The more severe cases will require admission to hospital. They are perhaps better in a psychiatric ward or hospital rather than a general hospital. Most will respond to encouragement and supervision of meals rather than to forced feeding. However if the weight loss is extreme and the general physical condition is poor then intravenous feeding may be necessary.

Apart from the attention to the physical state, the emotional side of this disorder needs treatment. The girl herself may need intensive psychotherapy. Often the family, especially the parents, may also need counselling, and it may be better in these cases for parents to have a different therapist to the girl herself.

Anorexia nervosa rarely results in death now unless as a result of suicide, but associated depression is not unusual.

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Symptoms: discolored urine, puffy eyes, headache and high blood pressure.

Home care:

Most cases of nephritis are mild and pass unnoticed. If the symptoms are marked enough to be recognizable, the child requires medical attention.

Precautions

-    If the child's eyes are puffy, or the urine is scanty and dark, the child may have nephritis.

-    If symptoms of nephritis are pronounced enough to be noticed, take the child to the doctor.

-    Nephritis usually follows a strep infection. Watch for the condition to follow a strep throat or impetigo, even if the infection is being treated with antibiotics.

There are many forms of nephritis, or inflammation of the kidneys, but the form that is most common in children usually follows a streptococcal infection such as strep throat, scarlet fever, or streptococcal impetigo. The first symptoms of nephritis develop one to three weeks after the onset of a strep infection, and these symptoms are usually mild. In fact, most cases of nephritis probably go unnoticed (or undiagnosed) and pass without treatment. Occasionally, however, nephritis starts abruptly and the illness is severe. Most children recover completely from nephritis, but a few develop chronic kidney disease.

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Chromium is a trace mineral increasingly thought to be vital in the production of diabetes, but

so far the work has mostly been done on Type 2 diabetes. Early research in rats found that

abnormal glucose metabolism could be corrected by adding chromium (as brewer's yeast) to the

diet.

The biological significance of this trace element has only recently been recognized, but now that it has been there are signs that many people are short of it. Chromium is physiologically active in the body in only one inorganic form (the trivalent form). This inorganic (non-living) type of chromium is very inactive in the body compared with another chromium-containing compound-the organic complex called the glucose tolerance factor (GTF). It is not known exactly what this is but it appears that animals have only a limited ability to produce it themselves and so need external sources. GFT is the only known form in which chromium can cross the placenta. When trivalent chromium is given orally less than 1 per cent is absorbed.

Chromium's main function is to help insulin control the body's sugar levels. Experiments with

animals have found that glucose (sugar) metabolism is quickly impaired if the animals are fed

diets poor in chromium and that giving the element soon returns the situation to normal.

Because animal work has found that chromium-deficient animals develop diabetes-like

symptoms, it was natural to ask whether a similar mechanism could be at fault in human

diabetics. Several reports have suggested that giving chromium has had beneficial effects on

diabetics and in one study four out of six maturity -onset diabetics improved with a dose of 250 micrograms of chromium a day. Other studies have found that diabetics put out more chromium in their urine than do non-diabetics. Studies of poorly-nourished children in Jordan, Turkey and Nigeria found that they grew faster when given extra chromium. In spite of this circumstantial evidence there are no definite indications that diabetes is caused by a deficiency of chromium, and it is certain that many diabetics will not be improved simply by taking chromium.

Unfortunately, the refining of foods removes a very substantial part of their chromium. Blackstrap molasses, honey and raw sugar are rich in chromium but white sugar has almost none. This is especially unfortunate since chromium is needed if the body is to handle sugar effectively, as we have seen. White bread contains only one third of the chromium of the original whole wheat and this, of course, goes for anything made from white flour.

The food richest in chromium is brewer's yeast but whole-grain bread, nuts, shellfish, liver, kidneys, grape juice, beef and beer are also rich sources.

As with many other trace elements, absorption is very poor, especially from tablets. Overall, only about 3 per cent of the chromium in our food is absorbed, so with our relatively chromium-deficient diet there is not much of a safety margin.

The recommended daily intake of chromium varies from 5 to 100 micrograms a day. Given that the body needs to absorb about 10 micrograms a day and that only 3 per cent is absorbed, perhaps the amount we consume should be even higher than 100 micrograms.

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Indigestion is a vague term used to describe pains or discomfort in the abdomen after eating or drinking. Dyspepsia is a discomfort in the uppermost part of the abdomen after food. Some people's indigestion is caused by a peptic ulcer.

What causes it?

• Peptic ulcer.

• Smoking.

• Alcohol, tea and coffee.

• Specific foods (often spicy ones or sugar).

• Fatty foods.

• Stress.

• Too little gastric acid.

• Hypoglycemia.

• Thrush.

• Reflux oesophagitis or hiatus hernia.

• Irritable bowel syndrome.

• Gall-bladder problems.

• Angina.

Prevention

• Smoking stimulates the production of gastric acid and can cause quite severe indigestion in some people. Smoking also reduces the efficiency of the valve of the top of the stomach, so allowing acid stomach contents to flow into the lower end of the gullet (oesophagus) and cause pain there. Other substances that do this are chocolate, alcohol, spearmint, and peppermint. Stopping smoking brings relief in days to many people with indigestion. Any treatment being given for indigestion is made less effective in someone who continues to smoke.

• Alcohol, tea and coffee stimulate gastric-acid production. Experiment with leaving out all of these for a few days and see the results. If the indigestion goes completely reintroduce one drink at a time (weak if it is tea or coffee, and infrequently in the case of alcohol) and stop as soon as you get indigestion again. It may be that there is one (or more) of them that you will never be able to drink without feeling ill.

• Research has found that certain individuals improve when they go on to a low-carbohydrate diet. Sucrose increases pepsin secretion by the stomach by 200 per cent. The same study found that eight out of nine people with hiatus hernia did better when they went on a similar diet, low in refined carbohydrates. Five out of eight people with duodenal ulcer also improved.

• Fatty foods often produce pain or discomfort in the upper abdomen (if the individual's gall-bladder is not working well) partly because of gall-stones. If fatty foods regularly bring on your indigestion, see your doctor.

• Stress is a potent stimulant to gastric acid, and many people complain of odd discomforts and uneasiness in the stomach when they are stressed. Stress also affects the rate at which the stomach digests food and passes it on to the intestine, and this can cause indigestion as well.

• Although many people with indigestion have too much gastric acid and improve when taking antacids, some do not. These people have too little acid in their stomachs and the antacids òàê them worse. Prevention here involves taking pepsin and hydrochloric acid supplements regularly. A good way to take hydrochloric acid is in the form of 1-3 tablets of betaine hydrochloride before each meal

• The yeast Candida albicans, which causes thrush, can infect the stomach and produce a sense î burning after the ingestion of food. This type of indigestion can only be cleared up by treating the infection.

• In the irritable bowel syndrome the colon (large bowel) goes into spasm after food. The middle part of the colon lies in the upper abdomen very near the stomach and this pain can be mistaken for indigestion.

• Angina pectoris can often mimic indigestion. If you have any history of heart disease in your family or have any of the risk factors known to be important in heart disease always take 'indigestion' seriously. The prevention of indigestion in your case might be to treat your angina.

• If you have indigestion don't take a sloppy diet or drink lots of milk as neither have been proven to reduce indigestion, except temporarily. Unfortunately, they often worsen it because milk produces a rebound overproduction of acid once its initial buffering effect has passed.

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