Medsarticles. Medical Weblog

Genetic predisposition

Some 5 per cent of breast cancers are related to an abnormal gene. Although this gene is rarely implicated in postmenopausal women who develop breast cancer, it is much more commonly present in pre-menopausal women with this disease, particularly in those under the age of 30.

Your risk of developing breast cancer is higher if you have a close relative with pre-menopausal breast cancer than if an affected relative is older than 50. The risk increases if you have two relatives with pre-menopausal breast cancer or one with the disease in both breasts.

The breast cancer family gene which has been identified is found not only in families with cancer of the breasts, but also in those with ovarian and colon cancer. Families with this gene should be given specialist advice and counseling at clinics run by geneticists or breast surgeons.

Geographic differences

Breast cancer is about eight times more common in Northern Europe, North America and Australia than it is in parts of Asia and Africa. However, women who move from low-risk countries, such as Japan, to high-risk countries such as North America, show a sometimes immediate increase in risk – certainly within one or two generations. Although this does not rule out the possibility of a genetic predisposition, it does seem to indicate an important role for some factor(s) in the environment.

Diet

Some dietary factor(s) may play a part in the increase in risk. Although it is not known how these exert their effects, it may be that they influence hormone synthesis or metabolism.

Many foods contain hormones or hormone analogues, either naturally or otherwise. For example, milk is a hormone-derived substance, as, therefore, are butter and cheese etc. Chickens and pigs are often injected with hormones which may be present in the meat from these animals. The early oral contraceptive pill was made from hormones naturally present in the sweet potato. Ginseng also contains naturally occurring oestrogen. These are just a few examples.

There is evidence to suggest an association between diet and various cancers, including cancer of the breast, although this is not conclusive and some studies have failed to find any such link.

Other studies suggest that a diet high in fat and in animal protein, common in most countries in the more affluent West, may be a significant factor in the development of this disease, although there is as yet no conclusive proof of this. Although the Japanese are now a well-nourished nation, they do not eat a large amount of animal fat, and, as mentioned above, do not have a high incidence of breast cancer when living in their own country.

It is also possible, but unproven, that vitamins A and C, found in dark green and yellow vegetables and in fruit, may have a protective effect.

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Tonometry

This is a simple, painless method of measuring the pressure of the fluid in the eyeball. It is valuable to be aware of this pressure because an early rise, if caught, can be treated and can save the person’s sight. It is a test worth doing every two to five years after the age of 40.

Sigmoidoscopy (Looking inside the rectum or back passage)

Most cancers of the bowel lie within the view of a special instrument, called a sigmoidoscope. It is generally considered sensible to have a sigmoidoscopy every three to five years following two negative examinations a year apart at age 50. Other experts recommend one examination at age 56 because this is the peak age for this cancer, which is the second commonest.

Testing the stools for blood

Because microscopic amounts of blood can be lost in the stools in people who have bowel cancers this can be a very good way of detecting such cancers early and certainly long before they start to produce symptoms. It is probably sensible to have such a test done every year after the age of 50.

Testing for anaemia

Recommendations for the screening of adults for anaemia range from, every two to every five years. Women are particularly at risk because of having periods and childbearing. Many millions of people, women especially, are walking around sub-clinically unwell with anaemia yet remain unscreened. This is an easy and cheap test to do and the treatment is straightforward and inexpensive.

Blood sugar tests

Whether or not it is worth screening populations for their blood sugar levels to see if they are undiagnosed diabetics is controversial-mainly because there is no evidence yet that the early detection of diabetics without symptoms does anything to alter the long-term outlook. Some experts think that as the test is relatively cheap it is worth doing every five years until 65 and then every two years. Others feel that looking for sugar in the urine (another sign of diabetes) every five years is quite sufficient.

Screening for sickle cell trait

Certain high-risk populations (mainly black) should be screened prior to childbearing so that they can receive genetic counseling about the likelihood of having an affected baby. Some experts recommend that the test be done at the age of 10 years.

Checking for German measles (rubella) immunity

This disease, whilst not serious during normal life, can produce terrible handicaps in the baby of a pregnant woman who catches it. It is estimated that even with rubella vaccinations being widely available, about 15 per cent of women get to childbearing with no immunity to the disease. The most logical time for screening is just before childbearing age. Pregnancy should not be allowed to occur for three months after the immunization. A girl who is not immune can be vaccinated in her early teens. Many authorities think that every pregnant woman should be routinely tested for antibodies to rubella.

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After the birth of her second daughter, Melissa Katz was stunned to discover that her weight had settled in at 240 pounds. The veteran yo-yo dieter from Brooklyn found herself at a crossroads.

“I thought, ‘If I don’t get a handle on this now, I’m going to be fat my whole life,’” she says.

She decided to join Weight Watchers. After just a few meetings, she realized just how much food she had been eating each and every day. “No wonder I had gained so much weight,” she says. “The problem was that I was used to eating big meals and big snacks. I felt hungry all the time.”

Weight Watchers taught her that she could have plenty of food—if she made-the right choices. So she turned to fruits and vegetables to fill her plate. “They made me feel full without supplying lots of calories,” she explains.

As the weight started to melt away, her self-esteem grew. “As I became more confident, I became more physically active,” she says.

It took only a year for Melissa to lose 100 pounds. She has maintained that loss for 214 years. And her casual interest in exercise has turned into a career as a physical trainer.

But what Melissa, age 35, is most proud of is the impact that her new eating habits are having on her daughters. “They make good food choices, too,” she says. “They’ll pick a piece of fruit over a piece of cake. That’s what gives me the biggest joy.”

WINNING ACTION

Stock up on produce with a high satisfaction quotient.

Australian researchers put together a list of “bargain foods” that, calorie for calorie, have the greatest potential to satisfy your hunger. At the top of the list: the baked potato. It fills you up faster and with fewer calories than any other food tested.

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These drugs have the effect of stabilizing mast cells so that they do not release histamine and other mediators. The main one used is sodium cromoglycate. It is only effective if it reaches the mast cell before the allergen. So it can be used to prevent the symptoms of allergy, as long as the patient remembers to take the drug when they are feeling well, before they encounter the allergen.

The drug is given in inhalers (Intal) as a preventive treatment for asthma. The time from when treatment starts to when the good effects become noticeable is variable – from a few days to several weeks. The drug must be taken continuously to be effective. In some people, it can cause irritation of the throat, coughing or, more rarely, an asthmatic attack. In rare cases there may be a true allergic reaction to the drug. In general, however, sodium cromoglycate is remarkably free of side-effects.

Although the main effect of sodium cromoglycate is to stabilize mast cells, it appears to make the bronchi less reactive in other ways as well. Thus it is used for exercise-induced asthma. Its long-term effect is to make the bronchi less sensitive, which is beneficial.

A related drug, nedocromil sodium (Tilade), is sometimes prescribed instead of sodium cromoglycate for asthma. It acts in much the same way but is a more powerful drug, and is not prescribed for children. Sometimes sodium cromoglycate is combined with other drugs, as in Intal Compound which contains isoprenaline.

In cases of food allergy, taking sodium cromoglycate by mouth (Nalcrom) can block the allergic reaction. But it is only used where the symptoms are not of the immediate-and-violent kind. Thus it might be prescribed for patients with food-induced symptoms such as diarrhoea, asthma, rhinitis, eczema or chronic urticaria, but not for those who suffer swelling of the mouth and tongue on eating a particular food. In such cases, the slight risk of the drug not working has to be considered, because of the serious consequences of such a failure.

Sodium cromoglycate appears to block mast cell degranulation in the gut wall, which prevents the gut wall becoming inflamed and thus makes it less permeable to food molecules.

To be effective, sodium cromoglycate (taken by mouth) must be taken 10 or 15 minutes before the food is eaten. The beneficial effects of the drug may not appear for several days. Occasionally, the drug may make the symptoms worse, for reasons that are not yet understood, and sometimes it has no effect, or only

partially controls the symptoms. Sometimes patients experience side-effects such as headaches, urticaria, diarrhoea or vomiting.

Because of doubts about its effectiveness if used long-term, simply taking sodium cromoglycate is not the best way to deal with food allergy. Its main use is in patients with reactions to a very wide range of foods, who find it difficult to avoid them all. Even though they are taking the drug, such patients must usually restrict their intake of the main offending foods as well. Babies who react to a wide range of foods on weaning have been helped by sodium cromoglycate.

This drug can also be useful in giving food-allergic people a ‘day off from their restricted diet. Children may be given it for Christmas or birthdays, to allow them to eat normally for a day. Sodium cromoglycate is also used in hay-fever and other forms of allergic rhinitis (Rynacrom) and in allergic conjunctivitis (Opticrom). It can cause stinging when applied but this wears off quickly and again there are no serious side-effects. The drug must be used regularly and consistently for the good effects to be maintained. In Rynacrom Compound, sodium cromoglycate is combined with xylometazoline, a sympathomimetic .

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Wait until you have been free of symptoms for two or three days, but don’t wait any longer than this. Begin by testing foods that are probably not the cause of any trouble – things you do not eat very often. Choose items that you like – if the foods pass the test, then you can incorporate them into your menus, which will allow you to eat less of the exclusion-phase foods. Throughout the reintroduction phase it is vital that you keep your diet varied and do not eat too much of any one food. In particular, do not eat any one food every day. Continue to record everything you eat, and your symptoms – if something goes wrong, this record will prove invaluable.

Only test one food at a time. Eat a normal-sized portion of the food in question, preferably with your evening meal. Notice any changes that occur at the time, or later in the evening, or the following day. During the first five weeks of testing, test each food for one day only. (Although eating the food for three days in succession is preferable, it takes so much time that you cannot test enough foods – there are far more to test than on Stage 2). If you think you may have reacted slightly, but are unsure, then test the same food again the next day.

After five weeks, your sensitivity may be declining, so you need to test each food more thoroughly, by eating it for three days in succession. If you get no reaction by the fourth day, then the food can be considered safe, but avoid it again for four days (to offset any possible effect of eating it for three days in succession) before beginning to eat it once more.

If you get a reaction to any food, stop eating it immediately. Allow the symptoms to subside before testing any more foods.

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Although all elimination diets work on the same principle, doctors differ considerably in the sorts of food they allow during the exclusion phase. The objective is to avoid all foods that are likely to cause problems. In essence, this means all foods that are eaten frequently because these are the most likely culprits. However, the ’safeness’ of foods is also taken into consideration – some foods seem less likely to cause problems than others. The question is – how far do you take this? Some patients will be sensitive to 20 or more foods – to get better, they need to avoid almost everything they normally eat. But these patients are a tiny minority. Most patients will be sensitive to between two and five foods. For them, a rigorous exclusion phase is not necessary – they simply need to avoid the most frequent offenders, such as wheat, milk, eggs, citrus fruits, yeast, chocolate and additives. On the whole, the latter group have a much easier task ahead of them in discovering which foods make them ill, so doctors tend to think more about the unfortunate patients with multiple sensitivities. With them in mind, they devise diets that will eliminate most commonly eaten foods, even if this means putting the patients with just a few sensitivities through an unnecessarily arduous regime. The approach to elimination diet that we recommend is a flexible three-stage procedure that provides the best possible diet for each type of patient.

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The first step for any parent is to decide whether their child’s behaviour really is abnormal. As Dr Philip Graham of the Institute of Child Health in London points out: ‘All normal children show some degree of aggressiveness, disobedience and antisocial behaviour: all at times show sadness, depression, anxiety and social withdrawal. All are at times unusually active and distractible. What makes a child a cause for concern is the severity and persistence of the problematic behaviour in question.’

Although a child like Matthew clearly shows abnormal behaviour, others with hyperkinetic syndrome may only be mildly affected. In such cases, it may be quite difficult to distinguish hyperkinetic syndrome from ‘normal’ behaviour – emotional upset and misconduct may be due to family tensions, lack of discipline, an unsettled home life, difficulties at school, or a great variety of other causes. It is very tempting for parents to attribute their child’s awful behaviour to some simple external cause when the real problem lies within the family. Conversely, some parents may find lively, childish behaviour disruptive and label it as ‘hyperactive’ when in fact it is perfectly normal. Parents may not always be the best judge of what is wrong with their child, and it is a good idea to discuss the problem with a sympathetic teacher, doctor or child psychiatrist, keeping an open mind about the possible causes of the problem.

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Antibodies are special molecules produced by the body to fight off infections. They bind firmly to the bacteria or virus that causes the infection and, with luck, this stops the infection in its tracks. Antibodies can block infection in a variety of ways. With viruses, they may be able to prevent them from invading the body’s cells simply by binding to them. With bacteria, however, antibodies alone are ineffectual. They need help to defeat the bacteria and their job is to act as signals to other cells and molecules in the body which have the power to kill. The antibodies form a coat on the surface of the bacterial cells and this stimulates the immune system’s ‘assassination teams’ to go into action against the bacteria.

Antibodies are protein molecules, as are many of the important, hardworking components of the body (see p23). Proteins are infinitely variable molecules and this is what makes them so useful. In the case of the antibodies, their versatility is employed in making molecules that bind specifically to a particular target molecule, or antigen, and to no other. The measles virus, for example, is bound by antibodies that specifically recognize proteins in the outer coat of the virus – these being the measles antigens. They do not normally bind to anything else, apart from the measles virus.

The body produces a vast range of different antibodies – millions of them so that if it has to combat a new bacteria or virus it is certain to find an antibody ‘in stock’ that is just right for it. The antibodies are produced by special factory cells called B cells, and each B cell produces its own particular form of antibody. When faced with an invading microbe, the body selects a B cell with the right antibody to match that microbe, stimulates the cell to divide, and then instructs all the cells that are descended from it to produce their much-needed antibody. This continues until there is enough of the correct antibody to defeat the infection.

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The fresh plant extract has a marvellous effect on the digestion, helping to overcome loss of appetite, irritation of the stomach lining and also stomach cramps. For these complaints, take ten drops in a little water three times a day, half an hour before meals. Moreover, it is excellent for bronchial and deep-seated catarrh if a few drops are taken with a little honey once an hour.

The seeds of angelica are also used. For example, a liqueur can be made from them. And here is the recipe for the genuine angelica liqueur known as ‘Vespetro’:

Angelica seeds (or chopped angelica root, if you are unable to obtain the seeds) 60g (2 oz) Fennel seeds 8g (V* oz) Anise seeds 8g (Ó4 oz) Coriander seeds 6g {Vs oz)

Grind all the seeds together in a mill or crush in a mortar, put in a bottle and add 200 g (8 fl. oz) of pure alcohol. After eight days strain the mixture through muslin or cotton wool and mix it with a solution of 1-1.5 litres (2Óã pints) of water to which 500 g (lib) sugar (preferably grape sugar) has been added. And there you have it!

There, is no better or more pleasant remedy for digestive upsets or flatulence. Let us imagine a monastery in the Middle Ages. There the monks would enjoy a glass of this golden drink before appearing for duty in the morning. Late in the evening a guest arriving with an upset or chilled stomach would be given a glass of ‘Vespe-tro’, and just a small sip would have a quicker and better effect than any of today’s chemical liquids or tablets.

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It is one of nature’s wonders that the body is able to use silica and other minerals to provide the toes and fingers with tough horny plates. By diseases of the nails I do not mean deformities of the nails and diseases of the nail roots caused by the use of nail polish and manicures etc. The nails and hair are usually an indication of the person’s general condition of health. As a rule, those who suffer from metabolic disorders have neither strong nails nor healthy-looking hair. The nails and hair become brittle and lose their natural structure when there is a deficiency of minerals and trace elements. In such cases, the only worthwhile thing to do is to treat the basic cause of the problem.

A simple inflammation of the cuticle can be treated successfully with Bioforce Cream, Molkosan and Echinaforce. For the treatment of more serious cases of inflammation, for example onychia, use horseradish tincture instead of Molkosan. Finally, eating food that is rich in calcium and silica is an excellent way to strengthen the nails, as is the supplementary intake of Urticalcin and Gale-opsis.

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