My grandson, 25, can’t eat fruit, veg or salad
MY GRANDSON, aged 25, can’t tolerate the texture of fruit, vegetables or salad. His diet consists of meat (steak, sausages, pizzas or burgers) with just tomato sauce, baked beans or chips.
He has tried eating salad but it made him sick. He realises this lifestyle is not healthy, and has suggested seeing a hypnotist. Can you advise?
Name and address supplied.
The technical name for your grandson’s problem is avoidant/restrictive food intake disorder, and it will have been developing since he was a child. It’s thought to affect about 3 per cent of people between the ages of eight and 13, so it’s probably less common at his age.
Many types of eating problems fall into this category, such as avoiding certain colours or textures, eating very small portions or sticking to just one or two types of food. One patient I had would eat only chocolate yoghurt and French fries.
We don’t know exactly why such disorders occur, but they are thought to be down to a combination of genetic, cultural, psychological, family and environmental factors.
Though some people may dismiss it as simply fussy eating, one of the effects is that patients will often be underweight (but this may not apply to your grandson, given the type of food he eats) and up to 60 per cent will also have an anxiety disorder.
The foods you list are mainly high in protein and fat, with some fibre in the baked beans. Without a detailed diet history, it is difficult to say which important components of a healthy diet your grandson is missing.
however, we do know that eating a lot of processed meat can increase the risk of bowel cancer. And he is undoubtedly lacking the cancer-preventing antioxidants found in fresh fruit, salads, seeds, nuts, and vegetables.
He WILL also be missing out on essential fatty acids that are vital for the brain. These are mainly found in oily fish, nuts, olive oil, butter, eggs and avocado, though he will absorb some from meat.
But the fact that your grandson recognises his lifestyle is not healthy and wishes to eat a normal diet means there is good reason to be optimistic.
I would urge him to seek referral — via his GP — to a cognitive behavioural therapist (CBT), who will be familiar with managing this type of disorder.
CBT helps by changing the way a patient thinks and behaves. Ideally he should also be referred to a dietitian (all dietitians are trained in psychological care).
Correcting this long-term dietary pattern may feel like a mountain to climb, but CBT can make a difference within months, if not weeks.
In the meantime, I would recommend a daily multi-vitamin capsule. This is only a short-term measure and no substitute for a balanced diet, but it may help correct some of the deficiencies that are inevitable at the moment. I’VE had back problems for four years. It began with pains in my left leg, for which I was prescribed pain patches, tramadol, antiinflammatories and slow-release morphine tablets. I’ve also had three steroid injections, which eased the pain (now in both legs) .
My specialist diagnosed stenosis and referred me to surgeons. Should I have the three steroid jabs per year or surgery?
Roger Young, by email. STENOSIS is a common condition where the spinal canal — the hollow space at the centre of the spinal column which contains the spinal cord — becomes narrow, irritating and putting pressure on the nerves within it.
This narrowing may be the result of new bone forming (which can occur as the body attempts to repair itself from the damage of osteoarthritis of the spine), or as a result of the discs that separate the vertebrae shrinking with age.
When it develops in the lumbar spine (the lowest section), as in your case, it affects the cauda equina — a bundle of nerves that extend from the end of the spinal cord (at about the level of your lowest rib) and carry impulses to and from the legs.
Though it does not always cause symptoms, it can lead to pain in the lower back, and pain, tingling or numbness in one or both legs.
Diagnosis is confirmed by X-rays or, preferably, magnetic resonance imaging (MRI) scans — these allow us to see not only the bone but also the soft tissues and nerves, so we can identify exactly where the nerve is impinged.
Treatment starts with nonsurgical options. Physiotherapy can help improve muscle strength — this has often been lost over time because the symptoms can limit a patient’s movement and ability to exercise.
Painkillers may also be helpful, from the more simple options such as paracetamol to the more powerful anti-inflammatories including naproxen or ibuprofen.
You have already run the gamut of these, including the most potent type, morphine, which suggests that your pain is severe.
MANY patients are treated with steroid injections, carried out under X-ray to ensure precise placement. These have a powerful antiinflammatory effect but it is rarely a permanent cure (though the pain relief may make it easier to have physiotherapy).
And we currently don’t have much evidence for their benefit, though a small trial has shown improvement in some patients.
The reason you’re limited to three injections per year is to reduce steroid exposure.
This is because the potential benefits must be set against the potential for side-effects — which include type 2 diabetes, high blood pressure, osteoporosis and weight gain. And the injections themselves can lead to complications, such as infection.
surgery, which can banish symptoms and improve mobility, is offered to those who find their symptoms disabling — it appears that you fall into this category.
There are a number of different procedures that may help depending on the exact nature of the problem. One example is laminectomy, where part of some vertebrae are removed to give more space in the spinal canal.
I would not wait at this stage. see the surgical specialist and ask their opinion about whether surgery is a suitable option for you.
It could result in a much brighter and pain-free year, with a return to your previous activities.