San Joaquin CFIDS

San Joaquin CFIDS/ME/FMS
Support Network
P.O. Box 724
Woodbridge, CA 95258

January, February, March 2001

The material provided by the SJ/CFIDS/ME/FMS Support Network is for informational purposes only and should not be construed as medical advice or instructions. SJ/CFIDS/FMS Support Network does not provide medical advice, is not engaged in providing medical or professional services and does not endorse any treatment, medication or any medical or professional service. Consult your health professional for advice relating to medical problems or conditions. You are encouraged to learn about your own health. Information in Snail Mail is gathered from sources considered to be reliable but the accuracy of all information cannot be guaranteed.

THIS ‘N’ THAT Visit our web pages: http://www-cs-students.stanford.edu/~msimon/sanjoaquin.html

http://www.med-help.com/Link5521.html

SJ CFIDS/ME/FMS e-mail addresses

Vivien Haynes: n3iviv@softcom.net

Sherry Reese: sherwithme@juno.com

Gloria Young: GloryB43@webtv.net

Judi Plante: Teacupz@aol.com

Pat Ferdan: Pferdan@aol.com

Laurel Crokstrom: dulcimer@inreach.com

Karen Mellish: deltadwn@cctrap.com

Roz: gene@caltel.com

Linda: noescargot@elite.net

Carol: antclairol@aol.com

SJ CFIDS/ME/FMS SUPPORT NETWORK CONTACTS

Emily: 209/ 474-9520-after 1 pm
Carla: 209/ 957-7117- 10 am-9 pm
Sherry: 209/ 239-1639 Anytime, 24 hours a day
(if the line is busy: sherwithme@juno.com)
Elissa: 209/ 728-8863
Linda 209/ 357-8535
Roz: 209/763-5206 (please avoid dinner hour)
Karen: 925/ 684-3030-8am-11pm
Concord (Crisis): 925/ 284-2272

7am-10pm weekdays 8:30am-10pm weekends Check in your phone book to see which calls are local for you. Some calls within your area code might have toll charges.

SJ CFIDS/FMS SUPPORT NETWORK MEETING SCHEDULE

1• Stockton: 2nd Wed. each month, St. Joseph’s Hosp., Lower Level, *Class Room 3:00 p.m.

2• Lodi: 3rd Wed. each month, 1:00 p.m., Richmaid Restaurant, 100 S. Cherokee Lane, Lodi Call 209/334-6680 for more info.

3• Stockton: 4th Wednesday Suspended for the winter.

*Always check the schedule posted outside each classroom to verify meeting room.

OTHER MEETINGS OF INTEREST

1• Merced, Calif., CFIDS/ME/FMS/MPS, Mercy Hosp. Lower Level, Staff Room, 1st Tues. each month 7 pm .

2• Capitol CFIDS: Medical Clinic, 3rd floor conf. room, 3160 Folsom, Sacto., 2nd Sat. of each month, noon.

3• Greater Sacramento FM, Cancer Center, UC Davis Med.Center, 4501 X St., Sacramento, 3th Fri. of each month, 6:00 p.m.

4• CFIDS Support of Northern Nevada, Health S. Rehab. Hosp. of Reno, 555 Gould, Reno, Reno, NV, 2rd Sat. of each month 1:30 p.m.

5• FMS Sharing, Kaiser Med. Center South, 600 Bruceville Rd. 1st Sat. each month 1 p.m. MOB II Conf. Rm A. Info: Janne 916/688-1697

IMPORTANT

Due to the chemical sensitivity of some

Person’s With CFIDS (PWC), we ask that

NO SCENTED PRODUCTS BE WORN TO ANY

CFIDS/FMS MEETINGS. THANK YOU

SJ CFIDS/ME/FMS Support Network is a self-funded, self-help group. Members are expected to a pay share of cost when possible, estimated to be $12 per year. Many pay more. If your address label has a red check box, this could be your last issue. The date on the line under your name should be the last time you paid $ to SJ CFIDS/ME/FMS. If any information on your label is incorrect, send the corrected information to SJ CFIDS/ME/FMS. It is not necessary to make photo copies of checks or any other document with highlighted notations to make corrections, a note will do. Any corrections to your label, checks or information to be included in Snail Mail should be sent to: P.O. Box 724, Woodbridge, CA. 95258 If you are new to Snail Mail you will receive one or two sample issues unless we see you at a meeting or receive your share of cost.

Tip: In most cases articles in Snail Mail are in a format designed for ease of copying. Continuations are not sprinkled through the issue. Feel free to make copies of any article that might be

important in your life.

MAKE CHECKS PAYABLE TO: SJ CFIDS/ME/FMS
Internet Message Boards:
http://www.InsideTheWeb.com/mbs.cgi/mb685436
http://www.InsideTheWeb.com/mbs.cgi/mb882424

Information in Snail Mail is gathered from sources considered to be reliable but the accuracy of all information cannot be guaranteed.

Page 3
Snail Mail
Newsletter of the San Joaquin CFIDS/ME/FMS Support Group
January, February, March 2001
NEWS AND RUMINATIONS on
CFIDS/ME/FMS/IVN, which are considered one and the same in this Newsletter.

Off we go.......’nudder Snail Mail for the stack.
Please make a note on your
calendar [see items marked with (J)] for any dates mentioned herein that you might have an interest.

The survey from last month’s Snail Mail is a long way from being considered a success at this point. It is not too late to return the survey. Selected comments from the survey are on page 8. The survey did contain an error in asking if the meeting on the third Wednesday of each month at St. Joseph’s Medical center in Stockton is enough. The actual date for the afternoon meetings at St. Joseph’s Medical Center is, of course, the second Wednesday of each month at 3 p.m.

Several respondents mentioned that morning meetings would be easier. The Lodi meeting on the 3rd Wednesday of each month is earlier in the day and in a location that makes it easy for most people in Stockton and Lodi to attend. A few PWC/FMS would like meetings in other towns. In the past we have scheduled additional meetings in other locations like Tracy, Manteca and the evening meeting at St. Joseph’s. The low attendance does not warrant reserving a meeting room on a regular basis. Everyone is encouraged to be in contact with other PWC/FMS in their own town. Small meetings can be held in homes, coffee shops, even at McDonalds even on the telephone. It is important not to be isolated.

Speaking of meetings, there is an interest in resuming the meetings for the Sierra Foothills area on the first Wednesday of the month in Valley Springs. If you have an interest in a meeting in Valley Springs, call Alice at 786-2470.

This little ragtag support group has been puttering along since December 1986. During that time considerable research and information has become available. Of course not all that research and information has been considerate. But by fits and jerks we are moving forward. There is currently new interest in a name change that more correctly described CFIDS without that “F” word. Some doctors are softening on their attitude that not all cases can be resolved with a pill, a surgery, a cast or signature on a death certificate. We just keep turning up with our shopping list of symptoms that wax and wane baffling the patient and the doctor. It’s a tough awakening for a doctor to realize “my talents cannot fix this patient”. The good doctors continue trying; the other kind might send the PWC/FMS away or worse, over medicate with medications that anesthetize the patient into shutting up about their symptoms. It is often tough to keep smiling when told it’s all in one’s head. Often we can agree. It is all in the head, an aching head.

Happy 14th Anniversary SJ CFIDS/ME/FMS

Support Network

Make a note of the date and plan to join us for our Annual Holiday Pot Luck (J) Wednesday, December 27, 2000. See below for location. Cheesy potato soup, tableware and drinks provided. Bring your favorite easy to prepare pot luck dish and have a great, social time. See you at a meeting soon..............Vivien

(J) CURRENT MEETING SCHEDULE (J)

2nd Wednesday each month: 3 p.m. St. Joseph’s Hospital, Lower Level, check schedule outside any class room

3rd Wednesday each month: 12:30 p.m., Lunch meeting, Richmaid Restaurant, 100 S. Cherokee Lane, Lodi.

You don't stop laughing because you grow old, you grow old because you stopped laughing.

Thanks to Allie: egallie@webtv.net

Magnesium Deficiency and it’s role in CFS

by Sarah Myhill, M.D.ImmuneSupport.com

11-14-2000 - Editor’s Note: Sarah Myhill, M.D., is a British doctor working both for the National Health Service and with a private practice. About 10% of her NHS patients suffer from CFS and approximately 70% in her private practice have it. Dr. Myhill is a medical advisor to Action for ME, a national support organization in the UK for ME/CFS sufferers. She is also the Honorary Secretary of the British Society for Allergy Environmental and Nutritional Medicine.

Dr. Myhill has written extensively about CFS over the years, covering all aspects of the disease from diagnosis to causal theories to treatments. This excerpt is adapted from her book “Diagnosing and Treating Chronic Fatigue Syndrome”, and is used with permission of the author.

Treating Magnesium Deficiency

Magnesium deficiency is the most difficult deficiency to correct. In evolutionary terms, magnesium was abundant in the diet and therefore no good mechanisms to conserve magnesium evolved. It appears to be poorly absorbed and easily excreted even by so- called normal people (and I don’t think there are many of those left!).

Magnesium is necessary for the normal function of over 300 enzyme systems, for muscle relaxation, immune function, cardiac function, clotting, nerve conduction etc. Indeed I cannot think of a bodily department in which magnesium is not essential. It prevents heart disease, cancer, blood pressure, kidney stones and improves energy, sleep etc.

I can guarantee to get magnesium levels up by using injections. One injection of 2mls of 50% magnesium sulfate (1gm MgSO4, or 100mgs elemental Mg or 4 millimols) will usually keep levels up for two weeks (however, some people need them more often). By the third week, levels will usually have fallen again. For some people this is the only method that has worked, but it is tedious to have to keep injecting. It astonishes me that so small a dose of magnesium works as 100mgs is only one third of the RDA (recommended daily allowance).

There are other interventions to improve magnesium levels and some work for some people. It is impossible to predict which will work for everyone but all are worth trying.

What is Sufficient Magnesium?

Are you taking enough magnesium in the diet? The recommended daily allowance is 300mgs for men, 350mgs for women. Magnesium is extremely safe by mouth – too much simply causes diarrhea. I have yet to see a red cell magnesium which is too high. However, it is theoretically possible in people with kidney failure.

The richest source of magnesium in the diet is from chocolate (yippee, but care with the sugar!), nuts, green vegetables, whole grains and seeds. Use a magnesium rich salt such as Solo. Use a bottled water rich in magnesium. Hard water also contains more magnesium than soft water. Most processed foods are low in magnesium.

Can magnesium be supplemented? Yes, of course. Too much magnesium can cause diarrhea in which case your magnesium levels will fall. I am cautious about using minerals in isolation, because too much of one can induce deficiencies in others. So I start off with a mineral complex daily (each capsule of the brand I use contains 90mgs of magnesium). If this does not do the trick, add in other magnesium salts such as Epsom salts (1/4 to ½ teaspoon daily – too much gives diarrhea), magnesium citrate, chelated magnesium, magnesium EAP.etc.

Try Epsom salts in the bath because minerals can be absorbed through the skin. I do not know exactly how much to use, but I suggest a handful or two.

Is Magnesium’s Absorption Blocked?

Calcium and magnesium compete for absorption and so too much calcium in the diet will block magnesium absorption. Our physiological requirements for calcium to magnesium is about 2:1. In dairy products the ratio is 10:1. So, consuming a lot of dairy products will induce a magnesium deficiency.

Tea contains tannin which binds up and chelates all minerals including magnesium. If tea is to be drunk, don’t have it with food. Incidentally, tea drinking is the commonest cause of iron deficiency anaemia in UK for this same reason.

Vitamin D is necessary for the body to utilize magnesium. The major sources of vitamin D are dairy products, sunshine on the skin, and seafoods (at least 3 servings a week).

Are You a Magnesium Loser?

All diuretics will make you lose magnesium through urination. By this I do not just mean drugs, but also tea, coffee and alcohol. Even some herbal teas are mildly diuretic.

Hyperventilation makes you lose magnesium in the urine. This is because hyperventilation induces a respiratory alkalosis, the body excretes out bicarbonate to compensate, but each bicarbonate is negatively charged and carries a positively charged cation (charged ion) with it – in this case magnesium.

Heavy exercise also makes you lose magnesium in the urine. This should not be a problem for CFS patients but does explain why long distance runners may suddenly drop dead with heart arrhythmias.

Magnesium is lost at times of stress. This also includes food allergy reactions and detoxification.

Can You Hang on to Magnesium?

For magnesium to get into cells it requires thiamin (vitamin B1). Try thiamin 100mgs daily – if you are already taking some in a multivitamin preparation, then take the B1 at 100mg a day.

For magnesium to be retained inside cells you need good antioxidant status. Selenium is the main mineral antioxidant. Food tables are unreliable because food content is dependent on soil levels of selenium. Assuming good soil levels, (which is a big assumption), foods rich in selenium include whole grains, organ meats, butter, garlic and onion. Seafoods are rich in selenium and obviously not dependent on soil levels.

Boron is necessary for normal calcium and magnesium metabolism. I also find boron very useful for arthritis, perhaps because of its effect on calcium and magnesium. For arthritis you need 9mgs a day for 3 months, then reduce to a maintenance dose of 3-6mgs daily.

At present the only way I know how to ascertain whether or not magnesium levels are replete is to measure a red cell magnesium.

Magnesium by Injection

Parenteral magnesium is often used as part of the treatment of myalgic encephalitis (ME). It can have many effects but the main ones are to improve energy, muscle aches, cold hands and feet and help hyperventilation. It seems to have a different effect from oral magnesium and, even in the presence of a normal red cell magnesium, can bring benefits. However, it is usually given to those patients who are deficient. A red cell magnesium (test) is a reasonable test of levels. A serum magnesium (test) is an unhelpful test since the heart stops if these levels fall. Therefore serum magnesium is maintained at the expense of body stores. Unfortunately most hospital laboratories only measure serum levels - usually in intensive care medicine.

Magnesium sulfate is available on prescription, (in the UK). The usual regime is 1gm/2mls given intramuscularly, weekly for 10 weeks. About 70% of patients will see useful improvement. After this time about 50% of those who have improved will need a top-up dose every 1-4 weeks depending on clinical response. 1gm of 50% contains 100mgs of elemental magnesium. Some of my patients have received over 50 injections. Since the RDA (recommended daily allowance) for magnesium is 300mgs, it is almost impossible to overdose. A possible risk may be to a patient in advanced renal failure, who cannot excrete magnesium and may already have high levels.

The injection is painful because one is injecting a concentrated solution. It is best given at room temperature or blood heat, intramuscularly, either into triceps or deltoid, slowly over one to two minutes. I usually use an orange needle, at least 1” long to get deep into the muscle. Magnesium is a powerful vasodilator. Even if one takes care to check the tip of the needle is not in a vein, sometimes there is such a powerful local vasodilatation that the vessels open up and an i.v. injection is inadvertently given. This does not matter much, except that the patient develops a generalised vasodilatation, feels hot and alarmed, goes red and may faint (if upright).

In fact it is partly this effect which is taken advantage of in the treatment of acute myocardial infarction or acute stroke. In both these conditions there is a local obstruction of blood supply. I use i.v. magnesium (2-5mls of 50%) as a bolus to treat both these conditions - often with dramatic effects. With acute myocardial infarctions there is often immediate pain relief, as either the obstruction is relieved or good collateral circulation restored. Furthermore, magnesium is antiarrhythmic. Trials with magnesium have clearly demonstrated benefit and magnesium is used as a front line drug in many hospitals. In acute stroke, function can be restored within a few minutes - most satisfying. However, if there is a possibility that the stroke is haemorrhagic (about 15% of cases) then magnesium should not be used.

I have recently discovered that for magnesium to get into cells thiamine is required. Some patients can correct levels by taking thiamine 100mgs daily.

Magnesium Per Rectum

Giving magnesium by injection is the quickest way of restoring normal blood and tissue levels of magnesium. However for some patients the injections, while giving benefit, are too painful to be considered long term.

At a recent conference in Australia, I spoke to a doctor who had been trying magnesium sulphate given PR (per rectum - like a suppository) with some success. If this technique works, then it would be a cheap, safe, do-it-yourself at home technique, which could replace uncomfortable injections. With this in mind, Dr Keith Eaton made up some kits for my patients (and his) to try. I have now tried magnesium PR with 10 patients and it has been as effective as the injections in six of them.

If the magnesium is being absorbed then I would expect patients to get the same response as from a magnesium injection, but of course without the pain. It does work for a useful proportion of CFS patients, so it is well worth trying if you get benefit from the magnesium injections.

Magnesium by Mouth

Magnesium is poorly absorbed by mouth. That is why I start off with injections. By injecting magnesium I can guarantee 100% to bring the levels up. I cannot guarantee to do this with either PR or oral magnesium. However if the injections do help then it is well worth trying oral or PR if only to reduce the pain and trouble of injections.

All magnesium salts can cause diarrhea if too much are taken. The cheapest source of magnesium is Epsom salts. The key is to take “sub-diarrheal” doses. I suggest a quarter teaspoon daily, building up slowly until you get “the trots”, then reduce just enough to give a normal bowel movement. It does taste awful – try with fruit juice.

(http://www.immunesupport.com)

Used with Permission

Page 6

Drug Treatments For Sleep

by John. W. Addington, ImmuneSupport.com, 10.10.2000

Sleep can be one of the most illusive quests for those with Chronic Fatigue Syndrome (CFS) or Fibromyalgia (FM). In fact, unrefreshed sleep, sometimes accompanied by insomnia, is a hallmark of these disorders. Fortunately though, a host of drugs (see table below), are being used by many CFS and FM to improve these symptoms. This article outlines these medications and how they are being used.

Sonata (zaleplon)

One of the newest sleep aids on the market, Sonata, is unique among other sedatives in the speed and short duration of its affect. The majority of patients using Sonata fall asleep within 20 minutes and the affects of the drug usually last only an

hour. This makes Sonata excellent for both those who have difficulty initially getting to sleep and for those who awake at

night and need to take something to return to sleep. Because the affects of other sleep aids can last 8 hours or more, those that have to rise from bed within several hours usually cannot use them. However since Sonata's sedation is brief it is excellent for persons in this situation. Additionally Sonata is not addictive, and its side effects are few and not serious.

Ambien (zolpidem)

Another quick acting sleeping pill with few side effects is Ambien. Ambien has the advantage of not worsening the sleep cycle like other sedatives can, and it normally does not cause any grogginess the next morning. Its affects, however, are longer than Sonata making it a better choice for those having difficulties with frequent awakenings. Studies have shown Ambien improves sleep quality by decreasing the time needed to fall asleep and increasing total sleep time resulting in greater evening energy levels. Further Ambien has shown to continue to be effective even with daily use. Nancy Klimas, M.D., cautions however, that this kind of medication may just trap you into a lighter sleep instead of the more restful deeper stages of sleep.

Klonopin (clonazepam)

In a class of medications like Ambien, is the drug Klonopin (clonazepam). "In sleep management, one of the best things we have found is Klonopin," states Charles W. Lapp, M.D. Klonopin can help you get to sleep fast and sleep longer and thus have less fatigue the next day. It also is a muscle relaxant that can help with restless leg syndrome and, as it is closely related to Valium, can relieve anxiety and panic attacks. Klonopin is not without drawbacks though, since it can be addictive, and thus if you need to discontinue its use, you must carefully taper it under a doctor's care. Also as with many sedatives one can build up tolerance to Klonopin's effects, thus reducing its benefit. Providing suggestions on use, Jacob Teitelbaum, MD, says ".25 to 2 milligrams of Klonopin at night can have a dramatic effect. Start with low dose and work up gradually because Klonopin is initially quite sedating. I use Klonopin as a last resort because it is potentially addictive."

Elavil (amitriptyline)

Elavil is an antidepressant commonly used in low dosages for CFS and FM patients to improve sleep and reduce pain. Elavil can actually restore the deeper delta stages of sleep. Peter Manu, MD, observes that a trial in Elavil's use with FM revealed "highly significant levels of improvement for the severity of pain, fatigue, and sleep disturbance."

Nevertheless, because Elavil can cause daytime grogginess it should be used at the lowest possible dosage yielding the best results. Many CFS and FM sufferers not excessively bothered by its side effects including dry mouth and possible weight gain feel this medication is a godsend.

Flexeril (cyclobenzaprine)

Flexeril is similar to Elavil in makeup and is used for its muscle relaxant, antiinflammatory properties. Some studies in Flexeril use for FM have found it able to reduce pain and increase quality of sleep. Flexeril can be used to normalize altered sleep patterns found in CFS and FM patients. Like Elavil, however, it can have the side effects of dry mouth and mild weight gain.

Desyrel (trazodone)

Many others swear by the drug Desyrel (trazodone). According to Dr. Lapp, "if you are one of those persons who fall asleep pretty readily, but then wakes up every hour, or wakes up and can't go back to sleep, Trazodone may be the thing you want to take because it works best for that sort of problem." Dr. Lapp also notes that Desyrel can induce the more beneficial deeper sleep stages. Because Desyrel in addition to be an antidepressant is a calming agent it can be helpful for those whose sleeping difficulties are coupled with anxiety. What makes many people prefer this medication is what it does not do. Desyrel does not cause the same degree of dry mouth or weight gain as some sedating medications do. Also since Desyrel does not reduce respiration, it does not aggravate sleep apnea. This medication may not be for all males, though, since can cause prolonged erections of an hour or more in time.

Antihistamines (diphenhydramine, doxylamine)

The antihistamines diphenhydramine and doxylamine found in many over the counter sedatives such as Nytol, SleepEze, Tylenol P.M. or Unisom have been used regularly by many. These ones have found that such medications help them to get to sleep and prevent awakenings during the night. This class of antihistamines has few side affects especially for younger persons and does not cause dependence or withdrawal symptoms. However, since they can negatively impact sleep cycles antihistamine sedatives are best for occasional use.

When To Use Drug Therapy

When should one turn to medications to assist with sleeping problems? When insomnia is chronic, that is, lasting more than several weeks and not the result of a condition such as medication side affect that should remedied differently. Additionally, it is wise to first attempt behavior changes that may resolve the sleep difficulty. These include avoidance of alcohol and caffeine, especially late in the day, exercising early in the day and keeping regular bed times and wake times. (For behavioral modifications see Breaking Fibromyalgia's Sleepless Cycle at the end of this article)

Further, before turning to drug therapy, it is important that sleep apnea or restless legs syndrome first be ruled out as a possible cause of the difficulty, since some sleep aids can actually worsen such conditions. Sleep apnea is a nighttime breathing difficulty usually caused by obstruction of the windpipe. A common sign of sleep apnea is heavy snoring and pauses in breathing during sleep. One study found that almost 50% of men with fibromyalgia had significant sleep apnea. Restless leg syndrome is more obvious to the patient as it is characterized by an uneasy sensation in the legs when trying to rest, relieved by moving the legs or walking. To best diagnose these kinds of sleeping difficulties a study of a patient's sleeping patterns may need to be done in a special sleep lab.

Finally before trying heavier medications used for sleep, one might want to first try the more natural sleep aids available without a prescriptions. These include melatonin and valerian with lemon balm. To learn more about these natural sleep aids see the article written by Jacob Teitelbaum, MD, "Importance of Solid Sleep in Chronic Fatigue Syndrome and Fibromyalgia Sufferers,"

Sleeping Difficulties

A little background on the nature of the sleep difficulties in CFS and FM will round out this discussion. Normal sleep cycles through four stages becoming deeper and deeper followed by a dream stage called REM (rapid eye movement). Stages 1 and 2 of sleep are lighter and are called alpha whereas stages 3 and 4, referred to as delta, are much deeper. The progression through these stages repeats throughout the night with the deeper delta stages of sleep occurring more in the first part of the night and REM becoming more predominant in the latter stages of the night.

Studies done have shown that some CFS and FM patients have deviations in the normal sleep cycle. A Belgium study observed "sleep initiation and sleep maintenance disturbances" in a group of CFS patients. Similarly in England it was reported that "CFS subjects showed significantly higher levels of sleep disruption by both brief and longer awakenings."

Susan M. Harding, MD, states that the normal sleep pattern "is altered in FM patients showing an increase in stage 1, a reduction of delta sleep, and an increased number of arousals." Devin Starlanyl, MD, says that the irregularities in sleep causes persons with FM to be "jolted awake or into shallow sleep so that they either wake up many times during the night or sleep very shallowly." Many CFS and FM patients concur that insomnia, whether the inability to get to sleep, stay asleep, or sleep soundly is one of their more difficult symptoms.

Conclusion

Sound, restful, restorative sleep while more difficult for CFS and FM patients, may still be possible at least part of the time. Diet and other behavioral changes, sleep labs, natural sleep aids, overthecounter sleep inducing medications and prescription drugs are all remedies we have at our disposal. And as research reveals why these sleep disturbances occur in the first place, other even more effective longterm resolutions may be available.

Sleep Medication Chart

(This list is not comprehensive but represents some of the most common medications used in several classes of drugs. Even with the over the counter medications, it is best to consult with one's physician before use.)

DRUGS COMMONLY USED AS SLEEP AIDS*

(http://www.immunesupport.com)

Breaking Fibromyalgia's Sleepless Cycle

by Source: ImmuneSupport Staff

ImmuneSupport.com 01-01-1999 -

For most of us, a night of tossing and turning leaves us feeling groggy the next day but we usually recover after a good night's sleep. But for those suffering from Fibromyalgia (FM), such restless nights are not only common, their result actually worsens that disease's symptoms. Fibromyalgia's frustration of pain-filled days and unsettled nights create a vicious cycle that sometimes feels inescapable. Luckily, there are approaches that can make a difference – and offer an escape.

It's not that those with Fibromyalgia don't get enough sleep, it's that they don't get enough deep sleep. It boils down to the alpha and delta brain waves. While humans are awake and resting, alpha brain waves are emitted at about 8 to 13 per second. Then, when that same person is deeply sleeping, the delta brain waves take over and are released at less than 3.5 per second. When there is a disorder in the delta sleep wave pattern (like for those with Fibromyalgia) the alpha waves intrude during deep sleep and reawaken the person to a lighter, less refreshing sleep. This affects those with FM much more drastically than the average person who, after such a restless night, may just feel "a little out of it". Since the deep sleep state is never reached, the muscles never fully relax and are not repaired during sleep. Not surprisingly, many experience constant tossing and turning and commonly also suffer from RLS or Restless Leg Syndrome. (For more on RLS, take a look at the next story in this bulletin.) Furthermore, the non-refreshing sleep only worsens the daytime fatigue felt by those with FM; they commonly awake tired and in significant pain. So, what to do from here? There ARE steps that can be taken to promote deeper, more restorative sleep. Some of those steps are:

Behavioral Modification

Go to bed and awaken at the same time each day.

Don't use your bedroom for activities like eating, reading or watching TV.

When you can't sleep, get up and do something else, like read. Then return to bed when you become sleepy.

Regular exercise. Work up to 20-30 minutes per day. There are some doctors who believe that FM symptoms will never be eliminated without daily, moderate aerobic exercise. Such activity releases endorphins, the body's natural painkillers and promotes more restful sleep.

Stop napping. If this seems impossible, try limiting naps to no more than 30 minutes in length.

Prescription Medication For people with FM, Tricyclic antidepressants (like Elavil) are the most commonly prescribed for disrupted sleep patterns.

Herbal Remedies

There are a number of herbal remedies for sleep, including Valerian, Kava Kava, GABA and Melatonin. (See more on sleep page 9)

Letters...

From the survey

From “C” ..... I love the Snail Mail. It’s like a life line for me. Sometimes we all feel like we are all alone in this foggy,painful life. Your help makes me smile on the worst days. I wish I could spend more time with all of you—you are in my prayers.

From “L” ..... (I) appreciate all to keep us informed. This is the most valuable issue I have read. It is most enlightening to me, as of the age of 22, just as I finished “nurse’s training”, I had polio, and spent 3 year recovering. Also in 1965 I had “viral encephalitis” and spent another 3 years recuperating. So no wonder CFS caught up with me in 12/95. So I can understand a lot better...Thanks so much for this information.

From “G” ..... Just getting a few year’s publications out of the file cabinet to loan to a school friend we think may have CFIDS. These are so helpful and whoever is putting news together is doing a fine job! I like the index on the front. It is easier to find a topic to share when in a hurry........

From “S” ..... I look forward to Snail Mail even though I have to re-read the articles as my concentration and memory are diminishing—-in time I forward my copy to my sister-in-law who has lupus. She also enjoys reading the articles.

...............S

From “M” ..... Thanks

From “S” ..... The Snail Mail is invaluable and a major life line to many of us we cannot attend meetings. The incredible effort put out to put out this cornucopia of information deserves the highest accolades. I pray it will continue.

From “K” ..... I miss everyone. I’m sending a check.

From “H” ..... We all learn from each other and need to return again and again.

From “J” .... (I am looking for) information leading to relief of symptoms, particularly pain.

From “A” .... My street name is spelled like this _____

From “D” ..... (SM needs) less general medical info for me; but others may find it useful.

From “M” ..... Because of a recent bout with the flu and a recent reduction in my (medication) dose, I feel I may be having a fibromyalgia flare up or my symptoms may have been masked by the (medication), so I’m still definitely interested in the newsletter.

From “S” ..... I appreciate the variety of articles, the stories & jokes, the latest info about CFIDS. Keep up the good work! I’m still sick but keep trying different things & hoping I’ll get better or just have a little more energy. I’m enclosing my (share of cost). I wish all the members of the Support Group Happy Holidays.

Page 9

Can Sleep Apnea Cause FM- and CFS-like Symptoms?

08-11-2000 Being low on energy during the day might be caused by trouble breathing while you sleep, even if you don't actually feel sleepy, a new University of Michigan study suggests. In fact, doctors and patients may be missing the real cause of some cases of daytime fatigue and lack of energy: a potentially serious but treatable condition known as sleep apnea.

The finding, in the August issue of Chest, demonstrates that patients with undiagnosed sleep apnea don't always describe their symptoms using the term -- sleepiness -- that doctors are currently trained to listen for. In effect, the words that patients use may get in the way of the doctor's initial diagnosis. But, the paper says, if patients who are fatigued but not sleepy have laboratory sleep tests, they may show the interrupted breathing patterns of sleep apnea.

Sleep apnea is a common and underdiagnosed condition in which breathing stops temporarily dozens or even hundreds of times a night. It can have an important impact on a person's productivity, quality of life and health if not treated," says Ronald Chervin, M.D., M.S., assistant professor of neurology.

Many people suffer from interrupted sleep and do not even realize it. But interrupted sleep can cause as many health problems as not enough sleep. Jacob Teitelbaum is a firm believer in the importance of sleep if you suffer from CFS or FM.

Breaking the cycle of poor sleep and maintaining quality sleep for six to nine months is critical to breaking the cycle of FM, CFS, and severe fatigue,” says Teitelbaum.

It is important to note that growth hormone released during stages three and four of sleep is responsible for many of the repair processes that go on in our muscles and in the rest of our body. It is theorized that this loss of repair function that normally occurs during deep sleep contributes to the pain of FM. Several studies have now shown that if you wake up people whenever they go into deep sleep, or even lightly shake them so they go from deep sleep into light sleep, they will develop classic FM-like pain within one to two weeks and often within one night.”

The study points out how important it is for physicians to listen carefully to how patients describe their problems. In fact, Chervin made the finding by "listening" to patients - both their words and their sleep patterns. He reviewed survey answers and sleep test results from 190 people who had been referred by their regular physicians for sleep studies at the U-M's Michael S. Aldrich Sleep Disorders Laboratory, where Chervin is director.

The subjects or their physicians suspected a sleep disorder, so these individuals don't represent the general population. But the results from their sleep tests, and their answers to questions about how they felt, yield surprising trends that may be important to doctors and the many Americans who haven't yet sought help for problems with getting a good night's sleep.

In all, 73 percent of the study's subjects said they suffered from sleepiness, fatigue, tiredness or lack of energy often or almost all the time. But when the four descriptive terms were compared independently, less than half the patients reported feeling sleepy often or always, while 62 percent said they lacked energy often or always, 57 percent reported problems with fatigue, and 61 percent said they felt tired. Women were more likely to describe such symptoms.

Asked which of the symptoms was most significant to them, more patients chose "lack of energy" than any other problem, and almost twice as many chose it than chose "sleepiness." Chervin and his colleagues also asked subjects which symptom most kept them from accomplishing what they wanted to do during the day. Forty-four percent said lack of energy, while only 16 percent said sleepiness.

Women in the study reported all four symptoms more than men did. They were four times as likely to say they had a lack of energy, and three times as likely to state they felt tired during the day. Chervin theorizes that men may be culturally less willing to admit any of the problems asked about in the survey. Only when told they had to choose one of the symptoms did the men show similar rates of complaint as women. But, Chervin adds, there may be some neurophysiological differences in the way men and women perceive the effects of poor sleep.

"These results suggest that patients who deny being sleepy may not be as unlikely to have sleep apnea as is sometimes assumed," Chervin says. "We need more research, in the broader population, on relationships between symptoms patients report and the results sleep tests."

The most common form of the disease is called obstructive sleep apnea, in which the upper airway in the throat becomes obstructed. Breathing stops or diminishes for periods of 10 seconds to a minute or more. Often, apnea is worsened by excessive weight, having oversized tonsils, or having other structural or neurological problems in the upper airway. There is growing evidence that it may cause numerous medical conditions such as high blood pressure, heart attack, heart arrhythmia, stroke, and cognitive problems.

Source: EurekAlert!

By: http://www.immunesupport.com

Link Between Poor Sleep and Irritable Bowel

Syndrome Studied

by ImmuneSupport Staff

ImmuneSupport.com, 06-07-2000 - Researchers have documented a link between poor sleep and subsequent gastrointestinal disturbances, both common problems for people with chronic fatigue syndrome (CFS) and fibromyalgia (FM).

The University of Washington study followed women with IBS and found that more gastrointestinal disturbances occurred after a night of poor sleep. This news is the most recent supporting the possibility of a casual relationship between the two.

Over the course of the 2-month analysis, 82 women with IBS and 35 women without used a combination of 7-day recall and a daily diary to test the relationship between the two ailments. Approximately 25% of the IBS women suffered from sleep disturbances. The severity of the disturbance correlated strongly with the severity of gastrointestinal symptoms.

Although the relationship between IBS and gastrointestinal symptoms remained significant even after researchers adjusted for psychological stress, they noted that this adjustment weakened the possibility of a definitive relationship.

A brief analysis of the data showed that poor sleep on a single night leads to significantly increased symptoms on the following day, while increased symptoms on a particular day do not appear to cause sleep disturbances that night.

Original report published in Digestive Diseases and Sciences.

2000 Pro Health, Inc.http://www.immunesupport.com)

Page 10

What Your OB/GYN Should Know

Devin Starlanyl

This information may be freely copied and distributed only if unaltered, with complete original content including: © Devin Starlanyl, 1995-1999.

Please read “What Everyone on Your Health Care Team Should Know.”

It is vitally important that every OB/GYN specialist understands the concepts that lie behind the facts of fibromyalgia (FMS) and Myofascial Pain Syndrome (MPS), because they will have an impact on every aspect of your dealings with your FMS/MPS patient. Often it is you who will make the diagnosis, due to the nature of your interactions with your patient, and an understanding of trigger points (TrPs) is essential in this task. To learn about TrPs see The Trigger Point Manuals (1998; 1992).

For example, piriformis TrP nerve entrapment can be the cause of sharp pain during pelvic exams. Other TrPs in that area can cause pain and muscle spasms during vaginal and rectal exams. Because the experience of pain is amplified by FMS, that may require you to modify some of your procedures. Also, people with FMS often have sicca syndrome. This means that all the mucous membranes can dry, including the lining of the vagina, and the GI tract. Fibromyalgia has a direct effect on the HPA axis, which in turn affects the gonadal axes (Torpy and Chrousus 1996). Fibromyalgia can interact with and be affected by the sex hormones (Carett, Dessureault and Belanger 1992) and reproductive events (Ostensen, Rugelsjoen and Wigers 1997).

Pregnancy and Health Issues

Stretches and other physical therapy to promote myofascial elasticity are important for the FMS/MPS patient during pregnancy, as well as extra vitamins and minerals. Benedryl is a remedy for sleep suitable in pregnancy. Unfortunately, for some FMS/MPS patients, it causes insomnia. Many of us have the alpha-delta sleep anomaly and get little restorative sleep. Disruption of delta sleep may be tied to hormone dysregulation. Many of us also have nutritional problems, because of a malabsorption condition in the GI tract. I have observed that some women with FMS have had prolonged gestational periods, perhaps due to the unbalanced adrenaline serotonin axis. This may be the result of lowered serotonin. Nontraditional symptom management methods may be useful during pregnancy if there are complications of FMS and/or MPS (Schneider 1992; de Aloysio and Penacchioni 1992).

I have observed that people with FMS/MPS have a tendency to form cysts, fibroids, heavy scarring, and adhesions. Even our cuticles and pierced earring holes overgrow. This is something to keep in mind when surgery is contemplated.

Hysterectomy

Many FMS/MPS patients have had hysterectomies to relieve pain. Often just the uterus is removed, but in many cases the ovaries are taken out later to balance hormonal swings and ovarian pain, which can refer pain to the groin and legs.

The Menses

FMS is a pain amplification syndrome (Sorensen, Graven-Nielsen, Henriksson, et al. 1998). and our autonomic nervous system is hypersensitized. Both central and peripheral mechanisms seem to be involved (Yunus 1992). Your patient really hurts. During menses, it is not unusual for the patient to be able to feel what area of the uterus is sloughing off. Some have said that it is like being skinned alive on the inside, every month. Menstrual problems such as severe cramping, irregular periods, long periods with a great deal of bleeding, membranous flow, late periods, missed periods, and periods with blood clots are common in FMS/MPS. Irregular periods and long flows are also common, due to neuroendocrine and gonadal imbalances mentioned earlier. There seems to be an increased incidence of female urethral syndrome, as well (Wallace 1990).

Trigger Points

Some part of these menstrual problems can be caused by coccygeus, ilicostalis, rectus abdominis, pyramidalis, and other pelvic and low-back TrPs. There is also a TrP high in the adductor magnus which refers a diffuse pain and soreness throughout the pelvic area, and can mimic pelvic inflammatory disease (PID). Even some multifidi muscle TrPs refer pain to the abdominal area. It’s not unusual for pregnancy or even dysmenorrhea to activate TrPs. Find a good TrP-savvy physical therapist to work with your FMS/MPS patients.

Active TrPs in the abdominal muscles, especially in the rectus abdominus, may cause a lax, pendulous abdomen with gas problems. Your patient can’t pull in the gut because the TrPs inhibit contraction. A fat pad forms over the abdomen. That fat pad is hard to get rid of, due to the TrPs. The first thing to do is to find and eliminate the back muscle TrPs that refer pain to the abdomen. These can cause burning, fullness, bloating, and swelling. Only then can you hope to eliminate the belly TrPs.

Genetics

Because studies show that 50 percent of the children of people with FMS/MPS may have an inherited tendency to develop the condition, female children of parents with FMS/ MPS should be monitored carefully during their first menses (Pellegrino, Waylonis and Sommer 1989). If severe dysmenorrhea occurs, the patient should be checked out for signs of FMS/MPS.

Therapies

I have found that if patients use tennis-ball acupressure before their period, (it hurts, but it flushes out the TrPs), there will be less constriction in the abdominal area, and less bloating. It is especially important to work the line where the leg joins the trunk. Patients can do this by lying on the floor and placing the tennis ball between their bodies and the floor. If the area is extremely sore, there is a TrP there. Nerve entrapment by TrPs may be present as well, leading to neuropraxia. If there is nerve involvement, often ice will help ease the pain. If the pain is muscular alone, the patient will find heat more comforting.

Vaginal Discharge

Vaginal discharge, sometimes with an itch, is common. So is mittelschmerz. This pain, as in menstrual pain, often triggers the adductor longus and iliopsoas TrPs. These TrPs can respond to galvanic muscle stimulation, sine-wave ultrasound with electrostimulation, Spray and Stretch, and Cranio-Sacral Release.

Yeast Infections

Frequent yeast infections, an itch on the roof of the mouth after eating tangy cheese, and bloating after drinking beer may be signs that your patient has a yeast problem. This is usually a sign of increased acidity and toxicity. Many people with FMS/MPS have reactive hypoglycemia which sets up conditions favorable for rapid yeast growth. The “Zone” diet works well for this (Sears 1997b). I also find that allergy shots for molds are very helpful, as well as guaifenesin therapy.

Breast Pain

Hypersensitive nipples and/or breast pain are commonly due to pectoralis TrPs. Many of us have latent pectorals and sternalis trigger points. “Doorway stretches” help these TrPs. Fibrocystic breasts are also common in FMS/MPS Complex. This may be due to ductal entrapment by myofascial TrPs.

Medication Effects

Many FMS/MPS patients have unusual reactions to medications due to their altered metabolism. Sometimes, just a small portion of a normal dose of a medication will have very strong effects. At other times, we can take whopping doses of a medication and feel no effects at all.

Secretions

A lot of us have thick secretions. Guaifenesin ends this problem, and the way it thins secretions may be part of why it is so effective in “reversing” the effects of FMS. I’ve heard that it has been used to help promote conception (Check, Adelson and Wu 1982). It seems to help us get rid of accumulated toxins and acids.

Sexual Intercourse and Pain

Pain with intercourse is often due to vaginal TrPs and pelvic floor TrPs. For aching discomfort and cramps during coitus, check for abdominal and low back TrPs. For sharp pain, check for a piriformis muscle TrP with pudendal nerve entrapment. Vulvar vestibulitis, vulvodynia, hyperesthesia, and general pelvic muscle aches are also common. Progesterone will affect the levels of serotonin, and serotonin levels may vary from day to day as the amount of delta sleep varies. Expect mood swings and difficulties with neurotransmitter fluctuation, and hormonal irregularities.

References

Carrett S., M. Dessureault and A. Belanger. 1992. Fibromyalgia and sex hormones. J Rheumatol 19(5):831.

Check, J. H., H. G. Adelson and C. H. Wu. 1982. Improvement of cervical factor with guaifenesin. Fertil Steril 37(5):707–708.

de Aloysio, D. and P. Penacchioni. 1992. Morning sickness control in early pregnancy by neuguan point acupressure. Obstet Gyn 80 (5):852–854.

Ostensen, M., A. Rugelsjoen and S. H. Wigers. 1997. The effect of reproductive events and alterations of sex hormone levels on the symptoms of fibromyalgia. Scand J Rheumatol 26(5):355–360.

Pellegrino, M., G. W. Waylonis and A. Sommer. 1989. Familial occurrence of primary fibromyalgia. Arch Phys Med Rehab 70(1):61–63.

Schneider, M. J. 1992. Soft tissue effects of sacroiliac and lumbosacral joint manipulation. Chiro Tech 4(4):136–142.

Sears, B. 1997. Mastering the Zone. NY: HarperCollins.

Simons, D. G., J. G. Travell and L. S. Simons.1998. Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1, edition II: The Upper Body. Baltimore: Williams and Wilkins.

Sorensen, J. T., K. Graven-Nielsen, G. Henriksson, M. Bengtsson and L. Arendt-Nielsen. 1998. Hyperexcitability in fibromyalgia. J Rheumatol 25(1):152–155.

Torpy, D. J. and G. P. Chrousos. 1996. The three-way interactions between the hypothalamic-pituitary-adrenal and gonadal axes and the immune system. Baillieres Clin Rheumatol 10(2):18–198.

Travell, J. G. and D. G. Simons. 1992. Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume II: The Lower Body. Baltimore: William and Wilkins.

Wallace, D. J. 1990. Genitourinary manifestations of fibrositis, and increased association with female urethral syndrome. J Rheumatol 17(2):238–239.

Yunus, M. B. 1992. Towards a model of pathophysiology of fibromyalgia: Aberrant central pain mechanisms with peripheral modulation. J Rheumatol 19:6:846–850.

page 11

FYI: Sharing cancer info...

Written by Jane L. Margolis

I have Primary Peritoneal Cancer. This cancer has only recently been identified as its OWN type of cancer; but it is, essentially, Ovarian Cancer. Both types of cancer are diagnosed in the same way (with the "tumor marker" CA-125 blood test), and they are treated in the same way (surgery to remove the primary tumor and then chemotherapy with Taxol and Carboplatin).

Having gone through this ordeal, I want to save others from the same fate. One thing I have learned is that each of us must take TOTAL responsibility for our own health care.

I thought I had done that because I always had an annual physical, had my annual mammogram and PAP smear, did monthly Self Breast Exam, went to the dentist at least twice a year, etc. I even insisted on a sigmoidoscopy and a bone density test last year.

When I had a hysterectomy in 1993, I thought that I did not have to worry about getting any of the female reproductive organ cancers. LITTLE DID I KNOW! I don't have ovaries (and they were HEALTHY when they were removed!), but I have what is essentially ovarian cancer. Strange, isn't it?

These are just SOME of the things our doctors never tell us: -- ONE OUT OF EVERY 55 WOMEN WILL GET OVARIAN OR PRIMARY PERITONEAL CANCER.

-- THE "CLASSIC" SYMPTOMS ARE AN ABDOMEN THAT RATHER SUDDENLY ENLARGES AND CONSTIPATION AND/OR DIARRHEA.

I had these classic symptoms and went to the Doctor. Because these symptoms seemed to be "abdominal," I went to a gastroenterologist. He ran tests that were designed to determine whether there was a bacterial infection; these tests were negative, and I was diagnosed with "Irritable Bowel Syndrome." I guess I would have accepted that diagnosis had it not been for my enlarged abdomen. I swear to you, it looked like I was 4 months pregnant!

I, therefore, insisted on more tests. They took an X-ray of my

abdomen; it was negative. I was, again, assured that I had Irritable Bowel Syndrome and was encouraged to go on my scheduled month-long trip to Europe. I couldn't wear any of my slacks or shorts because I couldn't get them buttoned, and I KNEW something was wrong.

Again, I INSISTED on more tests and they (reluctantly) scheduled me for a CT-Scan (just to shut me up, I think). This is what I mean by taking charge of our own health care.

The CT-Scan showed a lot of fluid in my abdomen (NOT normal!). Needless to say, I had to cancel my trip and have FIVE POUNDS of fluid drawn off at the hospital - not a pleasant procedure, I assure you, but NOTHING compared to what was ahead of me. Tests revealed cancer cells in the fluid. Finally, finally, finally, the Doctor ran a CA-125 blood test and I was properly diagnosed.

I HAD THE CLASSIC SYMPTOMS FOR OVARIAN CANCER AND, YET, THIS SIMPLE CA-125 BLOOD TEST HAD NEVER BEEN RUN ON ME - not as part of my annual physical exam and not when I was symptomatic. This is an inexpensive and simple blood test!!!

Please, PLEASE, P-L-E-A-S-E tell all your female friends and relatives to insist on a CA-125 blood test every year as part of their annual physical exams. Be forewarned that their doctors might try to talk them out of it, saying "it isn't necessary." Believe me, had I known then what I know now, we would have caught my cancer much earlier (before it was a stage 3 cancer)!!! INSIST on the CA-125 blood test: DON'T TAKE "NO" FOR AN ANSWER.

The normal range for a CA-125 blood test is between zero and 35. (Mine was 754 -- that's right, 754!) If the number is slightly elevated, you can have another one done in three or six months and keep a close eye on it just like women do when they have

fibroid tumors or when men have a slightly elevated PSA test - "Prostrate Specific Antigens") that helps diagnose Prostate Cancer.

Having the CA-125 test done annually can alert you early and that's the goal in diagnosing any type of cancer-CATCH IT EARLY. I hope I haven't bored you with all of this. But I hope I HAVE scared you enough to motivate you to action. Do YOU know 55 women? If so, at least one of them will have this VERY AGGRESSIVE cancer -- and maybe, just maybe, it will be YOU. I hope not.

Please, go to your Doctor and insist on a CA-125 test and have one EVERY YEAR for the rest of your life. And forward this message to every woman you know and tell all of your female family members and friends. As the Nike ads say, "JUST DO IT!" Please don't think youth will protect you, either. Though the median age for this cancer is 56 (and, guess what, I'm exactly 56), women as young as 22 have it. Age is not a factor.

Thank you for your time. My best wishes for your continued good health.

Jane L. Margolis

Thanks to Cathie Lawrence

page 12

Could Your Lifestyle Lead to Diabetes?

Studies Show a Good Diet and Exercise Can Help You

Prevent the Illness

Lee Hickling

Losing just 10 pounds, combined with a healthy diet and regular moderate exercise, may prevent the development of type 2 diabetes for people who are at risk because their bodies cannot use insulin properly or are not secreting enough of it.

Several recent studies, including one reported to the 60th annual Scientific Session of the American Diabetes Association by Dr. Jaakko Tuomilehto, indicate that this is the case.

Tuomilehto, a professor at the National Public Health Institute in Helsinki, Finland, said a Finnish study of 523 overweight people who had impaired glucose tolerance -- meaning they were in danger of developing the disease -- showed that intensive lifestyle changes involving eating and exercise habits averted the illness in 90 percent of the test group. Twenty-two percent of a control group became diabetic. That, he said, was a 58 percent reduction in the incidence of the disease.

An intensive, individualized program of intervention, like the one tested in Finland with overweight people who had a family history of diabetes, Tuomilehto said, is so effective and economical that it should become part of standard medical practice and be covered by health insurance.

Type 2 diabetes, the most common type, was once called adult-onset diabetes because it usually occurred in people over 45 who were overweight. However, the American Diabetes Association said it is increasingly being found in children and teen-agers because of the growing number who are obese and sedentary.

Earlier this year, Dr. Lynn L. Moore of the Boston University School of Medicine said a 16-year study of 618 overweight people suggested that even a small weight loss could reduce the risk of diabetes. Those who lost 8 to 15 pounds had a 33-percent reduction in risk, and those who lost more had a 51-percent reduction. However, those who lost weight and then gained it back showed no reduction whatsoever.

Exercise has been found to be effective in reducing the risk of type 2 diabetes, and Dr. Laurie J. Goodyear of Harvard Medical School believes she knows why. She told a meeting of the American College of Sports Medicine that exercise appears to increase the activity of a substance called AMP kinase, which makes muscles use more glucose, the sugar that is the main source of energy for the body's cells.

Both types of diabetes are caused by abnormalities in the way the diabetic's body manufactures or uses insulin, a hormone made in the pancreas that is essential to the cells' proper use of glucose.

Type 1, or insulin-dependent, diabetes was once called juvenile diabetes, because it more often appears in infants and children, although adults develop it, too. About 1 in 10 diabetics have type 1 diabetes. It is caused by a lack of insulin-making cells in the pancreas. Without these cells glucose builds up in the blood. The results include a lack of energy, weight loss, hunger and thirst, problems with vision, and even coma. For type 1 diabetics, insulin shots replace the hormone that a patient's body can no longer supply.

In type 2 diabetes, there is also too much glucose in the blood, but for different reasons: Either the body is not making enough insulin, or the cells are not responding to the insulin, which allows glucose to enter the cells.

A proper diet -- low in fat and high in complex carbohydrates -- and exercise are important components of the treatment of both diabetes types. For type 1 sufferers, diet and exercise can lower the amount of glucose in the blood, although the type 1 diabetic will usually need insulin to keep blood sugar levels normal.

Type 2 diabetics can very often control their blood glucose level by losing weight, exercising, maintaining a healthy diet and stopping smoking, but many do not even try to do those things, according to a report in the medical journal Preventive Medicine.

Because of this, they run a serious risk of heart attacks and strokes, circulation impairment in their feet and legs that can lead to amputation, nerve damage and loss of feeling in their extremities, irreversible damage to their eyes, and severe damage to their kidneys.

The authors of the report, Dr. Faryle Nothwehr and Tim Stump of the Indiana University Center for Aging Research, said, "Given the devastating effects of diabetic complications, one might expect that those diagnosed with this disease would be motivated to make greater efforts than the general population to control their weight, to improve eating habits and to increase their level of physical activity."

They said their study of 733 people aged 50 to 62 showed that few patients seriously try to lose weight. Of those who do, many soon abandon the effort.

drkoop.com Health News

Page 13

But You "LOOK" Good

"Why Seeing Is Not Believing When Dealing With A Chronic Illness!"

What Is A Chronic Illness, Anyway?

A chronic illness is a disease or disorder that a person has to cope with on a continuous basis. Many people become so ill, they are unable to work and are forced to give up activities they have always enjoyed. Often their illness goes undiagnosed for years, leaving thousands of people frustrated, depressed and without answers to why their bodies will not cooperate with their desires.

But, They "LOOK" Fine! How Can They Be Ill?

Many chronic illnesses such as: *Arthritis, Chemical Depression, Crohn's Disease, CFIDS, Cystic Fibrosis, Diabetes, Fibromyalgia, Heart Disorders, Hypothyroidism, IBS, Lyme Disease, Lupus, Multiple Sclerosis, Neurological Disorders, Osteoporosis, Parkinson’s, RSD, Women's Chronic Disorders and many, many others cannot be seen with the naked eye, but are nevertheless persistently keeping the person from enjoying life the way they once knew.

Unfortunately, their families and friends are rarely supportive and understanding, because they do not see a broken bone or bleeding head to confirm the complaints. However, do not expect to see a disease that lives below the skin, because most illnesses are invisible until the person has had chemo or organ failure! Your friend or family member needs you to believe what they are saying is true, without judgment or question.

*This is only a very small sample of the hundreds of chronic illnesses which can be disabling; it is not intended to be a complete list of all debilitating disorders.

So, They Have "Good" & "Bad" Days, Right?

Actually, not everyone with a chronic illness has the same symptoms or degree of symptoms; yet, there are basically three stages in any chronic illness:

1) THE EARLY STAGE: This person may notice occasional symptoms or lack of energy. They start experiencing setbacks from activities which previously never took a thought. If diagnosed in this stage, which is rare, many can get help from their doctors and proper nutrition to cure or prevent further progression of the disease. This person has mostly "good" days with occasional "bad" days.

2) THE MIDDLE STAGE (or the Relapsing/Remitting Stage): This person may have frequent bouts of symptoms and is forced to make limitations for themselves in order to avoid extreme fatigue and relapse of illness. They reluctantly begin discovering that the simple things they used to enjoy, now must be done with care or sacrificed completely. In this stage, some can lower the frequency of relapse and progression of the disease with help from their doctors and proper nutrition. This person has both "good" and "bad" days, depending on activity and stress.

3) THE LATE STAGE (or the Chronic/Progressive Stage): This person’s disease has progressed to the point where it does not remit. They live each and every day with symptoms that feel much like having the stomach flu, complete with extreme to unimaginable fatigue, muscle aches, weakness, nausea, cognitive difficulties, dizziness and/or pain.