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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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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.

*28/35/5*

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.

*82\89\8*

Robin, aged twenty-three, was given Valium as a muscle relaxant when he injured his knee playing rugby. After four months he was walking normally and decided to stop taking the Valium. He became anxious and depressed and could not sleep. This was very unusual for him. He thought the injury must have upset him more than he realized. The same thing happened again when he stopped the Valium three weeks later.

His doctor said he had become physically dependent, and apologized for not watching him more closely. With regular support from his doctor, and a slow withdrawal programme, Robin did very well. He learnt to meditate and felt that this helped him to accept the insomnia and physical discomfort.

Laura’s story illustrates how a combination of a psychiatrist who only knows half the story, plus repeated dosing with tranquillizers and anti-depressants can result in what appears to be a serious psychiatric problem.

*72\49\8*

Start by asking the members of the group who only want to chatter to leave the room.

Sit in a circle on stools or hard chairs. Notice how many members are pulling one or both shoulders up to their ears, and how many heads are pulled to one side or pulled down and back with chins poking forward. The reason for this is that in withdrawal, muscles on the side of the neck shorten. This unbalances the head, and because it is so heavy (about one and a half stones), it puts a strain on the neck and shoulders that goes right down the spine through the pelvis to the knees. That is why so many people complain of weak aching knees. Notice how many people are pulling their feet back under the chair, or have their legs crossed.

Retraining muscles involves learning where tensions are and, without causing more tension by trying too hard, letting them go. The blur of aches and pains all over that people endure are often nothing more than tension. The pain-relieving chemicals produced by the brain are disturbed during withdrawal and that is why pain from old injuries or scars often reappears for a time.

If there is a teacher of the Alexander technique in your area you would not regret money spent on some lessons. The principle of the teaching is to show you how to live in the world without your body reacting to stress.

*56\49\8*

In withdrawal, suicidal feelings can come out of the blue’. Some people don’t get them at all, others have vague feelings, some feel as if they are at risk. If you are worried, see your doctor as soon as possible. He may want you to take an anti-depressant for a while.

Many callers say, ‘I have a wonderful family, why do I get overwhelming suicidal feelings?’ Over-strained nerves often provoke suicidal thoughts, but in withdrawal, it may be an indication that you are cutting down too quickly.

The Samaritans are always there ready to listen. Many people say ‘I had awful suicidal feelings, but felt I could not ring the Samaritans because I knew they were just feelings and that I would not do anything.’ The Samaritans give up their time to comfort and support people. Use the service if you need it.

Creative visualization is helpful in agoraphobia too. Several times a day take a moment to relax, close your eyes, and see a television screen and make a picture of yourself looking happy and relaxed. Do it again and again until it B easy to imagine yourself with a smile on your face taking a short walk in the street. Keep at this until you extend your imaginary trips to crowded shops, or whatever you are most afraid of.

If any anxiety symptoms appear, practice abdominal breathing and put cold wet cloths on your face to control them. You will be surprised by what can happen when you give your brain the right messages.

In most people, the symptoms disappear when the physical symptoms improve, particularly if there was not a problem before taking tranquillizers.

Dr Claire Weekes’s book on agoraphobia is very helpful.

*40\49\8*

Loss of Memory

When users become aware again after years of emotional hibernation, they realize that they have no recollection, or only vague impressions of significant events in their lives. One woman said ‘My grandson is now eleven, he has always lived in my house, and since I have come off pills, my thinking is clearer, but I cannot remember his birth or his growing up’. This experience is typical.

Some people have said that they have gone back to the emotional state they were in when they first took drugs. One man in his thirties who was first prescribed tranquillizers when he was seventeen said he felt adolescent again when he was drug-free.

Panic Attacks

These can cause a great deal of distress during withdrawal. The sufferer is suddenly overwhelmed by fear for no apparent reason, and often feels that death is not far away. Some feel unable to move or speak, others shout out for help. Although the attacks usually last only a few minutes it can seem much longer to the sufferer.

In a person who is not nervously ill, an exam, or even an exciting social event may produce ‘butterflies in the stomach’; sweating hands; constriction of the chest; a rise the heart rate, etc. This is a normal response. A panics attack is an exaggeration of this, due to an exhausted nervous system. If you are over-enthusiastic the ^first time you go out jogging, your muscles will complain the next day, by being stiff and sore. Panic attacks, agoraphobia, irritability, and many other symptoms are a similar cry for help from your nervous system. It is raying ‘Do not abuse me, I have had enough’.

It is often hard to convince someone who is having pani^ attacks that it is not the onset of some terrible disease. Every symptom—wildly beating heart; rapid breathing; sweating; shaking—is part of the ‘fright and flight’ response. We would be lost without it. We do not want to stop it, but to get it back to normal.

Primitive man needed to be able to react like this to escape from dangerous animals. We may need it now to get out of the path of the number 33 bus, or a youth on a skateboard! Fear stimulates the chemicals that make us respond quickly. That unpleasant sinking feeling in the abdomen is only a sudden diversion of blood away from internal organs to the legs to make them move faster.

*19\49\8*

Those who are exposed to large quantities of airborne allergens can develop a serious inflammation of the lungs known as alveolitis. In this disorder it is not the tubes leading to the lung that are affected (as in asthma) but the lungs themselves. Tiny air-sacs known as alveoli perform the actual work of the lung in extracting oxygen from the air and passing it to the blood. If an allergic reaction to airborne allergens occurs in the alveoli, the large number of immune complexes produced can be deposited there and cause highly damaging inflammation. The structure of the alveoli begins to break down, causing shortness of breath,-tightness in the chest, fever and a dry cough.

There are several forms of alveolitis including farmer’s lung and mushroom-worker’s lung, but the only one likely to have any relevance to food allergy is bird-fancier’s lung. In this disorder, it is tiny particles from the birds’ droppings that initiate the allergic reaction in the alveoli. The connection with food allergy is a tenuous one, but some doctors claim that eating eggs can exacerbate the symptoms in a few patients. This might occur if the antibodies produced to the antigens in the droppings also bind to antigens from egg proteins carried in the bloodstream. This dual binding – known as cross-reactivity – can occur where antigens are chemically similar. Laboratory experiments suggest that there is cross-reactivity between the antigens of chicken’s eggs and the antigens found in the droppings of budgerigars and pigeons.

*89\180\8*

If the blood pressure is too high, it is not advisable to take pollen. A necessary precaution would be, first of all, to bring down the pressure by eating a natural diet of whole rice, soft white cheese (cottage cheese or quark) and salads. This diet is described in detail on pages 128-9. Only when the blood pressure has been normalised can a person start taking pollen.

Those who have exophthalmic goitre, that is to say, a hyperfunc-tion of the thyroid, should take pollen only after the functional disorder has been eliminated.

On the other hand, metabolic disorders such as constipation and diarrhoea can benefit from treatment with pollen.

*896/28/1*

In the lush woodlands of Florida there are found not only thousands of cabbage palms and many other tropical plants, but also a great number of wild papayas. The Indians living there have always enjoyed the juicy fruit because it is delicious and healthy. They also made use of the plant in cooking. Since time immemorial those primitive tribes have known that papaya leaves, stems and fruit contain a substance that breaks down protein. So, whenever the hunters happened to kill an old animal the cook would wrap the tough meat in papaya leaves and leave it overnight. On the following day it would be tender enough to be roasted over a fire. The substance which tenderises meat, called papain, causes a kind of predigestion process, one might say.

*860/28/1*