Scientists writing in The New England Journal of Medicine, The Lancet, The Journal of Clinical Investigation, and many other journals have reported a physiological dysfunction that leads to overweight in many people. This dysfunction results in the wrong amount of insulin in the blood. Although overweight may be caused by a number of different disorders, an insulin imbalance appears to be very important to understanding some of the underlying mechanisms involved in many people who are overweight.
In order to understand what goes wrong in the carbohydrate addict, it is important to know what happens in someone who is not a carbohydrate addict.
If carbohydrate consumption continues for a prolonged period of time, additional insulin is released. Again, the amount of insulin is appropriate to what is needed, in proportion to the amount of carbohydrates eaten at that particular time. When a normal person consumes carbohydrates, his or her body releases insulin within a few minutes of eating. The amount of insulin released is based upon what that person has eaten in previous meals. When the system is functioning normally, just enough insulin is released to help deliver the carbohydrate energy (in the form of the blood sugar glucose) to the liver and to muscle or fat cells throughout the body.
As the cells take in the glucose, the level of insulin in the blood drops. The drop in insulin also results in the release of a brain chemical called serotonin. The presence of serotonin produces a feeling of satisfaction.
Insulin is sometimes called the hunger hormone because it stimulates people to eat. When insulin is released in normal people minutes after they start eating, it may cause them to feel hungrier than they thought they were when they started eating. But upon completing their meal they feel satisfied—their insulin level drops and their brains get the signal to stop eating.
Hours later, after the body has used some of the glucose that remains in the blood, the insulin-to-glucose ratio in blood changes. It appears that this increase signals the body to eat again. We recognize this signal as the sensation of hunger. The normal person then eats, and the whole process begins again.
The balance of carbohydrates and insulin is a delicate one—and it can malfunction. Within a few minutes of eating carbohydrates, in fact, the carbohydrate addict’s body releases far more insulin than is necessary. If the carbohydrate addict has recently consumed another serving of carbohydrates, the amount of insulin that is released will be greater still. The overabundance of insulin “insults” the cells that should be taking up the carbohydrate energy (glucose), interfering with the normal absorption of glucose.
An excess of insulin remains in the bloodstream. As insulin levels fail to drop, the brain levels of the chemical serotonin fail to rise, and the carbohydrate addict may not feel satisfied. Some carbohydrate addicts report that they do feel satisfied after eating, others that they find that they again feel like eating within two hours or so. And if the carbohydrate addict attempts to satisfy his or her hunger by again consuming carbohydrates, the insulin release that follows will be even greater and the sense of satisfaction even less.
The repetition of this cycle appears to form the physical basis of what we call carbohydrate addiction.
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Yes. We think a little common sense goes a long way. The most common problems for children with epilepsy are the paternalism of the physician and of society and overprotection by families. Sports are an excellent way for your child to develop skills and self-confidence. These skills will be useful in adult life, whether or not the seizures are cured or controlled. Children with epilepsy have enough problems without being made to feel different because of the overprotectiveness of others who fear another seizure.
We are far more permissive than many physicians. You or your doctor may put more restrictions on what your child can do, with or without epilepsy. The risks of participation in a particular sport will vary with your child and his seizures. The benefits of a particular sport also vary with the child. Participation in a sport like football may or may not be very important to your child. You and your child will have to weigh both the risks and the benefits of participation. Your physician may be a good advisor.
Sports, particularly competitive sports, are about participation, about being a member of a team. They’re about trying to be the best at something. They’re about self-esteem. Sports seem to be good for most children; perhaps they are even more important for the child with epilepsy.
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Uterine sarcomas are rare malignant tumours of the muscular wall of the womb. As in endometrial cancer, total abdominal hysterectomy and removal of both tubes and ovaries (‘bilateral salpingo-oophorectomy’) is the common treatment. In some circumstances, lymph glands will also be removed to determine whether the cancer has spread.
Since the most common type of sarcoma – the ‘leiomyosarcoma’ – is usually found in association with fibroids, then it is not unusual for the diagnosis of this cancer to occur as an incidental finding following removal of the uterus because of abnormal bleeding due to uterine fibroids.
Under these circumstances, the ovaries are usually left because spread of sarcomas to the ovaries is very rare. In some cases, the ovaries have to be removed such as when an ‘endometrial stromal sarcoma’ is diagnosed since this sort of cancer may be hormone dependent.
There is increasing evidence that the addition of radiation to the pelvis in women with uterine sarcomas reduces the risk of recurrence in the pelvis. Because these cancers are rare, there has been no study comparing women who have been given radiation and those who have not. But studies of women who have been given radiation have shown that compared to other previous patient case histories, there is a reduction in local recurrence.

Survival Rates
The cure of cancer depends on many factors but the most important single factor influencing outcome relates to how far the cancer has spread at the time of diagnosis . . . ‘the stage’ or extent of the spread that the cancer is at.
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