A condition in which the pancreas produces too much insulin (usually in response to a high sugar load in the diet) which in turn produces a host of mental, emotional and physical symptoms.

Hypoglycaemia is a normal phenomenon too. When our stomachs get very empty the level of glucose (sugar) in the blood falls and makes us feel hungry and faint. We remedy this by eating. The sort of hypoglycaemia we are looking at here is somewhat different.

All the cells of our bodies need glucose for energy but this is especially true of the brain. It cannot function normally for long without its supply of glucose. Some parts of the body store glucose but the brain needs a reliable ongoing supply. This is why any shortage of glucose in the brain’s blood supply can cause so many symptoms related to the brain. Nervousness, anxiety, irritability, depression (even suicidal feelings), forgetfulness, poor circulation, poor decision-making, nightmares, weepiness, and sensitivity to noise, are just some of the mental and emotional symptoms that have been reported in hypoglycaemia.

The physical symptoms of hypoglycaemia are just as real and just as disturbing as are the mental and psychological ones. Palpitation, weakness, dizziness, shaking and sweating, blurred vision and headaches are all common. Some people black out altogether if their blood sugar falls very low.

*175/72/5*

Do families with an eating-disordered member have more physical and psychiatric disease? Studies produce different – and conflicting – answers. There does appear to be a higher incidence of weight problems, especially among families with a bulimic child. And the rate of depression is higher, again particularly among bulimics, than in the population as a whole.

What about personality? Is there a “typical” eating disorder family? Are there certain traits that would lead a bystander to say, “If the Joneses aren’t careful, they’re going to turn their daughter into an anorexic one day”?

No, although a lot of studies claim to identify such traits. One researcher, Dr. Joel Yager of UCLA Medical School, took a close look at these studies. He found they contained more different “family portraits” than you’d find on the walls of a photographer’s waiting room.

One such study declared that an anorexic family was characterized by a fussy, nervous mother and a father who alternated between being quick-tempered and laid-back. No, said another, an anorexic’s mother is robust and nagging, her father passive. Wrong, said a third; fathers are domineering and aggressive. Close, another chimed in; fathers are domineering but ïîï aggressive. Or sometimes domineering or sometimes not. Depending on your source, mothers are either attached or ambivalent toward their daughters; they are too strict or too lenient. Fathers are lenient, kind, and affectionate. No, they are cool, antagonistic, and hostile.

Remember the blind men and the elephant?

As Dr. Yager concluded, “If common personality patterns are to be found in these families, they will have to be at more subtle levels.”

Does this mean that therapists must start from scratch every time a family walks into their office? Is there any pattern among eating-disordered families that provides some basis for therapy?

Yes – sort of. Recent research has found a number of different patterns among anorexic families, but certain anorexic families do fit to some extent the “model” of functioning I’ll describe in a minute. While these traits are by no means universal, they may provide a good place to begin working with an anorexic family.

Perhaps the most important trait is the lack of joint parental authority. The parents disagree about basic issues in child rearing. As a result, the child gets mixed signals; she doesn’t know what’s expected of her.

Another common theme is that the mother tends to be the center of the family. Fathers tend to be absent because of work, death, or divorce. The children understandably develop closer relationships with the mothers.

The stereotype of an anorexic family is that the members all think and act as one unit—they are, to use the technical term, highly cohesive. Conversely, bulimic families are often thought to be highly disorganized. The reality is much more complex. Some anorexic families are so chaotic they can’t plan a trip to the mall without arguing, while some bulimic families stick together like Velcro. Interestingly, as the patient gets older and is ready to leave home, some families grow more cohesive. It’s as if they realize that the illness has served as a stabilizing force, and they are reluctant to face the changes that will befall once the patient leaves.

Families can sometimes delude themselves that the eating disorder is the only problem they must confront. One father said, “If only Gwen weren’t starving herself, we’d be the all-American family.” Such families are sometimes in for a rude shock: When the eating disorder abates, they must confront the presence of other issues in their lives.

*97/35/5*

Since 1992, Linda Matulin has lost 400 pounds, a full two-thirds of her body weight. The 44-year-old Tucson resident attributes her success to discipline, determination, and one well-timed television show.

At her heaviest, Linda carried more than 600 pounds on her 5-foot-6-inch frame. “I don’t remember a time in my life when I wasn’t overweight,” she says. “But I really started to gain when I got a job working third shift. I don’t know why, but I ate all the time.”

Linda went on and off diets, never making much progress in her battle of the bulge. “Maybe that’s because I never tried really hard,” she says. “It may be difficult to believe, but I never saw myself as fat, even at 600 pounds. I lived a full life, doing everything I wanted—socializing with friends, going to concerts, traveling.”

Her mindset abrupdy changed on the day that she happened to catch a television interview with country singer Lorrie Morgan. “The interview had nothing to do with weight loss or fitness. Lorrie was talking about herself and her life—how she took control and made changes,” Linda recalls. “For me, something clicked. I became absolutely convinced that this time, I could really lose the weight.”

Despite her excitement, Linda said nothing to her family. “I knew that they meant well, but I didn’t want their advice,” she says. “The people closest to you tend to put a lot of pressure on you when you’re dieting.” She’d been through all that many times before, when she had tried different diets—and failed.

On her own, Linda began making dramatic lifestyle changes that supported her weight-loss goals. Most important, she stopped eating on autopilot, instead letting her body tell her when it needed food and how much. “It had always been telling me these things,” she says. “I just never took the time to listen.”

Having grown accustomed to eating as much as she wanted, whenever she wanted, Linda found the going to be tough at first. She had days when she devoured almost anything in sight. “But the more I focused on my body’s hunger signals, the less food—especially fatty food—appealed to me,” she says. And that’s when she started to lose weight.

Linda also looked for ways to be more active during the day. | She started with some gentle movements in her backyard swim- ST ming pool. After she dropped some pounds, she graduated to working out on a treadmill. “I’d do what I felt like doing on a par- § ticular day,” she says. “I didn’t have a set exercise plan, but I tried to move around a lot.”

Even as she lost weight, Linda continued to conceal her § trimmer physique under her newly baggy clothes. “I remained reluctant to tell my family what I was up to because I didn’t want them offering me advice,” she explains. When she finally broke down and bought some smaller-size attire, she wowed even those closest to her. “They were surprised, to say the least,” she says. “But they were really happy for me, too.”

Today, Linda is literally a shadow of her former self. In the years since she first began her weight-loss program, she has dropped to 200 pounds. She hopes to get down to 175 pounds, a goal that is certainly within her reach.

“Sometimes, I get a little frustrated because I’m not there yet,” she says. “But then I remind myself that I didn’t lose 400 pounds overnight. I’ll achieve my goal in good time.”

WINNING ACTION

Remember that you can do it. Linda’s story is an important inspiration for all of us. No matter how many pounds you want to lose, even if it’s 400, you can succeed. It may take some time—but remember, if Linda could do it, so can you.

*151\89\8*

Attitudes to physical beauty still seem harsher for women in their middle years than for men of the same age. We are so geared to youth, and youth is so tied up with femininity and sexuality, that once you reach menopause you may be viewed as ‘past it’.

The environmentalist and anti-nuclear campaigner Dr Helen Caldicott, whose marriage of twenty-six years broke up on the eve of her fiftieth birthday, says blinkered attitudes do not help. ‘In the eyes of some men, older women . . . have lost almost all value when they reach menopause because their hormones are no longer at the level they were before.’ Dr Caldicott has achieved a new beginning and a sense of liberation and independence since moving out of the family home, to settle first on the north-east coast of New South Wales and then in Gippsland, Victoria. ‘Doing it released me and made me understand the strength I had.’

Women actors complain that few challenging roles are available once they reach about forty-five. While men such as Sean Connery, Sam Neill and Robert Redford still play romantic leads into and beyond their fifties, women are rarely seen in such parts. Genevieve Picot, who played the role of the obsessive Celia in Proof and is deputy federal president of the Actors Equity section of the Media, Entertainment & Arts Alliance, says she is frustrated about being considered ‘old’ in the industry. ‘The irony and the disappointment for me is that as a performer I’m feeling much more confident and my skills are so much better than they were ten or fifteen years ago, yet I just don’t have the opportunity to use them very much.’

There are signs of change, however, the most obvious place being on television, where presenters and commentators are increasingly likely to include women over forty who do not necessarily look like stunners.

The highly regarded SBS newsreader Mary Kostakidis believes women themselves must make the first move. She refuses to dye her greying hair because she sees no point in camouflaging the maturity and complexity that come with midlife and beyond. ‘As a younger woman I was often attracted to older men because of these sorts of qualities. And now that I’ve arrived there myself, I’m not about to cover up the fact.’

She says that women presenters on Australian television are still largely ornamental. ‘It’s boring. We are an ageing population, and decision-makers who cannot accept this and act accordingly are behind the times. In many cultures older women assume positions of great status and respect. Australian women also have pride in their years. The time must come when they are no longer discarded for no other reason than their age. If not — if our institutions don’t reflect our values — our democracy is a farce.’

Women throughout Australia are, like Mary, Helen and Genevieve, asking questions, getting information, and deciding what is important for them at midlife and beyond.

*133\38\8*

Who would have believed, a generation ago, the current popularity of ‘alternative’ therapies and the challenge they have thrown down to orthodox medicine? There was little to indicate in the 1970s that the so-called fringe therapies like naturopathy, homeopathy, traditional Chinese medicine and herbal medicine would attract a vast pool of clients who alternated between orthodox and less conventional practitioners with breezy savoir-faire.

Equally unexpected were the greening of the Western diet and the enthusiastic adoption of power walking, jogging, aerobics and weight training by women of all ages. Many older women took to the challenge with gusto, viewing their increased involvement in physical activity as an antidote to the lack of strenuous exercise in their lives. When the 1991 Bulletin/Qantas Businesswoman of the Year, Sara Henderson, was writing her bestselling autobiography From Strength to

Strength and its sequel (still to be published at the time of writing), she felt the need to restructure her writing days to include short time-outs for exercise.

‘I’d played sport till I was forty-five, mainly tennis and squash. And there was a lot of physical activity at Bullo, down in the yards, working gates, building fences, lifting cases of beer in and out of the store. [Sara and her daughters own and run Bullo River, a remote Northern Territory cattle station.] To keep in nick when I’m writing twelve hours a day, I take a few minutes off every hour or so and do a couple of hundred skips. In the evenings I walk some kilometres along the airstrip with the dogs and, before going to bed, I do weights for my upper body for twenty minutes or so.’

Sara went through a fairly straightforward menopause when she was fifty. There were several months of irregular and heavy bleeding, followed by a return to normal periods, then irregularity again and so on, the whole process taking about three years and coinciding with the deaths of her husband, mother and son-in-law. Sara has not had HRT, says that people comment on how well she looks, and remarks on how well she feels. She enjoys a balanced diet mainly of fresh meat, vegetables and fish, does not smoke, and since the age of forty-five has drunk alcohol on special occasions only.

Whether women choose HRT or not, they should be aware of the range of lifestyle changes and alternative or complementary therapies capable of lessening menopausal symptoms and enhancing long-term health.

A common criticism of alternative therapies is the lack of solid scientific evidence about their effectiveness and safety, a problem compounded by the lack of quality control in the manufacture of some substances. As with HRT, uncertainties about effects should be considered carefully in assessing the benefits and risks.

*96\38\8*

‘The fact is that women are relatively protected, in terms of their cardiovascular status, by having oestrogens. It’s relative because it’s true as long as they have oestrogens. After the menopause, however, the incidence of heart disease rises rapidly, parallel to that in men; and as everybody knows, women live on average seven years longer. While men may have a head start, women have a higher chance of living widowed and with serious cardiovascular disease.’

Another unpalatable reality is that the causes and the most effective prevention *and treatment strategies for heart disease in women are still being learned, whereas they are well established for men with heart disease. This discrepancy relates to the male focus of much heart disease research, a fact that concerns health authorities in many countries. ‘Women die of heart disease almost as often as men do, but later in their lives,’ says Judith Dwyer, who chairs the Women’s Health Committee of Australia’s major health watchdog, the National Health and Medical Research Council. ‘It is surely inexcusable to base clinical advice on data that is good for the gander but may be worse than useless for the goose, even if that data is easier to gather.’

Judith Dwyer says the exclusion of women as participants in heart research is longstanding and ingrained in the system that governs trials of new pharmaceuticals. ‘Drug companies in Australia are almost required to use only healthy, young male volunteers when testing new formulations,’ she says. ‘It seems to me to be perfectly possible to develop methods of avoiding many of the perceived problems, such as the danger of liability in the case of pregnancy in women.’ In a bid to overcome the problem, a new approach has been devised to redress this kind of imbalance in Australian heart research.

*61\38\8*

It is a hormone that contributes to feelings of wellbeing and to the maintenance of a woman’s so-called ’secondary sexual characteristics’ such as distribution of hair, type of voice, and libido. Although testosterone is usually thought of solely as a male sex hormone (also known as an androgen), this is incorrect. It is more accurately described as ‘the third female sex hormone’. Women are already producing testosterone during childhood and continue to do so for the rest of their lives.

TESTOSTERONE AS PART OF HRT If you have had your ovaries removed surgically, you may become aware of lethargy and loss of libido. The addition of testosterone to HRT, or perhaps testosterone on its own, may prove helpful in your case.

*27\38\8*

Rheumatoid arthritis is characterized by painful, swollen joints that feel warm to the touch and are often stiff. The stiffness and pain are usually worse in the morning. Various blood tests are used to confirm the diagnosis – they look for certain factors in the blood that are characteristic of rheumatoid arthritis.

Inflammation is the cause of the problem, and the part to be affected first is the synovial membrane, although the inflammation later spreads to other parts of the joint. The synovial membrane has an important role to play in the joint, because it produces the fluid that lubricates the joint. The synovium, which surround the joint, is filled with this fluid. In rheumatoid arthritis the synovial membrane is invaded by large numbers of immune cells which cause the inflammation.

The presence of all these immune cells suggests that there is an infection in the membrane, and early theories about rheumatoid arthritis invoked some bacteria or virus. But despite many years of searching, no infectious agent has been found. An alternative theory suggests that the body is mounting an immune reaction against its own proteins – in other words, that rheumatoid arthritis is an autoimmune disease. Some recent discoveries tend to support this idea. A third theory suggests that there is an overgrowth of cells in the synovial membrane which attracts the attention of the immune system – this idea is currently being tested.

*157\180\8*

Fortunately, there are still some people left who resist being infected by discontent but know how to remain cheerful in spite of difficulties. I remember a very sick farmer’s wife who suffered from multiple sclerosis and had been paralysed for fourteen years. When she achieved a slight improvement with great effort and was able again to use her arms and eat without help from other people, she was so happy and grateful for the fact that she could cope so well with her still deplorable condition. Whenever I had to face some unpleasant jolt such as cannot be avoided on our bumpy earth my mind always returned to this lady and her quiet contentment.

Especially when we are tired we tend to look at the present, future and past with a negative spirit, but this does not contribute to a contented attitude by any means, nor will it provide the basis for restful relaxation and refreshing sleep. Therefore, we would do better to think of all the positive things that have happened to us and are still going on every day; in other words, we should count our blessings. This attitude will allow a pleasant sense of gratitude to enter our heart and will help to restore the mind and body to a state of well-being. We must admit that every person has sufficient grounds to feel upset, to worry and feel unhappy. However, if you place these negative factors on one side of the scales, then the same quantity of active, positive factors should be placed on the other side in order to balance them. So when you feel depressed and beset by problems, think about all the valuable things you have, the good you have been able to do in your life, your successes, the many gifts nature offers you day by day. All these encouraging memories and experiences are able to fill your heart with gratitude so that life’s burdens, all your complaints, appear small indeed.

*1233/28/1*

So, if one values life, the heart muscle ought to be well cared for. This brings to mind some words of ancient wisdom: ‘More than all else that is to be guarded, safeguard your heart, for out of it come the sources of life.’ Even though these words have a deep symbolic meaning, they indicate nevertheless that our heart is an organ that demands our whole attention, for if the heart fails what else remains but death? When the liver or the kidneys fail the patient is able to stay alive for a little while, but when the heart suddenly stops beating the person will drop as if struck by lightening and death follows instantly. Anyone who has witnessed a case of heart failure is extraordinarily affected by the tragedy -the sudden transformation from life to death. The pathologist will probably say that the heart muscles had been starved of blood for many years and were therefore terribly changed. The information that nicotine had been responsible for the fatal damage is then, unfortunately, no longer of any use. It is too late. Fortunately, it need not come to this, because the mere fact that the effects of nicotine poisoning become apparent long before the possible fatal consequences should make the addict decide to give up the habit before it is too late. Or would it not be better to give up smoking long before disturbances arise?

*1164/28/1*