EDmedblog

Though family history is a strong indicator of the diseases that may be in your future, it is far from the last word, Dr. Pyeritz says. “Two people can, have the same high-risk gene mutation, and one will get the disease and the other will not. It’s hard to know one way or another when we’re talking about one gene among 99,999 other genes that also have some influence,” he says.

But the greatest influence is exerted by the lifestyle choices-some small, some large-that you make every day: whether you smoke, how much you drink, what you eat, whether you exercise.

The following are some tips that experts offer for taking your health into your own hands.

Know your tree. “You should retrieve all the information you can about your family history and what diseases run in your gene line,” Dr. Mulvihill says. “When it comes to fighting disease, knowledge is power. When we know what we’re up against, we can keep on the watch for it and do all we can to prevent it. A good example of how helpful this can be is the skin cancer called melanoma.

“If you’ve inherited a mole pattern on your skin that contributes to melanoma, you’re not going to change that,” Dr. Mulvihill continues. “But before we started identifying people with this risk pattern, the death rate was much higher. Now that we know what to look for, some of these folks may still get the disease. But we catch it in stage one, so people don’t die from it.”

Keep a running tab. Knowing you’re at risk does you little good if you don’t bother watching for signs of disease. That’s why Dr. Ken Goldberg of the Male Health Institute recommends keeping tabs on yourself, including performing a monthly testicular self-exam, a skin exam for changes in moles or unusual markings, a quick check of your glands for swelling, a heart-rate check, and a scan for lumps around your chest. If you have high blood pressure or have had a high blood pres sure reading, you should also have your blood pressure checked monthly. And if you have a family history of or are at risk for diabetes, you should have your blood glucose measured monthly as well, says Dr. Goldberg. If your blood pressure and blood glucose are normal, you need have them checked only once a year, he adds.

Recognize your inherited habits. Bad habits often can run as strongly down the family lines as bad genes, says Dr. James Enstrom of the University of California, Los Angeles.

Take an inventory of your habits, Dr. Enstrom says. Do you smoke? Do you exercise? Do you sleep enough? How much do you drink? Do you eat too much? While these things are important for all of us, they’re particularly important for folks who have a history in their family of poor health, he says.

Don’t pull that trigger. Once you’ve tracked down your disease profile, learning the common environmental factors that trigger that disease and avoiding them is your best line of defense, Dr. Mulvihill says.

People who are at high genetic risk for colon cancer may be able to lower their risk for polyps by following a low-fat, high-fiber diet because they’re staying away from known triggers, Dr. Mulvihill says.

Likewise, diabetes is often a case of genetic tendency meeting an environmental trigger, says Dr. Mulvihill. Genes that predispose many people to adult-onset diabetes were probably survival genes for our ancestors to help them store energy during prolonged periods of near-starvation. Today, when these genes are combined with the typical sedentary Western lifestyle and high caloric intake, we end up with obesity, insulin resistance, and adult-onset diabetes. The answer again is to control what you can, Dr. Mulvihill says. And that’s how you live. It’s well-known that avoiding high-fat, high-sugar fare is a good way not only to keep off excess pounds but also to avoid adult-onset diabetes.

Finally, when it comes to beating your odds for heart attack,

I there’s still nothing better than giving your lifestyle a good spring cleaning, says Dr. Ichiro Kawachi of the Harvard School of Public Health.

“Things like not smoking cigarettes, eating less fat and junk food, eating more fruits and vegetables, exercising, and relieving stress are a whole lot more important than worrying about your genes,” Dr. Kawachi says.

Genes or no genes, the incidences of heart disease and stroke have decreased markedly during the past 30 years because people have been taking their health into their own hands, says Dr. Pyeritz.

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Social improvements

As we saw earlier, the sober truth is that the poor are much less healthy than the more advantaged socioeconomic groups and do not benefit nearly so much from medical advances. A book like this is no place to go into this in any great detail but suffice it to say that the resources that would be needed to make an impact on the health of poor families are so great that they could not come solely out of the ‘health’ kitty.

Modification of lifestyle

If no one smoked, death from all cancers would fall by a third; almost all long-term lung diseases would disappear; several diseases of the arteries would be eliminated; about one quarter of heart attacks would be prevented and there would be a small reduction in perinatal mortality. Some of these benefits can be obtained by switching to low-tar cigarettes. Preventive measures include better health education, further restrictions on tobacco advertising, the restriction of smoking in public places, and increased taxation of tobacco. All of these have been proved to work both alone and in combination.

Any diet that helps people slim, increases dietary-fibre intake and reduces calorie and fat intake will reduce the risk of cancer of the endometrium and gall bladder, may reduce the risk of breast and colon cancer, and may reduce the risk of cancer generally in a number of ways. There is little doubt from several studies that being overweight makes it more likely that you will get a cancer. The avoidance of obesity also reduces the risk of high blood pressure and diabetes, and can reduce the risk of having a heart attack. It reduces the likelihood of suffering from a hiatus hernia, other hernias, degenerative arthritis of the knees and many foot problems. Most people say that when they lose weight the quality of their lives improves dramatically because they feel better, look better and enjoy life more.

Alcohol produces effects not only on the drinker but on those whom he or she influences while drunk. Alcohol consumption is rising and although a little alcohol has been claimed to protect against heart disease most people who drink find it difficult to draw the line and end up having too much.

Too little physical activity results in obesity, high blood pressure, high cholesterol and too much insulin. The benefits of regular, controlled physical activity are now beyond doubt. Perhaps the most valuable is the effect it has on weight loss. People who take regular exercise find it easier to lose weight and to keep it off. This occurs because the body’s metabolic rate continues to remain high even after the person stops taking the exercise. There are also suggestions that the sense of well-being that exercise produces means that people who would otherwise have eaten because they felt ‘low’ now have no urge to do so.

3 Protection against injury

Death rates on the roads are now below the levels of the 1930s despite the vast increase in traffic, but car accidents are still far too common. Worldwide the traffic death toll is calculated to be 250,000. Given that there are about forty times as many injuries as actual deaths it is easy t see how big a problem road-traffic accidents are.

But injuries don’t just take place on the roads. Accidental injury, which includes homicide and suicide, is the fourth commonest cause of death in the US and is the commonest cause of death under the age of 35 in the UK. In the US more people are killed as a result of accidental injury under the age of 40 than by all other causes put together. About one in three of the population of the US each year has a non-fatal injury bad enough to cause them to lose a day or more of normal activities and a fifth of these injuries put the person in bed for at least a day. In the developing countries also, injury is a very common cause of death.

*17/72/5*

A New Year’s Eve party to welcome 1994 served as the wake-up call that Meredith Willson needed to get serious about slimming down.

“At the time, I weighed more than 300 pounds,” recalls the 43-”§ | year-old Athens, Tennessee, resident. “Someone that I hadn’t seen

in years came up to me and said, ‘What happened to the Meredith I used to know?’ It was a shock—and shock therapy is a good way to get inspired.”

The next day, Meredith set her sights on a rather lofty resolution: to lose 120 pounds in 12 months. It was ambitious, but Meredith was convinced that eliminating red meat and processed food from her diet would do the trick. “Cheese and butter were the toughest,” she says. “Instead of giving them up completely, I switched to fat-free cheese and butter substitutes.” She also began eating more fresh foods—fruits, vegetables, and whole grains.

Meredith read cookbooks that taught her how to make the most of fresh ingredients in her cooking. She also planted a garden chock full of organic produce, including tomatoes, squash, broccoli, asparagus, and eggplant. “The closer you get to the ground, the better off you’ll be, nutrient-wise,” she says. Then, using her homegrown produce plus healthful staples from the supermarket, she spent time each weekend preparing food from scratch. She even made her own pasta, tomato sauce, and baked sweet-potato chips.

Even Meredith couldn’t believe how well her switch from processed foods to fresh worked. “I lost 12 pounds every month— ka-bam, ka-bam, ka-bam,” she says. “I never even hit a plateau.”

In just over a year, Meredith managed to take off 150 pounds. And she has maintained that weight loss ever since.

WINNING ACTIONS

Take a fresh approach to eating. Fresh foods are naturally high in fiber and low in fat—the perfect weight-loss com-

bination. Plus, they have more intense flavors, so you won’t feel compelled to overeat. Among the best fresh foods for weight loss are potatoes, oranges, apples, and grapes. Researchers have identified these as high-satisfaction foods, which means that they keep you full longer.

*11\89\8*

PEANUT BUTTER

Almond butter and cashew butter are both delicious. They are sold by some healthfood shops or can be obtained by post. Be careful not to eat too much of either as nuts are frequently implicated as allergens. Hazelnut butter is another useful alternative, along with tahini (ground sesame seeds) and sunflower spread.

CHOCOLATE

Carob makes a reasonable substitute. Healthfood shops stock various carob products, and you can also buy carob powder for cake-making.

COFFEE AND TEA

Redbush or rooibosch tea tastes very similar to the real thing. It contains no caffeine and little tannin, but may still provoke symptoms in people who are sensitive to tea. Caffeine-free coffee substitutes abound, including dandelion coffee based on the roasted root, and Barleycup and Pioneer which are both based on roasted barley and chicory. Any coffee substitute may irritate the stomach lining of those who are already sensitive to coffee. Herb teas are much less likely to cause problems.

SNACKS

Pumpkin seeds and sunflower seeds make an excellent snack, and both are sold by most healthfood shops. Such shops also sell most kinds of nut, including some of the more unusual varieties, such as cashews, pistachios, Brazil nuts and pecans – these can be useful for keeping the diet varied. Macadamia nuts are very filling, although rather expensive – they are only sold in large supermarkets as a ‘cocktail nut’. Potato crisps without additives can be bought at healthfood stores, and make a good snack. Maize chips, also without additives, and popping corn are useful for those not sensitive to maize. Dried fruit, dessicated coconut and roasted chickpeas (sold in most Indian groceries) are other useful snack items.

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You can substitute other starchy foods such as sweet potatoes and buckwheat for some of these – see p301. Be careful to distinguish buckwheat from bulgur wheat – the latter is true wheat, but buckwheat comes from an entirely different plant. Millet is a cereal, but few people react to it. You should not eat it at first, but if you find you are unable to eat wheat, you could test it as a potential substitute.

If you are used to eating lots of bread, then you may feel rather empty and it might be tempting to stoke up on potatoes. Try to avoid this temptation, and use some other, less usual foods as fillers sometimes – parsnips or turnips, for example. Acquiring a sensitivity to potatoes is not going to be helpful.

Maize is found in sweetcorn, corn-on-the-cob, cornflour, corn syrup, cornflakes and popcorn; also in the American products known as grits or hominy grits. The Italian dish, polenta, is made with maize. The gum on stamps and envelopes is often made of cornstarch and highly sensitive people may react to licking these.

Wheat is found in macaroni, spaghetti and other forms of pasta, couscous, semolina, biscuits, cakes and pastry – as well as in bread, most breakfast cereals and most packaged foods. When labels say ‘flour’ they usually mean wheat flour – or maize.

If you are eliminating rice, then you should also avoid wild rice, since the two are related (though not closely). If you find you are sensitive to rice, then test wild rice later as a potential substitute.

Potato flour, rice flour or arrowroot can be used to thicken sauces and gravies – these are available from healthfood shops and delicatessans. Do not use instant mashed potato as this contains various additives.

*359\180\8*

Antibiotics

If changes in the gut flora are an important factor in food intolerance, then the use of antibiotics must undoubtedly shoulder some of the blame. The major antibiotics have only been in widespread use since the 1940s, and no-one would deny their major contribution to medicine. Indeed, a short course of antibiotics is unlikely to do anyone much harm. It is prolonged use, or very high doses, that are most likely to affect the gut flora. In some situations the antibiotics are not strictly necessary – in treating acne for example, or in repeated childhood ‘infections’ that are not really infections at all but undiagnosed allergies.

Modern life

A lot of things have changed in the last 50-100 years. Of all the momentous changes that have occurred, is there anything that might have made people more susceptible to food intolerance? On the basis of what we already know about how food intolerance begins, there are several obvious candidates.

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Of course, it is not always easy to tell why a baby is crying – there may be many different causes. Even the question of how much crying is ‘natural’ is contentious. The following quotations illustrate the widely differing views of this common problem:

‘During the first few weeks of life the average baby sleeps a great deal but, when awake, cries lustily and often …. It is only from about six weeks of age onwards, when the baby is becoming aware of his or her surroundings, that there are some wakeful periods without crying…. There is no reason why the simple milk diet (whether natural or otherwise) of the normal baby should cause tummy ache. If the baby cries uncontrollably for several hours each evening, it is more likely that the cause is so-called 3-month or 10-week colic (sharp tummy ache). But, although some doctors consider that the baby has genuine physical pain, others believe that this is an example of the baby reacting to the tensions of the mother at the end of a hard day: and they believe that the crying stops after 10 to 12 weeks because by then the mother has become more competent and confident in her handling of the baby, and has communicated this new calmness to the baby.’ (The Macmillan Guide to Family Health, edited by Dr Tony Smith).

SOME MINOR SYMPTOMS THAT MAY ACCOMPANY COLIC

Frequent regurgitation of food (posseting) Loose stools Wind and bloating Constipation

Poor appetite, stops feeding and screams after a few minutes

Stuffy or runny nose, nose-rubbing

Frequent sneezing, coughing, sniffing or snorting

Noisy breathing

Frequent hiccoughs

Frequent ear infections or colds

Bad breath

Dry, cracked skin, rashes, eczema

Constant scratching or rubbing

Sweatiness, slight fever, or cold hands and feet

Redness around mouth or anus, or on cheeks

Swelling around eyes

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Until fairly recently, most conventional allergists believed that the sort of symptoms seen in a patient depended largely on the type of allergen involved: the part of the body affected would be the part that first encountered the allergen. Thus, allergens that fell on the skin or brushed against it, called contactants, would tend to produce skin reactions such as eczema. Inhaled allergens or inhalants, such as pollen or dust, would produce symptoms in the nose and airways. Food allergens, obviously, would produce symptoms in the lips, mouth, stomach and gut. It was all very logical.

Among the patients treated by allergists, there were always some whose allergens could not be identified. With these unfortunate patients, it was assumed that some other non-allergic mechanism was producing the symptoms. Asthma patients, for example, were given the label ‘intrinsic asthma’ if no allergen could be pinpointed. Like many of the labels used in medicine this is just a clever way of saying that no-one has any idea what is causing the disease. These insoluble cases were an indication that something was wrong with the traditional concept of allergies, although few doctors realized this at the time.

*13\180\8*

“Now, stand before me. Turn around. Bend over.” “What are you going to do, sir?” “I said don’t ask questions.” “Yes, sir.”

“Do you like my finger in your hole?” “Yes, sir.”

“You would, an inferior little nothing like you.” “Yes, sir.”

“Now, get over on the bed.” “Yes, sir.” “Lie back.”

“What are you going to do, sir?”

“Didn’t you hear me when I told you not to ask questions?”

“Sorry, sir.”

“Now, I’m going to fuck you, even though you’re inferior to me.”

“Thank you, sir.”

“My cock is too good for your pussy, but I’m going to put it inside you anyway. Once my golden cock is inside you, you’ll feel as though you’re almost as good as I am.”

“Thank you, sir.”

“Do you like that?”

“Yes, sir.”

“Of course you do. Why wouldn’t an inferior being like it?”

The game can have as many variations as the temperamerits and limitations of the couple allow. At first it may seem awkward, but if the players stay with it they will be rewarded. All narcissistic couples benefit from playing this game, because it enacts both their grandiosity and the feelings of low self-worth for which the grandiosity overcompensates.

*118/196/1*

“Do you want me?” she asks.

“Do I want you?” the husband may ask in surprise. “Yes. Yes, I do want you.”

“How much are you willing to pay?” “Pay?”

“Yes. I’m for hire.”

“You’re for hire? What are you doing?” “What does it look like I’m doing? I’m a hooker. I’m your hooker for a night.” “Are you serious?”

“I’m dead serious. Care to sample my goods?” She flashes a breast.

“You’ll do anything I ask?”

“Yes. Within reason, that is. And for a price.”

“What’s the price?”

“That depends on what you want. Straight sex is $200. If you want something extra, that’ll cost you more.” “Extras? Like what?”

“Well, like if you want a striptease first. Or if you want me to do something unusual—play out some fantasy.” “Hmmm.”

“I’ll tell you what. I’ll throw in the striptease for free.” “That’s nice of you.” “So, do we have a deal?”

“I guess so. I’m not sure what you’re up to, but I think I’m going to like it.” “That’ll be $200.” “I have to pay you now?”

“I prefer that clients pay up front. That way there’s no problem later. Not that I don’t trust you.” “I understand.”

*93/196/1*