Here are some steps and suggestions that should take the tension out of toilet training for both you and your child:

1. Keep a sense of humour. This is one of the most important things to remember, not only for toilet training but for parenting in general.

2. Stay relaxed and remember that it should be no big deal — the more of an ‘issue’ it becomes, the greater the manipulative power the child has over you, and the greater the chance of hassles and disappointment on both sides.

3. Wait until you and your child are both ready. For you, the parents, this means when you are logistically and psychologically ready and prepared to be committed to it, not when someone else tells you ‘It’s about time’. For example, it is not a good time to start when the bathroom is being renovated, or the family is going on a camping holiday, or you bring a new baby home.

For the child, this means not starting before about 18 months to 2 years of age — children are simply not ready physically and neurologically before this time, no matter what stories are told of youngsters being trained before their first birthday. Parents can often see clues that the child is ready. He may object to his nappy being dirty, or begin to take an interest in the parents’ or older siblings’ use of the toilet. He may begin to develop an awareness that a bowel movement is coming, sometimes revealed by his facial expression, or by his becoming very quiet, or going to a corner or another room.

4. Allow him to follow you into the toilet, and explain to him/her what you are doing. Create an interest for the child in the idea of going to the toilet.

5. Buy the child a potty chair or potty, and allow him to help in choosing it, making it very clear that it belongs to him, but downplaying at this stage any expectations that he should begin to use it immediately. A potty chair seems preferable to a special child’s toilet seat. The child is able to sit on it without the parents’ assistance, and the sitting position, with the child’s legs resting on the floor, is a better physical position for the child to open his bowels.

6. Put the potty near or next to the toilet and encourage the child to sit on it, initially fully clothed. Allow the child to sit on the potty at any time, but it is a good idea to make a point of the child accompanying a parent to the toilet and sitting on the potty while the parent sits on the toilet. Praise the child for sitting on the potty, but do not make a fuss if the child does not want to do it, or only does it occasionally, or only sits momentarily.

7. At some stage — the exact timing will vary with the child, and indeed the child may even suggest it — sit the child on the potty with his nappy off. You may wish to time this when it is likely that the child may have a bowel action. This is easier to predict in those children who are regular and predictable. After a meal is sometimes a good time to suggest it, or when the child indicates through his behaviour that a bowel movement is coming.

Again, do this with no expectations, and in a very low key and relaxed way. If the child resists it, or does it only intermittently, that is fine. Allow your child to dictate the pace.

*124\90\8*

One approach is simply to have treatment directed at the symptoms. For example, antacid for indigestion, painkillers for headaches, or sleeping pills for sleeplessness. Another is to reduce your nervous tension by taking sedatives, or anti-depressants, or by learning relaxation techniques, mediation, yoga and so on.

However, I think that the best way to get rid of any physical or mental symptoms of nervous tension is to tackle the cause directly. Stop trying to hide or deny your feelings of sadness, anger, or fear. When you try to force these natural feelings underground they are more likely to express themselves in the form of some unpleasant symptoms. So try to let them out — talk about them and allow yourself to feel them. You may be able to do this with family, friends, your practitioner, a nurse, a priest, social worker, psychologist, or psychiatrist. Choose one or more of these people that you trust and feel comfortable with.

Any or all of these approaches may reduce your discomfort and help you to take and keep control of your life. Don’t let your need to appear tough and able to cope with anything prevent you from seeking relief of all your symptoms, whatever their cause.

We’ll now go on to look at some of the symptoms you could experience and what you can do about them.

*162/40/1*

Promiscuous homosexual men must alter their lifestyles so as to reduce the risk.

Anal sex, whether male-to-male or male-to-female may be associated with an increased risk of AIDS. This may be so, not only from direct spread of the virus through the semen but also because this sexual practice may impair the body’s immunity. This may occur through injury to the bowel wall allowing sperm to enter the blood stream and produce antibodies which may interfere with immunity against disease. By wearing a condom for anal sex this may greatly reduce the risk of spreading AIDS, and also the other sexually transmitted diseases such as syphilis and gonorrhoea.

There is virtually no risk to the general public who do not belong to one of the high-risk groups. The widespread alarm in the community and in specific groups appears to be unwarranted.

The number of cases of AIDS is doubling every six months in the U.S. and no doubt the same will apply here. This is a great worry for those in the high-risk groups and also for the public health bodies. It is NOT a problem for the average person.

*604/71/1*

Let’s have a look at some of the good points. It depends on what you do, how often and for how long. Stretching exercises make the body flexible and are a necessary preliminary to any sustained effort, if muscle and ligament strain is to be avoided.

But be careful of flexing exercises such as touching your toes. They may play havoc with your back, particularly if you are beyond 35 and have done little exercise for some years. You can easily damage the spinal discs.

When you bend or lift, please bend your knees. You can damage your back bending over in the shower to pick up the soap. Bend your knees.

Weightlifting increases muscle mass but it does little to improve the efficiency of your heart and lungs. Isometric exercises are also useful in increasing the strength and efficiency of muscles. They do little for the heart.

Long, slow, sustained exercise is what makes the heart and lungs work and what builds up cardiopulmonary fitness.

*347/71/1*

There is now a variety of tests to determine if the baby has developed enough to be able to cope with life outside the womb. Ultrasound can measure the baby’s size. A hormone excreted in the mother’s urine — oestriol — can be measured and is related to the function of the placenta or afterbirth. Prior to delivery, an amniocentesis — removing some of the fluid surrounding the baby — can be used to measure substances in the fluid to check whether the foetal lungs are fully developed.

But what do women think? Many feel cheated that they are not awake when their babies are born. Few hospitals will allow the father to be present at a caesarean birth.

One way to overcome this is for the operation to be done under a local or regional anaesthetic. Caudal or spinal anaesthetics are increasingly used to reduce the pain of childbirth or to allow forceps procedures to be carried out.

This form of anaesthetic is a skilled procedure and not all anaesthetists are sufficiently skilled to use it routinely. If the anaesthetic is being used and a decision to do a caesar is made, the operation can be done by this means. But under emergency conditions, there may not be time to induce anaesthesia this way.

*97/71/1*

Thus practitioners do not weigh cost against benefit when recommending treatments. They barely consider cost. The only benefits they usually believe to be important are those to do with size of tumours and length of life.

Like many fathers, doctors are used to being in a position of power and authority. They want their patients (children) to be obedient and submissive. They are used to telling patients what to do and they are used to patients meekly obeying their instructions. To share basic information and explain and justify their own decisions would be to weaken their power and to undermine their authority. Patients who ask questions are often treated like naughty and rebellious children. How do fathers deal with children who threaten their authority? They get angry. Or they act as though they are too busy and/or important to bother with answering such silly questions. Or they simply ignore the questions. Or they answer using words that are beyond the child’s understanding, hoping to embarass them out of asking any more questions. Or they dismiss the questions with a fatherly pat on the shoulder and a patronising statement such as: ‘Just leave it all to me’ or Til take care of you’ or ‘I know what’s best for you’. Do you recognise these tactics? Many doctors use them to establish and maintain a paternalistic type of control over their patients.

Don’t let your doctor treat you like this. You are a responsible adult and you deserve to be treated like one. It is your cancer, your comfort and your life that’s at stake. You can make better decisions for yourself than anybody else can. Don’t let anyone bully or cajole you out of your basic right to be in control of what happens to your own body.

*127/40/1*

Scientists have been studying what makes one food high and another low for more than fifteen years. There is a wealth of information that can easily confuse. We have summarised the results of their research in the following table which looks at the factors which influence the G.I. factor of a food.

The key message is that the physical state of the starch in the food is by far the most important factor influencing the G.I. value. That’s why the advances in food processing over the past two hundred years have had such a profound effect on the overall G.I. factor of the food we eat.

The degree of starch gelatinization. The starch in raw food is stored in hard compact granules that make it difficult to digest. This is why potatoes might give you a pain in the stomach if you eat them raw.

Most starchy foods need to be cooked for this reason. During cooking, water and heat expand the starch granules to different degrees, some granules actually bursting and freeing the individual starch molecules. This is what happens when you make a gravy by heating flour and water until the starch granules burst and the gravy thickens.

If most of the starch granules present have swollen and burst during cooking, the starch is said to be fully gelatinised.

The swollen granules and free starch molecules are very easy to digest because the starch-digesting enzymes in the small intestine have a greater surface area to attack. The quick action of the enzymes results in a rapid and high blood sugar rise after consumption of the food (remember that starch is a string of glucose molecules). A food containing starch which is fully gelatinised will therefore have a very high G.I. factor.

In foods such as biscuits, the presence of sugar and fat and very little water, makes starch gelatinisation more difficult, and only about half of the granules will be fully gelatinised. For this reason, biscuits tend to have intermediate G.I. factors.

*78\33\4*

In general, fat is only mobilised significantly during aerobic activity. However, because of the energy deficit produced from periods of anaerobic activity (i.e. oxygen debt) and a lack of glucose in the system, fat may be called in to make up this deficit after the activity. The limitations, therefore, come in the body’s ability to provide oxygen to the working muscles.

There is one further requirement we need to introduce here to understand this fully. Lactic acid is a by-product of anaerobic glycolysis. The build-up of tactic acid develops exponentially with increases in exercise intensity, until a ‘threshold’ is crossed where extended exercise can no longer be continued. This is called the ‘lactate threshold’ or ‘anaerobic threshold’ which is the point at which lactic acid production is greater than its rate of removal (although in reality, this is probably not a well defined cut-off point but a phase). As a result, a build up of lactic acid occurs and this is generally considered to be the limiting factor in performance. In practical terms it is where someone gets so exhausted and ‘out of breath1 that they have to stop what they are doing and allow the oxygen debt to be repaid. The anaerobic (lactate) threshold indicates a point above which fat utilisation becomes negligible.

The amount of fat used during exercise therefore becomes dependent on two things:

(1) the total amount of energy used during physical activity

(2) the proportion of this which is below the anaerobic threshold.

Both, in turn, are dependent on the amount and type of exercise carried out, and the aerobic capacity and anaerobic threshold of the individual concerned.

A confusion in the fitness industry often arises in relating these events. It is often argued, for example, that although the proportion of fat utilisation is lower as a result of high intensity exercise, the total amount of energy used is higher, and therefore the absolute amount of fat burned for a given individual will be greater at high intensity.

Comparing total energy and fat use at 70 per cent VO2 max versus 50 per cent VO2 max (equivalent to moderate intensity exercise) over a set time period. Fat utilisation at 70 per cent VO2, shown on the right hand side of Figure 12.3, is 40 per cent of energy use compared to 50 per cent at 50 per cent vo2. The higher total energy use at 70 per cent over a 30 minute period (i.e. 206kcal v 146kcal at 50 per cent VO2) means that the absolute amount of fat oxidised is greater at 70 per cent VO2 (i.e. 82kcal of fat energy) than at 50 per cent VO2 (73kcal fat energy). This general view has support from some clinical research, although other work suggests greater fat utilisation at lower intensity.

It has thus been suggested that higher intensity exercise (i.e. around 70-80 per cent of VO2 max) will always result in greater absolute fat use (even though this type of activity is both de-motivational and potentially dangerous for fat people!) However, this ignores the fact that fat metabolism is related to aerobic fitness and is therefore a graded function of aerobic capacity, which in turn is inversely correlated with body fat levels. The theoretical differences in oxidative capacity at the same levels of relative exercise intensity for an unfit versus a fit individual. It can be seen from this that as the relative intensity of exercise increases, the ability to oxidise fat decreases at a much greater rate in the unfit than the fit individual. Hence, exercise at low-moderate relative intensities is more likely to provide greater absolute fat utilisation for the fat, unfit person than exercise at a higher intensity. The cut-off point is not definitively known and needs to be more closely researched, but there are indications that exercise at around 40-65 per cent VO2 max is optimal in these people.

Again of interest is the finding that fat oxidation plateaus early for the unfit, but continues to increase over time for the fit. The difference in fat utilisation appears to be not so much in release of fat from the fat cells, as demonstrated by the increase in fatty acids in the blood, but in the uptake and combustion of fat by the muscle tissue itself. It seems that fit muscle has a greater supply and is able to ‘soak up’ intra-muscular fat stores more readily than unfit muscle.

The association between fitness and fatness is not a direct one. It is possible, of course, for two individuals of the same aerobic capacity to have different levels of body fat and this seems to be determined by a number of factors, in particular, genetics and gender. In general though, it’s reasonable to suggest that a fat person is likely to be at the lower end of the aerobic fitness scale.

*141\186\4*

There are still large sections of Western populations who are classified as totally sedentary or inactive, i.e. they don’t do any regular physical activity in their leisure time. It’s quite likely that a large proportion of these people also make up that section of the population regarded as overweight or obese. They are unlikely to spring from their lounge chairs into an aerobics class, even though they may wish to decrease their own creeping corpulence. To them, fitness is anathema. They’d like to be less fat, and possibly more healthy in the process, but they have no real desire to break world records, or be highly ranked among the triathlon set. And they don’t want to miss out on too many of life’s little luxuries to get rid of their excess body fat.

There’s another reason why fitness and fatness are less correlated than thought in the past. Much of the traditional nutrition and exercise advice for increasing fitness is now no longer regarded as appropriate for fat loss. This knowledge has come about through research in the area of exercise physiology, down to the microcellular level, particularly since the early 1980s. The same has not yet happened in the body fat area and scientific knowledge on fat physiology is only just starting to accumulate.

*2\186\4*

There are 21,708 people in the Soviet Union who are over 100 years old, according to the 1959 census. And there are quite a few who have reached the respectable age of 150 and over.

Some years ago the famed Russian scientist, biologist and experimental botanist, Dr. Nicolai Tsitsin, was engaged in research on longevity. The aim of his inquiry was to find out ways of prolonging human life.

“We decided to send letters to 200 people claiming to be over 100 years old with the request to answer the following three questions: what was their age, how had they earned their living most of their lives, and what had been their principle food.”

Dr. Tsitsin received 150 replies to his 200 letters.

“We made a very interesting discovery. The answers showed that a large number of them were bee-keepers. And all of them, without exception, said that their principal food always had been honey!”

But as sensational as this discovery was, this was not all!

“We found,” continued Dr. Tsitsin, “that in each case it wasn’t really honey these people ate, but the waste matter in the bottom of the beehive. They were poor and they sold all the pure honey on the market, and kept only the dirty residue for themselves.”

After a series of laboratory experiments and tests, Dr. Tsitsin discovered that the “dirty residue” of the honey scrap was neither dirt nor honey, but almost pure pollen, which falls off the bees’ legs while they deposit their honey. Tsitsin was on the verge of a great nutritional discovery!

*116\58\2*

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