Mens Health Blog. Medical Blog

•    Although no one knows quite why it should be, hypertension is much more common in fat people. One study of 10,940 hypertensive patients found that 60 per cent of them were overweight. Hypertension does, of course, occur in thin people but it is almost unknown in cultures where all the population is thin. Often, mild blood pressure can be treated simply by losing a stone or two. Certainly preventing obesity also helps prevent high blood pressure. This starts at the cradle. Breastfeeding exclusively for at least six months and then weaning on to unrefined, whole-foods rich in dietary fibre will prevent many children from becoming obese. It is during these rapid-growth early years that obesity sets in, mainly because of poor eating habits and even an addiction to sweet, refined foods. These habits are difficult to change later in life and almost inevitably produce obesity.

A study in California looked at twenty-five obese hypertensives and after only a twelve-week weight-reducing diet found a significant decrease in blood pressure to within the normal range. Furthermore, few (only about a quarter) of the subjects reduced to their ‘ideal’ body weight but the reduction they did achieve was enough to reduce their blood pressure to normal. They found that a 10-30 per cent reduction towards ideal weight was enough to lower blood pressure significantly. Interestingly, such losses in weight reduced the blood pressure of all the obese subjects whether or not they started out with high blood pressure.

•    Several studies have suggested that salt added to food during cooking or at the table is responsible for much of the hypertension we see in the West. However, a great deal of salt (probably the majority) is added during food manufacture and processing and we have little direct control over this hidden salt (especially in cured and processed foods). This is a real danger. Get used to reading labels and avoiding pi ducts where salt comes high î the list (ingredients are listed in order of weight in the product Buy salt-free products if possible. Unfortunately, even drinking water can be very rich in sodium (salt). A Massachusetts study found that a particular town had a very high level of sodium in the drinking water. Even high-school students in this study had raised blood pressures, and it was found that the water they drank accounted for 40 per cent of the difference in total salt intake between these children and those of a neighboring town.

•    When cutting down salt do it slowly over a month or two, first by not adding salt during cooking. Use a salt shaker with smaller holes for adding salt to food at the table, and over 6-8 weeks use less and less. Once again, prevention starts in the cradle. Discourage children from eating salty foods and wean them on to salt-free foods whenever possible. Research suggests that children have already acquired a taste for salt by the age of two.

Interestingly bound up with the salt story is potassium-another essential mineral. Potassium is vital for the transmission of messages in nerves, aids digestive enzymes, and is essential in muscle function. Sodium and potassium are intimately interlinked within and outside cells, and the balance has to be finely maintained if we are to remain healthy. A study at the London Hospital Medical School showed that potassium seemed to act as a shield against sodium-induced hypertension. In the first study sixteen people with mild hypertension and a group with normal blood pressure ate one diet for a twelve-week period, and then a different diet for the next twelve weeks. During the first twelve weeks both groups ate their normal diet plus sodium tablets. During the second period the normal diets were supplemented with potassium and they were asked to avoid salty foods and not to add salt.

The high-sodium diet produced a slow rise in blood pressure in both groups. But with potassium and a low-salt diet both systolic and diastolic pressures fell sharply and significantly in the hypertensive group-in contrast to an insignificant rise in the normal group! A month after the study ended both groups went back to normal eating. The hypertensive blood pressures shot back up again. This rise was explained by the researchers as due to the poor levels of potassium in their food rather than the marginal rise in sodium (salt). Other research found that if you have a family history of blood pressure you are especially likely to be sensitive to the blood-pressure-lowering effect of potassium. Such people develop the condition when the potassium in their diets falls below a certain essential level. Fruits and vegetables are among the best sources of potassium so this could be yet another advantage of a high-fibre diet. Particularly rich sources are potatoes, Brussels sprouts, broccoli, wheat germ, dates, chicken, salmon and halibut. A banana contains 350 mg potassium and only 1 mg sodium. A glass of pure orange juice contains 180 mg potassium and only 2 mg sodium.

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Bulimics are generally better suited to the group approach than anorexics. They tend to be older, more socially involved, and thus less afraid of other people. But for many bulimics, dealing with others produces feelings of inadequacy, rejection, and worthlessness, feelings that drive them to seek solace in a heaping plate of food. Groups can provide a setting to improve social interactions. Groups work better if, as in anorexia, members are selected carefully. Some groups are comprised of members who have never been anorexic or who are all married, for example. Having patients of similar age reduces the risk that older patients will ignore younger patients who may have different concerns. However, groups are never “perfectly” compatible. It helps to have patients explore their differences in order to lower resistance and increase their willingness to engage in therapy. The goal should be to achieve a “good enough” fit among members.

One way of selecting a group is by severity of the illness. Patients who binge and purge frequently (at least once a day for several years) but who aren’t in immediate medical danger may need an intensive program with several sessions a week. Twice-a-week bingers might do better in a more relaxed program.

In any case, group therapy should focus on symptomatic eating behavior. When patients regain healthy control over their eating, they can work more productively on other issues.

One such issue is assertiveness. We spend a lot of time discussing ways of handling apologies, compliments, and criticism. One patient complained, “I always do exactly what my husband tells me to do. If I don’t he’ll sulk and pout and make me feel guilty. Maybe we bulimics need a ‘Just Say No’ campaign of our very own!”

Problems: As in anorexia, some common features of bulimia can interfere with group therapy. One writer, Janice M. Cauwels, put it this way: “Bulimics tend to distrust people, especially other women, and most of all bulimic women.”

Bulimics can be perfectionists. If other members of the group don’t quite live up to their expectations, they may feel frustrated or angry.

Some patients place too much emphasis on food. They may use a “verbal binge” as they would a food binge to escape from their feelings. Group should address this issue. For example, during one session a patient said, “Hilary talks so much about food that I feel like I’m stuck in quicksand. I think she’s just doing that so she won’t have to talk about her problems with her boyfriend.”

Some patients expect a “magic cure,” believing that if they just show up at group meetings their symptoms will disappear. The group can help them confront and deal with this misconception.

Gradually, members realize that getting better takes time and work.

As with any group, feelings of competition and rivalry may emerge among patients. In groups that have a more psychodynamic orientation, members – guided by the therapist – can explore such conflicts. Doing so usually results in a deeper understanding of how the patients’ feelings influence their past and present relationships.

Group therapy should offer patients positive role models. Sometimes, however, newer members may feel jealous or inadequate when they see how other people have succeeded at reducing their symptoms. Conversation should focus on such feelings, especially if the patient’s pattern is to binge immediately before or after the group session.

One final note: Eating-disordered patients with drug or alcohol problems need additional help, because such problems can both substitute for bulimic symptoms and trigger them. Abstinence from substance abuse is usually a prerequisite for successful eating disorder treatment.

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Rita Wolberg traded in her scale for a tape measure. It helped her slim down not once, but twice.

When she was 31, Rita, an IRS program analyst from Alexandria, Virginia, decided to join Weight Watchers to unload some extra pounds that had accumulated over the years. “I just overate, and I didn’t know what I should eat to be slim,” she explains. She followed the program to the letter, taking off 22 pounds in 12 weeks.

After the birth of her son some 5 years later, Rita developed chronic sinus infections. Four sinus surgeries later, she found that she had gained 30 pounds. “I had put on so much weight that I moved up 3 clothing sizes,” she says. She went back to Weight Watchers, and this time, she took off 30 pounds in 18 months. “I wasn’t quite as vigilant about sticking with the program,” she admits. “I knew it would work. I just had to be patient.”

On both occasions, Rita used a tape measure—not a scale—to monitor her weight-loss progress. She found that by checking the circumference of her bust, waist, hips, and thighs once a week, she had a more accurate record of her changing body shape. “Even the second time, when the pounds came off slowly, I could count on my tape measure to show that I was improving,” she says. “Some part of my body was getting smaller, even if the scale didn’t show it.”

Rita, age 45, now serves as a program leader for Weight Watchers. “I started there as a receptionist in 1988, and they let me stay even when I regained weight,” she says. “That really inspired me tunity to tell others how valuable a tape measure can be as a weightloss motivator.

WINNING ACTION

Trade your scale for a tape measure. A scale won’t tell you how your body composition has changed, but a tape measure can. As you lose fat and gain muscle, certain body parts get smaller. To check the size of your waist, wrap the tape around the narrowest part of your waist, roughly halfway between your bottom ribs and your hipbones. For your hips, wrap the tape around your hips and butt at their widest points, usually slightly below the actual hipbones. Write down younmeasurements, then track them from week to week.

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You should be educating your daughters now about the need to eat nutritious foods rich in calcium. The recommended daily calcium intake for girls of eight to eleven is 900 mg (boys need 800 mg), which is equivalent to three or four daily serves of calcium-rich food (one serve can be 250 mL milk, 200 g yoghurt or 35 g cheese). Girls aged twelve to fifteen years should have around 1000 mg daily (boys 1200 mg), which is four to five serves of calcium-rich food. For women aged sixteen to fifty, three serves daily or 800 mg of calcium-rich food suffice (the same for men of all ages), and from fifty onwards women should increase their intake of calcium-rich foods to four or five serves (1000-1500 mg).

It is also important to remember that the growth patterns of boys and girls vary, with girls starting their spurt at around the age of eleven and boys later, at around thirteen. So an eleven-year-old girl will probably be eating more than her twelve-year-old brother. It’s important to realise this, otherwise parents may be critical of a daughter’s appetite.

Girls also tend to be excessively concerned about the amount of body fat they acquire during adolescence. They need reassurance that fat on breasts, legs and hips is normal. Otherwise they may turn to fad diets or excessive exercise and quickly become deficient in energy, protein, calcium and iron. In extreme cases this may lead to anorexia nervosa. Regular moderate exercise will improve appearance, even if it means gaining weight in terms of muscle.

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Vaginal lubricating compounds such as K-Y jelly, and new hormone-free substances that last for several days and are not messy (such as Replens), are helpful. You can also make use of’male dew’, the natural lubricant from the tip of the penis. Masturbation, either alone or with your partner, can also help to promote

lubrication. Although frowned on in some religious circles, masturbation is widely regarded as a healthy way to handle sexual needs and expression with or without a partner. Some couples find that a hand-held vibrator and sexually stimulating magazines or videos also help. Think about your range of sexual positions. Be adventurous in trying new ones, bearing in mind that some will put less stress on vaginal tissues that would otherwise tend to be hurt by penetration. A woman on top, for example, has increased control of the situation. She should also take plenty of initiative in the type and duration of love-making and ensure that she is completely comfortable throughout.

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Mood-altering medications such as antidepressants, antipsychotics and benzodiazepines (for example, Clozapine and Diazepam) can also contribute to bone problems. Elderly patients taking these medications are more likely to have falls and fractures’. The medications may add blood pressure changes and physical instability to existing vision problems, poor flexibility, and depleted muscle mass and strength.

As mentioned briefly, osteoporosis is more likely in women who have an early surgical removal of their ovaries, a hysterectomy without removal of the ovaries or a premature natural menopause (before the age of forty). In addition, you may be more likely to get osteoporosis if you have had anorexia nervosa, exercised so much at some time that your menstrual periods stopped for six or more months (known as amenor-rhoea), used steroids over a long period (for example, to treat asthma or arthritis) or been confined to bed for some months, perhaps because of a serious accident.

Bobbi was in her early fifties when she fractured her wrist after slipping on some wet grass. Her medical history included a three-year period of anorexia nervosa in her twenties, together with smoking throughout her adult years, so a DEXA investigation was ordered. This revealed a worryingly low bone density, which prompted Bobbi to quit smoking, improve her diet and start treatment with HRT. A bone density measurement two years later indicated that the deterioration of Bobbi’s bones had been arrested.

The most important factor of all in determining your risk of osteoporosis is the genes that control the way your body functions, and that may conspire with neglect of weight-bearing exercise, smoking, or a low calcium intake. If genetic vulnerability is combined with any other risk factor, the likelihood of osteoporosis multiplies. Attempts to put figures on these risks have proved controversial.

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Women who are starting HRT for the first time some years after their menopause (whether it occurs naturally or as a result of medical treatment) should always be prescribed natural forms of oestrogen, and the dose should be low initially and increased slowly if necessary. Start low and go slow is a wise motto for any hormone therapy. Examples of widely used natural and synthetic oestrogens, and the typical dosage range, are listed on page 175.

Lydia was sixty-two when she went onto HRT with a view to halting a worrying deterioration in bone density. This had been diagnosed by comparing the results of bone density scans performed when she was fifty-nine and then three years later. She was prescribed a dose of oestrogen usually given to women immediately after the menopause and developed sore breasts, excessive nipple sensitivity and nausea. Her doctor should have started her on a lower dose and slowly increased it over a period of three to six months. When Lydia was prescribed a natural oestrogen at a low dose, she experienced no worrying side effects, and for her this was a sufficient dose to stabilise bone density.

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Food intolerance can apparently cause aching joints in some people. It is likely to be the most heavily used joints, such as the knees, that are afflicted first, but it may later spread to other joints. Assuming that all the disorders mentioned above have been ruled out, then food intolerance is a very likely-cause for joint pain, especially in patients with a variety of other minor symptoms as well. Studies have found that between 50 per cent and 85 per cent of patients respond to an elimination diet.

Since immune complexes are known to produce joint pain in several other diseases, they are a logical suspect in food intolerance as well. In this case, the immune complexes might well consist of food molecules (absorbed intact into the blood from the gut) and antibodies to the food. At present there is no evidence to show whether this idea is right or not, and it is possible that food produces joint pain by some completely different mechanism.

An acute, immediate allergic reaction to a food, with characteristic symptoms such as swelling of the lips, can also include transitory pain and swelling in the joints, especially those of the hand and wrist. Other atopic (‘allergic’) patients experience more long-lasting joint pain, which may be due to food whether this is food allergy or intolerance is a debatable point but mast cells do seem to be involved in some of these patients.

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Some old people take a constitutional walk every day, inhaling a good supply of oxygen in the fresh air, even though it is almost impossible nowadays to find a quiet country road free of all traffic. Everywhere you go there are cars, leaving only narrow meadow paths and remote trails in the forests where they have not yet been able to advance. So, if older people escape from the motor exhausts and flee to nature’s solitude, the exercise, healthy air and available oxygen will be a boon to them. In addition, older people should eat natural food and in moderate quantities, with only a little fat. Their protein intake should also be limited, which avoids the formation of too much cholesterol.

Experience teaches us that the normal signs of old age can be put off by years, even decades, if the right and natural measures are taken in time. But this is only possible if we do not let the speed of our times infect us; rather, we should remember Goethe’s advice and take things slower and calmer as we get older. The transition from a fast pace of life to a quieter one may not be easy; on the contrary, many people complain as different physical problems crop up and they find it increasingly difficult to cope. They confirm Solomon’s observation that the years of old age are far from welcome. For this reason the wise man of biblical fame admonished the young: ‘Remember, now, your Grand Creator in the days of your young manhood, before the calamitous days proceed to come, or the years have arrived when you will say: “I have no delight in them”.’ All those who maintain the right attitude towards the Creator throughout life will not moan about the difficulties of old age, because their heart will remain young.

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Monotonous work can be so tiring that our limbs feel heavy, while an interesting activity can involve our whole being to such an extent that we forget to breathe properly. The deficiency, however, can be rectified in a simple way if we take an evening walk in the fresh air in order to unwind. For the best results go uphill because this will necessitate deeper breathing. Our feeling of tiredness will soon vanish, faster in fact than if we decided to lie down and rest in a room with little oxygen.

The healing processes will proceed much faster in the case of illnesses that enable the patient to move around, if he increases his intake of oxygen by walking briskly in the fresh air, possibly through an aromatic forest or woodland, on a regular basis. Anyone putting this ‘prescription’ conscientiously into practice will enjoy positive results. As a rule, even depression can be overcome by taking a brisk walk in the fresh air for as little as an hour. Mind you, a slow walk will not have the same effect or benefit as would a strenuous march requiring vigorous breathing, which results in oxygen rushing to the brain cells and normalising their function.

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