Women’s menstrual cycles are almost as individual as they are — there’s a large variation in what is ‘normal’. The cycle can take from 24 to 35 days (counting the day you start bleeding as the first day); bleeding can last for between two and seven days; and the amount of blood lost can range from 10ml to 80ml (the average being around 35ml). If blood loss is heavy it can lead to anaemia (iron deficiency).

To familiarise yourself with what is ‘normal’ for you, it’s a good idea to keep a menstrual dairy. Some women are extremely regular, others less so, but once you get a feel for your usual pattern, you can be more alert to ‘abnormal’ variations.

Heavy periods (also called menorrhagia) may be caused by things like fibroids, pelvic inflammation, hormonal disturbances, tumours, and IUDs, but there may also be no apparent cause (this is known as ‘dysfunctional uterine bleeding’). If your periods become much heavier than what’s normal for you, you should seek advice from a health practitioner as it may indicate an underlying problem.

Shortages of iron, zinc, Vitamin B6 and Vitamin A have been suggested as causes of excessive bleeding, so supplements may help (but beware of taking large amounts of Vitamin A without supervision). Food intolerance may be a factor for some women, and if you’re being treated for candidiasis, your periods may get heavier for a while before settling down again. Make sure you eat plenty of iron-rich foods such as green leafy vegetables and lean meat to counteract the possibility of anaemia. Among the herbs, bayberry, raspberry leaves, golden seal, sage or shepherd’s purse may be useful, and supplements of dolomite (calcium and magnesium) taken for a few days before and during the period have been reported as effective.

Period pain (dysmenorrhoea) varies greatly among women. There are two types: primary dysmenorrhoea is related to the uterus actually contracting under the influence of prostaglandins (hormones); secondary dysmenorrhoea tends to extend outside the time when you are actually bleeding and can be caused by problems such as cysts, fibroids, polyps, infections or tumours.

You should investigate the cause if you feel you are experiencing secondary dysmenorrhoea, but there are many self-help treatments that can help relieve the pain. A hot water bottle against the abdomen can be soothing, as can a warm bath or shower. Exercise, especially swimming or yoga may help. Try massaging the uterus directly — pressing into your abdomen just above the pubic hairs; or experiment with acupressure — direct pressure on the Achilles tendon behind your ankle. Eat plenty of fresh fruit and vegetables, vegetable juices, fish and liver. Useful supplements may include magnesium, calcium and potassium; and the herbs crampbark, cimicifuga, chamomile, golden seal and raspberry leaf.

Amenorrhoea — absence of periods — is most commonly the result of pregnancy or breast-feeding. But if this is not the case, you should consult a health practitioner to try and track down the reason. Amenorrhoea can be caused by hormonal imbalances, extreme loss of weight (for example, as a result of a disorder such as anorexia nervosa — see separate entry), or by some drugs used to treat high blood pressure or cancer.

Cessation of menstruation is known as menopause.

*6\69\2*

Anxiety commonly shows itself in irritability. We react too quickly and too much to all manner of minor frustrations. We become upset by things which would not normally disturb us. We are more sensitive to noise, and are easily irritated by it. The noises at work which we had not previously noticed become a source of irritation; and at home the noise of the children brings us to distraction. We tolerate it as long as we can, then suddenly let go. We punish the child too severely, and then immediately regret it.

If someone finds fault with what we have done, we normally take the criticism in stride. But when we are anxious, we overreact to the situation; we flare up, we say what we should not say, and then regret it. The girl in the restaurant attends to us in the usual way, but because we are tensed up we feel that she is unbearably slow. The mannerisms and quirks of our friends and relatives, which we once enjoyed, now irritate us. There soon develops an atmosphere of tension in the home. Members of the family become cautious; they are restrained, and no longer laugh arid joke openly for fear of triggering off this unnatural irritability. The anxious one senses that the others are acting differently toward him, he becomes still more on edge, and the cloud of misunderstanding deepens.

A young woman in her early thirties, extremely tense and aggressive, came to consultation on account of her intense irritability with her two young children. These were her exact words: «With her like she is how could I be relaxed?» «It is not as if I am completely ignorant. I have had experience with doctors and that makes me a bit doubtful.»

For some years her husband had been under treatment for a peptic ulcer which I thought might easily be related to his wife’s irritability.

Her state was so severe that I arranged for her admission to a hospital, but she was so irritable and aggressive that she promptly left against advice. However, she returned to me some months later, just as irritable as ever, but determined to seek help. It took her several sessions to learn to do the relaxing mental exercises. She then underwent an extraordinary change in personality; she could smile and be pleasant in a way that had not seemed possible before. She learned to cope with the children and tolerate frustration without undue irritability.

*8\57\2*

This is the other kind of period pain. The one sure way to find out whether someone is suffering from this type is to ask her how she knows when a period is due. Those who suffer from the cramps have little or no warning that a period is on its way; the blood and the pain often arrive together. But if you suffer from the aching miseries, you know for days beforehand that a period is due. You probably ache, your breasts may be sore and your belly swollen; you feel bloated and heavy; you can’t do up your skirt and your bra is too tight; you may have a headache, backache, or aching thighs; you may feel exhausted or disagreeable or irritable; you may be off-balance (some of the trouble areas are indicated in figure lb). Do you break more cups just before a period, or trip over your feet, or find it impossible to park the car? Do you sleep badly? Do you develop inexplicable bruises on your thighs or upper arms? They’re all symptoms of the aching miseries, and they can last for anything from two or three days to more than a fortnight. The period itself is probably not too painful once it gets under way. And after the first day of the actual period you feel a lot better. Many women say they’re back to normal then.

Strangely enough, although the aching miseries seem to be almost the reverse of the cramps, deliberate relaxation helps them too. It is not yet known for certain why this is, but it looks as though it is to do with the hormone balance of our bodies. The changes which occur when a woman has periods, carries a baby, and gives birth are mainly controlled by two chemical messengers, or hormones, called oestrogen and progesterone. To simplify, it seems likely that the cramps are caused by a shortage of oestrogen and the aching miseries by a shortage of progesterone.

*4\177\2*

The stimulatory (plus) levels can all be considered, in a sense, adaptive responses by the body to some environmental substance(s). When the body can no longer adapt, it enters the various stages of maladaptation (see Chap. 11). These are the withdrawal reactions, also called hangovers or letdowns. Most people never identify their stimulatory (plus) reactions as symptoms until the bigger picture is pointed out to them. The negative reactions are clearly problems, however, and doctors’ waiting rooms are filled with the victims of such reactions.

Minus-one reactions are those symptoms, mainly physical, which are commonly called allergic reactions. They include running nose, coughing, wheezing, asthma, itching, hives, eczema, excessive gas, diarrhea, constipation, colitis, and other localized physical problems.

Because such reactions are ordinarily considered as allergic in origin and handled by conventional allergists, I have given little detailed attention to them in this book. It can be assumed, however, that they are often caused by allergies to foods and common chemicals.

Minus-one reactions (—) such as these may disappear, only to be replaced by even more troublesome minus-two (- -) reactions. Minus-two reactions are «systemic» allergic symptoms, affecting not just one but many parts of the body. A person in this stage of allergy is typically tired, dopey, sleepy, or mildly depressed. He is frequently plagued by painful syndromes, such as headache, neckache, backache, neuralgia, myalgia, and arthralgia. This is the phase in which chest pains and .cardiovascular effects are noticed. Cardiovascular simptoms can include rapid or irregular pulse or heartbeat, hypertension, phlebitis, anemia, or tendencies toward bleeding and bruising.

Typically these symptoms do not occur alone. That is, by the time a patient has fallen to the minus-two level, he often has many of these problems. Doctors like to deal with anatomically distinct problems: «Where does it hurt?» is a typical opening question. Few doctors like to hear, «It hurts all over,» or some such reply. In fact, as we have mentioned, many doctors are told in medical school to discount the statements of parents with many complaints. For this reason, patients in the minus-two and minus-three categories are often told, condescendingly, that their problems are «all in their head,» or psychosomatic. This may be due to the unfamiliarity of orthodox physicians with the findings of clinical ecology. In actuality, such multiple ‘symptoms are often the end result of a long process of developing allergy. The individual nature of the patient’s problem can usually be demonstrated through the methods of clinical ecology.

Minus-two (- -) is the stage at which we find such common problems as physical fatigue and headache (Chap. 12) and muscle and joint aches and pains, including arthritis (Chap. 13). Fatigue, when related to food allergy, tends to be worse in the morning, because this »s when the patient has been without his addictant for several hours. He needs, and craves, his fix. Fatigue on an allergic basis is usually quite different from physical fatigue resulting from exertion, which is relieved by rest and sleep- Allergic fatigue is seemingly without cause, and is not ordinarily relieved by prolonged periods of rest; it is basically quite unpleasant.

Minus-three (- – -) is the stage I call «brain-fag.» The term «brain-fag» is found in Webster’s dictionary as a synonym for mental exhaustion. It was suggested to me by a patient who suffered from this problem, and I have used it ever since. «Brain-fag» is more than just exhaustion. In this stage, thinking is confused, and people become indecisive, moody, sad, sullen, withdrawn, or apathetic. There is frequently much emotional instability and impaired attention. The «brain-fagged» patient cannot concentrate properly, and his comprehension and thought processes are impaired. This includes aphasia (the inability to speak, or to find words for things), mental lapses, and blackouts. A fuller discussion of «brain-fag,» with case histories, is given in Chapter 14.

As with the minus-two reactions, «brain-fag» is characteristically polysymptomatic. The patient has many symptoms and often has periods of physical illness (minus-one or -two) interspersed with his generalized mental exhaustion (minus-three).

Severe depression, or minus-four (- – - -), can be called the end of the line of this entire problem. This depression can be preceded by a superstimulated (plus-four) phase, as in manic-depressive disease, or by less severe withdrawal symptoms (minus-three).

While depression does occur in the young, it is most commonly found in the middle-aged or elderly, who have had a lifetime to develop to this stage. Such depression is often believed to be the result of unhappy events in the life of the patient, such as bereavement, retirement, or changes of locale. While such life events may contribute to the problem, usually mild depression and «brain-fag» precede them, and provide the underlying mechanism for the development of a crisis. Most often, in my experience, depression is caused by lifelong addictions to common foods, drinks, and environmental chemicals.

The severely depressed person may be unresponsive, lethargic, disoriented, and melancholic. While he may remain rational for long periods of time, he may eventually lapse into paranoid thinking, delusions, hallucinations, and sometimes even amnesia and coma.

*5\110\2*

Chest pain is common during childhood. Although chest pain in adults can be serious, it is rarely a symptom of serious disease in children.

A very common form of chest pain in children is the so-called stitch in the side—a stabbing pain in the lower chest, more often on the left side than the right. This pain occurs with exercise and will stop after a minute or two of rest. This type of pain may be caused by gas pains in the large intestine, contraction of the spleen, or spasm of the diaphragm. Regardless of the cause, it is harmless.

Pain in the area of the sternum (breastbone) is common when a child has bronchitis or a head cold combined with a cough. A frequent, hard cough often makes the diaphragm sore, causing a pain just below the ribs. Pain on one side of the chest may be caused by pleurodynia (inflammation of the lining of the chest cavity) or by shingles.

Injuries (including muscle strains, bruises, and fractured ribs) cause pain that is worsened by deep breathing and movements of the chest. All of these types of chest pain are relatively minor and usually can be cared for at home.

There are a few causes of chest pain in children that are more serious, but these are also uncommon. Pleurisy that develops as a complication of pneumonia may cause chest pain; the pain is accompanied by other signs of pleurisy (fever, difficult breathing, cough).

Another more serious cause of chest pain is spontaneous pneumothorax, which is a bursting of a small bubble on the surface of the lung. When the bubble bursts, air escapes into the chest cavity, causing gradual collapse of the lung. This condition comes on suddenly, often with sharp pain, and causes increasing shortness of breath. A hernia of the diaphragm causes chest pain that is usually worse when lying down and less or absent when sitting and standing. Heart pain in children, even those with serious heart conditions, is so rare that it is practically unknown.

Signs and symptoms

Chest pain may occur alone or along with other symptoms. The exact location of the pain and the circumstances that bring on the pain or make it worse are clues to the type and cause of chest pain. Other symptoms (cough, fever, rash at the site of the pain, and shortness of breath) are also clues to the cause.

Home care

Most cases of minor chest pain can be treated at home with aspirin or paracetamol, mild heat, and reassurance. If chest pain is caused by a hard cough, cough medicines may help.

Pleurisy, spontaneous pneumothorax, and hernia of the diaphragm should be treated by a doctor.

Precautions

• If chest pain is accompanied by shortness of breath, high fever, a cough producing blood flecks, or prostration (collapse), get medical help immediately.

• If there is persistent pain beneath either armpit that is made worse by breathing, see your doctor.

• Do not give cough medicines if the child is having difficulty breathing.

Medical treatment

Your doctor may recommend X rays and blood tests. Pneumothorax is treated by hospitalization, close observation, and possibly a puncture of the chest wall to remove trapped air.

*31/84/5*

Fructose Test

If there are no sperm in the semen analysis it may mean that none are being produced by the testes, or that they are being produced but the tubes are blocked and they cannot get through to be ejaculated. Where no sperm are present, a test for fructose is done. Fructose is a sugar normally found in semen. The absence of fructose in the semen can mean that the seminal vesicles are blocked, stopping both sperm and fructose from getting through. It may be possible to surgically correct such a blockage. Alternatively, the absence of fructose could mean that the man does not have any seminal vesicles. If fructose is present but the man does not have any sperm in the sample, further investigations need to be done. These can reveal whether there is a blockage nearer to the testes or whether the testes are not in fact producing sperm.

Anti-sperm Antibody Test

This test attempts to determine whether the man is producing substances which are causing the sperm to clump together, lose motility or prevent fertilisation. These antibodies would make the man’s immune system ‘see’ his own sperm as foreign bodies and try to destroy them.

The most common test for antibodies is the MAR (mixed antiglobulin reaction) test which is now often done as part of the normal semen analysis. If antibodies are present, the sperm will be clumped together instead of moving freely.

Sperm antibodies can be produced in response to an infection. Antibodies can also be produced in about 70 per cent of men after a vasectomy. During the procedure some sperm may leak out and, because previously they had been contained within the reproductive system, the body views them as a foreign substance and produces antibodies to them.

Treatments for anti-sperm antibodies may include steroids which carry their own side-effects, such as weight gain, stomach bleeding and depression. IVF may be a possibility if the sperm can still penetrate the egg, otherwise ICSI will be suggested.

It is also possible for the woman to be producing antibodies to her partner’s sperm and this can be checked by a blood test.

Post-coital Test

The post-coital test has been used since the 1860s to assess the cervical mucus and the sperm’s ability to swim through it. You go to the clinic around the time of ovulation after having intercourse about four to ten hours before. A cervical mucus sample is taken and examined under a microscope. The clinic is looking to see whether there are any sperm in the mucus, whether they are dead, or whether they are just shaking rather than moving forward. If a man has active, healthy sperm when he gives a sperm sample, and yet in the post-coital test the sperm are dead, then something is obviously happening once the sperm are inside the vagina. The test needs to be performed precisely at the right time of the cycle and it is possible to get a number of false results. This means that it has to be repeated, if it looks as if the woman is killing off her partner’s sperm.

There are not many clinics who still do this test and it is interesting that a study published in the British Medical Journal in 1998 came to the conclusion that ‘Routine use of the post-coital test in infertility investigations leads to more tests and treatments but has no significant effect on the pregnancy rate’. The researchers took couples who were attending an infertility clinic and then split them randomly into two groups. One group had all the usual fertility investigations plus the post-coital test and the other group just the fertility investigations without the post-coital. At the end of the study there was no difference in the number of pregnancies between the two groups, and yet the group having the post-coital test was given more fertility treatments on the basis of their post-coital results.

*3/73/5*

In order to establish meaningful contact with other humans, you have to learn how to talk-openly. Learn how to communicate in ways that let others hear you better. A key, says Dr. Ornish, is to practice expressing feelings rather than thoughts. Feelings connect; thoughts-particularly judgmental ones-isolate us, he says. Here are some of Dr. Ornish’s communication tips.

•     Express a thought-»I think you’re wrong,» for instance-and your listener may feel attacked and argumentative. Express a feeling, though-»I feel sad about what you said,» for instance-and the listener is more likely to hear you, Dr. Ornish says.

•     Express feelings and you make indisputably true statements. No one can argue about how you feel. How you feel is how you feel.

•     Express feelings and you exhibit a bit of vulnerability that people generally recognize and respond to in kind, raising the level of the communication.

•     Feelings-that is, emotions-are more effective than thoughts in influencing people.

It is just as important to express negative feelings as positive ones, Dr. Ornish says. Just learn to express them as feelings, not as judgments or attacks. Add the words I feel to your vocabulary. One caution, though: Dr. Ornish says that if you add the word that after an I feel, you probably are not truly expressing a feeling but, rather, a thought.

One way to encourage more expressions of feelings rather than thoughts is to rid your language of the phrases «You should,» «I think,» «You ought,» «You never,» and «You always.» Instead, add the phrase, «I want.»

We communicate more intimately when we acknowledge what we hear other people saying to us, making it clear that we really listened and really heard what they said and making sure that we understand their meaning, Dr. Ornish notes. Try it and you’ll see that people warm to you as they feel more understood. And you will warm to them, too, because you will be focusing on their feelings and expressions, rather than paying more attention to what you’re going to say next.

*37/36/5*

Eczema

Eczema of the nipple may sometimes occur as a result of irritation caused by the rubbing of clothes – contact eczema – or of a general skin infection. Some people are born with eczema, and it can occur on the nipple as on any other area of the body.

Once the diagnosis has been confirmed by a specialist, which may, rarely, be done by means of a wedge excision under local or general anesthetic, and the cause of the irritation has been removed, a short course of steroid cream may be necessary. Infection can be treated with antibiotics.

Paget’s disease of the nipple

Paget’s disease normally occurs in women over the age of 45, and is caused by a ductal cancer growing onto the areola. It is quite a rare condition which may be confused with eczema, but which spreads over the areolar region far less quickly and may destroy the nipple completely over a long period of time. If left untreated, it never heals and eventually forms an ulcer.

Wedge excision of the affected area, or the cytological examination of scraped cells under a microscope, will confirm the diagnosis. This is a far more serious disease than eczema and treatment may involve complete removal of the breast. A woman with persistent redness or nipple discharge should always report it to her doctor even if she has eczema elsewhere on her body as the cancer associated with Paget’s disease is not palpable.

Infective ‘mastitis’

This can occur in women who are breast-feeding their babies. It may be caused by the transfer of micro-organisms from the hands to the breast through a cracked or inverted nipple, by an infection passed on from the baby’s mouth, or by blood-borne infection such as a sore throat.

If the ducts become blocked when a woman is lactating, the milk may stagnate within them and an infection can develop. This may cause a dull pain with inflammation, tenderness and swelling or engorgement of the breast, and sometimes an infective discharge from the nipple.

Treatment with antibiotics is usually effective if given early, but breast-feeding will have to stop while these are being taken. Breast milk can be expressed with a breast pump, but, as the milk will contain traces of the antibiotic, it should not be given to the baby. Your midwife will be able to advise you in this situation.

Ulcers

Rarely, ulcers can develop on the nipple during breast-feeding. The baby’s sucking can irritate the skin, leading to pain and bleeding from the affected area.

Washing and drying the nipple carefully after each feed, and the use of Calendula ointment can help to prevent ulcers forming, but once present, frequent washing with a sterile solution and breast-feeding using an artificial nipple should help. If necessary, breast milk can be expressed with a breast pump.

Ulcers are more common in fair-skinned women, particularly those with red hair.

*15/39/5*

Many-if not most-people believe that they should have ‘a thorough check-up’ now and again. There is a widely held misconception that a doctor (usually a general practitioner) can do a kind of 10,000 miles service of everything that really matters and do it in a few minutes. This is totally untrue. Even a very lengthy clinical examination by a highly expert physician might well miss even quite obvious disease which cannot be picked up by his or her bedside diagnostic skills. The problem with such examinations, even if they are very well done, is that if given an ‘all clear’ patients imagine themselves to be well and may as a result actually take less care of themselves because their current lifestyle, they argue, appears to be doing them no harm.

Young children and the elderly need more regular professional examinations because they get ill more often and can go downhill very quickly once something starts. Physical examinations in middle age are more worth while than in younger people because of the higher rates of heart disease and cancer.

Obviously it makes sense to limit physical examinations to those periods of life at which they are most likely to produce results. A thorough physical examination at birth and periodically throughout early childhood makes good sense because so much is going on developmentally that it is reasonable to try to pick up abnormalities so that they can be dealt with quickly. It is probably sensible to have a physical examination every five years after this up to the age of 40 and then every other year up to 65.

*31/72/5*

Pete Falk never sets foot in a grocery store without a plan—a menu plan, that is. Writing down exactly what he needs to prepare each week’s meals keeps him away from all of the high-fat, high-calorie temptations that line supermarket aisles. It’s the key to how he lost 63 pounds.

Pete, a 35-year-old computer engineer from Denver, got in the menu-plan habit while attending a medical clinic specializing in weight loss. At the time, he weighed 257 pounds, too much even for his 6-foot-1 frame. «I had been heavy since I was a kid,» he explains. «I wanted to slim down, and I had tried numerous times on my own. I didn’t get really motivated until my allergies and asthma started getting worse. Then I knew that I needed help.»

At the clinic, Pete went on a physician-supervised eating plan for the first couple of months. Then, he worked with the doctor and a nutritionist, learning how to make smart food choices on his own. «They gave me sample menus, which I took to the supermarket with me so I’d know what to buy,» he says. «Eventually, I realized that by sticking with the menus, I was filling my cart with healthy foods, not the junk that helped me gain in the first place.»

The menus encouraged Pete to make other healthful changes in his eating habits. He stopped skipping breakfast, he started packing his lunch on workdays, and he tried to have dinner at about the same time every evening. «Because of my job, I had been eating really late some nights—around 10 o’clock,» he says. «I was so hungry by then that I’d stuff myself.»

As Pete’s eating habits improved, his waistline shrank. He joined a local gym, where he worked out 6 days a week. Within 4 months he was 63 pounds lighter.

That was more than 2 years ago. Pete has since started lifting weights, which has added some bulk—all muscle—to his physique. He’s holding steady at a fit 200 pounds.

While exercising regularly has helped Pete get in shape, eating healthfully has kept him trim. These days, he writes his own menus, but he still takes them to the grocery store. «My menus help me shop conscientiously,» he says. «I get the right ingredients and buy only what I need—no junk food.»

WINNING ACTION

Get a plan. If you’re prone to straying down the wrong supermarket aisle, like Pete, get a plan. Decide on your meals for a full week. Write down what you need to make each meal. Use that as your shopping list. This

way, you’ll leave the supermarket with exactly what you §. went in for, and you’ll minimize impulse buys.

*25\89\8*

There are two major problems in choosing a filter. Firstly, it is impossible to tell if the product is working properly, without chemical analyses, although if it has a serious defect, a smell of chlorine in the filtered water might be noticeable. Secondly, there are no British Standards for domestic water filters at present. As a customer, you therefore need to be well informed about what you are buying. Some of the filters at present on the market actually remove very few contaminants from the water supply. Others may work well at first, but their performance drops off sharply – long before they have filtered the number of gallons claimed by the manufacturer.

The only country to apply consumer standards to domestic water filters is the USA, where the Environmental Protection Agency requires filters impregnated with silver to be registered and sets a limit on how much silver can leach into the water. In Britain, the Water Research Centre operates an approval scheme for some aspects of water filters, but not for their overall performance. It seems likely that the approval scheme in Britain will be improved in the next few years.

The vast majority of water filters bought in Britain are of the jug type. The advantage of these is that the initial outlay is very low (£10-15). The cost per gallon is between 12 pence and 30 pence, which is cheaper than bottled water, although the taste of the water is not as good.

The prime objective of the jug filters is to improve the taste and appearance of water, and to remove hardness (calcium carbonate or ‘chalk’) so that kettles do not

become lined with scale. They contain an activated carbon filter to remove chlorine and another component, an ion exchange resin, which takes out the calcium carbonate. The latter component also removes lead and some other metals. Calcium carbonate is not injurious to health and cannot cause sensitivity reactions, so it is the kettle that benefits rather than the drinker.

*420\180\8*

Once you have felt consistently better for three or four days then you should start the reintroduction phase. Don’t delay doing this. Write down exactlv how you feel at this point – it may be useful and encouraging to refer back to this later if you suffer a lot of reactions during food testing.

Feeling much bettei- quite quickly

This can happen, especially in children and young people – they seem to miss out on the withdrawal symptoms. Go on to the reintroduction phase.

Feeling much better, but with one or two lingering symptoms It looks as if you have cut out your main offending foods, but are still eating something that is a problem (assuming that you have ruled out all other problems, such as candidiasis, airborne allergens, hyperventilation and environmental chemicals. Think again about your previous eating habits – is there anything you used to eat quite frequently and are still eating? Cut all these out.

If your symptoms clear, then go on to the reintroduction phase immediately. If they don’t, then the best option is to go on to a full ‘rare-food diet’, only eating foods that you have never eaten before.

If the remaining symptoms are mild, and fairly constant from day to day, then you could go on to the reintroduction phase – you may get some sort of useful result from testing. If you can discover which foods are the main source of trouble, and establish a diet on which you are reasonably well, then you are in a good position to investigate further. It could be that the remaining symptoms are due to some other problem – see below, under Feeling about the same, for a list of possibilities.

*373\180\8*

One thing that is thought to trigger off food intolerance is a heavy exposure to toxic chemicals. Such exposures are usually accidental and unforseen, of course, but there are some avoidable ones. If a house is to be sprayed with insecticides to eradicate woodworm, or with fungicides for wet or dry rot, then it is advisable to move out for at least a week, to allow time for the fumes to disperse. The company doing the spraying may claim that this is unnecessary, but there are instances of both children and adults being ill after spraying, even though they were not directly exposed to the spray. The fumes travel throughout the house, so even if only one part is being sprayed you should try to find somewhere else to stay for a while. Another hazard that can be very largely avoided is direct exposure to pesticides used on crops. If you see fields being sprayed, keep your distance, especially if they are being sprayed by a plane. The spray can easily drift. If you have a choice, don’t buy a house next to a large arable field. Avoid using sprays in your own garden and keep household chemicals to a minimum.

Finally, the general health measures listed on p290 are recommended to anyone who might be at risk of developing food intolerance. Above all, don’t ignore symptoms such as recurrent headaches, regular bouts of indigestion or persistent fatigue. Living on aspirin, antacids, or strong coffee is going to make the problem worse rather than better, and experience suggests that the decline into severe food intolerance is a very gradual one that begins with symptoms of this sort. Treating a mild form of food intolerance – the early stages – is a great deal easier than trying to tackle entrenched symptoms and multiple sensitivities. The longer you leave it the more difficult it may be.

*326\180\8*

It would appear, from more recent studies, that food additives are important in a great many children with hyperkinetic syndrome, but that it is unusual to find a child for whom additives are the sole problem. Most also show sensitivity to various commonly eaten foods, pollen, dust, other common allergens and chemicals. The role of natural salicylates seems to be a minor one. When food and other allergens are considered, as well as additives, 50-80 per cent of children respond, although not all of them are completely cured. Sensitivity to unavoidable synthetic chemicals, such as solvents and the contaminants of natural gas, may account for the partial success with some patients.

Although Feingold’s theory was not entirely right, he was correct to single out food additives for blame – they do seem to play a disproportionate role in hyperactivity, compared to other types of illness such as asthma or eczema. This suggests that enzyme deficiencies may contribute to hyperkinetic syndrome, because such additives need to be detoxified by the body’s enzymes. They may also prevent some enzymes from working properly. The involvement of additives may explain why the incidence of hyperkinetic syndrome seems to have increased dramatically in the last 20 years – a period that has seen the meteoric rise of junk food’, take-aways and instant-everything. All these convenience foods tend t6 be rich in colourings, flavourings, preservatives and other additives.

*275\180\8*

Enzymes are specialized molecules found only in living things (the ones in biological washing powders are extracted from living things). They are absolutely essential to life, because they make specific chemical reactions happen. For example, they join other molecules together to build up the cells that make up living bodies. They also break down food (digestive enzymes), so that the energy it contains can be utilized, and break down toxins (detoxification enzymes) to make them harmless. They transform surplus food into fat stores, or break down the fat to yield energy when food is short.

Although they cannot be seen, even under a microscope, there are hundreds of thousands of different enzymes in the human body. Each enzyme has a very specific job to do: most of them only control one reaction, although others are slightly more versatile. For example, some of the digestive enzymes can break

down a variety of food molecules of the same general type. Enzymes themselves are controlled by smaller molecules which can turn a particular enzyme on or off.

Enzymes are just one type of protein molecule. Like all proteins, enzymes are made according to an inherited pattern which is passed on from parent to child. This pattern is stored in the genetic material, the DNA. In fact, DNA acts as a template, from which all enzymes and other protein molecules are made. If there is a change in the DNA – a mutation – then the enzyme which is coded for by that part of the DNA will be altered. Usually these changes are for the worse, and the enzyme does not work as well as the original version. What sort of effect this enzyme defect has will depend on how important the enzyme is, what sort of reaction it controls and how badly it has been affected. Defective enzymes may play a part in food intolerance.

*27\180\8*

Scientific research is no doubt of great interest to the therapist and can tell him a lot. But when it comes to assessing the medicinal value of a herbal preparation, there is no substitute for practical experience with actual patients. A pure remedy, made from the whole plant, contains a complex of active elements, some of which are known and others unknown. For this reason, it is the practical treatment of a patient that really matters in determining whether a preparation is effective or not. This is why the medical researcher needs the cooperation of the herbal therapist in order to develop the best remedies from nature’s bountiful storehouse for the benefit of the sick. After all, is this not the real purpose of all medical research? At least, that is what it should be!

*687/28/1*

A patient told me once that she had suffered from this troublesome problem for years despite all her efforts to get rid of it. The fungus had settled under her breasts and on her arms, causing frequent soreness, and for more than twelve years she had used all kinds of remedies without success. Then she learned about Molkosan and an African plant remedy, Spilanthes, which complements and reinforces the healing effect of Molkosan. After applying these two remedies in alternation for about two weeks, she was pleased to note great improvement. The skin had been rehabilitated and was clear once again.

It goes without saying that such a splendid result makes one glad, if only because of the great patience the sufferer must have had in order to endure the unpleasant problem and its bothersome effects in spite of years of treatment. Think of the discouragement and disappointment first of all, then the great relief when the stubborn fungus disappeared in a relatively short space of time, restoring the skin to normal.

*643/28/1*

Of course, primitive people in unspoilt areas of the world are exposed to the same tooth-destroying bacteria that affect people in the industrialised world, but the enamel of their teeth is harder and does not allow the bacteria to penetrate and lodge in crevices; that is why their teeth remain healthy and resistant. But why are the teeth of those people so excellent? The answer is simple: their food is unadulterated, natural, not like ours that has been changed, refined, denatured, bleached and adulterated – to our detriment. Our faulty nutrition impairs healthy resistance, not only in the teeth but also in the bones, indeed the entire organism; we have become soft.

Solid, unrefined food as originally produced by nature enables those primitive peoples to use their teeth for the purpose originally intended by our Creator. They use their teeth in such a way that the function of chewing is properly exercised, and the teeth are cleaned at the same time. Wholewheat bread and bread or cakes made with whole corn require vigorous chewing, and so does all the rest of the hard food that makes up their diet. Thorough chewing guarantees a maximum health benefit from the outside, while healthy nutrients make for internal health, vigour and resistance.

*599/28/1*

This may well explain why some people who stick strictly to sound rules of nutrition nevertheless fall victim to cancer. No doubt you can now see that caring for our mental condition is just as important as adopting the right kind of diet. It is also true that the person who is able to maintain his mental balance finds it much easier to relax, slow down and keep calm, even though life may be stormy all around him. This ability will save much energy and help to avoid tension. If your duties are highly demanding, and you cannot reduce them, then make it a point to get plenty of oxygen, at least before going to bed; take a quiet walk and, what is even more important, do retire early. Is it not true that you get little done in the evening or night when your mind is tired? You will not be able to do as much as you want to, and you will have to make a far greater effort than you would in the morning after a good night’s rest, when the problems we face seem much less overpowering and are easier to solve than the night before when vigour and efficiency levels were low.

So there are quite a few things we have to watch in our difficult and critical times if we want to protect our health. Happily, we can do justice to what we have to do if we use sound common sense and judgment and act circumspectly, even though we may have to make some sacrifices. Such precautions are all in the interest of good health.

*555/28/1*

The most important remedy for arthritis is potato juice. It is not only its alkaline constituents which contribute to curing arthritis but possibly other, as yet unknown factors. Patients should take the juice of a potato daily and in severe cases the amount should be slowly increased. Grate the potato, squeeze out the juice and take it first thing in the morning before breakfast. It can also be taken in warm water or added to soup if you feel you cannot drink it neat. This is the most important remedy and should be taken every day. There should be no difficulty at all in obtaining potatoes anywhere on earth. Additional curative juices which should be taken daily are those of white cabbage and kale, as well as carrot. These principal medicinal juices should be taken every day without fail, even if only in small amounts, in addition to following a simple, natural diet. If you do not like the taste, mix the juice in with vegetables after they have been boiled or otherwise prepared. The best way to take the juices is, of course, undiluted. Sip them slowly so that they are insalivated before swallowing.

*511/28/1*

It is always wise to obtain a complete and detailed sexual and background history. At the Masters and Johnson Institute, two histories are taken from each member of the couple: one each by both of the therapists, first, male-male, female-female; then male-female, female-male, with an opportunity for the therapists to discuss the first history with each other before the second one is taken. This gives an opportunity for obtaining additional information by exploring any lead which may have been developed in the first history session.

The next day the therapists meet with the couple to go over the histories and to clarify any misunderstandings which may have occurred. This is described as the «round table.» Should any material in the individual history reveal something that the patient does not want the partner to know, then this is red-lined and not disclosed. However, if it seems essential to the therapeutic process for this to be discussed with the other partner, then this is explained to the person concerned, but even then is not disclosed if the individual insists on it even after its importance is explained.

It is believed at the Masters and Johnson Institute that no sexually dysfunctional relationship can exist with an uninvolved partner, even though the presenting complaint is primarily by one partner, such as impotence in the male or a non-orgasmic female. As Masters and Johnson have written, «There is no such thing as an uninvolved partner in any marriage in which there is some form of sexual inadequacy».

Both primary and secondary orgasmic dysfunction, vaginismus in the female, and impotence, premature ejaculation, and ejaculatory incompetence in the male are usually successfully treated by the method developed by Masters and Johnson. The basic approach is that of the history and round-table routine. Each type of dysfunction requires some variation in approach. At the round table after clarification of the history, the couple is instructed to carry out what Masters and Johnson describe as the «sensate focus.» In effect, each partner is instructed in ways of caressing the other in order to give the greatest degree of pleasure without involving the breasts or genitals. This is done first by one, then the other partner. The following day these areas may be included in the caressing, but without any attempt to perform sexually, thus obviating performance anxiety. It is emphasized that this should be a sensual, not a sexual activity. Although no time limit is given, it is suggested that the exercise should last for twenty to thirty minutes. The reaction of the couple to this experience is discussed with them, since it is usual in most instances that this type of activity would lead to sexual performance. It does, however, lead to a significant degree of sexual stimulation without performance anxiety, which is an important factor in causing sexual dysfunction. The fear of inability to perform may be a very important factor in causing whatever type of dysfunction exists. The sensate-focus activity is, of course, undertaken with both partners in the nude and in comfortable and pleasant surroundings.

Following the basic approach described above, attention in therapy is directed to the type of dysfunction involved. Thus, the treatment of impotence requires a different approach from that of premature ejaculation, even though such symptoms are quite likely to be closely inter-related. Different procedures are also used in the treatment of the non-orgasmic female or the female with vaginismus. In treating premature ejaculation it is generally conceded that the squeeze technique is the best approach.

This was first described by Semans and more specifically developed by Masters and Johnson. In this approach the female stimulates the male to erection and when the male is aware that ejaculation is about to occur, she is instructed to squeeze the phallus with the first two fingers, one above and one below the corona on the anterior surface of the penis, with the thumb on the frenulum. Considerable pressure can be applied without causing pain when the penis is erect, and if the squeeze is undertaken soon enough it invariably prevents ejaculation. This can be repeated a number of times at each session and after satisfactory reaction has been developed, it should be kept in mind that this procedure should be repeated occasionally. Dr. Kaplan and others recommend this even after the premature ejaculation is under control.

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Diagnosis

As in the case of homosexuality, bisexuality per se is a condition or way of behaving erotically, not a syndrome. Therefore, in the strict sense, there is no diagnosis. The condition is identified by the history either of sexual practice or imagery, or both. In its most covert form, bisexuality may not be identifiable as such, being manifest only as a failure of complete heterosexual abandon. Physical signs are noncontributory.

Differential Diagnosis

The issues are the same as in the differential diagnosis of homosexuality.

Therapy

Of and by itself alone, bisexualism is not a disease and does not require therapy. The vast majority of individuals with a bisexual history never see a therapist. If bisexualism is associated with a lack of well-being, however or if it is experienced as a source of distress to the person or partner, then either or both will benefit from some form of psychological counseling or therapy. The goal of treatment most often is to restore a sense of bisexual well-being. Less often and in selected instances, the goal may be one of predominant heterosexual eroticism.

Prognosis

Bisexuality as an optional life style, equally acceptable to consenting partners; is like a vocational life style in not requiring a diagnosis. If a prognosis is required, it is for the sequelae of the life style. For some, overt bisexuality represents a solution to problems of erotic relationships. Then the prognosis is positive. For others, it represents a compounding of problems, with a prognosis that is guarded, but not necessarily negative.

With less social stigmatization, bisexualism could become therapeutically accepted as a variant of human sexuality. For some individuals who otherwise might be victimized by social pressures into becoming patients, bisexuality enlarges the range of their behavioral options in eroticism and love so that they need not become patients.

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If a woman chooses a nonconventional career, she then has to acquire a position enabling her to pursue it. She «applies» for a job. It is at this point that the most obvious and concrete examples of access discrimination can occur. The fact of discriminatory treatment in selection decisions has been documented widely. Before presenting these data, however, it is important to consider why such processes are so prevalent.

Because of the lack of competing information, when an individual first seeks to enter an organization, sex stereotypes are apt to be a predominant element in decision making. One of the functions of such stereotypes is a cognitive one—to make the world less complex and less ambiguous and thus more manageable. By treating an individual woman as merely one member of a large and well defined subgroup, «women,» and ascribing attributes to her that presumably are characteristics of that group, a great deal of information about that individual is generalized. Whether true or not, assumptions about any one woman and what she is like are likely to be made on the basis of her subgroup identity when little other information is available.

Without exception, the attributes ascribed to females are not those believed essential to work success. As we already have seen, achievement-oriented traits are sorely lacking in the stereotypical profile of women’s attributes. Consequently, work success, especially in occupations not traditionally feminine, is associated only with males.

Schein empirically demonstrated this by asking male management personnel in insurance companies to describe either women, men, or successful middle-level managers. She found that «men» and «successful middle manager» were described in very similar terms but «women» were described quite differently. Apparently, those attributes characterizing a successful manager are not at all those typically ascribed to women. Success at managerial work is indeed considered to be a «male» phenomenon.

The pervasiveness of this point of view was documented in a study conducted by Feldman-Sumners and Kiesler. In the course of designing the procedure for their experiment, these researchers administered a pretest survey to approximately eighty-five male and female undergraduates at the University of Kansas. Each was shown descriptions of people and was asked to indicate how successful he or she believed them to be. The following professionals were described: pediatrician, writer, child psychologist, surgeon, dancer, diagnostician, clinical psychologist, and biographer of famous women. For each subject, half of these were presented as male and the other half as female. The results were dramatic. In no instance was a woman expected to be more successful than a man! The authors also report that in later work with additional professions and work categories they were unable to find even a single occupation in which women rather than men are expected to be more successful. This was found even when the traditionally female occupations were used, such as nursing and elementary school teaching. This is indeed very compelling evidence that success at work is generally associated with men more than women.

Sex-stereotypic norms also are likely to have a detrimental effect on women’s access to jobs. The demands of traditionally masculine jobs, such as managerial ones, are incongruent with the behavior thought to be appropriate to women. Dealing with subordinates, competing for resources, and making hard-nosed decisions are not activities consistent with the view of women as the gentle sex. Women interested in positions with these job descriptions are apt to be seen as «out-of-line» and to be penalized for their violation of sex-related expectations no matter what their background or qualifications. The result: steering the woman applicant to less challenging positions or not considering her for employment at all.

A related point is that concerning the persistent notion that women are unreliable workers, lacking commitment to their work. Starting from the view that a certain type of lifestyle is appropriate to a woman, many personnel decision makers are likely to assume that a woman would be pursuing a nontraditional career only because she either has nothing better to do (has not as yet any family obligations or has a bad marriage) or she is doing so out of economic necessity. Each of these can neatly explain her unconventional behavior. They foster the belief that if the woman in question should «find a man and settle down,» «divorce and remarry» or «get her hands on some money» she no longer would be interested in working. Taking this point of view, it is easy to understand the argument that the company should not make an investment in such an individual.

Some women are, of course, exempt from these allegations. Generally they are the «masculine» women who fit into «old maid» or «asexual» categories. Because they seem to have clearly rejected their femininity they are less suspect. Their motives for working appear to be clear, their role conflicts minimal, and the risk in hiring them less grave than in hiring a more feminine woman.

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One of the most striking aspects of the anthropological literature on sexuality is the near-universal concern that men have about pollution or contamination resulting from contact with women. The Kaluli men of Papua New Guinea repeatedly warned anthropologist Schieffelin against sleeping with his wife and pointed to Schieffelin’s clumsiness on the trail as a result of such indiscretion (Schieffelin). The Kaluli men share the same concern as the men of the Central Highlands of New Guinea, as reported by Read: «In their view of the world, too close and constant an association with the opposite sex, even with one’s own wife, could impair a man’s vigor or retard his growth during the critical years of adolescence». Mead generalizes that for all of Polynesia, «all women, and especially menstruating women, are considered contaminating and dangerous». Suggs found this to be the case in the Marquesas; men would refuse sex during menstruation for a variety of reasons. Impotence might result, and they also voiced complaints against the practice on aesthetic grounds (Suggs). Tahitian males consider menstrual blood dangerous (Levy). The Fulani of Upper Volta designate menstruation with a phrase which, literally translated, means «to see dirt» (Riesman). Fulani women cannot pray during their menstrual periods. Menstruation and its associations seem to stand as the basis for the Fulani’s radical separation of male and female spheres, women being naturally weaker. Navajo women of the American Southwest cannot conduct a chant while menstruating (Bailey). The Navajo have an interesting paradox: although it is dangerous to have intercourse with a menstruating woman, to do so increases the likelihood of pregnancy (Bailey). In native South America, we find Mehinaku men who see menstrual blood as especially dangerous, capable of causing sickness and cramps in men.

Schieffelin observes from Kaluli:

Those women are weaker and less dynamic than men, that they are slow and clumsy and know less, is part of the same general condition of debility they manifest in menstruation. And this condition is dangerous to men because it is capable of destroying their manhood. The man who spends too much time in the woman’s section . . . who touches his wife too often or who eats food a woman has stepped over is likely to become emaciated, develop a cough, or lose his endurance on the trail.

The implication here is that menstrual blood or menstruation is not dangerous per se; it is symbolic of the weakness or danger that men more generally attribute to women. That Schieffelin’s clumsiness on the trail could be attributed by the Kaluli to his sharing a bed with his wife indicates a more general cultural separation between strength and weakness and agility and clumsiness that ascribes success to men but places blame on women. After all, a man should be able to negotiate a trail smoothly by nature; should a man falter, he is suspected of female contamination. Schieffelin, who knows he is clumsy by nature, sees the irony and sexism in the Kaluli men’s comments, and states: «It struck me as poignant irony that the person on whom a man most depends in his domestic household and whom he usually holds in his affections is also the one most dangerous to his vitality».

Because the pattern is so pervasive and consistent in male/female antagonism, one might conclude that there are important, cross-societal universals about men and women. Although such a claim can be substantiated, to do so would be to miss the point about context. Many of these societies seem to be built on a «we/ they» male opposition; the «we» is generally the male domain, and the «they» consists of women, who some of the time are incorporated into «we» but usually are treated as a weaker, more dangerous «they.»

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Marriage is the only human relationship within which sexual intercourse is universally sanctioned. We have seen, however, how variable are individuals within groups. Among some people, marital intercourse is proscribed at certain times, as during menstruation and pregnancy. Among others, provision is made routinely for extramarital liaisons, as among the Turu, and in Western countries which have institutionalized the mistress-lover relationship. Within groups data also testify to individual variation in needs, tastes, and behavior. Even within an individual’s historical repertoire, changes over time may be observed as a life style evolves and new behaviors emerge.

Generalizations about sex in marriage seem possible only for carefully defined samples, the results qualified by attention to the sources of variation and their effects. Currently in our society, we can describe the scene of marital sexuality only as pluralistic, providing many models, each with adaptations and variants. From one couple’s brief, once-a-week encounter, never deviating from the male superior position, to another’s daily, highly sensual, experimenting adventure, to yet another’s exploration of swinging and group sex, and many others closer to and farther from the norm, we gain a sense of the plasticity of human sexual experience as it occurs in the old institution of marriage.

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While research continues on osteoporosis, it is not possible to say whether it is due solely to calcium malnutrition, lack of exercise or hormone deficiency, but probably it will be found to be an interplay of all three factors. Each woman is unique with her individual needs and concerns.

There has been a great deal of confusion and controversy concerning hormone therapy to prevent osteoporosis, with research still being carried out and new aspects continually being discovered.

The term ‘Oestrogen Replacement Therapy’ was formerly used, but since it was realized that therapy frequently involves more than oestrogen, the terminology ‘Hormone Replacement Therapy’ (HRT) is preferred by physicians.

If you are at high risk of developing brittle bones in later years, with many of the negative factors that cannot be eliminated, when calcium absorption may be insufficient and exercise impossible, discuss hormone replacement therapy with your physician. HRT is available under the National Health Service, and may be prescribed by your GP or NHS clinic. Your doctor will probably strongly recommend hormone replacement therapy if:

your menstrual periods stopped at an early age; or

you have had surgery to remove your ovaries, effecting a

surgical menopause; or

•    you have had bone-mass tests at regular intervals that reveal

an increasing porosity and risk of fracturing.

Just what is HRT, what are the good points and what are the bad? The ‘balance sheet’ of hormones for bone formation, with oestrogen and progesterone from the ovaries on the positive side. It’s natural for ovaries to start producing hormones at puberty and wind down production at menopause. It’s a misconception that you produce no more natural oestrogen and need full replacement of this hormone at that time. In many menopausal women, ovaries still produce oestrogen, but in insufficient amounts to menstruate. When your ovaries stop making oestrogen, you are not completely lacking this hormone from other sources in your body. Oestrogens come

from the adrenal cortex in the adrenal gland (precursors of \ oestrogens);

indirectly from the body’s fat cells which convert androgens to oestrogens; and

from your ovaries (unless you have had them surgically removed), continuing to manufacture small quantities of androgens which are converted to oestrogens.

While it is true that the quantity of oestrogen drops, the big questions are whether this deficiency needs to be replaced, and if such replacement is safe.

It is important to ask probing questions of your physician if hormone replacement therapy is suggested, so you are aware of all the facts to make an informed decision. Know both sides of the issue and get a second opinion from another physician before reaching any conclusions. A decision made now may need reevaluating years hence if you experience severe deterioration in bone mass or if particular drugs are later produced that may be suitable for you.

*52\114\2*

Hip fractures generally affect older people, and are more frequent in women than in men. The hip is the only true ball-and-socket joint in the body, and the largest joint except for the knee. When porous and brittle, the thigh bones are most vulnerable to fracturing, especially in the top at the hip socket where this part of the femur (the ‘neck’) is the narrowest and yet has to carry the full load of the upper body.

Although fractures of the vertebrae can happen spontaneously, hip fractures are usually caused by an accident such as tripping over a small rug or slipping in the bath. Occasionally a hip fracture happens for no apparent reason, which triggers the thought – was the fall caused by a broken hip, or did the hip fracture because of the fall? A woman who has suffered a fractured hip on one side is twenty times more likely to have a subsequent fracture on the other.

Disabilities from such fractures are often the beginning of serious physical decline for the elderly: after leaving hospital, many osteoporotic patients are so afraid of falling that they lead very sedentary lives, depressed and full of despair at the disruption of their lives, remaining in nursing, homes until death. Statistics

can be frightening: 15 per cent of women die shortly after a hip fracture; almost 30 per cent die within a year; less than 50 per cent are able to return to normal life. A wrist fracture can be disabling for two months, but long-term disability is not uncommon. A hip fracture is one of the leading causes of accidental death among elderly white women, reducing life expectancy by 12 per cent. The cause of death is not the fracture itself, but the result of ailments associated with prolonged nursing home or hospital stays – pneumonia, blood clots, or a fat embolism.

*4\114\2*

The calcium content of grain products depends upon which kind of flour is used, the extent to which it has been milled, and whether calcium carbonate has been added. White wheat flour uses mainly the inner kernel while wholewheat flour includes the germ and outer husks. Because the composition of flour in the UK is controlled by certain orders and regulations, calcium carbonate (chalk) must be added to all flours except wholemeal and some self-raising flours, at the rate of about 235-390 mg per l00 g. Many breads and cereals have an enriched calcium content with the addition of nonfat dry milk, so read nutrition information labels, talk with the baker, or write to the food manufacturer.

The outer husks of cereal seeds as in bran contain phytic acid, a substance that forms phytates when combined with phosphorus. Phytates, similar to the oxalates in green vegetables, can interfere with calcium absorption if eaten in excessive quantities. Unlike raw bran, when wholegrain wheat or rye bread is being leavened before baking, the enzyme phytase in the flour splits the phytic acid so that it will not bind with calcium – thereby releasing the calcium to be absorbed and making the bread more nutritious.

Because phytate also occurs naturally in other plant material such as coffee beans and tea leaves, strong infusions of coffee, tea and cocoa have the similar potential to inhibit calcium and zinc absorption, or extract these minerals from your body.

*41\114\2*

Ordinary table salt is sodium chloride, and sodium is very necessary for us. Sodium attracts water into the blood vessels, keeping the proper blood volume and the pressure within the blood vessels more or less constant, regulated by your kidneys. But, as you probably know, too much salt is unhealthy, increasing blood pressure and the risk of heart disease and kidney problems, and many of us consume salt in far greater quantities than necessary. A high intake of sodium can also lead to an extraction of calcium into the urine, although at the moment it is uncertain what is an excessive amount. But the conservative approach is to maintain a low-salt diet – no more than 2000 mg per day, as recommended by the World Health Organization and the American Heart Association.

Apart from table salt, sodium is found in many other foods, naturally present or as a part of processing and preserving. The wisest course is to eat fresh unprocessed foods as much as possible, seasoning generously with herbs and spices. When eating out, forsake fast foods and choose the salad bar without a large serving of dressing.

*28\114\2*

It’s a good idea to keep weight constant, as already-weakened bones may not be capable of supporting an extra 20 or 30 pounds.

In the 1983 report Obesity by the Royal College of Physicians, 8 per cent of women and 6 per cent of men are obese. Chronically overweight women seldom suffer from osteoporosis, probably because they put heavier stress on their bones, with the bone responding by building new tissue to meet the demand for more strength. Or it could be that larger women produce more of the male hormone, androgen, which in turn is converted to oestrogen to reduce the risk of bone loss.

Because of this higher production of androgen hormones after menopause, being obese (or grossly overweight) increases the chances of endometrial cancer (cancer of the lining of the uterus). Obesity also increases the risk of cancers of the cervix, uterus, ovaries and breast, and of developing high blood pressure, heart disease and diabetes.

If you are seriously overweight, ask your doctor to refer you to a trained dietician for expert advice.

*17\114\2*