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Some research has suggested that several of these essential fatty acids are present in lower quantities in the CNS of people with MS than in that of people without the disease; one theory has been that MS arose because buy discount viagra professional 50mg on line impotence drugs for men, in their early years such people were deprived of (or unable to assimilate) these essential fatty acids in the development or maintenance of the structure and function of the CNS generic viagra professional 50 mg with amex erectile dysfunction pills in india. However, the reasons for this lower level of fatty acids remain a matter of speculation. Some scientists have thought that the obvious remedy would be to increase the intake of these fatty acids. However, things did not prove to be as simple as that, for many of the essential fatty acids are produced indirectly by the breakdown in the body of particular constituents from the food that we eat. The use of oil from the evening primrose plant, and some other oils, has become quite common amongst people with MS, for they do provide some of these constituents in a relatively ‘purer’ form (see Chapter 3 on Complementary therapies and MS) but its effectiveness has not been proven scientifically. It is not clear, however, even if the level of the essential fatty acids is returned to ‘normal’, whether this will affect the course of MS, if the CNS damage has already been under way for some time. Research on this point has not proved conclusive, although many 134 MANAGING YOUR MULTIPLE SCLEROSIS people with MS still feel that, on a precautionary basis, they wish to continue taking these essential oils. It would not be wise to assume that, if you eat more of the food containing essential fatty acids, it will have a definite and positive effect on your MS or its symptoms. There are several reasons for this: • The deficiency in essential fatty acids in the brain may be a result of some other process that causes MS; remedying this deficiency may not of itself produce major benefits in relation to the disease. It is this conversion process in the body, which changes simpler forms of fatty acids into more complex ones needed by the brain, that appears to be defective in people with MS. So, even if you have eaten good quantities of the simpler fatty acids, they may not be converted into the vital and more complex ones. In principle, whilst more of the fatty acids should assist nervous system function, the relationship between one and the other, and particularly in reducing any symptoms that you might have, appears to be very complex. Nevertheless, there are a number of studies, not many of them scientifically well designed, which suggest that there may be specific benefits to MS from increasing your intake of those foods that help form complex essential fatty acids, and from decreasing your intake of saturated fats. Although many people believe that this broad strategy can help fight the disease, most scientists and doctors do not. To get technical for a moment, there are two important families of essential fatty acids for brain function. The first of these is called the EATING AND SWALLOWING DIFFICULTIES; DIET AND NUTRITION 135 ‘omega-6 group’, with linoleic acid as its ‘parent’ – the parent meaning the basic fatty acid from which all the others in the family are derived. Foods rich in the omega-6 family are those such as: • sunflower and safflower seed oil • evening primrose oil • offal such as liver; kidney, brains, sweetbread • lean meat • legumes (peas and beans). Food rich in the omega-3 family are: • green vegetables • fish and seafood • fish liver oils • linseeds • certain legumes. The difficulty is that most of these foods contain only small quantities of the relevant fatty acids, and then only in their simplest form. However, one or two foods have been found to have not only larger quantities of essential fatty acids, but to have them in a form that is closer to that needed by the brain. For example, the oil of the evening primrose plant has become a very popular dietary supplement for people with MS, because it is unique and contains large quantities of a substance called gamma-linoleic acid, a more complex form of linoleic acid, which is converted into further important fatty acids by the body. In principle, the effects of taking these fatty acids could be profound on some key characteristics of the underlying pathology of MS, but in formal clinical trials the results have not been as good as hoped for, although there is some evidence from one or two good trials that attacks of MS may be fewer over time in those taking additional fatty acids. However, these results do not approach the more dramatic findings from studies on the latest immune-based drugs. Many people with MS continue to take evening primrose oil even if, for example, they do not follow religiously all the other dietary recommendations, either as a kind of ‘insurance policy’, in that they are doing something that they hope will help the MS, or – and there are reasonable grounds for this – knowing that is not actually harmful, and may be helpful to your general health. It is likely to be a more costly alternative than modifying your diet to include some of the other foods 136 MANAGING YOUR MULTIPLE SCLEROSIS containing essential fatty acids, but may be easier to manage. We must state again that the effectiveness of evening primrose oil has not been proven scientifically. Saturated fats People argue about whether changes in your saturated fat intake will make any difference to your MS. If, in general, essential fatty acids are ‘good’, then you could increase your intake of these as we have noted, and/or reduce your intake of the ‘bad’ saturated fats. Of course, there are general health grounds for suggesting that you should lower your intake of saturated fats, but some people who have devised low saturated fat diets for their MS claim that such diets may be far more beneficial for their MS. Again, there is little formal evidence that reducing your intake of saturated fats will specifically stabilize or improve your MS. Exclusion diets Cutting out saturated fats is an exclusion diet, but there are other diets that cut out many more specific substances. MS symptoms are considered by some people to be an allergic reaction to certain foods or drinks, and this view has led to other exclusion diets.

One school of thought is based on a concept known as independence of fatal and nonfatal diseases and the the compression of morbidity hypothesis cheap viagra professional 100 mg on line erectile dysfunction jason. According to premise that there are no active genetic programs for this hypothesis buy discount viagra professional 100mg royal jelly impotence, lifestyle changes and advances in medi- death (i. The rationale supporting the diseases and simultaneously lead to a postponement in latter premise is that it is not possible for the forces of the onset and age progression of the nonfatal disabling natural selection to have favored the evolution of death diseases. That is, selection cannot lifestyles simultaneously postpone the onset and expres- effectively remove genes carried by those who have sion of fatal diseases and nonfatal but highly disabling already made their genetic contribution to the next diseases and disorders, more people will be pushed generation. The evolutionary explanation for why senes- toward their biologic limit to life, and morbidity and dis- cence arose is that it is a by-product of an evolved repro- ability will be compressed into a shorter duration of time ductive pattern and unprecedented survival into an older before death. It is possible that healthy life eases and disorders of senescence have the opportunity expectancy (the proportion of total life expectancy free to be expressed. Implicit in this theory is the etiologic from disability) could improve at a faster pace in the 4. The Demography of Aging 41 short term, only to give way to a more rapid increase in how much further death rates can decline and how high disabled life expectancy at a later date when survival into life expectancy can increase. Early scientific studies addressed to a bio- damentally altered the age distribution of death, shifted logically based limit to life were often presented within the primary causes of death to chronic lethal conditions the context of a fundamental "law of mortality" that associated with senescence, and increased genetic het- would explain why different species have different life erogeneity at older ages. In addition to its impact on pat- spans, and why the risk of death increases in a predictable terns of health and mortality, population aging has also fashion with the passage of time. The social, eco- within living organisms that resulted in the breakdown of nomic, and health consequences associated with popu- cells and tissues, reactions that in the world of chemistry lation aging are rapidly emerging as fertile areas of operated in a time-dependent fashion consistent with the scientific inquiry. Although these early visions of a law of mortality have remarkable similarities to theories about the mechanisms Individual Aging of senescence that prevail today, scientists early in the twentieth century were unable to measure the chemical The transformation of birth rates and death rates to their reactions that they believed led to increasing mortality currently stable low levels not only brought forth rapid with age. Subsequent studies addressed to the question population growth and aging, it also led to unprecedented of a law of mortality were focused on interspecies com- increases in life expectancy. It is estimated that during the parisons of mortality,38 and these later gave way to more Roman Empire life expectancy at birth was about 28 mathematically oriented models designed to characterize years. This limited replicative capacity of ity revolution of the past two centuries are a result of fibroblasts has been interpreted as a form of programmed dramatic reductions in death rates at younger ages. In death, as if a death gene evolved that is triggered after a fact, in today’s high life expectancy populations of North certain amount of elapsed time. In subsequent articles, America, Western Europe, Australia, Scandinavia, and Hayflick40,41 made it clear that his findings should not have Japan, death rates at younger ages have declined to such been interpreted as a biologic clock designed by evolution low levels that 98 of every 100 babies born will survive for the purpose of causing death. Deaths that occur among those tion, the concept of a biologic limit to life based on these younger than age 30 result mostly from accidents, homi- studies remains part of the scientific literature. This latest 100 years by the middle to latter part of the twenty-first trend in old-age mortality is so unique that it has been century43,48 and that cohort life expectancy at birth for referred to as the fourth stage of the epidemiologic females born since the early 1980s is already at 100. Census the transition from high unstable mortality to low stable Bureau,44 Social Security Administration (SSA),11 and mortality as depicted in Figure 4. Olshansky The underlying premise behind demographic extrapo- associated with both of these demographic phenomenon lation models is that patterns of mortality decline from are profound. Although it is recognized that magnitude require the near elimination of all senescent the majority of the rise in life expectancy at birth in the mortality throughout the age structure, it is difficult to twentieth century is attributable to reductions in death justify assumptions that lead to such high life expec- rates at younger ages, reliable evidence has emerged to tancies. Furthermore, as death rates Extrapolating past trends in mortality into the future from other major killer diseases decline, the population is the conventional approach, and this appears quite reli- saved from dying of these diseases remains exposed to able if the forecasts do not extend out too far into the the risk of developing cancer, a phenomenon known as future. Yet, during time periods when mortality rates competing risks (for more details on this concept, see either remain stable or decline rapidly, even short-term Chapter 5). From the reverse engineering perspective, forecasts based on the extrapolation method will lead life expectancy at birth could rise beyond about 85 years to substantial underestimates56 or overestimates55 of only if advances are made in the biomedical sciences that longevity. This difference has important policy implica- somehow influence the basic rate of senescence itself. Recently, Conclusion scientists have questioned the use of statistical methods for speculating on trends in vital statistics that are In the past 200 years, the demographic components of ultimately determined by biologic phenomenon. This transformation has is that a linear extrapolation of past trends in mortality led to two unprecedented changes in the demography into the future would eventually lead to low death rates of humans—population aging and increased longevity.

For psychiatrists and psychotherapists who take a spiritual orien- tation purchase viagra professional 50 mg line erectile dysfunction treatment milwaukee, the human being has three traditional dimensions: the body purchase 50mg viagra professional free shipping smoking and erectile dysfunction statistics, the soul and the spirit. Mental pathology is thus seen as having connota- tions of a spiritualistic dimension, so that it becomes possible to rein- troduce concepts such as the soul, incarnation, karma, fear of the earthly — all concepts that belong to the religious domain and far from the fundamental diagnostic and therapeutic needs. Ultimately, this approach is dangerous at a most profound level: it can take the place of analyzing the causes of phenomena like depres- sion. Indeed, a state of depression that is a reaction to unemployment can easily be analyzed in terms of karmic life rather than in terms of economic crisis. Spiritual psychiatrists, by recommending meditation and prayer, in fact act as guardians of the established social order. Spiritual psychiatry is thus reactionary, whereas real psychiatry aims to give the patient a capacity of individualization that, possibly, will enable him to question his status and the role that has been as- signed to him in a system upon which he is dependent and which con- strains him. MEDICINE AND CULTS Cults flourish in the field of health and disease, which gives them a context in which to expound their doctrines, as well as to conduct their research and to present evidence in support of the claims they make. The function of a cult is to lead the follower toward a model of personal fulfillment that fits in with the general theme of the group. Cults use disease as a proof of some form of deviance, of error, or even as the price of errors made in a former life. Through their doctrines and the resulting practices, the group tries to return the follower to the state of equilibrium that he is supposed to have lost. The teachings are thus reinforced by the individual’s healing; the healing becomes proof of the doctrines’ validity. Medical concerns are the main focus of some groups’ doctrines (instinct-therapy, Zen macrobiotics). Others derive some medical techniques from their general theories and teach them to all the follow- ers or to a particular group (such as drug addicts). And others (Scientology, Grail) develop elaborate doctrines that arise from the leader’s "medical" vision. Some groups are satisfied with spelling out an all-encompassing theory on the nature of man and his place in the 159 Healing or Stealing? Ageac, a Case in Point 1 Ageac promotes medical doctrines that amount to an extremely precise theoretical corpus, a veritable therapeutic guide and a codex that reflect the thought of Samaël Aun W eor, the group’s guru. These writings reveal the dangers that such groups pose for the health of the members. The theories described below are excerpted from W eor’s writings, and specifically from the Treatise on Occult Medicine and Practical Magic, Endocrinology and Criminology and Practice with the Elementals of the Physical Body, works that are distributed by Ageac. In reality, he is the terrestrial expression of a cosmic energy that traverses various levels and gradually manifests through them in two forms: the etheric body and the astral body (a reference to theosophy). The sexual center decides how man evolves and, by controlling it, man can decide his fate: self-realization or downfall (a reference to 2 tantric yoga ). Each center of the machine must function with its own energy, but unfortunately, the other centers of the machine steal the sexual en- ergy. W hen the intellectual, emotional, motor and instinctive centers function incorrectly, they steal the sexual energy, and then we have sexual abuse. Sexual abuse ends when we establish inside ourselves a permanent center of gravity. Naturally, the sexual center is the physical point where sexual 160 Medicine and Cults hydrogen H Sil12 is produced, in a marvelous synthesis of the food we eat, the air we breathe and the input of all our impressions. From the transcendental and gnostic point of view, the following activities can be detected in the sexual center: x reproduction of mankind; x transformation of the "genetic libido", or "sexual libido", i. The sexual center can incontrovertibly be used as an instrument of the Being’s manifestation, as long as we are liberated from the vari- ous "psychic aggregates" or "ego-defects". This center functions poorly as a result of the "undesirable ele- ments" of lust, secret or open adultery, homosexuality, lesbianism, and in general any type of sexual psychopathy. Similarly, when the infra-instinctive "egos" block its delicate mechanisms, they cause all kinds of perversions that cause it to degen- 3 erate. W hile the concepts of tantric yoga can be justified by references to traditional teaching, the appearance of "sexual hydrogen" comes as a surprise, not to mention the condemnation of homosexuality, for example. Krumm-Heller, invented a system of healing that many people have qualified as im- moral.

Do not be afraid to 13 HOW TO PRESENT AT MEETINGS make the introduction simple cheap viagra professional 100 mg with visa impotence from diabetes, especially if there are lay people present; you do not want to lose the audience at this very early stage generic 50 mg viagra professional visa impotence after prostate surgery. This applies especially to international meetings even if the same language is spoken in the respective countries. Main message The preparation of your talk will have largely taken place in the library, where you are surrounded by reference material, or in your office or at home where you will be surrounded by reprints. Your personal computer will have undoubtedly played some part in your preparation, but you may not have many journals on line. It is imperative that you read all the papers to which you refer and not just the summaries. When you have collated all your data, you should write the lecture (some will prefer a word processor) in the order in which you are going to give the talk. When it comes to delivering the main message, then do so in a logical sequence, using plain English, and giving your supporting evidence. Take the trouble to explain your visual aids, which the audience are seeing for the first time. Conclusions At the end of your talk the audience will expect relevant conclusions and it is also sensible to make some suggestions as to where the future lies, if applicable. Remember that if your title asked a question, then the audience have a right to expect an answer. When you have written the talk you should now make the appropriate visual aids, having already established with the organisers what equipment is available. The rationale behind a rehearsal is: • to time the lecture, especially the shorter ones • to assess the technique of delivery, where annoying mannerisms can be spotted and removed • to anticipate questions • to give confidence to the speaker. This should be done a minimum of two weeks in advance so that there is still time to correct slides and iron out flaws in your delivery technique. For the longer talks you should sit with your manuscript and visual aids and go through the talk and slides and time how long it takes. You should do this several times before your talk and you should do it every time you are going to lecture, even if it is the same talk. When rehearsing in this way, always go through the slides as you would at the actual presentation. Presentation You are going to be nervous when you stand up in front of an audience to talk, particularly the first time. Although the more experienced lecturers may not give this impression, you can guarantee that there will be a degree of apprehension. Under no circumstances should you resort to pharmacological help to allay this apprehension. It gives the impression that you don’t know your subject and also keeps your head down and encourages you to mumble. Your head must be up, talking to the back row and, in order to do this, you must know and have learned what to say. Turn to them to refresh yourself as to the next point, then turn back to talk to the audience. The only reason why people want to read the manuscript is because they are frightened they might forget to say something. This is totally irrelevant because nobody in the audience would know you were going to say it anyway. If you do suddenly remember that you were going to say something five minutes ago, ignore it; do not go back to it. This does not mean that you shouldn’t have the full script available, and even refer to it very briefly from time to time, but the professional doesn’t need one. Visual aids The most important thing to remember about visual aids is that they are aids. Very clever things can be done with them these days, 15 HOW TO PRESENT AT MEETINGS but they must not be allowed to take over.

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