Herbal Health

1.    Calc. fluor.

salt: Calcium fluoride

function: Promotes elasticity of tissues

uses: Cold sores at the corners of the mouth, cracked lips and

tongue, circulation problems, muscle weakness, piles, mptures,

strained tendons.stretch marks, varicose veins

2.    Calc. phos.

salt: Calcium phosphate

function: Helps build new blood cells, aids digestion, strengthens bones and teeth

uses: Convalescence, chilblains, indigestion, iron deficiency anaemia, lowered vitality, poor circulation, tooth decay and teething problems

3.    Calc. sulph.

salt: Calcium sulphate

function: Blood constituent and purifier

uses: Adolescent spots, sore lips, slow healing skin and wounds

4.    Ferr. phos.

salt: Iron phosphate

function: Constituent of red blood corpuscles which helps in distribution of oxygen in the body

uses: Chestiness, coughs, colds, chills, fever, inflammation of the skin, muscular rheumatism

5.    Kali mur.

salt: Potassium chloride

function: Promotes respiratory health

uses: Asthma, bronchitis, catarrh, colds, sluggish digestion, sore throat, tonsillitis, wheezing

6.    Kali phos.

salt: Potassium phosphate function: Nerve soother and nutrient

uses: Depression, excitement or worry causing irritability or loss of sleep, headaches, indigestion, tension

7.    Kali sulph.

salt: Potassium sulphate

function: Promotes and maintains healthy skin

uses: Catarrh, discharge of the nose or throat, poor condition of

nails, hair and scalp, skin eruptions with scaling, sticky or

yellowish discharge

8.    Mag. phos.

salt: Magnesium phosphate

function: Nerve and muscle fibre nutrient

uses: Acute spasms, colic, cramp and menstrual pains, darting

pains, hiccups, wind

9.    Nat. mur.

salt: Sodium chloride

function: Controls distribution of water in the body

uses: Loss of smell or taste, watery colds with runny nose and

eyes

10.    Nat. phos.

salt: Sodium phosphate function: pH regulator of the cells

uses: Acidity, gastric indigestion, heartburn, rheumatic pains

11.    Nat. sulph.

salt: Sodium sulphate function: Balances body water

uses: Biliousness, colic, digestive problems, headaches, influenza symptoms, morning sickness, queasiness

12.    Silica

salt: Silicon dioxide

function: Conditions, cleanses and eliminates wastes uses: Boils, pimples, sties, toxic accumulations

*64\69\2*

The only studies of efficacy of St John’s Wort conducted to date have been done in Europe. These studies came to the attention of the US medical community initially when an issue of the Journal of Geriatric Psychiatry and Neurology was devoted to Hypericum in 1994 and later, when the highly regarded British Medical Journal published a meta-analysis of randomized clinical trials of the herbal remedy. In a meta-analysis, several small studies are combined together in order to determine whether certain general conclusions can be derived from the data obtained from them.

In their meta-analysis, Linde and colleagues addressed three simple questions: Is Hypericum more effective than placebo? Is it as effective as standard anti-depressant treatments? And does it have fewer side-effects than standard anti-depressant treatments ? In order to increase their chances of reaching valid conclusions, these researchers included in their meta-analysis only those studies that randomly assigned patients to different treatment conditions, which is generally regarded as a prerequisite for a valid clinical trial. It would not be valid, for example, to assign severely depressed patients one type of treatment and mildly depressed patients another. These researchers also used state-of-the art statistical methods to compare the treatment interventions.

Interestingly, when Linde and colleagues used only conventional computerized searches of the medical literature, they located fewer than a third of those clinical trials that they ultimately chose to include. This reflects the division separating herbal and conventional medicine which has been so prominent until recently and which persists to some extent even at the present time. Almost all studies were published in languages other than English, reflecting the fact that the recent development of herbal medicine has come predominantly from the German-speaking world. Finally, the authors had to go through many revisions before the prestigious mainstream British Medical Journal was willing to publish the review.

Altogether the authors analysed 23 randomized trials involving 1,757 patients suffering from mild to moderate depressions. In 13 trials of Hypericum versus placebo, Linde and colleagues found Hypericum to be clearly superior to placebo, yielding a response rate of 55 per cent as compared with 22 per cent for the control placebo treatment. In three trials of Hypericum versus standard anti-depressants, the two treatments were very similar, possibly favouring Hypericum. But when side-effects were compared, Hypericum emerged as the clear winner, with approximately 20 per cent of the Hypericum group reporting side-effects, as compared with about 53 per cent of those taking standard anti-depressants. Several studies reviewed by the researchers used combinations of St John’s Wort and valerian, an herbal sedative. I have excluded those studies from the present discussion, though their results were consistent with those which used St John’s Wort alone.

Linde and colleagues concluded rather persuasively that Hypericum is superior to placebo in the treatment of mild to moderate depression and that it has a very benign side-effect profile. Evidence is less persuasive when it comes to comparing the relative efficacy of St John’s Wort with other anti-depressants, mostly because adequate studies have not been performed. Studies comparing herbal and synthetic anti-depressants used dosages of the synthetic compounds that were lower than those often used in clinical practice.

Clearly there is room for more research on the efficacy of St John’s Wort, especially into questions of who would best benefit from Hypericum versus conventional anti-depressants, how best to regulate dosage and how to blend Hypericum with conventional anti-depressants. To date, there have been no head-to-head comparisons between St John’s Wort and the SSRIs. Such a comparison is part of the design of the multi-centre US study currently being planned under the aegis of the US National Institute of Mental Health. It is important to compare these two types of anti-depressant, since the SSRIs are the most commonly used anti-depressants at present and, in practice, both doctor and patient may often wish to choose between these and St John’s Wort in deciding how to initiate the treatment of a depression. There have also been no long-term studies of the anti-depressant effects of St John’s Wort but, in this regard, the herbal antidepressant is no different from many of the conventional anti-depressants for which long-term studies are lacking. While these questions have yet to be resolved to the satisfaction of scientists, for the person seeking relief from the painful symptoms of depression they are of much less importance than the fundamental question, ‘Does the herbal anti-depressant work?’ In my view this question has already been answered with a resounding ‘Yes.’

To date there has been only one study that has addressed the question of whether St John’s Wort works for more serious depression. The work of Daniel in the 1930s, mentioned in Chapter

6, suggests that the herbal remedy might be helpful in severe as well as in milder cases. In recent times, Vorbach and colleagues in Germany conducted a multi-centre study of 209 severely depressed patients, of whom 38 were hospitalized at the time of the study. They used a higher dosage of Hypericum than has been used in the studies of mild to moderate depressions (1,800 mg as opposed to 900 mg) and compared this with imipramine, an old standard anti-depressant. While the anti-depressant effects of these two treatments were very similar, far fewer side-effects were reported by those receiving Hypericum than by those receiving imipramine (23 per cent versus 41 per cent). This study suggests that there may indeed be a role for Hypericum in the treatment of severe depression, though more studies in such patients are clearly needed before St John’s Wort can be used with any confidence as a first-line treatment in those suffering from profound depressions.

As I have noted elsewhere, there is one study that suggests that Hypericum may be of value in seasonal affective disorder (SAD), though no one has properly researched how best to combine the herbal remedy with light therapy.

I should mention that most of the research on the St John’s Wort and depression has been conducted with the Kira™ brand of the herb. This preparation is extracted from the leaves and flowers of the plant by a special method and it is unclear whether the research findings with this type of extract can be generalized to other preparations.

*38\75\2*

Connie Mullens was an attractive woman in her early thirties. She appeared to have many of the things which would help to make a person happy: a loving spouse, a beautiful home, a good educational background, and a rewarding job. Yet before she came to the Ecology Unit, she was contemplating suicide. Mrs. Mullens had many illnesses and problems practically all her life, but was completely unhelped by conventional treatment. In fact, her health was endangered by being prescribed amphetamines. Clinical ecology helped her, in part by breaking her dependence on these drugs.

During her childhood, she had had many illnesses, some of them bizarre. She had had asthma so badly that her parents doubted at times that she would live. This problem went away after the family moved to a new house. In high school, she had frequent stomach problems, diagnosed as the result of a “virus.” One such “virus” lasted for over a year.

In college, she demonstrated superior academic ability, got straight A’s most of the time, and was elected to Phi Beta Kappa. Nevertheless, during this same period a curious sort of malaise started to creep over her, imperceptibly at first.

At times, especially in chemistry lab, she would feel a kind of euphoria. She was known as the chemistry class prankster and would devise complicated practical jokes to play on her instructors. Of course, this sort of behavior among college students is “normal” when looked at in isolation. It is only when seen in the context of her overall development, and the onset of her more serious symptoms, that it begins to take on medical significance. In retrospect, some of this behavior may have been a lesser stimulatory reaction (plus-one) to the presence of chemicals and natural gas (in the bunsen burners) in the classroom.

At the same time, Mrs. Mullens had an increasing number of bad days. On these occasions, she had headaches of ever-increasing frequency and intensity. On some days, she could not get out of bed, could not concentrate, and could barely stay awake. To combat these doldrums, she relied on junk food. She would drink cola beverages or eat chocolate and candy whenever she had to “cram” for a test. Every day she would go down to the drugstore and have a chocolate malt and a piece of pie, which seemed to temporarily relieve her tiredness and headaches.

Because she was, not surprisingly, overweight, she consulted an internist, who prescribed diet pills which contained amphetamines. “With these,” she later recalled, “I could leap tall buildings at a single bound.” She stopped taking them when she realized that she was becoming addicted.

Connie was married in college, but the marriage did not work out, This was mainly because of her irritability, she says. She would throw temper tantrums in the house, fling shoes at her husband, or force him to watch his favorite television shows with the sound off (she was very sensitive to noise). She kept on eating, too; her husband called her the “cookie monster” because of her insatiable sweet tooth.

By the time she reached graduate school, her problems were worse. She now had headaches once or twice a week, but each lasted a couple of days. She began to consult doctors, and each had a different diagnosis and solution. One internist, she says, prescribed twenty different pills, mostly amphetamines. She was instructed to try each of them in turn and keep a record of their effects. None of them did anything for her head pain.

She also saw an endocrinologist (hormone specialist), an otolaryngologist (ear-nose-and-throat specialist), and, of course, a psychiatrist. The psychiatrist analyzed her psyche in depth and at length. He came to the conclusion that, as an only child, she had had too much pressure put on her to achieve. In fact, except for her illnesses, she had had a particularly happy childhood. Her parents were both successful and well-educated and probably expected their daughter to be the same, but did not force her to emulate them in this regard.

Connie could not drive an automobile. If she attempted to she became confused and could not interpret traffic signs or even make sense out of a simple stop light. Rather than look for something in the environment (for example, automobile fumes) that might cause such a condition, the psychiatrist interpreted this problem as a psychological need for perfection. He recommended that she relax more.

After finishing graduate school, Mrs. Mullens undertook a job which brought her into contact with industrial chemicals. All of her symptoms worsened. She got married again and gave up the full-time job.

As bad as all these symptoms were, her condition took a sharp turn for the worse (from minus-two or -three to minus-four) when her new home was sprayed with powerful pesticides, inside and out. Winter came, and the gas-fired heater was turned on. Soon afterward she started to feel so weak that she could not get out of bed. She was depressed to the point of dwelling on suicide. Her new husband would come home each day and find her crying uncontrollably.

Her psychiatrist prescribed amphetamines again, this time for ten days, to bring her out of what he called a “short-term depression.” At the end of this period, she was worse and had developed a numbness in her fingers and a tingling in her limbs. To all of her other problems, she now added a fear of multiple sclerosis—an unfounded fear, it now appears.

When she was admitted to the Ecology Unit, her symptoms were particularly bad. The water fast accentuated her symptoms; she developed a terrible headache and cried almost continually at first. After a few days on the fast, however, she underwent a remarkable recovery. “I got completely better,” she recalls. “I became absolutely convinced that my problem was related to the environment.”

Mrs. Mullens reacted to most of the foods she was given. Some brought on arthritislike aches in her fingers and other joints. The worst food for her was beef. After eating a portion of beef, she told the nurse on duty that she wanted to kill herself. She wandered the halls, crying aimlessly. The next day she said that she felt as if she “had been run over by a bulldozer.”

All of her many symptoms were reproduced in several weeks of food testing. What is more, tests with chemicals in various forms showed that this patient had the problem of chemical susceptibility. Mrs. Mullens has made excellent progress in controlling her food and chemical difficulties. “In the real world we face serious problems,” she has said. For example, it is difficult for her to avoid all exposure to natural gas. The gas heater and range have been removed from her house, but she still runs into them in other peoples’ homes, as well as in stores. In certain shops, she becomes so irritable that she feels like strangling those who get in her way. It is only in gas-heated stores that she has this problem. Despite periodic setbacks, her mental state recently has been cheerful.

An understanding of the food and chemical problem has brought with it many rewards. But it also has added responsibilities. Once, when she was in a hospital for some physiological testing, a conventional doctor “caught” her making lists of her reactions to artificially colored and flavored medicine. He actually took papers which she had discarded out of the wastebasket, read them, and remarked, “I see that you are involved with your symptoms. You apparently want to be sick!” When she tried to reason with the man, who was a gastroenterologist, he said brusquely, “I have forty other cases in the hospital. I don’t need you.” To his amazement, she promptly checked herself out of the hospital.

Mrs. Mullens’ case thus represents both the triumph and the tragedy of treatment by the methods of clinical ecology. On the one hand, like many other patients, she was brought back from the brink of suicide by coming to understand the multiple environmental factors responsible for her reactions. She credits it with saving her life. Yet, on the other hand, the world itself sometimes seems hostile to this new approach. Much yet needs to be done to make the environment completely livable for the Connie Mullenses of this world.

In summary, it may be said that the concepts and techniques of ecologic mental illness are opening up new horizons for patients with the symptoms of depression and related psychiatric disturbances. In contrast to the longstanding artificial distinctions between physical and so-called mental illnesses, both physical and cerebral and behavioral manifestations of allergy/ecology represent different levels of reaction. At long last, large sectors of the field of psychiatry are yielding to medical management based on the demonstrability of cause and effect.

*89\110\2*

Aspirin is one of the non-steroidal anti-inflammatory drugs (NSAIDs), a group of medications used in the symptomatic treatment of arthritis and many other causes of mild to moderate pain. Other drugs included in this group are Indomethacin, Motrin, Nalfon, Naprosyn, and Tolectin. Since they are “non-steroidal” (not like cortisone), they lack many of the undesirable properties of cortisone-like drugs, such as cortisone’s ability to raise the blood pressure, weaken the bones, depress immunity, and to mask infections.

The NSAIDs, however, have some serious side effects of their own, and one of these is a type of kidney damage, which occurs in about 1 percent of people treated with these drugs, particularly if they are taken for a long time. For this reason, some people are afraid to take an aspirin every day to slow blood clotting and hence to help reduce their risks of coronary heart attack and stroke.

That worry, according to correspondence in the Lancet (1:736), is an unnecessary one, since aspirin differs from all the other NSAIDs in that it lacks any ability to harm the kidneys when taken in usual doses by mouth. The reason for this is that aspirin is broken down by digestion in the intestine and further changed in the liver immediately after absorption so that, after usual dosages by mouth, not enough intact aspirin gets into the general circulation to harm the kidneys.

*167\143\2*

Symptoms: Swelling in the front of the neck

Home care Do not attempt to treat at home. Treatment depends on the cause, which must be diagnosed by a doctor.

Precautions:

-    During pregnancy, do not take medications (even over-the-counter drugs) without your doctor’s approval.

-     Since not all thyroid glands are in exactly the same position, a lump in the neck should never be removed without first testing to be sure it is not the thyroid gland.

A goitre is an enlargement of the thyroid gland which causes a swelling in the front of the neck. The thyroid gland lies just below and to either side of the larynx (Adam’s apple). The thyroid gland produces hormones that control the body’s metabolism rate – the rate at which foods are used for energy and growth. A normal thyroid is barely if at all visible and can barely be felt.

A goitre may be present in a newborn infant, especially if the pregnant mother was on certain medications (including iodides in anti-asthma or cough medicines). Insufficient iodine in your child’s diet also can cause a goitre. Once common, this disease is now rare because of general use of iodized table salt and more widespread eating of seafood. (Seafood is naturally high in iodine content.)

A goitre is most common between the ages of six and 16 years. It occurs in girls nine times as often as it does in boys. It is most often due to an autoimmune (self-destructive) disease-Hashimoto’s thyroiditis -of unknown cause. Enlargement of the thyroid is rarely due to malignancy. A goitre may be hyperactive (producing too much hormone) or hypoactive (producing too little hormone), but usually it is neither.

Signs and symptoms

A goitre can be seen and felt as a swelling in the front of the neck. This swelling usually appears just below and to either side of the Adam’s apple. Often the swelling is noticed when a shirt collar or neck jewelry no longer fits. Generally, there are no other symptoms.

Home care

No home treatment should be attempted until the cause of goitre is diagnosed by your doctor. The cause cannot be diagnosed without laboratory tests.

Precautions

• During pregnancy, do not take medications (even over-the-counter drugs) without your doctor’s approval.

• Not all thyroid glands are in exactly the same position in the neck. Any lump in the midline of the neck may be a goitre of an unusually positioned thyroid. A lump should never be removed from this area without first testing to be sure it is not the thyroid gland.

Medical treatment

Blood tests, often requiring complicated laboratory work, are used to find the cause of goitre. The treatment for goitre depends on the cause and can include giving oral thyroxine (thyroid hormone) or desiccated thyroid for months or years. Surgery is rarely necessary except in rare cases of malignancy or when the goitre obstructs breathing in infants.

*84/84/5*

Some very recent studies are showing that statin drugs can reduce inflammation in the body; specifically they are able to lower C-reactive protein (CRP) levels. According to Dr Christopher P. Cannon, a cardiologist at Brigham and Women’s Hospital in Boston, USA, “CRP is a global screen for bad things in the cardiovascular system”. If you have high blood levels of this substance, you are much more likely to have a heart attack.

Currently the mechanism by which statin drugs lower CRP is not known, but patients who have low levels (especially lower then 2mg/L) are less likely to have a heart attack, regardless of what their LDL level is. Perhaps statin drugs are exerting their protective effects on cardiovascular disease not by lowering cholesterol, but by lowering C-reactive protein.

It is good to know that statins can do something useful for your health, like lowering inflammation, but there may be a high price to pay. It is very easy to lower C-reactive protein with a healthy diet and lifestyle.

Maintaining a healthy weight, exercising regularly, and having a high intake of vegetable juices and antioxidants are simple ways to lower your CRP level. The thing is that these natural treatments don’t make much money. Drag companies make enormous profits on cholesterol lowering drags.

*30/53/5*

Certain kinds of work may be linked with reduced fertility for both partners. This is backed up by substantial research.

For example, professional drivers spend long hours sitting which can result in a lower sperm count and higher numbers of abnormal sperm.

Likewise, welders exposed to intense heat may have reduced quantity and quality of sperm. In the same way, firefighters face intense heat, and they are also exposed to a large variety of chemicals which affect their fertility. Indeed, any man who works in a hot environment (such as a foundry or bakery) could find that his sperm production decreases.

Agricultural workers exposed to pesticides and other chemicals have low sperm counts. Research also shows that their partners have a high rate of miscarriages. In 1991, 1,500 men in Costa Rica became sterile after being exposed to a pesticide used to treat bananas. Other pesticides, such as DBCP (dibromochloropropane), have caused changes in sperm counts, of which were reversible after exposure had stopped. Women exposed to pesticides can have problems conceiving and an increase in miscarriages.

Healthcare workers can be exposed to waste anaesthetic gases, ethylene oxide, cytostatic drugs, mercury and X-rays. And, as we have already seen, s and their assistants experience fertility problems due to the mercury in amalgam fillings.

Painters and printers are exposed to solvents and pigments which can affect male fertility.

Women who are exposed to chemicals and heavy metals often have problems with their menstrual cycle, experiencing hormone imbalances and miscarriages, while taking longer to get pregnant.

Problems with fertility can occur if you or your partner works with lead (used to make storage batteries), radiation, pesticides and/or solvents. For example, workers in drycleaners and hairdressers come into contact with a wide range of chemicals.

In 1997 the Lancet, the leading medical journal, published a whole range of occupations and their implications for fertility. Agents toxic to sperm included inorganic mercury, dibromochloropropane, ethylene dibromide, ethylene glycol ethers, chloropropene and carbon disulfide. Certain other occupational risks were found, including heat, strenuous work, ionising radiation, exposure to lead, antineoplastic agents, waste anaesthetic gases, ethylene oxide, methyl mercury, polychlorinated biphenyls and carbon monoxide.

Visual Display Units

Like televisions, VDUs produce a range of electromagnetic radiation frequencies, including ultraviolet, infrared, microwave, radio frequency and extra low frequency (ELF). Even though so many workers, male and female, now sit in front of a screen all day, surprisingly little is known about the impact of VDUs on health and fertility.

The Health and Safety Executive, the UK’s main workers’ watchdog, found no evidence of an increased miscarriage risk among VDU operatives in a 1992 survey. But other studies point to dangers.

The length of time spent at the computer may be the key. One study found that women who spent more than 20 hours a week in front of the screen had twice as many miscarriages as non-VDU workers. But under 20 hours there was no increased risk. Researchers have also found that not only are miscarriages correlated to the amount of time spent on a VDU but also the same for premature births and stillbirths. Out of those spending up to 6 hours a day at a computer 66 per cent had a problem relating to either a miscarriage, premature birth or stillbirth compared to only 25 per cent for those women spending one hour a day on a VDU.

A number of studies on women VDU workers have also considered stress as a contributing factor to fertility problems. Working at a screen means that women can be sitting in the same position for long hours, doing repetitive work, and often under time pressure.

*15/73/5*

Breathing’s pretty much what it’s all about in the death-defying game. But more than 96,000 Americans each year stop doing it thanks to an increasingly rampant form of lung disease called chronic obstructive pulmonary disease, or COPD. This isn’t pneumonia or lung cancer but a group of conditions characterized by blocked air flow.

There are two principal players in this death act-chronic bronchitis and emphysema-and they often do a duet in the same victim. You may have had a bout with acute bronchitis, with all that coughing and mucus accompanying a severe cold. Imagine those symptoms as a permanent result of inflamed and scarred bronchial tubes and you know what chronic bronchitis is all about.

Emphysema weakens and breaks the inner walls of the air sacs in the lungs, impairing the flow of air into the lungs and the distribution of oxygen into the rest of the body. The damage is irreversible, and emphysema victims find themselves short of breath and unable to do much of anything that requires physical exertion.

About 14 million Americans suffer from chronic bronchitis (a 60 percent increase since 1982), and 2 million from emphysema, 61 percent of them male. The cause of this sad state of affairs is smoking, for the most part. It accounts for 82 percent of all COPD. Don’t smoke, and you’re 82 percent of the way there. Here are some other ways to keep on breathing.

Find clean air. Hawaii might start looking pretty good to you if you’re in the early stages of COPD. The best way to control chronic bronchitis is to keep your nose, throat, sinuses, and bronchial tubes away from things that can inflame or irritate them, says Dr. Steven Mostow of the University of Colorado. Those things include smog, dusty working conditions, and cigarette smoke. Air pollution also aggravates emphysema symptoms. If Hawaii’s out of the question, the American Lung Association recommends that you plan your activities in the early morning or evening when smog levels are at their lowest.

Nip infections early. Any cold or respiratory infection is going to make COPD symptoms worse. So it’s not wimpy to consult a doctor at the first sniffle of a cold. And ask your doctor about getting vaccinated against influenza and pneumococcal pneumonia, two illnesses that can severely hinder breathing, says Dr. Mostow.

Keep moving. COPD or no, general health is still a good way to fight off infections. The American Lung Association recommends regular exercise that doesn’t tire you out much for chronic bronchitis sufferers. You should also exercise with emphysema, but as part of a doctor-guided pulmonary rehabilitation program, says Dr. Mostow.

*93/36/5*

A. Refusal to maintain body weight over a minimal normal weight for age and height, e.g.,

weight loss leading to maintenance of body weight 15 percent below that expected; or failure

to make expected weight gain during period of growth, leading to body weight 15 percent

below that expected.

B. Intense fear of gaining weight or becoming fat, even though underweight.

Ñ Disturbance in the way in which one’s body weight, size, or shape is experienced, e.g., the

person claims to “feel fat” even when emaciated, believes that one area of the body is “too

fat” even when obviously underweight.

D. In females, absence of at least three consecutive menstrual cycles when otherwise expected

to occur (primary or secondary amenorrhea). (A woman is considered to have amenorrhea if

her periods occur only following hormone, e.g., estrogen, administration.)

The first guideline, Criterion A, gives physicians an objective means of measuring the degree to which a person is emaciated: 15 percent below minimum normal body weight. This 15 percent figure (a somewhat arbitrary number, but still useful) is considerably less than the 25 percent given in the earlier edition. The change reflects the reality: Like other clinicians, I have seen numerous patients who seem to have anorexia but who, like Paula, haven’t lost enough weight to meet the criteria.

You might be puzzled by the use of the term “refusal to maintain body weight.” Doesn’t the word “refusal” suggest that the patient has made a conscious decision to act (or not act) in a certain way?

Yes, that’s true, but it still doesn’t mean that the anorexia is the patient’s fault. You have to think of the “decision” to lose weight as one made under duress. In a sense, the brain is held hostage to the disease and can’t think clearly. Anorexia is not a well-thought-out, rational plan; it’s more like a compulsion.

Still, such refusal makes life difficult for doctors as well as patients. Many a hospitalized patient declares war on the doctors and the staff. She sees them as members of a conspiracy whose evil aim is to force her to become fat. Patients may feel that they are being hunted down and annihilated by the “fat-doctors.” The patients, who see themselves as valiant rebels fighting to preserve freedom, will do anything to thwart this scheme: hide butter under the tray, spit out bites of food into their milk glass, exercise frantically while lying in bed, even run away from the hospital. Naturally, it’s hard to build a sense of trust and mutual cooperation under such circumstances.

One more point. The first diagnostic guideline lets us think of body weight in one of two ways: either as weight actually lost or weight never gained. The difference is important. Some anorexics feel fat now, and thus want to shed pounds. Others, particularly the younger ones, fear becoming fat in the future, and thus starve themselves to keep from gaining weight in the first place. It’s not necessary for a woman to reach a certain weight and then lose it in order to be considered an anorexic.

Criterion  mentions the intense fear of becoming fat. The earlier DSM specified that this fear doesn’t diminish even as weight loss progresses. The new version lets us acknowledge the presence of anorexia even in those cases where the woman reports that the fear does lessen as her weight shrinks.

Criterion Ñ expands the concept of disturbed body image. The disturbance might now reflect the patient’s perception of her body size or shape, as well as her weight. It also identifies a common anorexic symptom: the tendency to isolate and focus on one part of the body in particular.

Not long ago I visited a patient named Caitlin in her room at the hospital. In the course of our conversation, I indicated that she was making progress and was now eligible to go for short walks outside the hospital.

“I can’t do that!” she wailed. She threw back the bedclothes to reveal her legs, each of which wasn’t much thicker than a baseball bat. She pinched the skin between her fingers-she had to try a couple of times before she could actually grab anything-and shouted, “Look at this fat thigh! I can’t go out in public looking like this!”

The final criterion, D, acknowledges a feature of anorexia that the previous guidelines ignored: the loss of menses (menstrual periods), specifically three periods in a row, at some time during the course of the illness. In about four out of five cases, the loss of menses (also called amenorrhea) occurs as a direct result of starvation. Without proper nutrition, the brain senses that there is not sufficient energy for menstruation and doesn’t supply the “on” signal to the reproductive organs. (In male anorexics the equivalent problem is a loss of interest in sex, usually due to a reduction in the amount of testosterone produced.)

In another 20 percent of female patients, however, amenorrhea occurs before significant weight loss-that is, before starvation takes its toll. Sometimes a report of skipped periods is nothing more than a figment of the patient’s faulty memory. But not always.

The fact that some anorexics stop having periods before they lose weight may be evidence of a biological problem, at least in some cases. Because the hypothalamus regulates both eating and the reproductive system, any malfunction may affect both systems.

Other problems can also cause the loss of menses before weight loss occurs. In order to menstruate, a woman’s body needs not just sufficient weight, but a certain reserve of energy as well. Female athletes, for example, may eat adequate meals and maintain proper weight. But they may expend so much energy during exercise that they deplete their reserves. Menstruation then stops. Also, through chemical changes we don’t yet fully understand, emotional stress can interrupt the monthly cycle.

*24/35/5*

When Tawni Gomes stopped making excuses, she started losing weight—almost half of her body weight, in fact.

Tawni’s epiphany came one day in September 1996 as she watched The Oprah Winfrey Show on television. Oprah’s guest was her personal trainer, Bob Greene. As Greene explained the basics of

weight loss to the audience, Tawni began to feel inspired. At 300 pounds, she knew that she had to slim down. So the San Francisco resident headed for the nearest bookstore and picked up a copy of Make the Connection, Winfrey and Greene’s book. She read it cover to cover that very night.

Over the next month, Tawni struggled to stick with the exercise program. Excuses like “There aren’t enough hours in the day” and “I don’t have a personal trainer” conveniently prevented her from making a serious commitment to slimming down.

Then she heard that Greene was coming to town to speak and do a book signing. Book in hand, she went to hear him. “A woman in the audience asked Bob how she was supposed to find time to exercise with four kids, a house, and a full-time job,” she said. “Bob looked her straight in the eye and without hesitation said, ‘You’re not ready to lose weight.’ He turned to the rest of the audience and said, ‘Next question.’”

Tawni’s jaw dropped. “I was so shocked by his bluntness. But I had to admit that I was making the exact same excuses,” she says. “Everybody has the same number of hours in a day. If people with kids and tighter schedules than mine can find time to exercise, then, I figured, so can I.”

The very next morning, Tawni rolled out of bed at 4:00 A.M., laced on her walking shoes, and headed out—alone—for a brisk walk. It was the start of what would become a daily ritual. “With my work schedule and family commitments, that was really the only time I had to exercise,” she says. “At that early hour, it was so quiet and peaceful that it gave me a chance to think about my life and clarify my goals.”

Over time, Tawni switched from brisk walking to running. She also began lifting weights and performing stretching and toning exercises. The combination enabled her to take off 125 pounds in 3 years.

“No excuses” remains Tawni’s life motto. At age 34, she continues to work out regularly, and her weight is holding steady at 175 pounds. “That’s about right for my height and bone structure, though I’d like to lose about 20 more,” she says. She now has an online support group to help others get on the road to “no excuses.”

WINNING. ACTION

Make time, not excuses. We all have things that we need to get done, so we end up doing what’s important to us. Decide what’s most important for you. When you make yourself and your desire to live a healthier life a top priority, that’s when weight loss will happen for you.

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