Health and medical information

The most common type of diabetes (type 2 diabetes) is the result of insulin not working properly and usually affects people over the age of 40. Overeating, being overweight and not exercising enough are important factors (what we call lifestyle factors) which can lead to this type of diabetes, especially when there is someone else in the family with diabetes.

Many people who live in societies which are undergoing rapid westernisation are developing this type of diabetes. Why ?

It takes time for our bodies to adapt to such major changes in diet. Because our European ancestors had thousands of years to adapt to a diet with a lot of carbohydrate, they were in a better position to cope with the changes in the G.I. factor of foods. That is why people of European extraction have a lower prevalence of type 2 diabetes compared with people whose diets have recently changed to include lots of high G.I. foods.

However, there is only so much that our bodies can take. As we continue to consume increasing quantities of foods with a high G.I. factor plus excessive amounts of fatty foods, our bodies are coping less well. The result can be seen as a significant increase in the number of people developing diabetes.

But, the most dramatic increases in diabetes have occurred in populations which have been exposed to these changes over a very much shorter period of time. In some Australian Aboriginal communities up to one person in four now has diabetes. In some groups of native American Indians and in some populations within the Pacific region, up to one adult in two has diabetes because of the rapid dietary and lifestyle changes in the twentieth century.

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In many cases, our thought patterns have been programmed by life, coming from inter-personal relationships, childhood experiences or situations of emotional trauma. The extent to which the fat loss leader needs to recognise and deal with these is covered more extensively in separate publications.7 An introductory perspective, however, can be gained from some of the more popular psychological techniques. Rational Emotive Therapy (RET) is an example of one of these. Developed by US psychologist Albert Ellis in the 1950s, this technique has now been adopted by many modem popular psychologists including Chicago University’s Professor Martin Seligman. Seligman is a psychologist who discovered, when working with animals in the 1960s and 1970s, that living organisms can have a tendency to defeatism if continually placed in powerless situations. If a rat is constantly shocked, for example, with no escape available, it eventually gives up and settles down to its fate, which is often death. Similarly, in very deprived circumstances, human beings learn helplessness—they actually regard their situation as hopeless and don’t even try.

Seligman called this experience ‘learned helplessness’ and published a book on the topic in 1974. After a 20-year gap he then published what he considered to be the antidote to this, ‘learned optimism’10 in which he utilises a lot of the techniques used by Albert Ellis in RET. Ellis’ approach was developed to counteract his own shyness as a young psychology student and his inability to communicate because of this. He reasoned that this inability was because of the anticipated anxiety he felt every time he went to make contact with another individual (in Mark Twain’s terms his life was full of ‘potential disasters’). Ellis realised that the problem was within himself, because of the way he thought about the situation; it was his belief that he was an unworthy person, because he must always succeed, other people must always treat him well and the world must be good to him. He realised, however, that these beliefs were irrational, and based on no solid, objective evidence. In a similar way, it is the belief of many fat people, that they are unworthy and that others regard them as unworthy, while in reality, others are generally too concerned about their own problems to even consider them This belief can then become self-fulfilling, exacerbating the problem of overfatness itself.

Ellis based his thesis of RET around a very simple format based on the letters ABCD. Ellis claimed: ‘We consciously and unconsciously choose to think and hence to feel in certain self-helping and self-harming ways’ and ‘Once you understand the basic irrational beliefs you create to upset yourself, you can use this understanding to explore, attack, and surrender your other present and future emotional problems’.

Beliefs, according to Ellis, can be rational or irrational. Irrational beliefs which, according to Ellis are the major problem in maladaptive behaviours, are generally associated with musts, shoulds and have to`s, and are usually ‘hot’, or charged with emotion in comparison with rational beliefs which are more ‘cool’ or ‘warm’. An example of an irrational belief would be ‘I MUST NEVER binge or I am a bad person’, or T HAVE TO always be good or I will feel miserable and horrible’.

It is easy to see how these irrational beliefs can lead one into cognitive habits, or thinking patterns, that are self-defeating, self-limiting and self-punishing. Ellis, therefore, adds D or Disputation to his program in order to help overcome these irrational beliefs. An individual should learn to systematically analyse his or her beliefs, he claims, and logically argue against these. This cannot be done by the therapist, but it may be aided. For example, the question can be asked: ‘Why must you always succeed on your diet or eating plan? It may be nice, but must it always happen? What would be the worst consequence if this did not happen? Could you live with this? What are the consequences of maintaining this irrational approach?’ The thought process is thus ‘renamed’ to provide an opportunity to reduce irrational thoughts.

RET is a relatively simplistic approach to a complex problem. It is used for a range of different psychopathologies including fear of flying, fear of spiders and many other phobias. It has potential use in body fat maintenance, although it would not be expected to be applicable under all circumstances. In many instances, such as those that lead to problems of obesity, there may be a role for a more detailed approach to the problem.

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The energy balance equation has underpinned most efforts to explain the energy dynamics of obesity. Obesity is characterised by high energy stores and usually a high energy intake and expenditure (metabolic rate). To reach a state of obesity, there needs to be a chronic imbalance between energy intake and expenditure over a long period of time. However, an initial positive energy balance will cause energy stores to increase (both fat mass and fat-free mass) which in turn causes an increase in energy expenditure, due mainly to the increased resting metabolic rate from the greater fat-free mass. At some point, the weight gain and increased energy expenditure will offset the original imbalance and a new equilibrium will be achieved.

Therefore, the energy balance equation helps to explain how a positive energy balance leads to weight gain and how a new steady state is achieved. However, it fails to answer two critical questions: why did the positive energy balance occur in the first place and why does it remain chronic over long periods? The answers to these questions may come from an understanding of the regulation of individual macronutrients (carbohydrate, protein, fat, and alcohol). However, separating out each macronutrient balance equation can only be valid if the biochemical highways do not allow a free flow of nutrients. What are the restrictions for converting one nutrient to another for storage and, in particular, are glucose and alcohol converted into fat through the process called de novo lipogenesis?

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Inhalation of a foreign body by a child may produce serious symptoms which may endanger life. Parents should not allow small children access to potentially dangerous foreign objects; this includes peanuts (shelled—one of the worst offenders), small objects such as beads, eyes from dolls and teddy bears, buttons and certain foods which are obviously hazardous. Children should be discouraged from running when eating or at any time they have objects in the mouth. Brothers and sisters should be discouraged from feeding junior when playing. It may all lead to trouble.

Often when the foreign object becomes lodged in the upper airway there is considerable coughing, choking and gagging, and emotional and physical distress. There may be inspiratory stridor, which means a wheezing noise when the child breathes in. If a large airway has been blocked, there may be cyanosis (blueness), indicating the child is not receiving enough oxygen.

Treatment

Keep your head. Do not panic. The risk of the child suffocating to death within minutes is usually not high. But prompt action is necessary. The old idea of tipping the child upside down in the hope of the foreign body dropping out is now not favoured by many doctors. Neither is back-slapping. It appears that this may dislodge the foreign body, but it may become re-lodged in a narrower part of the airways making the condition more acute and hazardous.

If a foreign body is not obviously visible (and chances of it being seen are not high), then get the child to the nearest large hospital as a matter of urgency. Telephone the hospital first to explain your problem so they may be ready to help you on arrival. Talk encouragingly to the child. Usually, after the initial stress the child tends to quieten down and the so-called ‘silent period’ ensues.

At the hospital, doctors are equipped with special facilities to both investigate and treat. It is usually fairly straightforward in retrieving a foreign body from the air passages.

An overlooked foreign body may prove serious, and deaths have occurred when they have been left there indefinitely. Local infections which may smoulder on and involve adjoining organs may occur. It is important that if there is any query about the foreign body still being there, full investigation be carried out by doctors expert in this field.

X-rays are available. The doctors also have instruments for peering into throats and air passageways, and these are equipped with devices that can pick up and remove foreign objects.

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Babies sometimes bring up some of their feeds, and find pleasure and gratification from the action. ‘Rumination’ actually means chewing the cud, a natural action in cows who enjoy regurgitating some of their previously eaten meal to chew on it again. It often starts in babies still on liquids, possibly starting when food is brought up with wind. Bottle-fed babies readily learn to regurgitate at will. One merely makes a funnel of the tongue, tightens the abdominal muscles, and presto! Up it comes. The food will be partially dribbled out. Some will be rolled around in the mouth and later swallowed.

Treatment

Most cases are self-curative and require no active treatment. The baby is not vomiting, as many parents believe, and reassurance can be given that baby is not suffering from some dire gastro-intestinal disorder. Ideally, prop the baby up after feeding. Soon after starting solids and cereals the baby will stop the habit.

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