FAT DISTRIBUTION: WAIST-TO-FOP RATIO (WHR) AND WAIST CIRCUMFERENCE

WHR is a ratio of abdominal subcutaneous and visceral fat to hip subcutaneous fat. The measure is ‘anchored’ to a measure around the hips because it had been thought that this was less variable to change. Recently though, Canadian researchers at Laval University in Quebec have suggested that waist measures alone may be sufficient. WHRs (or other ratio measures used, such as waist-to-thigh ratio) generally have a cut-off point determined by epidemiological studies with large populations. Figures of 0.9 for men and 0.8 for women are often used as the cut-off points for WHR beyond which increased disease risk is indicated, but in some studies the figures of 1.0 and 0.9 respectively are used.

Some research has shown that with fat loss in some people, there is a loss from the hips as well as the waist and therefore WHR can remain relatively constant. For this reason it is probably best used as an absolute measure of risk in the first instance of measurement, rather than a relative measure of change, and is best used in combination with other measures such as BMI.

Attempts are currently being made to incorporate WHR and BMI into a single formula, but so far these have not added to the individual predictive value of either single measure. Waist measurements suggested by the Laval group as indicative of disease risk are above 100cm for men and 90cm for women—irrespective of height. Researchers at Glasgow University8 have compared waist measurements with BMI and have come up with the following conclusions for health promotion:

• men with a waist size of > 102cm and women with a waist size of >92cm should be encouraged to lose weight

• men with a waist of between 94-102cm and women with a waist of 80-88cm should be encouraged not to put on any more weight

• men with a waist size of <92cm and women with a waist size of <80cm do not need weight management.

WHR has a relatively high validity in the measurement of abdominal fat distribution, particularly in men and post-meno-pausal women, however validity may be affected by changes in hip size that occur with changes in body fatness. Reliability and sensitivity of waist measures alone is quite high, particularly in the hands of an experienced measurer.

Correct sites for measurement of waist and hips can vary and although there are currently attempts to standardise these, there is still controversy about the correct locations. There is general agreement that hips should be measured at the widest part of the buttocks as determined from side-on. Protocols for waist measurement include measures at umbilicus (the navel), which has the particular advantage of being easy to find, but the disadvantage of being almost at hip level in some obese women. Another waist site is mid-way between the lowest rib and the top of the iliac crest (hip bone), which has the advantage of bony landmarks but does not always capture the large abdominal mass in very obese people. In lean people the waist is the narrowest part between the chest and the hips but in obese people it can be the widest, therefore this is not recommended as a definition. Each has its disadvantages, but provided the measure is used constantly, the actual site becomes less relevant.

WHR and waist circumference measures have the advantages of being quick, non-intrusive and useful for large scale population surveys. WHR has disadvantages in making comparisons between varying groups of people such as is often seen in different cultural groups. Asian women, for example, have small hips and WHR measures are much less valid as an indicator of health risk. Negroid women on the other hand have large hips and buttocks and their health risk may be misinterpreted from WHR measures. Overall WHR, or waist alone, may provide a quick and simple indication of health risk. Waist alone can then be used to examine the success of a fat loss program in those groups where abdominal fat is stored readily.

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BABY AND CHILDHOOD HEART DISORDERS: CONGENITAL HEART DISEASE

Congenital heart disease occurs in six to eight babies for every 1000 born. Nobody is certain why it happens. In some cases, the mother may have suffered from a bout of rubella in the early days of pregnancy. But with widespread use of vaccination this is becoming much less common.

So-called chromosomal abnormalities may take place. This means there has been damage to the fine filaments in the cells, occurring soon after conception. Once more, the reason why this happens is usually elusive. If a parent or other member of the family has this disorder, there may be an increased risk for future babies. Certain drugs taken during pregnancy may cause some cases. X-rays of the mother during pregnancy may in some cases be responsible. But in most, there is no known obvious cause.

Severe cases may result in the baby perishing during the first year of life. However, in recent years enormous progress has been made in medical research, and many cases can be surgically corrected to allow the child to develop into normal adulthood.

There are many and varied symptoms, but as a general guide the following should alert a parent to seek medical advice promptly. It could indicate some kind of heart disorder.

The infant or child may show a poor weight gain, and there are commonly feeding problems. There may be attacks of fainting, or even blackouts. In young infants this may show up as sighing bouts, when the infant becomes pale.

The infant may have difficulty in swallowing and may have a tendency to regurgitate curdled milk. Or may have difficulty in breathing comfortably. Sometimes the mother finds that the little fellow is more comfortable if he bends backwards. Often the child may decline activity and normal exercises which are being enjoyed by his or her friends. The child may simply want to squat down and watch the others at play.

Some cases are accompanied by a bluish skin colour- called cyanosis. This may occur from a very early age. A check of the mother’s case history may indicate that during pregnancy she suffered from rubella or had various other abnormalities.

Treatment

Any suspicious symptom needs prompt medical attention. The paediatrician has the facilities and knowledge for investigating all kinds of heart abnormalities. In the first instance this medical specialist will be seen because the parents feel their baby is not well or not normal. It is then up to the paediatrician to initiate the investigations and tests that will give the correct diagnosis.

Many different kinds of heart abnormalities exist, and because they are intricate and detailed we cannot here go into a minute study of them. But they involve various, single or multiple defects. There may be narrowing of the entrance to the different vessels; valves may be deficient and defective. One side of the heart may be connected directly with the other side via holes which should not be present. Similarly, the large heart vessels may interconnect in the wrong places. These will all lead to symptoms, and an increasing strain on the heart and on the child’s health in general.

Left unchecked, many of these will cause a deterioration of health either rapidly or during a period of some years. The outlook, when untreated, is usually poor.

However, with correct therapy, which often involves surgery, the outlook has been revolutionized in the past few years and in many cases the future prospect is excellent.

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BABY AND CHILDHOOD INFECTIOUS DISEASES: IMMUNIZATION AFTER CHILDHOOD

‘Are schoolgirls still given rubella vaccines?’ Jane asked.

‘They certainly are. It’s offered to any girl between the age of 12 and 14 years, usually soon after they enter secondary school. Again, a single injection is given, and this appears to give adequate immunity. Medical practitioners may also immunize girls and women in the childbearing years. However, it is advised that it shouldn’t be given to pregnant women or to any woman who may become pregnant within two months of immunization. But it’s available again to women in maternity hospitals immediately after they have been confined if they haven’t already been immunized.’

‘How about smallpox vaccine? Is that a dead topic, or still alive?’

‘It is now believed that smallpox, once a terrible killer, may have been virtually eliminated from the face of the globe. Many countries have relaxed their laws requiring vaccination. But a few are still holding on, and it is now only recommended for persons travelling to countries that specifically insist on vaccination.’

‘What about booster shots and all that? The story seems to be a never-ending one,’ Jane said.

‘It is certainly advisable to maintain immunity to those diseases which could continue to pose a threat,’ I answered. ‘For that reason, health commissions suggest that diphtheria and tetanus immunization be repeated at certain intervals—certainly tetanus should be reinforced every five to ten years, and definitely if a potentially infective wound is sustained. It’s better to be sure than sorry.’

‘Are there any others I should know about?’

‘Not really. Of course, if Sarah plans to visit various overseas lands when she grows up, protection against such diseases as malaria, typhoid, cholera and perhaps hepatitis are worth thinking about. We get reports of about 260 cases of malaria each year in Australia from overseas travellers—it is still a major killer disease in other lands.

‘However, let us now concentrate on the potential troublemakers that are knocking at Sarah’s front door,’ I said, pulling out my ball point pen and prescription pad. ‘Supplies for Sarah’s immunization still have to be obtained, for I prefer to use a fresh batch for every patient.’

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PRIMAL THERAPY

Primal therapy was developed by Dr Arthur Janov, an American psychiatrist, in the 1970s, who noted that many patients uttered intense cries when they faced deep-seated and formerly repressed pain, typically associated with unfulfilled needs for parental love. These cries he named the ‘primal scream’.

Influenced by the Swiss psychotherapist, Alice Miller, who believed that children in many societies were ill-treated by parents and educators and consequently developed a false self, Janov developed a therapy which aims at dismantling neurotic defence mechanisms which the false self uses to protect the individual from the experience of pain. He believed that the ‘false’ or ‘unreal’ self begins to develop from around the age of six, and emotional and intellectual defence patterns have become fairly fixed by the teens. It is the job of the therapist, in a series of intensive sessions, to lead the patient into the ‘primal zone’, where the painful feelings of the suffering child within the adult can be brought into consciousness and integrated.

Since this therapy is so intense and often traumatic, it is important that a properly trained therapist be consulted.

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ST JOHN’S WORT AND PANIC DISORDER: ADDING AN SSRI TO ST JOHN’S WORT

Vanessa is a scientist in her mid-forties who has suffered from recurrent depressions for as long as she can remember. During her depressed periods, which can last for months at a time, Vanessa withdraws from others, needs to sleep a great deal of the time, has difficulty concentrating and feels sad and worthless. Although a highly intelligent woman, she lacks confidence in her abilities and for many years worked in a job that was beneath her skills and qualifications. She was reluctant to ask her boss for a promotion, however, as she questioned whether she deserved it and feared that her request would be denied, which would confirm her sense of worthlessness.

In the past, Vanessa was treated with Lustral during the worst parts of her depression, requiring dosages of as much as 150 mg per day in order to obtain therapeutic effects. Although the medication removed the most painful aspects of her depressions, it also sedated her. In addition, she felt that it took away her range of feelings so that she was unable to respond fully to the events in her life, unable to muster great joy in response to good news or feel appropriately sad when bad things happened. As she described it, T felt zombified,’ and for this reason she would discontinue the medication shortly after emerging from her depression.

Vanessa happened to be in one of her depressions when St John’s Wort was becoming widely publicized in the US and she decided to try the herbal remedy at the dosage of 300 mg three times a day. After a few weeks she felt it was helping her – but now, instead of her feelings being flattened out, she felt greater swings in mood than before. Within the same day her mood would fluctuate several times from good humour to despair and discouragement. On the advice of a psychiatrist, Vanessa added Lustral to the mix, trying only 50 mg per day, one-third of the amount that she had previously required. For the first time in her life, she felt good in a sustained way without feeling medicated. As she put it, T feel like myself at my best all of the time. I get upset when things go wrong and happy when they go right, but they feel like normal feelings, not depression nor like being a dull zombie.’

Since feeling better, Vanessa has managed to travel and socialize much more freely and happily than had ever previously been possible. She has also plucked up the courage to ask her boss for a promotion, which he readily agreed she deserved and promptly took the necessary steps to make happen.

In another patient of mine, a combination of Prozac and St John’s Wort appears promising. The young woman in question wanted to switch from Prozac 20 mg per day to St John’s Wort because she had gained weight while on Prozac. Several weeks after the switch she began to feel depressed and we decided to restart her Prozac at a lower dosage of 10 mg per day in conjunction with the St John’s Wort. This combination appeared to hold her depressive symptoms in check, but we have yet to see whether it helps her to lose the weight she gained on the higher dose of Prozac.

The lesson to be learned from this young woman and from Vanessa is that one does not have to choose between herbal and pharmaceutical anti-depressants. The best outcome may come from mixing the two. I would not, however, recommend trying such mixtures on your own, since medications can interact adversely as well as favourably and one is best off having a doctor involved to minimize the chance of that happening.

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LOCALIZED WITHDRAWAL SYMPTOMS OF ALLERGIES AND ADDICTIONS

The first stage of negative reaction, minus-one, includes all of the localized withdrawal symptoms. In other words, these are physical problems which only occur in one distinct part or organ of the body. There are six major kinds of localized reactions:

1. Upper Respiratory Symptoms. These include inflammation of the nasal membranes (rhinitis), sinus problems, conjunctivitis and other eye or ear diseases, and problems associated with these, such as coughing, frequent clearing of the throat, raising of excessive phlegm, postnasal drip, and nasal obstruction. Other eye problems include an abnormal sensitivity to light (photophobia), blurring or dimness of vision, and excessive crying or itchiness around the eyes. Ear problems may include discharge from the ear, earache, deafness (especially of the intermittent kind), and inner or middle ear problems, such as vertigo, dizziness, lightheadedness, giddiness, or floating sensations.

Intense itching of the nose, palate, eyes, and ears, as well as profuse mucus production from the nose, eyes, throat, and sinuses, is often the result of some specific food allergy. Itching of the eyes, on the other hand, more frequently indicates susceptibility to particles in the air, especially pollen. Nasal polyps are often the result of drug sensitivity, especially, it seems, to aspirin.

2.    Lower Respiratory Symptoms. The lower respiratory system includes

the vocal cords (larynx), the bronchial tubes, and the lungs. Vocal cord symptoms

range from hoarseness to periodic voice loss. Coughing and bronchitis often

occur and can be either seasonal or year-round, constant or intermittent, mild

or severe.

Some respiratory symptoms can be the forerunners of bronchial asthma. One of these is a form of difficult breathing called “sighing dyspnea” in which the patient experiences difficulty or distress in breathing, frequently accompanied by sighing-type noises. This condition often is regarded as the sign of a neurotic or nervous person. However, it also characterizes the patient with chemical or food allergy and can be the prelude to asthma.

The most common causes of hoarseness and loss of voice are reactions to specific foods. Tobacco smoke, however, is a very common cause of persistent coughing in patients who do not have asthma. Even nonsmokers can be affected in this way if subjected to someone else’s smoke. Bronchial asthma may also be caused by exposure to inhaled particles, chemicals, animal danders, or drugs.

3.    Dermatologic (Skin) Reactions. This category includes such problems as eczema, itching, and hives. Many cases of eczema are caused by environmental exposures and most are characterized by itchiness. Exceptions are some cases of acne, psoriasis, and certain rare skin diseases which may or may not respond to ecologic management.

The most common sites for skin problems caused by food allergy are the neck, ears, and, in general, the folds of the body. Reactions to ointments are a common source of skin problems, which is ironic, since many ointments which are used to treat skin problems actually induce contact-type reactions.

Hives, or wheals, are commonly caused by drugs, and somewhat less frequently by specific foods. This type of reaction to drugs, such as penicillin, is of course common and well known. Less well known are similar reactions to chemical or biological drugs, which can be caused by both the active ingredient in the drug and by dyes, chemical preservatives, or other constituents.

4.    Gastrointestinal Problems. Such illnesses include problems of the stomach or gut, such as diarrhea, constipation, gas, bloating, abdominal distress, nausea, vomiting, ulcerative colitis, and regional ileitis. In fact, any chronic or intermittent stomach or intestinal problem of unknown origin may have its basis in the environment, particularly in the foods one eats.

Peptic ulcers, which kill almost 6,000 Americans a year, can be either caused or perpetuated by responses to particular foods. There is no universal diet that can be given as a mass prescription for this problem: the proper diet for the individual depends on his particular response to foods. For example, milk, which has often been given as a treatment for ulcers, frequently turns out to be a cause of such reactions.

Specific food responses may also mimic gallbladder disease, appendicitis, and even intestinal obstruction. Colitis and ileitis are most often caused by food allergies. It is tragic to remove parts of the digestive system by surgery before food allergy has been ruled out in each and every case.

Genitourinary System Symptoms. These symptoms include urgency or frequency of urination, proneness to urinary tract infections, and some prostate trouble. The most common cause of such problems is foods. Specific foods can also cause an excessive discharge from the female organs, in cases where infection is not involved. (As a side note, the presence of infection does not rule out the parallel problem of allergy. The two problems can and do occur together, since allergic irritation can prepare the ground for a subsequent infection by microorganisms.)

Cardiovascular System Symptoms. The cardiovascular system includes the heart and the circulatory system. The principal problems encountered include edema (swelling), arrhythmia (irregular heartbeats), and hypertension. Swelling and water retention, especially when it is generalized through the body, tend to have an allergic basis. Some local swelling can also occur: For example, edema around the eyelids is fairly common, resulting in the characteristic “allergic shiners” and a lacklustre appearance of the eyes.

High blood pressure (hypertension) and cardiac irregularities have long been associated with reactions to specific foods. Less commonly, they are caused by environmental chemicals and drugs. The cardiovascular effects, although localized to one anatomical system, take place through the body. They thus serve as a kind of bridge between localized and systemic reactions, which we shall consider next.

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THE BASIC CONCEPTS OF ALLERGIES: PESTICIDES

Prominent among the sources of indoor air pollution are the pesticides. These are toxic agents which people introduce into their homes, offices, and neighborhoods for the control of insects or rodents. Since World War Two, there has been an explosive increase in the use of these agents. The foundations of houses are now routinely treated with a powerful insecticide to deter termites. Many persons contract with exterminators for the periodic treatment of their homes. Apartment-dwellers are encouraged, or pressured, by landlords to permit extermination to be done on a periodic basis. External mosquito-abatement programs are carried out in many communities, and rural areas are saturated with farm and forest pesticide programs. To a greater degree than almost anyone realizes, a kind of pesticide fog now hangs over the United States and some of the other industrialized countries.

Yet many people are highly susceptible to these agents. Pesticides are among the leading health dangers for those with the chemical problem. In some cases, exposure to pesticides may trigger acute episodes of distress. Ellen Sanders almost died from a particularly heavy exposure (Chap. 3). Other patients trace the onset of their worst symptoms to massive contact with pesticide spray.

More commonly, undetected, long-term health problems are brought on by daily exposure to spray. Unexplained chronic illnesses develop as a reaction to spray, possibly in combination with other chemical or food susceptibility. A woman with arthritis, for example, will rarely associate her joint pain with the brightly colored fly-killing pest strip hanging in her kitchen. Much less will anyone connect a general feeling of malaise and fatigue with the exterminator who comes knocking once a month.

Once pesticides are applied in the home, it is extremely difficult to remove them. Even minute amounts of residues can perpetuate symptoms. When my special facility, the Ecology Unit, was first set up, in the ward of a hospital, for the diagnosis and treatment of environmental disease, it was found that we could not clear some patients of their symptoms. The difficulty was ultimately traced to the fact that this ward, along with the rest of the hospital, had previously been sprayed with pesticides. The only solution was to rip up the floors and baseboards and replace them with unsprayed materials. In some extreme instances, patients have had to sell their homes and move, after their dwellings had been carelessly treated with pesticides.

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CHILDREN’S HEALTH: EARRING PROBLEMS

Pierced ears frequently cause problems involving the earlobes. These problems not only are annoying but are occasionally serious. Three common earring problems are infection, eczema, and injury. Problems may occur if the ear piercer does not give proper instructions for care of the ears, or if the instructions are not properly followed.

Infection of the earlobes immediately after the operation may be caused by lack of proper sterile technique during the piercing. Infection occurring weeks later is usually from failure to leave “training” (post) earrings in place or to care for the pierced earlobes adequately.

Infections that occur after the first month are the result of improperly inserting the earrings. One common error is inserting earrings with posts that are too short for the earlobes. Another common error is pushing the guards in too far along the posts. Both of these mistakes cause pressure on the earlobes and injury to the skin; infection quickly sets in. Pulling down the lobe to insert the post can also cause infections. Pulling the lobe curves the straight channel the piercer has made and results in scratching the inside of the channel with the end of the post; the scratches then become infected. Sometimes infection is caused simply by inserting unclean earrings.

Eczema is a skin irritation. Eczema may develop on the earlobe if a person is sensitive or allergic to the metals used in inexpensive earrings. The skin of the ear-lobe becomes red, scaly, itchy, and sometimes infected.

The most common injury occurs when wearing hoop earrings during athletics and dancing. If a hoop is accidentally pulled or gets caught on something, the hoop can tear the earlobe neatly in half.

Signs and symptoms

Signs of eczema are redness, irritation, itching, and scaliness of the skin of the earlobe. Signs of infection are swelling, redness, lumps in the earlobes, tenderness, discharge, and rawness around the pierced openings.

Home care

At the first sign of any earlobe problem, remove the earrings. Then leave them out until the condition is corrected. Infection often is impossible to cure with earrings in place. If the infection is severe, the opening may heal closed and require re-piercing.

After removing the earrings, apply antibiotic ointment to the front and back of the lobes. Soak the earlobes in warm water.

If the irritation is severe, if the irritation does not clear up with treatment, or if there are signs of infection, see your doctor.

Precautions

• Ask the ear piercer for detailed instructions for care of newly pierced ears.

• Inquire whether the piercer will treat problems if they should occur.

• Leave training earrings in for one month after piercing. Turn them daily, and splash the fronts and backs with alcohol.

Medical treatment

Oral antibiotics may be required to cure infection. If the earlobe is badly cut or torn, plastic surgery may be necessary. The doctor may prescribe a steroid ointment if there is eczema but no infection.

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CHOLESTEROL AND OTHER FATS IN OUR BLOODSTREAM

Cholesterol is not very soluble in water; therefore it must be carried around our bloodstream in various transport molecules. Certain proteins called apolipoproteins can wrap around cholesterol and other blood fats (lipids) to form what is called lipoproteins; these are essentially a combination of protein and fat. A description of the major fats in the bloodstream follows:

Chylomicrons

These are the largest lipoproteins, and mainly transport fat from the intestines to the liver. They mainly carry triglyceride fats and cholesterol which came from the diet, and those manufactured by the liver.

Very Low Density Lipoprotein (VLDL)

These are the lowest density lipoproteins because they are highest in fat; (the more dense the liproprotein, the more protein it contains). VLDLs are made in the liver and deliver triglycerides to various tissues, especially muscle (for energy production), and body fat (for storage).

Low Density Lipoprotein (LDL)

This is the so called “bad cholesterol”. It is the major transporter of cholesterol and triglycerides, taking them from the liver to other parts of the body, where they can be used for various functions. You need your levels of LDL to be as low as possible.

There are other types of LDL:

Small dense LDL

This form of LDL is more likely to be taken up into the inner lining of arteries and promote atherosclerosis.

Oxidized LDL

This is what happens when free radicals cause damage to LDL molecules.

This makes them more likely to promote damage to the inner lining of arteries, and for atherosclerosis to develop.

High Density Lipoprotein (HDL)

This is the so called “good cholesterol”. It is high in protein, which makes it denser and lower in cholesterol. This lipoprotein takes cholesterol from various parts of the body to the liver, where it can be excreted in bile. HDL carries antioxidant enzymes and vitamins to prevent the oxidation of LDL cholesterol. You want your HDL to be as high as possible.

Triglycerides

These are a storage form of fat, made up of three fatty acids attached to a glycerol molecule. High triglyceride levels in the blood make it thick and sticky; they are a major risk factor for heart disease. Both excess carbohydrate and fat in our diet are converted into triglycerides in the liver.

Lipoprotein (a)

This particle is similar to LDL, but carries a sticky repair protein called apolipoprotein (a) which is used for tissue repair. It is a major risk factor for heart disease because it thickens the walls of the arteries.

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FERTILITY: FORESIGHT’S SUCCESS

Most couples who seek fertility treatment find out a great deal about sophisticated medical technologies but very little about the relatively simple measures they themselves can take to improve their chances of conceiving. These highly effective self-help strategies include easily implemented dietary and lifestyle changes. Such measures cost little or nothing, their success has been scientifically documented, and yet most of these couples will not have been told about them. Why on earth is this?

The cynical answer is that infertility has become ‘big business’. As Professor Robert Winston points out in his book Making Babies, there are now at least 21 IVF units in London alone. And more and more units are opening because they are ‘highly profitable in the private sector’. Couples who desperately want to have a baby are very vulnerable. Even though some IVF units have extremely low success rates, such couples are still willing to gamble a great deal of time and money in order to try to conceive.

In contrast, there are no big financial gains to be made in helping couples to look at their lifestyle or to correct their vitamin and mineral deficiencies. Yet this approach makes such sense, and its success can now be measured -thanks to an organization called Foresight, of which I am the Chair.

Over the last 20 years, Foresight has pioneered an approach to fertility that looks at the fundamentals of health, including lifestyle, diet, pollutants, infections and environmental and occupational hazards and gives an unprecedented 80 per cent success rate. Researchers from the University of Surrey followed the progress of 367 couples over a period of three years (1990-3). The women were aged between 22 and 45, and the men were aged 25 to 59. In all, 37 per cent of the couples had a history of infertility, and 38 per cent had experienced between one and five miscarriages (others had had other problems, including still births, malformations and low birth-weight babies).

Many of the couples were older, coming to the trial as a ‘last resort’. They were all asked to eliminate smoking and alcohol, and to follow the recommendations (such as buying organic food, having infections checked and having mineral analysis). All the couples were given personal supplement programmes and were then re-tested to make sure their levels had returned to normal.

By the end of the three-year trial, 89 per cent (327 of the couples) had given birth. Out of those couples with a previous history of infertility, 81 per cent conceived and had babies. Out of those who had experienced a previous miscarriage, 83 per cent had a baby within the three years of the study, without experiencing another miscarriage.

Of the 327 babies born to the couples in the study, no baby was born before 36 weeks and none was lighter than 51b 2oz (2.368kg).There were no miscarriages, perinatal deaths or malformations. The national average for miscarriages is one in four so one could at least have expected 80 miscarriages, but there were none. No baby was admitted to a special care baby unit.

A number of the couples had already tried IVF – sometimes two or three times – without success. Yet 65 per cent of this group conceived naturally on the Foresight programme without needing another IVF cycle.

These results are undeniably impressive and speak for themselves. Yet sceptics maintain that they are ‘too good to be true’. To date, the results have been published in the Journal of Nutritional and Environmental Medicine but not in a standard medical journal. This is because, in order to be accepted by a medical journal, there must be a control group.

In a normal double-blind placebo controlled trial, to assess the efficacy of a headache remedy, for example, volunteers are randomly assigned to either a control group (placebo) or a treatment group (headache remedy). The volunteers don’t know if they are taking the placebo or the remedy, and nor does the scientist running the trial. All the volunteers in the treated group get the same dose of headache remedy.

However, in the Foresight study each person was given an individual supplement programme according to their needs. So they were all taking different dosages and supplements, depending on how deficient or toxic they were.

This is an important point because the double-blind placebo controlled trial is the ‘gold standard’ in medicine but it cannot take into account that we are all unique and that we may need different treatments to increase our fertility. And it is this ‘individually tailored’ approach which I believe is the key to finding a natural solution to infertility. The fact is that 37 per cent of the couples in the Foresight study had an established history of fertility problems and had undergone medical investigation. They did something different – changed their dietary habits and lifestyle – and then conceived.

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