В настоящее время имеется ряд медикаментозных препаратов, снижающих уровень атерогенных липопротеидов: мисклерон, холестирамин, арахиден и др. Во многих странах, в том числе, и в России, ведутся интенсивные поиски новых препаратов, снижающих уровень атерогенных липопротеидов, а, следовательно, холестерина и триглицеридов в крови. Каждые три года проводится специальный международный симпозиум, на котором учёные обсуждают достоинства и недостатки того или иного препарата. Действие таких препаратов, получивших название гиполипидемических, различно: одни препараты (холестирамин) задерживают всасывание холестерина в кишечнике; другие (мисклерон) тормозят образование атерогенных липопротеидов в организме; третьи (арахиден), напротив, ускоряют распад липопротеидов.
Применение гиполипидемических препаратов сочетается с диетотерапией и проводится строго по назначению врача с учётом характера нарушения липидного обмена у каждого отдельного больного. Опыт применения гиполипидемических препаратов в сочетании с диетотерапией свидетельствует о том, что длительное снижение уровня холестерина и триглицеридов в крови у больных ИБС приводит к улучшению кровоснабжения сердечной мышцы, что предупреждает возникновение новых приступов стенокардии или инфаркта миокарда. По данным специалистов, занимающихся изучением эффективности гиполипидемических препаратов на больших группах населения, снижение уровня холестерина в крови всего лишь на 5% приводит к постепенному уменьшению частоты новых случаев стенокардии на 12170, а снижение уровня холестерина на 10% – соответственно на 24%.
Всё более активно и успешно в лечении тяжёлых форм осложнённого атеросклероза коронарных артерий применяются хирургические методы. В частности, хирургами разработаны методы наложения окольных соустий с коронарными артериями, что позволяет частично восстановить кровоснабжение сердечной мышцы.
В случаях с особенно высоким устойчивым уровнем липидов в крови, не поддающимся диетологическим и лекарственным воздействиям, сопровождающимся нарастающей недостаточностью коронарного кровообращения, некоторые хирурги проводят операцию частичного выключения подвздошной кишки. Поскольку кишечник играет активную роль во всасывании и выделении холестерина, эта операция ведёт к довольно стойкому снижению его концентрации. Однако сложность этого метода и недостаточный опыт отдалённых результатов этой операции пока не позволяют широко её рекомендовать.
В случаях повреждения сердечной мышцы, сопровождающихся тяжёлыми нарушениями сердечного ритма, освоен способ подключения к сердцу искусственного водителя сердечного ритма (кардиостимулятора) или восстановления естественного сердечного ритма с помощью специального электрического разряда – дефибрилляции. Сегодня тысячи людей обязаны жизнью своевременно проведенным процедурам дефибрилляции и кардиостимуляции.
В остром периоде инфаркта миокарда, если больной своевременно доставлен в стационар, проводится активная терапия препаратами, снижающими свёртываемость крови, что позволяет уменьшить очаг поражения в миокарде и предотвратить сёрьезные осложнения. В России в кардиологическом научном центре (Москва) для лечения больных острым инфарктом миокарда стал применяться метод внутрикоронарного введения противосвёртывающих препаратов, в частности, фибринолизина и гепарина. Через специальный зонд эти препараты непосредственно подводятся к очагу поражения в коронарной артерии, что позволяет частично ликвидировать тромб и улучшить кровоснабжение пострадавшего участка сердечной мышцы.
Одним из путей, позволяющих понизить уровень липидов в крови, сбалансировать избыточный калораж пищевого рациона, нормализовать массу тела и повысить устойчивость сердечной мышцы к состояниям, связанным с увеличением потребности в кислороде, является регулярная активная физическая деятельность человека. Ходьба в быстром темпе, бег трусцой, езда на велосипеде и другие виды умеренной физической нагрузки в настоящее время всё шире внедряются не только как профилактический, но и как лечебный комплекс, необходимый для многих больных с ИБС и для больных, перенёсших в прошлом инфаркт миокарда. Однако если практически здоровый человек после консультации с врачом может строить режим своих тренировок самостоятельно, под контролем собственного самочувствия, руководствуясь соображениями здравого смысла, то тренировки больных с ИБС должны начинаться под строгим наблюдением врача и методиста по лечебной физкультуре с постепенным переходом к самостоятельным занятиям при регулярном врачебном контроле.
Подсчитано, что 20-минутная ходьба в быстром темпе, 15-минутная езда на велосипеде и 10-минутный бег трусцой требуют расхода 100 ккал. Между тем, дополнительный ежедневный расход 100 ккал при одинаковом и адекватном питании позволяет добиться потери более 5 кг избыточной массы тела в течение года.
Само собой разумеется, что нетренированный человек должен начинать физические упражнения осторожно, с 15-минутной ходьбы или бега трусцой 2-3 раза в неделю, постепенно увеличивая время нагрузки до ощущения одышки или до частоты пульса, которая может быть рассчитана для каждого по формуле: 180 минус возраст тренирующегося.
Очень важно, чтобы физическая нагрузка стала привычкой, ежедневной частью обыденного режима для каждого человека. С этой целью рекомендуется взять себе за правило проделывать пешком хотя бы часть пути на работу. Подсчитано, что вероятность благополучного выхода из наиболее опасного острого и подострого периода инфаркта миокарда в 5 раз выше у тренированных в физическом отношении лиц по сравнению с людьми, которые вели сидячий образ жизни.
«Избегайте лифта», «живите в движении», «человек рождён, чтобы двигаться», «не увлекайтесь телевидением» — таковы призывы, которые всё чаще и чаще появляются на страницах газет и журналов.

This is all well and good, says the conventional skeptic, but the so-called results of the Ecology Unit, and of clinical ecology, are actually based on suggestion. This is the so-called placebo effect (from the Latin «I will please») in which a totally inert «sugar pill» sometimes has curative properties. In the case of clinical ecology the patient wants to get well to such an extent, we are told, that he accepts the physician’s idea that wheat, pork, or some other substance is the source of his illness.

Such arguments are sometimes heard from critics of this new approach, although never yet from a physician who has closely observed our methods nor from a patient who has been treated in the unit. The door of the Ecology Unit is always open to qualified professionals who wish to investigate our methods first-hand.

The impression of those who have studied the response of patients in our clinic is usually the opposite of those who speculate about the «placebo effect»: patients are in fact more likely to respond negatively to suggestions that their illness is caused by some common food. Remember, these are not only frequently eaten foods we are talking about, staples in the diet, but more often than not favorite foods, which may be eaten in an addictive manner. Patients do not ordinarily encourage doctors to tell them to give up cherished pleasures. Nor do they usually enjoy a new interpretation of their illness which may impinge on their freedom.

The discovery of a food addiction can be unpleasant, for it may mean preparing unaccustomed meals, as well as the chance of social awkwardness. Anyone who thinks patients are easily persuaded to give up their favorite food addictants should try to separate a wheat-a-holic from his bowl of pasta or daily portion of bread.

Similarly, a diagnosis of chemical susceptibility is rarely greeted with enthusiasm by patients. It entails serious changes in lifestyle. Few patients look forward to the opportunity of changing or moving their heating systems, for instance. Their tendency is to deny the problem, not to embrace it as one does a placebo. Once a correct diagnosis is made, however, and the patient sees some improvement in his life, he will then often enthusiastically—and rationally—embrace the new regimen.

There is additional evidence that the reactions which patients have to food and chemicals during our testing program are not based on suggestion: blind tests have been performed sufficiently often to prove that such reactions are not dependent on foreknowledge on the part of the patient. Some of the most dramatic of these tests have been recorded on film and shown repeatedly at medical conferences.

Patients have also been given sham feedings through a tube of foods to which they were not allergic or of no food at all, while being told that they were receiving a food to which they were allergic. I have never elicited what appeared to be a psychological reaction from such patients. Invariably, they do not react under such circumstances, no matter how they have been primed with suggestion. In one case, discussed at length earlier, I let a beet-sensitive patient glimpse some red juice on a dish after she was given a tube feeding. The dish was then quickly whisked out of her sight and hidden. She failed to react to the feeding, however. When asked if she thought that the feeding had been beets she admitted that she had seen the red juice left in the pan. The juice was actually from a pomegranate and had been deliberately placed in the bowl in an attempt to trigger a psychological reaction.

Other patients have accidentally and unknowingly eaten food to which they were known to be allergic. In these cases, they suffered the same kind of reaction as during a deliberate feeding, although they would have to retrace their steps to discover the cause. Joan Kowan, the student nurse with the headache problem, suffered such an attack after accidentally eating some butter.

Another case was a physician who suffered from diarrhea whenever he ate milk or milk products. One day he went into a diner and ordered a hamburger and then suffered a reaction. He returned to the diner when he was better, sat himself at the counter, and watched the chef prepare another hamburger. The burger itself contained no milk products, but it was cooked on a griddle still sizzling with butter from the previous order. Even this small amount of a milk product was enough to cause a reaction in him.

Many patients have had similar reactions to coffee, pork, corn, or other foods. Environmental pollutants can unknowingly create symptoms in the same way. Ellen Sanders suffered irregular heartbeats (cardiac arrhythmia) after pesticide was drawn into her apartment by an air conditioner. She became deathly ill, but it was not until she was taken to the hospital that it was discovered that these pesticides had been released, in massive quantities, in her vicinity.

It is easy to theorize about psychological effects and placebo reactions. In the Ecology Unit our primary responsibility is in healing the patient, not in performing double blind tests, for which we have neither the facilities nor the funding. It is possible that psychological factors play some unknown role in all healing processes. Innumerable facts, however, show that the chronic ailments of patients usually have real causes in the material world, many of which can be unmasked through the methods of clinical ecology.

To summarize, it may be said that the technique of comprehensive environmental control in an isolated hospital unit set up for this task has filled a useful purpose. It is especially helpful for advanced complicated cases in which efforts at outpatient management have failed.

There tends to be a deteriorating continuum in advanced and complicated instances of environmentally related illness which sometimes is difficult to change on the basis of office or outpatient management. This downhill course may often, but not always, be reversed by the application of more detailed observations favored by this approach. It is especially useful in instances where home and work exposures are suspected of maintaining chronic illnesses. Once such chronic manifestations have been reversed, the clinical effects of trial reexposures— either in the hospital or upon returning to home or work conditions—often induce acute convincing test effects.

*100\110\2*

Some foods contain large amounts of histamine, and this can cause unpleasant symptoms when they are eaten. The histamine has a drug-like (pharmacological) effect on the body. Although this is not false food allergy (according to the definition we are using) it is appropriate to discuss it here – since histamine is also the main mediator produced by mast cells, the effects are similar.

Histamine is formed in foods by the action of certain bacteria. These are not disease-causing bacteria, and their presence is normally harmless, but if they are too numerous the histamine they generate can cause problems. The principal foods concerned are well-ripened cheeses and Continental sausages, especially those that are kept for a long time. Some types of fish, principally mackerel and tuna, may cause similar problems if they are not kept at low temperatures before being eaten or canned. Bacteria in the fish produce a cocktail of toxins that includes generous quantities of histamine. Fish affected in this way have a sharp, peppery or metallic taste.

The symptoms of histamine poisoning are nausea, diarrhoea, skin rashes, flushing and headaches. The liver is well-equipped to detoxify histamine, and these unpleasant symptoms are relatively short-lived, usually clearing up within 12 hours. However, the drug isoniazid, used for the treatment of tuberculosis, reduces the liver’s ability to break down histamine, and anyone taking this drug should avoid histamine-rich foods. Viral hepatitis and cirrhosis of the liver also make the body less able to detoxify histamine.

Any increase in the leakiness of the gut wall increases susceptiblity to histamine in foods, simply because more histamine gets through. It seems likely that greater permeability of the gut is a common feature of both food allergy and food intolerance, so avoiding histamine-rich cheeses and sausages may be generally advisable.

*96\180\8*

Naturopathic and herbalist therapies rely on various combinations of diet, cleansing the system, and administration of natural or herbal remedies to alleviate symptoms. They, like other complementary therapies, look at the individual in the round, taking into account the person’s temperament, constitution and life situation.

Therapies of this kind can be extremely effective against allergies and sensitivity. (A form of Chinese herbal treatment for eczema is currently undergoing medical trials in the UK by doctors to assess how widespread its effectiveness is.)

If you have food and chemical sensitivity, you may need to take care with any special diet proposed (including special drinks or infusions), or with taking herbal remedies. If you have a pre-disposition to food or chemical sensitivity, you may become intolerant of, and start to react to, components of the diet or remedies. If you start to feel ill on a special regime, test out whether you are sensitive to remedies, drinks or herbs. Again, take extra care if these therapies are used on a highly sensitive child. Do not give to a baby.

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Decongestants work by shrinking blood vessels, thereby relieving the effects of an allergic reaction, particularly in the mucus membranes of the nose. They can be taken as tablets or as nasal sprays (e.g. Otrivine, Afrazine and Sudafed). They can be effective against hay fever and rhinitis, but their major drawback is that they lose their effectiveness as time goes on. Moreover, they can actually make symptoms worse when their use is stopped. The blood vessels react to this cessation by expanding again, which causes congestion once more, even if the allergen is absent and you are not reacting.

The best advice is not to use decongestants continuously for more than three to five days, and to avoid prolonged use. You should use them on doctor’s advice rather than buy them over the counter.

Some decongestants are combined with anti-histamines (eg. Congesteeze, Haymine, Sudafed Plus).

Decongestants can be dangerous if you have a history of high blood pressure or heart disease. Consult your doctor.

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Many people with chemical sensitivity find that they can tolerate bottled water better than tapwater. But some bottled waters can upset people, even with minute levels of contamination of chemicals. Particular brands of bottled water are consistently better tolerated by chemically sensitive people and, if you are thinking of switching to bottled water, it is a good idea to try these ones first. The well-tolerated brands are Malvern, Buxton and Evian. Carbonation – adding carbon dioxide to water to make it fizzy -has no effect on people’s tolerance of bottled water.

If you are very sensitive to plastic, try to obtain bottled water in glass bottles. Evian is not generally available in glass; it is worth trying in plastic since even very sensitive people are often unaffected by it.

If you or your family and friends drink a lot of bottled water, it may be worth buying wholesale. Suma, wholefood wholesalers, stock a number of brands. Natural Foods deliver bottled waters in the London Area. Malvern is sold by wholesalers supplying the pub trade, and Buxton and Evian are sold by wholesalers and cash and carry merchants supplying grocers, confectioners and newsagents. Look for these in Yellow Pages.

If you react even to these brands, or to reverse osmosis water, you can try rotating waters. Set up a four-day rotation for waters, allocating one type or brand of water to each day, Brand One to Pay One and so on. Use just that water for drinking and cooking on that day, and change waters on each of the four days.

Neutralisation, a form of de-sensitisation, can sometimes be effective with bottled water. It can help if you are desperate.

Another method that sometimes helps is to pass bottled water through a jug filter. Again it is worth a try if you feel desperate.

If you are sensitive to tapwater, your symptoms should be clear or improve after four days. You may feel worse with withdrawal symptoms initially if you are extremely sensitive to water, but these will clear fast.

*397\117\8*

If you are allergic to moulds or house dust mites, you should take care if buying a car secondhand. If a car appears very dusty and damp, or smells fusty, it will probably have house dust mites and moulds. You may be better buying a new car or one of more recent date.

If you are allergic to pets and animals, and buying a secondhand car, check with the owner whether any animals (or people in close contact with them) have travelled regularly in the car, even if the owner does not have pets. (Even traces from clothes, or from the rear of a car can upset the very sensitive.) Look for traces of pet hair, often difficult to remove.

If you are sensitive to tobacco smoke residues, check when buying a car secondhand whether anyone has ever smoked in the car. A good tip is to look in all of the ashtrays – these are virtually impossible to clear of smells and ash. You will be able to detect any traces of smokers from the ashtrays even if the owner or dealer cannot say whether the car has been exposed to smoke. When you travel by taxi, ask for a non-smoking taxi.

If you are very sensitive to chemical cleaners and air fresheners, sniff the car carefully to see if any strong agents have been used. Fumes from air fresheners – often stuck to the dashboard, in or under the glove compartment – take a very long time to wear off: avoid a car which has had these recently, if you can. If you buy privately, rather than from a dealer, it is often easier to find out what has or has not been applied to the car. This applies also to recent repairs, rust-proofing or service treatments as well.

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There are three leading brands of peroxide system in the UK: 10/10, Oxysept and Perform. They differ in the neutralising agent used in the second step of the system. In 10/10, the neutraliser contains sodium pyruvate; this is a chemical produced naturally in the body as a byproduct of metabolism and is well tolerated. The neutraliser in Oxysept is an enzyme called catalase; in practice, few problems arise with this, In Perform, the neutraliser is sodium thiosulphate. This is a less powerful agent than sodium pyruvate or catalase. Follow the manufacturer’s instructions carefully and it should prove acceptable.

Some other modern preservative-free systems use as their germ-killing agent chemicals which release free chlorine in the process. These type of systems do not require a neutralising agent; they are cheaper to buy and less time-consuming to use. In theory, the chlorine released should disperse during soaking overnight and not cause problems in the morning. In practice, most people do not have problems with this type of system but even some people who are not chemically sensitive find that they get irritation from the minute traces of chlorine left on the lens.

On balance, the more expensive and less convenient peroxide plus neutralising agent systems, such as 10/10 and Oxysept, are a better choice for the chemically sensitive.

*366\117\8*

If you are sensitive to many foods, or even to a small number of basic foods, it can be virtually impossible to avoid everything to which you react. If you have come through exclusion dieting and found this to be the case, do not despair. Except for some very rare individuals, it is quite possible to manage your diet and live with multiple sensitivity. Food intolerance and mild allergies respond to dietary management -eating foods seldom and in small quantities will help you to keep them in your diet and maintain some kind of balance.

With food intolerance and mild allergy, the severity of reactions often declines markedly if you do not eat a food constantly or in large quantities. The body seems able to build up a certain level of tolerance. Therefore, a doctor may recommend that you keep a food to which you are sensitive in your diet, but eat it in moderation.

You may also be recommended to leave a food out for a long time -say, a few months or even a year – and then try it again, even if you had severe reactions to it on testing. (Doctors are only likely to recommend this where you have food intolerance rather than allergy.) The reason for trying this is that many people find that they regain tolerance for a food to which they been sensitive after leaving it out for a long time. You can then include the food in your diet, but again eating it in moderation and at intervals.

A rotation diet will also help to maintain the body’s level of tolerance to foods, and to prevent you developing new sensitivities.

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If you are exceptionally sensitive, you may continue to react even to very tiny levels of fumes once things are aired off, and you may have to avoid some chemicals totally, but this is extremely rare. For most people, taking care with specific situations means they can live happily with substances that upset them.

If you investigate for yourself what chemicals are found in anything you use, it is also worth remembering that chemicals are usually only troublesome when they are given off as vapour or released into the atmosphere. If a chemical has been used in the manufacture or finishing of a product, it may not be released as free vapour at all and it will not bother you. Formaldehyde, for instance, is commonly a troublesome chemical when it is released as free formaldehyde. It is used in the manufacture of many products, but in some circumstances is not released after manufacture as free formaldehyde and should pose no problems. Formaldehyde resins are used in the making of plywood, for instance, but, if manufacture has been correct, no free formaldehyde is given off at all, and plywood should not give problems. Formaldehyde resins are also used in the manufacture of chipboard but, in this case, free formaldehyde continues to be released after manufacture is complete, and chipboard is known to cause some people persistent reactions.

*59\117\8*

Pure cotton underwear is relatively easy to find in High Street shops. Cotton jersey vests and pants are commonly sold by all the major clothing chains, as are warmer knitted cotton winter underwear. Flocky knitted cotton underwear can sometimes irritate sensitive skin where cotton jersey (also called cotton interlock) does not. If you are very sensitive, stick to cotton jersey. You may need to beware of trimmings, lace and elastic upsetting you

Nightwear can be harder to track down. Some chemically sensitive people react to cotton poplin, cotton lawn and winceyette, because of fabric treatments. Again, cotton jersey can be safer. Most High Street chains usually have a selection of cotton jersey nightwear for women and children. Marks and Spencer commonly stock 100 per cent cotton poplin men’s pyjamas. Mail order sources for cotton jersey nightwear are given below. Finding 100 per cent cotton bras can also be tricky. Specialist underwear shops or departments usually stock light cotton jersey sports bras which are practicable if you need only light support. Playtex make a 100 per cent cotton support bra, the ‘Whisper* bra. Natural Fibres supply 100 per cent cotton bras by post, with a size range up to 115 cm (46 inches). David Nieper also supply 100 per cent cotton bras by post. Schmidt Natural Clothing sell a silk and cotton blend bra top. Maternity bras are commonly available in pure cotton. Even if not pregnant, you may find them useful, since they are designed for proper support.

Nice Irma’s sell Indian cotton dressing gowns. Women’s slips and petticoats in cotton are sold by post by David Nieper.

*333\117\8*

It is difficult to detect whether you are sensitive to building materials already used or applied in your home or other environments. Changes in your symptoms when you go into different places, or if you stay away from home, can be indicative, but not always conclusive, evidence of sensitivity to materials.

You can be tested by patch testing or sublingual tests for allergy or sensitivity to specific chemicals. There are also two environmentally controlled units in the UK, which are as chemical free as possible, where rigorous testing for chemical sensitivity can be done.

You can use the Tile Test (opposite) to test specific materials to see if these induce symptoms, but the only reliable way of finding out in your own environment whether materials around you upset you is to remove and replace potential hazards. However, for most people this is impracticable, as well as costly and disruptive. At work or school, it is invariably impossible. Unless you are absolutely confident that materials are the key source of trouble for you, it is wiser first to reduce chemicals from other sources around you – cleaning materials, toiletries, personal hygiene products, clothing, furniture, bedding, flooring before you make significant changes to your decoration or building.

If, thereafter, you determine that you need to change the materials, or if you are obliged to redecorate or do repair work, use low-hazard materials as suggested below and see, after a period of airing, whether your symptoms improve.

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When You Come Back In

If you have been close to high sources of pollen, it can help to shower and wash your hair on returning home. Changing clothes can also be a help. If a dog has been out in long grass or near trees, brush or wash it down before it comes indoors.

When Indoors

At the height of pollen seasons, keep doors and windows closed as much as you can. Surprisingly high levels of tree and grass pollens have been monitored inside buildings. Keep them closed, especially at peak hours, and above all keep bedroom windows closed during the day and early evening. A good time to open windows is overnight, between 10.00 p.m. and 6.00 a.m., although on some hot nights there can be pollen peaks at around midnight.

Using an air filter can help. It will not remove all traces of allergens, but people report that using a filter can make enough difference to make life bearable indoors.

Some people also report that hanging damp butter muslin or damp net curtains at windows helps trap pollens, and reduce their level indoors. It may not be possible to keep windows and doors closed as much as you would like at work or school. Sitting away from a window will help a little, as will holding a damp cloth to your nose.

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