I was visited by a distinguished, well-dressed gentleman, who told me that he was prepared to undergo any treatment in order to be cured of his skin condition. He had been diagnosed as suffering from a condition called vitiligo, a skin disease characterised by pigment-free patches surrounded by a darker band, which can occur anywhere on the body. Hairs that grow on these patches of skin are colourless and the condition originates from a melanin disturbance. The gentleman explained that he was sometimes ashamed even to offer to shake hands, as the vitiligo condition was very visible on his upper limbs. (The skin affliction on other parts of his body was naturally not quite as obvious.)

I immediately recognised the condition, because I have come across it often in Asian people who have emigrated to the United Kingdom. I can well understand that it is a cause of embarrassment to people, but the condition can be helped and although loss of pigmentation causes the milky-white patches surrounded by hyper pigmented borders, the tissue of the skin is otherwise unaltered.

Officially the cause of vitiligo is unknown, but over the years I have reached the conclusion that it is nutrition-related. This premise has resulted in an individual treatment approach which has proven relatively successful. Another unfortunate characteristic is that usually these pigment-free patches increase quickly, and therefore it is very hard to attempt to cover the affected areas of the skin with makeup.

The gentleman in question was reasonably successful in blocking the development of new patches with special skin brushing methods. He also used cold water treatments and a variety of herbs, e.g. burdock, chaparral, Oregon, coke-wood, and red clover blossom. I also prescribed Chelidonium, which he used in a homoeopathic form to help the skin in general. At a lecture, I had heard that a deficiency of zinc can influence the condition and quality of the skin, and therefore I also advised him to use a zinc supplement.

According to leading nutrition researchers, such as Dr Carl Pfeiffer, people find it more difficult to obtain enough zinc than any other mineral. Soil deficiencies of zinc have reduced levels available in plant foods, and zinc is removed by food processing. High levels of calcium and phosphates found in plant foods or fertilisers are thought to block absorption of zinc from food. The body’s stores of zinc may be threatened by missing meals, weight-reducing diets or fasting. The most reliable sources of zinc are shellfish, herrings and meat, and many vegetarians choose to supplement their diet with zinc. Smokers, alcohol drinkers, users of the contraceptive pill, the elderly, and athletes (zinc is lost in perspiration) may also take extra zinc.

Zinc is well known for its role in growth and tissue repair and in the immune system. It is vital that children and adolescents receive enough. Zinc is not only required for overall growth, but it is particularly important for the healthy function of reproductive organs and the prostate gland. It is also a component of semen. But these functions only scratch the surface of zinc’s importance, since it is involved in hundreds of metabolic pathways. Some of these maintain vision and our senses of smell and taste; others deal with digestion of carbohydrates and the balance of blood-sugar controlling insulin, the absorption of other nutrients, such as vitamin A and the B-complex vitamins, and cell metabolism. It is so important because it is a part of many different chemical catalysts, or enzymes. It is also one of our most important antioxidants, as part of the major antioxidant enzyme, super-oxide dismutase (SOD), and protects cells from the damage caused by oxidising fats.

Nature’s Best has led the way by making high-quality zinc supplements available. The first manufacturer to offer an inexpensive and reliable taste-testing kit, Nature’s Best has also been quick to use new technology to make available new forms of zinc supplements. A breakthrough that is still popular, not just in winter, is the convenient, orange-flavoured Zinc-Plus Lozenge.

I have also noticed with vitiligo sufferers, especially in the Asian community, that many are often very thirsty. It is quite possible that the liver also plays a small part in this condition, and the body reacts as if it does not have enough fluids. First the secretions of the glands are reduced and saliva dries up, indications that the level of body fluids is too low. Body fluids provide the internal environment for the billions of body cells which constitute up to 55 or 60 per cent of total body weight. In addition to serving as the fluid conveyor of nutrients, body fluids are used as a route for removal of waste. The intake of water, to maintain balance, should equal the output. Fluid intake takes place from all kinds of food and drink: loss of fluid includes a fixed loss through the lungs, perspiration and a variable loss through the kidneys. Extra-cellular fluid, or that outside of the cells, makes up 35 per cent of the total. All extra-cellular fluids are nearly identical in type and concentration, but differ in protein concentration. Sodium and chloride are the primary extracellular electrolytes, while protein concentration is highest in plasma compartments. Intra-cellular fluid contains more protein than extra-cellular fluid and contains potassium and phosphate as primary electrolytes.

Electrolytes are electrically charged particles, ions that conduct electricity. Amino acids act as transporters to conduct these charged particles through membranes. Electrolytes are needed in order to establish osmosis (which is the movement between cell walls from areas of high to low density, the balancing nutrients), as components in buffer systems and in the acceptability in all cells of membrane potentials. The principal electrolytes with a positive charge are sodium, potassium, calcium and magnesium. Electrolytes with a negative charge are chloride, phosphate, sulphate and bicarbonate.

I have described the behaviour of fluids and the body balance in detail in order to demonstrate that fluids are essential for purification of the system and, ultimately, the skin. Better balance here often causes vitiligo to reduce or even disappear. It was very satisfying to notice a steady improvement in the condition of the gentleman I mentioned earlier. I have treated quite a number of vitiligo patients, some with good results and others with no change at all. There is certainly no easy treatment; for instance I have discovered that it cannot be cured by sunshine. However, drinking ginseng and chamomile tea sometimes helps and I usually advise that the patient does so three times daily. Dietary instructions are to avoid acid-containing foods, e.g. pork, sweet foods, coffee, tea, and chocolate. Whether these foods are detrimental to the development of vitiligo is not certain, but I am in no doubt that they will definitely not help to overcome this embarrassing skin condition.

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Thrush is a yeast infection of the mouth caused by the fungus Candida albicans. The symptoms are white patches in the mouth, along the gums, on the inside of the cheeks, or on the tongue. Thrush is a common medical condition that also occurs in people who do not have HIV infection, most frequently in people using antibiotics or cortisone, and in diabetics. Thrush virtually never occurs without some underlying medical problem. It is also one of the infections people with HIV infection most frequently develop: about 80 percent of those with HIV infection have thrush at some time.

If thrush is associated only with HIV infection—that is, if thrush is not associated with diabetes, or with taking such drugs as antibiotics or corticosteroids—it indicates a high probability that the person will develop AIDS within the next two or three years. In fact, when thrush patches extend to the esophagus, the diagnosis of AIDS is considered established.

Thrush is easily treated with a variety of medicines and is generally controlled after one or two weeks of treatment. It does, however, tend to recur when the drugs are stopped, so these drugs are often given in prolonged courses, initially to control the infection and then to prevent its recurrence. If any one of the drugs for thrush fails, another drug will usually control the infection.

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1. By glucose measurement in plasma.

2. Administration of 50g oral glucose load between the 24th and 28th week, without regard to time of day or time of last meal to all pregnant women who have not been identified before the 24th week as having glucose intolerance.

3. Venous plasma glucose measured 1 hour later.

4. A glucose value of 140 mg% (7.8 mmol/L) in venous plasma indicates the need for a full diagnostic glucose tolerance test.

1. Administration of 100 g oral glucose load in the morning after overnight fast of at least 8 hours but not more than 14 hours and after at least 3 days of unrestricted diet (>150 g of carbohydrate) and physical activity.

2. Plasma glucose is measured fasting and at 1,2 and 3 hours after the oral glucose load (subject should remain seated and should not smoke throughout the test).

Diagnostic Criteria for Gestational Diabetes Mellitus :

Two or more of the following venous plasma glucose concentrations must be met or exceeded for a positive diagnosis:

Fasting     105 mg% (5.8 mmol/L)

1 hour     190mg%( 10.6 mmol/L)

2 hour     165mg%(9.2mmol/L)

3 hour     145 mg% (8.1 mmol/L)

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