Elimination diets often act as weight-reducing diets, and on average, Dr Darlington’s patients lost about 4.5 kg (10 lbs) during the trial. Being overweight has a bad effect on diseased joints, especially those in the knees and ankles. So one might argue that the loss of weight could have contributed significantly to the improvement seen. To check this, Dr Darlington compared weight losses in those that had responded well and in those that had responded poorly. There was no difference, so this seemed unlikely to have been an important factor.

In spite of these striking results, Gail Darlington is in no way a propagandist for the food-intolerance idea: ‘I’m a very routine, orthodox physician and rheumatologist. If I spend the next ten years of my life helping to prove that the whole thing is a nonsense, or a placebo effect, or a non-specific manipulation of the immune system, I won’t be at all concerned -1 simply feel it’s an area that needs to be investigated in just as scientific a way as we look at Drug A versus Drug B. Before 1981, most people in the UK thought that food intolerance was rubbish in a rheumatologic context, as indeed I did at that time -one is fairly definitely trained to believe it’s rubbish. But I was impressed by the results I saw in my patients who had gone to other people to have their diets manipulated. After seven years working in this field, I’ve gradually come to believe that it is relevant to some patients. To take one example, I have a patient of 33 who has changed from being a limping acute arthritic to being a perfectly fit, normal young man – and that is an improvement he has maintained for two and a half years.’

Rheumatologists tend to attribute such results to natural remissions, because rheumatoid arthritis is a disease that comes and goes for no apparent reason. It is also notoriously susceptible to placebo effects. Gail Darlington understands these doubts, but feels they are misplaced: ‘Yes, obviously, it could be purely coincidental, but I do have quite a few patients in this bracket now, and it does seem unlikely that they all just happened to go into natural remission at the moment they began their diet. As for placebo effect, our trial was carefully designed to measure this in the control group. We showed that there was a placebo effect, but that it certainly couldn’t account for all the improvement seen in the patients on the diet. What is more, when the control group were later put on elimination diets, they responded just as well as the first group -far better than they had done on the placebo.’

*108\180\8*

This procedure costs less and is less invasive than open-heart surgery. Often, the patient can go home the same day.

The surgeon inserts a catheter into a tiny incision in the leg and threads it into the coronary artery. A balloon on the tip is then inflated to flatten the plaque against the artery wall, widening the artery and easing the flow of blood.

drawback: About 25% of the time, angioplasty has to be repeated to eliminate plaques that recur—sometimes within six months of the original operation.

To prevent recurrence, some cardiologists now use stents— tiny metallic tubes inserted into the artery to keep it open.

This experimental procedure is a less invasive variant of conventional bypass surgery. Instead of cracking the chest, the surgeon makes a small incision between the ribs. Using an endoscope, he/she removes the internal thoracic artery from the chest and grafts it onto the coronary artery.

For accessible blockages, keyhole surgery should prove just as effective as CABG. But it’s still too early to know its exact success rate.

*87/47/1*

I try to combine discounts from different sources. I’m able to get many products for free or close to it because I create “triple plays,” combining savings from store sales, newspaper coupons and Web sites.

example i: A 12-pack of Pepsi was advertised at my local supermarket for $2. A rebate sticker on the cans offered $10 back if I mailed in proofs of purchase for three 12-packs and three bags of Lay’s potato chips. I purchased the three bags on sale for $5, less 75 cents off because I used three 25-cent coupons that I found on the Frito-Lay Web site.

final cost for the soda and chips: 25 cents—$10.25 minus the $10 rebate.

I love “double coupons.” If I had made my purchases using double coupons at the supermarket, the soda and chips would have cost me nothing.

*78/47/1*

In my 40 years of practicing medicine, I’ve seen every kind of diet aid you can imagine. But when it comes to producing lasting weight loss, I’ve never seen anything like chitosan (KITE-o-san).

This natural food supplement—made from the shells of lobsters—forms a gel in the stomach. This gel bonds with any fats that are present, forming fatty “clumps” that are indigestible. These clumps pass out of the body in the feces. Animal studies have shown that chitosan taken before a meal blocks absorption of up to 50% of consumed fat.

One double-blind study in Italy found that people who ate a low-fat diet and used chitosan lost an average of 16 pounds…

compared with seven pounds for those who followed a low-fat diet without chitosan.

*69/47/1*

self-defense: Stop smoking. Cut down on caffeinated foods and beverages. Switch shoes at least once a day, wearing shoes of different heel heights. Shift your weight back and forth while standing. Each night, take a bath in lukewarm water.

Once a day, do these three circulation-boosting exercises…

exercise #1: Cross your legs at your ankles, then try to pull them apart as you simultaneously resist. Hold for one minute. Switch sides, and hold again.

exercise #2: Place the balls of your feet on a telephone book, with your heels resting on the floor. Push up and down. This exercise may be done sitting or standing for one minute.

exercise #3: Lie on the floor with your feet pressed flat against the wall. For about one minute, “climb the walls” using your feet.

*59/47/1*

Some alternative practitioners recommend a related substance called choline (or lecithin, which contains 10% to 20% choline). Neither choline nor lecithin looks anywhere near as good as phosphatidylserine, and they can cause unpleasant side effects.

• L-acetyl carnitine. This form of the amino acid carnitine plays a key role in energy production in the body. It seems to help both Alzheimer’s patients and those with mild mental deterioration. The usual dose is 500 mg to 1,000 mg three times a day.

• Ginkgo biloba. Like vitamin E, ginkgo helps thin the blood, boosting circulation inside even the tiniest capillaries—including those that feed the brain. Ginkgo also acts as an antioxidant, protecting the brain against attack by free radicals.

Ginkgo has been found to be effective in slowing the progression of Alzheimer’s disease.

*50/47/1*

The importance of recognizing the distress behind Mrs B. ‘s difficult exterior cannot be emphasized too much. If the damage that she believed that the birth had done to her body had not been explored and dealt with at that stage, she could well have continued with pain and possibly sexual difficulties for months or even years. As it was, the time taken to help her explore her own vagina and her feelings about it was time well spent. Such a patient might find it extremely difficult to pluck up the courage to come specifically to ask for help with a sexual problem, and the emotional pain would be more likely to become fixed on her perineum as time went by, even possibly leading to requests for surgical treatment. Thoughtful handling of the contraceptive consultation and a brief body/mind approach to the genital area can prevent much future distress.

*177/197/1*

Not all complaints about condoms should be taken at face value.

Mr D. complained that using a condom often left him soft with no erection and his wife was disappointed. He was married with two children and the doctor felt surprised by the complaint. Later he told how he had recently led a discussion about contraception at his church youth club. It was OK to talk at church, but at home it was difficult. ‘Women don’t understand how men find it difficult to talk.’ He added, ‘Whenever she talks to me about condoms, it turns me off, and I wouldn’t want her to try and put one on me.’ This sounded like a polite complaint and the doctor listened quietly. Mr. D. went on, ‘If I join in the conversation when she goes on about coming off the Pill, she seems to get excited and silly and I don’t like that.’ It was becoming clear that his real worry was that his wife might want another baby. The doctor realized that these two people were not communicating. He observed the house – a few essential jobs done, but in need of partial rebuilding. He knew that Mr. D. was a carpenter who did his own small building jobs on the side. Why was his own home so neglected? The doctor reflected, ‘Sarah has to wait a long time to get what she wants from you.’ Mr. D. laughed uncomfortably and other subjects were talked about. That was a while ago. Sarah is now off the Pill, much happier and they are using condoms. He is on the waiting list for a vasectomy, and as he says, ‘It’s time I did my bit.’

Here was a man who was complaining that condoms made him soft, but discussion with his doctor allowed him to talk more freely with his wife and to identify his real worries that his wife might want more children. However, when they could communicate openly he discovered his fears were groundless and they could use condoms happily again.

*140/197/1*

One learns that all is not what it may initially seem. The patient who is in a great hurry to get everything over and done with, or who asks a lot of technical questions may be afraid of allowing herself to feel. The angry patient may not necessarily be angry at the clinic staff but at herself, her partner or her family, or she may be reacting to an enormous burden of guilt. The bossy patient may feel very vulnerable. The tearful patient may lead one to believe that she is crying over her baby and does not want an abortion. This may be the case, or she may be crying to disarm the doctor, or cover the loss of her own self-esteem. ‘I never thought I would end up having an abortion’ is a common comment.

*103/197/1*

An unhurried, gentle approach is valued by this age group during what is often their first genital examination. The doctor should give some thought to minimizing discomfort. Choosing a warm, small speculum for the first smear is one obvious kindness. The question ‘Will it hurt?’ should alert the doctor to the possiblity that the patient may have some degree of ‘dis-ease’ with that part of the body, which may present as vaginismus. Allowing time to explore what may be behind a question like that, rather than attempting to reassure or give opinions, may allow the patient to reveal anxieties. More significant in terms of psychosexual problems is repeated procrastination or cancellation of smear appointments. All too often this type of behaviour is seen as irresponsible, when instead it should alert the doctor to the possibility that the patient may have a psychosexual problem. The young patient knows that exposure of this part of the body will expose her sexual difficulty and is fearful (consciously or unconsciously) of doing so.

*67/197/1*