parents.

In the early acute stages, when diagnosis is being established, hospital care may be needed. Antibiotics, aerosol bronchodilators, postural drainage and breathing exercises all form an important part of treatment. Adequate nutrition is also important. Sometimes diseased tonsils or adenoids may require surgical removal, or sinus drainage undertaken. In severe cases, when the disease is confined to a particular lobe of the lung, removal of the lobe may be advisable.

The crux of ongoing home treatment is the postural drainage and breathing exercises routine. This is aimed at removing as much debris from the lungs as possible, and opening up the air passageways to enable as much oxygenation as possible of the lung tissues. The routine may be continued for many months, for years, or possibly for a lifetime.

There is often no simple do-it-yourself cure for bronchiectasis. It usually is diagnosed in hospital, and treatment and ongoing care must often continue for a considerable period of time. Parents should make certain they carry out full instructions to the best of their ability. They should also explain to all their children (especially older ones) the nature of the problem and the need for continual co-operation. Without this, it becomes an even more difficult medical problem.

In early stages, moderate bronchiectasis is often completely curable. However, some cases continue for many years and require ongoing management under the experts.

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Many speech problems may occur, from the child speaking indistinctly, to repetition of the same syllable, or to speech being delayed. Often overprotective parents may unconsciously retard their child’s speech ability by pursuing baby talk as their method of communication. This is no fault of the baby. Stuttering or stammering (in which certain words or syllables are compulsively repeated or there is a complete blockage of certain words) are almost always nervous in origin. There is usually nothing anatomically or physiologically wrong with the speech mechanism; it is simply because of tension and stress at the subconscious level.

Occasionally there may be a question of normal mental development, but this can usually be quickly evaluated. In most cases, this is not the cause. A changed attitude by the parents and their efforts at helping the child speak normally often helps, with avoidance of baby talk as the child gets older. Stuttering often starts in the 3-6 age group when the child is often subjected to emotional stresses or tensions.

Treatment

Like most other anxiety-induced symptoms, eliminating the cause, as much as possible, as early as possible, is the ideal. Special anxiety-producing situations and circumstances must be carefully sought out. It may take time to do this, for situations that are of little importance to a parent may be major to a child. A sense of being wanted, of security, warmth and affection, is important. Instilling confidence into the little person, reducing fears and dreads and removing frightening situations all assist. Stuttering and stammering in the older child and adult are often very difficult to treat. In recent years, considerable success has been achieved in older children with the use of medical hypnotherapy. This again indicates the emotional nature of the disability.

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This is a hormone, a chemical substance secreted into the bloodstream by the endocrine glands to direct the body’s functions and development. Oestrogen is one of the two female hormones which alter in balance with one another to control the reproductive cycle and the sexual characteristics in women.

Oestrogen is secreted by the follicles in the ovaries, one of which develops each month in sexually mature women to contain an unfertilised egg. Under direction itself from hormones released by the pituitary gland at the base of the brain, the follicle bursts and releases the egg into the woman’s fallopian tube for fertilisation by the male sperm. Throughout the egg’s development, the follicle has secreted oestrogen to direct the uterus to prepare a blood enriched lining ready for the egg to implant in once fertilised. If fertilisation does not take place, the follicle, now emptied of the egg and known as the corpus luteum, secretes a second hormone, progesterone, which will cause the uterus to shed its lining, a process familiar to most people as the monthly or menstrual period.

The enormous influence of oestrogen on many aspects of women’s health is often only fully appreciated after menopause, when the menstrual cycle ceases and the body’s production of oestrogen reduces dramatically. All kinds of side effects can result. The hot flushes, insomnia and mood swings experienced by many women during menopause are related to the fall in oestrogen levels, as are the more permanent conditions such as thinning hair and loss of skin elasticity. Similar side effects can accompany the surgical removal of the ovaries in younger women.

More serious is the increase in the risk of coronary heart disease experienced by post-menopausal women: an increase up to ten times greater than that of women just prior to menopause. Oestrogen, it seems, helps to limit fatty deposits in the arteries and relaxes the blood vessel walls to increase blood flow.

Receiving particular attention in the 1990s is the role oestrogen plays in the maintenance of bone mass and bone strength. Osteoporosis is caused when calcium leaches from the bone, leaving it porous and brittle. The condition is known to be accelerated by decreasing levels of oestrogen in the body, suggesting that oestrogen helps the cells maintain their calcium content.

To avoid this and other unpleasant and even dangerous conditions associated with aging, many women are turning to Hormone Replacement Therapy, a program whereby synthesised, plant or animal oestrogens and some progesterone supplements are taken regularly from the onset of menopause onward. While many women find that HRT removes all unwanted symptoms of the change of

life, it makes other women sick and may have serious side effects.

Oestrogens are powerful substances, particularly many of the synthesised forms, and they are far from fully understood. Oestrogen is now thought to play a significant role in the development of several kinds of cancer in women, including breast cancer, and in triggering conditions like thrombosis or blood clots in the veins. It is also believed that synthetic oestrogen given to women in the 1950s and 1960s to prevent miscarriage is responsible for a higher than normal incidence of rare cancers in their offspring. Naturopaths may suggest herbal alternatives to hormone replacement therapy. For example, the Chinese herb Dong quai contains plant oestrogens and can actually help to balance the body’s oestrogen levels by adding oestrogen to the system when concentrations are low and inhibiting oestrogen action when the levels are too high, competing as it does with the oestrogen molecule for binding sites. In China it has been used for centuries to treat menopausal symptoms and menstrual problems in women and dong quai is now gaining respect in the West.

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Although a common maxim holds that ‘seeing is believing,’ this statement is actually not always true. Seeing can be quite deceptive, as anyone knows who has witnessed the tricks of a competent magician. Conversely, we believe many things that we do not actually see, for example that the earth revolves around the sun. But in some ways the maxim carries the weight of truth: Those things that we cannot see are hard to believe, which is one reason why they gave poor Galileo such a hard time when he maintained that the sun and not the earth was the centre of the solar system. Similarly, controlled treatment studies can appear quite unconvincing if one doesn’t believe in the treatment and the studies are performed by someone else. I encountered this phenomenon after conducting numerous light treatment studies in patients with seasonal affective disorder (SAD), or winter depression. The studies from my group at the National Institute of Mental Health, as well as those of numerous colleagues, told a clear story. Light therapy worked. Yet many psychiatrists who had never treated a single patient with light therapy remained sceptical. On the other hand, the successful treatment of a single patient with this modality was in certain instances more persuasive than all the published data on the topic. So, after studying SAD for several years and treating many hundreds of patients with light therapy, I was amused when an old colleague approached me at a meeting and said to me with an air of discovery, ‘You know that light therapy that you have been talking about all this time? I treated a patient with it and the damn thing works.’

In truth, though, it is wonderful to discover a phenomenon for oneself even if it has been described a thousand times before. And so it was for me with the use of St John’s Wort in depression. I had read about controlled studies performed in Europe and had actually seen some of the data. Yet it was only when I saw some of my own patients benefit from the herbal remedy that I felt the excitement that might be expected to greet the arrival of a novel form of treatment for an old and nasty adversary – depression.

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Plus-one cases are rarely seen by a physician. The plus-one patient is basically a happy person, mildly stimulated by a “natural high.” He rarely, if ever, thinks of himself as a candidate for serious illness.

Plus-three and plus-four cases, on the other hand, are sometimes brought to a physician, and such cases could be presented. (In her manic phase, for instance, Nora Barnes was a plus-four case.) These cases are relatively rare, however, since before the average food or chemical addict reaches this stage, his withdrawal symptoms have usually become more and more pronounced. It is this withdrawal phase which brings him to the doctor’s office—not the previous “high.”

This is why a discussion of stimulatory reactions focuses on the plus-two stage. It is here that we find at least three serious medical problems: hyperactivity in both children and adults; obesity; and alcoholism, the acme of the food-addiction problem.

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Since the end of World War Two, a staggering array of synthetic hormones, tranquilizers, and antibiotics, has been used to treat meat, poultry, and fish.

The most common hormone used for this purpose—diethylstilbesterol, or DES—was given as a medicine to pregnant women to prevent miscarriage. It is now known that the substance has caused cancer in the children of women who used it, the so-called “DES babies.” The United States government is now waging a major campaign to warn such children, the potential victims, of the danger that was incurred.

For years, however, this hormone and other related substances, such as Ralgro and Zeranol, were implanted in chickens, cattle, and sheep to make them grow fatter and come to market sooner. Industry has argued that only minute amounts of the chemicals were left in the meat which reached the consumer. But a growing number of scientists countered that it only took a few parts per billion to cause cancer in experimental animals.5

In addition to the use of hormones, it is common practice to inject animals with tranquilizers just before they are slaughtered and to dip certain foods (such as fish) in an antibiotic solution, to prevent them from spoiling. One of my patients became sick from eating store-bought fish. One day, her husband went deep sea fishing and brought back some fresh bluefish. She had no adverse reaction to this fish and soon learned that she could eat most freshly caught fish with impunity. She could also eat pieces of large commercial fish which were sawed into small portions while still frozen. Her problem apparently arose from the antibiotic solution which the industry routinely uses to treat smaller fresh fillets.

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