Children tend to lose their appetite during illness, whether it is a simple throat infection or a cold, or some more serious disorder. Perhaps vomiting may occur, or the child will be too nauseated to eat.

Carbohydrates must be given during illness

In ordinary circumstances the natural thing to do is to let the child take clear fluids (or whatever he feels like) and not worry about meals. In diabetes however, it is still necessary to balance the insulin with carbohydrates, as on no account is it safe to omit the insulin during illness.

So with a child with diabetes we cope with loss of appetite or nausea by omitting the proteins and fats from the diet, and giving the carbohydrates in an easily tolerated form. Perhaps the child will feel like dry biscuits, or fruit juice. Perhaps all he can take is barley sugar, or lemonade or coca-cola. In whatever form it is given it must still be equivalent to his usual dietary allowance.

See the doctor if vomiting persists

If vomiting occurs, it is wise to wait a little while and then replace with another, perhaps more acceptable form of sugar. Ordinary soft drink may be tolerated, and it may be better to give small amounts at a time over a period. Even if vomiting is repeated it is probable that some sugar is being absorbed, but it is important to consult your doctor if the vomiting persists or if your child appears ill.

If vomiting has continued over two meal periods you should certainly contact your doctor, but of course earlier if you are worried or if your child appears very ill.

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Why is a diet necessary?

Children in good health and without diabetes, who are provided with plenty of good food, tend to eat enough to satisfy the needs of their body to maintain their good health and to grow properly. Appetite (or a feeling of hunger) and satiety (or the feeling of having ‘had enough’) operate to ensure that the body’s needs are met by determining the amount of food taken at meals. The mechanisms which control appetite and satiety are complex and not fully understood, and if a child has an excess of some foods at one time he tends to compensate for this by eating less at other times.

Appetite may be erratic

Appetite, particularly in children, is not always directly related to the immediate needs of the body. Perhaps pocket money and a visit to the milk bar – or a particularly nice pudding or cake or a party may lead to an excessive intake of carbohydrate on some occasions, while an unpopular dish or an illness may lead to an inadequate intake on other occasions.

The body copes with irregularities of eating in this way by storing the excess foods and using these stores at other times. To do this, insulin is produced by the pancreas to match the intake of food and to allow its storage, as one of the functions of insulin is to store energy, mainly as fat, in the tissues of the body.

The person with diabetes cannot cope with a varying food intake

In diabetes the pancreas cannot meet the needs of the body in this way and it is seldom convenient or possible to judge the varying amounts of insulin, perhaps several times a day, needed to cope with a varying food intake.

Food must be regular

So it is that children with diabetes need a regular amount of food each day. Naturally appetite will still determine the basic amount of food to be taken, and naturally it is important that a child’s healthy hunger is satisfied. However eating binges and large quantities of concentrated carbohydrates are no longer possible but could lead to a return of the illness, due to diabetes.

A diet keeps meals regular

In fact it is generally felt that the safest way to provide a child with diabetes with regular quantities of food is to work out a definite diet programme so that we can be sure that the needs of the body are met and the daily insulin injections are balanced with the correct amount of carbohydrate foods.

A diet is designed to suit the needs of the child The dietitian will judge the diet, taking several factors into account. The most important factor is your child’s appetite – if he has a big appetite and likes plenty of food then (provided he is not getting fat) presumably he needs the food, and the diet must supply it.

Another important factor is knowledge of the basic needs of children of varying ages for growth. Clearly, we want your child to have plenty of food for him to grow properly.

Likes and dislikes, family customs, and family preferences for certain foods or cooking are also important, and are taken into account.

Meals must be regular in quantity and time

In addition to regulating the meals in quantity and type of food, it is also necessary to have them at regular times. These meal times can be adjusted to suit the family, and school or work hours, but they should be at the same time each day.

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Many parents rather dread their children’s adolescence. They have probably heard about rebellion, poor diabetic control and difficult behaviour. They know that they won’t have the same control over their child’s health and diabetes management as they become increasingly independent.

This is true to some extent. On the other hand the teenage years can be fun for the family, and there will be more freedom for parents, especially mothers, who previously had to be responsible for their young child all the time.

The rapid growth that occurs during adolescence and the changing hormone levels in the blood that accompany this growth and sexual development may make diabetes more unstable. Moreover, the teenager tends to have a more variable life-style than before – very vigorous sport one day, sitting around watching television the next. Out late for a party one night, impossible to get out of bed the next day. Too busy for blood tests but plenty of time to monopolize the family telephone.

Naturally all this leads to variable blood glucose levels and less perfect control.

Adolescence is a time when most girls put on weight – often more than ideal. This may also lead to poor diabetic control, but then they think they are too fat (even when they aren’t) and try ‘diets’ which don’t coincide with the diabetic diet they are supposed to be on.

All these factors may upset diabetes control for a while, but they are a natural part of adolescence and neither parent nor teenager has much control over the body’s physical and physiological changes at this time. Regular medical check-ups will help to reassure you and your teenager that things haven’t got out of hand.

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There is more than one type of diabetes, and you may hear things from your friends or relatives about diabetes and its treatment that apply to a form of diabetes that affects older people but not your child or yourself.

Type 1 diabetes mainly affects children and young people, particularly those under the age of thirty. This type of diabetes requires insulin for treatment because the pancreas makes insufficient insulin. It is called ‘Insulin Dependent Diabetes Mellitus’ (shortened to I.D.D.M.) for this reason.

Children may get insulin dependent diabetes

Diabetes affects about one in a thousand children, more in some countries and much less in others. It is most common in Caucasian people and is much less common in Asian people. We now believe that some people are born with an increased risk of developing this type of diabetes. This risk is inherited and helps to account for the fact that diabetes may occur in families and is more common in certain races than others.

The risk to develop diabetes is related to a system in the body called the immune system. The immune system is responsible for the body’s defense against infections and other foreign substances that can invade the body.

The immune system has genetic factors that are inherited — like everything else in the body — by a series of particular genes. There are a number of inherited factors that are concerned with this immune system. These factors are called human leukocyte antigens (HLA for short).

Everyone has a set of HLA factors — there are many different factors and we inherit a set rather like we inherit a blood group.

Certain HLA factors (the important ones are called DR3 and DR4) are linked with a risk to develop insulin dependent diabetes. We sometimes think of them as ‘genetic markers’ because they help us identify whether there is a risk for diabetes or not.

Those people that have the HLA factors that are linked with diabetes risk do not necessarily get diabetes though they have a much stronger chance to do so. We believe that something has to happen to bring on diabetes in such people.

We don’t really know what the precipitating factor is. Probably there are many factors which can do it. We do know that some viruses can precipitate diabetes in children and perhaps there may be other factors in the environment that we haven’t yet identified.

What happens then is that the body’s immune system may turn on its own pancreas and gradually damage the cells that make insulin. This process is called an auto-immune process.

When this process of damaging cells has proceeded to a point where most of the cells have been destroyed or damaged (about 80%) then the body can’t make enough insulin and diabetes develops. This process may take many years.

Older people may get non-insulin dependent diabetes

The other important type of diabetes is sometimes called Type 2 diabetes. This type of diabetes rarely affects children. It is common in older people (usually over thirty years of age) and it particularly affects people who are overweight. It probably occurs in 2% of people in our society though not all people who have this form of diabetes know that they have it in the early stages. In some other countries it is very much more common. This form of diabetes occurs, not so much because there is insufficient insulin, but because the insulin that is produced does not work properly. For this reason it is not dependent on insulin treatment so that it is called Non-Insulin Dependent Diabetes Mellitus (N.I.D.D.M.). It can often be treated by diet, weight reduction and tablets. Occasionally people with this type of diabetes however will benefit from insulin treatment.

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You may need less insulin when you are active

Strenuous exercise also increases the efficiency of insulin, so that when people take regular exercise they may be able to have a lower insulin dose than when they are inactive. Some children – especially those who play vigorous sport – find they need to reduce the dose on days of intense physical training or sport. Knowing how much to reduce the dose comes from your own experience, but discuss it with your doctor if you play sport.

The effect of exercise on the action of insulin may last for many hours (up to 12 hours) afterwards. Thus, someone may have a hypo in the evening after playing sport in the afternoon. It is wise to do an extra blood test before bed if there has been strenuous and unusual exercise during the day. Have extra carbohydrate if the test is low.

The blood glucose level may occasionally rise with sport

Some young people with diabetes find that their blood glucose values rise after sport even though they may have a hypo some hours later. This could be due to taking too much extra carbohydrate before the sport but there is another possible

The body needs energy for exercise and during the intense activity of competitive sport, glucose is released into the bloodstream to provide this energy. This may be in part due to the adrenalin that is released when the body is keyed up for sport. The release of extra glucose may be greater than the body’s need. This could account for the rise in blood glucose values for some people after sport.

Strenuous exercise may be unwise if diabetes control is poor

If blood glucose levels are high and ketones are present in the urine, strenuous exercise may make diabetic control worse. Before embarking on any strenuous sporting activity be sure your diabetes control is satisfactory. This is particularly important for prolonged exercise as the risk of dehydration will increase.

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Fatty acids can be classified based on their length, and this gives them different properties.

Short-chain fatty acids contain between four and six carbon atoms and are always saturated. Examples include butyric acid, containing four carbon atoms and present in butter, and capric acid, containing 6 carbon atoms and found in goat milk. Short-chain fatty acids have an anti-microbial effect in our digestive tract; they help to protect us from infections by bacteria, viruses and yeasts. They do not need bile to get digested; they are absorbed straight through our intestines and can be used straight away for energy.

Medium-chain fatty acids contain between eight and 12 carbon atoms. They are commonly found in butterfat and tropical oils like coconut fat. These fats also do not need bile to be digested, thus provide a quick source of energy. You may have heard of medium chain triglycerides (MCTs) used in the diets of people with digestive or liver diseases. They are also sometimes used by athletes, and are popular because they require very little digestive effort, and are quickly burnt off as energy, not stored as fat. They also have antimicrobial properties. Coconut fat is very high in lauric acid, which is a medium-chain fatty acid. In our body lauric acid is turned into monolaurin; this fat has antiviral, antibacterial and antiprotozoal properties. It acts to destroy lipid coated viruses such as herpes, influenza, cytomegalovirus, HIV, some bacteria such as listeria and Helicobacter pylori, as well as protozoa including giardia lamblia. Unrefined, or virgin coconut fat is an excellent addition to a healthy diet.

Long-chain fatty acids contain between 14 and 18 carbon atoms, and they may be saturated, monounsaturated or polyunsaturated. One example of an 18 carbon saturated fatty acid is steric acid; it is found mainly in beef and lamb fat. Long chain saturated fatty acids are solid at body temperature and are sticky. If we consume large amounts of this type of fat, our bloodstream can become sticky, placing us at greater risk of heart disease. Our body can actually convert refined carbohydrates and sugar we have eaten into long chain saturated fatty acids. Therefore, eating a lot of sugar increases the amount of saturated fat and cholesterol in our body.

An example of an 18 carbon monounsaturated fatty acid is oleic acid, round in olive oil. The Omega 6 essential fatty acid linoleic acid and the Omega 3 essential fatty acid alpha-linolenic acid are both long chain polyunsaturated fatty acids, with 18 carbon atoms each. Very-long-chain fatty acids contain between 20 and 24 carbon atoms. These include the Omega 3 essential fatty acids found in fish; eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), as well arachidonic acid (AA), found mainly in red meat. Most of these fats are used in the production of prostaglandins; hormone like substances in the body.

Plant sterols and stanols are also called phytosterols, and have a very similar structure to cholesterol. Plant sterols are found in the oils of plants such as nuts and seeds. The major plant sterol is called beta-sitosterol. Sterols are often refined and concentrated and added to margarines which claim to lower cholesterol levels. They can help to lower our cholesterol level by competing with cholesterol for absorption in our intestines.

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There are a number of medical conditions that can affect fertility. Some are directly linked to the reproductive process, such as blocked fallopian tubes. Some, like coeliac disease, are not obviously linked. However, many of these conditions can be treated. And, by improving your general health and fitness, you can do a great deal to help overcome these problems and regain your fertility.

Blocked Fallopian Tubes

The fallopian tubes are the route between the ovaries and the womb. The sperm swim along these tubes in order to reach the egg. The fallopian tube also provides a home for the fertilised egg for the first seven days of life, before it gets to the womb where it will implant itself. If the tubes are blocked then this is a major problem and medical intervention is needed.

Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is the main reason why some women stop ovulating. In its most extreme form, it can be a very distressing condition. Women affected by PCOS will tend to be overweight, prone to acne, menstruate seldom or not at all, grow unsightly body hair (often on the face, breasts and inside of the legs), and be susceptible to mood swings.

Fibroids

Fibroids are non-cancerous growths which grow in or on the wall of the womb. They are very common and many women never realize they have them, as they may not cause any symptoms. If they grow in a way that doesn’t exert pressure on neighboring organs, a woman can live with large fibroids for many years without needing medical help. They can, however, cause infertility and some fibroids can cause miscarriages. Fibroids can vary in number and size. If the fibroids grow significantly they can cause the uterus to enlarge and/or distort which makes it difficult for the embryo to implant properly. So you might conceive easily but miscarry unawares, at a very early stage, because the fertilised egg could not ‘hold on’ with the fibroid there. The size of a fibroid is usually compared to a foetus of that size (e.g. a 12-week fibroid) but some can be as small as a pea.

Endometriosis

Endometriosis is a condition where the lining of the womb (the endometrium) grows in places other than the womb. Sections of womb lining may grow in the fallopian tubes, ovaries, bowel and bladder. More uncommon places include the lung, heart, eye or knee. The womb lining, no matter where it is situated, then responds to the natural hormone cycle and will bleed when the period occurs. This can be extremely painful, especially in those sites where there is no natural escape route for the blood, and inflammation may occur. For instance, I have seen women who get a nose bleed during their period because the womb lining has migrated to the nasal passages and bleeds when they menstruate.

Endometriosis can affect female fertility because it can cause scarring and blockages inside the pelvic cavity, and it is thought that 50 per cent of women with endometriosis may have problems getting pregnant. It is more common in women over 30 who have not had children. So, as more women delay having children, the possibility of infertility being caused by endometriosis rises.

In some cases the endometriosis scars and obstructs the fallopian tubes so severely that the tubes cannot pick up the egg. And if the ovaries are scarred badly then ovulation may not occur. When the endometrial tissue implants on the ovary then cysts may form called ‘chocolate cysts’ because they are filled with dark, brown, old blood.

Coeliac Disease

This is a medical condition caused by intolerance to gluten which pre-vents food being absorbed properly. Symptoms can include foul-smelling greasy stools, weight loss, anaemia, bloating, fatigue, and signs of multiple vitamin and mineral deficiencies.

Unfortunately, coeliac disease can also cause fertility problems. A study in 1996 confirmed that women with coeliac disease were sub-fertile and had an increased risk of stillbirths and perinatal deaths.

Gluten is a major component of wheat; and other cereals, such as rye, barley and oats, can also be a problem. Rice and corn are fine. The gluten damages the villi, which are minute, hair-like projections lining the intestine, and this can stop the absorption of vital nutrients. The disorder is diagnosed by having a biopsy in which a sample of the small intestine is removed for examination.

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Get physical. In some circles, it’s no longer physically correct to use the term exercise. The focus, if you please, is now on physical activity, “Exercise tends to be a negative term for many people,” says Kerry Stewart, Ed.D., a clinical exercise physiologist and director of cardiac rehabilitation and prevention at Johns Hopkins Bayview Medical Center in Baltimore. “They think of exercise as pain or extremely hard work.”

Buried somewhere in that semantic sideshow is a helpful message for the retooling of your lifestyle- namely, that while structured, moderate exercise is best, any kind of regular movement helps. “The major problem is not doing anything,” Dr. Stewart says. “With physical activity as the goal, you can build activities into your lifestyle that aren’t usually considered exercise-like a sport you think is fun or just mowing the lawn regularly.”

Make exercise your cornerstone. The beauty of the disease-free lifestyle is that every element seems to boost every other. For example, reducing stress helps you quit smoking, which helps you exercise, which helps you lose weight. But exercise itself may be the sultan of synergy. “Start by exercising and that will ignite all the other things,” Dr. Burke says.

Exercise may work as your lifestyle cornerstone because it has been shown to increase what is known as self-efficacy. “That means that people who exercise have a higher degree of confidence in their ability to do things and they’re more likely to do them,” Dr. Stewart says. “People who are physically active tend to do other things as well to keep them healthy.”

Keep it positive. If you equate a healthy diet with deprivation, you’re not going to be very enthusiastic about it. So concentrate on what you should eat, not what you shouldn’t, suggests Edward Giovannucci, M.D., Sc.D., assistant professor of medicine at Harvard Medical School. “Rather than obsessing about the fat content of your diet, focus on positive things like getting more whole grains and fruits and vegetables,” he says. “Think more along the lines of balance. It’s not that you can’t eat any dairy products or beef. Just don’t make them the focus of your diet.”

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Are eating disorders all in the mind?

No. There may be a physical malfunction in the way the body regulates hunger. And the longer a disorder persists, the greater the damage it does to the body. The impact of starvation on the brain can lead to worsening mental and emotional problems.

Is an eating disorder a sign that some other psychiatric illness exists, such as a personality disorder?

Eating disorders are illnesses in and of themselves. They are not necessarily the product of some other illness. Of course, an eating disorder arising in a young person can affect the way her personality develops.

Do eating disorders cause depression?

Depression is a separate problem. A woman can be depressed and have an eating disorder; the former doesn’t necessarily cause the latter. Some patients feel depressed because they are struggling with a chronic illness. However, there does seem to be a connection between a family history of mood disorder and the risk that a member may develop an eating disorder.

Will a teenage girl who worries about her figure develop an eating disorder?

Unfortunately, over-concern about one’s body is normal in our culture. But when other emotional pressures bear down on a vulnerable person, the risk rises that she’ll develop an eating disorder.

Does dieting lead to eating disorders?

Many patients did diet before their disorder arose, but others who diet never develop an eating abnormality.

Do food allergies, vitamin deficiencies, or improper diet cause eating disorders?

We need more research before we can answer this conclusively. Improper diet is destructive to a person’s health, as are vitamin deficiencies and untreated food allergies, but there’s not enough evidence to show that these in themselves can cause an eating disorder. However, there is evidence that imbalances in some vitamins or minerals may cause certain problems. Too much vitamin A, for example, can cause menstrual problems, while too little zinc can affect one’s mood, appetite, and sense of taste.

Is it true that anorexics have no appetite?

No. Anorexics do experience hunger much of the time and need considerable willpower to conquer these feelings. The more they starve, the more their bodies crave food.

Do anorexics hate sex?

Better to say that most anorexics would rather avoid sex. Starving uses up all the patient’s energy, leaving her none for any other activity, including but not limited to sex.

Are anorexics lying when they say they are fat but are obviously starving?

No-they mean it very sincerely, because the disorder has warped their ability to think and see accurately. The longer the illness persists, the more the patient misjudges her appearance and the more she feels compelled to keep starving herself.

Do an anorexic’s psychological problems have to be cured before she can gain weight?

Absolutely not. This would be like trying to fix a broken leg by analyzing the hidden motivations behind someone’s decision to go skiing. It won’t work and it only delays therapy that might do some good. An anorexic is in danger of dying. Job One is to restore weight so that her body-and her ability to think clearly- can return to normal. Only at that point will psychotherapy have some chance of succeeding.

Do anorexics starve themselves so they can look good?

Looking “good” has a different meaning for anorexics than for normal people. Many anorexics know they look skeletal and emaciated. For them, starvation is a compulsion they can’t control, not a plan to become more attractive.

Do laxatives and diuretics help control weight?

Not really. By the time food passes in a bowel movement, the body has absorbed most of its calories anyway. Any weight lost is probably just temporary “water weight” loss.

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Dina Jachens lost 40 pounds without giving up any of the foods that she craves. Instead, she learned to enjoy them one piece at a time. Dina, a 31-year-old full-time mom from Midland, Michigan,

had her three children within 4 years. Each pregnancy left her a little bit heavier, and she had an increasingly difficult time getting rid of the extra pounds. “I was busy every minute, but not doing the things I could have done to keep in shape,” she says. “And I tended to eat whatever I could grab, which included lots of chips and other salty snacks.”

Even as her weight climbed toward 175 pounds during those 4 years, Dina didn’t think much about slimming down. Then, one day, as she sorted through some size 10 and 12 clothes that no longer fit, she began thinking about a family reunion that she had recentiy attended. At past reunions, she had always received lots of compliments about her appearance. But not this time.

Dina looked in the mirror and took a good long look at herself. She didn’t like what she saw. She vowed that she would get back into the size 8 that she had worn before having her kids.

“I realized that my eating habits had gotten out of control,” Dina says. “I was eating whatever I wanted to, as much as I wanted to. I’m a salt freak, so I’d eat chips by the handful. And before my periods, I’d crave chocolate, so I’d eat a good part of a bag of M8cM’s.”

Dina knew that she couldn’t completely give up the foods that she loved. But she learned how to control how much of them she ate by savoring them one piece at a time. Take those M&M’s. Dina stopped tossing them in her mouth a fistful at a time. Rather, she put one on her tongue and allowed it to completely melt before starting another. “It usually takes only about 10 M8cM’s until I feel satisfied,” she says. “That’s a lot better than a whole bag.”

The same rule applied to chips. Instead of eating them by the handful, Dina crunched one at a time, giving herself a chance to really savor the taste.

Dina made other changes in her eating habits, like giving up most desserts as well as high-fat, high-calorie foods that she didn’t really care for. “If there was something that I simply couldn’t pass up, I’d eat only a bite or two, just to get the taste,” she says. She also launched an exercise program, walking 6 days a week.

In 12 months, Dina managed to take off 40 pounds. She’s maintaining her weight at a healthy 135 pounds—and she’s back into her ^ size 8 clothing.

WINNING ACTION

Indulge yourself one bite at a time. Dina has found a terrific way to deal with her cravings for high-fat, high-calorie foods: by eating treats one piece at a time. It sounds like she’s enjoying them more, too! Do the same, and I bet you’ll find out how much you really enjoy every bite. Another suggestion is to look for your favorite treats in single-serving packages. If you crave chocolate, for example, buy a box of Fudgsicles instead of a half-gallon of ice cream. It will give you built-in portion control.

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