The trend is away from ‘dieting’ and ‘calorie counting’ and in the direction of an ‘eating plan’ which is compatible with a long-term lifestyle change. In general, we will talk of food selection rather than a diet. In cases of obesity-related disease or extreme obesity, a restricted diet may be necessary, however the term ‘diet’ generally has negative connotations. Selecting appropriate foods with minimal restriction is a sensible goal for fat loss.

Eating for fat loss is essentially little different to that for eating for health, as described in the Healthy Eating Pyramid. Food selection should focus on generous quantities of breads, cereals, fruits and vegetables; moderate amounts of protein such as meat, fish and dairy products; and only small amounts of fats, sugars and salt.

The emphasis in both fat loss and healthy eating plans is a reduction in dietary fat and an increase in complex carbohydrates and fibre. For more information on other aspects of eating for health, the reader is encouraged to consult other texts.

The emphasis on a reduction in dietary fat does not disregard total energy. As we have described, fat intake is the main determinant of total energy intake. However, minor reductions in total fat and significant increases in other calories will lead to an overall increase in total energy and thus weight gain. This often happens when a person has been ingrained with the thinking that sugars, bread, potatoes and pasta are fattening. Those previously ‘blacklisted’ foods suddenly become good ‘fat-free’ foods and are over-eaten in large quantities.

*87\186\4*

Relaxation techniques are now used extensively for the control of chronic pain. Many women with endometriosis coupled with chronic pain have forgotten how to relax. It is not a new skill but one that needs to be relearnt. It will take time and practice, but once mastered it will not only give relief from pain but will also offer a general improvement in your total well-being.

Pain is a vicious cycle. It causes fear, tension, stress and anxiety which leads to muscles tightening, which in turn aggravates the pain. An increase in blood pressure and heart rate may also occur. More energy is used up when a woman is anxious and tense and this may lead to feeling drained and exhausted.

If the cycle of pain, tension, more pain and exhaustion can be broken, then it should eventually result in a reduction of pain.

Most people develop tension throughout their lives as a reaction to some type of stress. You need to learn how to release your tension and develop the ability to relax. There are several ways of developing relaxation skills. Here are two examples of relaxation techniques that you may like to practice.

Controlled breathing

This is one of the oldest and simplest relaxation techniques. With this method you can relax tense muscles, slow your heart rate and lower your blood pressure.

Choose an area where you will be alone and undisturbed for about half an hour. Find a spot where you can sit or lie in a well supported, comfortable position.

Close your eyes and try to relax your body. Now take a breath slowly and deeply through your nose and out through your partly-closed lips. Concentrate on the rhythm of breathing in and out and feel your tension begin to melt away. Try to maintain this slow, deep, rhythmic breathing for fifteen minutes. It is recommended that this breathing technique be performed daily to gain maximum relief.

Progressive muscle relaxation

If your muscles are tense and tight as a direct consequence of your pain then muscle relaxation can be helpful.

When practising muscle relaxation you should again choose an area where you will be undisturbed for about twenty minutes.

Start by taking slow deep breaths and then concentrate on curling up your toes and tightening them as hard as you can. Maintain this tension and tightness in your toes and feet for about ten seconds. Then relax the feet completely and you will notice how the toes uncurl and your feet become heavy. Feel the contrast between when your muscles are tense and when they are relaxed.

Gradually move up your body, systematically tensing and relaxing the muscles of your legs, thighs, buttocks, abdomen, shoulders, arms, hands, neck, jaw and face.

As you continue to work through this regime you will again notice the contrast between muscle tension and relaxation; with practice you will be able to relax your muscles when they tighten in response to pain.

*78\83\2*

Dyspareunia means painful sexual intercourse. It is another common, but often unacknowledged, symptom of endometriosis. In the survey conducted by the Endometriosis Association nearly half (48%) of the women with endometriosis had experienced dyspareunia.

Dyspareunia often causes much heartache for women with endometriosis and it can have devastating effects on their self-esteem and their sexual relationships.

Dyspareunia due to endometriosis may be felt during or after intercourse and may be so severe as to make intercourse impossible. The pain maybe described as sharp, stabbing, jabbing, or a deep aching. Intercourse may always cause pain or only when intercourse occurs at certain times of the month — for example, during menstruation or at ovulation. The pain may be felt only during deep penetration but it may also be felt during any form of intercourse, particularly if the uterus is rigidly fixed by adhesions in a retroverted position.

Dyspareunia is usually associated with endometriosis in the Pouch of Douglas, the

utero-sacral ligaments and the rectovaginal septum. It may also be associated with cysts or implants on the ovaries, vagina or cervix.

If the endometriosis is located in the Pouch of Douglas, the utero-sacral ligaments or the recto-vaginal septum the pain may be due to stretching or jarring of the endometriosis on those tissues.

If cysts are located on the ovary the pain may be due to compression of those cysts, particularly if the ovary is rigidly held in position by adhesions. In addition, penetration may cause some implants to bleed slightly and this may cause pain for some time after intercourse.

*18\83\2*

The mouth ulcer is the most common form of ulcer in humans. There are two types — aphthous and traumatic.

Aphthous ulcers usually develop when you are rundown or stressed. Some women are prone to them just before a period. Traumatic ulcers are, as the name implies, the result of injury to the inside of the mouth. Mouth ulcers usually heal on their own within a couple of weeks, but they can be healed more rapidly and prevented by careful attention to diet. Fruit juices, fruit, vegetables and grains are all helpful. Junk food, chocolate and refined sugars should be avoided. Antioxidants and Vitamin C should be taken to boost the immune system.

Stomach ulcers are caused by a loss of tissue lining the lower oesophagus, the stomach or the duodenum. Stomach ulcers are also called gastrointestinal or peptic ulcers. They are the result of erosion of membranes by pepsin and acid found in the digestive juices. It is not known what causes the changes that make membranes unable to resist pepsin and gastric acid when ulcers occur. Genetic, environmental, psychological, viral and chemical causes have all been put forward. Relatives of those suffering from gastric ulcers, for example, have three times the likelihood of developing them than the rest of the population. Stomach ulcers are more likely to occur in people who are poorly nourished. Stress is also given as a cause of ulcers, and chemicals like asprin and alcohol can induce them in some circumstances.

Herbs useful in the treatment of stomach ulcers include slippery elm, liquorice, marshmallow root, arrowroot and chamomile. These should be taken before meals, but individual tolerance to each herb should be tested by taking them separately at first. Dietary recommendations include large amounts of grains and vegetables and a reduction in red meat, spicy foods, coffee, alcohol and cigarettes. Cigarette smokers have a higher incidence of ulcers than non-smokers and require a longer healing period. Vitamin A and the tissue salt ferr phos are also helpful. Relaxation, massage and meditation are beneficial for stress-related ulcers.

*66\69\2*

As I have mentioned, in Germany St John’s Wort vastly outsells Prozac, which is the number-one selling prescription drug in the US. In recent years German doctors have written about seven prescriptions for St John’s Wort for every Prozac prescription – and this does not take into account the millions of St John’s Wort tablets sold over the counter. There is every reason to believe that St John’s Wort can become as popular an anti-depressant in Britain and the US as it is in Germany, and if that occurs the sales of the herbal anti-depressant will take over a major fraction of the antidepressant market. The over-the-counter availability of St John’s Wort gives the herb the additional market advantage of easier accessibility as compared with prescription anti-depressants. Many patients may seek to treat their own depressions as opposed to seeking help from the medical establishment. Whatever the wisdom of such a decision on the part of the patient, this change in behaviour will mean more money in the pockets of producers of herbal compounds, owners of health food shops and, most important, patients themselves.

Private insurance companies and even the NHS are in a position to influence the relative cost of St John’s Wort versus conventional anti-depressants. Should private insurers choose to reimburse patients for synthetic anti-depressants but not for St John’s Wort, they would make the herbal anti-depressant more expensive than synthetic ones for some patients. The current situation in Germany is that St John’s Wort is reimbursed by insurers if it is prescribed by a doctor but not if it is purchased over the counter. This seems like a reasonable guideline to follow in other countries as well.

The questions raised in this chapter, such as ‘Should people be encouraged to treat their own depressions?’ or ‘Should active antidepressants be available over the counter?’ are worth debating in their own right and will no doubt be discussed in the years to come. Given the economic and political stakes involved in these issues, however, it is important for the consumer to be aware of the potential biases of those who are most likely to be engaged in the debate even though these biases do not invalidate the content of their arguments. With this in mind, let us examine some of the controversies that have been raised in relation to St John’s Wort.

*40\75\2*

The difference between clinical ecology and conventional medicine becomes apparent as soon as one enters the waiting room. In my office, (or instance, the physical setup is adjusted to the needs of the susceptible person. This is done to provide a more hospitable environment and also because test procedures undertaken in the office itself might be ruined by chemical exposures.

No smoking is allowed, and this rule is strictly enforced. Signs to this effect are posted not only in the waiting room but in the bathroom as well, where confirmed tobacco addicts may be tempted to depart from the rule. Care has been taken in the selection of office furniture. Wood and leather are used extensively, not plastic or synthetics. Office machinery is kept to a minimum in order to avoid the kinds of fumes and odors which frequently foul the air indoors. Almost all of the typewriters, for instance, are manual, not electric. The copying machine was chosen because it emits the least amount of environmental pollutants. In fact, it is rarely used. Even the partitions are made of hardwood and not of any building material which gives off gases, as plastics often do. Nurses, secretaries, and other employees are instructed to refrain not only from smoking but also from the use of perfumes, scents, and after-shave lotions. We have little trouble in this regard, however, for almost all office personnel themselves have food and chemical susceptibilities, and are chosen with this fact in mind. Because of their own experience, they can provide more help and understanding to patients than those who are not aware of environmental disease in a personal way.

The office is located high above Lake Michigan, and the air is about as good as one is likely to find in a big city like Chicago. For heat, we employ portable electric heaters. In a sense, then, a patient’s treatment begins as soon as he enters the office itself, since the environment is conducive to recovery.

*91\110\2*

Forty-four people (adults and children) who have remained unwell for as long as one year were recently described in the Annals of Internal Medicine (102:1&7). Their symptoms have included sore throat, fever, swollen and tender lymph nodes in the neck and elsewhere, aching joints, slow thinking, tiredness, physical fatigue, and a feeling of gloom. They were generally unwell without first having gone through any recognizable acute illness.

Investigation of these people with blood tests revealed the presence in their tissues of the Epstein-Barr (EB) virus, which, among other things, is responsible for mononucleosis. The illness from which they were suffering is known as the chronic mononucleosis syndrome (CMS).

Mononucleosis of such gradual onset and persistence is not usual. Why, in such cases, the body cannot rid itself of the EB virus is not understood. To date, there is no treatment for CMS, but extra rest seems to help us cope better with its symptoms. After several months to a year, most of the patients begin to feel better, but in a few cases, the illness lasts even longer.

The behavior of children with vague fatigue, and who seem to have lost all interest in school, has often been attributed to some emotional difficulty. Now, Pediatric Notes (9:24) suggests, one of the first things to think about is testing them for CMS.

*169\143\2*

Signs and symptoms

Gonorrhea of the genitals in boys causes burning during urination and a discharge from the penis. In girls, gonorrhea may cause vaginal discharge and abdominal pain, but frequently there are no symptoms at all. In cases with no symptoms, diagnosis can be made only by alertness and awareness of the possibility of the disease.

Home care

There is no home treatment. Gonorrhea must be diagnosed and treated by a doctor. Diagnosis requires special culture techniques with microscopic examination of discharges from the vagina or penis.

Precautions

• Be aware that the disease still exists and that it exists in children of all ages.

• Provide sex education for your children.

• Many physicians advocate the practice of taking periodic vaginal cultures at the time of routine school and annual examinations of sexually active girls.

Medical treatment

Your doctor will diagnose gonorrhea by smear and special culture techniques. If gonorrhea is diagnosed, antibiotics will be prescribed. Although some gonococci germs are now resistant to penicillin (that is, not destroyed by it), other new antibiotics are reliably effective. By law, cases of gonorrhea must be reported to health departments. Most cases are diagnosed by tracing the sexual contacts of the individuals with known cases of gonorrhea. In New South Wales treatment of minors between 14 and 16 is confidential, at the doctor’s discretion; parental consent is not necessarily required. However, there could be variations from State to State.

*86/84/5*

Nicotinic acid agents

Drug name and brand name: Niacin, nicotinic acid.

How do nicotinic acid agents work? Nicotinic acid is vitamin B3; a water soluble vitamin. When given in doses much higher than required for good health, niacin is able to lower LDL cholesterol and triglyceride levels, and raise HDL cholesterol levels. A typical starting dose is 250mg three times daily, which is usually increased up to a maximum daily dose of 3-4.5g. The Recommended Daily Intake (RDI) for niacin is only 13mg for women and 19mg for men. Nicotinic acid can lower LDL cholesterol by 10-20%, lower triglycerides by 20-50% and increase HDL cholesterol by 15-35%.

Side effects of nicotinic acid agents: The most common and annoying side effects are hot flushes, as it has the effect of dilating blood vessels. Clearly this is not the drug of choice for menopausal women! Digestive upsets such as nausea, indigestion, gas and diarrhea can occur. Nicotinic acid is contraindicated in people with peptic ulcers, as it can severely aggravate them. This drag can also enhance the effect of high blood pressure medication. Other problematic side effects include gout, an increase in blood sugar levels and inflammation of the liver.

Fibrates

Drag names and brand names: Gemfibrozil (Lopid, Ausgem, Gemfibrozil-ÂÑ, Gemhexal, Genrx Gemfibrozil, Jezil, Lipazil), fenofibrate (Lipidil).

How do fibrates work? The exact mechanism is not fully understood; however fibrates do lower triglyceride and VLDL levels, and can slightly increase HDL cholesterol levels. These drags come in tablet and capsule form, and are typically taken twice daily, half an hour before the morning and evening meals.

Side effects of fibrates: The most common problem is gastrointestinal discomfort, and these drugs can increase the chance of developing gallstones. Fibrates can increase the effects of some drags, making it more likely for you to suffer side effects from them; these drags include the blood thinning drag Warfarin, some diabetic medications and statin drags. If fibrates are taken together with statins, they greatly increase the chances of suffering severe side effects of statins such as myopathy (muscle pain), and rhabdomyolysis (the breakdown of muscle tissue). However, the Heart Foundation does recommend these two drags are combined in high risk people if one drag has not worked on its own. Regular blood tests for liver enzymes and creatine kinase (CK) are recommended if statins and fibrates are taken together to monitor side effects.

Probuchol

This is not a commonly used drag because it lowers both the LDL “bad” and HDL “good” cholesterol. Therefore, it is only used in some types of hereditary high cholesterol cases or in patients where other cholesterol lowering drugs have been ineffective. Probuchol can cause nausea, bloating, diarrhea and dizziness.

*32/53/5*

Results of treatment (Reproductive Healthcare Clinic in St John’s Wood, London) showed that women between 32 and 43 years old who underwent 40 cycles of assisted conception achieved an astonishingly successful pregnancy rate of 50 per cent, compared to the standard 15 per cent.

These remarkable results were achieved by a combination of conventional and complementary medicine. While the couples were being medically investigated by Reproductive Healthcare’s director consultant gynecologist and specialist in reproductive medicine and treated in collaboration with one of London’s leading fertility centers, they also came to see me and had full nutritional analysis, lifestyle recommendations and a supplement programme for the months leading up to treatment.

By having ‘the best of both worlds’ they achieved a 50 per cent pregnancy rate. This shows that conventional and complementary medicine need not mutually exclusive. They can be used very successfully together – all it res is open-mindedness on the part of both the conventional and the complementary practitioner, who can learn from each other, and open-mindedness on your part too. You have nothing to lose and everything to gain, as Jill and her partner discovered.

Case History

Before coming to see me, Jill and her partner, both in their early thirties, had been trying to conceive for two years. Jill’s blood tests showed abnormal reproductive hormone levels and her scan showed that one ovary was not functioning and that the other one had multiple cysts, a symptom of polycystic ovary syndrome (PCOS).

Her partner had had a number of sperm tests with conflicting results, and a post-coital test had shown no sperm in the sample. They both had stressful jobs and worked long hours.

Before the diagnosis of PCOS she had been treated for eight months with clomiphene citrate, and they had had one unsuccessful IUI attempt. They had already decided to go for IVF treatment by the time they came to see me, so the aim was to get them as healthy as possible before the treatment started. From the mineral analysis, I could see a number of deficiencies so these were corrected before the IVF cycle started. They were successful on their first IVF attempt and now have a lovely baby girl.

*17/73/5*