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Not surprisingly, people with anorexia and bulimia have a suboptimal supply of a long list of nutrients. This is due to both a lack of nutritional intake as well as to digestive problems that routinely develop. Ironically, the first to go are often the minerals that are not only essential for good health but necessary to keep our bodies naturally thin. The following list describes some of the important minerals, other than zinc, that are commonly lost and their effects on the body.
• Calcium loss can add a complication to eating disorders—a loss of bone density that eventually can cause osteoporosis. Furthermore, since calcium is a natural tranquilizer, not having enough of it can lead to nervousness, irritability, insomnia, and depression.
Chromium has been found to help remove excess fat from the blood. When there is a chromium deficiency, fat is not removed adequately, and atherosclerosis can develop. In addition, the liver becomes unable to make lecithin, which is needed to break down cholesterol. Not only will cholesterol levels remain high, but fatigue, overweight, and premature aging can result. The adrenal glands suffer as well, making it more difficult to cope with stress. And as if these problems were not bad enough, with chromium deficiency the immune system easily wears down and sickness is more frequent. Iodine is needed to stimulate the thyroid, which, in turn, keeps the metabolic rate up so that calories can be burned efficiently. Iodine also is needed to make the hormone thyroxine, which is needed for childhood growth and the maintenance of healthy adult tissue, resistance to infection, cholesterol level control, and protection from heart disease.
• Magnesium, found in dark, leafy vegetables and whole grains, has a calming effect on the nerves. A range of digestive processes depend on magnesium; a lack of this mineral is associated with many symptoms experienced by those with eating disorders—vomiting, indigestion, flatulence, abdominal pain, cramps, and constipation.
• Manganese is needed by the brain and nerves to protect against mental disorders. In addition, it keeps the blood sugar in balance and is important for fat metabolism. This trace mineral also plays a major role in protection against cancer, neuromuscular diseases such as Parkinson’s, and other degenerative illnesses. One such disease, lupus, usually attacks young women, the same group most likely to develop eating disorders.
• Potassium assists iodine in the creation of thyroid hormones, needed to increase metabolism and regulate glucose metabolism. Potassium is needed by the muscles, nerves, and brain cells.
• Selenium is an antioxidant that protects against degenerative diseases, such as cancer and heart disease. In addition, selenium stimulates the immune system to protect against bacteria and viruses. It is vital to eyesight and needed to keep the blood sugar balanced.
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Let us now look at the vertebral column as a whole. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae and 5 sacral vertebrae, which fuse completely between 25 to 30 years of age. The total length of the vertebral column of an adult averages 28 inches.
The vertebrae do not form a straight and rigid structure. If you look at the spine from the side (see Figure on page 61) you will see that it has several curves, namely (1) the cervical curve, (2) the thoracic curve, (3) the lumbar curve and (4) the sacral curve.
The thoracic and sacral curves are called primary curves as they appear by the end of foetal development and are present in the newborn. They are also called ‘accommodation curves’ as they accommodate the thoracic organs (lungs, heart and other related structures) and abdominal and pelvic organs (large intestines, small intestines, uterus, kidney, bladder, rectum etc). These organs are voluminous and they need space, so the spine in the thoracic and sacral regions curves out (convex) to accommodate these organs. In the case of the sacrum, the weight of the abdominal organs tends to push them downwards into the pelvic region where they need ample space to be accommodated.
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Several research laboratories have tried using FES to enable paralyzed individuals to perform highly complex functional activities such as walking, bicycle riding, stair climbing, and self-feeding. However, they have encountered problems with electrode design, tissue tolerance, and detection and processing of the relevant sensory information.
The problems with electrode design are due, in part, to the difficulty in controlling each muscle individually. When a muscle is stimulated through the skin, all nearby muscles are stimulated indiscriminately. And deep muscles cannot be stimulated through the skin at all. To address this problem, several laboratories are working on tiny stimulating electrodes that can be implanted surgically, with electrode wires that extend under the skin to the target nerve or muscle. Unfortunately, the wires tend to weaken and may break over time, so new materials are being developed to do the job better.
The tissue tolerance problem relates to scarring at the site of stimulation. Although low-level FES is quite safe, it promotes gradual scar formation. The scarring can make the stimulation of underlying nerve and muscle tissue increasingly difficult, so higher levels of stimulation are needed to achieve the same muscular response. Eventually, the area may be so scarred that the desired response is no longer possible. The stimulating electrodes then have to be moved to a new location, which can require another surgical procedure.
The requirement for continuous detection and recording of information about the position of the body in space and the motions of the many joints and muscles creates yet another problem. Proper control of even a single joint requires constant monitoring of that joint’s position, with continuous feedback to the FES computer controlling the motion. The activity of multiple muscles must be properly coordinated to control motion at that joint.
Multi-joint systems have even greater complexity, and the amount of information to be processed and integrated increases dramatically with the increasing number of joints and muscles to be controlled. Developing a system that is powerful enough to produce real functional human movement, yet small enough to be practical for use outside the laboratory, will require miniaturization of all parts and materials.
Another major problem with FES is dealing with the tremendous complexity of human movement in a natural environment. Functional movement involves some interaction with the environment, such as transporting the body through space (as in walking, climbing, lifting, or carrying) or changing the body’s orientation in specific ways (as in moving the body from a lying to a sitting position, or turning the dials on a radio). In either case, control of motion requires measuring changes not only in body position but in the body’s interaction with the environment. For example, planning foot placement for walking requires a way of measuring the shape of the surface of the ground. Lifting heavy objects requires an assessment of the physical stresses applied to the bones and joints, so as to prevent stress fractures and other damage. And the lifting of fragile, lightweight objects (such as a glass of water) requires measurement of the force applied to the object in order to prevent accidental breakage.
A final problem with FES is that it does not work for everyone. Injuries of the lower lumbar spine usually involve the cauda equina, not the spinal cord itself (which extends only to the LI level or thereabouts in adults). The cauda equina is a bundle of nerve fibers carrying impulses to and from the spinal cord. When the motor nerves in the cauda equina are damaged, the muscles associated with these nerves do not respond to FES. (It is technically possible to stimulate these muscles electrically to produce contraction, but this requires an enormous and potentially harmful shock.) The same phenomenon may occur with injuries of the spinal cord itself, if there is also damage to the nerve roots at their junction with the spinal cord. Thus, for a given muscle, it is difficult to predict whether FES will be effective. The muscles can be tested individually to determine whether they are responsive to FES. If they are not, no therapy can make them respond to FES.
FES holds great promise for restoring movement to paralyzed muscles and limbs. The greatest success thus far has been with highly specialized systems for performing specific, narrowly defined tasks use of FES for improved hand function. With technological advances in designing electrodes, measuring positions and forces, rapidly processing huge amounts of information, and precisely controlling the electrical output to each individual muscle, FES will steadily become more useful. It is reasonable to assume that FES will improve the lives of many people with spinal cord injury within our lifetimes.
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Normally, negative ELM form reveals itself as the “weak moments in the life of the strong”. Sometimes, in our own lives, we come across Negative Elm State, when we suddenly find ourselves unequal to do our normal duty. Elm remedy would immediately remove the temporary feeling of inadequacy from the mind and restore our confidence to do our job. The weak moments of the Elm type may be regarded as warning signals, not to allow one’s capabilities to be overstretched beyond a certain limit. It also brings home to the
strong man’ the stark reality that every human being is ultimately a weak being unless he keeps himself connected to his Higher Self, and is being guided by it.
In the negative Elm state, the following symptoms occur:
1. Suddenly feels overwhelmed by the heap of responsibilities, doubts his ability to do the job.
2. Temporary feeling of inadequacy, resulting in despondency .
3. Complete exhaustion of mind and body due to ceaseless work without respite.
4. Imbued by over-confidence in his ability, he undertakes so many works that it is humanly not possible to complete them. Hence the temporary feeling of inadequacy and sadness.
5. When undertaking the numerous responsibilities, he makes no allowance for such exigencies as illness, incidents and accidents of life, the age factor, natural physical changes as menopause etc.
When there is a disturbance in the time-schedule due to the above “unforeseen and unprovided for” causes, he feels temporarily frustrated.
*103\308\8*


A long list of medications negatively affect your bones, so if you use any of the problematic ones (below) over the long term, be sure to consult with your doctor about how to protect your bone density. Pay particular attention to diet, exercise, and calcium supplements, and make bone density evaluation a regular part of your medical follow-up. If you are a women near or past menopause, think long and hard about the risks and benefits of HRT.
Many of these medications cause rapid bone loss at the outset, and the rate slows over time, so it pays to think about prevention as early in your treatment as possible, preferably before you take your first dose. It is never too late to take action, even if you’ve been taking something for years, unaware of the potential harm to your skeleton. If you get to work now, you can stop any further loss and build back much of what is already gone.
Steroids—corticosteroids or adrenal corticosteroids, officially— are among the leading offenders because they interfere with calcium absorption, block calcium from being deposited into bone, and increase the amount of calcium you excrete. All this results in bone loss, primarily from decreased bone formation (as opposed to increased breakdown). This group includes prednisone, commonly used for asthma and arthritis, cortisone, and many other drugs commonly used to treat asthma, psoriasis, rheumatoid arthritis, lupus, Crohn’s disease, ulcerative colitis, and multiple sclerosis, among others, and sometimes given along with chemotherapy for cancer and to people receiving an organ transplant.
You should consider getting a bone density scan before starting long-term treatment with a steroid drug, with a follow-up six months or a year later. In patients on oral or systemic cortisone, and especially in children, dramatic bone changes develop within three months. If you take it for longer than three months, or if your bone density drops more than 5 percent, you should adjust your dosage if possible, follow a serious bone-density boosting nutrition and exercise program, and consider adding a drug treatment like alendronate, calcitonin or risedronate preventively.
Some studies suggest some inhaled corticosteroids may cause less harm than others. When they are more targeted to specific parts of the body, as with nasal cortisone for allergies, for example, you don’t get the same interference with your adrenal glands and your metabolism. However, more investigation is needed before we can simply switch to the inhaled form and rest easy. Again, let me stress that every improvement helps.
Taking thyroid hormone is another risk factor for low bone mass. Hypothyroidism (not making enough thyroid hormone) is a common—and probably underdiagnosed—condition. Despite the problems associated with the treatment (which you’ll see in a minute), it is a condition you want to address. The thyroid helps balance the calcium level in your blood and assists in bone formation, so you want to be assured of having enough of it. Once diagnosed with hypothyroidism, the standard treatment of taking supplements of the hormone (like Synthroid) is quite effective. But if you don’t strike just the right balance, it can quicken bone breakdown. If your body makes too much thyroid hormone on its own—hyperthyroidism—you’ve got the same problem.
The thyroid is normally involved in bone remodeling, so an overactive thyroid means overeager bone turnover. Be sure your doctor tests your blood regularly and adjusts your prescription until you find the lowest dose that works for you and keeps blood levels of the hormone in the normal range. From the perspective of your bones, most doctors wait too long to treat for low thyroid levels: thyroid stimulating hormone (TSH) levels up to 4 are considered normal, which is when most doctors would become concerned, but I recommend treatment if it is over 2.5-3. Another common mistake is to treat too aggressively, pushing TSH levels as low as possible. Though the low end of normal is considered to be just .4, the lowest levels are associated with bone loss, so I try to help my patients stay in the 1 to 2 range.
Do not suddenly stop taking thyroid hormone, but try cutting down gradually, with your doctor’s supervision, spending a few weeks at each new level before deciding whether to go lower still. If you deal with thyroid disease with natural remedies, even better! Norwegian kelp is sometimes recommended, as is the yoga shoulder stand (which is said to stimulate the thyroid), among other things. If your original diagnosis is far in the past, a thorough new evaluation is in order to make sure you in fact still need the hormonal supplement. Either way, if properly controlled, thyroid conditions won’t negatively impact the bones, but if not handled properly, are a common contributor to low bone density.
Antacids containing aluminum are another area of concern. Long-term, frequent use can cause bone loss because aluminum combines with phosphorus and calcium and prevents them from being absorbed. Aluminum, on the other hand, can also be absorbed into the bones, causing osteomalacia. Antacids are a very common source of aluminum, but no matter where the aluminum comes from (polluted air or water, for example, or soda cans, or the pots and pans your food is cooked in, or other medications), it is hazardous. Even low levels of aluminum can step up the loss of calcium. The combination of osteomalacia and bone pain has been observed in people using this kind of antacid over a long period of time, so the importance of avoiding them is clear.
The newest antacid medicines, like Zantac, Tagamet, Pepcid, and Axid, which you take to prevent too much acid (as opposed to neutralizing what is already there) can be even worse. They work by preventing stomach acid from being made, which interferes with digestion and absorption of all nutrients, including calcium.
Some antacids, like Alka-Seltzer and Turns, have little or no aluminum, so they are your best option if you must use an antacid. The best tactic is to improve your diet and digestion so you don’t need antacids at all, and to rely on natural alternatives when you do need relief. In any case, always read the label of any antacid (any medicine, actually) so you know exactly what you are getting.
Many chemotherapy drugs—toxic as they generally are—can damage your bones. In addition, many patients undergoing chemotherapy are inactive, which isn’t good for bones. Many patients also have less of an appetite than they normally do, and if they don’t eat enough, they won’t get the nutrients their bones need. There are some options to relieve nausea and boost your appetite, and you should seek out appealing, nutritious foods, and be sure to resume exercising when you feel up to it. Cancer treatment is always difficult emotionally, and often difficult physically, but don’t forget that preserving your general health is important, too, and bone density is an important aspect of that.
Diuretics used to treat high blood pressure, edema, and congestive heart failure are another danger because the increased urine output means an increase in the nutrients excreted, including calcium.
Anticonvulsants, including phenytoin and barbiturates, taken to prevent seizures or for any other reason, can damage bone over time. This includes medicines to treat epilepsy.
If you have to take a long-term course of antibiotics, including tetracycline, or if you take them often, you will excrete more calcium—calcium that then won’t be available for your bones. Antibiotics can interfere with absorption of nutrients in general. Make sure you really need antibiotics before you take them; resist pestering your doctor for a prescription on the off chance your colds are actually bacterial (almost all are viral, and antibiotics won’t do anything good for them). Sometimes you do really need them, and then of course you should take them—antibiotics are one of the most beneficial discoveries in the entire history of medicine. But if you use them a lot over time, you must take the necessary steps to protect your bones, including exercise, diet, and supplements.
Other drugs that interfere with bone remodeling include cholestyramine, cyclosporin A (for organ transplants), and gonadotropin-releasing hormone analogues and agonists. You should also be concerned about methotrexate (for arthritis, cancer, psoriasis, and immune disorders); anticoagulants, including heparin and warfarin (Coumadin); lithium (and other drugs that treat bipolar disorder); benzodiazepines; warfarin; and other drugs. There are no doubt many more that impact on bone density, only we don’t know it yet.
*31\228\2*


We must start with the obvious question: How much weight would you like to lose?
Patients often have far greater expectations for weight loss than do their doctors. Physicians and other scientists agree that it is best for your health to lose a reasonable number of pounds and to maintain this new weight; it may be hazardous to your health to “yo-yo,” constantly losing and regaining great amounts of weight.
The choice is yours: you must decide how much you would like to weigh. Don’t assume that the number that appears on some standardized chart next to specifications that match your height and bone structure is the only answer. You decide, with your doctor’s guidance, what should be your weight.
Some of the dieters who have come to us have known from the start exactly what their final goal was; they were ready to go for it the moment that they heard the starter’s gun. Others have had to think hard before they could establish an initial weight goal. In some cases it was a weight at which they felt comfortable, although it wasn’t their ideal or their final goal. In other cases, they would reach their goal weight and decide to go further; in still others, they felt that their initial weight was quite acceptable. But no matter what their goals, almost all of these dieters moved steadily toward their goals, enjoying their Reward Meals with a sense of purpose and energy.
Whether you decide to go all the way right away or to lose your weight in stages is up to you. Some of the people we work with say that the staged weight loss offers some psychological benefits. They find it comfortable to pause between steps; stopping allows their bodies and their minds to adjust to weight loss, giving them new confidence. Some are convinced it helps them ensure the permanent success of weight-loss maintenance.
Some dieters who have opted for the staged approach found that upon reaching their initial goal, they were comfortable there. Some reported improvements in their health and energy levels, others experienced increased satisfaction with their personal appearance. Many of these people have happily maintained their weight at their initial goals for years with no particular desire to continue to another stage.
Many of our dieters do not want to lose in stages—they know what they want and just want to get there. In considering the weight that is to be your goal, make sure it is a reasonable one. For instance, trying to go back to the weight you were as a teenager probably isn’t realistic.
Check with your physician and then follow the plans to your new weight-loss goal. Plans C and D will result in more rapid weight loss; Plans A and B will help you slow down your loss as you approach your goal weight and move naturally into your lifetime maintenance program.
*37\236\2*


Risk factors are the reasons which lead to or aggravate the deposition of cholesterol or fat in the coronary arteries. If one desires to know the total number of risk factors responsible for the development of coronary heart disease it will amount to hundreds.
Williams in 1981 identified 246 risk factors that directly or indirectly lead to the development and onset of heart disease. To give you a rough idea, the distribution of these risk factors is mentioned below:
Habits and lifestyle, psychosocial 54
Physical and biochemical 16
Serum / blood measurements 44
Medical conditions or diseases 45
Dietary deficiency (inverse association) 23
Dietary excess (negative association) 21
Constitutional, demographic 16
Blood clotting (platelet) disorders 16
Environmental 5
Drugs 6
If you consider the major 10 or 15 risk factors, those which are important in the development of coronary heart disease, they have been classified into two categories:
1) Modifiable Risk Factors: These include risk factors which can be altered and prevented so that further progress of heart disease can be arrested.
2)   Non-Modifiable Risk Factors: These are risk factors which cannot be altered such as age, sex and heredity.
Modifiable Risk Factors
1. Stress and mental tension
2. High blood cholesterol
3 High blood triglycerides
4. Low blood HDL level
5. Lack of antioxidants in the diet
6. High blood pressure
7. Diabetes mellitus
8. Obesity or overweight
9. Sedentary life-style/lack of physical activity
10. Smoking or tobacco consumption
Non-Modifiable Risk Factors
1. Age
2. Sex
3. Heredity
*10/283/5*


Certain precautions are necessary while cooking vegetables for use by cancer patients. All vegetables must be cooked over a low flame, without addition of water. This will preserve the natural flavor of the vegetables and will make them easily digestible. Valuable minerals are lost by excessive heat – as the cells burst, minerals lose their colloidal composition and are thus not absorbed easily. An asbestos mat may be used to prevent burning. Tomatoes may be placed at the bottom of the pan to make available more fluid. This also improves flavor in some cases. Spinach water however, should be discarded as it contains too much oxalic acid. Red beet should be cooked like potatoes, with their peel in water. All vegetables must be thoroughly washed and cleaned. Peeling or scraping of vegetable should be avoided as important mineral salts and vitamins are deposited directly under the skin. The cooking pot should be closed tightly, to prevent escape of steam.
Pressure cookers should not be used for cooking of vegetable, nor saucepans or other utensils of aluminium. Stainless steel, glass, enamel, earthenware and cast iron utensils may be used.
*30/355/5*


Students with BDD may find gym class particularly painful because their defects are more exposed or because they have to change their clothes or shower in front of their peers. Rita, who worried about her thighs, told me, “I always flunked gym because I wouldn’t wear shorts.” Doug skipped gym class because he thought his wrists and body build were too small and didn’t want them to be seen. Another man had avoided all sports and skipped gym class because of his shame over his genitals. He eventually dropped out of the ninth grade and never returned because he was so terrified of having a required physical exam and the doctor seeing him naked.
BDD can also interfere with caring for children and managing a household. Ann Marie spent so much time worrying about her facial creases and shriveled eyelids that she was unable to care for her young son. “I’ve neglected him,” she said. “My appearance problems are so time consuming and energy consuming. My ex-husband has to take care of him.” A 30-year-old woman told me, “I feel so extremely ugly, I can’t get through my day. I’m not mentally or emotionally there for my kids. I’m removing myself from my family. My kids know something’s wrong with me, but I haven’t told them what it is. I want to lead a normal life so badly.”
*127\204\8*


As with the medical history and physical examination, basic laboratory studies should be performed before progressing to advanced diagnostic testing. Very often, clues from the history and physical examination can guide laboratory testing. Various authors have provided opinions on the initial group of tests that should be performed. These investigators have attempted to determine the diagnostic utility of various laboratory studies in the work-up of an FUO.
A complete blood cell count and a peripheral smear should be performed, since these may provide valuable clues. Atypical lymphocytes suggestive of a viral infection can be identified. A monocytosis may be suggestive of mycobacterial or fungal infection, and eosinophilia may prompt consideration of a parasitic or allergic disease. Rarely, one might observe parasites directly on a peripheral smear. Malaria and Babesia parasites are the most common organisms seen on a peripheral smear. Abnormal hematopoietic cells or their precursors can suggest a hematologic malignancy. Anemia may prompt consideration of myelophthisis or hemolysis. The presence of schistocytes, or torn red blood cells, could suggest microangiopathic or autoimmune hemolysis. Thombocytopenia can also be noted on peripheral smear.
Serum chemistries should also be performed to assess for abnormalities. Liver function test abnormalities are vague diagnostic clues in FUO but can nonetheless be helpful. Abnormalities can prompt earlier assessment of hepatobiliary system. A urinalysis can specifically be useful in determining the presence of genitourinary disease. The erythrocyte sedimentation rate and C-reactive protein, despite their lack of specificity, may be useful in assessing the extent of inflammation. An elevated uric acid level could be a clue to unapparent gout as a cause of the FUO.
Microbiological studies can be used to detect the presence of occult infection. Blood cultures can be very useful in detecting persistent or transient bacteremias caused by endocarditis, occult abscesses, and osteomyelitis. The highest sensitivity is obtained from three sets of blood cultures. Every effort should be made to obtain cultures with the patient off antibiotics. Blood cultures utilizing lysis-centrifugation systems can be used to detect more fastidious organisms such as mycobacteria, endemic mycoses, Bartonella species, and Brucella species. A sputum Gram stain, acid-fast smear for mycobacteria, and routine and mycobacterial cultures can have utility if pulmonary disease is suspected. The tuberculin skin test may prompt consideration of mycobacterial disease. A urine culture can assist in diagnosing infections of the urinary tract and, if positive, may prompt a more thorough search for disease in this region. Finally, stool cultures for bacterial pathogens should be considered when gastrointestinal disease is suspected.
Serologic studies may also be useful in the course of the diagnostic evaluation. Antibody testing for the human immunodeficiency virus may be warranted even if only risk factors are present. In addition, rapid plasma reagent testing should also be performed if syphilis is under consideration.
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