De novo lipogenesis is the term used for making fat from other nutrients such as carbohydrate and alcohol. De novo lipogenesis is not thought to have a significant role in humans under normal physiological (day-to-day living) conditions.

• Unlike carbohydrate and protein, fat is not finely balanced in the body.

• Fat (from the diet and adipose tissue) is the energy buffer for the body—it makes up the difference between what the body obtains from non-fat calories and what it needs.

• Alcohol is the highest priority fuel for burning, but unlike protein and carbohydrate, it does not reduce hunger.

• Energy balance and fat balance are essentially equivalent.

An anecdotal survey of people living in the modem world reveals an interesting paradox in energy balance. On the one hand, it seems that the body has an excellent, in-built energy balancing system which for some people keeps them at the same body mass, or at least within a variance of about 1 per cent, over decades. This is a remarkable feat if one considers that over a

10-year period the body can balance about 10 million kcal in, with 10 million kcal out, without the individual having to consciously count a single one! On the other hand, for some people, this system seems to go very wrong as they gain fat over time, despite their best conscious efforts not to. Has the system broken down in these people? This seems unlikely and the probable resolution of the apparent paradox is that the body has excellent balancing mechanisms for all types of calories except one—fat. So high-fat diets and low fat burning can result in fat gain without the usual energy balancing systems detecting it, because they are not designed to detect it.

*48\186\4*

Some babies from birth make a strange rasping noise when they breathe. It may be more noticeable when they cry. There are many causes, and the doctor will try to discover the underlying reason, and have this corrected if possible.

Infections of the voice box are the commonest cause. (In serious cases this may develop into croup, as previously described.) Foreign bodies the infant has inhaled, or structural abnormalities that occurred during baby’s development, all may play a part.

Noisy breathing is the key symptom. The parent may notice that when the infant breathes, the area between the ribs seems to suck in. Hoarseness, breathing difficulty, and a ‘laryngeal crow’ (this is a strange crowing noise when baby breathes) may be present.

Treatment

If any of these symptoms are present, they need a full check by the doctor. When the cause has been found, the doctor will work out the necessary treatment. It will vary with the individual; and as treatment varies with cause, it is a matter of tailoring the therapy for the young patient.

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Tics commonly occur between the ages of five and ten years. They are repetitive, purposeless, involuntary movements. Often they commence for a reason, such as a sore eye, but then their automatic nature takes over. Winking the eye, tossing the head, shrugging the shoulders or jerking an arm or hand are common movements. Nearly always these have an emotional basis. The well-adjusted, normal child will rarely have persisting tics.

Treatment

An effort to find an emotional cause is often worthwhile, for most cases have a nervous origin. Strict parental domination, with no available outlet for emotional stresses, is a common cause. Stressful situations at home, or at school, or with peers, may often provide causes for this outward manifestation. Frequently, if the cause is found and relief can be offered (by correcting the problem), the condition may be resolved. Sometimes tics persist into adult life.

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(Epistaxis)

Nosebleeds have a variety of causes, most of which are minor. Most nosebleeds are caused by the rupture of small blood vessels in the anterior section of the nasal septum. There are often obvious causes like a blow to the nose, irritation from a foreign body, excessive nose-blowing during a cold or sinusitis and nose-picking. Nosebleeds can also occur during menstruation. Some people suffer more from nosebleeds than others.

Occasionally nosebleeds are related to more serious illnesses and injuries such as the presence of polyps or other growths in the nose, high blood pressure, allergies to certain foods, vitamin deficiencies and conditions like haemophilia. Arteriosclerosis, or hardening of the arteries, can cause nosebleeds in old people, while in children they are sometimes a symptom of rheumatic fever.

When bleeding from the nose cannot be sourced to a blood vessel inside the nose, it may indicate an internal injury. The blood may be caused by a skull fracture or injury to the stomach or lungs. If the nose bleeds regularly or excessively, or if the bleeding is difficult to stop, medical advice should be sought. Persistent bleeding may require cauterisation of the blood vessel.

*22\69\2*

There is a close relationship between the skin and the nervous system. In the early development of the fertilized human ovum into the embryo, adjacent cells are split off so that some will ultimately develop into the skin and others into the nerve cells of the central nervous system. When our skin is gently stroked our nerves are calmed, but when our skin is tickled our whole nervous system is convulsed. It is therefore not surprising that activity of brain cells is often reflected in the activity of the cells of the skin. In other words, emotional stresses in the mind are apt to produce nervous rashes in the skin. This is such common knowledge that it is reflected in our everyday speech when we talk of something “getting under our skin”; and we can observe emotional reactions in the skin when people blush with embarrassment, go pale with fear, or turn livid in anger. Thus the self-management of nervous rashes involves both a reduction in the general level of anxiety and a reduction of responsiveness to emotional stress.

A doctor’s wife came to see me because of a nervous rash which she had had for the past two years. I showed her a little about relaxation, and as she lived in the country it was arranged that she would return to the city in a month’s time for an extended visit so that I could help her further. But she wrote cancelling her appointment, saying that the rash had already cleared.

She came to see me some two years later when she had a slight recurrence. The rash quickly settled down just as on the previous occasion.

*25\57\2*

Tips for a headache-It’s also possible to massage headaches away with a gentle fingertip massage. Here again it’s easier if your husband, boyfriend or a friend does the massage, but you can do all these for yourself quite successfully. Again I am giving instructions for two people, because that really is the best way, but if you are alone it’s quite easy to adapt the instructions, with the proviso that you sit comfortably with your head supported by a high-backed chair or cushions. The first two massages described are for headaches above the eyes and around the hairline.

Fingertip massage l-If you’re going to try your hand at being a masseuse, sit your patient in a low-backed chair, facing away from you. The back of the chair should be below your patient’s head and shoulders. Get her to rest her head against you as you stand behind her. Then, when you’re both comfortable, place your hands across her forehead so that your thumbs are resting gently on her temples and your fingertips meet one another in the centre of her forehead. Draw your hands apart, stroking very gently with your fingertips as you go. Stop the stroking movement when your fingertips reach the hair at her temples, just above her ears. Repeat, gently and rhythmically. You’ll soon know if it’s doing any good. If it works, your patient will begin to purr. It’s a very pleasant sensation.

Fingertip massage 2-If that kind of massage doesn’t have much effect, try this one. Lay the palm of one hand across your patient’s forehead, so that your fingertips are resting in the hair above one temple and the edge of your little finger and the side of your hand are touching her eyebrows. Using the edge of your little finger and the side of your hand like a delicate brush, sweep up gently towards the hairline. As the sweep with your right hand reaches her hairline, start another sweep with your left hand, beginning just above her eyebrows as you did before. Repeat, gently and rhythmically. One or the other of these massages should be helpful. Many people enjoy them both.

Circular massage of the scalp-If your patient has a headache across the top of her skull or in a band right round it, try this. Put both your hands into her hair just above her ears, with your fingers splayed out to cover as wide an area of her scalp as you can. Now make circular

movements with all your fingers at once. This is helpful as a gentle massage, but sometimes does more good if you press down quite firmly on to the scalp. Start gently and increase the pressure gradually until you find out what’s best for your patient.

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Although we rarely think about it, many of the foods we eat have been exposed to natural or synthetic gas. Small but potentially harmful residues of this gas may remain in these foods and cause problems for susceptible individuals.

Most bananas, for instance, are artificially ripened by exposure to ethylene gas immediately before they are distributed to the markets. The more time that elapses after this gassing, the more readily the bananas are tolerated by those who are highly susceptible to chemical exposures. This is apparently why chemically susceptible people are sometimes able to eat bananas and sometimes are not. There is a fairly certain way, however, to detect gassed bananas. The naturally ripened bananas have black seeds and tend to have small, specked spots on their skins, in contrast to the gassed bananas, which have immature white seeds and large blackened areas of the skin at points where they were bruised in handling or shipping.

One of the most common forms of food allergy is suceptibility to coffee. Many people are made chronically ill from the steady and habitual drinking of this, our national “grown-up” drink. But when patients with alleged coffee allergies were given electrically roasted coffee in an office test, some of them had no reaction at all. They only reacted to coffee which had been roasted over a gas flame. Almost all commercial coffee is gas-roasted, however. How much this fact contributes to the high incidence of susceptibility to coffee has not been investigated adequately.

The difficulty of separating the effects of chemicals and foods is illustrated by the following episode. In 1950, I co-authored an article on apparent susceptibility to sugarcane in a medical journal.4

Six patients were each given a glass of spring water with two heaping teaspoons of cane sugar dissolved in it. Each of them showed some adverse reactions to the drink, ranging from dizziness to sudden, uncontrollable fatigue.

We published these findings, feeling quite certain that these patients were sensitive to cane sugar per se. As I learned more about the effects of chemical contaminants in food, however, I realized that these patients may have been reacting to something other than sugar itself.

I visited a large sugar refinery and observed the process by which sugar is converted from rough cane to fine, white crystals for the table. Suspicions of chemical contamination centered on one particular stage in this process, clarification, when the cane syrup is filtered through roasted animal bones (called “bone char”). From time to time, these filters are washed, dried, and then reactivated at 1,000°F. over a gas-fired flame. It is highly likely that the char absorbs some of the combustion products of the gas. The sugar then picks up microscopic particles of this gas: not enough to taste or see, but enough to trigger a reaction by chemically susceptible patients.

In order to check this idea, several patients with other aspects of the chemical problem, who appeared to be also susceptible to cane, were tested with a special lot of cane sugar. This lot had been manufactured by means of a process which bypassed the bone-char filter. The test was “blind,” in that the patients did not know whether they were receiving the special or the normal commercial sugar. Several of the patients became sick from the uncontaminated sugar; they were truly susceptible to cane. But a surprising number of those who had believed themselves unable to eat sugar discovered, to their surprise, that they could eat the unfiltered sugar with impunity. (Beet and corn sugar are also manufactured by similar processes.)

*20\110\2*

Cystic fibrosis is a chronic (lifelong), inherited disease. It affects the lungs, pancreas, sweat glands, and sometimes the liver and other organs.

Cystic fibrosis (CF) is passed from parents to child through a particular gene. Genes are the parts of the body’s cells that determine inherited characteristics (such as hair color, eye color, and size, as well as inherited diseases). To have cystic fibrosis, a child must inherit the particular gene from both parents. A child who has the CF gene from only one parent will not have the disease. A person who carries the gene but does not have the disease is known as a “healthy carrier.” When both parents are healthy carriers, only about 25 percent of their children receive the gene from both parents and develop the disease.

CF may appear at birth as an obstruction or blocking of the intestines. Symptoms may also appear during infancy or childhood and sometimes as late as adolescence.

Signs and symptoms

Some common symptoms of cystic fibrosis are frequent respiratory infections, including bronchitis and pneumonia; chronic cough; failure to gain adequate weight; constipation or diarrhea with foul-smelling stools; protrusion of the rectum; and clubbing (broadening) of the fingertips and toes. Almost all persons with cystic fibrosis have unusually salty sweat. A very salty taste to a child’s skin when kissed is sometimes a sign of CF.

Home care

If you have any reason to suspect your child has CF, see your doctor. If CF is diagnosed, home treatment will be directed by your doctor. Treatment at home may include taking antibiotics, following a special diet, taking pancreatic enzymes by mouth, inhaling vapor and medications, and postural drainage.

(Postural drainage, conducted in a home setting, involves positioning the child over the bed with the head pillowed on the floor. The child’s chest is tapped soundly to allow excess fluids to drain from the lungs. Your doctor will give specific instructions for performing postural drainage.)

Precautions

• If your child shows any CF symptoms, a sweat test should be done. A sweat test is a painless, harmless, inexpensive, and generally reliable test for cystic fibrosis.

• If there is any history of CF in the family, a sweat test should be considered for all children, even if they appear to be healthy.

• The sweat test is not reliable before age one month and is not as reliable during adolescence.

Medical treatment

The doctor will perform an inexpensive test for CF called the sweat test. The doctor may also order a chest X ray. If cystic fibrosis is diagnosed, your doctor will refer you to a medical center where there are specialists in treating CF.

The outlook for prolonged life of a child with CF who is in relatively good health is better now than in the past, but a cure for CF is still being sought. The earlier the diagnosis is made and treatment started, the better the outcome.

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Believe this fish story.

Some fish have a good type of fat called omega-3 fatty acids, and salmon is one of the richer sources of that element. Our bodies use omega-3 fatty acids to make hormone-like substances called eicosanoids, which help regulate processes such as inflammation, blood clotting, and constriction of blood vessels.

Omega-3′s appear to assure the orderly inflow of calcium, sodium, and other charged particles into each heart cell, which helps ensure a nice, steady, strong thump-bump, thump-bump.

And talk about capable: Fish like salmon, anchovies, and herring, which are all rich in Omega-3′s, reel in one of the shadiest characters implicated in rheumatoid arthritis inflammation, leukotriene B4. Scientists can measure a significant drop in leukotriene when fish oil is added to the diet.

Omega-3′s don’t stop there. They also soothe the effects of Crohn’s disease (a serious inflammation of the small intestine), may lessen your sweetheart’s severe menstrual cramping, and are thought to help stave off depression.

Need more convincing of this fishy health benefactor? One study showed that people who ate the equivalent of just one serving of salmon weekly had half the risk of cardiac arrest as those who ate no omega-3′s.

How much, how often? A single 3-ounce serving of baked salmon provides 10 times the amount of omega-3′s the typical American gets in a week. Eat at least one serving weekly, experts say.

Tofu.

So it sounds a bit like an invective. Too many of us have shunned it as though it were. But this simple, palatable, easy-to-use, and oh-so-versatile soybean derivative is nothing short of a super-food when it comes to our health.

Cultivating a taste for tofu is easy; it can be added to just about anything without changing the taste. Tofu is mild and light-bodied and represents “one of our very best food choices,” Dr. Anderson says.

What can you do with tofu? Blend it in a shake or smoothie. Crumble it on a salad. Chuck chunks into soups, stews, chili, marinara sauce. Slice it for a sandwich to replace cheese. Blend it into dips, dressings, custards, puddings. Slip it into stir-fries.

The potential health benefits of soy are sweeping, says Dr. Anderson. Topping the list: major heart protection. Add to that preliminary but encouraging studies suggesting reversal of osteoporosis, and other studies suggesting reduction in the risk of kidney disease and a lower risk of prostate and colon cancers. You begin to see why Dr. Anderson is soy excited.

Researchers haven’t determined precisely how soy manages its heart-healing magic, but they’re thinking that compounds in soy might function as antioxidants.

In addition, emerging research suggests that isoflavones (another plant version of estrogen) in soybeans may actually repair damaged, sluggish blood vessels, restoring their youthful flexibility – something that’s important for healthy blood flow, says Dr. Anderson.

The isoflavones’ estrogen-like and estrogen-altering activities may be key to the reductions in risks of prostate and breast cancers. These activities may also be why the isoflavones are credited with preserving bone and actually promoting new bone mass. Isoflavones are also known kidney-protectors.

How much should you eat? It depends on what you want. For general health, Dr. Anderson recommends 30 to 40 milligrams of isoflavones per day. (A 1/2-cup serving of tofu has 35 milligrams of isoflavones, 1 cup regular soy milk has 30 milligrams, and 2 tablespoons roasted soy butter has 17 milligrams.) To tap tofu’s help in reversing heart disease and osteoporosis, Dr. Anderson recommends that you triple your daily dose.

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Smoking

If you are a heavy smoker and have not been able to cut down or stop altogether, you will be advised not to smoke in the hours before your operation. It is, of course, much better to stop smoking some months before surgery. The carbon monoxide contained in cigarette smoke poisons the blood by replacing some of the oxygen which is carried in it and which is vital to processes such as wound healing.

Obesity

Obesity adds to the risk of anesthesia, and for this reason people who are very overweight should try to lose weight before entering hospital. Some surgeons are reluctant to carry out nonemergency operations on heavy smokers or obese patients as they consider the risks to be too great. However, starting a long, strict diet before your operation is inadvisable. The consultant will have assessed your weight when seeing you at your outpatients’ appointment, and will probably have given you some guidance at that time.

Waiting

It may seem that you have been admitted to hospital unnecessarily early, and you may find you have to wait on the ward with little to do. Apart from having to be seen by all the medical staff mentioned above, who are responsible for many other patients as well, time will also have been allowed for the assessment of any medical problems you may have, and for the results of any blood tests to be received.

Sometimes operations have to be cancelled at the last moment if an emergency has arisen and an earlier operation has taken longer than expected. Your operation may have to be postponed, perhaps for a few hours or until the following day, but as the stress a cancelled operation of this sort would cause is well understood, it is extremely unlikely that you would be sent home.

You will probably be given only an approximate time for your operation, being told if it is scheduled for the morning or afternoon. Surgery being done before yours may take longer than expected if complications arise.

Leaving the ward for your operation

Before being taken from the ward to the anesthetic room or operating theatre, you will be given a hospital operating gown to wear and will be asked to put on your anti-embolism stockings. A plastic-covered bracelet bearing your name and an identifying hospital number will be attached to one or both of your wrists. You will then be taken from the ward on a hospital trolley.

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