Archive for 23rd April 2009

HAZARDS OF LOW CHOLESTEROL: WEAK IMMUNE SYSTEM AND OTHERS

Weak immune system

Having a low cholesterol level makes you more susceptible to infections, especially post operative infections. Hospitalized patients with low cholesterol are more likely to die than patients who have normal or high cholesterol levels. The lipoproteins that carry cholesterol around our bloodstream help to protect us against the harmful effects of bacterial endotoxins, which are released whenever we have a bacterial infection. Since cholesterol is a fat, it helps to carry the antioxidant, fat soluble vitamins E and A around our body.

People with high cholesterol have stronger immune systems than people with low cholesterol; they have greater numbers of various immune cells. Clearly you need some cholesterol in your body to help keep your immune system strong.

Hormone deficiencies

The sex hormones oestrogen, progesterone, testosterone and DHEA, as well as the adrenal hormones aldosterone and Cortisol are all referred to as steroid hormones. All of these hormones are made in the body from cholesterol. If you did not have cholesterol in your body, you would not be able to make any of these hormones.

The diagram below describes how cholesterol is converted into the various steroid hormones.

The parent molecule from which all steroid hormones are manufactured is called pregnenalone. This is an important hormone, as it helps to prevent inflammatory conditions such as arthritis, eczema, fibromyalgia and auto-immune conditions. Cortisol is an anti-inflammatory hormone produced by the adrenal glands, and it is involved in the metabolism of carbohydrate and protein. Aldosterone is another adrenal hormone that controls water and sodium balance in the kidneys.

Many people who take cholesterol lowering medication experience a reduction in their libido; this makes sense as their body is less able to produce sex hormones. Low levels of sex hormones may also contribute to erectile dysfunction and aggravate the symptoms of fibromyalgia, such as aching, tender muscles.

Shorter life span

People with low cholesterol die earlier than those with normal to high levels, and they seem to have higher rates of cancer. A study titled “Low serum total cholesterol is associated with marked increase in mortality in advanced heart failure” was published in the Journal of Cardiac Failure. 1 134 patients were studied, and low cholesterol was associated with worse outcomes and impaired survival in patients with heart failure. People with higher cholesterol had better survival rates. In this study, the researchers observed that high cholesterol in these patients was not associated with high blood pressure, diabetes or coronary heart disease.

A study of 4 521 Italian men and women between the ages of 65 and 84 was published in the Journal of the American Geriatrics Society. The study found that people with a total cholesterol level below 4.8mmol/L are at higher risk of dying, even when many other factors are taken into account. Low cholesterol levels seem to be associated with poor health, or declining health.

Greater risk of cancer

It has long been noted that people with low levels of cholesterol are more likely to develop cancer than people with normal or high levels. This pattern occurs among all age groups. Austrian researchers followed more than 149, 000 women and men (aged 20-95 years) for 15 years as part of the European Health Monitoring and Promotion Programme. Low cholesterol was found to be a significant risk factor for all-cause mortality in men across the entire age group, and in women, especially from the age of 50 onwards. People with low cholesterol suffered significantly more death from cancer, liver diseases and mental disorders.

How Low Should You Go?

You should aim for a cholesterol level of 4.7mmol/L to 5.5mmol/L. Levels below 4.6mmol/L can be unhealthy. The all-cause death rate is higher in individuals with cholesterol levels lower than 4.6mmol/L

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SOLUTIONS TO INFERTILITY: WHAT HAPPENS IN A MONTHLY CYCLE?

As you can see, the monthly cycle is governed by the reproductive hormones, the main ones being oestrogen, progesterone, follicle stimulating hormone (FSH) and luteinising hormone (LH).

What are hormones?

Hormones are chemical messengers and the word conies from a Greek word meaning ‘urge on’. Carried in the bloodstream, they trigger activity in different organs and body parts. The reproductive hormones control the monthly cycle and help to maintain pregnancy.

At the beginning of each menstrual cycle, the oestrogen and progesterone levels are low and the follicle stimulating hormone (FSH) is produced by the pituitary gland in the brain which controls the whole endocrine (hormone) system.

This begins the process of ovulation by stimulating the ovaries to produce the hormone, oestrogen.

Oestrogen

Oestrogen is not just one hormone but several grouped together. But for the sake of clarity I will use the term oestrogen to include all of them. Oestrogen is the key hormone responsible for a woman maturing from childhood to adulthood. It causes the breasts to develop and produces the characteristic feminine shape.

The lining of the womb (uterus) starts to thicken each month as it prepares to receive a fertilised egg.

Ovulation

The oestrogen level continues to rise until the middle of the month when the pituitary gland produces luteinising hormone (LH) which triggers ovulation. The egg (ovum) is then released from a follicle in the ovary and passes down the fallopian tube.

After ovulation, the ovaries produce progesterone, which prevents any further ovulation taking place in that cycle. If fertilisation does not occur, the lining of the womb breaks down and menstruation takes place. At the same time there is a dramatic and rapid fall in the levels of oestrogen and progesterone and, with this drop in hormone levels, the cycle starts all over again.

Fertilisation

When fertilisation occurs the egg implants itself into the thick and nourishing wall of the womb, where it begins to develop.

Fertilisation usually takes place in the fallopian tube. Once this has happened, the empty follicle, which released the egg, forms the corpus luteum which produces progesterone.

In each menstrual cycle, a group of about 20 follicles containing the developing eggs grows on the surface of the ovary. Generally only the biggest follicle continues to develop, which is why humans usually only have one baby at a time.

Progesterone

Progesterone is an important hormone in fertility because it maintains the womb lining during the second half of the cycle, in readiness for a fertilised egg. It is also responsible for maintaining the pregnancy.

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DEFEATING DISEASE: ARTHRITIS STRATEGIES

This piece of information may not make your day, but there are more than 100 kinds of arthritis inflicting their brand of pain on the joints of some 17 million American men (and 23 million women).

In osteoarthritis (the most common), the underlying bone of a joint degenerates because the protective cartilage has broken down over time. Rheumatoid arthritis, on the other hand, can affect younger people because the inflammation is the result not of wear and tear but of the body’s own immune cells doing a Benedict Arnold act on the joints.

Doctors treat arthritis with anti-inflammatory drugs and physical therapy. But you can do some things on your own to reduce the need for their services.

Ease the burden. Research shows what common sense dictates: Your joints do better if you put less weight on them. “On average, population surveys indicate that for every 10 pounds you lose, you decrease the occurrence of arthritis by 50 percent,” says David Pisetsky, M.D., Ph.D., professor of medicine and chief of research at the Duke University Arthritis Center in Durham, North Carolina. “If you’re overweight, get back as close to your normal body weight as you can.”

Don’t be too smashing. Play rough and you push up your risk for arthritis. “If you play football, to use an extreme example, you’re subject to joint injury all the time,” Dr. Pisetsky says. “That increases the likelihood of arthritis.” But that doesn’t mean that you should go motionless. “Exercise is likely to decrease the symptoms of arthritis,” Dr. Pisetsky says. Make that moderate exercise. Go easy on those extreme sports.

Take your vitamins. Research indicates that vitamin B12 stimulates bone-generating osteoblasts, which could stem the forward march of arthritis. Vitamins E and Ñ have also received some support for pain relief and cartilage repair because of their antioxidant qualities. “We know that oxidative damage occurs in the joints, and studies have indicated that people who have increased their intake of antioxidants may have less arthritis,” Dr. Pisetsky says. “There’s a lot of interest in it, but it’s not at a point yet where we can make definite recommendations.” In the meantime, Dr. Pisetsky recommends packing your diet full of antioxidant-rich foods and for older men to take add a multivitamin to their diets.

Up your fish ante. The oils in fish contain the friendly polyunsaturated fats called omega-3 fatty acids. Scientists can measure a significant drop in inflammatory immune substances if there’s enough fish oil in your diet. That means less morning stiffness and tender joints if you have rheumatoid arthritis. Fish with the most omega-3 to offer include herring, salmon, mackerel, and tuna.

Rout the gout. Gout is one form of arthritis more common in men than women. You get it from too much uric acid, so cut down on anything that creates uric acid, says Dr. Pisetsky. That includes alcohol, and purine-rich foods such as anchovies, mussels, fish roe, and organ meat.

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WEIGHT LOSS: DEFINING BULIMIA NERVOSA

The DSM-III-R, published in 1987, substantially improved the definition of bulimia, largely because physicians had had time to study many more Patients with the condition. The revised definition reads as follows:

Diagnostic criteria for bulimia nervosa

A. Recurrent episodes of binge eating (rapid consumption of a large amount of food in a

discrete period of time).

B. A feeling of lack of control over eating behavior during the eating binges.

C. The person regularly engages in either self-induced vomiting, use of laxatives or

diuretics, strict dieting or fasting, or vigorous exercise in order to prevent weight gain.

D. A minimum average of two binge eating episodes a week for at least three months.

E. Persistent over-concern with body shape and weight.

 

One subtle but significant change appears in the very name given to the illness: from bulimia to bulimia nervosa. Such a change, never made lightly, was the result of intense debate by experts on both sides of the Atlantic.

When the disorder first attracted notice, experts focused attention on the single symptom of bulimia-”ox hunger,” or uncontrolled bouts of overeating. Bulimics resemble anorexics in many ways, especially in their attitudes about body shape and weight. The main difference, however, is that a bulimic’s weight is more likely to fluctuate-sometimes wildly-yet on the average it tends to stay within the normal range. An anorexic, by contrast, falls considerably below even a minimal normal weight.

Different experts proposed a variety of terms to identify these patients. A British physician, Gerald Russell, introduced the term bulimia nervosa in 1979. The name identifies more than just the symptom of overeating and helps forge a link with anorexia nervosa. Of course, you can’t please all the people all the time, especially when those people are doctors. The controversy over the name continues.

The first criterion in the DSM-IH-R attempts to define an eating binge. Even so, the definition is somewhat vague: What exactly constitutes “a large amount of food”? How rapid is “rapid”? And what qualifies as a “discrete period of time”?

Actually, this vagueness is purposeful and has its advantages. It grants physicians some leeway in applying the standard to different patients.

“Rapid” simply suggests that the food is consumed quickly. A normal person might eat a normal meal in, say, half an hour. At a formal dinner she might eat a larger amount of food, but that dinner might stretch out over the entire evening. In contrast, a bulimic will often gorge herself as quickly as she can, sometimes eating a day’s worth of food within fifteen minutes.

“Discrete time” sidesteps the need to specify the period over which the patient eats. This is an improvement over the 1980 version of the DSM, which stated that the binge usually takes “less than two hours.” True, most binges occur within that time, but I treat patients who get home from work around six o’clock and begin eating whatever they can find. When that’s gone they send out for pizza. Finally, around ten o’clock they make a bee-line for the convenience store, where they buy as much ice cream and as many cookies as they have money for, then dash home and continue eating. These people qualify as bulimics, even if their eating binge doesn’t quite match the original guideline.

The second criterion makes the crucial point that the bulimic feels her eating behavior is out of control. In this way she resembles alcoholics or drug addicts who also can’t control their behavior. Her lack of control produces strong feelings of shame and inadequacy. To compensate she goes to extreme lengths to regain mastery, but as we have seen, such actions just perpetuate the vicious cycle.

The third criterion identifies the flip side of binge eating: weight control through extraordinary means. The authors of these revised guidelines felt that purging or other similar behavior was such a cardinal feature of the syndrome of bulimia that it deserved a listing of its own. The guideline also helps differentiate between bulimics, who tend to be of normal weight, and people who just overeat. This latter group may be overweight, a problem that requires a different therapeutic approach.

The fourth criterion specifies that the pattern of bingeing and purging must reach a certain severity before medical intervention becomes necessary. By stating the frequency with which binges occur and by indicating that the behavior must persist for a certain period of time, the DSM-IH-R helps differentiate those people with a severe disorder from those who might binge only occasionally. The actual figures (at least two episodes a week for three months) are useful but somewhat arbitrary.

The last criterion, addressing the bulimic’s distorted attitudes about her body, appeared in the manual only after a lot of wrangling. Some physicians felt that bulimics showed their “over-concern” about the body simply through the extraordinary measures they use to control weight. Surely, they argued, self-induced vomiting by itself reflects over-concern about the effect of food; another criterion would just be redundant.

However, other experts felt that the extreme importance bulimics (and anorexics, for that matter) attach to body shape and weight is an essential feature of the illness. In fact, without evidence of these distorted attitudes, some physicians are reluctant to enter a diagnosis of bulimia, choosing to classify the problem as a type of depression or some other variety of disturbed eating.

Almost all of the people I see for bulimia express concern about body shape to one degree or another. If a patient doesn’t appear to have these attitudes, I attribute their absence to my inability to perceive them, or to the patient’s skillful ability at disguising them.

The 1980 criteria stated that depressed mood was an essential component of the illness. The new version drops that requirement. Many patients do have depressive symptoms. The strong association between eating disorders and depression suggests a possible link somewhere in the brain: The cause of one may be the cause of the other. In the past, some experts thought of eating disorders as just one subtype of depression.

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GET YOUR BODY MOVING: RUNS TO READ— AND LOST 68 POUNDS

Rebecca Harding wasn’t always an exercise buff. In fact, the 49-year-old Salt Lake City woman used to shy away from most physical activity because she was too ashamed of her size. Now, she’s an avid runner, sometimes going out twice a day. And she’s 68 pounds lighter.

What transformed this former couch potato into a fitness fanatic? She credits Books on Tape.

“I was always much heavier than I wanted to be,” Rebecca says. “As a teenager, I was 30 pounds overweight.” Through marriage and three pregnancies, she continued to gain. By age 35, she weighed 204 pounds.

All the while, Rebecca’s self-esteem plummeted. She began avoiding social events, and even dreaded grocery shopping, for fear that she’d run into someone she knew who’d notice how much she had gained. “All I wanted to do was stay home and eat,” she says. “The more I ate, the worse I felt about myself. The worse I felt about myself, the more I ate.”

Rebecca’s turning point came the day she waited in a hospital emergency room with one of her sick children. “A nurse asked me when my baby was due,” she said. “I was mortified. I wasn’t pregnant.” she says. “Then and there, I made up my mind to slim down.”

Out went the junk food and fast food, replaced by healthful choices such as whole-grain cereals for breakfast, salads for lunch, and skinless chicken breast—stir-fried in lemon juice instead of oil—for dinner.

For exercise, Rebecca joined a walking group in her neighborhood. As she got trimmer and fitter, she went out on her own, graduating to jogging and eventually to running.

Rebecca enjoyed the faster pace of her workouts, but she missed the companionship of her walking-group buddies. To keep herself from getting bored, she decided to listen to Books on Tape while she ran. “I had used the tapes occasionally while I was driving, and I enjoyed them immensely,” she explains.

She began borrowing tapes from her local library and listening to them during her workouts. “I told myself that I could play them only when I was running,” she says. “If I got really caught up in a particular tape, I’d run twice in one day just to finish it.”

That may explain why she was able to lose 68 pounds in just 8 months. Fifteen years later, she maintains her weight at 136 pounds. And she continues to eat healthfully and run daily, always with her Books on Tape in tow.

“Just recently, I ran to a tape of The Horse WhispererRebecca says. “Later, when I drove my route to measure it, I couldn’t believe how far I had gone. Almost 9 miles up a steep hill—and in the rain. I hadn’t even noticed because I was so into the tape.”

WIN NING ACTIO N

Catch up on your reading while you work out. Listen to ^ Books on Tape, available at most libraries, while you run, walk, or do other types of exercise. The stories will keep your mind occupied, and you’ll finish your workout before you know it. In fact, you may even find yourself looking forward to your next session. A word of caution, however: If you live in an area where there’s lots of traffic, you may want to leave your headphones at home. You need to know what’s going on around you, for safety’s sake.

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