in2uract

Posted by: faithful | January 9, 2010

Domestic Violence and Abuse: Types, Signs, Symptoms, Causes, and Effects

Domestic violence and abuse can happen to anyone, yet the problem is often overlooked, excused, or denied. This is especially true when the abuse is psychological, rather than physical. Emotional abuse is often minimized, yet it can leave deep and lasting scars.

Noticing and acknowledging the warning signs and symptoms of domestic violence and abuse is the first step to ending it. No one should live in fear of the person they love. If you recognize yourself or someone you know in the following warning signs and descriptions of abuse, don’t hesitate to reach out. There is help available.

Understanding domestic violence and abuse

Men can be victims, too

Women are not the only victims of domestic violence and abuse. Men also suffer from domestic abuse—especially verbal and emotional abuse—and may be even more ashamed to seek help.

Domestic abuse, also known as spousal abuse, occurs when one person in an intimate relationship or marriage tries to dominate and control the other person. Domestic abuse that includes physical violence is called domestic violence.

Domestic violence and abuse are used for one purpose and one purpose only: to gain and maintain total control over you. An abuser doesn’t “play fair.” Abusers use fear, guilt, shame, and intimidation to wear you down and keep you under their thumb. Your abuser may also threaten you, hurt you, or hurt those around you.

Domestic violence and abuse do not discriminate. It happens among heterosexual couples and in same-sex partnerships. It occurs within all age ranges, ethnic backgrounds, and financial levels. And while women are more commonly victimized, men are also abused—especially verbally and emotionally.

Recognizing abuse is the first step to getting help

Domestic abuse often escalates from threats and verbal abuse to physical violence and even murder. And while physical injury may be the most obvious danger, the emotional and psychological consequences of domestic abuse are also severe. No one deserves this kind of pain—and your first step to breaking free is recognizing that your situation is abusive. Once you acknowledge the reality of the abusive situation, then you can get the help you need.

You don’t have to live in fear

If you are afraid for your safety or have been beaten by your partner:

Dial 911 or call the National Domestic Violence Hotline at 1-800-787-3224.
Read Help for Abused and Battered Women: Domestic Violence Shelters, Support, and Protection

Signs of an abusive relationship

There are many signs of an abusive relationship. The most telling sign is fear of your partner. If you feel like you have to walk on eggshells around your partner—constantly watching what you say and do in order to avoid a blow-up—chances are your relationship is unhealthy and abusive. Other signs that you may be in an abusive relationship include a partner who belittles you or tries to control you, and feelings of self-loathing, helplessness, and desperation.

To determine whether your relationship is abusive, answer the questions below. The more “yes” answers, the more likely it is that you’re in an abusive relationship.

SIGNS THAT YOU’RE IN AN ABUSIVE RELATIONSHIP
Your Inner Thoughts and Feelings	Your Partner’s Belittling Behavior
Do you: feel afraid of your partner much of the time? avoid certain topics out of fear of angering your partner? feel that you can’t do anything right for your partner? believe that you deserve to be hurt or mistreated? wonder if you’re the one who is crazy? feel emotionally numb or helpless?	Does your partner: humiliate or yell at you? criticize you and put you down? treat you so badly that you’re embarrassed for your friends or family to see? ignore or put down your opinions or accomplishments? blame you for his own abusive behavior? see you as property or a sex object, rather than as a person?
Your Partner’s Violent Behavior or Threats	Your Partner’s Controlling Behavior
Does your partner: have a bad and unpredictable temper? hurt you, or threaten to hurt or kill you? threaten to take your children away or harm them? threaten to commit suicide if you leave? force you to have sex? destroy your belongings?	Does your partner: act excessively jealous and possessive? control where you go or what you do? keep you from seeing your friends or family? limit your access to money, the phone, or the car? constantly check up on you?

Physical violence is just one form of domestic abuse

When people think of domestic abuse, they often picture battered women who have been physically assaulted. But not all domestic abuse involves violence. Just because you’re not battered and bruised doesn’t mean you’re not being abused.

Domestic abuse takes many forms, including psychological, emotional, and sexual abuse. These types of abuse are less obvious than physical abuse, but that doesn’t mean they’re not damaging. In fact, these types of domestic abuse can be even more harmful because they are so often overlooked—even by the person being abused.

Emotional or psychological abuse

The aim of emotional or psychological abuse is to chip away at your feelings of self-worth and independence. If you’re the victim of emotional abuse, you may feel that there is no way out of the relationship, or that without your abusive partner you have nothing.

Emotional abuse includes verbal abuse such as yelling, name-calling, blaming, and shaming. Isolation, intimidation, and controlling behavior also fall under emotional abuse. Additionally, abusers who use emotional or psychological abuse often throw in threats of physical violence.

You may think that physical abuse is far worse than emotional abuse, since physical violence can send you to the hospital and leave you with scars. But, the scars of emotional abuse are very real, and they run deep. In fact, emotional abuse can be just as damaging as physical abuse—sometimes even more so. Furthermore, emotional abuse usually worsens over time, often escalating to physical battery.

Sexual abuse

Sexual abuse is common in abusive relationships. According to the National Coalition Against Domestic Violence, between one-third and one-half of all battered women are raped by their partners at least once during their relationship. Any situation in which you are forced to participate in unwanted, unsafe, or degrading sexual activity is sexual abuse.

Forced sex, even by a spouse or intimate partner with whom you also have consensual sex, is an act of aggression and violence. Furthermore, women whose partners abuse them physically and sexually are at a higher risk of being seriously injured or killed.

Economic or financial abuse

Remember, an abuser’s goal is to control you, and he will frequently use money to do so. Economic or financial abuse includes:

Rigidly controlling your finances.
Withholding money or credit cards.
Making you account for every penny you spend.
Withholding basic necessities (food, clothes, medications, shelter).

Restricting you to an allowance.
Preventing you from working or choosing your own career.
Sabotaging your job (making you miss work, calling constantly)
Stealing from you or taking your money.

It Is Still Abuse If . . .

The incidents of physical abuse seem minor when compared to those you have read about, seen on television or heard other women talk about. There isn’t a “better” or “worse” form of physical abuse; you can be severely injured as a result of being pushed, for example.
The incidents of physical abuse have only occurred one or two times in the relationship. Studies indicate that if your spouse/partner has injured you once, it is likely he will continue to physically assault you.
The physical assaults stopped when you became passive and gave up your right to express yourself as you desire, to move about freely and see others, and to make decisions. It is not a victory if you have to give up your rights as a person and a partner in exchange for not being assaulted!
There has not been any physical violence. Many women are emotionally and verbally assaulted. This can be as equally frightening and is often more confusing to try to understand.

Source: Breaking the Silence: a Handbook for Victims of Violence in Nebraska (PDF)

Violent and abusive behavior is the abuser’s choice

Despite what many people believe, domestic violence and abuse is not due to the abuser’s loss of control over his behavior. In fact, abusive behavior and violence is a deliberate choice made by the abuser in order to control you.

Abusers use a variety of tactics to manipulate you and exert their power:

Dominance – Abusive individuals need to feel in charge of the relationship. They will make decisions for you and the family, tell you what to do, and expect you to obey without question. Your abuser may treat you like a servant, child, or even as his possession.
Humiliation – An abuser will do everything he can to make you feel bad about yourself or defective in some way. After all, if you believe you’re worthless and that no one else will want you, you’re less likely to leave. Insults, name-calling, shaming, and public put-downs are all weapons of abuse designed to erode your self-esteem and make you feel powerless.
Isolation – In order to increase your dependence on him, an abusive partner will cut you off from the outside world. He may keep you from seeing family or friends, or even prevent you from going to work or school. You may have to ask permission to do anything, go anywhere, or see anyone.
Threats – Abusers commonly use threats to keep their partners from leaving or to scare them into dropping charges. Your abuser may threaten to hurt or kill you, your children, other family members, or even pets. He may also threaten to commit suicide, file false charges against you, or report you to child services.
Intimidation – Your abuser may use a variety of intimidation tactics designed to scare you into submission. Such tactics include making threatening looks or gestures, smashing things in front of you, destroying property, hurting your pets, or putting weapons on display. The clear message is that if you don’t obey, there will be violent consequences.
Denial and blame – Abusers are very good at making excuses for the inexcusable. They will blame their abusive and violent behavior on a bad childhood, a bad day, and even on the victims of their abuse. Your abusive partner may minimize the abuse or deny that it occurred. He will commonly shift the responsibility on to you: Somehow, his violent and abusive behavior is your fault.

Reasons we know an abuser’s behaviors are not about anger and rage:

He does not batter other individuals – the boss who does not give him time off or the gas station attendant that spills gas down the side of his car. He waits until there are no witnesses and abuses the person he says he loves.
If you ask an abused woman, “can he stop when the phone rings or the police come to the door?” She will say “yes”. Most often when the police show up, he is looking calm, cool and collected and she is the one who may look hysterical. If he were truly “out of control” he would not be able to stop himself when it is to his advantage to do so.
The abuser very often escalates from pushing and shoving to hitting in places where the bruises and marks will not show. If he were “out of control” or “in a rage” he would not be able to direct or limit where his kicks or punches land.

Source: Mid-Valley Women’s Crisis Service

The cycle of violence in domestic abuse

Domestic abuse falls into a common pattern, or cycle of violence:

Abuse – Your abusive partner lashes out with aggressive, belittling, or violent behavior. The abuse is a power play designed to show you “who is boss.”
Guilt – After abusing you, your partner feels guilt, but not over what he’s done. He’s more worried about the possibility of being caught and facing consequences for his abusive behavior.
“Normal” behavior – Your abuser does everything he can to regain control and keep you in the relationship. He may act as if nothing has happened, or he may turn on the charm. This peaceful honeymoon phase may give you hope that your abusive partner has really changed this time.
“Normal” behavior — The abuser does everything he can to regain control and keep the victim in the relationship. He may act as if nothing has happened, or he may turn on the charm. This peaceful honeymoon phase may give the victim hope that the abuser has really changed this time.
Fantasy and planning – Your abuser begins to fantasize about abusing you again. He spends a lot of time thinking about what you’ve done wrong and how he’ll make you pay. Then he makes a plan for turning the fantasy of abuse into reality.
Set-up – Your abuser sets you up and puts his plan in motion, creating a situation where he can justify abusing you.

Your abuser’s apologies and loving gestures in between the episodes of abuse can make it difficult to leave. He may make you believe that you are the only person who can help him, that things will be different this time, and that he truly loves you. However, the dangers of staying are very real.

The Full Cycle of Domestic Violence

A man abuses his partner. After he hits her, he experiences self-directed guilt. He says, “I’m sorry for hurting you.” What he does not say is, “Because I might get caught.” He then rationalizes his behavior by saying that his partner is having an affair with someone. He tells her “If you weren’t such a worthless whore I wouldn’t have to hit you.” He then acts contrite, reassuring her that he will not hurt her again. He then fantasizes and reflects on past abuse and how he will hurt her again. He plans on telling her to go to the store to get some groceries. What he withholds from her is that she has a certain amount of time to do the shopping. When she is held up in traffic and is a few minutes late, he feels completely justified in assaulting her because “you’re having an affair with the store clerk.” He has just set her up.

Source: Mid-Valley Women’s Crisis Service

Recognizing the warning signs of domestic violence and abuse

It’s impossible to know with certainty what goes on behind closed doors, but there are some telltale signs and symptoms of domestic violence and abuse. If you witness any warning signs of abuse in a friend, family member, or co-worker, take them very seriously.

General warning signs of domestic abuse

People who are being abused may:

Seem afraid or anxious to please their partner.
Go along with everything their partner says and does.
Check in often with their partner to report where they are and what they’re doing.
Receive frequent, harassing phone calls from their partner.
Talk about their partner’s temper, jealousy, or possessiveness.

Warning signs of physical violence

People who are being physically abused may:

Have frequent injuries, with the excuse of “accidents.”
Frequently miss work, school, or social occasions, without explanation.
Dress in clothing designed to hide bruises or scars (e.g. wearing long sleeves in the summer or sunglasses indoors).

Warning signs of isolation

People who are being isolated by their abuser may:

Be restricted from seeing family and friends.
Rarely go out in public without their partner.
Have limited access to money, credit cards, or the car.

The psychological warning signs of abuse

People who are being abused may:

Have very low self-esteem, even if they used to be confident.
Show major personality changes (e.g. an outgoing woman becomes withdrawn).
Be depressed, anxious, or suicidal.

Speak up if you suspect domestic violence or abuse

Do’s and Don’t’s

Do:Ask.Express concern.

Listen and validate.

Offer help.

Support her decisions.

Don’t:Wait for her to come to you.Judge or blame.

Pressure her.

Give advice.

Place conditions on your support.

If you suspect that someone you know is being abused, speak up! If you’re hesitating—telling yourself that it’s none of your business, you might be wrong, or the woman might not want to talk about it—keep in mind that expressing your concern will let the person know that you care and may even save her life.

Talk to the person in private and let her know that you’re concerned about her safety. Point out the things you’ve noticed that make you worried. Tell her that when and if she wants to talk about it, you’re there for her. Reassure her that you’ll keep whatever she tells you between the two of you, and let her know that you’ll help in any way you can.

Remember, abusers are very good at controlling and manipulating their victims. Abused and battered women are depressed, drained, scared, ashamed, and confused. They need help to get out, yet they have often been isolated from their family and friends. By picking up on the warning signs and offering support, you can help them escape an abusive situation and begin healing.

Help for Abused and Battered Women: Domestic Violence Shelters, Support, and Protection

Learn how to protect yourself from domestic violence and leave an abusive relationship safely. Includes tips on getting a restraining order, finding a shelter, and staying safe after you’ve left.

divorce can protect children

Divorce: Protecting The Children

by Debra R. Marsilia, November 1999

Children are our most precious gifts. As parents, the most challenging responsibility we have is protecting our children. We must realize the importance of protecting them, not only from the outside world, but sometimes from someone within our own homes. Many people suffer from verbal and emotional abuse from spouses and do not realize that the children, whether the abuse is directed at them or if they are only witnessing the abuse, are also affected. “Emotional abuse is a pattern of behavior that attacks a child’s emotional development and self-worth.”(1) It can include excessive or unreasonable demands on the child, constant criticism, insulting and teasing. This form of abuse can be just as painful as, if not more so, than physical abuse because the effects remain long after any physical injuries have healed. Children deserve the stability, warmth and safety of a loving home. Divorce can be a way to protect children and provide them with a home in which they know they are safe from abuse.

Many religions view marriage as a holy commitment, not only to another person, but also to God. The Catholic Church, for example, believes that once you enter into the “holy state of matrimony”, marriage being one of the seven sacraments, you can not terminate the marriage. However, the Catholic Church also believes that “Parents have the first responsibility for the education of their children. They bear witness to this responsibility first by creating a home where tenderness, forgiveness, respect, fidelity, and disinterested service are the rule.”(2) The church places, with the parent, the responsibility of raising a child in a tender, caring, forgiving, and respectful household. If a person is in an abusive situation, the well-being of the child is at risk of being sacrificed.

There are many that portray the idea of “staying together for the sake of the children” as valid. According to Ashton Applewhite in her 1997 article, DOES DIVORCE DEVASTATE CHILDREN?, two professors, Sara McLanahan and Gary Sandefur compiled a study and arrived at the conclusion that “The worst thing for kids is to be around a constant state of warfare.”(3) Children absorb what goes on around them. If they are being abused or are witnessing their parents yelling at and tearing down each other, they can become confused, hurt and angry and it is likely to affect their attitude towards both parents and others. They may begin to act out this anger and confusion on their parents, teachers and even their friends.

A child that suffers from verbal and emotional abuse can begin to “act out” their pain and anger in many ways. There are observable and behavioral indicators that can be present when a child is in an abusive situation. Observable indicators can include, but are not limited to; inappropriate aggressiveness, destructive attitude towards others, sleep or speech disorders and demonstration of compulsions, obsessions, phobias, and hysterical outbursts. Behavioral indicators can include; negative statements about themselves, overt shyness, slow physical, mental and emotional development, self destructive behavior, increased aggressiveness and cruelty to others. These indicators should be seen as warning signs to caring, loving parents. A child cannot develop socially and emotionally with the tremendous amount of stress brought on by verbal and emotional abuse. If an abusive situation exists, and children are beginning to exhibit these traits, it is the parent’s responsibility to do something to change the surrounding conditions under which the child lives. If one parent can not see the pain they are inflicting on their child, sometimes the only viable solution is to remove the source of the pain through divorce.

There are many reasons to remain married, children being one of the most important, and there are many reasons to seek a divorce, again, children being one of the most important. Children’s lives, regardless of age, are affected by witnessing what goes on around them. Parents who remain in marriages that are, in effect, detrimental to themselves, sometimes don’t understand that it is even more damaging to the children. “If a child is abused or is witness to abuse, the child suffers.” (4) A child will grow up believing that this type of behavior is acceptable and will, in turn, cause him to not only react in the same way as his parents, but to also seek that same type of relationship that will provide him with more pain and unhappiness. A parent that remains in an abusive marriage not only runs the risk of having a tremendous amount of problems with their young children, they are also potentially condemning their children to adult lives full of anger, hurt, and mistrust.

According to “Dr. Irene’s Verbal Abuse Site” on the Internet, “Abused children manifest a myriad of disorders in adulthood: post-traumatic stress disorder, panic and anxiety disorders, mood disorders, substance abuse problems.”(5) If a parent realizes the importance of removing a child from an abusive household and providing a warm, stable home for the child, he may have a better chance at preventing many of the problems that could occur. However, many people hold onto the idea that marriage should be “forever”. Patricia Evans writes in her 1992 book “The Verbally Abusive Relationship”, that “It is important to know that children can be better off in a nonabusive single-parent home than in one in which abuse takes place.”(6) If parents choose to leave an abusive marriage and remove their children from a hostile environment, this could provide the children with the security and stability they need. Barbara Cyr, believes that “The children feel more secure because they are living in a stable environment.”(7) This comfort and stability could help the child develop a better mental and emotional outlook on life and possibly prevent many future problems.

“Staying can hurt the child. It is totally invalid to think that staying in a marriage ‘for the sake of the children’ has any merit whatsoever. It is extremely detrimental. Whether the abuse shifts to the child or the child just unconsciously absorbs the mechanics of an abusive relationship, it is agonizingly painful in the long run.”(8) As parents, our responsibility lies in what we teach our children. We need to provide them with a stable environment, free from the stress and anxiety of the abusing parent, in which they can grow emotionally and physically. The children should be taught, by watching their parents, how to love and respect others, as well as themselves. We need to show them, by example, what a loving, caring relationship with another person is supposed to be. If a parent remains in an abusive relationship, the parent is validating that type of behavior for their children. It is the parent’s duty to end the relationship and show the child that an individual must be strong enough to admit their mistakes and move on with their lives. We must show our children how much we value ourselves and how much we love them by providing them with a warm, loving, nurturing environment in which to live. This will, in turn, teach them to value themselves, make them stronger, as children and adults, and help them make better choices in their adult lives.

FOOTNOTES

(1) 1997 Safe Child-Child Abuse

(2) Catechism of the Catholic Church, Doubleday Publishing, New York, 1995, Section 2223

(3) Applewhite, Ashton. DOES DIVORCE DEVASTATE CHILDREN?, 1997, p. 1

(4) Evans, Patricia M. The Verbally Abusive Relationship. Expanded Second Edition. Adams Media Corporation, Holbrook, MA , 1992, p. 200

(6) Evans, Patricia M. The Verbally Abusive Relationship. Expanded Second Edition. Adams Media Corporation, Holbrook, MA , 1992, p. 200

(7) Barbara Cyr, Divorce and its Effects on Children, p.1

(8) Evans, Patricia M. The Verbally Abusive Relationship. Expanded Second Edition. Adams Media Corporation, Holbrook, MA , 1992, p. 17

BIBLIOGRAPHY

Applewhite, Ashton. DOES DIVORCE DEVASTATE CHILDREN?, 1997

Catechism of the Catholic Church, Doubleday Publishing, New York, 1995

Evans, Patricia M. The Verbally Abusive Relationship. Expanded Second Edition. Adams Media Corporation, Holbrook, MA , 1992

Safe Child-Child Abuse, http://www.safechild.org/childabuse3.htm

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Posted in abusive relationships, child development, domestic violence, victim advocacy

Posted by: faithful | December 17, 2009

amino acid predicts alzheimers

Diet high in methionine could increase risk of Alzheimer’s

Posted On: December 16, 2009 – 4:10pm

A diet rich in methionine, an amino acid typically found in red meats, fish, beans, eggs, garlic, lentils, onions, yogurt and seeds, can possibly increase the risk of developing Alzheimer’s disease, according to a study by Temple researchers.

The researchers published their findings, titled “Diet-induced hyperhomocysteinemia increases Amyloid-β formation and deposition in a mouse model of Alzheimer’s disease,” in the journal Current Alzheimer Research.

“When methionine reaches too high a level, our body tries to protect itself by transforming it into a particular amino acid called homocysteine,” said lead researcher Domenico Praticò, an associate professor of pharmacology in the School of Medicine. “The data from previous studies show — even in humans — when the level of homocysteine in the blood is high, there is a higher risk of developing dementia. We hypothesized that high levels of homocysteine in an animal model of Alzheimer’s would accelerate the disease.”

Using a seven-month old mouse model of the disease, they fed one group an eight-month diet of regular food and another group a diet high in methionine. The mice were then tested at 15 months of age — the equivalent of a 70-year-old human.

A brain sample taken from mice used in a Temple University study on how a diet rich in the amino acid methionine may increase the risk of Alzheimer’s disease. The dark spots are consistent with amyloid plaque, indicative of the progression of Alzheimers disease. Mice fed diets rich in methionine had an increased level of homocysteine and up to 40 percent more amyloid plaque in their brains.

(Photo Credit: Temple University)

“We found that the mice with the normal diet had normal homocysteine levels, but the mice with the high methionine diet had significantly increased levels of homocysteine, very similar to human subjects with hyperhomocysteinemia,” said Praticò. “The group with the high methionine diet also had up to 40 percent more amyloid plaque in their brains, which is a measurement of how much Alzheimer’s disease has developed.

The researchers also examined capacity to learn a new task and found it diminished in the group with the diet high in methionine.

Still, Praticò emphasized, methionine is an essential amino acid for the human body and
“stopping one’s intake of methionine won’t prevent Alzheimer’s. But people who have a diet high in red meat, for instance, could be more at risk because they are more likely to develop this high level of circulating homocysteine,” he said.

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Posted in HEALTH AND WELL-BEING, healthy eating

Posted by: faithful | December 17, 2009

colorectal cancer and genetic markers

New England Journal of Medicine publishes CWRU review of the ‘molecular basis of colorectal cancer’

Posted On: December 16, 2009 – 10:30pm

CLEVELAND — December 16, 2009 — Every year in the United States, 160,000 cases of colorectal cancer are diagnosed, and 57,000 patients die of the disease, making it the second leading cause of death from cancer among adults, after lung cancer.

As researchers and clinicians fervently look for causes and cures for colorectal cancer — simultaneously generating thousands of studies producing more and more promising results – Dr. Sanford Markowitz, professor and researcher of cancer and genetics at Case Western Reserve University School of Medicine and oncologist at the Case Comprehensive Cancer Center at University Hospitals Case Medical Center, today published his forward-looking view of the “Molecular Basis of Colorectal Cancer” in the Dec. 17, 2009 issue of the New England Journal of Medicine, with co-author, Dr. Monica Bertagnolli, from the Brigham and Women’s Hospital, Harvard Medical School.

“Today’s challenges are to understand the molecular basis of individual susceptibility to colorectal cancer and to determine factors that initiate the development of the tumor, drive its progression, and determine its responsiveness or resistance to antitumor agents,” wrote Dr. Markowitz.

Key advances that the article singled out toward meeting these goals are:

Discoveries in DNA sequencing technology have made it possible to sequence the entire
genome of a human cancer. Colorectal cancer provided the first example of the power of this technology. Sequencing of 18,000 (nearly all) of the known human genes in 35 colon cancers identified 140 as candidate cancer genes that were mutated in at least two colon cancers and that probably contributed to the cancer phenotype.
Biological pathways that are deregulated in colon cancer have been identified, and could now form the basis of new therapeutic agents. Although some high-frequency mutations are attractive targets for drug development, common signaling pathways downstream from these mutations may also be tractable as therapeutic targets.
Studies that aid in the understanding of colorectal cancer on a molecular level have provided important tools for genetic testing for high-risk familial forms of the disease, predictive markers for selecting patients for certain classes of drug therapies and molecular diagnostics for the noninvasive detection of early cancers.
Recent progress in molecular assays for the early detection of colorectal cancer indicates that understanding the genes and pathways that control the earliest steps of the disease, and individual susceptibility, can contribute to clinical management in the near term. For example, patients whose colon cancers have mutations in either RAS or BRAF genes are known not to benefit from treatment with the anti-colon cancer agent Cetuximab.
Moreover, patients with inherited mutations in tumor-suppressor genes, such as APC, MLH1, and MSH2 have a very high risk of colorectal cancer and require early and frequent surveillance for colon cancer and often prophylactic surgery.
Last, the development of molecular diagnostics for the early detection of colorectal cancer is emerging as an important translation of colon-cancer genetics into clinical practice. One example is the development of stool DNA tests to detect cancer-associated aberrant DNA methylation as a method for early detection of patients with colorectal cancer or advanced adenomas. Stool DNA testing for colorectal cancer has been added to the cancer-screening guidelines of the American Cancer Society.

Dr. Markowitz and Bertagnolli’s concluding observations are optimistic ones that the considerable recent and ongoing advances in our knowledge of the molecular basis of colorectal cancer will continue to result in markedly reducing the burden of this disease.

Dr. Markowitz reports being listed on patents licensed to Exact Sciences and LabCorp and is entitled to receive royalties on sales of products related to methylated vimentin DNA, in accordance with the policies of Case Western Reserve University. No other potential conflict of interest relevant to this article was reported

New England Journal of Medicine publishes CWRU review of the ‘molecular basis of colorectal cancer’

Posted On: December 16, 2009 – 10:30pm

Key advances that the article singled out toward meeting these goals are:

Discoveries in DNA sequencing technology have made it possible to sequence the entire
genome of a human cancer. Colorectal cancer provided the first example of the power of this technology. Sequencing of 18,000 (nearly all) of the known human genes in 35 colon cancers identified 140 as candidate cancer genes that were mutated in at least two colon cancers and that probably contributed to the cancer phenotype.
Biological pathways that are deregulated in colon cancer have been identified, and could now form the basis of new therapeutic agents. Although some high-frequency mutations are attractive targets for drug development, common signaling pathways downstream from these mutations may also be tractable as therapeutic targets.
Studies that aid in the understanding of colorectal cancer on a molecular level have provided important tools for genetic testing for high-risk familial forms of the disease, predictive markers for selecting patients for certain classes of drug therapies and molecular diagnostics for the noninvasive detection of early cancers.
Recent progress in molecular assays for the early detection of colorectal cancer indicates that understanding the genes and pathways that control the earliest steps of the disease, and individual susceptibility, can contribute to clinical management in the near term. For example, patients whose colon cancers have mutations in either RAS or BRAF genes are known not to benefit from treatment with the anti-colon cancer agent Cetuximab.
Moreover, patients with inherited mutations in tumor-suppressor genes, such as APC, MLH1, and MSH2 have a very high risk of colorectal cancer and require early and frequent surveillance for colon cancer and often prophylactic surgery.
Last, the development of molecular diagnostics for the early detection of colorectal cancer is emerging as an important translation of colon-cancer genetics into clinical practice. One example is the development of stool DNA tests to detect cancer-associated aberrant DNA methylation as a method for early detection of patients with colorectal cancer or advanced adenomas. Stool DNA testing for colorectal cancer has been added to the cancer-screening guidelines of the American Cancer Society.

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Posted in colorectal cancer genes/molecules, health

Posted by: faithful | November 29, 2009

a recipe i’d like to try

Grillades and Grits

I’ve heard this was a breakfast dish made for the men before they went out hunting. I serve it at brunches, well when I had brunches and often for dinner. It is Creole at its finest. And make the grits! Even if you think you don’t like them make some creamy white grits. Quick grits are okay instant grits are not.

Grillades & Grits Recipe

2 lbs Round Steak
2 teaspoons Kosher Salt
¼ teaspoon Cayenne Pepper
½ Cup A.P. Flour
1.4 tspn pepper

1 tspn dried thyme

4 tbls unsalted butter
1 Medium Onions, Chopped
1 Bell Pepper, Chopped
2 Ribs Celery, Chopped
2 Cloves Garlic, Minced
2 Cups Beef Stock
3 Tbsp Worcestershire Sauce
2 Cups Tomatoes, Chopped or 1 14.5 ounce can

Salt & Pepper to taste
1 Recipe of Grits made according to the Package Instructions

Pound the Round Steak on both sides to about ½ inch thickness, then cut into 4 inch squares. Season the Grillades with the salt & pepper. Combine the flour, cayenne pepper and thyme then dip the Grillades one at a time into the seasoned flour and shake off any excess. In a cast iron dutch oven, heat 2 tbl butter over medium heat until very hot, but not smoking. Brown the Grillades well on both sides without burning. Transfer the Grillades to a plate. Melt the remaining butter over medium heat. Add the Onions, Bell Pepper, Celery, and Garlic and, stirring frequently, cook until the vegetables are soft but not brown. Add the remaining flour to the vegetables and stir for a few minutes to remove the floury taste. Stir in the Beef Stock, Worcestershire, Tomatoes; bring the mixture to a boil. Reduce the heat to medium-low. Return the Grillades and the accumulated juice from the plate back to the pot. Submerge the Grillades in the sauce and simmer for about 1 to 1 ½ hours or until they are very tender.

Serve over grits.

Gillaades is pronounced GREE-ahdes.

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Posted in recipes

Posted by: faithful | November 20, 2009

depression in children: treatment considerations

Childhood Depression

Childhood and Adolescent Depression

SHASHI K. BHATIA, M.D., and SUBHASH C. BHATIA, M.D., Creighton University, Department of Psychiatry, Omaha, Nebraska

(abstract)….Juvenile depression may manifest in different forms….children younger than seven years may not be able to describe their internal mood state and may express their distress through vague somatic symptoms or pain. Irritable mood may be the cause of angry, hostile behavior. Impaired attention, poor concentration, and anxiety may resemble attention-deficit/hyperactivity disorder, and substance abuse may be a means of self-medication for depression.

Diagnosis

Diagnosis of primary depressive mood disorders (Table 2) requires that physicians rule out depression from medical causes, such as endocrinopathies, malignancies, chronic diseases, infectious mononucleosis, anemia, and vitamin deficiency (especially folic acid),10 and from medications, such as isotretinoin (Accutane).13 If any of these causes are present, the condition is referred to as secondary depressive mood disorder or depressive mood disorder secondary to medical conditions. Lack of improvement following treatment or medication discontinuation warrants further evaluation and treatment.

TABLE 2Key Clinical Decision Points for Depressive Disorders
Question	Action
Is this depression caused by a general medical condition, a medication, or both?	Rule out other causes of depressive mood disorders.
Is this depression related to drug or alcohol abuse?	Determine whether secondary to or complicated by substance abuse.
Is this depression related to a reaction to a stressful life event?	Consider a diagnosis of adjustment disorder.
Is this a chronic, mild depression?	Consider dysthymic disorder.
Is this another type of depressive disorder?	Consider minor depression, bipolar depression, depression caused by seasonal affective disorder, or atypical depression.
Is this major depression?	Apply DSM-IV criteria (see Table 3). Assess for severity and psychotic features.
Is there a coexisting mental illness?	Dysthymic disorder, anxiety disorders, attention-deficit/hyperactivity disorder, oppositional defiant disorder, and substance use disorder are common comorbidities.
Is this a dangerous depression?	Perform suicide risk assessment.
DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th ed.

Major depressive disorder is the most severe of the depressive mood disorders. The Diagnostic and Statistical Manual of Mental Disorders, 4th ed., criteria for diagnosing major depressive disorder in children and adolescents are similar to those for adults (Table 3).20-24

TABLE 3Criteria for Major Depressive Episode in Adults, Children, and Adolescents
Adults	Children and adolescents
A. Five (or more) of the following symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is (1) depressed mood or (2) loss of interest or pleasure.
(1) Depressed mood most of the day, nearly every day, as indicated by subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful)	Mood can be depressed or irritable. Children with immature cognitive-linguistic development may not be able to describe inner mood states and therefore may present with vague physical complaints, sad facial expression, or poor eye contact. Irritable mood may appear as “acting out”; reckless behavior; or hostile, angry interactions. Adult-like mood disturbance may occur in older adolescents.
(2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by subjective account or observation made by others)	Loss of interest can be in peer play or school activities.
(3) Significant weight loss when not dieting, or weight gain (e.g., a change of more than 5 percent of body weight in a month), or decrease or increase in appetite nearly every day	Children may fail to make expected weight gain rather than losing weight.
(4) Insomnia or hypersomnia nearly every day	Similar to adults
(5) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feeling of restlessness or being slowed down)	Concomitant with mood change, hyperactive behavior may be observed.
(6) Fatigue or loss of energy nearly every day	Disengagement from peer play, school refusal, or frequent school absences may be symptoms of fatigue.
(7) Feeling of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)	Child may present with self-depreciation (e.g., “I’m stupid,” “I’m a retard”). Delusional guilt usually is not present.
(8) Diminished ability to think or concentrate, or indecisiveness, nearly every day (by subjective account or as observed by others)	Problems with attention and concentration may be apparent as behavioral difficulties or poor performance in school.
(9) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide	There may be additional nonverbal cues for potentially suicidal behavior, such as giving away a favorite collection of music or stamps.
B. Symptoms do not meet the criteria for mixed bipolar disorder.	Same as adults
C. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.	Clinically significant impairment of social or school functioning is present. Adolescents also may have occupational dysfunction.
D. Symptoms are not caused by the direct physiologic effects of a substance (e.g., drug of abuse, medication) or a general medical condition (e.g., hypothyroidism).	Similar to adults
E. Symptoms are not caused by bereavement-i.e., after the loss of a loved one, the symptoms persist for longer than two months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.	Psychotic symptoms in severe major depression, if present, are more often auditory hallucinations (usually criticizing the patient) than delusions.
Adapted with permission from American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4th ed. rev. Washington, D.C.: American Psychiatric Association, 2000:356, with additional information from references 21 through 24.

If substance abuse is present, an independent diagnosis of major depression requires the presence of depression before substance abuse or during periods of remission. Concurrent treatment of substance use disorder and depression is needed to improve outcomes for both.25

Adjustment disorder with depressed mood is the most common depressive mood disorder in children and adolescents. Symptoms start within three months of an identifiable stressor (e.g., loss of a relationship), with distress in excess of what would be expected and interference with social, occupational, or school functioning. Symptoms should not meet criteria for another psychiatric disorder, are not caused by bereavement, and do not last longer than six months after the stressor has stopped.

Dysthymic disorder is a chronic, milder form of depression characterized by a depressed or irritable mood (indicated subjectively or described by others) present for more days than not for at least one year (as opposed to two years for adults). Two of the following additional symptoms also are required: changes in appetite, sleep difficulty, fatigue, low self-esteem, poor concentration or difficulty with making decisions, and feelings of hopelessness.20 About 70 percent of children and adolescents with dysthymic disorder eventually develop major depression.26

Diagnosis of minor depression requires the presence of two out of the nine symptoms for major depression (Table 3), one being depressed mood or decreased interest, and a time course similar to that of major depression. If present between the episodes of major depression, minor depression can be a risk factor for relapse.20

Atypical depression is characterized by hypersomnia, increased appetite with carbohydrate craving, weight gain, interpersonal rejection sensitivity, feeling of heaviness in the arms and legs, and reactivity of mood.20 It is relatively common in children and adolescents.27

Presence of depressed mood, increased sleep, decreased appetite, and social isolation between October and February of two consecutive years suggests seasonal affective disorder.

Although less common, bipolar disorder is an important differential diagnosis. In 40 percent of children and adolescents with bipolar disorder, the illness begins with a major depressive episode.2 Risk factors for bipolar disorder are acute and early onset of depression, presence of psychotic symptoms (e.g., hallucinations), significant psychomotor slowing, family history of bipolar disorder, any mood disorder in three consecutive generations of family members, and antidepressant-induced mania.28 Physicians should maintain a higher level of surveillance in patients at greater risk of bipolar disorder.

In severe major depression with psychosis, auditory hallucinations (often criticizing the patient) rather than delusions (as occur in adults) are present. This age-related variability in psychotic symptoms may be a result of differences in cognitive maturation. Treatment of major depressive disorder with psychosis requires the combination of an antidepressant and an antipsychotic medication.29 Patients with this disorder are at a greater risk of suicide and often require inpatient psychiatric admission.

Suicide Risk Assessment

During the first visit, physicians should assess the suicide risk of patients with depression and decide on the most appropriate treatment venue. Depressive disorders are the most common diagnoses present in all suicides. Twenty percent of teenagers seriously contemplate suicide,30 and 8 percent attempt it.31 In 2001, there were 1,833 suicides in children and adolescents 10 to 18 years of age; and in 2000, suicide was the third leading cause of death among those 10 to 19 years of age.31

Suicidal communication in any form must be taken seriously. Documentation of suicide risk should include high-risk and protective factors for suicide (Table 4).1,30-36 Patients with multiple high-risk factors should be referred to a child and adolescent psychiatrist. However, patients with low-risk and protective factors (e.g., a close, warm, supportive family; religious beliefs against suicide; a positive future outlook) are less likely to harm themselves32 and may be treated as outpatients.

TABLE 4Risk Factors and Protective Factors for Suicide in Children and Adolescents
High-risk factors	Protective or low-risk factors
Biodemographics
Age: late teens through early 20s32; 20 percent of teenagers contemplate suicide,30 and 8 percent attempt it.31Sex: ideation and attempts more common in females32; completed suicides five times more common in males.32Ethnicity: teenage suicides are more common in whites and Hispanics than in blacks; rates are highest in Native American teens and lowest in Asian teens and those from the Pacific islands.	Black female child
History
Major depression: increases the risk of suicide 12-fold for both sexes,1 especially if hopelessness is a symptomSubstance abuse: increases the risk of suicide1 about twofoldConduct disorder: linked to one third of suicides in adolescent boys1 and increases overall risk twofold1Current stressors or losses (e.g., trouble in school or with the law, loss of romantic relationship, unwanted pregnancy, intense humiliation)33 Physical or sexual abuse32 Minimal communication with parents34	No current depressionNo current alcohol or substance abuseGood problem-solving and coping skillsNo current stressors or losses No history of physical or sexual abuse Close supportive family relationships and good communications with parents Availability of parental support and close supervision during stressful life event Strong religious belief or faith Positive, hopeful outlook about future with specific positive and concrete plans and goals Ability to articulate reasons to live Ambivalence about suicide
History of suicidal behavior
Suicidal thoughts with plan: specific plans for suicide and the means to carry it out, including nonverbal suicidal behaviors (e.g., giving away valued possessions or collections)Previous suicide attempt: one of the strongest predictors of completed suicide1Family history of suicide and depression35,36Availability of firearms or toxic substances	No active suicidal thoughts or intent; no nonverbal suicidal behaviorsNo history of suicide attemptNo family history of suicideNo access to firearms or toxic substances
Contagion effect
Media coverage of suicide: imitation plays a part in suicidal behavior, often following intense media coverage of a celebrity suicide or a string of suicides in school.32

SORT: KEY RECOMMENDATIONS FOR PRACTICE
Clinical recommendation	Evidence rating	References
Tricyclic antidepressants should not be used to treat childhood or adolescent depression.	A	18, 40, 41
Selective serotonin reuptake inhibitors have limited evidence of effectiveness in children and adolescents and should be reserved for treatment of severe major depression.	B	42-44
Cognitive behavior therapy is effective for the treatment of mild to moderate depression.	A	18, 37-39
Children and adolescents taking antidepressants should be monitored closely for suicidal thoughts and behavior.	C	53
Depression should be treated for a minimum of six months.	C	29
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, see page 13 or http://www.aafp.org/afpsort.xml.

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Posted in depression

Posted by: faithful | November 20, 2009

early onset bipolar disorder

Childhood and Adolescent onset of BiPolar Disorder

Stephanie E. Meyer, Ph.D., and Gabrielle A. Carlson, M.D.

Correspondence: Address correspondence to Stephanie E. Meyer, Ph.D., Division of Child and Adolescent Psychiatry, Cedars-Sinai Medical Center, 8730 Alden Drive, Thalians W101, Los Angeles, CA 90048; e-mail: Stephanie.Meyer@cshs.org

….Distinguishing between mania and other conditions of childhoodis complicated by overlapping symptoms and by the confoundinginfluences of development itself. At the center of the debateregarding symptom overlap has been a focus on differentiatingbetween symptoms of ADHD and mania (41, 42).

At this point,several studies have shown that these two conditions are distinctand separable (32, 43). However, in practice, mental healthprofessionals may continue to struggle with the question ofhow to categorize certain behaviors. Indeed, a detailed historyand symptom ascertainment are often required to distinguishbetween the disinhibited silliness of a child with ADHD andthe euphoric mood associated with mania. Similarly, impulsivitycan closely resemble the pleasure-seeking behaviors of mania,and resistance to bedtime must be distinguished from decreasedneed for sleep (see reference 4 for a review).

There is somequestion as to whether rage episodes may be diagnostic of bipolardisorder in youth (15). Although it is true that rages can occurin manic individuals of any age, as an isolated symptom explosiveirritability (presumably the affect underlying rage episodes)is common in a variety of childhood conditions and thus haspoor discriminatory power (32).

Therefore, although parentsoften refer to rages as “mood swings,” these should not be interpretedas sufficient evidence of a manic episode. Indeed, Mick et al.(16) found that although extreme explosiveness or “super” angry/grouchy/crankyirritability was common among children with mania, the majorityof youth exhibiting these behaviors did not meet the full diagnosticcriteria for a bipolar spectrum condition. Similarly, G. A.Carlson et al. (unpublished 2008 data) conducted a pilot studyof children referred specifically to “rule out bipolar disorder”(N=33) and found that those youth with the most severe rageepisodes (N=8) were a diagnostically heterogeneous group, with25% meeting the criteria for mania with comorbid ADHD, 25% meetingthe criteria for major depressive disorder with comorbid ADHD,25% with pervasive developmental disorder not otherwise specifiedand ADHD, and 25% with pervasive developmental disorder nototherwise specified and major depressive disorder.

The issue of differential diagnosis of pediatric bipolar disorderis further complicated by the fact that affective and behavioralsymptoms may be exacerbated by the emergence of new developmentaldemands and changing circumstances. Indeed, children with attentionor learning challenges may begin to look increasingly dysregulatedwith the heightened demands of late elementary or middle school.

Similarly, irritability may intensify in conjunction with increasingenvironmental challenges, such as difficulties with family andpeer relationships. Moreover, symptoms similar to pediatricmania have been found among maltreated children (reviewed inreference 4), and therefore clinicians may struggle to determinewhether presenting behaviors are sequelae of the abuse, symptomsof an emerging bipolar disorder, or both. In adolescents withsevere psychotic symptoms, schizophrenia and substance-inducedpsychosis must be considered.

Detailed information regardinghistory and longitudinal course of symptoms is necessary todistinguish such behavioral changes from the onset of a truemood disorder. In many instances, diagnostic clarity may onlycome with extended longitudinal follow-up.

^{Related Information:}

The DSM-IV-TR distinguishes among four bipolar phenotypes.

Bipolar I disorder is the most severe, requiring the presenceof at least one manic or mixed episode. Depressive episodesare not required for a diagnosis of bipolar I disorder but areusually present.

Bipolar II disorder is defined by a history of one or more majordepressive episodes and at least one hypomanic episode.

Cyclothymic disorder involves chronic and variable symptomsof hypomania and depression and is believed to represent a “temperamentalpredisposition” to more severe forms of bipolar disorder.

Bipolar disorder not otherwise specified is diagnosed when moodsymptoms are insufficient in number and/or duration to meetfull criteria. The DSM-IV-TR also provides a series of specifiersfor making a diagnosis of bipolar disorder, which characterizethe illness in terms of severity and chronicity, seasonal patterns,and rapid cycling.

Symptom patterns in youth with bipolar disorder often do notresemble the episodic nature of bipolar disorder in adults asit has been classically described (13). According to McClellanet al. (14), the most common presentation among youth with bipolardisorder in community settings is characterized by “outburstsof mood lability, irritability, reckless behavior, and aggression.”Shifts in mood state are short-lived (15), and irritability,rather than euphoria, tends to be the predominant and most impairingmood state (16).

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Posted in BiPolar Disorder

Posted by: faithful | November 17, 2009

paranoia: traits and difficulties

PARANOIA

An important feature of paranoid thinking is its centrality: that the paranoid person perceives himself as central figures in an experienced scenario which may be either dangerous (persecutory) or self-exalting (grandiose) and interprets events which have no reference to them in reality as directed at or about them.

Hypervigilance, hypersensitivity, suspiciousness, and guardedness of these patients can be quite muted, so that their role in the patients’ difficulties is not readily apparent. In many psychoanalyses of patients with unrelated character diagnoses, paranoid traits, especially fears centered on passivity, issues of narcissistic injury and rage, and masochistic and projective defenses, come to the surface. These traits are often subtle and muted but at times can be surprisingly intense. In paranoid personalities, ideas of reference may be present, but without the degree of delusional conviction found in psychotic paranoid patients.

Characteristically, patients with paranoid personalities have difficulty accepting responsibility for themselves, their lives, and the consequences of their behavior. They are quick to blame others, even fate or the gods, for their misfortune or unhappiness. Constant blaming is a typical paranoid posture. Their general guardedness is often reflected in keeping their ideas to themselves and communicating them reluctantly even under the best of circumstances. Consequently, although difficulties characteristically arise in more intimate contexts (e.g., marital relationships or work situations, particularly in relation to authority figures), their external impairment and maladaptation often escape notice or are rationalized as minor eccentricities.

Common Difficulties

Paranoid personality disorder is well established in the catalogue of personality disorders, but even so, the clinical literature, not to mention research, on its specific treatment is rather sparse. Most discussions of treatment of paranoid pathology deal more or less exclusively with psychotic conditions.

The dearth of careful study is striking but may be the result of a series of factors: 1) the personality disorder as such is rarely seen clinically; 2) the defensive organization is often ego-syntonic and does not give rise to symptoms or significant impairment – the impairment is more often interpersonal than intrapsychic and more disturbing or disruptive to those around the patients than to the patients themselves; 3) even when such individuals come to psychiatric attention, they often keep their emotional or interpersonal difficulties hidden because of their guardedness and mistrust; 4) for similar reasons, they are less likely to lend themselves to systematic investigation; 5) such patients tend to maintain a reasonably good level of functioning, coming to psychiatric attention only when their defenses have crumbled and they experience a regressive episode that may result in a more severe diagnostic evaluation; and finally, 6) often enough, the paranoid characteristics are mingled with other pathological personality features that allow the patient to be classified as narcissistic, borderline, antisocial, schizoid, or even depressed. The rigidity of paranoid defenses does not augur well for effective treatment, so that diagnosis should include assessment of the patient’s motivation and receptivity for psychotherapy as well as capacity to tolerate the therapeutic process.

The diagnosis of paranoid personality may be easy or difficult – easy when the paranoid characteristics can be identified but difficult when they cannot. The problem is that these traits are often not easily recognized. Even when recognition of traits is not complicated, mixed personality configurations and the potential overlap between paranoid personality characteristics and those of other personality disorders are persistent problems.

Paranoid Traits

The presence of paranoid traits may be muted and subtle. These “soft signs” of paranoia are continuous with a more normal range of personality characteristics and functioning and often are difficult to evaluate for this reason. They include the following:

Centrality – Often these patients believe that they are somehow the center of other people’s interest or attention. This can reflect their sense of being passive recipients of external influences over which they may feel they have little or no control. In patients with personality disorder, this more commonly may take the form of ideas of reference, whereas in psychotic paranoid disorders, it takes a more extreme form, in which evil and often powerful external forces or influences are seen as directed against and threatening the patient.
Self-sufficiency – Also characteristic is a facade of self-sufficiency, which may represent an attempt to defend against underlying narcissistic vulnerability. The self-sufficiency may involve a degree of grandiosity and isolation similar to that seen in patients with schizoid conditions.
Concern over autonomy – A concern over autonomy is fragile and easily threatened. This can especially be a problem in therapy.
Blaming – A tendency to blame others for any personal failures, shortcomings, or disappointments is often evident.
Feelings of inadequacy – Patients’ feelings of inadequacy or deficiency may be reflected in concerns about being different or feeling like an outsider or often in a more diffuse concern with having values or beliefs different from those of associates.
Concerns over power and powerlessness – Paranoid individuals typically have difficulty in relating to authority figures, taking orders, assuming appropriate responsibility, and generally fitting into preexisting social or group structures.

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Posted in CLINICAL INFORMATION, domestic violence, victim advocacy

Posted by: faithful | October 31, 2009

“free” foods

Foods commonly eaten in the United States:

All of the vegetables and fruits are raw, unless otherwise stated.

The numbers are the grams of available carbohydrate
(that is, carbohydrate minus dietary fiber)
in 100 grams of the portion of the food):

VEGETABLES:

Alfalfa seeds, sprouted 1.28
Arugula 2.05
Asparagus, cooked 2.63
Bamboo shoots, cooked 0.92
Beans, green, cooked 4.69
Beans, snap, green, cooked 4.68
Beet greens, cooked 2.56
Broccoli, cooked 2.16
Brussels sprouts, cooked 4.5
Cabbage, cooked 2.16
Cauliflower, cooked 1.41
Celeriac (celery root), cooked 4.7
Celery 1.95
Chard, swiss, cooked 2.04
Collards, cooked 2.1
Cucumber 1.8
Dandelion greens, cooked 3.5
Eggplant, cooked 4.14
Endive 0.25
Fennel, bulb 4.19
Hearts of palm, canned 2.22
Jicama 3.92
Kale, cooked 3.63
Lettuce, butterhead 1.32
Lettuce, cos or romaine 0.67
Lettuce, iceberg 0.69
Mustard greens, cooked 0.1
Mushrooms 2.94-3.57 (except shitake)
Nopales, cooked 1.27
Olives, canned ripe 3.06
Okra, cooked 4.71
Olives, canned ripe 3.06
Parsley 3.03
Peppers, serano 3.00
Peppers, jalapeno 3.11
Peppers, sweet green 4.63
Peppers, sweet red 4.43
Pumpkin, cooked 3.80
Purslane 3.43
Radicchio 3.58
Radishes 1.99
Rhubarb 2.74
Sauerkraut 1.78
Scallions (green onions) 4.74
Spinach, cooked 1.35
Squash, summer, cooked 2.91
Squash, zucchini, cooked 2.53
Tomatillos 3.93
Tomatoes 3.54
Tomato juice 3.83
Turnips, cooked 2.9
Turnip greens, cooked 0.86
Watercress 0.79

FRUIT:

Avocados 2.39
Chayote (christophene) 2.20
Raspberries 4.77
Strawberries 4.72

NUTS:

Macademia Nuts 4.83
Pecans 4.26

MEAT AND FISH:

All meat and fin fish 0.00
Caviar 4.00
Crab 0.95
Lobster 1.28
Shrimp 0.00

EGGS AND DAIRY:

Butter 0.06
Buttermilk, lowfat 4.79
Cheese, cheddar 1.28
Cheese, Edam 1.43
Cheese, Gouda 2.22
Cheese, Swiss 3.38
Cream cheese, 2.66
Cottage cheese, 2% milkfat 3.63
Eggs 1.22
Half and Half 4.30
Heavy Cream 2.79
Goat milk 4.45
Mayonnaise 2.70
Milk, 1% milkfat, added solids 4.97
Milk, 3.25% milkfat 4.66
Ricotta cheese, whole milk 3.04
Soy milk, 0.51
Yogurt, plain, whole milk 4.66

DIETARY FIBER:

Soluble and insoluble fiber (a part of other foods) 0.00

BEVERAGES:

Coffee (without cream or sugar) 0.00
Diet Soda 0.00
Tea (without milk or sugar) 0.00
Water 0.00

SWEETENERS:

Aspartame (NutraSweet) 0.001
Saccharin (Sweet’N Low) 0.001
Stevia 0.00
Sucralose (Splenda) 0.001

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Posted in diet, healthy eating

Posted by: faithful | October 30, 2009

common glycemic index questions

COMMON GLYCEMIC INDEX QUESTIONS

FOR AN UP-TO-DATE LIST OF EXACT GI VALUES CLICK HERE

What is the difference between glycemic index (GI) and glycemic load (GL)?

Your blood glucose rises and falls when you eat a meal containing carbs. How high it rises and how long it remains high depends on the quality of the carbs (the GI) and the quantity. Glycemic load or GL combines both the quality and quantity of carbohydrate in one ‘number’. It’s the best way to predict blood glucose values of different types and amounts of food. The formula is:

GL = (GI x the amount of carbohydrate) divided by 100.

Let’s take a single apple as an example. It has a GI of 40 and it contains 15 grams of carbohydrate.
GL = 40 x 15/100 = 6 g

What about a small baked potato? Its GI is 80 and it contains 15 g of carbohydrate.
GL = 80 x 15/100 = 12 g

So we can predict that our potato will have twice the metabolic effect of an apple. You can think of GL as the amount of carbohydrate in a food ‘adjusted’ for its glycemic potency.

Should I use GI or GL and does it really matter?

Although the GL concept has been useful in scientific research, it’s the GI that’s proven most helpful to people with diabetes. That’s because a diet with a low GL, unfortunately, can be a ‘mixed bag’, full of healthy low GI carbs in some cases, but low in carbs and full of the wrong sorts of fats such as meat and butter in others. If you choose healthy low GI foods—at least one at each meal—chances are you’ve eating a diet that not only keeps blood glucose ‘on an even keel’, but contains balanced amounts of carbohydrates, fats and proteins.

We suggest that you think of the GI as a tool allowing you to choose one food over another in the same food group—the best bread to choose, the best cereal etc.—and don’t get bogged down with figures. A low GI diet is about eating a wide variety of healthy foods that fuel our bodies best—on the whole these are the less processed and wholesome foods that will provide you with carbs in a slow release form. So what’s the take-home message?

Choose slow carbs, not low carbs
Use the GI to identify your best carbohydrate choices.
Take care with portion size with carb-rich foods such as rice or pasta or noodles to limit the overall GL of your diet.

Do I need to eat only low GI foods at every meal to see a benefit?

No you don’t, because the effect of a low GI food carries over to the next meal, reducing its glycemic impact. This applies to breakfast eaten after a low GI dinner the previous evening or to a lunch eaten after a low GI breakfast. This unexpected beneficial effect is called the “second meal effect”. But don’t take this too far, however. We recommend that you aim for at least one low GI food per meal.

While you will benefit from eating low GI carbs at each meal, this doesn’t have to be at the exclusion of all others. So enjoy baking your own bread or occasional treats. And if you combine high GI bakery products with protein foods and low GI carbs such as fruit or legumes, the overall GI value will be medium.

Why do many high-fibre foods still have a high GI value?

Dietary fibre is not one chemical constituent like fat and protein. It is composed of many different sorts of molecules and can be divided into soluble and insoluble types. Soluble fibre is often viscous (thick and jelly-like) in solution and remains viscous even in the small intestine. For this reason it makes it harder for enzymes to move around and digest the food. Foods with more soluble fibre, like apples, oats, and legumes, therefore have low GI values.

Insoluble fibre, on the other hand, is not viscous and doesn’t slow digestion unless it’s acting like a fence to inhibit access by enzymes (eg. the bran around intact kernels). When insoluble fibre is finely milled, the enzymes have free reign, allowing rapid digestion. Wholemeal bread and white bread have similar GI values. Brown pasta and brown rice have similar values to their white counterparts.

Can I download or can you email me a full list of all GI food values?

Sorry but we have no such list available for download or emailing purposes. Instead, we invite you to search out the foods you are interested in finding on our free GI Database (see the menu link on the left). There you will find a brief explanation on how best to conduct the search. Another option is to purchase our pocket book which is updated annually and contains the latest values at the time of publication: The New Glucose Revolution: Shopper’s Guide to GI Values.

Does the GI increase with serving size? If I eat twice as much, does the GI double?

The GI always remains the same, even if you double the amount of carbohydrate in your meal. This is because the GI is a relative ranking of foods containing the “same amount” of carbohydrate. But if you double the amount of food you eat, you should expect to see a higher blood glucose response – ie, your glucose levels will reach a higher peak and take longer to return to baseline compared with a normal serve.

If testing continued long enough, wouldn’t you expect the areas under the curve to become equal, even for very high and very low GI foods?

Many people make the assumption that since the amount of carbohydrate in the foods is the same, then the areas under the curve will finally be the same. This is not the case because the body is not only absorbing glucose from the gut into the bloodstream, it is also extracting glucose from the blood. Just as a gentle rain can be utilised better by the garden than a sudden deluge, the body can metabolise slowly digested food better than quickly digested carbohydrate. Fast-release carbohydrate causes “flooding” of the system and the body cannot extract the glucose from the blood fast enough. Just as water levels rise quickly after torrential rain, so do glucose levels in the blood. But the same amount of rain falling over a long period can be absorbed into the ground and water levels do not rise.

Why doesn’t the GI of beef, chicken, fish, tofu, eggs, nuts, seeds, avocadoes, many fruits (including berries) and vegetables, wine, beer and spirits appear on the GI database?

These foods contain no carbohydrate, or so little that their GI cannot be tested according to the standard methodology. Bear in mind that the GI is a measure of carbohydrate quality. Essentially, these types of foods, eaten alone, won’t have much effect on your blood glucose levels.

Some vegetables like pumpkin and parsnips appear to have a high GI. Does this mean a person with diabetes should avoid eating them?

Definitely not, because, unlike potatoes and cereal products, these vegetables are very low in carbohydrate. So, despite their high GI, their glycemic load (GI x carb per serve divided by 100) is low. Vegetables contain only small amounts of carbohydrate but loads of micronutrients and should be considered as “free foods”. Eat them all you like!

Can you tell me the GI of alcoholic beverages (beer, wine and spirits)?

Alcoholic beverages contain very little carbohydrate. In fact, most wines and spirits contain virtually none, although beer contains some (3 or 4 grams per 100 mL). A middy of beer (10 ounces) contains about 10 grams of carbohydrate compared with 36 grams in the same volume of soft drink. For this reason, a beer will raise glucose levels slightly. If you drink beer in large volumes (not a great idea) then you could expect it to have a more significant effect on blood glucose. As for enjoying an occasional drink, researchers from the University of Sydney found that a pre-dinner drink tends to produce a ‘priming’ effect, flicking the switch from internal to external sources of fuel and keeping blood-sugar levels low.

Why does some variability occur in the GI for the same food types? For example, Special K cereal shows values from 54 to 84.

The GI database confirms the reproducibility of GI results around the world. White and wholemeal bread, apples, cornflakes, breakfast cereals etc give the same results wherever/whoever tests them. Where there is variability, there are four possible explanations:

Some GI testing groups are not as experienced/accurate as ours. They use venous blood which gives more variability than capillary blood. If we test a product over and over again, we get the same result +/- 5%. That’s as good as nutrient data such as protein, fat, fibre etc.
The variability among different types of potatoes, rices, and oats is REAL. They contain different types of starch (amylose, amylopectin) and that affects the degree of starch gelatinisation. When it comes to sugars like fructose, the concentration of the solution makes a difference to the rate of gastric emptying and therefore the glycemic response. A more dilute solution, say 25 g fructose in 500 mL water will have a higher GI than 25 g fructose in 250 mL. But fructose has a very low GI whichever way you consume it.
Sometimes the manufacturer may change the formulation of their product by reducing the fat content for example. Reducing the fat can increase the GI. Manufacturers may have their products retested if they make significant changes to the formulation, or source ingredients from different suppliers.
Some foods have been tested in people with type 2 diabetes. These values may be higher than that seen in the normal population. Follow the food links in the GI database to find more information on the testing conditions.

Why does pasta have a low GI?

Pasta has a low GI because of the physical entrapment of ungelatinised starch granules in a sponge-like network of protein (gluten) molecules in the pasta dough. Pasta is unique in this regard. As a result, pastas of any shape and size have a fairly low GI (30 to 60). Asian noodles such as hokkein, udon and rice vermicelli also have low to intermediate GI values.

Pasta should be cooked al dente (‘firm to the bite’). And this is the best way to eat pasta – it’s not meant to be soft. It should be slightly firm and offer some resistance when you are chewing it. Overcooking boosts the GI. Although most manufacturers specify a cooking time on the packet, don’t take their word for it. Start testing about 2-3 minutes before the indicated cooking time is up. But watch that glucose load. While al dente pasta is a low GI choice, eating too much will have a marked effect on your blood glucose. A cup of al dente pasta combined with plenty of mixed vegetables and herbs can turn into three cups of a pasta-based meal and fits easily into any adult’s daily diet.

Most breads and potatoes have a high GI. Does this mean I should never eat them?

Potatoes and bread, despite their high GI, can play a major role in a high carb/low fat diet, even if your goal is to reduce the overall GI. Only about half the carbohydrate needs to be exchanged from high to low GI to derive health benefits. Of course, some types of bread and potatoes have a lower GI and these should be preferred in order to lower the GI as much as possible.

The good news for potato lovers is that a potato salad made the day before, tossed with a vinaigrette dressing and kept in the fridge will have a much lower GI than potatoes served steaming hot from the pot. There are a couple of simple reasons for this. The cold storage increases the potatoes’ resistant starch content by more than a third and the acid in the vinaigrette whether you make it with lemon juice, lime juice or vinegar will slow stomach emptying.

What about flour? If I make my own bread (or dumplings, pancakes, muffins etc) which flours, if any, are low GI? What about sprouted grain breads?

To date there are no GI ratings for refined flour whether it’s made from wheat, soy or other grains. This is because The GI rating of a food must be tested physiologically that is in real people. So far we haven’t had volunteers willing to tuck into 50 gram portions of flour on three occasions! What we do know, however, is that bakery products such as scones, cakes, biscuits, donuts and pastries made from highly refined flour whether it’s white or wholemeal are quickly digested and absorbed.

What should you do with your own baking? Try to increase the soluble fibre content by partially substituting flour with oat bran, rice bran or rolled oats and increase the bulkiness of the product with dried fruit, nuts, muesli, All-Bran or unprocessed bran. Don’t think of it as a challenge. It’s an opportunity for some creative cooking.

Bread made from sprouted grains might well have a lower blood-glucose raising ability than bread made from normal flour. When grains begin to sprout, carbohydrates stored in the grain are used as the fuel source for the new shoot. Chances are that the more readily available carbs stored in the wheat grain will be used up first, thereby reducing the amount of carbs in the final product. Furthermore, if the whole kernel form of the wheat grain is retained in the finished product, it will have the desired effect of lowering the blood glucose level.

Some high fat foods have a low GI. Doesn’t this give a falsely favourable impression of that food?

Yes it does, especially if the fat is saturated fat. The GI value of potato chips or french fries is lower than baked potatoes. Large amounts of fat in foods tends to slow the rate of stomach emptying and therefore the rate at which foods are digested. Yet the saturated fat in these foods will contribute to a much increased risk of heart disease. It is important to look at the type of fat in foods rather than avoid it completely. Good fats are found in foods such as avocadoes, nuts and legumes while saturated fats are found in dairy products, cakes and biscuits. We’d all be better off if we left the cakes and biscuits for special occasions.

Why not just adopt a low carbohydrate diet (like the Atkins diet) to keep my blood glucose levels and weight down?

Recent studies show that low carb diets such as the Atkins diet produce faster rates of weight loss than conventional low fat diets. The probable mechanism is lower day-long insulin levels – allowing greater use of fat as the source of fuel – the same mechanism underlying the success of low GI diets. We believe that low carb diets are unnecessarily restrictive (bread, potato, rice, grains and most fruits are restricted) and may spell trouble in the long term if saturated fat takes the place of carbohydrate. Low GI diets strike a happy medium between low fat and low carb diets – you can have your carbs, but must choose them carefully.

Is there a GI plan for nursing mothers?

A low GI diet is ideal while you are breastfeeding. Breastfeeding requires a lot of energy and theoretically this additional energy comes from the body fat laid down during pregnancy. Of course in reality it doesn’t all get used up and most have to make a concerted effort to work off the baby weight. To do this though it is important that you don’t go on a low calorie diet or any sort of extreme measure such as the low carb diets popular in the press. Since breastfeeding tends to increase your appetite (the body’s way of ensuring you have the energy required to produce milk) this is good news as staying on such a diet would be a nightmare! This is what makes the low GI approach so successful – forget about trying to count calories or even your portions of food.

First and foremost focus on the sorts of foods you are eating. Low GI foods are the wholegrains, fresh fruit and vegetables and legumes. By eating these foods as the mainstay of your meals you can trust your appetite and eat to satisfaction while you are breastfeeding. Also get back to some exercise – even if it’s just a daily walk with the pram/carriage. You should then find that the weight slowly starts to shift – realistically give yourself at least that first six months to get back to your pre-pregnancy weight.

How relevant is the GI for athletes?

The GI can be a useful tool to help athletes select the right type of carbohydrates to consume both before and after exercise. Studies have consistently reported that a low GI pre-exercise meal results in a better maintenance of blood glucose concentrations during exercise and a higher rate of fat oxidation. This is likely to result in reduced muscle glycogen utilisation during prolonged exercise and possibly improve endurance performance. Eating high GI meals before exercise may result in plasma glucose concentrations peaking before the onset of exercise and then hypoglycemia occurring within the first 30 minutes of the exercise period. There is little data available on the effect of the GI of carbohydrates eaten before intermittent, power or strength related sports.

During recovery from exercise, muscle glycogen resynthesis is of high metabolic priority. The eating of high GI carbohydrates after exercise increases plasma glucose and insulin concentrations and this facilitates muscle glycogen resynthesis. If however, you are exercising for weight loss purposes or are involved in weight restricted sports, low GI carbohydrates after exercise may be more beneficial as the lower glucose and insulin concentrations will not suppress fat.

I have recently been diagnosed with celiac disease (gluten sensitivity). It’s extremely hard to find both low GI and wheat-free foods. Any suggestions?

This is not as hard as you may think! There are low GI gluten-free foods in four of the five food groups.

Fruit and Vegetables

Temperate climate fruits – apples, pears, citrus (oranges, grapefruit) and stone fruits (peaches, plums, apricots) – all have low GI values. Tropical fruits – pineapple, paw paw, papaya, rockmelon and watermelon tend to have higher GI values, but their glycemic load (GL) is low because they are low in carbohydrate.
Leafy green and salad vegetables have so little carbohydrate that we can’t test their GI. Even in generous serving sizes they will have no effect on your blood glucose levels. Higher carb starchy vegetables include sweet corn (which is actually a cereal grain), potato, sweet potato, taro and yam, so watch the portion sizes with these. Most potatoes tested to date have a high GI, so if you are a big potato eater, try to replace some with lower GI starchy alternatives such as sweet corn, yam or legumes. Pumpkin, carrots, peas, parsnips and beetroot contain some carbohydrate, but a normal serving size contains so little that it won’t raise your blood glucose levels significantly.

Bread and Cereals

Opt for breads made from chickpea or legume based flours. For example chapattis made with besan (chickpea flour) have a low GI. If you make your own bread, try adding buckwheat kernels, rice bran and psyllium husks to lower the GI. Most gluten-free breads seem to be better toasted than used to make sandwiches.
Breakfast cereals containing pysllium husks are likely to have a lower GI – you could also add a teaspoon or two of pysllium to you usual cereal. To date there are just a few gluten-free breakfast cereals on our database that have a low GI. If you do have a higher GI gluten-free cereal, combine it with lots of fruit and low fat yoghurt or low fat milk, to lower the GI.
Noodles are a great stand-by for quick meals, a good source of carbohydrate, provide some protein, B vitamins and minerals and will help to keep blood glucose levels on an even keel. There are several low GI gluten-free options available fresh and dried: buckwheat (soba) noodles; cellophane noodles, also known as Lungkow bean thread noodles or green bean vermicelli, are made from mung bean flour; rice noodles made from ground or pounded rice flour, are available fresh and dried.
Gluten-free pastas based on rice and corn (maize) tend to have moderate to high GI values so opt for pastas made from legumes or soy. As for wholegrains, try buckwheat, quinoa, low GI varieties of rice such as basmati and sweet corn. Currently there are no published values for amaranth, sorghum, and tef. Millet has a high GI.
Minimise refined flour products and starches irrespective of their fat and sugar content such as crispy puffed breakfast cereals, crackers, biscuits, rolls, most breads and cakes or snack foods. Limit high GI snacks such as corn and potato chips, rice cakes, corn thins and rice crackers.

Legumes (pulses) including beans, chickpeas and lentils
When you add legumes to meals and snacks, you reduce the overall GI of your diet because your body digests them slowly. So make the most of beans, chickpeas, lentils, and whole and split dried peas.

Nuts
Although nuts are high in fat (averaging around 50 per cent), it is largely unsaturated, so they make a healthy substitute for foods such as biscuits, cakes, pastries, potato chips and chocolate. They also contain relatively little carbohydrate, so most do not have a GI value. Peanuts (actually a legume) and cashews have very low GI values.

Low fat dairy foods and calcium-enriched soy products
Low fat milk, yoghurt and ice-cream or soy alternatives provide sustained energy, boosting your calcium intake but not your saturated fat intake. Check the labels of yoghurts, icecream and soymilks as many contain wheat-based thickeners. If lactose intolerance is a problem, reach for live cultured yoghurts and lactose-hydrolysed milks. Even ice-cream can be enjoyed if you ingest a few drops of lactase enzyme first.

Is a low GI diet suitable for vegetarians?

The low GI diet is just as easy for a vegetarian to follow – in fact, teaching vegetarians to follow the low GI diet can be easier because most are eating many of the best low GI foods already. For the vegetarian, the same principles apply: substitute your plant protein sources for the meat. Eat more beans, lentils and other legumes – all among the lowest GI foods we have tested. Quorn is also a great meat substitute with no GI as it has almost no carbohydrate (2 g/100 g).

Some additional points:

The GI only applies to foods containing significant amounts of carbohydrate. Most vegetables have small amounts of carbohydrate and those that provide more usually have a low GI, with the exception of potatoes. You can therefore tuck into your veggies without considering the GI for every one – and benefit from antioxidants and all the micronutrients they supply!
Legumes should be a daily part of any vegetarian diet for your protein – happily these are also a mainstay of a low GI diet.
Almost every low GI food we talk about in the book is suitable as part of a vegetarian diet. Animal products are usually high in fat, protein or both and therefore do not have a GI.
The range of protein and carb intake that is healthy is fairly broad – as a vegetarian you will inevitable have a higher carb intake and slightly lower protein intake. This makes the GI important for you but easy to adapt if you choose wholegrain cereal products and legumes as your carbohydrate base.
Coffee has no carbohydrate (unless you add sugar and/or milk and the GI response comes from these foods) and hence it is not in the GI tables. Neither does it contain calories so has little impact on weight control.

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