What is peripheral neuropathy?

An estimated 20 million people in the United States have some form of peripheral neuropathy, a condition that develops as a result of damage to the peripheral nervous system — the vast communications network that transmits information between the central nervous system (the brain and spinal cord) and every other part of the body. (Neuropathy means nerve disease or damage.) Symptoms can range from numbness or tingling, to pricking sensations (paresthesia), or muscle weakness. Areas of the body may become abnormally sensitive leading to an exaggeratedly intense or distorted experience of touch (allodynia). In such cases, pain may occur in response to a stimulus that does not normally provoke pain. Severe symptoms may include burning pain (especially at night), muscle wasting, paralysis, or organ or gland dysfunction. Damage to nerves that supply internal organs may impair digestion, sweating, sexual function, and urination. In the most extreme cases, breathing may become difficult, or organ failure may occur.

Peripheral nerves send sensory information back to the brain and spinal cord, such as a message that the feet are cold. Peripheral nerves also carry signals from the brain and spinal cord to the muscles to generate movement. Damage to the peripheral nervous system interferes with these vital connections. Like static on a telephone line, peripheral neuropathy distorts and sometimes interrupts messages between the brain and spinal cord and the rest of the body.

Peripheral neuropathies can present in a variety of forms and follow different patterns. Symptoms may be experienced over a period of days, weeks, or years. They can be acute or chronic. In acute neuropathies such as Guillain-Barré syndrome (in which the body’s immune system attacks part of the peripheral nervous system and impairs sending and receiving nerve signals), symptoms appear suddenly, progress rapidly, and resolve slowly as damaged nerves heal. In chronic forms, symptoms begin subtly and progress slowly. Some people may have periods of relief followed by relapse. Others may reach a plateau stage where symptoms stay the same for many months or years. Many chronic neuropathies worsen over time. Although neuropathy may be painful and potentially debilitating, very few forms are fatal.

In diabetic neuropathy, one of the most common forms of peripheral neuropathy, nerve damage occurs in an ascending pattern. The first nerve fibers to malfunction are the ones that travel the furthest from the brain and the spinal cord. Pain and numbness often are felt symmetrically in both feet followed by a gradual progression up both legs. Later, the fingers, hands, and arms may become affected.

How are the peripheral neuropathies classified?

More than 100 types of peripheral neuropathy have been identified, each with its own symptoms and prognosis. In general, peripheral neuropathies are classified according to the type of damage to the nerves. Some forms of neuropathy involve damage to only one nerve and are called mononeuropathies. More frequently however, multiple nerves are affected, called polyneuropathy.

Some peripheral neuropathies are due to damage to the axons (the long, threadlike portion of the nerve cell), while others are due to damage to the myelin sheath, the fatty protein that coats and insulates the axon. Peripheral neuropathies may also be caused by a combination of both axonal damage and demyelination. Electrodiagnostic studies can help healthcare providers determine the type of damage involved.

What are the symptoms of peripheral nerve damage?

Symptoms vary depending on whether motor, sensory, or autonomic nerves are damaged. Motor nerves control voluntary movement of muscles such as those used for walking, grasping things, or talking. Sensory nerves transmit information such as the feeling of a light touch or the pain from a cut. Autonomic nerves control organ activities that are regulated automatically such as breathing, digesting food, and heart and gland functions. Some neuropathies may affect all three types of nerves; others primarily affect one or two types. Doctors may use terms such as predominantly motor neuropathy, predominantly sensory neuropathy, sensory-motor neuropathy, or autonomic neuropathy to describe the types of nerves involved in an individual’s condition.

Motor nerve damage is most commonly associated with muscle weakness. Other symptoms may include painful cramps and fasciculations (uncontrolled muscle twitching visible under the skin), muscle atrophy (severe shrinkage of muscle size), and decreased reflexes.

Sensory nerve damage causes a variety of symptoms because sensory nerves have a broad range of functions. Larger sensory fibers enclosed in myelin register vibration, light touch, and position sense. Damage to large sensory fibers impairs touch, resulting in a general decrease in sensation. Since this is felt most in the hands and feet, people may feel as if they are wearing gloves and stockings even when they are not. This damage to larger sensory fibers may contribute to the loss of reflexes. Loss of position sense often makes people unable to coordinate complex movements like walking or fastening buttons, or to maintain their balance when their eyes are shut.

Smaller sensory fibers without myelin sheaths transmit pain and temperature sensations. Damage to these fibers can interfere with the ability to feel pain or changes in temperature. People may fail to sense that they have been injured from a cut or that a wound is becoming infected. Others may not detect pain that warns of impending heart attack or other acute conditions. Loss of pain sensation is a particularly serious problem for people with diabetes, contributing to the high rate of lower limb amputations among this population.

Neuropathic pain is a common, often difficult to control symptom of sensory nerve damage and can seriously affect emotional well-being and overall quality of life. Often worse at night, neuropathic pain seriously disrupts sleep and adds to the emotional burden of sensory nerve damage. Neuropathic pain can often be associated with an oversensitization of pain receptors in the skin, so that people feel severe pain (allodynia) from stimuli that are normally painless. For example, some may experience pain from bed sheets draped lightly over the body. Over many years, sensory neuropathy may lead to changes in the skin, hair, as well as to joint and bone damage. Unrecognized injuries due to poor sensation contribute to these changes, so it is important for people with neuropathy to inspect numb areas for injury or damage.

Autonomic nerve damage symptoms are diverse since the parasympathetic and sympathetic nerves of the peripheral nervous system control nearly every organ in the body. Common symptoms of autonomic nerve damage include an inability to sweat normally, which may lead to heat intolerance; a loss of bladder control; and an inability to control muscles that expand or contract blood vessels to regulate blood pressure. A drop in blood pressure when a person moves suddenly from a seated to a standing position (a condition known as postural or orthostatic hypotension) may result in dizziness, lightheadedness, or fainting. Irregular heartbeats may also occur.

Gastrointestinal symptoms may accompany autonomic neuropathy. Malfunction of nerves controlling intestinal muscle contractions can lead to diarrhea, constipation, or incontinence. Many people also have problems eating or swallowing if autonomic nerves controlling these functions are affected.

What causes peripheral neuropathy?

Peripheral neuropathy may be either inherited or acquired through disease processes or trauma. In many cases, however, a specific cause cannot be identified. Doctors usually refer to neuropathies with no known cause as idiopathic.

Causes of acquired peripheral neuropathy include:

Physical injury (trauma) is the most common cause of acquired nerve injury.

• Injury or sudden trauma, such as from automobile accidents, falls, sports-related activities, and surgical procedures can cause nerves to be partially or completely severed, crushed, compressed, or stretched, sometimes so forcefully that they are partially or completely detached from the spinal cord. Less severe traumas also can cause serious nerve damage. Broken or dislocated bones can exert damaging pressure on neighboring nerves.

• Repetitive stress frequently leads to entrapment neuropathies, a form of compression injury. Cumulative damage can result from repetitive, awkward, and/or forceful activities that require movement of any group of joints for prolonged periods. The resulting irritation may cause ligaments, tendons, and muscles to become inflamed and swollen, constricting the narrow passageways through which some nerves pass. Ulnar neuropathy and carpal tunnel syndrome are examples of the most common types of neuropathy from trapped or compressed nerves at the elbow or wrist.

Diseases or disorders and their related processes (such as inflammation) can be associated with peripheral neuropathy.

• Metabolic and endocrine disorders impair the body’s ability to transform nutrients into energy and process waste products, and this can lead to nerve damage. Diabetes mellitus, characterized by chronically high blood glucose levels, is a leading cause of peripheral neuropathy in the United States. About 60 percent to 70 percent of people with diabetes have mild to severe forms of nervous system damage that can affect sensory, motor, and autonomic nerves and present with varied symptoms. Some metabolic liver diseases also lead to neuropathies as a result of chemical imbalances. Endocrine disorders that lead to hormonal imbalances can disturb normal metabolic processes and cause neuropathies. For example, an underproduction of thyroid hormones slows metabolism, leading to fluid retention and swollen tissues that can exert pressure on peripheral nerves. Overproduction of growth hormone can lead to acromegaly, a condition characterized by the abnormal enlargement of many parts of the skeleton, including the joints. Nerves running through these affected joints often become entrapped, causing pain.

• Small vessel disease can decrease oxygen supply to the peripheral nerves and lead to serious nerve tissue damage. Diabetes frequently leads to impaired blood flow to nerves. Various forms of vasculitis (blood vessel inflammation) frequently cause vessel walls to harden, thicken, and develop scar tissue, decreasing their diameter and impeding blood flow. Vasculitis is an example of nerve damage called mononeuritis multiplex or multifocal mononeuropathy, in which isolated nerves in two or more areas are damaged.

• Autoimmune diseases, in which the immune system attacks the body’s own tissues, can lead to nerve damage. Sjogren’s syndrome, lupus, and rheumatoid arthritis are among the autoimmune diseases that can be associated with peripheral neuropathy. When the tissue surrounding nerves becomes inflamed, the inflammation can spread directly into nerve fibers. Over time, these chronic autoimmune conditions can destroy joints, organs, and connective tissues, making nerve fibers more vulnerable to compression injuries and entrapment. Chronic conditions may alternate between remission and relapse. Acute inflammatory demyelinating neuropathy, better known as Guillain- Barré syndrome, can damage motor, sensory, and autonomic nerve fibers. Most people recover from this autoimmune syndrome although severe cases can be life threatening. Chronic inflammatory demyelinating polyneuropathy (CIDP) usually damages sensory and motor nerves, leaving autonomic nerves intact. Multifocal motor neuropathy is a form of inflammatory neuropathy that affects motor nerves exclusively. It may be chronic or acute.

• Kidney disorders may cause neuropathies. Kidney dysfunction can lead to abnormally high amounts of toxic substances in the blood that can damage nerve tissue. A majority of indviduals who require dialysis because of kidney failure develop polyneuropathy.

• Cancers can infiltrate nerve fibers or exert damaging compression forces on nerve fibers. Tumors also can arise directly from nerve tissue cells. Paraneoplastic syndromes, a group of rare degenerative disorders that are triggered by a person’s immune system response to a cancerous tumor, also can indirectly cause widespread nerve damage. Toxicity from the chemotherapeutic agents and radiation used to treat cancer also can cause peripheral neuropathy. An estimated 30 to 40 percent of people who undergo chemotherapy develop peripheral neuropathy and it is a leading reason why people with cancer stop chemotherapy early. The severity of chemotherapyinduced peripheral neuropathy (CIPN) varies from person to person. In some cases people may be able to ease their symptoms by lowering their chemotherapy dose or by stopping it temporarily. In others, CIPN may persist long after stopping chemotherapy.

• Neuromas are benign tumors that are caused by an overgrowth of nerve tissue that develops after a penetrating injury that severs nerve fibers. Neuromas are often associated with intense pain and sometimes they engulf neighboring nerves, leading to further damage and even greater pain. Neuroma formation can be one element of a more widespread neuropathic pain condition called complex regional pain syndrome or reflex sympathetic dystrophy syndrome, which can be caused by traumatic injuries or surgical trauma. Widespread polyneuropathy is often associated with neurofibromatosis, a genetic disorder in which multiple benign tumors grow on nerve tissue.

• Infections can cause peripheral neuropathy. Viruses and bacteria that can attack nerve tissues include herpes varicellazoster (shingles), Epstein-Barr virus, West Nile virus, cytomegalovirus, and herpes simplex members of the large family of human herpes viruses. These viruses can severely damage sensory nerves, causing attacks of sharp, lightning-like pain. Postherpetic neuralgia is long-lasting, particularly intense pain that often occurs after an attack of shingles. Lyme disease, diphtheria, and leprosy are bacterial diseases characterized by extensive peripheral nerve damage. Diphtheria and leprosy are rare in the United States, but the incidence of Lyme disease is on the rise. 

 
The tick-borne infection can involve a wide range of neuropathic disorders, including a rapidly developing, painful polyneuropathy, often within a few weeks of being infected. West Nile virus is spread by mosquitoes and is associated with a severe motor neuropathy. The inflammation triggered by infection sometimes results in various forms of inflammatory neuropathies that develop quickly or slowly.

The human immunodeficiency virus (HIV) that causes AIDS is associated with several different forms of neuropathy, depending on the nerves affected and the specific stage of active immunodeficiency disease. A rapidly progressive, painful polyneuropathy affecting the feet and hands can be the first clinically apparent symptom of HIV infection. An estimated 30 percent of people who are HIV positive develop peripheral neuropathy; 20 percent develop distal neuropathic pain.

Exposure to toxins may damage nerves and cause peripheral neuropathy.

• Medication toxicity can be caused by many agents in addition to those for fighting cancer. Other agents that commonly cause peripheral neuropathy as a side effect include those used to fight infection such as antiretroviral agents for treating HIV. In addition, anticonvulsant agents and some heart and blood pressure medications can commonly cause peripheral neuropathy. In most cases, the neuropathy resolves when these medications are discontinued or dosages are adjusted.

• Environmental or industrial toxins such as lead, mercury, and arsenic can cause peripheral neuropathy. In addition, certain insecticides and solvents have also been known to cause neuropathies.
• Heavy alcohol consumption is a common cause of peripheral neuropathy. Damage to the nerves associated with long-term alcohol abuse may not be reversible when a person stops drinking alcohol, however, doing so may provide some symptom relief and prevent further damage. Chronic alcohol abuse also frequently leads to nutritional deficiencies (including B12, thiamine, and folate) that contribute to the development of peripheral neuropathy.

Genetic mutations can either be inherited or arise de novo, meaning they are completely new mutations to an individual and are not passed along by either parent. Some genetic mutations lead to mild neuropathies with symptoms that begin in early adulthood and result in little, if any, significant impairment. More severe hereditary neuropathies often appear in infancy or childhood.

Advances in genetic testing in the last decade have led to significant strides in the ability to identify the genetic causes underlying peripheral neuropathies. For example, several genes have been found to play a role in different types of Charcot-Marie-Tooth, a group of disorders that are among the most common forms of inherited peripheral neuropathies. These neuropathies result from mutations in genes responsible for maintaining the health of the myelin sheath as well as the axons themselves. Key characteristics of Charcot- Marie-Tooth disorders include extreme weakening and wasting of muscles in the lower legs and feet, gait abnormalities, loss of tendon reflexes, and numbness in the lower limbs.

How is peripheral neuropathy diagnosed?

The symptoms of peripheral neuropathy are highly variable. A thorough neurological examination is required to sort out the cause of the symptoms and involves taking an extensive medical history (covering symptoms, work environment, social habits, exposure to toxins, alcohol use, risk of HIV or other infectious diseases, and family history of neurological diseases). In addition, tests are usually performed to identify the cause of the neuropathy as well as the extent and type of nerve damage.

A physical examination and various tests may reveal the presence of a systemic disease causing the nerve damage. Tests of muscle strength, as well as evidence of cramps or fasciculations, indicate motor fiber involvement. Evaluation of the person’s ability to sense vibration, light touch, body position, temperature, and pain reveals any sensory nerve damage and may indicate whether small or large sensory nerve fibers are affected.

Blood tests can detect diabetes, vitamin deficiencies, liver or kidney dysfunction, other metabolic disorders, and signs of abnormal immune system activity. An examination of cerebrospinal fluid that surrounds the brain and spinal cord can reveal abnormal antibodies associated with some immune-mediated neuropathies. More specialized tests may reveal other blood or cardiovascular diseases, connective tissue disorders, or malignancies. Genetic tests are becoming available for a number of the inherited neuropathies.

Based on the results of the neurological exam, physical exam, patient history, and any previous screening or testing, the following additional tests may be ordered to help determine the nature and extent of the neuropathy:

• Nerve conduction velocity (NCV) tests can measure the degree of damage in large nerve fibers, revealing whether symptoms are caused by degeneration of the myelin sheath or the axon. The myelin covering is responsible for the very fast speed of nerve conduction. During this test, a probe electrically stimulates a nerve fiber, which responds by generating its own electrical impulse. An electrode placed further along the nerve’s pathway measures the speed of impulse transmission along the axon. Slow transmission rates and impulse blockage tend to indicate damage to the myelin sheath, while a reduction in the strength of impulses at normal speeds is a sign of axonal degeneration.
• Electromyography (EMG) involves inserting a fine needle into a muscle to record electrical activity when muscles are at rest and when they contract. EMG tests detect abnormal electrical activity in motor neuropathy and can help differentiate between muscle and nerve disorders.

• Magnetic resonance imaging (MRI) can show muscle quality and size, detect fatty replacement of muscle tissue, and can help rule out tumors, herniated discs, or other abnormalities that may be causing the neuropathy.

• Nerve biopsy involves removing and examining a sample of nerve tissue, most often from the lower leg. Although this test can provide valuable information about the degree of nerve damage, it is an invasive procedure that is difficult to perform and may itself cause neuropathic side effects.

• Skin biopsy is a test in which doctors remove a thin skin sample and examine nerve fiber endings. This test offers some unique advantages over NCV tests and nerve biopsy. Unlike NCV, it can reveal damage present in smaller fibers; in contrast to conventional nerve biopsy, skin biopsy is less invasive, has fewer side effects, and is easier to perform.

What treatments are available?

Address underlying conditions

The first step in treating peripheral neuropathy is to address any contributing causes such as infection, toxin exposure, medication-related toxicity, vitamin deficiencies, hormonal deficiencies, autoimmune disorders, or compression that can lead to neuropathy. Peripheral nerves have the ability to regenerate axons, as long as the nerve cell itself has not died, which may lead to functional recovery over time. Correcting an underlying condition often can result in the neuropathy resolving on its own as the nerves recover or regenerate.

The adoption of healthy lifestyle habits such as maintaining optimal weight, avoiding exposure to toxins, exercising, eating a balanced diet, correcting vitamin deficiencies, and limiting or avoiding alcohol consumption can reduce the effects of peripheral neuropathy. Exercise can reduce cramps, improve muscle strength, and prevent muscle wasting. Various dietary strategies can improve gastrointestinal symptoms. Timely treatment of injuries can help prevent permanent damage. Smoking cessation is particularly important because smoking constricts the blood vessels that supply nutrients to the peripheral nerves and can worsen neuropathic symptoms. Self-care skills such as meticulous foot care and careful wound treatment in people with diabetes and others who have an impaired ability to feel pain can alleviate symptoms and improve quality of life. Such changes often create conditions that encourage nerve regeneration.

Systemic diseases frequently require more complex treatments. Strict control of blood glucose levels has been shown to reduce neuropathic symptoms and help people with diabetic neuropathy avoid further nerve damage.

Inflammatory and autoimmune conditions leading to neuropathy can be controlled in several ways. Immunosuppressive drugs such as prednisone, cyclosporine, or azathioprine may be beneficial. Plasmapheresis — a procedure in which blood is removed, cleansed of immune system cells and antibodies, and then returned to the body — can help reduce inflammation or suppress immune system activity. Large intravenously administered doses of immunoglobulins (antibodies that alter the immune system, and agents such as rituximab that target specific inflammatory cells) also can suppress abnormal immune system activity.

Symptom Management

Neuropathic pain, or pain caused by the injury to a nerve or nerves, is often difficult to control. Mild pain may sometimes be alleviated by over-the-counter analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs). More chronic and discomforting pain may need to be addressed through the care of a physician. Medications that are used for chronic neuropathic pain fall under several classes of drugs: antidepressants, anticonvulsant medications, antiarrythmic medications, and narcotic agents. The antidepressant and anticonvulsant medications modulate pain through their mechanism of action on the peripheral nerves, spinal cord, or brain and tend to be the most effective types of medications to control neuropathic pain. Antidepressant medications include tricyclic antidepressants such as amitriptyline or newer serotonin-norepinephrine reuptake inhibitors such as duloxetine hydrochloride or venlafaxine. Anticonvulsant medications that are frequently used include gabapentin, pregabalin, topiramate, and carbamazepine, although other medications used for treating epilepsy may also be useful. Mexiletine is an anti-arrythmic medication that may be used for treatment of chronic painful neuropathies.

For pain that does not respond to the previously described medications, the addition of narcotic agents may be considered. Because the use of prescription obtained pain relievers that contain opioids can lead to dependence and addiction, their use is recommended only after other means of controlling the pain have failed. One of the newest narcotic medications approved for the treatment of diabetic neuropathy is tapentadol, a drug with both opioid activity and norepinephrine-reuptake inhibition activity of an antidepressant.

Topically administered medications are another option for neuropathic pain. Two agents are topical lidocaine, an anesthetic agent, and capsaicin, a substance found in hot peppers that modifies peripheral pain receptors. Topical agents are generally most appropriate for localized chronic pain such as herpes zoster neuralgia (shingles) pain. Their usefulness for treating diffuse chronic diabetic neuropathy is more limited.

Transcutaneous electrical nerve stimulation (TENS) is a non-invasive intervention used for pain relief in a range of conditions, and a number of studies have described its use for neuropathic pain. The therapy involves attaching electrodes to the skin at the site of pain or near associated nerves and then administering a gentle electrical current. Although data from controlled clinical trials are not available to broadly establish its efficacy for peripheral neuropathies, TENS has been shown in some studies to improve peripheral neuropathy symptoms associated with diabetes.

Other complementary approaches may provide additional support and pain relief. For example, mechanical aids such as hand or foot braces can help reduce pain and physical disability by compensating for muscle weakness or alleviating nerve compression. Orthopedic shoes can improve gait disturbances and help prevent foot injuries in people with a loss of pain sensation. Acupuncture, massage, and herbal medications also are considered in the treatment of neuropathic pain.

Surgical intervention can be considered for some types of neuropathies. Injuries to a single nerve caused by focal compression such as at the carpal tunnel of the wrist, or other entrapment neuropathies, may respond well to surgery that releases the nerve from the tissues compressing it. Some surgical procedures reduce pain by destroying the nerve; this approach is appropriate only for pain caused by a single nerve and when other forms of treatment have failed to provide relief. Peripheral neuropathies that involve more diffuse nerve damage, such as diabetic neuropathy, are not amenable to surgical intervention.

What research is being done?

The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. The NINDS is a component of the National Institutes of Health (NIH), the leading supporter of biomedical research in the world.

NINDS-funded research on neuropathy ranges from clinical studies of the genetics and natural history of hereditary neuropathies to basic science investigations of the biological mechanisms responsible for chronic neuropathic pain. Other efforts are focused on understanding how immune system dysfunction contributes to peripheral nerve damage. Together, these diverse research areas will advance the development of new therapeutic and preventive strategies for peripheral neuropathies.

Specific genetic mutations have been identified for some of the known hereditary neuropathies. NINDS therefore supports studies to identify other genetic defects that may play roles in causing or modifying the course of disease. The Inherited Neuropathies Consortium, focused on Charcot-Marie-Tooth neuropathies, seeks to better characterize the natural history of several different forms and to identify genes that modify clinical features in these disorders. Better knowledge of genetic causes may help identify people who are at high risk for developing peripheral neuropathy before symptoms appear. Understanding the role of genetic mutations may also lead to the development of gene therapies that prevent or reduce cumulative nerve damage. In addition, advances from genetics research inform studies to understand disease mechanisms. For example, scientists are using animal models to study how inflammation and nerve damage result from mutations in the Autoimmune Regulator (AIRE) gene, the cause of chronic inflammatory demyelinating polyneuropathy (CIDP) in some people.

Several NINDS-funded studies aim to determine why nerve axons degenerate in different types of peripheral neuropathies. Rapid communication between the peripheral nervous system and the central nervous system depends on myelination, a process through which special cells called Schwann cells create an insulating sheath around axons. Research has shown that Schwann cells play a critical role in the regeneration of nerve cell axons in the peripheral nervous system. By better understanding myelination and Schwann cell function, researchers hope to find targets for new therapies to treat or prevent nerve damage associated with neuropathy.
One promising area of research focuses on a class of molecules called neurotrophic factors. These substances, produced naturally by the body, protect neurons from injury and enhance their survival. Neurotrophic factors also help maintain normal function in mature nerve cells, and some stimulate axon regeneration. Several NINDS-supported studies seek to learn more about the effects of these powerful chemicals on the peripheral nervous system.

Another area of research aims to better understand inflammatory peripheral neuropathies, such as Guillain-Barre syndrome (GBS), in which the body’s immune system attacks peripheral nerves, damaging myelin and impairing signal conduction along affected nerves. NINDS-funded researchers are investigating the mechanisms by which the body’s immune system stops recognizing peripheral nerves as “self” and starts attacking them. GBS is usually preceded by a microbial infection, some as common as food poisoning or the flu, and researchers hypothesize that antibodies generated by the immune system to fight bacteria also attack nervous system proteins. Studies to test this hypothesis may lead to treatments that prevent these antibodies from damaging nerves. As a different strategy, researchers are studying the blood-nerve barrier in inflammatory nervous system disorders and developing ways to reduce the movement of immune cells from the bloodstream into nerve tissue, which may reduce inflammation, demyelination and nerve injury.

Transcranial magnetic stimulation (TMS), which uses a coil either held above or placed on the scalp that delivers electromagnetic pulses to activate electrical currents in general or specific parts of the brain, has shown some analgesic effect in treating various pain conditions. Current studies are examining the effectiveness of TMS in treating peripheral and chronic neuropathies.

In addition to efforts to treat or prevent underlying nerve damage, other NINDSsupported studies are informing new strategies for relieving neuropathic pain. Researchers are investigating the pathways that carry pain signals to the brain and are working to identify substances that will block this signaling.
 

Chapter 11- DYING OF THIRST

Chapter 11- DYING OF THIRST

Clean water for drinking, bathing, and growing food is one of the most precious commodities on the planet. You constantly read in the news about how we're running out of oil and energy—how
these resources can only last another 20-30 years. But the simple fact is, that's 20-30 years longer than we have for water. Already, in many parts of the world, lack of clean water is the biggest problem facing huge numbers of people[1]. Just to hazard a guess, in the next 50 years, more wars will be fought over water than oil.

  Why is water so important? Quite simply, it's essential for life. And the sad fact is...most people just don't get enough. The vast majority of people living in the industrial world (even where
water is abundant) are dehydrated.

      Quantity

   In advanced societies, thinking that tea, coffee, alcohol, soda pop, or other forms of manufactured beverages are desirable substitutes for the purely natural water needs of the daily "stressed" body is a common, but potentially deadly, mistake.[2]

[1 China is currently running a water deficit equivalent to seven times the water usage of the entire state of California.
In the next few years, that deficit will triple. Already, the Yellow River, one of the most important rivers in China, is so low in water that it failed to reach the ocean on 226 days in 1997.]


[2 Batmanghelidj, F., Your Body's Many Cries for Water, Falls Church: Global Health Solutions, Inc., 1995.]

Water is the solvent in our bodies, and as such, it regulates all the functions of our bodies, including the action of all the solids dissolved in the water. In fact, every function of the body is
monitored and pegged to the efficient flow of water. Think for a moment of just a few of the functions that water regulates in our bodies:
>The movement of blood

>The transport of nutrients into our cells

>The movement of waste out of our cells

>The flow of lymph fluid

>The movement of nerve impulses through our nerves

>The movement of hormones throughout our bodies

>The functioning of our brains

   If we were to become dehydrated, all of these functions (and a thousand more) would be impaired. Unfortunately, that's exactly what happens for the vast majority of us. Over time, as we
become increasingly dehydrated, our thirst mechanism gradually fails,[1] which leads to even more dehydration. Symptoms of chronic dehydration include allergies, asthma, chronic pains, constipation, acidosis, dry skin, and the shrinking of internal organs and thinning of skin associated with aging—to name just a few.

   We need to consume between 64 and 96 ounces of pure water a day. Pure, fresh (not bottled or canned) fruit and vegetable juices may be substituted for some of this quantity—as may limited
quantities of non-diuretic herbal teas (without sugar). In general, however, pure water is the key.

     Quality

   When you look at the big picture, state and federal authorities have done a remarkable job in providing "clean" water for the country as a whole. Water-borne epidemics such as cholera are almost unheard of in the United States. On the other hand, acknowledging what has been accomplished does not mean that we should close our eyes to the problems that exist.

  Keep in mind that the MCLs (maximum contamination levels) that water districts so proudly adhere to merely represent a compromise standard designed to be econonomically feasible for water districts to meet. They in no way come close to the safety standards established by the US government's Safe Water Drinking Act.

  On average, drinking water in the United States currently contains over 2,100 toxic chemicals that are known to cause cancer, cell mutation, and nervous disorders. This is not particularly surprising
considering that there are close to 100,000 chemicals now in everyday use—with over 1,000 new ones being added each year. In fact, according to the EPA, US industries generatesome 79 million pounds of toxic waste each year that is not disposed of properly.
What is probably more surprising to most people, though, is the fact that, according to the EPA, 53 million Americans unknowingly drink tap water that is polluted by feces, radiation, or ....

[1 Even when our thirst mechanism is functioning properly, it's not a reliable indicator of dehydration since "thirst" is one of the last symptoms of dehydration to manifest.]

.... other contaminants. Also according to the EPA, some 45 million people drink water contaminated with the parasite cryptosporidium that killed more than 100 people in Milwaukee in 1993. Or that
over half of all Americans drink water that has been used at least once before.[1]

   According to an ABC News Special, US industries generate some 88 million pounds of toxic waste a year, 90% of which the EPA estimates is improperly disposed of, whcih makes its way into our water supplies. With close to 100,000 chemicals now in use and with the introduction of 1,000 new ones each year, it's impossible for treatment plants to keep up. Each year, at least 400,000 cases of illness can be attributed to contaminated water.

   With all due respect for the great job that all of the water departments in all of the states and cities do, you still don't want to be drinking tap water. It may not kill you immediately, but as sure
as the sun rises in the morning, it will compromise your health over time. The bottom line is that you need to drink filtered (or distilled water). Tap water, well water, and bottled water[2] are all suspect.

  Chlorine

  Chlorine is the primary disinfectant used to purify drinking water. Let me make it absolutely clear that I am not advocating eliminating chlorine from the purification process. That would be
stupid. Chlorination controls many water-borne diseases, including typhoid fever, cholera, and dysentery. When chlorination was stopped in Peru, for instance, there was a cholera epidemic of
300,000 cases.

However, it should be understood that:

> Chlorine is one of the most toxic substances known. It does everything from drying your skin and destroying your hair to wiping out the beneficial bacteria in your colon.

> And the byproducts of chlorination (such as chloroform, dichloro acedic acid, and MX), which are found in drinking water, are all proven carcinogens.

> According to the US Council on Environmental Quality, the cancer risk among people drinking chlorinated water is 93% higher than among those whose water does not contain chlorine. There is a higher incidence of cancer of the esophagus, rectum,breast, and larynx and a higher incidence of Hodgkin’s disease among those drinking chlorinated water.

> Chlorine has been strongly implicated as a major factor in the onset of atherosclerosis and its resulting heart attacks and strokes.

> By the same mechanisms that chlorine narrows blood vessels that feed the heart, it also narrows the blood vessels that feed the brain. Consequently, chlorine has been implicated as a major factor in the onset of senility.

[1 You probably shouldn't think about this particular statistic too long if you have any tendency toward a weak stomach.]

[2 Yes, if you're on the road and you're thirsty, picking up some bottled water at a 7-11 is a better alternative than drinking from the water fountain or buying some coffee or soda.]

There's no question but that the use of chlorine in drinking water has helped stopped the spread of many virulent water-borne diseases. On the other hand, there's also no question but that
chlorine in our drinking water presents us with serious long-term health implications. The bottom line on chlorine is that it pretty much needs to remain part of the city water purification  process. That means that you need to remove it from your water at your house.

      Fluoride

  At the risk of being accused of being a Luddite, let's take a look at the use of fluoride in our drinking water.

  Exactly what is water fluoridation? In fact, all water contains some fluoride. Fluoridation is
the process of adjusting the level of fluoride in the water supply to theoretically protect against
tooth decay. This concentration varies from 0.7 to 1.2 parts per million (ppm). While it is true that
"organic" fluoride itself is present naturally in soil, water, plants and many foods,[1] the "industrial"fluoride used in water fluoridation is a toxic waste product.[2]

  Does it work? Now that's a question of more than some debate. There's no question that since fluoridation began, the incidence of dental caries has gone down significantly in the United States.
Score one for water fluoridation! But hold on a second. It's gone down throughout the country—even in states that don't fluoridate their water! In fact, there is no good statistical evidence that fluoride (either in your water or your toothpaste) makes one iota of difference in terms of dental health.[3]  All of the improvement in dental health that we have seen in the United States can easily be attributed to better dental hygiene (brushing and flossing), not fluoridation.

  Which brings us to the key question: Is it safe?

  Well, to be fair, community water fluoridation is supported by the U.S. Public Health Service,[4]the American Dental Association,[5]
 the American Medical Association,[6] the American Heart Association, the American Cancer Society, and the National Academy of Sciences. On the other hand, the devastating, toxic effects of fluoride are well documented by mainstream organizations such as: 

>Numerous articles have appeared in the New England Journal of Medicine and the Journal of the American Medical Association challenging the safety of fluoridation. 

>National Institute of Environmental and Health Sciences has shown that fluoride
causes cancer.

>Scientists at the Environmental Protection Agency have come out against fluoridation because they have confirmed that it does not reduce tooth decay and that there is clear evidence that fluoride causes cancer.

>The Pasteur Institute in France, and the Nobel Institute in Sweden have caused fluoride to be banned in France and Sweden respectively because the health risks from using fluoride far out-way any possible benefit.


>Fluoridation is also banned in Finland, Holland, Chile, and Japan among others.

[1 Tea, for example, is an extremly high source of fluoride (even when made with unfluoridated water).]

[2 American industry loves water fluoridation. Instead of having to pay for the disposal of a toxic waste product, they now get paid by cities by selling them this same toxic waste. It's probably no surprise then that the industries producing fluoride byproducts are some of the biggest proponents (and backers) of water fluoridation.]

[3 In fact, as New Zealand's former chief dental-health officer, Jon Colquhon, a one-time proponent of fluoridation, said, "When any unfluoridated area is compared with a fluoridated area with a similar income level, the percentage of children who are free of dental decay is consistently higher in the unfluoridated area."]

[4 While at the same time, curiously, pushing for a reduction in our daily fluoride intake. Maybe you can explain that to me.]

[5 It's worth noting that the American Dental Association is on the horns of a dilemma. To admit that promoting the use of fluoride was a mistake would open up the floodgates of litigation.]

[6 While at the same time repeatedly publishing articles in their magazine proving the dangers of fluoride. No one ever said this has to make sense.]

Fluoride is a potent toxin[1] that accumulates (about 50% a day for adults and 75% a day for children) in the body. Each exposure stays in your body and adds to the accumulated levels. And that's the key. We are constantly being exposed to high levels of fluoride other than in our water. It is in our toothpaste.[2] It is sprayed on our food.[3] It is present in pharmaceutical drugs ranging from birth control pills to antibiotics. It is in soda pop, which is manufactured from fluoridated water. Once you look at the scope of the problem, you realize that there is no way in the world to determine what your flouride intake is, but it's far higher than is healthy.

  Health problems associated with fluoride include:

>Destruction of the immune system

>Up to a 39% increase in various cancers—with an astounding 80% increase in rectal cancer

>Genetic changes both in sperm and other cells

>Dramatic increase in heart-related deaths

>Brittle bones[4]

>Chronic fatigue

>Gastrointestinal disturbances

[1 Fluoride is used as a pesticide particularly for roaches, ants, and rats.]

[2 Note: fluoride toothpaste can double the level of fluoride in the blood within five minutes of being used—just from the amount absorbed through the cheeks and gums.]

[3 Apples and grapes are particularly high in fluoride for this reason.]

[4 One of the claims for fluoride is that it helps builds bones. That claim is so deliberately misrepresentative of the truth that it borders on the criminal. Yes, while it is true that there are studies that confirm that fluoride builds thicker bones, it is gross misrepresentation to cite those studies without also mentioning that fluoride makes bones more brittle. And, in fact, there are numerous studies that have appeared in the Journal of the American Medical
Association that show a significant increase in hip fractures in areas with fluoridated water. In addition, The New England Journal of Medicine reported that fluoride treatment of osteoporosis patients resulted in higher hip fracture rates.]

>Increase in Infant Mortality

>Skin rashes after bathing

>Miscarriages

>Dizziness

>Vision problems—including blindness

>Not to mention mottled teeth

   Also, it is well established that fluoride is an extremely potent enzyme inhibitor.

  The bottom line is what freakin right does anyone have to force such a potentially toxic substance into your drinking water[1] for no proven benefit.[2]

  Oh yes, I almost forgot, the aluminum/fluoride connection. New research has revealed that fluoride in drinking water makes the aluminum that we ingest more bioavailable. In the presence of fluoride, more aluminum crosses the blood-brain barrier and is deposited in the brain. As was reported in Brain Research, Vol.7 84:98, the combination of aluminum and fluoride causes the
same pathological changes in brain tissue that are found in Alzheimer's patients. Now don't misunderstand, I'm not saying that aluminum/fluoride is the cause of Alzheimer's. That would be premature. All I'm saying is that it might be prudent to limit your exposure until we know more one way or the other. Remember, even O.J. was found innocent in the end.

    Bathing

  As it turns out, it's not enough just to worry about the water you drink. The water you bathe and shower with is equally, if not more, important.

  You absorb more chlorine through your skin in a 15 minute hot shower[3] than you do by drinking 8 glasses of that same water throughout the day. (So much for that nice safe feeling you had drinking only bottled water.)

    Just for fun, stop by your local swimming pool supply store and pick up a chlorine test kit. Fill a glass with some of your local tap water and test it with your kit. The water will change color according to how much chlorine there is in the water. Now fill up another glass with water from the tap. This time, soak your hand in the water for 60 seconds before testing. Notice how the water shows no chlorine. In just 60 seconds you absorbed all of the chlorine in the water into your body through your hand. The absorption factor is that dramatic. (Note: the younger you are, the more absorbent your skin tends to be. And women should take special note; breast tissue is the most absorbent tissue in the body. Soak your breast in the same water, and it will clean out all of the chlorine in just 20 seconds.)

[1 At least with toothpaste, you have a choice to buy a non-fluoride brand]

[2 There are now at least 10 studies that prove as fluoride intake goes up, so does tooth decay!]

[3 Actually, when you shower, you absorb more chlorine through your lungs in the form of vapor (produced by the small droplets of hot water) than you do even through your skin.]

The trick is, if you want to protect your skin (and your body as well), you've got to mount a defense at the surface of the epidermis. Once a substance gets past this tough outer layer of dead skin cells, it generally has a much easier time passing through the living area of the epidermis and then into the body.

     Bioavailability

  Although all water consists of the same basic H20 molecules, water nevertheless varies according to how these molecules bond together to form "water molecule groups." To put it simply,
it is in the size of these groupings that water differs. The smaller the groupings, the more bioavailable the water is—the more easily it is able to pass through cell walls, to circulate through your body as a whole.

   What holds water molecules together in clusters is surface tension. This is what you see when you wash your car and the water beads up in droplets on the hood. When washing your car, you use detergent to break that surface tension—which makes the water wetter and better able to clean. Obviously, you can't use detergent to "improve" the bioavailability of your drinking water.

  But you can use magnetics. Magnetizing your drinking water breaks its surface tension, making it wetter and more useable by your body. In addition, there's a strong secondary benefit. Applying
a magnetic field to water raises its pH. This is of vital importance as we will see in the next chapter.

      General Recommendations

> You need to treat the water that comes into your house to remove the chlorine, fluoride, chemical residues, heavy metals, bacteria, parasites, etc. in your water. And you need to remove all of these toxins not only at the tap where you drink, but also where you bathe and shower. So how do you do it? You really only have 4 choices.

  Get a system for the entire house that treats the water where it enters your house.

  This is obviously the most expensive way to answer the problem, but if you actually get a good system that removes all of the toxins, it's the best way to go.

   There's no question that a good water distiller will provide the "cleanest" water you can get, but you need to be sure it incorporates a charcoal filter, since toxins like chlorine vaporize and recondense along with the water you're trying to clean.

- There's one other question to consider. Distilled water, by definition, has no mineral content. For years there has been much debate as to whether that's good or bad. "Distillerites" claim that demineralized water is more natural—like rain water and glacier water—and that minerals in the water end up in your joints. The argument against distillers is that most animals drink water that has had contact with the ground and acquired a high mineral content. Prime examples are the high mineral water of the Hunzas and the coral calcium water of the islands off of Okinawa—two areas renowned for the age and health of their inhabitants. As for me, I don't think it matters, provided that if you drink distilled water, you make sure that your diet and supplements provide an abundant supply of minerals.[1]
   And as for the question of mineral-laden water leading to joint deposits, studies have proven that the calcium which deposits in joints comes from inside the body—leached from your own
bones because of too much acid in your diet.


[1 Understand, because it is devoid of minerals, distilled water is bioelectrically dead.]

   Reverse osmosis units produce a good quality drinking water. The problem I have with them is that they waste a huge amount of water—many gallons of waste for each gallon of usable water. I'm not really sure that's justifiable nowadays with the looming water shortage we face.

   A good water filter is probably your best bet, but keep in mind that it will cost you more than $29.95 or even $100. To find one that will truly remove ALL of the bad stuff, while leaving in the beneficial minerals, you will need to pay $250-$300.

> Drink 8-12 glasses of pure water a day. (To follow the water-cure-protocol formula, see below) 

> When possible, use glass to hold your water, not plastic. Absolutely avoid drinking water that has a strong plastic smell or taste.

> Apply a magnetic field to your water for at least 20 minutes (depending on how large your bottle is).

> If you're not using a central home purification system, remember to get a good shower filter to remove the chlorine from the water you shower in. Understand that the filter is on the shower, not the bath. The bath water (unless you fill the tub from the shower) will still be toxic.

(To follow Water-Cure protocol formula: Drink at least 10% of your own daily water-quota (31.42 ml multiply by your present body weight(kg), every 90 minutes. Use 1/4 teaspoon of sea-salt in your daily diet, for every 1250 ml water drank.)

The sensory Effects of Aging and find out if you're at risk. - 5 .

Eyesight and Aging

Are you holding your newspaper at arm's length? 

Squinting at documents to see the fine print? 

Do you need more light to see clearly? 

Each passing decade brings changes that weaken eyesight, including the slow loss of ability to focus on close objects or small print.

Presbyopia, the most common reason why you and your peers need reading glasses, is characterized by decreasing ability to focus on nearby objects. This condition typically shows up around age 40 but often develops for decades before that.

Some of the age-related eye changes are obvious, while others go undetected until vision is limited in some way. For example, the tissues surrounding eyes lose their tone, and fat is lost, too, which results in droopy upper eyelids and the turning outward or inward of the lower lid.

On the other hand, cataracts, which cloud your vision by keeping the light from getting through the clear lens of the eye, are barely detectable because they form at a snail's pace, are painless, and don't result in any redness or tearing in the eye. Over the years, the iris, the colored part of your eyeball, loses flexibility.

Your pupils -- the black holes in the iris that respond to light -- get smaller, and the lenses start to accumulate yellow substances, possibly as a result of exposure to sunlight. These changes predispose you to glaucoma, the product of excessive pressure inside your eyeball, which can lead to vision loss and blindness. No one knows the cause of glaucoma, but it is more prevalent in older people, African-Americans, and in those with a family history of the disease.

Glaucoma is basically symptom-free, often until it is too late. Once glaucoma has damaged the optic nerve, which transmits visual information from the eye to the brain, you're past the point of treatment. That's why The Glaucoma Foundation recommends testing for glaucoma every four years until age 45 and every two years after that. Get tested every two years regardless of age if:

• you're of African-American descent
• glaucoma runs in your family
• you are nearsighted
• you have high blood pressure
• you've been using cortisone long-term

Decreased blood flow to the retina, the paper-thin tissue lining the back of your eyeball, can lead to macular degeneration. Macular degeneration destroys sharp, central vision.

Aging and Taste

You can thank your nose for your sense of taste, despite the thousands of taste buds populating your tongue: They can only detect a mere four out of thousands of possible flavors in foods.

The tongue recognizes only sweet, salty, bitter, and sour tastes. That's why enjoying food is limited without a healthy sense of smell. When you chew food and drink beverages, their aromas are released in your mouth.

Saliva dissolves flavor-producing substances in food and drink that make contact with your tongue's taste buds. More importantly, dissolved flavor compounds waft up the back of your throat, making their way to receptor cells in your nose. From there, nerves transmit flavor messages to the brain, allowing you to perceive and enjoy them.

If you're having trouble savoring the flavor of food, blame it on a lessened sense of smell. Time dulls your sense of smell, but not usually until you reach age 60, and then it varies from person to person. About half of adults over the age of 65 suffer from some diminished sense of smell. On the other hand, your sense of taste for sweet, salty, bitter, and sour foods may be remarkably intact until you're well into your seventies.

A zinc deficiency can also cause a decreased sense of taste. Zinc supplementation can help restore it if you do have a deficiency. Infections threaten sense of smell and, as a result, your ability to enjoy food. Some of the damage from the flu, colds, or hepatitis can be permanent. More often than not, acute illnesses, including sinus infections and seasonal allergies, block aromas from the receptor cells that relay flavor information to the brain.

As a result, you don't have as much capacity to savor the flavors of food. The pills you take every day to control medical conditions such as high blood pressure and arthritis can affect sense of taste, mainly by affecting the areas of the brain where you perceive flavors. Chemotherapy drugs and head and neck radiation also threaten flavor perception, sometimes permanently.

these letters are real-life stories. They are not "anecdotes."

EXCESS BODY WEIGHT
"The secret of caring for a patient is caring for the patient."--
Sir William Osier

Q: Why are 30 percent of Americans overweight? 
A: Because of a most basic confusion!

They don't know when they are thirsty; they also don't know the difference between "fluids" and "water."

Let us discuss the letters from Mr. Peck, Mr. Paturis, Priscilla Preston, and Donna Gutkowski that follow. All of them stated they lost between 30 and 45 pounds in weight when they switched to water as their preferred beverage.

There is another person who gradually lost 58 pounds in less than a year, weight she had gained in six years. As you read on, you will see how simply we gain weight. You would think it "simplistic" if you did not have the proof in front of you.

The central control system in the brain happens to recognize the low energy levels available for its functions. The sensations of thirst or hunger also stem from low, ready-to-access energy levels.

To mobilize energy from that which is stored in the fat, one needs hormonal release mechanisms. This process takes a while longer (and some physical activity for energy release) than the urgent needs of the brain. 

The front of the brain either gets energy from "hydroelectricity" or from sugar in blood circulation. Its functional needs for hydroelectricity are more, urgent—not only the energy formation from water, but also its transport system within the micro-stream flow system that depends on more water.

Thus, the sensation of thirst and hunger are generated simultaneously to indicate the brain's needs. We do not recognize the sensation of thirst and assume "both indicators" to be the urge to eat We eat food even when the body should receive water. In these people who lost weight, by drinking water before eating food, they managed to separate the two sensations. They did not overeat to satisfy an urge for the intake of water.

Overeating Further Explained
The human brain is roughly 1/50th of the total body weight. It is said to possess about nine trillion nerve cells (computer chips). Brain cells are said to be 85 percent water. 

Twenty percent of blood circulation is allocated and made available to the brain. This means that the brain gets to pick and choose from the circulating blood what is needed for its normal functions. The brain is the only part of the body that is constantly active. It processes all information from different parts of the body, as well as that which enters it from daily exposure to physical, social,and electromagnetic environment.

To process all these inputs and alert all parts of the body for coordinated response, the brain spends a vast quantity of energy. At the same time, it spends energy in manufacturing primary ingredients and different brain chemical messengers (neurotransmitters) that are made in the brain cells and have to be transported to the nerve endings wherever they are. The transport system uses a vast quantity of energy. This high rate of energy consumption by the brain is the main reason why it receives about 20 percent of blood circulation.

Brain cells stockpile energy in two main forms: ATP and GTP reserves—like the coal and coke dumps next to power plants. Certain actions are supplied with energy from ATP stockpiles that are located in different parts of the cell, mainly within its membranes. The cell membrane is where the information enters and where an action is initiated. There is a system of energy rationing in operation in each cell. Not all stimulation will achieve an allocation of energy from the ATP stockpile to get registered and invoke a response.

There is a threshold for energy release for some "inputs." The brain calculates and understands what is important and what is not for its energy expenditure. When ATP reserves are low, many stimuli do not invoke a response. This low ATP reserve in some overactive brain cells will become reflected as a fatigue state in functions controlled by those brain cells. Exactly the same process is in operation for the GTP stockpiles. In certain emergency actions,
some energy from GTP stockpile can be diverted to boost the ATP stockpile to sustain some of the most essential functions that would otherwise suffer from lack of local energy.
Storage of energy in the brain's energy pools seems to rely heavily on the availability of sugar. The brain is constantly drawing from the blood sugar to replenish its ATP and GTP stockpiles. Recently it has been discovered that the human body has the ability to generate hydroelectric energy when water, by itself, goes through the cell membrane and turns some very special energy generating pumps; very much like the hydroelectric power generation when a dam is built on a large river. Thus, the brain uses two mechanisms for its energy requirements: One, from metabolism of food and formation of sugar: two, from its water supply and conversion of hydroelectric energy. It now seems that the brain depends very extensively on energy formation from "hydroelectricity,"
particularly for its transport system in its nerve supply to different parts of the body.

To satisfy the brain's requirements, the human body has developed a very delicate balancing system to keep a normal range of sugar concentration in the blood. It/does this in two ways. One, by stimulating the intake of proteins and starchy foods that it will convert to sugar, in addition to the sugar in the diet; two, by converting some starch and proteins from stored reserves of the body into sugar. This latter mechanism is called "gluco-neo-gene-sis." It means remaking of sugar from other materials. This re-manufacturing of sugar for use by the brain is done in the liver.

The dependence of most brain functions on energy from sugar has developed a satiety or pleasure association for the sweet taste. It has established a certain coding system for coordination of functions by the other organs, particularly by the liver when sweet taste stimulates the tongue. When there is not enough sugar in circulation, the liver begins to manufacture it and constantly tops up blood levels by the addition of more sugar. At the beginning, it
will convert stored starch, followed by proteins and small quantities of fat. Fat conversion is a very slow process.

The body needs to go without food for some time before a higher rate of fat metabolism is established. Proteins are more accessible and broken down more easily than fat. Fat deposits are made up of many single units of "fatty acids" joined together. It is the individual fatty acids that are broken for their energy value. Each gram of fat gives nine calories of energy. Each gram of protein or sugar provides only four calories of energy. This is the reason,
when fat is metabolized, a person is far less hungry.

In children, fat stores are brown in color and have much blood circulation in them. In brown fat, fat is metabolized directly and heat is generated. In later years of life, fat stores have less blood circulation and are less accessible to the enzymes that would mobilize the fatty acids for conversion in the liver and the muscles. When muscles are inactive, they are more easily attacked and their protein is broken down for conversion into sugar. However, if
muscles are used, they begin to metabolize some of their stored fat as a choice source of energy to do work and maintain or increase their bulk To do this, they begin to activate a fat-breaking enzyme called "hormone sensitive lipase." It has been shown in repeated blood tests in Sweden that this enzyme's activity is seen after one hour's walk and retains its fat-breaking activity for 12 hours. Once muscles begin to use fat, more sugar will become available to be used by the brain.

With repeated walks, activity of the fat-burning enzymes become much more pronounced. Thus, a component of any dieting program should be muscle use for its long-lasting, primary and direct physiological effect on fat breakdown. It is this enzyme in blood circulation that will also clean all blood vessel walls of fatty plaques and deposits. It was this physiological response of the body to walking that reversed the health problems of Mr. John Fox. Increased water intake gave him energy and stamina and walking stimulated the enzymes that cleared his arteries.
Office work and desk jobs in our modern way of life are only a cultural transformation. The body physiology has not yet transformed sufficiently to accommodate for this functionally abnormal use of the human body. The human body still needs muscle activity to maintain normal functions. If the body functions normally, it will know when to eat and how much to eat without storing fat. Every part of the body will use its share of energy supply for efficient and well coordinated functioning. This is what it is designed for.

However, if the brain is used more (in times of stress) and the body is not used proportionately to supply the brain with its sugar needs, a less-disciplined person will give in to eating more often and in larger quantities. It becomes more dramatic if one does not recognize the other thirst signals of the human body when it needs water for its energy supply, when in place of drinking water by itself more food is consumed. In stress, the body becomes
dehydrated. The reason we tend to gain weight is one simple fact: we eat to supply the brain with energy for its constant round-the-clock activity. However, when food is eaten, only about 20 percent of it reaches the brain. The rest will gradually become stored if muscle activity does not use up its allocated portion. With water as a source of energy, this storage does not happen. Excess water is passed out in the form of urine.

Diet Sodas Can Cause Weight Gain.
My observation has been that diet sodas (all variety of manufactured soft drinks are called soda instead of using the
label on the drink), even though containing no appreciable number of calories, are possibly the cause of more weight gain in people who resort to taking them to control their weight. One person stands out: A young man in his twenties, about 5' 5" in height. Like most college students, he used to drink regular sodas while under constant pressure for completion of his studies. He had already gained excess weight by the time he graduated.

After graduation, to reduce weight, he began drinking eight cans of diet sodas per day. In about two years, he must have gained another 30 pounds. He seemed to get as round as he was tall. His walk became difficult, and he seemed to have to swing his hip to take a step. He also drank his diet soda at mealtimes and ate more than his
body needed. He still consumes his diet sodas—he seems to be addicted—and, despite all other efforts, continues to be overweight.
This paradox in our understanding of the relationship between taking a sweetener that does not directly contribute to the total calorie intake of the body and weight gain needs explanation. The following is the result of my research into this enigma. There are many such persons who resort to taking diet sodas and, instead of losing weight, they begin to gain it. The transcript of a testimonial from Donna Gutkowski, who for years only consumed sodas and steadily gained weight regardless of anything else she did to shed the excess pounds, will also follow.

In America in 1850, about 13 ounces of soda were consumed per person per year. In the late 1980s, more than 500 twelve-ounce cans of sodas were consumed per person per year.

The 1994 annual report of the beverage industry shows that per-capita consumption of sodas is 49.1 gallons per year. Of this amount, 28.2 percent of consumption is the share of different diet sodas. Diet soda consumption is beginning to decline. Eighty-four percent of all sodas consumed belong to two companies (Coca-Cola 48.2 percent and Pepsi-Cola 35.9 percent). Of this 84 percent share of market and their different labels manufactured, only 5.5 percent are caffeine-free diet sodas. These figures indicate that a vast number of people are drinking caffeinated sodas, of which 22 percent consists of diet sodas.

A survey at the campus of Pennsylvania State University has shown that some students drank 14 cans of soda a day. One girl had consumed 37 Cokes in two days. Many admitted they could not live without these soft drinks. If deprived, these persons would develop withdrawal symptoms, very much like those addicted to other drugs. Boys Life magazine surveyed its readers and found that eight percent of them drink eight or more sodas a day. The administrators of one Boy Scout Jamboree had collected 200,000 empty cans for recycling. The Soft Drink Association surveyed the use of soft drinks in hospitals in America and found 85 percent of them serve sodas with their patients' meals. Research has shown that caffeine is addictive. The media, to placate a beverage industry that spends vast sums of money for advertising its products, have come up with a less expressive word to announce the news. They call it "caffeine dependency."
When consumption of sodas is encouraged by society, it is assumed these manufactured beverages can replace the needs of the body for water. It is assumed, just because these beverages contain water, the body will be adequately served. This assumption is wrong. This broad-base increase in consumption of mainly caffeine containing sodas forms the background to many of the health problems of our society. The mistaken assumption
that all fluids are equivalent to water for the water needs of the human body is the main cause of many of the ills of the human body, and it is frequently associated with the initial excessive gain in weight. To understand the above statement, we need to recognize some simple principles of anatomy and physiology of the brain that regulate eating and drinking.
The confusion that all manufactured beverages will supply the body with its daily water needs, more than any other cause, is responsible for some of the diseases that we encounter. Gross disfigurement of the body by fat collection is the initial step in the decline of the human body, and in my opinion is caused by the wrong choice of fluids intake.
Some of these beverages do more damage than others.
Caffeine, one of the main components of most sodas, is a drug. It has addictive properties because of its direct action on the brain. It also acts on the kidneys and causes increased urine production. Caffeine has diuretic properties. It is physiologically a dehydrating agent. This characteristic is the main reason a person is forced to drink so many cans of soda every day and never be satisfied. The water does not stay in the body long enough. At the same time, many persons confuse their feeling of thirst for water. Thinking they have consumed enough "water" that is in the soda, they assume they are hungry and begin to eat more than their body's need for food. Thus, dehydration caused by caffeine-containing sodas, in due time, will cause a gradual gain in weight from overeating as a direct result of confusion of thirst and hunger sensations.
Caffeine has "pick-me-up" properties. It stimulates the brain/body even when a person is exhausted! It seems that caffeine lowers the threshold of ATP stockpile control. Stored ATP is used up for some functions that would not normally gain access to it when there is a set level of reserves.
When sodas contain sugar, at least some of the brain's need for sugar is satisfied. If caffeine is releasing ATP energy to enhance performance, at least its sugar companion will replenish some of the lost ATP, even if the final result is a deficit expenditure of ATP by the brain.
In early 1980s, a new product was introduced into the beverage industry—an artificial sweetener other than saccharin. It is called aspartame. Aspartame is 180 times as sweet as sugar without any calorie output. It is now in common use because the Food and Drug Administration (FDA) has deemed it safe to use in place of sugar. In a very short period of time, it has been incorporated in over 5000 recipes.
In the intestinal tract, aspartame converts to two highly excitatory neurotransmitter amino acids: aspartate and phenylalanine, as well as methyl alcohol/formaldehyde—wood alcohol. It is claimed the liver renders methyl alcohol non-toxic. I personally think this claim is made to brush aside voiced objections for commercialization of a
manufactured "food" that has a known toxic byproduct.
If caffeine converts ATP to AMP, a spent energy "ash," aspartate converts GTP energy stockpile to GMP. Both AMP and GMP are spent fuels; they cause thirst/hunger to replace the lost fuel stockpiles in the brain cells. Thus, diet sodas cause indiscriminate overuse of energy reserves of cells in the brain.
It is a well-recognized, scientific fact that spent fuel (AMP) does cause hunger. Caffeine causes addiction, and people who consume it on a regular basis should be assumed to be "sodaholics." Hence, caffeinated diet sodas in sedentary persons must cause weight gain; they indirectly stimulate more food intake because of the brain's forced use of its energy reserves. Bear in mind that only some of the energy value of foods eaten will be used by the brain.
The rest of the consumed energy will be stored in the form of fat if not used by muscle activity. This weight gain is one of many results of diet soda consumption.
The more important reflex that occurs is a brain reaction to sweet taste. The jargon used is "cephalic phase response." A conditioned reflex becomes established as a result of life-long experience with sweet taste that is associated with the introduction of new energy into the body. When sweet taste stimulates the tongue, the brain
programs the liver to prepare for acceptance of new energy— sugar—from outside. The liver, in turn, stops the manufacture of sugar from the protein and starch reserves of the body and instead begins to store the metabolic fuels that are circulating in the blood. As Michael G. Tardoff, Mark I. Friedman, and other scientists have shown,cephalic phase responses alter the metabolic activity in favor of nutrient storage; the fuel available for conversion is reduced which leads to the development of appetite.
If it is indeed sugar that stimulates the response, the effect on the liver will be the regulation of that which has entered the body. However, if sweet taste is not followed by nutrient availability, an urge to eat will be the outcome. It is the liver that produces the signals and the urge to eat The more sweet taste without the accompanying calories that stimulates the taste buds, the more there is an urge to eat—overeat.
The effect of cephalic phase response to sweet taste has been dearly shown in animal models with the use of saccharin. Using aspartame, several scientists have shown a similar urge to overeat in humans. Blundel and Hill have shown that non-nutritive sweeteners—aspartame in solution—will enhance appetite and increase short-term food intake. They report: "After ingestion of aspartame, the volunteers were left with a residual hunger compared with what they reported after glucose. This residual hunger is functional, it leads to increased food consumption."
Tardoff and Friedman have shown that this urge to eat more food after artificial sweeteners can last up to 90 minutes after the sweet drink; even when all blood tests show normal values. They showed that even when blood levels for insulin, the higher readings of which is thought to be the cause of hunger, achieved normal levels test animals consumed more food than the control batch. What this means is that the "brain" retains for a long time the urge to eat when the taste buds for sugar are stimulated without sugar having entered the system. The sweet taste will cause the brain to program the liver to store supplies rather than release supplies from its storage.
Basically, this physiological response to sweeteners without their accompanying calories that the body has been told has entered it will compel the person to find and make good the registered marker for energy consumption. This is another physiological reason why people who consume diet sodas to reduce weight may suffer from the paradoxical response of their body to repeated stimulation of the taste buds with sugar substitutes.
When caffeine and aspartame are introduced into the body, they will dictate their stimulating effect on the cell physiology in the brain, the liver, the kidneys, the pancreas, the endocrine glands, and so on. Aspartame is converted to phenylalanine and aspartate. Both have direct stimulatory effects on the brain. The sum total of the
effect of caffeine and aspartame will very quickly establish a new mode of activity for the brain just because they are repeatedly available in larger quantities than the ones that would otherwise establish a balanced physiology.
Most neurotransmitters are secondary products from one or another amino acid. However, aspartate is one of a pair of unique amino acids that don't need to be converted to a secondary product to act on the brain to cause an effect.
There are receiving points (receptors) for these two stimulant amino acids (aspartate and glutamate) on certain nerve cells that influence body physiology very dramatically.
The use of artificial sweeteners for their false stimulation of "nerve terminals" that register the entry of "energy" supplies into the body have more severe repercussions than simply causing increase in weight. These chemicals constantly swing the body physiology in the direction dictated by the nerve system they stimulate. Their use without a thorough understanding of their long-term effects in the body, just because they also pleasantly stimulate the taste buds, is shortsighted. My understanding of the micro-physiology within cells causes me concern when I think of the routine use of these amino acids. I worry for the outcome of the long-term effect of the direct stimulation of the nerve/ glandular systems in the brain with these chemical sweeteners. They are naturally positioned for other important, but balanced functions, in the body.
Research has shown that receptors for aspartate are abundantly present on some nerve systems whose products also stimulate the reproductive organs and breasts. A constant stimulation of breast glands without the other factors associated with pregnancy may well be implicated in the rise in the rate of breast cancer in women. The hormone, prolactin, may play a major role in this direction. One of the less explored complications of aspartame may be its effect as a possible facilitator in cancer formation in the brain. Fed to rats, aspartame has been implicated in brain tumor formation in experimental animals.
As an analogy, imagine a small sail boat that is going from one nearby port to another and has to reach its destination before dark when the direction of the winds is not ideal. If the sailor, instead of paying strict attention to the rules of sailing, gives in to the pleasure and exhilaration of fast sailing with the wind, he will have abandoned his purpose and sailed his boat to totally different and unknown shores, and in the dark. The odds are that he and his
boat will not survive the trip.
On its journey of life, the human body is just like a sail boat. If the mind abandons purpose and forgets the design of
the body, and gives in to the overstimulation of the palate with artificial and non-representative products (such as spices), in the long run, the body chemistry may not be able to deal with constant false information and not suffer damage.
It is primitive and simplistic thinking that one could easily lace water with all sorts of pleasure-enhancing chemicals and substitute these fluids for the natural and dean water that the human body needs. Some of these chemicals,caffeine, aspartame, saccharin and alcohol, through their constant lopsided effect on the brain, unidirectionally—single mindedly—program the body chemistry with results contrary to the natural design of the body. Very much like the sail boat in the dark that will get beached in uncharted shores if its sailor gives in to the pleasures and exhilaration of fast sailing in place of sticking to the rules of sailing with safety in mind, the intake of wrong fluids will affect the life of anyone who continually consumes them.

As it has been explained so far, the human body has many different indicators when it runs short of water. At these times, it needs only water. As it has been explained, it will complicate matters if one gives the body artificial taste enhancing fluids on a regular basis and in full substitution of the water needs of the body.
One should remember that caffeine is similarly an addictive drug, the use of which has become "legal." Children, in particular, become vulnerable to the addictive properties of these caffeine-containing beverages. Stimulating the body at the early stages of life of a child with pleasure-enhancing chemicals in beverages, in some will program the senses to use harder addictive drugs when they reach school age.

Thus, the long-term and constant use of sodas in general, and diet sodas in particular, should be assumed to be responsible for some of the more serious health problems of our society. Distorting the physical appearance of the body as a result of excess fat storage is the first step in this direction. Some manufactured beverages should only be used sparingly, if at all, by younger people, when the right programs for the future health of a child is the aim of parents.


Dr. Marcia Gutkowski is a nutrition consultant. After reading my book, she convinced her daughter Donna to begin changing her habit in fluids intake. The result has astounded the mother and daughter. The following is the transcript of Donna's testimonial.

Dear Dr. Batmanghelidj
April 25,1994
My mother asked, that I write to you and tell you about my recent weight loss success. I know that I could have a much more successful loss if I would follow your formula and curb my eating habits, along with starting a regular routine of exercise. However just getting myself to get off of 6 to 8 cans of Mountain Dew a day is a miracle in itself.

Within the last 9 months to a year, I have successfully been able to keep 35 excess pounds of baggage off. I am able to wear clothes that I thought would never touch my body again. I also have just about reached my goal size for my upcoming wedding. Even my fiancé had to admit that lam looking much better than when he first met me five years ago.

My success has been contributed to faithfully drinking 1/2 my body weight in ounces in water every day. Wherever I go, so does my water. To work, shopping, even my long 7 hour long car rides. (That does make for a lot of rest area stops, but they are worth it.) I do treat myself to an occasional mineral water or beer when I go out, but I have usually gotten my quota of water in for the day. One interesting thing that I have noticed however is that once I have finished drinking my quota of water, I have absolutely no desire to drink anymore. Also I have found that I'm not thirsty anymore and it will usually take me awhile to drink some other type of beverage whether it be juice, milk, beer, mineral water, etc.

I am looking forward to October 1st which is my wedding day when I can walk down the aisle looking better than I have looked in 15 years, since I graduated from high school. It will also be nice to put my weight on my new drivers license without having to cringe for the first time in my life.

Thanks for the smaller me!!!! 

Donna M. Gutkowski

It is now February of 1995. Donna is happily married. By the time of her wedding in October 1994, she had lost over 40 pounds.

This science-based way of weight loss will be permanent, whereas with only food limitation, even if some weight is lost, it is regained in a short period of time. Worse still, one is constantly hounded by the fallacy of needing to limit this or that food, particularly on the subject of cholesterol content of food, a temporary present-day vogue. Do not be shocked. Contrary to present trends for exclusion of eggs from daily diet, I eat as many eggs as I feel like eating—
no limitation whatsoever; eggs have a well-balanced protein content. I also happen to understand how excess cholesterol formation in the body is associated with prolonged dehydration.

 [Higher blood cholesterol is a sign that the cells of the body have ... Want To Read More Click Here ]

Priscilla Preston's letter on the next page further explains the relationship of dehydration, not only to weight gain, but to the more devastating problem of asthma, the subject of the next chapter. In taking steps to prevent asthma, she managed to lose 35 pounds.

 Another important point in her letter is the role of salt in disease prevention. Salt is important to the body. Salt sensors on the tongue, when strongly stimulated, remove the body's anxiety and stop it from panicking for water. When salt is available, the body is at least assured of an efficient water filtration system for its emergency supply to the important cells. You will read more about salt in this link, JUST CLICK HERE.

Please bear in mind, these letters are real-life stories. They are not "anecdotes." We do not need statistics to convince people of the efficacy of water, when the body is demonstrating an urgent need for it. Whose fault is it that the human body's regional calls for water, and its programs of adaptation to dehydration, have been labeled as disease conditions? Is there any plausible reason why, for evaluation of natural treatment procedures, we should adhere to the self-serving methodology and the yardstick of the pharmaceutical industry? Their inaccurate assertions have until now caused so much pain and agony for people whose bodies were only crying out for water!

NEVER LET YOUR BODY GOES WATER-DEFICIT,