How I deter demands for a sicknote
Dr FM Hunter (Letters, February 26) wants evidence for menopausal symptoms and depression responding safely to low-allergy diets and repletion of nutrient deficiencies.
The Lancet published proof of the effectiveness of low-allergy diets and avoidance of main precipitants of adverse vascular and mood reactions in 1978 and 19791,2. When migraine patients, most of whom also had depressive symptoms, were persuaded to stop OCs, HRT, ergot medications and smoking, their migraine attacks reduced 10-fold.
When those who still had headaches followed a high-protein, low-allergy exclusion and reintroduction diet, 85 per cent became headache-free, those with hypertension became normotensive, and none needed regular medications.
More references are in Environmental Medicine in Clinical Practice published by the British Society for Allergy, Nutritional and Environmental Medicine, which also runs training sessions and conferences for doctors.
In the 1960s I matched generalised vascular symptoms with endometrial blood vessel changes in normal and hormone-treated cycles3. Progesterone or progestogens increase monoamine oxidase (MAO) levels in endometrial glands and in circulating platelets4.
High MAO activity, either premenstrually or during use of oral contraceptives or combined HRT, causes irritability, tension and depression in women who have amine pathway co-factor hormone-induced deficiencies of zinc, copper, magnesium and B vitamins5.
Oestrogen HRT was popular because oestrogens raise MAO levels and mood but oestrogens can be addictive and cause tachyphylaxsis6. There are many references in Pub Med to essential nutrient deficiencies and depression. My publications since 1962 are listed under grant ec, and my recent Rapid Responses to bmj.com are listed under Grant, E.
Dr E Grant
Kingston upon Thames
1. Grant ECG. Food allergies and migraine. Lancet 1979;1:66-69
2. Grant ECG. Food allergy and migraine. Lancet 1979;2:358-59
3. Grant ECG. Relation between headaches from oral contraceptives and development of endometrial arterioles. BMJ 1968;3:402-5
4. Grant ECG, Pryce Davies J. Effect of oral contraceptives on depressive mood changes and on endometrial monoamine oxidase and phosphatases.
5. Grant ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity, and mineral imbalance. J Nutr Environ Med 1998;8:105-116
6. White M, Grant ECG. Addiction to oestrogen and progesterone.
J Nutr Environ Med 1998;8:117-120