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NUTRIENTS FOR YOUR BODY: FOLACIN AS A WATER-SOLUBLE VITAMIN
Functions
Folacin, like other ’ vitamins, is a component of specific enzymes. These are required for the formation of DNA and heme in the red blood cells, and for the metabolism of specific amino acids. Although both folacin and vitamin B12 are needed for the formation of red blood cells, one cannot replace the other.
Meeting daily needs
The recommended allowance of folacin is 400 mcg for adults and 100 to 300 mcg. for children.
The word “folacin” is derived from folium meaning green leaf. Thus, green, leafy vegetables are a good source. Other good sources include organ meats, meat, poultry, fish, and whole-grain cereals. Folacin is rapidly destroyed in prolonged cooking, with high temperatures as used in food processing, and with prolonged storage periods.
Clinical problems
Folacin deficiency is relatively uncommon. It does occur because of (1) lack in the diet, or (2) failure to absorb folacin in diseases of malabsorption, especially sprue. The principal characteristic of folacin deficiency is a macrocytic anemia. A sore mouth and diarrhea are often present.
During pregnancy a macrocytic anemia because of folacin deficiency is sometimes observed. Apparently the folacin needs of the fetus are high. Elderly persons who have had a diet low in folacin for a long period of time sometimes have a folacin deficiency.
The absorption of folacin is reduced in alcoholism, and with the use of anti-tubercular drugs and some anticonvulsants. Contraceptives also increase the requirement for folacin. Methotrexate, a powerful antitumor treatment, is also an antagonist to folacin.
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STAYING HEALTHY: SOME TOPS TO START EXERCISING
Set Your Own Goals, Keep Your Own Records
John Martin says research shows you will be more likely to stick to your program if you set your own goals rather than accept goals established by another. He favors both short- and long-term goals but says the short-term goals work best. Some short-term targets: walking a half-mile, lifting 10 pounds five times. With cycling, running, or swimming, set goals for time rather than for distance.
Some typical long-term goals: swimming 30 laps, lifting 50 pounds, doing 12 push-ups, getting your resting heart rate down to 60 beats a minute.
Write down your goals, and design your own exercise program to achieve them. Learn to take your pulse, and record the result after each exercise. If, during aerobics, your rate is below the training level, increase the speed with which you exercise or the distance (or duration), or both. Once you are in the habit of keeping an exercise diary, it will become a powerful motivator for you to continue.
Reward Yourself
Make workouts enjoyable. Research shows that high-intensity workouts lead to dropping out and injury. Plan to reward yourself for hitting short-term targets. Think of something specificЂ”go bowling, watch a favorite TV show. Then, when you meet that goal, give yourself that reward. Or arrange for someone special to do something nice for you.
You also can give yourself “thought” rewards and try to think of something pleasant as you exercise, rather than thinking about your effort. Dr. Martin calls this a “distraction” from your exercising discomforts. He also recommends listening to a radio or cassette while exercising, a pleasant distraction that cuts down the boredom. In his studies, those who learned to distract themselves pleasantly kept to the program much longer.
Caution: Get a medical exam before starting any exercise program, especially if you are overweight, smoke, have heart trouble or any chronic ills, have seldom exercised, or are over age 40.
It’s time to get off your duff and start moving – for life!
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FATTY ACIDS AND TRIGLYCERIDES: FOOD SOURCES
Some fats are “visible,” as in butter, shortenings, oils, and between and around muscle fibers in meat. Others are “invisible,” as in milk, egg yolk, and food mixtures. The meat and milk groups furnish about half of the fat in our diets. Visible fats and oils are the next important source of fats. The vegetable-fruit group (except olives and avocado) and the bread-cereal group are very low in fat.
The food sources of specific categories of lipids follow.
High in saturated fatty acids
Whole milk, cream, ice cream, cheeses made from whole milk, egg yolk
Medium fat or fatty meats: beef, lamb, pork, ham
Bacon, beef tallow, butter, coconut oil, lamb fat, lard, regular margarine, salt pork, hydrogenated shortenings
Chocolate, chocolate candy, cakes, cookies, pies, rich puddings
High in polyunsaturated fatty acids
Vegetable oils: safflower, corn, cottonseed, soybean, sesame, sunflower
Salad dressings made from the above oils: mayonnaise, French, and others
Special margarines: liquid oil listed first on label
Fatty fish: salmon, tuna, herring
Sources of cholesterol
High: egg yolk, liver, sweetbreads, brains, kidney, heart, fish roe, shrimp
Moderate: whole milk, whole-milk cheeses, cream, ice cream, butter, meat, poultry, fish, clams, crab, oysters, scallops
Low: non-fat milk, cheeses made from skim milk, nonfat yogurt
Absent: egg white; plant foods.
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ALZHEIMER’S DISEASE
The term Alzheimer’s disease refers to a condition first recognized in 1907. In that year Alois Alzheimer reported in the medical textbooks that a woman of 51 had died of ‘dementia’. It wasn’t the ‘dementia’ that caused the interest but the fact that this woman’s brain had been examined under the microscope and it showed changes not seen before. In certain parts the brain fibres were tangled up and there were areas of clumping together of brain matter. As time went by, some more quite young people who had died of ‘dementia’ were found to have brains that showed the same abnormalities. The condition was then called Alzheimer’s disease. At that time it was only described in younger people (before retirement age) and the dementia was called ‘pre-senile dementia’.
It was then noted that the same type of dementia (with the same symptoms) occurred much more frequently in older people. Their brains when examined under the microscope showed the same abnormalities. Because Alzheimer had described his condition in younger people, the elderly were described as having senile dementia of the Alzheimer type or SDAT This tended to make things rather complicated, and as dementia in younger people is quite rare it is becoming increasingly common to call the whole group Alzheimer’s disease.
The two words Alzheimer’s disease can’t convey the complicated set of symptoms that make up the condition, unless you personally know a suffer. A quick description often used is the slow onset of memory loss with a gradual progression to loss of judgment and changes in behaviour and temperament. A more complicated definition has been issued by the Royal College of Physicians:
Dementia is the global impairment of higher functions, including memory, the capacity to solve the problems of day to day living, the performance of learned perceptuo-motor skills, the correct use of social skills and the control of emotional reactions, in the absence of gross clouding of consciousness.
These definitions are only guides to the whole complicated condition called Alzheimer’s disease, so we need to work through some of the more common problem areas. The condition starts very slowly, so much so that close relatives and carers often do not notice that anything is wrong for a long time, then when certain things are pointed out they can often think back and realize that the dementia began a few years previously. It has been calculated that someone needs to lose about 80 per cent of their working brain cells before mild symptoms develop, i.e. problems occur late and the brain must adapt very well for a long time. It is useful to think of the condition having three phases: mild, moderate and severe -a sufferer does not always move on to the worst phase. A sudden deterioration usually means that an acute condition (such as a chest or urine infection) has occurred. A small group of sufferers do seem to have a more rapid and downwards course (like a malignant cancerous disease) and death can occur within a few years. For most however the decline is quite slow, especially if the person is well cared for and any other medical problems are tackled early and effectively. Many people with Alzheimer’s die of something else (heart attack, stroke and even old age).
The most common problems are those of memory loss, disorientation, loss of judgment, changes in personality, difficulty in communicating, loss of practical skills and changes in behaviour. Thus, it can be understood that Alzheimer’s disease is far more than just memory loss (as some of the definitions try to show) -eventually the condition affects all of the parts that make us an individual who relates and responds to other people. Even in the very late stages, however, a sufferer is able to show responses to kindness and gentleness, but early on part of the personality, the person’s individuality, is affected.
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OPHTHALMOLOGISTS OPEN EYES TO OPTOMETRISTS POWER PLAY
Ophthalmologists once were placed firmly at the top of the eye care “ladder,” many rungs above optometrists, dispensing opticians, and all others in the vision field, members of the American Academy of Ophthalmology and Otolaryngology (the study of the ears, nose, and throat) were told at their October 1976 annual meeting. But because eye surgeons were “legislatively asleep”, non-physician practitioners, primarily optometrists, have been able to fight for and win increasingly larger shares of the eye care domain.
“Ophthalmology has been overtaken and it is now in the process of being taken over,” warned Whitney G. Sampson, M.D., a Houston eye surgeon.
Legislative “battles have not been lost by ophthalmology; they have been forfeited,” said Byron H. Demorest, M.D., a Sacramento, California eye physician.
Particularly under the prospect of national health insurance, “all practitioners in the ophthalmic field are now scurrying for a position as close to the top of the ladder as possible in order to assure their own professional eminence in the future,” Dr. Demorest said.
“The future of ophthalmology rests in the hands hearts, and minds of our legislators. Supporting and working with local legislators is a high priority item for each doctor who is concerned about the future of his practice and of eye care for his patients. As state and national laws defining the boundaries for eye cad practitioners are changed, all of us must carefully monitor such actions,” urged Dr. Demorest.
Kenneth J. Myers, O.D., director of optometry for the Veterans Administration (VA), which does not authorize optometrists to use drugs, agreed. Dr. Myers said, “I feel equitable relations can more easily be developed [between optometrists and ophthalmologists] if it is clearly stated VA optometry will not practice therapeutic medical or surgical eye care … VA clinical procedures are now and will continue to be dictated by this basic division of responsibility: Ophthalmology staff definitely diagnoses all medical and surgical ocular conditions and provides any required medical or surgical ocular therapy. Optometry staff provides optometric diagnosis and therapy of vision dysfunction with referral to VA physicians of patients having signs and/or symptoms of ocular disease or injury. “It is not our intent to expand the practice of optometry into medical or surgical areas, for we believe these areas are the correct and historically established domain of the physician, and it is best for patient care that optometry and ophthalmology continue centered in their respective disciplines,” Dr. Myers said.
Calling himself “middle of the road” in the ophthalmology-optometry dispute, David M. Worthen, M.D.J head of ophthalmology at the University of California, San Diego, said, “In my opinion, the present optometrist ii over-trained for what he can do, yet doesn’t receive an education of high enough quality to allow him to give complete care.” The prescribing of medicines, especially, he said “just like the performance of surgery, must be founded on a broad-based medical curriculum,” which optometrists generally do not receive.
To allow any health care provider to prescribe therapeutic medicines or operate on the basis of limited classroom experience is the practice of medicine without a license and should be stopped, regardless of legislative changes. In my opinion, such erosion will lower the quality of medical care in all areas,” said Dr. Worthen.
Of course, another area of dispute exists between optometrists and ophthalmologists–the area of eye surgery for refractive problems. Optometrists don’t perform surgery but just prescribe corrective lenses. Ophthalmologists do both. Optometrists have been accused of discouraging people from engaging in surgical corrections strictly because surgery competes directly with the prescribing of lenses by them. Such discouragement of people from undertaking permanent correction by operative means to eliminate eyeglasses and contacts is considered unethical and an exploitation of trusting individuals.
Ophthalmologists additionally suggest that optometrists sometimes overprescribe eyeglasses for minimal refractive errors. They say that the total cost of examination and glasses by an optometrist could exceed that given by an ophthalmologist. If lessened expense is the object, refractive care delivered by trained ophthalmic assistants working under the direct supervision of ophthalmologists costs less and supposedly gives the patient equivalent care.
Frequently a patient with a serious eye problem first consults an optometrist for examination. Many individuals have been conditioned to believe that lenses are able to accommodate most eye difficulties, which is untrue. Finding at the problem consists of more than the simple need for a lens correction, the honest optometrist will likely refer his visitor to the patient’s physician for a re-examination. With a serious eye disorder present, the average family doctor probably won’t feel qualified to treat it. Finally the patient is referred, in turn, to the ophthalmologist who should have been consulted in the first place.
This situation, or a similar set of circumstances, is what may bring someone to seek eye surgery such as radial keratotomy (RK) or another of the operative refractive corrections. Indeed, controversy prevails within the ophthalmology profession about these various refractive surgeries.
*29/127/5*

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Other names: Dicycloverine
EYE CARE: VISITING OPTOMETRISTS
Another eye care professional using refractive corrections with lenses, the optometrist (pronounce (op/TOM/e/trist), has an O.D. degree which represents him or her as a doctor of optometry. The O.D. provides vita primary health care services. For instance, the optometrist examines, diagnoses, and prescribes specific treatment for conditions of the vision system.
Optometrists examine eyes and related structures to determine the presence of vision problems, diseases or other abnormalities. They utilize drugs for diagnostic purposes when permitted by state laws (which are changing throughout the country). By thoroughly evaluating the internal and external structure of the eyes, optometrists can detect systemic and eye diseases that require referral of thee patient to other health care practitioners.
The optometrist treats by prescribing and adapting spectacle lenses, contact lenses, or other optical aids and uses visual training/vision therapy to preserve or restore maximum efficiency of vision.
Education of the optometrist includes two to four years of college pre pre-optometric training and four additional years of specialized professional training at an accredited college of optometry.
In contrast to the other two eye care professionals, the optician (pronounced OP/ti/cian) is not degreed as a doctor. An optician is the technical part of the lens-servicing team. He or she may also be known as a dispensing optician or an ophthalmic dispenser. The optician could be both or either of these designated types of specialists. The dispensing optician makes and fits eyeglasses and/or contact lenses. He or she designs, verifies, and delivers lenses, frames, and other specially fabricated optical devices upon prescription to the intended wearer.
The ophthalmic dispenser both tests people for eyeglasses and also makes and fits them. The ophthalmic dispenser’s functions include, but are not limited to, prescription analysis and interpretation, the taking of measurements to determine the size, shape, and specifications of the lenses, frames, contact lenses, or lens forms best suited to the wearer’s needs; the preparation and delivery of work orders to laboratory technicians engaged in grinding lenses and fabricating eyewear; the verification of the quality of finished ophthalmic products; the adjustment of lenses or frames to the intended wearer’s face or eyes; and the adjustment, replacement, repair and reproduction of previously prepared ophthalmic lenses, frames, or other specially fabricated ophthalmic devices.
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RESPIRATION: TUBERCULOSIS
The decline in incidence of tuberculosis in the United States has been tremendous since about 1900. The death rate was five times as great then as it is fifty years later. When I was an intern, the children’s ward was pretty well filled with the victims of bone tuberculosis. Nowadays I think that it is mostly confined to the lungs. There is reason to believe that the incidence is still decreasing, but it is far from disappearing. Ignorance and poverty are always contributing factors; early diagnosis and improved treatment undoubtedly are helping us.
There is only one way by which it is spread and that is by contact. If you do not go near tuberculosis, you will not get it, no matter what your way of life is. But it is one thing to tell you to stay away from it and another to accomplish this. Statements as to the amount of it around are truly startling at first. It is said authoritatively that about 50 per cent of the population of the United States have been infected with the tubercle bacillus. But there is a bright ray of light shining through this gloom. Even if we belong to the infected 50 per cent we probably have a considerable degree of immunity. We have our tubercle bacilli encased in calcium as a hen’s egg is encased in the calcium shell.
When primitive people like the Eskimos or South Sea Islanders were attacked by tuberculosis or syphilis or even measles they died like flies. Although we do not thrive on some of these diseases, nevertheless we stand them fairly well. The theory is that many of our distant ancestors had these diseases and those who survived to become our more immediate ancestors gradually accumulated considerable immunity to them. So we do not just give up the ghost when we get tuberculosis. If it lands in our lungs, we may develop a small patch of pneumonia and perhaps kill off the bacilli. Failing this, our blood cells gather round and form tough tissue and then a condition known as caseation occurs, so-called because it resembles cheese formed from casein. Later on the firm calcium case mentioned above occurs. The modern scheme of X-raying almost everybody in the community shows that a large proportion of us have gone through this program and are doing well. The intensive campaign waged against tuberculosis for a half century or so has accomplished a great deal.
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NUTRIENTS FORYOUR BODY: FATTY ACIDS AND TRIGLYCERIDES
“The fat of the land.” The word “fat” brings to mind such ideas as wealth, prosperity, and well-being; likewise, the word makes one think of such rich foods as pastries, cookies, cakes, ice cream, butter, cream, and oil. But fat is also associated with overweight, and more recently with heart disease. Lipid is another term for fats and fatlike substances, including phospholipids and sterols.
Fatty acids and triglycerides
Fats are composed of three chemical elements: carbon, hydrogen, and oxygen. Fats contain much smaller proportions of oxygen than do carbohydrates. Some specialized kinds of fats, called compound lipids also contain other elements, for example, phosphorus and nitrogen in phospholipids.
Most fats are triglycerides; that is, they are formed from three molecules of fatty acids attached to one molecule of glycerol. About 20 fatty acids are commonly found in foods. Each fatty acid consists of a short or long chain of carbon atoms attached to an acid group. Short chain fatty acids contain 4 to 6 carbon atoms; medium chain fatty acids contain 8 to 10 carbon atoms; and long-chain fatty acids contain12 to 20 or more carbon atoms.
Long-chain fatty acids may be saturated, monounsaturated, or polyunsaturated. Saturated fatty acids are those having single bonds between the carbon atoms. They cannot take up any hydrogen. Myristic, palmitic, and stearic acids are three examples of such fatty acids; they are abundant in animal fats, including beef and mutton fat, butter, and others. Coconut oil, although liquid, consists mostly of lauric acid, a saturated fatty acid.
A monounsaturated fatty acid is one in which two of the carbon atoms are joined by a double bond. This means that a hydrogen atom could be added to each of the carbon atoms at the double bond. Oleic acid is the most abundant monounsaturated fatty acid. Olive oil is especially high in oleic acid, but most fats contain generous amounts of this fatty acid.
A polyunsaturated fatty acid is one in which two or more double bonds are present. Thus, each of four or more carbon atoms could take up a hydrogen atom. Linoleic acid has two double bonds and is the most common of the polyunsaturated acids; it is abundant in most vegetable oils.
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BRONCHOSCOPE FOR LUNGS EXAMINATION
If X-ray, like a shadow, proves the substance true, there are many who want to see the thing itself before they are convinced. This is now frequently accomplished, even in the recently inaccessible middle of the lungs. An instrument that is fearful to contemplate by one who is a candidate for its use, the bronchoscope, is, in clever hands, great for investigation as well as treatment. It is a rigid metal tube, about a foot long and large enough in caliber to hold a light and instruments with which the operator may perform innumerable cuttings and manipulating. Of necessity this tube must be straight. If you will study the anatomy of the head, neck, and chest of one of your acquaintances, I think you will be convinced that there is no straight line through the respiratory canal for this tube. But there is. The head has to be bent back more than one normally cares to hold it but once one resigns oneself to a physician’s bothersome ways his accomplishments may be surprising.
I imagine that the bronchoscope was developed originally for removing from the windpipe and large bronchi the peanuts, safety pins, and divers other things which children inhale. The removal of misplaced objects is no longer, however, the chief work of a bronchoscopist. His main concern is with the investigation and treatment of diseases of the lungs and bronchi. Lung .abscesses can be helpfully studied. Tumors of the lungs are now recognized as common and the majority is connected with the bronchi; they can be studied by direct vision, a piece removed for examination, or sometimes a whole tumor can be thus removed.
Tuberculosis of the lung is today treated, in many cases, by collapsing the lung in one of several ways. Before this is done, an examination is made with the bronchoscope to be sure that a bronchus is not blocked, which would interfere with its collapse.
*27/276/5*

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TRIALS INVOLVING POLYUNSATURATED FATS AND MS (MULTIPLE SCLEROSIS)

Thanks to the work of scientists like Professor R.H.S. Thompson, Professor Roy Swank and Professor Hugh Sinclair, who observed the link between saturated fat and multiple sclerosis, doctors working in the field of multiple sclerosis thought it was worth investigating polyunsaturated fats further.
The first big trial involving linoleic acid and MS was conducted in 1973 by Dr J.H.D. Millar of Belfast and Dr K.J. Zilkha of the National Hospital in London, and others. They found that when linoleic acid, in the form of sunflower seed oil, was given to patients with MS, it reduced the frequency and severity of relapses.
After this trial, sunflower seed oil in various forms became all the rage with MS patients. They drank it neat, they took it in emulsions, they mixed it with orange juice. Many of them didn’t like it.
At this time, evening primrose oil capsules were being manufactured by one company only, Bio-Oil Research Ltd, of Cheshire. It was Bio-Oil’s director, John Williams, who was the first to see the potential of evening primrose oil, originally for heart disease. But when the results of the sunflower seed oil trial were published in the British Medical Journal, John Williams had a brainwave. If sunflower seed oil helped a little, then surely evening primrose oil, being that much more biologically active, might help even more.
At around the same time, Professor E.J. Field was doing some very important research work on essential fatty acids and MS. He started this research while Director of the Medical Research Council’s Demyelinating Disease Unit in Newcastle, and later carried on with the research at Newcastle University. Professor Field tested evening primrose oil on the red blood cells of people with MS. The results of these blood tests proved that the gammalinolenic acid (GLA) in evening primrose oil was much better than linoleic acid in correcting the defects found in the blood of MS patients.
*28/60/5*

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EYE CARE CONTROVERSIES: STRUGGLE AMONG EYE CARE PROFESSIONS
While optometrists are sparring with ophthalmologists on the right to administer dilating drugs, they are also arguing with opticians about the right to fit contact lenses. There is nothing in most state regulations to prevent an optician from fitting contacts. Many state opticians’ licensing examinations include whole sections on contact lenses. Some opticians don’t choose to fit contacts and have asked that the lens part of the test be reserved for those practitioners who choose to go into the field. That way, an optician failing the contact lens portion, but not the eyeglass portion, of the test won’t have been deprived from taking a job or opening in an optical shop where eyeglasses are manufactured and sold.
In contrast, optometrists think that opticians do not have the training to fit hard and soft lenses directly on the eye. They say that all opticians should be prevented from doing the detailed work. They suggest that of the soft contact lenses alone, with more than two dozen manufacturers making them in a dizzying variety of shapes, widths, thicknesses, and materials, more knowledge is needed than available to the less-trained opticians. Some optometrists say, “Opticians don’t know which end is up” about contacts. Dr. Ross said, in referring to opticians fitting contact lenses, “It is a violation of the laws of medicine and optometry?
But opticians who do choose to fit contact lenses point to their success with patients. They question the economic motives of the optometrists’ efforts to restrict opticians’ practices. ItЂ™s strictly a matter of greed, they declare. An optician who asked not to be named said, “A optometrist has a major stake in contacts, but the ophthalmologist can prescribe them too. It hurts the optometrist’s business to have the job handled by the ophthalmologist and the optician. It cuts him out.” In some cases, the ophthalmologist prescribes the correction and the optician manufactures and sells it. The optometrist is like a
barnacle on a boat slowing down the patient’s passage to better sight. Opticians agree among themselves that the optometrist appears to be an unnecessary professional addition.
There is more politics mixed up with money and lenses. Ophthalmologists don’t usually sell eyeglasses and contact lenses, so they declare themselves above the conflict between eye care professionals and obvious economic interests where lenses are sold. Optometrists point out that this attitude smacks of cover-up.
For instance, optometrists claim they do not push unneeded lenses on patients, even though they sell the products. The ophthalmologists doubt this statement, Optometrists, in turn, claim that some ophthalmologists art not above making a profit on lenses, because they do, in fact, have affiliations with lens stores or opticians. Some eye surgeons have lens dispensing sections right in their offices, and they are not entirely truthful about not profiting from the sale of visual aids.
Finally, the opticians routinely complain that some ophthalmologists and optometrists are slow to furnish prescriptions to other specialists when it becomes clear the patient is going to shop around for the eye care products.
This interprofessional infighting goes on among opticians, optometrists, and ophthalmologists in almost every community in the United States. There is little love lost among any of them. Ophthalmologists are concerned about an ongoing power grab at the top rungs of the eye care ladder by optometrists. Optometrists are trying to get maximum mileage out of their training so as to enhance their income by an increased sale of services. With ever-present political resistance from both professions, vision-impaired people become the losers.
*28/127/5*

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Other names: Prinivil

MEMORY LOSS IN ALZHEIMER’S DISEASE
Memory loss occurs in all cases, but it can sometimes be difficult to detect as people cover it up very well. The most recent memories go first and only much later and in severe disease does the past memory get really affected. The things we’ve done in the last few hours, days, weeks and months are placed in our short-term memory. It is this recent storage that seems not to work properly in Alzheimer’s disease. Because memory loss is an important feature of the condition and can be tested for, it forms part of every assessment. One common test is to ask the person a variety of questions covering short- and long-term memory. Ten questions are asked.
Ђў How old are you?
Ђў What is your date of birth?
Ђў What is the day today?
Ђў What month are we in?
Ђў What year is it?
Ђў When was the First World War?
Ђў What is the name of the Prime Minister?
Ђў Where are you now?
Ђў Remember an address, e.g. 24 West Register Street and ask the person to repeat it after 5 minutes.
Ђў Count backwards from 20 to 1.
As long as the person is cooperative (and has been asked in a nice way!) this test is easy to perform. A score out of ten is achieved.
The importance of the test is that it gives a quick guide to the areas where there might be problems. The questions test short-term and long-term memory as well as orientation. A low score by itself never means that the person has dementia. It is only a guide that something is wrong. Someone with mild to moderate dementia will usually get the short-term memory questions wrong and won’t be able to remember the address. They will, however, usually know their birthday (the year might prove hard) and questions about the War. The question about the Prime Minister causes a lot of debate. Mrs. Thatcher was there so long and was so influential on the public in one way or another (and indeed still is) that some assessors feel it is only fair to give a point if her name is given. As a rule a low score that goes up as the weeks go by usually indicates that the initial poor performance was due to an acute confusional state. A persistently low score over many months is much more indicative of a dementia (as long as all the treatable causes of chronic confusion have been ruled out).
Psychologists are experts in the field of memory testing and use much more sophisticated tests than the modified Northwick Park test given above. When testing someone they use a whole range of different types of test so that they get a very accurate picture of where the serious memory losses are occurring. It has been shown that in mild to moderate cases of Alzheimer’s dementia the sufferer can remember something (often a picture) if asked about it immediately. If the person is asked to match one picture with an identical one they can do it if shown them one immediately after the other. Problems begin to occur if a delay is introduced. Indeed after only ten seconds some people cannot match the pictures or remember what they were shown. In other tests where the psychologist tries to get the person to learn something new and then remember it, there is good evidence that a dementia sufferer can do it, can learn something new and remember it, as long as they are given long enough to do it. It seems that they forget things at the same rate as everyone else; their main problem is in learning and retaining. Computers are now being used to help test memory and other aspects that the psychologist is interested in (reaction times – the time taken for the person to press a button when asked to do so or on seeing a certain picture).
In a social setting the loss of short-term memory can be easily missed. Evasive answers to a direct question – ‘It’s slipped my mind’, ‘I’m awful with dates’, ‘It will come to me’, are very common and it’s surprising how you can start a sentence, get stuck, look at someone and they will help finish it for you. However, a stage is reached sooner or later that cannot be concealed from carers. Memory for recent events gradually gets worse and worse, whereas the sufferer can recall childhood situations and young adult life easily. This short-term memory loss can have practical implications in that kettles and ovens can be left on, etc., and people may forget that they have eaten. The sufferer may go out on an errand and a few yards out of the house have forgotten where they were going and occasionally not be able to find their way home again. In the advanced severe stage the person may forget the names of their nearest and dearest, often a very distressing state for the carers. Finally the sufferer may forget their own name.
*28/128/5*

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CHLAMYDIA
Chlamydia is probably the most frequent cause of sexually transmitted disease in Australia today. Amongst men this very small bacteria produces Non Specific Urethritis (NSU). In women chlamydia causes Pelvic Inflammatory Disease (PID), infertility and ectopic pregnancies. Chlamydia can also cause infections in the eye and other organs.
Approximately 300,000 Australian women are at risk of infertility as a result of silent chlamydia infection. Most are not even aware they have the disease. When infection affects men they get some burning with the passage of urine and a slight penile discharge. Women receive no such warning and unless contacted by a treated partner, they receive no notice of the unpleasant complications to come.
Chlamydiae are sensitive to antibiotics such as the Tetracyclines, Bactrim and Erythromycin. Because these small bacteria live and reproduce inside the human host cells, long courses of antibiotics are necessary. Two weeks is the minimum period for treatment. Sometimes chlamydia finds a home in deeper tissues of the body and like herpes become difficult to eradicate. Recurrence appears in up to 15 percent of the treated population.
Home Remedies
Chlamydia means that condoms are the rule until there is some certainty that a sexual relationship is one on one. Chlamydia infection is silent in women, those with a history of frequent sexual activity with multiple partners should have a test for chlamydia when ever they present for a pap smear. A swab of the cervix and an anti cancer smear are easily done at the same time. Chlamydia is also detectable through the use of a blood test.
*28/131/5*

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Other names: Asacol, Pentasa, Asacol

VITAMINS AND MINERALS: READING LABELS
Breaking the RDA Code
Many people are bewildered by the variances between vitamin standards listed as RDA, U.S. RDA, and MDR. It becomes much less confusing when you understand that they are not the same thing.
RDA [Recommended Daily Dietary Allowances] came into being in 1941, when the Food and Nutrition Board of the National Research Council of the Academy of Sciences of the United States was established by the government to safeguard public health. The RDA are not formulated to cover the needs of those who are ill – they are not therapeutic and are meant strictly for healthy individuals – nor do they take into account nutrient losses that occur during processing and preparation. They are estimates of nutritional needs necessary to ensure satisfactory growth of children and the prevention of nutrient depletion in adults. They are not meant to be optimum intakes, nor are they recommendations for an ideal diet. They are not average requirements but recommendations intended to meet the needs of those healthy people with the highest requirements.
U.S.- RDA [U.S. Recommended Daily Allowances] were formulated by the Food and Drug Administration [GDA] to be used as the legal standards for food labeling in regard to nutrient content. [The RDA were used as the basis for the U.S. RDA.] Calories and ten nutrients must be listed on food labels – protein, carbohydrate, fat, vitamin A, vitamin C, thiamin, riboflavin, niacin, calcium, and iron. Because the U.S. RDA are based on the highest values of the RDA, the former is frequently higher than the basic needs of most healthy people, though very few individuals today fall into that hypothetical category. Individuals vary by wide margins, and stress and illness, past and present, affect everyone differently. As far as I am concerned [and many other leading nutritionists], the RDA and U.S. RDA are woefully inadequate.
MDR [Minimum Daily Requirements] were the first set of standards established by the FDA and have been revised and replaced by the U.S. RDA.
What to Look For
As noted, when buying minerals, look for chelated on the label. Only 10 percent of ordinary minerals will be assimilated by the body, but when combined with amino acids in chelation, the assimilation is three to five times more efficient.
Hydrolyzed means water dispersible. Hydrolyzed protein-chelate means the supplement is in its most easily assimilated form.
Predigested protein is protein that has already been broken down and can go straight to the bloodstream.
Cold pressed is important to look for when buying oil or oil capsules. It means vitamins haven’t been destroyed by heat, and that the oil, extracted by cold-pressed methods, remains polyunsaturated.
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NUTRIENTS FORYOUR BODY: PROPERTIES OF FATTY ACIDS AND TRIGLYCERIDES
Fats are insoluble in water, but soluble in ether, chloroform, benzene, and acetone. In the blood circulation they are held in solution by being attached to proteins (lipoproteins).
The flavor and hardness of a food fat depend upon the kinds and amounts of the fatty acids that are present. Food fats are a mixture of saturated and unsaturated fatty acids. For convenience a food fat is called saturated if it contains more saturated than polyunsaturated fatty acids; such fats are solid. If polyunsaturated fatty acids exceed the saturated fatty acids, the food fat is said to be polyunsaturated; such fats are liquid, such as oils, or very soft, such as some special type margarines. By dividing the amount of polyunsaturated fatty acids in a food by the amount of saturated fatty acids, one can obtain the P/S ratio; for example, 4 gm polyunsaturated fatty acid and 2 gm saturated fatty acid gives a P/S ratio of 2.
Hydrogenation is the addition of hydrogen to the carbon atoms in unsaturated fats to produce a solid fat. Regular margarines and many cooking fats are prepared from vegetable oils by this process. As might be expected, the addition of hydrogen increases the proportion of saturated fatty acids.
Fats become rancid if they are exposed to air and light. The change is more rapid at high temperatures. Many manufacturers add antioxidants to food tats to lengthen the time that they may be kept.
*26/234/5*

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CALCIUM CHANNEL BLOCKING DRUGS
For twenty years Isoptin was used to reduce the speed of atrial fibrillation and the pain of angina. As the side effects of the Beta Blockers blossomed into their full ugliness, attention centered on the blood pressure lowering effects of Isoptin. Isoptin reduced high blood pressure by relaxing the tight walls of tense arteries. The process involves a reduction in the flow of calcium across the concentric smooth muscles surrounding arterial walls.
A whole family of anti blood pressure drugs now utilizes the same effect. This family is called the Calcium Channel Blockers. Other members include Cordilox, Adalat, Agon and Plendil. Cardizem is a Calcium Channel Blocker used more in the treatment of angina than it is for high blood pressure. Side effects of Calcium Channel Blockers include constipation and headaches. In the management of high blood pressure, the Calcium Channel Blockers are probably less noxious than the ACE inhibitors, but they may not be as effective in the management of heart failure.
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CAFFEINE
Caffeine is a performance enhancing drug used to improve intellectual output. In beverages such as tea and coffee, caffeine stimulates mental activity when it falls below normal levels. Under the influence of caffeine, thought becomes more rapid, fatigue disappears and its onset is delayed.
Caffeine is also an addictive substance and withdrawal symptoms attributable to psychological and physical dependence occur in habitual coffee drinkers 12 to 16 hours after their last cup of caffeinated beverage. Withdrawal symptoms include headache, irritability, the jitters, poor concentration and an increase in absent mindedness.
There are few serious health implications relating to the widespread use of this true performance enhancing drug. A high intake of caffeine causes cancer in rats and raises cholesterol levels in men.
Home Remedies
Caffeine addicts who go cold turkey must expect withdrawal symptoms to last for at least a fortnight. Maintain the ritual of coffee or tea drinking through the substitution of decaffeinated coffee or tea for the formerly consumed hard core beverages. Decaffeinated coffee still manages to cause indigestion; but contains only 3-4 mg of caffeine which is much better than the 60-80 mg in a cup of coffee or the 30-50 mg of caffeine in a cup of tea. Some people worry about decaffeinated coffee because manufacturers remove the caffeine with trichloroethane. In theory this volatile organic solvent evaporates completely after the extraction of caffeine.
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NUTRIENTS FOR YOUR BODY: FUNCTIONS OF FATTY ACIDS AND TRIGLYCERIDES
Triglycerides account for most of the fat in food and in the body. Normally, about 95 per cent of the fat in food is digested and absorbed. Fats, as we all know, are important sources of calories; each gram contributes 9 kcal. It is quite normal for the body to have deposits of fat (adipose tissue) that serve as a continuing supply of energy each and every hour. In fact, if we had no reserves of fat in the body whatsoever, we would need to eat much more frequently in order to provide a continuous supply of energy. Judging by the frequency and degree of obesity, fat can be stored in almost unlimited quantity.
Fat is said to be protein-sparing because its availability reduces the need to burn protein for energy. Carbohydrates and proteins in excess of body needs are also changed into fatty tissue, just as fat in the diet contributes to these stores.
In addition to providing energy, fats are essential (1) to maintain the constant body temperature by providing effective insulation underneath the skin; (2) to cushion the vital organs, such as the kidney, against injury; (3) to facilitate the absorption of the fat-soluble vitamins A, D, E, and K; (4) to provide satiety and to delay the onset of hunger; and (5) to contribute to flavor and palatability of the diet.
Essential fatty acids. Linoleic acid, a long-chain polyunsaturated fatty acid must be present in the diet because it cannot be synthesized in the body. In the body it is converted to arachidonic acid which is essential for normal growth and skin health. Safflower, sunflower, corn, cottonseed, and soybean oils are good sources of linoleic acid.
Phospholipids. These are fats in which a phosphorus-nitrogen compound-has been substituted for one of the fatty acids in the triglyceride molecule. The diet contains some phospholipids, and the body readily makes them. Lecithin is the most abundant of these. Phospholipids are important in brain and nervous tissue. They also assist in the absorption of fats from the small intestine and in the transport of fats in the blood.
Lipoproteins. By being attached to proteins fats can be held in solution in the blood circulation and carried to the tissues. The lipoproteins are synthesized primarily in the liver. They contain varying amounts of triglycerides, cholesterol, phospholipids, and protein, and are classified according to their composition.
Cholesterol. Cholesterol is a white waxy substance related to fats, but very different in chemical structure. It is a normal constituent of the tissues, but is especially important in the formation of brain and nervous tissues-. It serves as a precursor of vitamin D; that is, cholesterol in the skin can be changed into active vitamin D by exposure to the ultraviolet rays in sunlight. Cholesterol is closely related to the sex hormones and to the hormones of the adrenal gland. Excess cholesterol is removed from the body in the bile.
The body can manufacture cholesterol to meet its needs from fats, carbohydrates, and amino acids. Beyond infancy there does not appear to be any need to supply cholesterol in the diet.
*28/234/5*

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TRIALS ON EVENING PRIMROSE OIL AND MS (MULTIPLE SCLEROSIS)
During the 1970s many patients with MS began to take evening primrose oil, without the oil ever having been tested in a trial. Then in 1978 a trial took place in Newcastle, conducted by Professor David Bates and others.
The researchers divided 116 people with MS into four groups. One group was given evening primrose oil (Naudicelle), six capsules a day; one group was given olive oil in capsules; one group was given ‘Flora’ to eat as a spread; and one group was given another spread. No one knew what he or she was taking.
At the end of the two years, there was no significant difference between any of the groups, as measured by the Kurtzke disability scale.
Of all the groups, those who did best were the ones who took the sunflower seed oil spread ‘Flora’. The duration and severity of their attacks were less severe. In this group, the amount of linoleate in their blood went up from 28% before the trial started to 39% at the end of the trial.
Professor Bates came to the conclusion that the amount of polyunsaturates taken has to be enough to affect plasma levels. Only when this level has been achieved does the PUFA have an effect on the severity and duration of relapses.
At the time, the results of this trial were taken to prove that evening primrose oil does not work for MS. But this is not a correct or fair assessment at all, and in fact the results of this Newcastle trial were later re-analyzed by a Canadian doctor by the name of Robert Dworkin. Some years later after the Newcastle study, Dr Dworkin looked closely at its results, but he also pooled these results together with results from two other trials, one jointly in London and Belfast (Millar and others) and one in Ontario.
What Dr Dworkin found was extremely important: patients who had very low levels of disability at the start of the trial, who took polyunsaturates, did not get worse in a two-year period.
This was indeed a crucial discovery – the length of time that a patient had had MS made a difference to the outcome of the trials. The newly-diagnosed, who were 0-2 on the Kurtzke disability scale at the start of the trials, were the ones who showed little change or deterioration by the end of the trial. This applied only to the group which had been treated with PUFAs.
The conclusion from this is that treatment with PUFAs helps to stabilize MS in the recently diagnosed who have no real disability.
So in fact the Newcastle study – far from showing the ineffectiveness of evening primrose oil and other polyunsaturates for MS – does the opposite. But it does show that someone with MS does need to take a certain amount of linoleate for it to be effective.
The trial results do show that six capsules of evening primrose oil on their own, without any additional intake of linoleic acid, is not enough to affect plasma levels of linoleate. The answer, surely, is to take eight to 12 capsules of evening primrose oil a day, plus use sunflower seed oil spread and a cooking oil high in linoleic acid.
Some people have also criticized this particular trial on other scores. Firstly, there was no advice given about cutting down on saturated fats in the diet. (Saturated fats are thought to compete with polyunsaturated fats.) Secondly, the Naudicelle capsules used at that time had orange and black coloured shells which used the dye tartrazine. It is known that tartrazine interferes with fatty acid metabolism. Since then, evening primrose oil capsules have been produced in clear gelatin shells, with none of the same problems.
It is a pity that no one has conducted another trial with evening primrose oil taking all these factors into consideration. Since there has been no scientific evidence in favour of evening primrose oil as a therapy for MS, it is not prescribable on the NHS and has to be bought from chemists or health food shops, or by mail order from the manufacturers. Many people with MS find evening primrose oil too expensive to buy so don’t take it at all.
*29/60/5*

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WHY POLYUNSATURATED FATTY ACIDS ARE IMPORTANT IN MS (MULTIPLE SCLEROSIS)
Ђў Tests have shown that the levels of linoleic acid in the plasma tend to be low in some – but not all – MS patients, and they go even lower during an exacerbation. (Low linoleic acid levels can also be found in several other diseases.)
Ђў They are needed for the growth and repair of nervous tissue.
Ђў They are needed for the maintenance and structure of nervous tissue. This is particularly important in MS, where the nervous system is under attack. If the body lacks these nutrients, any repair of damaged tissue is made more difficult.
Ђў People with MS show an unusual pattern of fatty acids in their blood. With a diet rich in PUFAs, this can return to normal within a few months.
Ђў Some research has shown that the white matter in the brains of people with MS is low in PUFAs.
Ђў Perhaps people with MS have an inborn inability to handle PUFAs correctly.
Ђў In people with MS, the myelin sheath, the red and white blood cells, the platelets, and the blood plasma are also deficient in PUFAs, particularly linoleic acid.
Ђў The activity of lymphocytes (white blood cells) may be dependent on the state of the cell membrane. They will behave differently according to whether a cell membrane is fluid (plenty of PUFAs) or rigid (not enough PUFAs). This influences the ability of certain lymphocytes to react immunologically.
Ђў EFAs have virus-killing properties. A virus may be involved in the causes of MS.
*27/60/5*