The medical name for these is syncope. Many of us have experienced one or more syncopal attacks, very often at school. In syncope, consciousness is disturbed or lost, not because of a paroxysmal discharge of cerebral nerve cells, but because the cerebral nerve cells are silenced by inadequate supply of oxygen through arterial blood.

When a man stands up, his brain is about 15 inches (38 cm) higher than his heart; when he lies down, the two organs are at the same level. When he stands up, therefore, the arterial pressure has to increase so that blood flow to the brain remains unchanged. Normally, this is accompained smoothly by a combination of increased heart rate and by constriction of the blood vessels in the abdomen and legs. Experience informs us of examples of a breakdown in this mechanism. The most familiar is the extreme slowing of the heart-rate produced in some sensitive people by the sight of blood or in response to pain. This cardiac slowing is mediated through the vagal nerve, and the name vasovagal attack is often given to such an episode.

The contraction of leg and thigh muscles during walking normally drives venous blood back to the heart. If venous return is insufficient because of immobility—for example, a soldier at attention on parade, or a young girl in assembly at school—then syncope may occur. Such syncope seems to be socially infectious—once a girl or soldier has slumped, others may follow in the next few minutes.

Normally blood returns to the heart from the legs smoothly through the chest and abdomen. During prolonged coughing, or straining while trying to pass a stool, the pressure within the chest is greatly increased, preventing venous return to the heart. What the heart is not getting back, it cannot put out, so this sequence of events again may result in impaired blood-flow to the brain, and syncope.

If the blood vessels in trunk and legs are pleasantly dilated in a hot bath or nice warm bed, suddenly getting up—for example, to answer the telephone—may cause syncope. This may also happen in older people, when they get out of bed at night to pass urine. The situation is more complex in this case because we know that, at the onset of urination, there is a reflex dilatation of blood vessels in the legs. This so-called ‘micturition syncope’ affects men more than women, not only because they more often have to pass urine at night (because of prostatic enlargement) but because they pass urine standing up.

Syncope may occur in association with certain diseases. For example, in diabetes the nerve fibres controlling the heart rate and the diameter of blood vessels may be diseased, and the normal adjustments to blood pressure to posture may fail to occur. There are other rare diseases of the brain in which a similar failure to control blood pressure occurs. One, which bears some similarity to Parkinson’s disease, is known as the Shy-Drager syndrome after the two American neurologists who first described it.

A much more common cause of syncope, however, is medication. Many people take tablets to control high blood pressure. One effect of some of these drugs is to cause syncope on standing up. Some antidepressants, such as imipramine (Tofranil), do the same.

How does the neurologist or paediatrician decide that his patient’s blackouts are due to syncope rather than epilepsy? Again, all depends upon the story. The first clue is the circumstances in which the blackout, occurred. If it happened at the scene of a road accident, or during a horror movie, syncope is very likely. A common story is for a man to faint while attending his wife’s delivery. Syncope virtually never occurs lying down, so if loss of consciousness happens then, a seizure is more likely. Very occasionally, vagal slowing of the heart can be so profound that syncope does happen lying down. For example, one of our patients was a woman who was so terrified of dental treatment that she lost consciousness due to syncope even if the dentist started treating her with the chair tilted back almost to the horizontal position.

The next point is the occurrence of pre-syncopal symptoms. Blood flow to the brain is reduced in syncope often for many seconds before consciousness is lost. During that time, the nervous system makes desperate attempts to constrict other blood vessels in order to elevate the central pressure. The constriction of blood vessels in the skin results in pallor, and the associated discharge of the vegetative (non-voluntary) nervous system causes nausea and sweating. The person therefore feels and looks cold, pale, and clammy.

Other points which help distinguish syncope from seizures include limpness, rather than rigidity and/or convulsions during the period of unconsciousness, and usually no incontinence during the event. Recovery of full consciousness and orientation is much more rapid after syncope than after a seizure, following which there is usually a period of confusion. Recovery after syncope often rapidly follows assumption of the horizontal position, whether the person falls, or is placed like this, so that the head is on the same level as the heart. This is nature’s safety mechanism whereby cerebral blood flow is restored. Occasionally the safety mechanism cannot operate—the position of a hand-basin or lavatory may prevent the limp body falling to the floor. Sometimes the sufferer is supported in a vertical position by well-meaning but ill-advised friends or bystanders. In these cases, cerebral blood flow may fall to such extremely low levels that incontinence, twitching, or a full-blown seizure may occur. This should be regarded as an ‘anoxic seizure’ rather than a seizure caused by epilepsy.

As an example of the difficulties that this unusual sequence of events can cause, one of us was asked to see a young nurse. Three days after a straightforward appendicectomy, she got up for the first time to go to the ward lavatory. She felt faint as she walked there, and therefore left the door ajar. She felt fainter still as she was sitting on the seat, straining to open her bowels. Before losing consciousness she called another nurse for help. This girl seeing her colleague about to tumble off the seat, held her up to prevent injury. The resulting cerebral anoxia caused an anoxic seizure. An incorrect diagnosis of epilepsy had been made, and her continued employment as a nurse was under threat.

Syncope in adolescents—usually girls—can be very troublesome, and occasionally injury occurs. Physique and life-style seem irrelevant, so the usual advice to take plenty of fresh air and exercise is probably useless. Much more important is to tell the young person to lie down at once if she feels the onset of typical pre-syncopal symptoms. Fortunately recurrent episodes are rarely troublesome for more than a year.

*36\188\2*

Apart from meow, woof, moo, baa, oink, squeak, and heehaw, their body language says that CMO is great. In fact, we’ve never seen a failure with an animal. Absolutely never! Be it horse, dog, cat, goat, hamster, or potbellied pig, we have yet to hear of any arthritic animal that has not responded well to CMO. For more details, refer to the chapter on animals.

One health food store owner told us this funny tale. As he was telling one customer about the wonderful benefits of CMO (98% success rate with his particular clients), another customer who was overhearing the conversation butted in. He related how he had heard one of Dr. Sands’ radio interviews and consequently bought CMO for his father. But his father refused to take the capsules, or any other form treatment for that matter.

Now that family also has an old but much-loved dog who, three months earlier, had just sort of given up on things. He just laid himself down by the door and refused to budge from that spot. He ate there, he slept there, and even did all his business there, forcing a rather annoying cleanup job on the family several times a day.

Well, rather than let those costly CMO capsules go to waste, the son decided to give them to the dog. In just a few days, the man said, that dog was up on its feet again and scampering around like it had many years before. But, despite it all, the son complained, he still can’t get his father to take the capsules.

*57\142\2*

Symptoms: poor appetite, vomiting, constipation, irritability, slow development, aggressive behavior, seizures, personality changes, clumsiness, paleness, fatigue, weakness.

Home care

Discourage your child from putting nonfood objects into his or her mouth and swallowing them.

If your home was built before 1950, have the paint and plaster tested for lead content.

Watch for changes in your child’s behavior.

Precautions

-    Check your home and yard for possible sources of lead.

-    Scraping, sanding, and other tasks involved in remodeling an older building may release lead into the air. Such a location should be avoided by infants, small children, and pregnant women until the work is completed.

-    A person who works in an occupation that involves exposure to lead should take steps to avoid bringing lead-containing dust into his or her home on work clothes.

-    Sources of lead poisoning can include artist’s pigments, exhaust from cars, soil around buildings on which lead-based paint was used, city air, and improperly glazed pottery.

Lead is a heavy and dense metal that, in the human body, acts as a poison. Microscopic particles of lead can enter the body if a person swallows something that contains lead or inhales air contaminated with lead. The metal then accumulates in the blood and in body tissues. The most serious effects of lead poisoning are on the brain and nervous system. It can also damage the digestive system and the kidneys.

Before 1950, lead was an ingredient in paint, plaster, and putty, and most cases of lead poisoning occur when a small child eats fragments of lead-based paint that have peeled off a wall or have been left in the soil around a house. Today, house paint does not contain lead, but the metal is found in many other places. Some of the sources of lead poisoning include artist’s pigments, exhaust from cars (some petrol contains lead), soil around buildings that were once painted with lead-based paint, and the air in cities where lead may be used in industry and where the exhaust from many cars is concentrated. Also, lead is found in high-acid food and drinks (for example, orange or tomato juice) that have been stored in lead-containing pottery that was not properly glazed.

Lead poisoning can cause permanent damage to the brain, especially in cases where the symptoms are severe. Such damage may not occur if the problem is quickly identified and treated. However, a child who has had lead poisoning may take as long as a year to recover completely. Lead poisoning occurs most often in children under five. It is most dangerous if the child is under two years old.

*143/84/5*

This is the worst kind of fat. We are continually being told that to reduce our risk of heart disease we must reduce our fat consumption, especially saturated fat. In its place we are encouraged to consume vegetable oil and vegetable margarine.

Just because vegetable oil comes from vegetables and is cholesterol free does not mean it is healthy for our heart. The main problem with vegetable oil is how it is processed. Modern manufacturing techniques process the oil in a way that exposes it to high temperatures, oxygen, light and chemical solvents. This damages the fragile essential fatty acids in the oil, and creates many toxic components, including trans fatty acids. When these same oils are used to manufacture margarine, even more toxic by-products are created, and because the oil has been hardened, more trans fatty acids are usually created.

The harmful effects of trans fatty acids include:

Lower HDL “good” cholesterol.

Raise LDL “bad” cholesterol.

Raise lipoprotein (a).

Inhibit insulin binding, promoting obesity, Syndrome X and diabetes.

Interfere with various enzymes, including delta-6-desaturase, needed for essential fatty acid metabolism.

Promote cancer.

Promote the development of fatty liver.

Promote inflammation in the body by stimulating the release of inflammatory cytokines.

How to avoid trans fatty acids in your diet

The easiest way to do this is to avoid foods that state the words “vegetable oil” on the label. You can assume that this term means highly processed, poor quality, refined vegetable oil. The term “hydrogenated vegetable oil” usually means that the product contains trans fatty acids.

Vegetable fat usually means fully or partially hydrogenated vegetable oil, and should be avoided also.

Another problem with the term “vegetable oil” is that you don’t know which vegetable oil in particular has been used. In Australia it is often cottonseed oil that is used in vegetable oil blends (such as cooking oil and I margarine), fried or baked foods and snack foods. Cottonseed oil is very unhealthy; you can read about it in chapter twelve.

If you eat takeaway fried foods, you are guaranteed to be consuming large amounts of rancid, oxidized fats rich in trans fatty acids. In many restaurants cheap vegetable oil and margarine are used. The word “butter” on the menu usually means margarine because it is cheaper and has a longer shelf life. Always ask about the type of fat that your food is being cooked in. Extra virgin olive oil, butter and unrefined coconut fat (not copha) are the healthiest options.

The nutrition panel of many foods now lists the trans fat content of the food. At this time, Australia does not have a stance on what level of trans fats can be safely consumed. However, according to the USA, there is no 1 safe level of trans fat intake; they should be entirely avoided. By the end of 2005, the Heart Foundation will only allow its tick on margarines that contain one percent or less of their total fat content as trans fats. This is half the maximum level allowed by the government of Denmark.

*46/53/5*

Breads

Organic whole meal bread is best and health food shops and supermarkets stock some good ones such as Shipton Mill. Some breads contain either sugar or dextrose and/or flour improvers, so read the labels carefully. If the flour improver is ascorbic acid, that’s OK as it is a form of vitamin C. Whole meal pitta bread makes a nice change but do check the label for undesirable ingredients.

Flavourings

Avoid over-processed, commercially-produced flavourings. Instead, choose from ginger, garlic, fresh and dried herbs, lemon juice, sea salt, Lo-salt, miso (soya bean paste), mustard (check for added sugar, chemicals, etc), and arrowroot for thickening to make gravies and sauces.

Soya sauce is good on rice, in salad dressings and sauces, as well as Chinese stir-fries. Choose organic where possible and avoid any makes which contain monosodium glutamate. There are also a number of ready-made salad dressings with no sugar or chemicals, but do check the labels.

Sweeteners

It is better to rely on the natural sweetness in foods rather than using artificial sweeteners. For example, if you are making cakes, try carrot and raisin or banana cake. However, if you do want to add a sweetener, use maple syrup, concentrated apple juice, barley malt, date syrup and honey.

When buying honey, avoid those which are ‘blended’ or the ‘produce of more than one country’, as they are often heated to temperatures as high as 71°C (160°F) which destroys their goodness. With maple syrup, if the label says ‘flavoured’ beware: if it is not the real thing it could contain sugar and chemical flavouring.

Beans/Pulses

Beans make a good base for many healthy dishes, especially if you are trying to stay off meat to improve your fertility. They are great added to salads, soups and casseroles, and you’ll find them a useful and economical addition to your culinary repertoire.

Most beans (not lentils) need to be soaked, some overnight, before cooking. Alternatively, you can buy organic beans in tins from most supermarkets which have a little salt added to them but no sugar.

Houmous, which is made from chickpeas, can be bought ready-made from most supermarkets and is a good source of protein and essential fatty acids.

Meat

Meat is high in saturated fat so you should try to cut down on it. Of all meat, poultry is the healthiest choice and several supermarkets now sell organic, free-range or corn-fed birds, all of which are preferable to the usual mass-produced birds. However, apart from saturated fat, meat also contains growth hormones, antibiotics and other chemicals given to many animals reared for human consumption.

In addition to its adverse effects on fertility, these is also a possible link between the consumption of red meat and bowel cancer. The Government has therefore suggested that our intake of red meat should be less than 90g (3.2oz) a day.

Fish

Fish has low saturated fat levels and is very nutritious. It’s best to grill or poach fish, rather than fry it. Oily fish is particularly good, as it contains high levels of essential fatty acids, so you can enjoy mackerel, tuna, salmon (eat the bones), sardines and anchovies. Fresh is best but frozen or tinned are acceptable.

Eggs

Buy organic free-range eggs. You want organic as well as free-range. ‘Free-range’ only implies that the hens, unlike their battery cousins, have been given a certain amount of freedom but they can still be fed on ‘junk’.

*40/73/5*

•     The causes of migraine are many. Some people are exceptionally sensitive to particular foods (typically cheese, citrus fruits, fried foods, chocolate, seafood or red wine). Others are sensitive to: stress; not enough or too much sleep; noise; certain smells; missed meals; excitement; bright and flickering lights; changes in daily routine; or the weather (especially thunderstorms and snowstorms). Migraines, and indeed all types of headache, are three times more common in women than in men. Perhaps a fall in oestrogen triggers an attack. Women taking the contraceptive pill often have headaches, and taking the Pill can make migraine worse.

•     Dehydration (too little fluid) is a common cause of headaches. Most people drink too little fluid and easily become dehydrated in hot surroundings or if they miss a drink or two.

•     Tension headaches are produced by anxiety and stress. They are often seen in people who are meticulous and fussy. Unlike with migraine the pain of tension headaches lasts all day. The sensation is described as being ‘like a weight pressing on the head’ or ‘a tight band around the head’. Sometimes the pain goes to the back of the head and down the neck. People who concentrate for long periods of time (such as lorry drivers) often get this kind of headache. A variation of this is the tense-jaw headache which is caused by the individual clenching the teeth.

•    Hangovers are a very common cause of headaches. They are the results of consuming too much alcohol, which overloads the body’s ability to detoxify the alcohol.

•     Foods cause headaches in certain susceptible people. Ice cream and very cold foods can cause pain in the head and throat. Cured meats often contain nitrates which make blood vessels around the skull wider and cause headaches. Monosodium glutamate (especially plentiful in Chinese food) causes a headache in some people-often accompanied by nausea, abdominal pains and dizziness.

•     Poor vision does not cause headaches but if you sit with your eyes screwed up, frowning to see better, you can easily get a tension headache.

•    Headaches are often a sign of an impending infectious illness or fever. A simple pain-killer usually tides the person over until the cause becomes obvious.

•     Head injuries are, undoubtedly, a cause of headaches but the cause is usually all too apparent and cannot readily be prevented (except for the obvious measures of driving carefully, and wearing seat-belts in cars and crash helmets on motorcycles).

•     Very high blood pressure can cause a severe, pounding headache which is worse in the morning and improves during the day. The pain improves with the head up and is worse when lying down.

•     Brain tumours certainly cause headaches and many people worry that they might have a tumour, especially if they have repeated headaches. However, brain tumours are very rare indeed. If your headache is worse on waking in the morning or if it is worsened by sneezing, bending down or exertion then you should see a doctor to discuss it. If you have double vision, vomiting, drowsiness or weakness in a limb and are not a migraine sufferer you should seek medical help at once.

*161/72/5*

Imagine you’re a telephone operator sitting in front of a huge console of blinking lights. Whenever a red light flashes, you’re supposed to plug a cord into a green socket. A blue light means to put the plug into a yellow socket. Orange light – purple socket. But what if you suddenly became color-blind? Imagine the chaos. Nothing gets connected No one can communicate with anyone else. Everything goes haywire.

In a sense, an eating-disordered person can be emotionally “color-blind.” When a bulimic feels angry-when the red light flashes-she plugs into the wrong socket. Instead of dealing directly with her anger, the signal gets diverted and triggers a binge. Similarly, an anorexic may fear intimacy, but her mind reroutes that feeling into a fear of fatness. The feelings are there, but the disorder causes them to short-circuit.

For years these people have denied or suppressed their feelings-”Angry? Me? Impossible.” Why does this happen? There are many reasons. Perhaps these people come from families that forbade emotional expression. They thus have no role models to follow when it comes to showing joy or pain. Or perhaps they were punished in some way for being emotional-”Don’t cry. Only babies cry. Go to your room.” They may think that a feeling such as anger, once it grabs hold, will hurl them out of control, and make them dangerous or bad.

Feelings become strangers, provoking strangely twisted responses. Recently I brought a seventeen-year-old bulimic and her parents into my office. I told them that she had to be hospitalized because, despite intense outpatient treatment, her severe bingeing and purging had put her in medical danger. “No!” she cried, throwing herself down, sobbing and pounding the floor with her fists. “I don’t want to go to the hospital! It’s not fair!” Despite her protests, the parents agreed to the plan and she was admitted. The next day, however, she was much calmer. She said, “To be honest, I’m kind of relieved you put me in here. I felt really terrible at home. Yesterday I thought that coming into the hospital meant leaving my mother to cope at home all by herself. I couldn’t let her know that I actually wanted to come into the hospital. She would think I was deserting her. I realize now that’s why I put on that little show in your office.”

Even a physical sensation such as hunger gets garbled in transmission. An anorexic says to herself, “Hungry? That’s not hunger, that’s, uh, nervous energy. I need to exercise more-exercise, yeah, that’s the ticket.” For a bulimic, the inner monologue might be: “Lonely? Nah. I’m just hungry, that’s what I am.”

*84/35/5*

Sharon Duke leaves nothing to chance.

The San Jose, California, resident meticulously plans out every detail of every day—from when and what she eats to where and how she exercises, from trips to the grocery store to trips out of town.

That may seem like a lot of work. But Sharon, 51, doesn’t want to leave anything to chance, especially in terms of maintaining a healthy weight.

What spurred this painstaking attention to detail? As her fiftieth birthday approached, Sharon noticed that her weight had crept up to 161 pounds—too much for her 5-foot-3 frame. She had been gaining a couple of pounds every year since her mid-forties. Because she ate healthfully and exercised regularly, she didn’t think that her lifestyle was to blame for the 35 extra pounds. Instead, she suspected that the combination of advancing age and menopause were stalling her metabolism.

Sharon decided that she’d have to be even more vigilant about her healthy lifestyle if she wanted to bring back her slim and shapely figure. “At the time, my health club was offering a 6-week nutrition-awareness class, so I signed up,” Sharon recalls. “I discovered that even though I was making good food choices, I was eating far too much. That’s what got me started on planning ahead.”

If she had a business lunch with colleagues, she found out in advance where they intended to eat and chose her meal beforehand. “I’d call the restaurant and ask if they offered a chef’s salad with grilled chicken, or a fruit salad,” she says. “If they didn’t have what I wanted, I’d eat before we went out, then just order a side salad at the restaurant.”

When her job required her to travel out of town, she called restaurants near where she was staying and inquire about their menus. “If I couldn’t find one with suitable menu items, I’d go to a grocery store and pick up some food to take back to my room,” she says.

Sharon applied her plan-ahead strategy to her exercise pro-•£ I gram, too. Before she traveled, she called the hotel to find out whether it had exercise equipment or if there was a gym nearby. If ^ \ not, during her hotel stay she got up early to take a 2-mile walk or she climbed stairs at the hotel.

Once she started mapping out her daily routine, Sharon lost the extra 35 pounds within 6 months. She has maintained her weight at 126 pounds since 1998.

WINNING ACTION

Prepare a daily plan. If you find yourself struggling to stick with your weight-loss program, Sharon’s strategy may work for you, too. You may even want to keep a daily planner, which you can buy in any office-supply store. Then each night, spend 15 minutes or so mapping out the next day. Include as much detail as you can, especially in terms of mealtimes ajid workout time. Of course, you can’t always anticipate what will happen every moment of every day. But a daily plan gives you a better chance of keeping your weight-loss efforts on track.

*138\89\8*

This is partly explained by differences in their efficiency at absorbing and metabolising the hormones used in HRT. The slower these processes are, the longer the hormones have to cause adverse effects. Individual differences in responses to oral HRT may also be due to medical conditions — gastric problems, chronic diarrhoea, vomiting or pernicious anaemia, for example – or to interactions with other medications like antibiotics and anti-epileptic drugs.

Your body build also affects the dosage required. Menopausal women who are overweight or have considerable muscular development may need less oestrogen than slim women, because they are producing considerable amounts of oestrogen in fat and muscle tissue, in addition to receiving a small but steady supply of oestrogen from their ovaries.

*117\38\8*

Occasionally menopausal women who use oestrogen develop a skin disorder called chloasma when exposed to the sun. The development of patches of darker skin on the face, legs and hands is similar to the skin reaction that sometimes occurs during pregnancy. The cause of the problem is uncertain, but deposits of melanin in the skin are involved. The discoloration usually becomes less noticeable when oestrogen therapy ceases, but it may become more noticeable on exposure to the sun, even after stopping HRT. Wearing a hat and applying a maximum-protection sunscreen should become part of your outdoor routine. Your doctor may have some suggestions about the most appropriate sunscreen in your particular case, and forms of treatment that may remove the discoloration.

Skin irritation or rash can occur when hormone patches are used and, less commonly, women report a more generalised allergic response. As we saw in the case of Margaret in chapter I, this can be severe enough to cause the abandonment of patch therapy. The problem appears to be worse in hot climates, and the reported incidence varies from 5 to 40 per cent in user groups worldwide. Occasionally there is also a severe local allergic response to the patch adhesive.

*83\38\8*