DYSTROPHIC EPIDERMOLYSIS BULLOSA

 What is dystrophic epidermolysis bullosa?

Epidermolysis bullosa is a group of genetic conditions that cause the skin to be very fragile and to blister easily. Blisters and skin erosions form in response to minor injury or friction, such as rubbing or scratching. Dystrophic epidermolysis bullosa (DEB) is one of the major forms of epidermolysis bullosa. The signs and symptoms of this condition vary widely among affected individuals. In mild cases, blistering may primarily affect the hands, feet, knees, and elbows. Severe cases of this condition involve widespread blistering that can lead to vision loss, disfigurement, and other serious medical problems.
Researchers classify dystrophic epidermolysis bullosa into three major types. Although the types differ in severity, their features overlap significantly and they are caused by mutations in the same gene.
Autosomal recessive dystrophic epidermolysis bullosa, Hallopeau-Siemens type (RDEB-HS) is the most severe, classic form of the condition. Affected infants are typically born with widespread blistering and areas of missing skin, often caused by trauma during birth. Most often, blisters are present over the whole body and affect mucous membranes such as the moist lining of the mouth and digestive tract. As the blisters heal, they result in severe scarring. Scarring in the mouth and esophagus can make it difficult to chew and swallow food, leading to chronic malnutrition and slow growth. Additional complications of progressive scarring can include fusion of the fingers and toes, loss of fingernails and toenails, joint deformities (contractures) that restrict movement, and eye inflammation leading to vision loss. Additionally, young adults with the classic form of dystrophic epidermolysis bullosa have a very high risk of developing a form of skin cancer called squamous cell carcinoma, which tends to be unusually aggressive and is often life-threatening.
A second type of autosomal recessive dystrophic epidermolysis bullosa is known as the non-Hallopeau-Siemens type (non-HS RDEB). This form of the condition is somewhat less severe than the classic type and includes a range of subtypes. Blistering is limited to the hands, feet, knees, and elbows in mild cases, but may be widespread in more severe cases. Affected people often have malformed fingernails and toenails. Non-HS RDEB involves scarring in the areas where blisters occur, but this form of the condition does not cause the severe scarring characteristic of the classic type.
The third major type of dystrophic epidermolysis bullosa is known as the autosomal dominant type (DDEB). The signs and symptoms of this condition tend to be milder than those of the autosomal recessive forms, with blistering often limited to the hands, feet, knees, and elbows. The blisters heal with scarring, but it is less severe. Most affected people have malformed fingernails and toenails, and the nails may be lost over time. In the mildest cases, abnormal nails are the only sign of the condition.

How common is dystrophic epidermolysis bullosa?

Considered together, the incidence of all types of dystrophic epidermolysis bullosa is estimated to be 6.5 per million newborns in the United States. The severe autosomal recessive forms of this disorder affect fewer than 1 per million newborns.

What genes are related to dystrophic epidermolysis bullosa?

Mutations in the COL7A1 gene cause all three major forms of dystrophic epidermolysis bullosa. This gene provides instructions for making a protein that is used to assemble type VII collagen. Collagens are molecules that give structure and strength to connective tissues, such as skin, tendons, and ligaments, throughout the body. Type VII collagen plays an important role in strengthening and stabilizing the skin. It is the main component of structures called anchoring fibrils, which anchor the top layer of skin, called the epidermis, to an underlying layer called the dermis.
COL7A1 mutations alter the structure or disrupt the production of type VII collagen, which impairs its ability to help connect the epidermis to the dermis. When type VII collagen is abnormal or missing, friction or other minor trauma can cause the two skin layers to separate. This separation leads to the formation of blisters, which can cause extensive scarring as they heal. Researchers are working to determine how abnormalities of type VII collagen also underlie the increased risk of skin cancer seen in the severe form of dystrophic epidermolysis bullosa.
Read more about the COL7A1 gene.

How do people inherit dystrophic epidermolysis bullosa?

The most severe types of dystrophic epidermolysis bullosa are inherited in an autosomal recessive pattern. Autosomal recessive inheritance means that both copies of the COL7A1 gene in each cell have mutations. Most often, the parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but do not show signs and symptoms of the condition.
A milder form of dystrophic epidermolysis bullosa has an autosomal dominant pattern of inheritance. Autosomal dominant inheritance means that one copy of the altered gene in each cell is sufficient to cause the disorder. About 70 percent of all people with autosomal dominant dystrophic epidermolysis bullosa have inherited an altered COL7A1 gene from an affected parent. The remaining 30 percent of affected people have the condition as a result of a new mutation in the COL7A1 gene. These cases occur in people with no history of the disorder in their family.

Towards a Quantum Mechanical Interpretation of Homeopathy

Michael H.F. Wilkinson

Centre for High Performance Computing,

University of Groningen, Landleven 1,

9747 AN Groningen, The Netherlands

URL: http://rc.service.rug.nl/~michael/mhfw.html

E-mail: michael@rc.service.rug.nl

Summary

A quantum interpretation of the homeopathic method is presented. It is shown that provided

neither the medication itself, nor the patient is observed, a net effect is expected, even at

homeopathic dilutions. The temporal dilution in homeopathic exercise is explained in terms

of Heisenberg's theory of energy-time indeterminacy. The results are fully compatible with

thought experiments of the eminent physicist and cat specialist Erwin Schrödinger.

Introduction

Homeopathic medicine contains fewer than one molecule per dose on average (2, 8). Such

preparations are made by diluting the active ingredient in a solvent, usually water, and

shaking, not stirring, vigorously at each step. Though Bond (1) found evidence that shaking

has a different effect from stirring a liquid, few scientists accept the "memory of water"

theory (2, 8) used to explain the effect of a fraction of a molecule on a patient (5). In the

pages of this distinguished journal, there has been a lively discussion of the effect of extreme

time-dilution in the case of homeopathic exercise (4, 7). It is proposed that exercise in the

order of minutes down to nanoseconds per month shows distinct health benefits. This paper

shows that quantum mechanics gives a sound basis to explain these phenomena.

Quantum theory and spatial dilution.

The famous thought experiment of Erwin Schrödinger describes how according to quantum

mechanics a cat may be in an indeterminate state between living and dead, until a conscious

observation is made. Likewise, Reitz (6) has shown that the location of a cat inside or outside

a garage is unspecified until the creature is observed. This phenomenon explains the curious

"tunneling" of electrons and even entire cats (6) through a region of space in which they

cannot exist. If we take the case of a homeopathic dilution of a single molecule over N flasks

of solvent, quantum mechanics tells us that the molecule is not located in a particular flask

until a conscious observation is made. In quantum parlance, the "wave function" of the

2

particle is said to "collapse" into a specific state (or flask) due to the act of observing.

Incidentally, this is why cats resent people staring at them: the constant collapse of their

wave function is a strain on their delicate senses.

The mathematically inclined reader can show that the expected energy of each flask is given

by (in Dirac notation):

E = E flask + N1 E mol (1)

In words, the energy of the preparation in each flask and any patient taking it, is increased by

the energy of a single molecule divided by the number of flasks, provided they are not

observed. Nonlinear dynamics and chaos theory predict that in a highly nonlinear, or chaotic

system, such a small change in net energy may have a profound effect (the famous "butterfly

effect"). Many humans are notoriously chaotic, so the treatment should have an effect.

However, it is to be stressed that none of these effects can, or indeed should be observed,

directly or indirectly, since this would collapse the wave function into a definite state,

obliterating the subtle, quantum nature of the treatment.

Temporal dilution and energy-time indeterminacy.

Lewbel (4) proposed that exercising 60 s per month (2.6352 x 106 s), or a time dilution of

one over 4.392 x 104, could have significant, homeopathic, health benefits. Steinschneider (7)

uses a value closer to 10-23 s per month at most, or a time dilution of one over 2.6352x1029.

This latter number is similar to the values used for spatial dilutions needed for homeopathic

medicine described above. It is not immediately clear why this should be.

Quantum theory states that the change in energy (DE) of a system and the time taken for that

change (Dt) to occur are related through energy-time indeterminacy:

DEDt ³ h 2p (2)

Combining this with Einstein's E=mc2, and given the value of Planck's constant (h=6.6 x 10-34

Js) the interested reader can show that a kilogram of weight per month could be lost through

homeopathic exercise in the order of 10-51 s. This energy impact may be too large for the

system, so more conservative exercise schemes using say 10-34 s are to be recommended. This

is still many orders of magnitude away from the values proposed in the literature (4, 7).

Discussion

The idea that homeopathic treatment acts on energy levels is in itself not new (3), but no

physical explanation is usually given for the nature of the energy changes. The quantum

theory of homeopathy is actually at odds with leading homeopathic researchers' theories

centered on the "memory of water" (2, 8). In fact, quantum theory shows up serious flaws in

their experiments, in which close, conscious observation of the energy level effects was

3

carried out. In all fairness, the same criticism should be leveled at the critics of said

experiments (5). By the very act of observation, the effects of homeopathic treatment are

destroyed, or at least obscured.

This theoretical approach to homeopathy leads to a whole spectrum of new insights. Given

the quantum nature of homeopathic preparations, collapse of the wave function into a definite

state, i.e., causing the molecules of working substance to be in a limited number of defined

flasks by conscious observation, is a real problem. Quality control should therefore only be

carried out by unconscious personnel. Likewise, there is a real danger that observation of the

patient, and especially of those quantum states pertaining to the ailment, leads to a collapse of

his or her wave function, and may destroy the beneficial effects of treatment. This is

especially true after treatment, and it is therefore recommended that the doctor has no further

contact with a patient after treatment. Best of all, he should move to another town, or for the

truly conscientious, commit suicide. All this is most in the patients' interest.

Cryogenics may have something to offer for practicing homeopaths in this respect. It should

be possible for the doctor to be frozen after treating a patient, and being revived only after

the demise of the patient. In that way, no deleterious effects of observing patients consciously

after treatment should be expected.

This paper is a first step towards a full, quantum understanding of homeopathy. It is clear

that quantum mechanics is the only way to understand the success of homeopathic medicine

in a physical context. It is also immediately clear that doctors should avoid patients after

treatment. Patients must also be aware of their responsibility in this respect. What is not yet

clear is whether conscious observation of patient by doctor pre-treatment may result in the

collapse of the wave-function as well. Double blind trials with doctors either seeing or not

seeing their patients should be carried out in a strictly controlled environment to ascertain the

importance of total patient-avoidance by homeopaths.

References

1. Bond J. (1966) A protocols for correct preparation of vermouth based beverages. J. Wine

Spirits 0:0-7.

2. Davenas E., F. Beauvais, J. Amara, M. Oberbaum, B. Robinzon, A. Miadonna, A.

Tedeschi, B. Pomeranz, P. Fortner, P. Belon. et al. (1988) Human basophil degranulation

by very dilute antiserum against IgE. Nature 333:816-818.

3. James G. (1993) Homeopathy: an energy level therapy. Prof. Nurse 9(1):54-57.

4. Lewbel A. (1997) One minute a month homeopathic exercise program. Ann. Improb. Res.

3(5):2.

5. Maddox J., J. Randi, W. Stewart (1988) High-dilution experiments a delusion. Nature

334:287-290.

6. Reitz, F.B. (1998) Cat tunneling. Ann. Improb. Res. 4(2):25-26.

7. Steinschneider B. (1998) Homeopathic Health Food. Ann. Improb. Res. 4(1):2.

8. Sudan B.J. (1993) Abrogation of facial seborrhoeic dermatitis with homeopathic high

dilutions of tobacco: a new visible model for Benveniste's theory of 'Memory of water'.

Med. Hypotheses 41(5):440-444.

DIABETES- AN OVERVIEW WITH HOMOEOPATHIC TREATMENT

DIABETES- AN OVERVIEW WITH HOMOEOPATHIC TREATMENT

Diabetes once diagnosed is for life. The perseverance and self discipline needed over a lifetime can often tax even the most robust of people to the limit. Those caring for them also require perseverance and an understanding of humanity combined with a cautious optimism, to guide those with diabetes through the peaks and troughs of their lives.

Definition

Diabetes occurs either because of a lack of insulin or because of the presence of factors that oppose the action of insulin. The result of insufficient action of insulin is an increase in blood glucose concentration (hyperglycaemia). Many other metabolic abnormalities occur, notably an increase in ketone bodies in the blood when there is a severe lack of insulin.

Diagnosis

The diagnosis of diabetes must always be established by a blood glucose measurement made in an accredited laboratory.

Glucose tolerance test

The glucose tolerance test is not normally needed in routine clinical practice, and then only if uncertainty exists in younger patients, or to establish an exact diagnosis in pregnancy. For reliable results, glucose tolerance tests should be performed in the morning after an overnight fast, with the patient sitting quietly and not smoking; it is also important that the patient should have normal meals for the previous three days and should not have been dieting. False results may also occur if the patient has been ill recently or has had prolonged bed rest. Blood glucose concentrations are measured fasting and then one and two hours after a drink of 75 g of glucose in 250-350 ml water (in children 1·75 g/kg to a maximum of 75 g), preferably flavoured, for example, with pure lemon juice. Urine tests should be performed before the glucose drink and at  one and two hours.

Interpretation of blood glucose values according to WHO criteria is shown below.

Gestational diabetes

This term embraces the criteria for both diabetes and impaired glucose tolerance when discovered during pregnancy

Glucose tolerance tests may also show:

Renal glycosuria—this occurs when there is glycosuria but normal blood glucose concentrations; this is a benign condition, only rarely indicating unusual forms of renal disease.

It is worth issuing these patients with a certificate to prevent them from being subjected to repeated glucose tolerance tests at every medical examination.

Steeple or lag curve—this is described when fasting and two hour concentrations are normal, but those between are high, causing glycosuria; this is also a benign condition, which most commonly occurs after gastrectomy but may occur in healthy people.

Impaired glucose tolerance

This is defined in the table. Patients are managed at the discretion of the physician. In general, no treatment is given to

 WHO Criteria For The Diagnosis Of Diabetes

1 Symptoms of diabetes plus casual venous plasma glucose _11·1 mmol/l. Casual is defined as any time of day without regard to time since last meal. The classic symptoms of diabetes include polyuria, polydipsia, and unexplained weight loss

2 Fasting plasma glucose _7·0 mmol/l or whole blood _6·1 mmol/l. Fasting is defined as no calorie intake for at least 8 hours

3 2 hour plasma glucose _11·1 mmol/l during oral glucose tolerance test using 75 g glucose load

In the absence of symptoms, these criteria should be confirmed by repeat testing on a different day. If the fasting or random values are not diagnostic, the 2 hour value post-glucose load should be used

Comparison of Type 1 and Type 2 diabetes

Type 1 diabetes Type 2 diabetes

Inflammatory reaction in islets No insulitis Islet B-cells destroyed B-cells function Islet cell antibodies No islet cell antibodies HLA related Not HLA related Not directly inherited Strong genetic basis (some cases)

Other specific types of diabetes

• Genetic defects of _ cell function—chromosome 12 hepatic nuclear factor-1_ (HNF-1_) (formerly maturity onset diabetes of the young (MODY) 3), chromosome 7 glucokinase defect (formerly MODY 2), chromosome 20 HNF-4_ (formerly MODY 1), mitochondrial DNA mutation

• Genetic defects in insulin action—Type A insulin resistance (genetic defects in insulin receptor), lipoatrophic diabetes, genetic defects in the PPAR_ receptor

• Gestational diabetes

• Diseases of the exocrine pancreas—pancreatitis, pancreatectomy, carcinoma of pancreas, cystic fibrosis, fibro-calculous pancreatopathy, haemochromatosis

• Endocrinopathies—acromegaly, Cushing’s disease, Conn’s syndrome, glucagonoma, phaeochromocytoma,

somatostatinoma

• Drug induced (these agents in particular exacerbate hyperglycaemia in patients with established diabetes)—corticosteroids, diazoxide, _ adrenergic agonists (for example, intravenous salbutamol), thiazides, _ interferon

• Uncommon forms of immune mediated diabetes—stiff man syndrome, anti-insulin receptor antibodies

(Type B insulin resistance)

• Infections—congenital rubella, cytomegalovirus

• Other genetic syndromes sometimes associated with diabetes—Wolfram syndrome, Down’s syndrome, Turner’s syndrome, Klinefelter’s syndrome, Prader-Willi syndrome elderly people, but diet, exercise and weight reduction are advisable in younger subjects

Types of diabetes

Type 1 diabetes (previously insulin dependent diabetes) is due to B-cell destruction, usually leading to absolute insulin deficiency). It can be immune mediated or idiopathic.

Type 2 diabetes (previously non-insulin dependent diabetes) ranges from those with predominant insulin resistance associated with relative insulin deficiency, to those with a predominantly insulin secretory defect with insulin resistance.

Type 1 and Type 2 diabetes are the commonest forms of primary diabetes mellitus. The division is important both clinically in assessing the need for treatment, and also in understanding the causes of diabetes which are entirely different in the two groups.

Type 1 diabetes

Type 1 diabetes is due to destruction of B-cells in the pancreatic islets of Langerhans with resulting loss of insulin production. A combination of environmental and genetic factors that trigger an autoimmune attack on the B-cells is responsible, occurring in genetically susceptible individuals. Thus, among monozygotic identical twins only about one-third of the pairs are concordant for diabetes in contrast to the situation in Type 2 diabetes where almost all pairs are concordant. The process of islet destruction probably begins very early in life and is known to start several years before the clinical onset of diabetes.

Associated autoimmune disorders

The incidence of coeliac disease, Addison’s disease, hypothyroidism, and pernicious anaemia are increased in Type 1 diabetic patients, and appear to occur especially in those with persisting islet cell antibodies.

Risks of inheriting diabetes

A child of a mother with Type 1 diabetes has an increased risk of developing the same type of diabetes, amounting to 1-2% by 25 years; the risk is about three times greater if the father has this disease. If both parents have the disease the risk is further increased and genetic counselling should be sought by these rare couples.

Type 2 diabetes

There are numerous causes of Type 2 diabetes, which is now known to include a wide range of disorders with differing progression and outlook. The underlying mechanism is due either to diminished insulin secretion—that is, an islet defect, associated with increased peripheral resistance to the action of insulin resulting in decreased peripheral glucose uptake, or increased hepatic glucose output. Probably as many as 98% of Type 2 diabetic patients are “idiopathic”—that is, no specific causative defect has been identified. Whether decreasing insulin secretion or increasing insulin resistance occurs first is still uncertain, but the sequence of events may vary in different individuals. Obesity is the commonest cause of insulin resistance.

Other rare insulin resistant states are shown below:

Obesity

Relative insulin resistance occurs in obese subjects, perhaps because of down regulation of insulin receptors due to hyperinsulinaemia. Obese subjects have a considerably increased risk of developing Type 2 diabetes. Fat distribution is relevant to the development of diabetes, so that those who are “apple shaped” (android obesity, waist-hip ratio_0·9) are more prone to Type 2 diabetes than those who are “pear shaped”

(gynoid obesity, waist-hip ratio_0·7).

The importance of leptin in the evolution of lifestyle related obesity is unclear. Leptin is a single chain peptide produced by adipose tissue and its receptors are expressed widely throughout the brain and peripheral tissues; when injected into leptin deficient rodents it causes profound hypophagia and weight loss. Plasma leptin levels rise in parallel with body fat content. Although very rare cases of morbid obesity due to leptin deficiency have been reported, and are shown to respond to leptin injections, there is in general an absence of measurable biological responses to leptin, which at present has no role in the management of obesity.

Increased risk for Type 2 diabetes

• People over 40 years of age

• People of Asian or African-Caribbean ethnic origin

• Overweight people

• Family history of diabetes

• History of gestational diabetes

• History of large baby (birth weight exceeding 4 kg)

Rare syndromes

Polycystic ovary syndrome

Syndrome x* hypertension

* Syndrome x includes hyperlipidaemia, hyperinsulinaemia, and glucose intolerance

Natural history of Type 2 diabetes

Birthweight and Type 2 diabetes

Recent observations suggest a relationship between low b irthweight and the development in middle age of insulin resistance, Type 2 diabetes, and coronary artery disease. Those who are smallest at birth and largest at one year of age are most at risk.

Dominantly inherited Type 2 diabetes (MODY)

Seven genetic syndromes, three of which are shown in the box at the top of page 2, cause MODY—defined as an early onset of dominantly inherited Type 2 diabetes. Two (or at the very least one) members of such families should have been diagnosed before 25 years of age, three generations (usually first-degree) should have diabetes, and they should not normally require insulin until they have had diabetes for more than five years.

Mitochondrial diabetes

Mitochondrial diabetes and deafness is a rare form of diabetes maternally transmitted, and is related to the A3243G mitochondrial DNA mutation. Diabetes is diagnosed in the fourth to fifth decades, usually in thin patients with symptoms. Patients respond better to sulphonylureas than to diet alone. Diabetic microvascular complications do occur.

Insulin resistant diabetes

Some rare insulin resistant states exist in which hundreds or even thousands of units of insulin may be ineffective. They are often associated with lipodystrophy, hyperlipidaemia, and acanthosis nigricans. Type A insulin resistance is due to genetic defects in the insulin receptor or in the post-receptor pathway.

Type B insulin resistance occurs as a result of IgG autoantibodies directed against the insulin receptor; it is often associated with other autoimmune disorders such as systemic lupus erythematosis, and it is much commoner in women of African descent.

Ethnic variations

The prevalence of Type 2 diabetes is particularly high in Asian and African-Caribbean people and presents a considerable health burden in some inner urban areas.

Prevention Of Type 2 Diabetes

Lifestyle changes in those prone to Type 2 diabetes can effectively delay the onset of this disease. Several studies in different countries have demonstrated the feasibility of achieving this by a programme of weight reduction, improved diet (less fat, less saturated fat, and more dietary fibre) and increased physical activity. Recent investigations show that the development of diabetes can be approximately halved if these lifestyle changes are maintained over four years.

Diabetic Complications

Patients with long-standing diabetes, both Type 1 and Type 2, may develop complications affecting the eyes, kidneys or nerves (microvascular complications) or major arteries. The major arteries are affected in people with diabetes, causing a substantial increase both in coronary artery disease and strokes as well as peripheral vascular disease. The greatest risk of large vessel disease occurs in those diabetic patients who develop proteinuria or microalbuminuria, which is  associated with widespread vascular damage. The distribution of arterial narrowing tends to be more distal than in non-diabetic people, whether in coronary arteries or in the peripheral arteries affecting feet and legs.

Medial arterial calcification (Monckeberg’s sclerosis) is also substantially increased in patients with neuropathy and in those with renal impairment. The functional effects of vascular calcification are uncertain.

Symptoms

Thirst, tiredness, pruritus vulvae or balanitis, polyuria, and weight loss are the familiar symptoms of diabetes.  Dry mouth rather than thirst, and patients have been investigated for dysphagia when dehydration was the cause. Polyuria is often treated blindly with antibiotics; it may cause enuresis in young people and incontinence in elderly people and the true diagnosis is often overlooked. Complex urological investigations and even circumcision are sometimes performed before diabetes is considered.

Confusion in diagnosis

Some diabetic patients present chiefly with weight loss. Perhaps weakness, tiredness, and lethargy, which may be the dominant symptoms, are the most commonly misinterpreted; “tonics” and iron are sometimes given as the symptoms worsen.

Deteriorating vision is not uncommon as a presentation, due either to change of refraction causing myopia (mainly in Type 1 diabetes) or to the early development of retinopathy (mainly in Type 2 diabetes). Foot ulceration or sepsis in older patients brings them to accident and emergency departments and is nearly always due to diabetes. Occasionally painful neuropathy is the presenting symptom, causing extreme pain in the feet, thighs, or trunk. Glycosuria itself is responsible for the monilial overgrowth which causes pruritus vulvae or balanitis; some older men are first aware of diabetes when they notice white spots on their trousers.

Patterns Of Presentation

Symptoms are similar in the two types of diabetes (Type 1 and Type 2), but they vary in their intensity. The presentation is most typical and the symptoms develop most rapidly in patients with Type 1 diabetes; they usually develop over some weeks, but the duration may be a few days to a few months. There is usually considerable weight loss and exhaustion. If the diagnosis is missed, diabetic ketoacidosis occurs. Type 1 diabetes occurs under 40 years of age in approximately 70% of cases but can occur at any age, and even in

Symptoms in patients with Type 2 diabetes are similar but tend to be insidious in their onset; sometimes these patients deny any symptoms, although they often admit to feeling more energetic after treatment has been started. These patients are usually middle aged or elderly, but increasingly children, especially those of ethnic minorities, or those who are inert and overweight, are developing Type 2 diabetes. Microvascular and macrovascular complications are frequently already present when Type 2 diabetes is diagnosed. Type 2 diabetes is commonly detected at routine medical examinations or on admission to hospital with another illness.

Simple dietary guidelines

• Never take any form of sugar

• Do not take too much fat

• There is no need to restrict most meat, fish, or vegetables

• Control your weight

A diabetic diet: elimination of sugar/glucose/sucrose

Do not eat or drink:

• Sugar or glucose in any form and do not use sugar in your cooking

• Jam, marmalade, honey, syrup, or lemon curd

• Sweets or chocolates

• Cakes and sweet biscuits

• Tinned fruit

• Lucozade, Ribena, Coca-Cola, Pepsi-Cola, lemonade, or other fizzy drinks

You may use artificial sweeteners, such as saccharin, Sweetex, Hermesetas, Saxin, but NOT Sucron, and any sugar-free drinks including squashes and Slimline range

Fibre content of diet

The following will increase the fibre content of the diet:

Bread Wholemeal or stoneground— wholemeal for preference

If these are not available use HiBran or wheatmeal or granary loaves

Biscuits and crispbreads Ryvita, Macvita, and similar varieties. Digestive, oatcakes,

coconut, and bran biscuits, etc.

Breakfast cereals Porridge, Weetabix, Weetaflakes, All Bran, Bran Buds, Shredded Wheat, Oat Krunchies, muesli, Alpen, and similar cereals

Wholemeal flour or Should be used with white flour

100% rye flour for making bread, scones, cakes, biscuits, puddings, etc

Fresh fruit and vegetables Should be included at least twice daily. The skin and peel of fruit

and vegetables such as apples, pears, plums, tomatoes, and potatoes should be eaten

Dried fruit and nuts Eat frequently

Brown rice, wholemeal pasta

Pulse vegetables Such as peas and all varieties of beans

Foods suitable during intercurrent illness

For patients who are feeling ill but need to maintain their carbohydrate intake, the following are useful (each item contains 10 g of carbohydrate):

• 1/3 pint (0.15 l) tinned soup

• 1 glass fruit juice

• 1 scoop of ice cream

• 1 glass of milk

The following each contain 20 g of carbohydrate:

• 2 teaspoons Horlicks and milk

• 2 digestive biscuits

• 1 Weetabix and a glass of milk

• 1 ordinary fruit yoghurt

• “Build-up” made with 1/2 a pint (0.25 l) of milk and 1/2 a sachet

Optimal control may not be needed and it is best to interfere as little as possible with the patient’s usual way of life.

Diets for Type 1 diabetic patients

Greater finesse is required in managing the diets of Type 1 diabetic patients; if they eat too much, diabetic control deteriorates; if they eat too little they become hypoglycaemic. The important principles are that carbohydrate intake should be steady from day to day and that it should be taken at fairly regular times each day. Severe carbohydrate restriction is not necessarily required; indeed, if the diet is fairly generous patients are less likely to resort to a high fat intake, which may be harmful in the long term. The actual requirement for carbohydrate varies considerably; it is unsatisfactory to recommend less than 100 g daily, and control may become more difficult if more than 250 g daily is allowed. The smaller amounts are more suitable

for elderly, sedentary patients while the larger amounts are more appropriate for younger, very active people particularly athletes who may need considerably more. Although it has been observed that not all carbohydrate-containing foodstuffs are equally absorbed and that they do not have the same influence on blood glucose values, it is impracticable to make allowances for such variations other than recommending that sugar (sucrose) should be avoided except for the treatment of hypoglycaemia.

For social convenience it is customary to advise that most of carbohydrate should be taken at the main meals—breakfast, lunch, and dinner—even though these are not necessarily the times when, according to blood glucose profiles, most carbohydrate is needed; for example, less carbohydrate at breakfast and more at mid-morning and lunch often improves the profile. Snacks should be taken between meals—that is, at elevenses, during the afternoon, and at bedtime—to prevent hypoglycaemia. At least the morning and night snacks are essential and should never be missed.

For the convenience of some, and for those adopting the DAFNE method of controlling Type I diabetes and therefore needing to calculate the carbohydrate content of their meals, 10 g of carbohydrate is described as “one portion” so that a 170 g carbohydrate diet is described to patients as one of “17 portions”. Patients sometimes find it valuable to know the carbohydrate values of different foodstuffs.

Weight control: the role of exercise

Weight control towards optimal levels yields considerable health benefits to all, notably in this context to those who have the combined disadvantages of being overweight and having Type 2 diabetes. Exercise has a central role in weight reduction and health improvement. The proven benefits include reduced insulin resistance (hence enhanced insulin sensitivity) leading to better glycaemic control which may even be independent of actual weight reduction. Risk factors for cardiovascular disease,

A sample meal plan for a Type 1 diabetic

Carbohydrate Recommended food portions and drink

Breakfast

1 Fruit

1 Wholemeal cereal

1 Milk

1 Wholemeal bread

Egg/grilled bacon

Tea/coffee

Mid-morning

1 Fruit/plain biscuit

Tea/coffee/diet drink

Lunch Lean meat/fish/

egg/cheese

2 Potatoes/bread/rice/pasta

Vegetable salad

2 Fruit/sugar-free pudding

Mid-afternoon

1 Fruit/plain biscuit

Tea/coffee/diet drink

Dinner Lean meat/fish/eggs/cheese

2 Potatoes/bread/rice/pasta/Vegetable salad

2 Fruit/sugar-free pudding

Bed-time

1 Bread/fruit/plain biscuit

Tea/coffee/diet drink

Total 15

Alcohol

• Alcohols containing simple sugar should not be drunk by people with diabetes, especially sweet wines and liqueurs

• Dry wines and spirits are mainly sugar-free and do not present special problems

• Beers and lagers have a relatively high sugar and calorie content and their amount needs to be both limited and counted as part of the controlled carbohydrate intake

• Sugar-free beers are high in calorie and alcohol content and therefore have some limitations to their usefulness, whereas “low alcohol” beers are high in carbohydrate • Profound hypoglycaemia may be provoked in those who take large amounts of alcohol, and omit their normal diet, especially in those taking sulphonylureas; this can be dangerous

• Normal social drinking is usually free from this hazard but care is still needed

• Reduction in alcohol intake is sometimes an important part of helping weight loss

A Healthy Lifestyle

This include high blood pressure, also diminish. Indeed, the prevention of Type 2 diabetes itself in those at high risk has been amply demonstrated . People with osteoarthritis, chronic heart failure, and chronic lung disease all benefit from appropriate exercise programmes and weight reduction, and there are advantages to those recovering from myocardial infarction. A healthier life is also gained by the very old and by the overweight child. For those with Type 2 diabetes it is recommended that exercise of moderate intensity should be undertaken for about 30 minutes each day. This can include walking, as well as both aerobic and resistance exercise. The effects of exercise in Type 1 diabetes present the hazard of hypoglycaemia and it is not a specific contributor to improvement of diabetes control. Advice is required on the use of insulin and the need for additional food (in particular carbohydrate) before, during, and after periods of exercise

especially (since hypoglycaemia may develop after cessation of exercise) for those engaged in major sports and athletics. The challenge for sportsmen can be extreme but nevertheless people with Type 1 diabetes are known for huge achievements.

Smoking

The addiction of smoking is now well established. Its harmful effects are numerous, and include a substantial increase in cardiovascular and peripheral vascular disease as well as the best known consequences of lung cancer and chronic obstructive pulmonary disease. In diabetes, higher rates of both nephropathy and retinopathy have been well documented.

A SHORT DESCRIPTION ABOUT THE POLYCRESTS - LYCOPODIUM CLAVATUM

LYCOPODIUM CLAVATUM

 General description and domicile:
Lycopodium is an evergreen plant native to Europe and North America. It is a slender, trailing plant. The roots of this moss resembles a claw - hence the name Wolf's Claw. Lycopodium grows wild in most of the northern hemisphere. In summer the plant produces spore cases at the tips of the stalks.

Part used and extraction:
In summer the spores are harvested by cutting the spikes and shaking the spores from the end of the spikes.

Remedy preparation:
The spores are soaked in alcohol for a week or more before it is filtered to obtain the mother tincture.

History:
This plant has been used medicinally since the middle ages when the spores were given to people suffering from gout, digestive disorders, kidney stones and water retention. The spores were also used as a coating on pills because of the water resistance of the spores. The spores are very flammable and were used in fireworks.

Remedy profile:
Good for chronic insecurity or fear of an upcoming event. Best for people that have a low self esteem and tend to hide this behind overconfidence and brashness. Night fears, sleeplessness, nightmares and headaches.
Physical symptoms are digestive disorders tending to bloating and wind. Low energy levels specifically in afternoons. Kidney stones, impotence and prostate disorders benefit men. Complaints often originate in the right of the body.

This drug is inert until the spores are crushed. Its wonderful medicinal properties are only disclosed by trituration and succussion.

In nearly all cases where Lycopodium Clavatum is the remedy, some evidence of urinary or digestive disturbance will be found. Corresponds to Grauvogle’s carbo-nitrogenoid constitution, the non-eliminative lithemic. Lycopodium is adapted more especially to ailments gradually developing, functional power weakening, with failures of the digestive powers, where the function of the liver is seriously disturbed.

 Atony. malnutrition. Mild temperaments of lymphatic constitutions, with catarrhal tendencies; older persons, where the skin shows yellowish spots, earthy complexion, uric acid diathesis, etc.; also precocious, weakly children.

Symptoms characteristically run from right to left, acts especially on RIGHT side of body, and are worse from about 4 to 8 P.M.

In kidney affections, Red sand in urine, backache, in renal region; worse before urination. Intolerant of cold drinks; Craves everything warm. Best adapted to persons intellectually keen, but of weak, muscular power.

Deep-seated, progressive, chronic diseases. Carcinoma. Emaciation. Debility in morning. Marked regulating influence upon the glandular (sebaceous) secretions. Pre-senility. Ascites, in liver disease. Lycop. patient is thin, withered, full of gas and dry. Lacks vital heat; has poor circulation, cold extremities. Pains come and go suddenly. Sensitive to noise and odors.Throat and stomach are better from warm drinks.

Key Symptoms:
Bloat, low self esteem, dread of upcoming event, constipation, insecurity. Craving for sweet comforting foods.

Used for treatment of:

Digestion:
Bloat and constipation as well as nausea, heartburn, effects of overeating and bleeding hemorrhoids.

Anxiety and fear:
Particularly fear of failure and a sense of inferiority. People that tend to hide a sense of inferiority by exaggerating their achievements and project an aura of false confidence. Aversion to change and fear of upcoming events typically those that are in the limelight like public speaking. Fear of failing in exams can lead to fear of exams or being tested. Fear is often accompanied by bowel disorders.

Prostate and kidney complaints:
Enlarged prostrate, sand like gravel in urine, blood in urine, mostly in men.

Skin disorders:
Psoriasis, nettle rash and other allergic reactions of the skin.

General Symptoms Worse for: Factors/Conditions that make the symptoms worse
After 4pm and before 8pm,
Hot weather
Tight clothes
Hot, stuffy rooms,
Extreme cold
Overeating
Cold drinks

General Symptoms Better for: Factors/Conditions that improve symptoms
Cool, fresh air
Late Night
Loose clothes
Hot meal and drink
Light exercise

 Some of the prominent components of Lycopodium are:

 – Lack of self-confidence;

 – Egotism;

 – Sentimentality;

 – Memory poor;

 – Irritability;

 – Cowardice; fear of people;

 – Desires company;

 – Contradiction, intolerance of;

 – Hurry/Impatience/Restlessness;

 – Lascivious;

 – Moods changeable;

 – Avarice;

 – Conscientious.

Every Lycopodium patient will have a combination of some of these attributes. Which of them will be prominent will depend upon age, sex and social situation. The ones approved by the society in which he operates will be prominent, while those which are frown upon will appear in a milder or compensated form.

 For example, in a society where lasciviousness is considered a sin, you will find the patient has compensated for it by some means. Or where egotism is frowned upon, the patient will try to avoid a display of this quality. Sometimes, he may purposely denigrate himself, so that even by mistake he does not sound egotistical.

Again, in an adult, cowardice my be hidden by an outward show of bravado. This becomes necessary to protect his ego. Occasionally, the Lycopodium patient may take recourse to tall talk, boasting with false bravado. This eventually produces a feeling of guilt with a fear of being discovered.

 An offshoot of this egotism is the censorious attitude towards others. The Lycopodium patient is not unhappy with others, but he nevertheless criticizes them in order to establish his own superiority. At the same time, his “Conscientiousness” will not allow him to overcriticize others. However, he will justify his criticism and say (and feel) that it is his duty to do so in the interest of the person criticized. Thus, Lycopodium can be very subtle in his criticism of others.

 “Egotism” also makes him “Intolerant of contradiction”. His views are supreme and must be accepted. This creates a lot of hurt feelings in those around him, and also for the Lycopodium patient himself. In the Repertory, “Egotism” is also to be compared with rubrics like: “Haughty”, “Contemptuous”, “Presumptuous”, etc. This egotism ultimately shapes many symptoms of Lycopodium.

 The Lycopodium child will have: “Fear of new people”, “Fear of men”, “Fear of strangers”, “Cowardice”, “Timidity”, etc. Hence, he stays away from new situations and new people, sticking always to the familiar and the known. In an adult this quality gets heavily compensated or overcompensated.

 Lycopodium’s ego does not allow him to accept his “Cowardice”, “Lack of self- confidence” and “Fear of men and people”. So he creates for himself a world within a world, where he surrounds himself with people whom he does not have to fear, but, in fact, who fear him. He will select a woman who is mild, who will never raise her voice and he will marry her. The Pulsatilla woman is the best for him, I suspect. In his work, play and social situation, he will gather around him only such people whom he can dominate and who he needs not fear.

 Also such people will praise him and boost his ego. They will never contradict him. In such an environment, Lycopodium will dominate, dictate and rule with an iron hand. But outside the safety of his domain, he will still remain anxious and timid. He will never venture out of this domain; yet, at the same time, he will seek to expand it, and will bring more and more people under his power. This situation is found under the rubric “Love of power”.

 This “Love of power” makes Lycopodium very ambitious. He will seek to achieve a position where he can dictate to others and he dare not be contradicted. Whether it is political power, or scientific authority or even an executive post or as the head of an institution, Lycopodium seeks power anywhere and everywhere. A frustrated ambition, displacement, even retirement can be a severe blow for Lycopodium. He may not give up so easily; nevertheless, there are going to be times when he is deeply upset about the whole incident.

 Lycopodium represents the constant struggle of a man between “Cowardice” and “Egotism”, between “Lack of confidence” and “Haughtiness”, between “Timidity” and “Dictatorial” attitude. The earliest signs of this struggle are seen in childhood. The child is usually lean. He is timid, especially in the presence of new people. For example, it would be difficult for him to approach a shopkeeper for something. He wants to speak on the stage before an audience, but gets a stage-fright. So, he indulges in childish fancies and theories and has to remain content with this for some time. He imagines, or dreams, that he is someone big, a leader of people, a much respected and powerful man – “Delusion, childish fantasies, has”.

 Lycopodium remains a loner; he cannot make new friends easily and does not like to play. This “Aversion to play in children” arises out of his timidity and also his physical weakness. He is scared also because his brain is more developed than his physique. He is scared of those in authority, of his father and of the head of the college, but not of his mother. So, in his home, he dominates, rules like a tyrant, makes others do what he wishes, commands them; but in the school he is an angel, a pet of his teacher. To those with whom he can be, he is rude and contemptuous – “Contemptuous, hard on subordinates and agreeable to superiors or people he has to fear”.

 Once, a child of six or seven was brought to the OPD. The parents were describing the child’s nature, and I was observing the child. He was mild, reserved, scared, timid and cowardly, whereas his parents were saying that he was very irritable, rude and dictatorial. The contrast between what the child did in a familiar circumstances and what he did in the presence of new people struck me and enabled me to give a prescription of Lycopodium with success. 

 This contrast comes up again when deciding about his profession, his future. His two main considerations in this respect are: security, and a position of power and a challenging job. Therefore, he will have a lot of irresolution while searching for a job that fulfils both these needs. Ultimately security will win, but he will scheme and plan for a better position in the future.

 With this basic framework, let us now examine the other aspects of the Lycopodium personality.

 “Desire for company”: Firstly, Lycopodium has a fear of being alone in a hostile world, amidst unfamiliar persons. He seeks out known persons, wants someone around him all the time, “even if in the next room”, or to accompany him. Thus, he becomes dependent on those few relationships that he develops and he feels anxious if these are threatened by illness or death or if they move away. This makes the Lycopodium appears sentimental, desiring company, affectionate, sympathetic and these qualities make Lycopodium appear like Phosphorus, but the big difference is that the Lycopodium does not like others to depend on him. He would like to avoid responsibility as far as possible. Hence the rubrics: “Estranged, flies from her own children” and “Escape, attempts to, from her family, children”. 

 “Lasciviousness”: Next comes the “Lasciviousness” of Lycopodium which, with his desire for company, leads to love affairs. His fear of the new initially makes him shun them, but once he overcomes the fear, he plans the love affair with great care and thought, that is the characteristic approach of Lycopodium to all his problems.

 He is willing to share and give, but not to commit. So, when an affair reaches a peak, he backs out. Thus, he has a string of love affairs until he eventually decides to settle down. Lycopodium usually has late marriage. He now plans the choosing of his spouse seriously – one whom he can depend upon, lean on, who can be his constant companion, one who can be relatively independent but who can reciprocate his warmth and care and allow him to dominate. When he finds such a mate, he marries.

 “Strong sense of duty”: The third feature of the Lycopodium personality is his “Strong sense of duty”. Once he commits, he accepts full responsibility, as he is duty bound to do. In short, once he commits himself he is not irresponsible.

 “Affectionate”: Another feature of the Lycopodium personality is that behind his irritable exterior he can be very “Affectionate”, “Sentimental” and “Emotional”. Hence, the rubric: “Abrupt, rough, yet affectionate”. The sentimental and emotional part of Lycopodium is rarely seen; it is often hidden. He can weep when seeing sentimental scenes, both of joy and sorrow. Nostalgia, pleasant memories, relationships with his parents, memories of his relatives – these can cause tears. Thus the rubric: “Weeps when thanks”. He can be sentimental also from scenes in novels and cinema.

 Naturally, with all these contradictions in his nature – his irritability and sympathy, his cowardice and love of power, his lack of confidence and dictatorial tendency – all these are bound to create a split in his personality and give rise to two symptoms: “Irresolution” and “Moods changeable”.

 Let me now emphasize two more aspects of Lycopodium, viz. hurry and impatience, and restlessness.

 “Hurry”: “Hurry” is a component which usually does not need to be compensated, as it is encouraged and approved by social standards. In this fast paced world, hurry can be an asset. Therefore, this symptom of Lycopodium will be found directly in most patients. They do things fast, but not necessarily in an orderly manner. They are impatient and cannot wait for anything (like Histaminum). In the clinic during the interview, especially during the follow-ups, they are quite impatient and want to get away quickly. Combined with their poor memory, this impatience accounts for a lot of mistakes. So, there are mistakes in speech, writing, etc. Their mind works too fast, and is always racing ahead (Natrum muriaticum lives in the past, while Lycopodium lives in the future).

 “Weakness of memory”: Another aspect of Lycopodium is his “Weakness of memory” and “Mistakes in speech and writing”. The weakness of memory is especially for proper names; it also extends to dates, events and the things he has to do. This poor memory is a big handicap for Lycopodium.

 In some aspects, Lycopodium resembles Nux vomica with the irritability, impatience and dictatorial nature. These two remedies may come close, but the main difference is that Nux vomica is not so cowardly inside; he is more rash and audacious. He is more forceful and expressive, more impulsive and explosive. From a young age we can see this difference. Lycopodium has a shy and introverted childhood, while Nux vomica has a daring and mischievous one.

 In adulthood, when given a job, a Nux vomica will do it “by hook or crook” and he will break all the obstacles in his way like a “road roller”. He can often get violent. The Lycopodium is not so ardent and daring; he weighs each step and does not rush into things. If the obstacle is big, he will hesitate and may even withdraw.

 Other remedies to be compared are Aurum metallicum, Staphysagria, Chelidonium, Phosphoricum acidum, Platinum, Medorrhinum, Sulphur (Lycopodium is called vegetable Sulphur), China, Silicea, Argentum nitricum, Bryonia, Calcarea carbonica (the exact opposite of Lycopodium in that Calcarea carbonica is slow and indolent while Lycopodium is fast paced and emotional).

 Lycopodium is a man who was told  that he is not loved as he is, but only if he achieves something in his life. So his feelings are connected with achievement. He feels he must achieve in order to be loved. A mother tells her son: “Look on, you must achieve a position of eminence for me to care for you, to feel good about you and value you.” He receives the message that in order to get her love he must achieve, reach somewhere which is not easy, but difficult, because the circumstances around him are difficult. When Shivaji’s mother told him: “You must reach that fort and conquer it”, he had no army and the fort belonged to the Emperor, so he had an uphill task. He had to collect an army around him, to conquer and achieve what his mother wanted to do; and when he said: “Mother, I have done it”, she replied: “Conquer another fort.” Lycopodium is the son of a mother who demands achievement, the son of a father demanding achievement.

 In order to conquer and achieve he needs people to whom he can dictate, he needs an army around him, and he is afraid that he will not reach the goal, it is too difficult. So, he has “Anticipatory anxiety” and “Lack of self-confidence”. On one side he has “Egotism”, “Ambition”, “Love of power” and “Dominance” and on the other side he feels uneasy without achievement. It is the feeling of inferiority which requires him to be egoistic. Lycopodium is duty conscious because he feels it is his duty to please the person who demands, yet he feels that his slender means reduce his capacity, therefore the rubric: “Fear, unable to reach his destination”.

 This feature of love of power and achievement never leaves a Lycopodium patient even when he tries to look for a wife; he feels that a woman can love him only if he achieves. When he is close to a woman, he wants her to like him not because he is what he is, but because of his achievements. He does not like a woman who likes him for what he is. He feels the need to show her that he is achieving, and he constantly emphasizes that he is a great achiever. The moment he knows that it is not so, the whole relationship breaks down. He always likes to be on a pedestal; if he steps down from the pedestal, he is low/short. He has to be on a pedestal. He has to be an achiever.

 When a woman leaves a Lycopodium person, he feels she left him because he had not achieved. He will now be more busy in achieving; he has no attachment to his children – rubrics: “Children, flies from his own”, “Indifference to her children”, “Estranged, flies from her own children”, “Escape, attempts to, from her own children”.

Relationships
Complementary: Lycop. acts with special benefit After calcar. and Sulphur. Iod.; Graphites; Lach.; Chelidon.

Antidotes: Camph.; Puls.; Caust.

Compare: Carbo-nitrogenoid Constitution: Sulphur; Rhus; Urtica; Mercur.; Hepar. Alumina ( Lycop. is the only vegetable that takes up aluminum. T. F. Allen.) Ant. c.; Nat-m.; Bry.; Nux; Bothrops (Day-blindness; can scarcely see after sunrise; pain in right great toe). Plumbago Littoralis - A Brazilian plant - (Costive with red urine, pain in kidneys and joints and body generally; milky saliva, ulcerated mouth). Hydrast. follows Lycopodium Clavatum. in indigestion.