DrugsRead – Read about Health

Occasionally the forced introduction of one preventive measure has unexpected beneficial effects elsewhere. The best example was the introduction of the 55 mph speed limit in the US in 1974. During the 1970s life expectancy went up by 2.7 years in the US and much of this was the result of the slower driving and reduction in car accidents. In 1973 the death rate was 4.17 deaths per 100 million miles travelled; by 1976 this figure had dropped to 3.3-an all-time low. So what started as a way of saving fuel because of the oil crisis ended up substantially reducing road deaths.

Unfortunately, not all illnesses and diseases are as clear-cut as are accidents. The vast majority of modern illnesses are still poorly understood. This makes preventing them difficult, if not impossible. It is probably this confusion within the medical profession over the causes of many conditions that has held back so many preventive efforts in the past. These debates among the professionals have confused the public who, in turn, have often wished a plague on all their houses and gone on living as normal until the facts are incontrovertibly established.

All of this has given prevention a bad name but the medical profession is not wholly to blame. The ‘simple’ diseases have all been conquered and we are now left with highly complex conditions which involve many factors-the majority of which are beyond the influence of medicine in its present sense. Almost any real advance in preventive medicine now involves major social rethinking on a scale every bit as adventurous as the major sanitation programmes of the last century. The difference is that no one wanted foul drinking water and open sewers but convincing people they don’t want junk food, cigarettes and alcohol is a task of a very different order-because they do want them. The complexity of the modern world is now so great that any mass change in public behaviour would have repercussions on employment, social structure and many other areas as well as simply health.

As the prevention of many conditions is so difficult because of a lack of knowledge of how to achieve it, it has been very difficult to get the ball moving in much simpler areas such as screening for disease. In the current tight economic climate no one wants to waste money on preventive programmes that do not in fact prevent anything. Decision-makers and consumers would rather carry on with curative medicine they know works, even if it is obvious that this is a second best to preventing the illness in the first place. Money is cheerfully allocated to curative services but not to preventive ones. This attitude is commonplace throughout the western world and is especially obvious in the US and other countries where health insurance pays most medical costs. It has arisen mainly because modern medicine sees itself as being about curing people or at least dealing with their symptoms, but also partly, as we have seen, because the effectiveness of many preventive measures is difficult to prove. This situation will almost certainly change in the next decade or two as costs of this kind of ‘health’ care spiral out of most societies’ abilities to pay for them. There is also growing interest among ordinary men and women in a more holistic approach to living generally and this too will hasten a serious interest in prevention. But until the medical profession accepts this approach, no real change will occur.

There are, fortunately, signs that this is happening. With the present interest in ‘alternative’ medical practices such as osteopathy, acupuncture, herbal medicine, homoeopathy and healing, increasing numbers of people are by-passing the orthodox profession to go straight to an alternative practitioner. Many, if not most, of these stress the importance of prevention so it cannot be long before this rubs off on orthodox doctors. The current fashion for all things ‘natural’ and the growth of interest in do-it-yourself health all favour a growth of preventive medicine and a reduced reliance on the medical profession as suppliers of health. The current medical system in the West is a sickness service not a health service, but things could change very fast. Medical unemployment is now a serious problem in almost every western country so doctors are having to make greater efforts and change their ways of thinking about prevention, or more people will go elsewhere.

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Three times a day, Alice Layne takes a trip around the world—not in an airplane, but on her plate. Her adventurous approach to eating helped her lose 67 pounds and four sizes within 2 years.

Alice, a 42-year-old New York City resident, didn’t always have a daring palate. Growing up, she feasted on lots of pizza and sugar. “My mother’s idea of a treat was a box of brown sugar cubes, a chocolate bar, or a can of ready-mixed frosting,” she says.

Alice’s unhealthy food choices caught up with her during her teenage years, when she started gaining weight. Her eating habits didn’t improve as she got older, either. A typical day featured a sugary cereal for breakfast, a bulky sandwich for lunch, and dinner in a restaurant, where she’d eat to the point of discomfort.

By her late thirties, despite bouts of yo-yo dieting, Alice had reached 235 pounds. Her waistline wasn’t all that suffered. Her back ached due to her weight, and her self-esteem tumbled.

“My breaking point came when I had to go away for a weekend and I ordered several new outfits for the trip,” she says. “I didn’t try on the clothes before leaving, and when I got to where I was going, I discovered that nothing that I had bought fit.”

Hurting physically and emotionally, Alice knew that she had to slim down. Over the next year and a half, she made a modest effort to improve her eating habits, which led to a 23-pound weight loss:

At that point, she felt that she needed a program with structure, so she joined Weight Watchers. Her group leader introduced her to international foods that made her meals more exciting and healthy.

Alice enticed her tastebuds with ethnic favorites that she found in cookbooks: tabbouleh, a minty wheat salad from the Middle East; couscous, a pebbly pasta from northern Africa; and polenta, a corn-brea’dlike food flavored with roasted red peppers and tomatoes that’s popular in Italy. Along the way, she learned how to cook with the salsas and spices that flavor many ethnic cuisines. “The new tastes transformed my palate,” she says. “Now, when I take even a bite of the some of the foods that I used to eat, I don’t like them.”

Alice had so much fun experimenting with exotic new recipes that she never felt like she was dieting. Yet she lost 44 pounds in less than 6 months, reaching her personal goal weight of 168 in December 1998. And she has held steady ever since.

Alice says that she seldom visits her chiropractor for her aching back anymore. And she feels much stronger emotionally, now that her self-esteem isn’t bogged down by extra weight. “Since I’ve slimmed down, I’ve gotten my hair cut and styled differently,” she says. “Many people don’t even recognize me, which is fun.”

WINNING ACTION

Explore the world via your dinner plate. Some of the healthiest low-fat meals come from other cultures. Tempt your tastebuds with Greek souvlakia (lamb served

on skewers), French ratatouille (a vegetable dish cooked in olive oil), Japanese yakitori (grilled chicken), Thai ginger beef, or Indian mulligatawny (a kind of lentil soup). These are just a few examples of the “world’s fare” that can please your palate without widening your waistline. Consider investing in an ethnic cookbook such as The Mediterranean Diet Cookbook, Step-by-Step Indian Cooking, or Steven Raichlen’s Healthy Latin Cooking.

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Preservatives, E200-297. These prevent bacteria and fungi from decaying the food. Over 40 are approved for use in Britain, and the amount that can be used is limited by law. Those most dangerous to health are the nitrates and nitrites (E249-252) which have been used for hundreds of years to make bacon and ham – they are potentially carcinogenic. Because of the long tradition of use, and the fact that the characteristic flavour of bacon cannot be produced in any other way, these preservatives are difficult to outlaw.

Preservatives are used in almost all wines (but see p333). One group of preservatives, the benzoates (E210-219) sometimes seem to cause sensitivity problems in people who are also sensitive to aspirin and/or tartrazine (El 02). The sulphites, metabisulphites and sulphur dioxide (E220-227) can trigger off asthmatic attacks because they have an irritant effect on the airways.

Antioxidants, E300-321. These stop fats and oils from going rancid. These are restricted to certain foods and the amount used is limited by law. Those most likely to cause health problems are BHA and BHT, (E320 and 321). One study showed BHT to cause behaviour disorders in animals.

Emulsifiers, stabilizers and thickeners,

(E322-495). These improve texture. The

amount that can be used is not limited, but they are restricted to certain foods. Several of those permitted in Britain are banned by the EEC because they are potential carcinogens – these include E430, E433 and E435.

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Wait until you have been free of symptoms for two or three days, but don’t wait any longer than this. Begin by testing foods that are probably not the cause of any trouble – things you do not eat every day. Choose items that you like – if the foods pass the test, then you can incorporate them into your menus, which will allow you to eat less of the exclusion-phase foods. Throughout the reintroduction phase it is vital that you keep your diet varied and do not eat too much of any one food. In particular, do not eat any one food every day. Continue to record everything you eat, and your symptoms – if something goes wrong, this record will prove invaluable.

Only test one food at a time. Eat a normal-sized portion of the food in question, for lunch and supper. Notice any changes that occur at the time, or later in the evening, or the following day. Most symptoms will show up within this timespan, although bowel symptoms may take longer – they can occur anywhere between four and 48 hours after the food is eaten.

If there is no reaction by the following day, eat two portions of the food again. Should you get no reaction this time then repeat for a third day. If there is still no reaction, then the food can be considered safe, but avoid it again for four days (to offset any possible effect of eating it for three days in succession) before beginning to eat it once more.

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The aim of the preventive measures described here is to reduce the child’s exposure to potent allergens, and other factors that can trigger off allergy, during the early phases of life. The measures are relevant to any Type-1 (IgE-mediated) reaction to food, whether that food causes an immediate, violent reaction centred on the mouth and lips, or a much more delayed reaction such as asthma or eczema. In general, however, the former are more difficult to prevent, because the child can become sensitized by such minute amounts of food. In the case of asthma, rhinitis and eczema, a mixture of allergens may produce symptoms: the effect of allergens in food may be exacerbated by inhaled allergens such as pollen, or by allergens touching the skin. For this reason, any preventive measures must include inhalants and contactants as well as foods.

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Interestingly enough, the researchers did notice a link between the foods the mother ate and her baby’s symptoms. They observed that the colic was worst in those babies whose mothers ate all the commonly implicated foods such as milk, eggs, chocolate, nuts and fish. The fewer foods the mother ate from this list, the less severe was the colic. They concluded that the mother’s diet ‘may influence the likelihood of infantile colic in breast-fed children, but that the source of the colic cannot be attributed to a single dietary component [ie milk]. It may however involve a variety of foodstuffs.’ Despite this clear statement of their findings, this paper is widely quoted as showing that there is no link between colic and maternal diet.

Other evidence supporting the second point of view comes from a retrospective study of 68 children with proven sensitivity to cow’s milk. When the medical history of these children was investigated, it turned out that a very high proportion had persistent screaming and colic as babies. This is only circumstantial evidence for a link between food sensitivity and colic, of course, but it is of interest. And it gives support to the idea that treating the colic is important, because the children in the study all had serious health problems as a result of their sensitivity to milk – problems that might have been avoided if they had been taken off cow’s milk at an earlier age.

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Skin-prick tests do not work in the case of food intolerance, as we have already seen, and sadly there are no other simple tests to take their place. The only reliable way to discover if a food is causing illness is to eliminate it from the diet, then reintroduce it and observe what happens. This is not as easy as it sounds, because few people are sensitive to just one food, and eliminating different foods one at a time rarely has any substantial effect. All the offending foods have to be cut out simultaneously for an improvement in health to occur. Without such a return to health, the effect of individual foods cannot be tested, simply because the symptoms vary so much from day to day anyway.

The standard test used for diagnosing food intolerance is die elimination diet, in which all or most of the commonly eaten foods are avoided for a period of one to three weeks. If an improvement in health occurs, then foods are reintroduced individually and their effect assessed. Every doctor working in this field has a slightly different approach to the elimination diet – some begin with a complete fast, others allow anything from two to 50 foods in the initial stage – but the results show a remarkable consistency. The patient often feels a great deal worse initially, but then recovers fairly spectacularly on day six or seven. Occasionally the process takes a little longer, but if there is no improvement after about three weeks then the diet should be abandoned. Detailed advice on how to carry out an elimination diet, how to prepare for it, and what to do afterwards, are given in Chapters Fourteen and Fifteen.

The elimination diet is a fairly lengthy and tiresome procedure, and sometimes the results are not entirely clear-cut. But it is the only diagnostic process that can be recommended. Some of the alternatives on offer from both doctors and fringe practitioners are considered on pp96-98, and readers are urged to look carefully at this section before wasting time and money on bogus diagnostic tests.

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One of the best known obsessive-compulsive couples is depicted in The Odd Couple, a play by Neil Simon, which was also made into a movie and then a television series. The story concerned a relationship between two men—one meticulously neat and controlling, the other a careless slob. Many male-female couples like this form “odd” relationships that often seem to have an undertone of strife.

Actually, the control freak and the slob are two sides of the same coin. Both have the same compulsions to be neat and controlling, but one acts them out while the other just gives up, assuming he will never be able to maintain such high standards. One is compulsively rigid, one compulsively loose. Both use their defensive posture to express anger—the one through manipulating and dominating the other with his neatness, orderliness, and stinginess, and the other through defiance, stubbornness, and slovenliness.

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“No, sorry—I can’t. That show gives me a headache.”

“Well, it’s my favorite show, and I want to watch it.”

“Don’t bother me right now. I have a headache.”

“Would you please switch the channel.”

“No.”

“Then I’ll go watch it in the bedroom.”

“Suit yourself, but I’m not switching the channel, because that show will make my headache worse.”

Of course, the wife will be suspicious and may tell him she is not fooled by him—that she knows he is imitating her, and it is not going to work. But the husband should persevere despite her protests, bemusement, taunts, and the like, never letting on to her that he is playing a game, and always insisting that he really does have a headache. This is important, because if he lets up and admits he is just imitating her, the effect of the game will be lost. Indeed, this game (like every other paradoxical game in this book) relies on giving exacting performances that frustrate and wear down the “opponent.”

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The next step in the massage (if he has persuaded her to go on) is to take a few ice cubes, wrap them in a face cloth or clean handkerchief, and slowly slide that along her spine to the nape of her neck. Then he slowly, lovingly slides the cold compress all around the shoulders, the back, the arms, the underarms, and the palms of the hands; between the fingers; all over the legs and the bottom of the feet; between the toes; up the inner leg and inner thigh on one side and down the inner thigh and inner leg on the other; then up the crevass between her buttocks, and circling around each cheek; then up the spine again; and finally around the sides of the head, across both the left and right temples.

Next he takes a hot “washrag” (dipped from time to time into a bowl of hot water) and slides it over her body, following the very same route as was used with the ice-filled cloth.

Next he takes a new feather duster and glides it along her body, following the same route as in the previous examples.

Next he begins slowly to kiss her body. He kisses in little pecks, again following the same route.

Next he takes something soft, such as a velvet or silk comforter, and covers her with it, slowly and lovingly rubbing the comforter all over her body.

Next he lies on top of her and envelops her with his naked body. He gently slides around, holding her hands in his as he does so, and kissing the back of her neck.

Then he asks her to roll over.

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