Defined as “a condition in which the amount of glucose (sugar) in the blood is too high because the body cannot use it properly”, word “diabetes” derives from the Greek for “siphon”, a reference to the copious urine excretion that characterizes this affliction. In common usage, the term diabetes is synonymous with diabetes mellitus. As it is another major non-communicable disease that has affected millions of people around the world, this disease has two varieties, each with its own cause: diabetes mellitus type I, caused by deficiency of the pancreatic hormone insulin and diabetes mellitus type II, in which insulin is available but cannot be properly utilised. According to the Food and Agriculture Organisation and World Health Organisation (FAO/WHO, 2003), the incidence of diabetes is “currently estimated to be around 150 million”. They even predict this number “to double by 2025, with the greatest number of cases being expected in China and India”. In the UK, 1.4 million people were inflicted with diabetes in 2002 and a million more people “have the condition but are not yet aware of it” (Food Standards Agency, 2002).
Eating is an essential human activity because this is where we derive our nourishment to provide us the energy we need to perform other functions. However, when we have eating disorders, our bodies may not be able to cope with the required nutrients because we cannot eat normally. As a result, eating disorders can trigger various health problems that may endanger our general well-being. As one type of eating disorder, bulimia is defined as “binge eating followed by inappropriate attempts to compensate for the binge, such as self-induced vomiting or the excessive use of laxatives, diuretics, or enemas” (Encyclopædia Britannica, 2008). Some cases of bulimia can be “followed by excessive exercise or fasting” and “the episodes of binge eating and purging typically occur an average of twice a week or more over a period of at least three months, and repetition of the cycle can lead to serious medical complications such as dental decay or dehydration” (Encyclopædia Britannica, 2008).
The severity of bulimia is a cause of alarm because the Anorexia Nervosa and Related Eating Disorders, Inc. (ANRED, 2005) claimed that “four percent (4%), or four out of one hundred, college-aged women have bulimia”. It is also claimed that “50% of people who have been anorexic develop bulimia or bulimic patterns”. Since bulimic people are often secretive about their condition, “it is difficult to know how many older people are affected” (ANRED, 2005).
Guertin (1999) described that the binge itself usually occurs in secret, most commonly at home during unstructured afternoon or evening hours Bulimic individuals typically gag themselves to induce vomiting. Most attempt to conceal their behavior. Fear of gaining weight is a constant factor. Although an overconcern with body shape and weight is a cardinal feature of bulimia and anorexia, bulimic individuals do not pursue the extreme thinness characteristic of anorexia. Their ideal weights are similar to those of women who do not suffer from eating disorders. A binge typically lasts from 30 to 60 minutes and involves consumption of forbidden foods that are generally sweet and rich in fat. Binge eaters typically feel they lack control over their bingeing and may consume 5,000 to 10,000 calories at a sitting. One young woman described eating everything available in the refrigerator, even to the point of scooping out margarine from its container with her fingers. The episode continues until the binger is spent or exhausted, suffers painful stomach distension, induces vomiting, or runs out of food. Drowsiness, guilt, and depression usually ensue, but bingeing is initially pleasant because of release from dietary constraints.
Like anorexia, bulimia is associated with many medical complications. Many of these stem from repeated vomiting: skin irritation around the mouth due to frequent contact with stomach acid, blockage of salivary ducts, decay of tooth enamel, and dental cavities. The acid from the vomit may damage taste receptors on the palate, making the person less sensitive to the taste of vomit with repeated purgings. Winston (2008) emphasized that hypokalemia (low levels of potassium), dental erosion, parotid enlargement, esophagitis and the Mallory–Weiss tears of the esophagus are the complications that may develop from having bulimia. Cycles of bingeing and vomiting may cause abdominal pain, hiatal hernia, and other abdominal complaints. Stress on the pancreas may produce pancreatitis (inflammation), which is a medical emergency. Excessive use of laxatives may cause bloody diarrhea and laxative dependency, so the person cannot have normal bowel movements without laxatives. In extreme cases, the bowel can lose its reflexive eliminatory response to pressure from waste material. Bingeing on large quantities of salty food may cause convulsions and swelling. Repeated vomiting or abuse of laxatives can lead to hypokalemia (potassium deficiency), producing muscular weakness, cardiac irregularities, even sudden death - especially when diuretics are used.
Treating eating disorders like bulimia is difficult. A combined feeding regimen and psychotherapy might be needed to quell this condition. Van den Eynde and Schmidt (2008) recommended Cognitive–behavioral therapy (CBT) because it is “efficacious in both bulimia nervosa and binge eating disorder, but there is a need to improve outcomes further”. Also, they said that “Interpersonal psychotherapy (IPT) has… shown to have benefits although in bulimia nervosa the response has been slower than with CBT”. Delivering psychotherapy is also costly and is often hampered by limited availability, although self-help versions of CBT may help to overcome these difficulties. Van den Eynde and Schmidt (2008) also found that “pharmacotherapy is a potential treatment option for bulimia nervosa and binge eating disorder, with evidence predominantly on antidepressants”. A high dose of fluoxetine can be administered “because it is relatively better tolerated than antidepressants of other classes”. However, “combined psychotherapy and pharmacotherapy in patients with bulimia nervosa produces somewhat better outcomes than pharmacotherapy alone, but is not clearly superior to psychotherapy alone”.
Anorexia Nervosa and Related Eating Disorders, Inc. (ANRED). (2005). Statistics: How many people have eating disorders? Retrieved April 23, 2008, from ANRED: http://www.anred.com/stats.html.
Encyclopædia Britannica. (2008). Bulimia nervosa. Retrieved April 23, 2008, from Encyclopædia Britannica Online: http://www.search.eb.com/eb/article-9018019.
Guertin, T.L. (1999). Eating behavior of bulimics, self-identified binge eaters, and noon-eating disordered individuals: What differentiates these populations? Clinical Psychology Review, 19(1): 1-24. Retrieved April 23, 2008, from ScienceDirect Database: http://www.sciencedirect.com/science/article/B6VB8-3VMDX64-1/1/f01b286cf02b1ff6d0c379c40f494e58.
Van den Eynde, F. & Schmidt, U. (2008, April). Treatment of bulimia nervosa and binge eating disorder, Psychiatry, 7(4): 161-166. Retrieved April 23, 2008, from ScienceDirect Database: http://www.sciencedirect.com/science/article/B82Y7-4SB7N5V-7/1/4bc426b9ac564690d229dd5781f63bfa.
Winston, A.P. (2008, April). Management of physical aspects and complications of eating disorders, Psychiatry 7(4): 174-178. Retrieved April 23, 2008, from ScienceDirect Database: http://www.sciencedirect.com/science/article/B82Y7-4SB7N5V-B/1/08f35b60dc0906bb9b8f7f0c8f8573eb.
Weaning is defined as “progressive transfer from the first milk diet to family diet of many foods”. Shifting from breast milk to solid food for babies can be a tricky process because it needs proper timing and the gradual introduction of appropriate food sources in order to “accustom” the baby to learn new food textures and tastes. It is also through weaning where babies learn to swallow and chew food. However, there are risks involved in weaning children. It is said that Queen Anne lost 18 children through infections caused by improper weaning methods in the 1700s. Thus, the timing of the first introduction of solids is an important confounding factor for subsequent health. Alder et al. (2007) revealed that infants introduced to solid food before 4 months had higher levels of cardiovascular risks such as increased body fat and had “more wheezy respiratory illness”.
The Committee on Medical Aspects of Food in its Report of the Working Group on the Weaning Diet(Department of Health and Social Security, 1994) recommended that the majority of infants should not be given solid food before the age of 4 months. Also, the World Heath Organization (2002) recommended exclusive breast-feeding until 6 months. Delaying the introduction of solid food until after 4 months may confer benefit in families with a history of atopy or gluten enteropathy (celiac). After years of intensive research, the experts determined that the best time to introduce solid food in a baby’s diet is at 6 months.
If the baby is weaned to solid foods earlier than 4 to 6 months, they will have an inability to take in solid food because they could only do sucking and not drinking. They may have extrusion (gagging) reflex that would eject solid foods and they may experience problems with their head control. Also, their gut permeability will be high because they are not ready to process foreign proteins that may cause them allergies. At this age, babies still have no salivary or pancreatic amylases and their kidneys might not cope with high solute load. Supplements can also decrease iron absorption from milk and increase infection. They may also have a strong risk of bacterial infection, develop coeliac disease from gluten intolerance or be induced to obesity because of overfeeding. On the other hand, weaning the baby later than 6 months would also have problems like “breast addiction”, where babies don’t learn about foods’ taste, smell and texture, so it becomes very hard to introduce food later. Introducing solid food later than 6 months would also exhaust the baby’s iron stores because milk is not a good source of iron for gut hygiene reasons. Energy and protein intake will also become inadequate, while other nutrients may not be supplied by milk alone.
When starting solid foods at 6 months, mothers should first use gruels, mashed potatoes, and purées. Rice is recommended but gluten should be avoided as long as possible (including biscuits and rusks). It is also important to keep sugar and fat reasonably high. Choking on large lumps is still a danger at this age. Pipped, seeded or skinny fruits, nuts or highly spiced foods need a mature digestive system, good teeth and the ability to avoid accidental inhalation. After six months a mix of foods is necessary to provide sufficient energy, trace elements (especially iron and zinc) and vitamins. Vitamin C is needed daily as it is not stored in the body. Sodium levels will be excessive if unmodified cow’s milk is given as the only milk source from birth; cow’s milk protein is also difficult for the child under one year to digest and, if given as the main food, is thought to be one of the common causes of iron deficiency anaemia in this age group (McGregor 2000, p. 112). In fact, salty foods should be restricted for the first few years of life as sodium intake has been implicated in the onset of hypertension in adulthood. Also, mothers should avoid high nitrate/nitrite content foods like bacon, ham, hot dogs and spinach because of the risk of methaemoglobinaemia. Hygiene in handling baby food can also be essential to avoid infection. High infection risk foods include cooked rice, cream, meat, milk and egg dishes.
Babies still have undeveloped digestive system and this is why people should be careful in giving them solid food. The key should be the right timing and gradual introduction of solid food. When done properly, the weaning process may help babies eat properly to promote good health in later life.
As a country nestled in the southernmost part of the African continent, South Africa gained prominence for the “great natural beauty, and cultural diversity, all of which have made the country a favored destination for travelers since the legal ending of apartheid (Afrikaans: “apartness,” or racial separation) in 1994” (Encyclopædia Britannica, 2008).