FAQ>Multiple Sclerosis & Obesity
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Multiple Sclerosis
What
is MS?
MS is a
demyelinating disease of the brain and spinal cord (the central
nervous system); it is the most common neurological dysfunction
afflicting young adults—women mostly, though men often more
severely—and fatigue is one of its most common symptoms.
Who
Gets MS?
Ages of onset are usually from 15 to 50, though reports of younger
individuals having it have surfaced. It occurs more often in those
living farther from the Equator, be it north or south of the Equator,
and in Caucasians with ancestors from Northern Europe.
What is demyelination?
Demyelination means that the fatty material covering
nerves,
deteriorates. When the myelin goes, so does coordinated, quick, and
efficient movement. This happens because myelin, think of it as
insulation like that on an electric cable, allows the nerves it shields
to
send and receive impulses properly without interference. You want
to push your chair away from the kitchen table and stand up. Before
demyelination of the nerves involved in those acts, you did them
easily and speedily with hardly a thought. After demyelination, you
struggle or simply can't do them. Quick flowing movement has
become slow, confused, or impossible.
What causes demyelination?
Believe it or not, you probably do.
Scientists think the culprit is the MS
sufferer's immune system. Its soldiers—T-cells, killer cells, and
hungry
macrophages that amoebas—seem to attack the myelin and inflame it; in
time, scar tissue forms where once was myelin. Normally and usually
your immune system is a best friend, but MS destroys the friendship.
Exactly why and how, no one knows for sure. Possibly an wholesome
alliance forms between a gene or genes and some environmental pathogen
(perhaps a virus) that commands these soldiers to rebel against the
central
nervous system and attack it.
What is the course of MS?
As are the
treatments to control MS unknown, so are the data to predict
its course inexact. Indeed, there is more variability than consistency
in
how MS presents: some persons are disabled immediately; some not for
years; some never; some go through relapsing-remitting phases with
flare-
ups and recoveries (most typical kind of MS); some with this type of MS
go into a secondary phase of progressive deterioration; and some (like
me)
deteriorate slowly and steadily from onset. The attack on the central
nervous system compromises abilities to walk, see, speak, stand,
defecate,
or urinate—likely several of these at one time, perhaps all, perhaps
more.
Who will experience what and how fast though cannot today be
forecasted precisely.
What
is MS Fatigue?
MS fatigue frequently is experienced as feeling tired and sapped before
noon or (worse) soon after arising; it's depressing to many. About
three-
quarters to nearly all with MS will at some time suffer it, and over
half of those who do will claim
it's their worst problem. According to the 1998 report of the
Multiple
Sclerosis Council for clinical practice guidelines many
ms-fatigue sufferers have lost their jobs because
of it. The council experts define such fatigue as
"a subjective lack of physical and/or mental energy
that is perceived by individual or caregiver to
interfere with usual and desired
activities."
Even
after 10 years of study, says the council, scientists still don't
understand its
physiology but do understand what many MS victims know all too well:
unlike normal fatigue, it occurs anywhere and allows little quarter or
reprieve. Ask your neurologist for management tips. You'll find these
six
described in Multiple Sclerosis:
Think Better to Feel Better:
Activate
Not Over-activate, Nap, Keep Cool, Relax, Anti-fatigue" Medicines,
Stimulus control for Sleeping Better.
Obesity
I sometimes use the words
obesity, heavy, overweight, and fat
interchangeably, and for that perhaps I
should be punished; the terms mean different things. For style,
however, I use one for the other and
mean nothing offensive in what I choose. Words can hurt but try not to
take umbrage at the terms,
for they tell only about a part of you; you're more, far more, than
angles, contours, bulges.
Is Obesity Predestined?
Numbers of scientists
claim that genes for fat cause obesity. One proof offered is that
identical
twins—twins from one egg(100% of genes in common)—are closer in weight
than are fraternal twins
(50% of genes in common) even when reared apart. Also, according to a
few scientists, grown-up
adopted children have weights closer to those of their biologic versus
adoptive parents. What's more,
obesity runs in families; fat parents often have fat children. Upon
reflection, though, family obesity
may have as much to do with family practices—much eating, not much
exercising—as it does with
genes in common; indeed, fat pet owners are liable to have fat pets.
One may well be genetically
predisposed to becoming obese, but predisposed isn't the same thing as
predestined: genes may make
reducing more difficult, not impossible. Both nature and nurture, genes
and environment, play major
roles in the story of getting and staying fat.
Is Obesity Unhealthy?
Many scientists and health care professionals would loudly declare yes.
Obesity—the more, the
worse—is, they'd say, a disease or very risky in terms of getting a
disease. They' d point out that
obesity and overweight are linked to a panoply of physical ills
including hypertension and
hypercholesterolemia (high cholesterol), hernia, maturity-onset
diabetes, toxemias of pregnancy,
gallbladder disease, low back pain, osteoarthritis of the hips and
knees, dermatological problems,
surgical problems, and cancer. But don't think you're sick or
definitely going to get sick if you're overweight or obese because not
everyone who is gets sick. Ask your physician about you.
What
Is Obesity?
What is obesity?
Obesity means excess fat (triglyceride). Babies come into this world
12% fat. A year later the fat part of their
weight more than doubles, reaches about 30%, but then declines by half
or more. By year five, boys are roughly
12% fat and by their first decade about 17% fat. At puberty boys and
girls begin to diverge: by 16, boys get to
about 11% fat and girls to about 24%. A 200 pound, 5ft. 10in. man who
is 20% fat has 40 pounds of fat and
160 pounds that's not.
Is he obese? One way of
assessing (not foolproof but scientifically acceptable) is calculating
the man's body
mass index (BMI). Developed by the Belgian statistician Quetelet and
based upon height and weight
measurements, the BMI formula divides weight (in kilograms) by height
(in meters squared).Using inches and
pounds, the BMI formula is:
(a)Multiply Weight in Pounds by 703 [200
lb. x 703= 140,600]
(b)Divide the Answer by Height in Inches [140,600/70in=2008.57
(c)Divide this Answer as well by height in Inches [2008.6/70in =28.7]
A 200 pound,5ft 10in person
has a BMI=28.7
Such a person would be considered overweight, almost obese.
The National
Institutes of Health (NIH)
interprets BMI values for adults thusly:
(a)BMI of <18.5 is
Underweight
(b)BMI of 18.5-24.9 is Normal Weight
(c)BMI of 25.0-29.9 is
Overweight
(d)BMI of 30.0-34.9 is Class 1 Obesity
(e)BMI of 35.0-39.9 is
Class 2 Obesity
(f)BMI of equal to or >40 is Class 3 Obesity
Classes of obesity have to
do with disease risks.
Class 1=moderate
risk
Class 2=severe risk
Class 3=very severe risk
Does My Body Shape Affect My
Health?
It may. There's evidence that how fat you are fat is less important
than how you are fat—how your
fat is distributed. To tell which shape you are, that is how your fat
is distributed, divide waist size in
inches by hip size in inches. The more your waist size exceeds your hip
size (the higher the ratio),
the more apple-looking you are But, the more your hip size exceeds your
waist size (the lower the
ratio), the more pear-looking you are. Apple shapes, called central,
abdominal and android obesity,
are fattest at the middle. Pear shapes, called femoral, gluteal and
gynoid obesity, are fattest below the
middle. Apple shapes risk future disease more than do pear shapes, or
so it seems. For men, when
waist divided by hips equals 1 or more, there may be trouble; for women
the concern is at about .8
or more.
Are The Obese Victimized?
As described in the
Dieter's Snake Pit, many of the obese will
try almost anything to reduce.
So, bigness has come to be big business, a business that too often
promotes the strange, the
worthless, and even the dangerous. Cure-alls come as
nutritionally-depleted nonsensical diets or
special arrays of food. Sometimes they are marketed as extraordinary
elixirs or pills or injected
potions with "secret" ingredients. To work their voodoo, such nostrums
usually advise (in very fine
print) to cut calories. Often accompanying diet-chicanery is
exercise-gimmickry (sauna suits and
body wraps) pledging effortless solutions through absurd processes (
freeing fat cells of toxic fluid).
What
Are Calories?
Calories are units of energy, units of heat. When we talk of calories
in the context of dieting, we mean,
kilocalories (calorie x 1000). Defined, a kilocalorie is the heat
needed to raise the temperature of one kilogram
of water one degree centigrade. When you eat cheese, hamburger,
lettuce, or apple pie, any food, your body burns calories, uses
them for life's fuel.
We talk as if foods contain
calories, but they
don't; calories aren't in foods in
the sense of tiny things that can be extracted and seen under a
microscope. Calories are in chemical
bonds, and when your body's biochemistry breaks down these bonds in
food, energy is released. You eat food
that supplies fuel that, when things are right, you use to grow,
repair, survive, and move. Calories can be converted into pounds and
pounds into calories—extra pounds means energy-saved
(roughly 3500 calories to the pound), and pounds-lost means
energy-lost. But every time you burn
up 3500 calories, you won't necessarily shed a pound of fat—the
arithmetic of reducing is
imprecise—but spend calories long enough and you'll spend pounds.
Is Dieting Difficult?
On again, off again. Starting and stopping. Dieting
does appear hard to do, at least sticking to a diet
appears hard to do, for dieters often turn slips into catastrophes:
they have that piece of pie or that
doughnut or that second helping and feel so guilty, so hopeless, so
helpless, so worthless, so
stressed, they quit altogether and then months or years later, dozens
of pounds heavier, start over.
Dieting is especially
difficult when it works
against itself. When your body answers your dieting adaptively,
energy needs drop. Metabolic rate, the rate you use up calories to
breathe, to pump blood, to
process thoughts—to stay alive—may slow because of dieting. How much
energy you need to run the
body-machine may adapt to your diet such that in time you need less,
and because you need less you
lose less, if at all. Losing weight gets tougher. When metabolic rate
slows, energy is saved; if you
want to take off pounds, you want to spend not save energy. After
dieting for a while, even just a
couple of weeks, the hourly drain on energy likely decreases. It's as
if the body says if you feed me
less, I'll need less. But there may be something one can do about the
less-feed, less-need metabolic
trouble: exercise.
What Are the Dos of Exercise?
1. Check with your physician to see if
there are reasons for you to restrict or avoid exercise.
2. Precede
exercise with a stretching warm-up and end with a stretching cool-down.
Failure to do
either could mean soreness later; the pride of exercising on Monday
could transmute to the agony of
rising from bed on Tuesday.
3. Avoid trying to be Tarzan or Superwoman. The human body is capable
of great deeds, when
these are built gradually.
4. Avoid trying to be a weekend warrior. You
can't overcome six Rip-Van-Winkle days in one heroic
bout.
5. Avoid becoming pace-conscious. Running and tennis and squash
are fun and exerting. If you
include them in your program of exercise, do so because they're fun,
not just because they're
exerting. Unfortunately, for many the true measure of the exercise is
breathlessness. But if exercise,
especially for the beginner (and you're still a beginner even though
years ago you weren't) is to be
enjoyed and integrated into your day, avoid the kind that makes you
gasp for air during and after it.
Intense exercise isn't your game. Sustained activity is. WORK LESS, GET
MORE. Indeed,
jogging a mile in six or eight minutes expends the same number of
calories as jogging it in twelve
minutes does. The six minute miler burns more calories faster than does
the twelve minute miler, but
runs half as long as the slower fellow. The greater rate of calorie
burning lasts six minutes, the
lower rate, twelve; time counterbalances speed. To break records, if
you're in good shape, jog fast.
But if you're like many of your comrades and exercise is a new
challenge or a fond memory, focus
on duration; increase time at it before pace of it. Don't jog a mile in
eight minutes and end up
panting, jog two in twenty-four minutes and spend twice the calories.
6. Avoid exercise-problems and walk. For most of us, regularly walking
is the best exercise.
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