Philosophy

Moderation Management

When you have made the healthy decision to drink less, and you stay within moderate limits, you should not experience any health, personal, family, social, job-related, financial, or legal problems due to alcohol. The suggested guidelines below allow for a degree of individual interpretation, because moderation is a flexible principle and is not the same for everyone. The suggested limits, however, are more definite.

A Moderate Drinker:

• considers an occasional drink to be a small, though enjoyable, part of life.
• has hobbies, interests, and other ways to relax and enjoy life that do not involve alcohol.
• usually has friends who are moderate drinkers or nondrinkers.
• generally has something to eat before, during, or soon after drinking.
• usually does not drink for longer than an hour or two on any particular occasion.
• usually does not drink faster than one drink per half-hour.
• usually does not exceed the .055% BAC moderate drinking limit. (see Note 1 below)
• feels comfortable with his or her use of alcohol (never drinks secretly and does not spend a lot of time thinking about drinking or planning to drink).

The MM Limits:

• Strictly obey local laws regarding drinking and driving.
• Do not drink in situations that would endanger yourself or others.
• Do not drink every day. MM suggests that you abstain from drinking alcohol at least 3 or 4 days per week.
• Women who drink more than 3 drinks on any day, and more than 9 drinks per week, may be drinking at harmful levels.
(See Note 2 below for definition of a "standard" drink)

• Men who drink more than 4 drinks on any day, and more than 14 drinks per week, may be drinking at harmful levels.

  Notes:

  Standard drink: one 12 oz-beer (5% alcohol), one 5-oz glass wine (12% alcohol), or 1 and 1/2 oz of 80-proof liquor (40% alcohol).

These "number of drinks" limits are LIMITS and not TARGETS. Blood Alcohol Concentration (BAC) charts are more accurate than number of drink limits because they take into account weight, sex, and rate of drinking. If you are very light in weight use the BAC upper limit of .O55%. Some researchers advise a limit of one drink per day for older adults (55+).

The limits used by MM are based on research published in 1995 in the American Journal of Public Health, by Dr. Martha Sanchez-Craig, Addiction Research Foundation, Toronto, Canada and other published limits.

PLEASE CHECK WITH FAMILY AND FRIENDS WHETHER OR NOT THIS PROGRAM IS SUITABLE FOR YOUR INDIVIDUAL SITUATION. Consider consulting a trained Drug and Alcohol Treatment Program/Counsellor or AA.

Coeliac Disease Diet

Treatment

The only treatment for CD/DH is the lifelong adherence to a gluten-free diet. When gluten is removed from the diet, the small intestine will start to heal and overall health improves. Medication is not normally required. Because osteoporosis is common and may be profound in patients with newly diagnosed CD, bone density should be measured at or shortly after diagnosis. Consult your physician regarding specific nutritional supplementation to correct any deficiencies. The diagnosed celiac should have medical follow-up to monitor the clinical response to the gluten-free diet. Dietary compliance increases the quality of life and decreases the likelihood of osteoporosis, intestinal lymphoma and other associated illnesses.

Adapting to the gluten-free diet requires some lifestyle changes. It is essential to read labels which are often imprecise, and to learn how to identify ingredients that may contain hidden gluten.

Be aware that hidden gluten can be found in some unlikely foods such as: cold cuts, soups, hard candies, soy sauce, many low or non-fat products, even licorice and jelly beans.

Gluten may also be used as a binder in some pharmaceutical products. Request clarification from food and drug manufacturers when necessary.

Potential harmful ingredients include:

• unidentified starch
• modified food starch
• hydrolyzed vegetable protein - HVP
• hydrolyzed plant protein - HPP
• texturized vegetable protein - TVP
• binders
• fillers
• excipients
• extenders
• malt

Coeliac Disease

Coeliac disease, also known as gluten intolerance, is a genetic disorder that affects 1 in 133¹ Americans. Symptoms of coeliac disease can range from the classic features, such as diarrhea, weight loss, and malnutrition, to latent symptoms such as isolated nutrient deficiencies but no gastrointestinal symptoms. The disease mostly affects people of European (especially Northern European) descent, but recent studies show that it also affects Hispanic, Black and Asian populations as well¹. Those affected suffer damage to the villi (shortening and villous flattening) in the lamina propria and crypt regions of their intestines when they eat specific food-grain antigens (toxic amino acid sequences) that are found in wheat, rye, and barley³. Oats have traditionally been considered to be toxic to coeliacs, but recent scientific studies have shown that this is not the case.

Because of the broad range of symptoms coeliac disease presents, it can be difficult to diagnose. The symptoms can range from "mild weakness, bone pain, and aphthous stomatitis to chronic diarrhea, abdominal bloating, and progressive weight loss.³" If a person with the disorder continues to eat gluten, studies have shown that he or she will increase their chances of gastrointestinal cancer by a factor of 40 to 100 times that of the normal population⁴. Further, "gastrointestinal carcinoma or lymphoma develops in up to 15 percent of patients with untreated or refractory coeliac disease³." It is therefore imperative that the disease is quickly and properly diagnosed so it can be treated as soon as possible.

Based on the figure mentioned above we can extrapolate the total number of people in the United States with coeliac disease: 2.18 million (based on the total population: 290,356,028⁵). It is very important that doctors understand just how many people have this disease so that routine testing for it is done to bring the diagnosis rate in line with the disease's epidemiology. Testing is fairly simple and involves screening the patient's blood for antigliadin (AGA) and endomysium antibodies (EmA), and/or doing a biopsy on the areas of the intestines mentioned above, which is still the standard for a formal diagnosis.

The only acceptable treatment for coeliac disease is strict adherence to a 100% gluten-free diet for life. An adherence to a gluten-free diet can prevent almost all complications caused by the disease³. A gluten-free diet means avoiding all products that contain wheat, rye and barley, or any of their derivatives. This is a difficult task as there are many hidden sources of gluten found in the ingredients of many processed foods.

Symptoms

Celiac Disease may appear at any time in a person's life. The disease can be triggered for the first time after surgery, viral infection, severe emotional stress, pregnancy or childbirth. CD is a multi-system, multi-symptom disorder. Symptoms are extremely varied and can often mimic other bowel disorders. Infants, toddlers, and children often exhibit growth failure, vomiting, bloated abdomen and behavioral changes.

Classic symptoms may include:

• abdominal cramping, intestinal gas, distention and bloating
• chronic diarrhea or constipation (or both)
• steatorrhea -- fatty stools
• anemia - unexplained, due to folic acid, B12, or iron deficiency (or all)
• weight loss with large appetite, or weight gain

Other symptoms:

• dental enamel defects
• osteopenia, osteoporosis
• bone or joint pain
• fatigue, weakness and lack of energy
• infertility - male/female
• depression
• Aphthous ulcers

Dermatitis Herpetiformis (DH) is skin manifestation of celiac disease characterized by blistering, intensely itchy skin. The rash has a symmetrical distribution and is most frequently found on the face, elbows, knees and buttocks. DH patients can have gastrointestinal damage without perceptible symptoms.

Putting Brains on the Couch

By Sharon Begley

Newsweek

"The American Psychiatric Association is updating its immense (911 pages) diagnostic manual, which offers 20 forms of bipolar disorder alone. "But it's still just a checklist of symptoms, which different physicians can interpret differently," says psychiatrist James Greenblatt, who directs the eating-disorders unit at Waltham Hospital in Massachusetts. For him and a growing number of psychiatrists, the search for a modern, objective diagnostic tool has led to the past: the electroencephalogram, first used in 1929 to record the brain's electrical activity. "EEGs let you look at patients the way cardiologists do with EKGs, focusing on physiology, not symptoms," says psychiatrist William Richardson, who is at Overlook Hospital and in private practice in Summit, N.J. Brain measurements like EEGs not only offer the possibility of better treatment for mental illness, however. They also show that the line from brain to mind can meander like a mountain stream.

For an EEG, which typically costs about $150 and takes 45 minutes, a patient has about 20 electrodes pasted to his scalp, where they measure the electrical activity of neurons—brain waves—directly beneath. In the 1980s, researchers tried to base diagnoses on EEGs, but it didn't work. The same squiggles could mean different illnesses, and one illness could be marked by different EEGs. The new use of EEGs skips the diagnosis (a label like "anxiety disorder") and goes straight to a recommended treatment. An EEG is compared with a database that includes 13,000 pairings of EEGs with which drugs helped in each case. A California company called CNS Response, which runs the database, finds a match and sends the physician an analysis indicating which drugs patients with that EEG are sensitive or resistant to.

That would be humdrum if, say, the analysis said "Prozac" for a patient with depression. But according to studies of hundreds of patients—CNS Response is launching larger trials this fall—"in some three quarters of patients the EEG database leads the physician to something he wouldn't have thought of," says CNS president Len Brandt. One middle-aged woman, for instance, suffered from depression for years, even after Richardson prescribed one antidepressant after another, marching through Wellbutrin, Cymbalta, Zoloft and more. Her EEG, it turned out, matched those of patients who had responded to Depakote, which is used for bipolar disorder and impulse-control disorders. She showed no signs of either. Yet on the drug and continued psychotherapy, her depression lifted in a week.

The EEG matches aren't perfect. For about one quarter of patients, the $500 analysis suggests treatments that work no better than what they'd already tried. It has proved most beneficial in stubborn cases and in those with no obvious first-line drug, such as eating disorders and addictions. A 16-year-old was repeatedly hospitalized for bulimia, purging up to 10 times a day despite being on the usual antidepressants, for instance. But her EEG pointed Greenblatt toward an anticonvulsant and a stimulant—not a duo anyone would have prescribed. She overcame her bulimia and is now in college.

Still, EEGs have not exactly taken psychiatry by storm. "It's a gross oversimplification to believe that the sum total of neuronal firing could give you anything worthwhile in terms of diagnosis," says Michael First of Columbia University, who is leading the team updating the diagnostic manual. "The scans are not specific for the illness." He's right: that's what those 1980s studies, trying to match symptoms to EEG, found.

But rather than being a fatal flaw, maybe it sheds light on the age-old conundrum of how brain gives rise to mind. One reason for the sometimes-odd pairings of illnesses and drugs is that many different brain states can produce the same mental symptoms, and many different symptoms can arise from the same brain state. Now replace "symptoms" with "mind." The path from electrical firings to mind is less mechanical than neuroscience dogma suggests. The mind has not yielded all its mysteries quite yet."

With Jeneen Interlandi

© 2007 Newsweek, Inc. | Subscribe to Newsweek

21st Century Psychiatry

Referenced EEG/Brainwave Testing

EEG & Psychiatry

Souvenir

Abandoned cars
"One of the tragedies about this car park is that for many weeks after when I returned to my apartment, many of these cars were still there. They belonged to a lot of the people who would drive in from Jersey and upstate and go to the Trade Center. It's rather sad how many of those cars were there."

Dom Foulsham was in New York on business on 11 September 2001. He was staying in a Manhattan apartment, just south of the World Trade Center, and was woken when the second hijacked plane hit the south tower. His first instinct was to pick up his camera and begin taking pictures.

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