We all know ex-smokers who tossed out the butts and immediately thereafter started taking on pounds. Arnold McD. (known to all as “Mac”‘ came to us with exactly that story to tell.

He’d quit smoking three months earlier at his doctor’s insistence. In the intervening weeks, he had gained about a dozen pounds. Added to the “six or seven pounds I didn’t need in the first place, that meant Mac was carrying around twenty pounds he wanted to be rid of.

At forty-four, Mac bad reached the age when many of us start to examine our habits to determine how they impact on our health and longevity. Mac’s doctor had. too. and as well as telling him to abandon the cigarettes, he had told him it would be necessary for him to drop some weight.

Mac had tried by himself. “I had heard that some people gained weight after they stopped smoking, but 1 didn’t think it was anything that I couldn’t handle. Now I’m finding it isn’t so easy.”

Oddly, he reported, “I don’t think that I’m eating that much more. I know that doesn’t make sense, but it’s true.”

That’s why he came to see us.

He tested in the? moderate addiction range, so he appeared a good candidate for the Carbohydrate Addict’s Diet. We explained the diet to him and also talked about research on post-smoking physical changes, which often result in increases in the body’s tendency to hold on to or gain weight.

Mac said that lie didn’t quite1 grasp file bio logical underpinnings’, but he was willing to give the diet a try.

He may not have been a scientist, but Mac trusted that we knew what we were” doing. The first week he lost four pounds. We needed to slow down his weight loss, to bring it closer to the ideal of 1 percent of body weight per week. We advised him to increase his intake of low-carbohydrate foods at breakfast and at lunch. It worked, and several visits later his weight-loss rate was down to two pounds per week.

Mac lost his twenty pounds, then decided to “lose a few more while I’m at it.” At twenty-five pounds lighter, his weight leveled off. “I could probably lose more if I cut down on my Low-Carbohydrate Meals, but I don’t need to. I’m five- pounds thinner than 1 planned, 1 haven’t smoked in almost a year, and 1 look better than 1 did at eighteen.”

About three years after his first visit, Mac was in the neighborhood and stopped by to see us. His weight was holding constant, and he felt good about himself. He was even running stop-smoking groups for the organization that had helped him to stop in the first place.

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In the USA, doctors use a manual called The Physician’s Desk Reference which is much more detailed than anything we have access to in the UK. Drug companies by law are required to state the risks of their drugs in this manual. The Physician’s Desk Reference lists the side effects for HRT which include:

•   endometrial (womb) cancer,

•   undesirable weight gain/loss,

•   breast tenderness/enlargement,

•   bloating,

•   mental depression,

•   thrombophlebitis (inflammation of the wall of a vein),

•   elevated blood pressure,

•   reduced carbohydrate tolerance,

•   reduced glucose tolerance,

•   skin rashes,

•   hair loss,

•   abdominal cramps,

•   vaginal candidiasis (thrush),

• jaundice,

•   nausea,

•   vomiting,

•   cystitis-like syndrome.

Although research has not shown that women on HRT gain weight – other than the weight gain that would normally be associated with ageing

- I find that it is one of the greatest concerns of the women who come to see me. Their main complaint is the ‘sudden’ increase in weight (and increases in breast size by up to two cups larger) soon after starting HRT. I also see women not on HRT and the weight gain is definitely different between the two groups.

So this is a prime symptom that makes women want to stop taking HRT. They are also concerned about psychological changes — feelings of being suicidal, feeling ‘not there’ and headaches. Organizations like the Amarant Trust, the UK charity that promotes the use of HRT, have drawn attention to the fact that many British women who try HRT give it up after only a few months. It believes the reason is that women do not persevere for long enough, do not try alternative HRT products, and that their GPs do not spend sufficient time and effort explaining the therapy to them. There are, however, many GPs who have reservations about the over-prescribing of HRT. Many women feel perfectly well on HRT. But it is not surprising that others come to the conclusion that the side effects they experience are worse than the symptoms the HRT is designed to ‘cure’. And as the years roll on there is increasing evidence that taking HRT involves some serious health risks that many of us would rather avoid.

*12/101/5*

“Some of the new, state-run pre-school early-intervention programs like Child Find are helpful in getting the parents of handicapped children, and the infant or young child himself, involved with appropriate stimulation and physical therapy. Schools now are taking these handicapped children at a young age, at least for part of the day. These programs give the parents some hope, some respite, and more realistic expectations about their child’s progress and future.

“While counseling is fun and rewarding when you’re dealing with a teenager like Karen (who will be a winner if only she’ll get her act together), at times counseling can be even more challenging and more rewarding when you have a family with a severely-damaged child. Just think what you have accomplished when you help them to cope, to grow with the situation, to make the best of it, whatever that is, for themselves and for their child. If you look at the alternatives, such as the family breaking up, then you will have a single parent facing that future alone. Or the child could end up in a foster home with the family disintegrated. If you look at these bleak alternatives, then anything you can do to help the family to cope and to make a reasonable life for themselves and for their child is a success. If you define success in these terms, yes, we are usually, but not always, successful.”

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