Are you taking too many pills?

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CAPTION: My seventy-something parents – were they taking too many pills?

I’ve been writing about the growing problem of polypharmacy – put simply that means taking multiple daily prescription pills for long-term chronic conditions. You can read the full article here in the Daily Mail’s Good Health section http://www.dailymail.co.uk/health/article-2280761/Pills-The-patients-prescribed-25-different-drugs-day-devastating-results.html.

I got the idea for the story after my lovely parents (pictured above) who are both in their mid seventies, came to stay with me with a rucksack jam-packed full of their prescription medication. I was shocked when I saw how many tablets they had been instructed to take. Admittedly, they do both have long-term chronic health conditions including diabetes, heart disease and arthritis – but what I was surprised at was how many additional pills they were taking to counter side effects of other tablets. Also some of the drugs they had been on for years and no-one had ever mentioned coming off them or reviewing the dose. It seemed to me that once you started taking a drug that was it and you were on it for life. I wouldn’t have worried but they’d both been complaining of non specific health problems including mental fogginess,fatigue and muscle pain and never really got a satisfactory explanation for them. They were just putting it down to old age.Then I started wondering whether drug interactions might be to blame for their symptoms.It had to be at least a consideration surely?
The polypharmacy debate
The truth is that no-one really knows the long-term effects of being on multiple pills for years and years. Dr Chris Fox, an old age psychiatrist from the University of East Anglia, who has carried research on the cumulative effects of commonly prescribed drugs, says he was always taught that if you take more than three drugs at time you will get a drug interaction. The trouble is these days lots of elderly people are taking a daily cocktail of prescription pills to treat medical conditions, prevent others and increasingly, to deal with the side effects of prescribed medication. Dr Fox says the effects of this have never been studied in large trials. In drug trials the patients selected are generally younger and not on medication for other conditions.
The annual number of prescriptions has increased from 11.9 per head in 2001 to 18.3 per person in 2011 in England and Wales. Most of this increase has been in prescribing in the over 65s. Almost half the elderly population have three chronic health problems including arthritis,diabetes and high blood pressure.It’s now quite common for this age group to be taking eight to 12 different pills daily.
Dr Fox’s own research has suggested that commonly prescribed anticholinergic drugs used for treating movement disorders, depression, incontinence and chronic obstructive pulmonary disease – can be associated with cognitive decline. I find this worrying (and so does he).
Too much of a good thing?
Dr Trisha MacNair a specialist in medicine for the elderly at Milford Hospital,Surrey, says a big part of her workload is working out whether patients admitted are suffering from an illness or drug interactions.
One review published by the University of Sydney of nine studies where elderly people had been taken off medication concluded that between 20 and 85 per cent of patients taken off blood pressure pills had normal blood pressure and did not need to go back on the pills and there was no increase in deaths as a result.
An Israeli study conducted by Dr Doron Garfinkel found 88 per cent of elderly patients in a study who were taken off some of their medication reported a global all-round improvement in their health.Only two per cent had to restart their pills because of a recurrence of symptoms and there were no adverse events or death attributable to the discontinuation of their drugs.
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CAPTION: Millions of elderly people are taking multiple daily pills for chronic conditions
IMAGE:SHUTTERSTOCK
The cascade of prescribing
Take statins (prescribed for lowering cholesterol)as an example. You could suffer muscle pain as a side effect and be prescribed a non steroidal anti-inflammatory painkiller, which in turn could cause gastric problems. This could then result in you requiring a proton pump inhibitor (PPI) prescription (omeprazole for instance – there are currently 2.6 million prescriptions a year for this one PPI alone).
And so it goes on and on. Easy to see how the so-called cascade of prescribing can happen isn’t it? And doctors are probably only following the guidelines so doing nothing wrong – the problem is there are so many clinical guidelines for each condition these days. Another problem is that a patient might be under lots of different specialists too and communication between doctors isn’t always great – so no-one is looking at the whole picture. Patients might also be taking over the counter medicines and herbal remedies too – not realising they can also interact with their medication.Nightmare.
What to do for the best
Dr Fox advises that anyone on more than five daily pills needs to have a prescription review ‘at least once a year’ and that no-one should be left on drugs without one. He suggests you should ask your GP or community pharmacist for a prescription review and discuss any drug side effects with them. He stresses of course that you shouldn’t stop taking any drug suddenly or without medical advice.
And my parents? Well, they came off their statins and had some other dosages reviewed and feel much perkier. Dad’s muscle pain, fatigue and mental fogginess have all gone away and he now walks two miles a day and watches his diet to keep his cholesterol down instead. My mother’s health has improved too – not so markedly – but she has more chronic conditions. Both say they no longer feel drugged up to the eyeballs though.

 

Why gout is no laughing matter

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CAPTION: Beer drinking is linked to gout – but it’s not the whole story

This article is all about gout. Yes,that funny disease that causes an inflamed, painful, big toe – you know the one. It’s hilarious – you get it from overdoing the booze and eating too much rich food – so it’s all self-inflicted and you don’t deserve any sympathy. Well, at least that’s the popular perception of it anyway.

By this point you’re probably sniggering about gout being something boozy hedonists suffer from. And yes, you’ll have that portrait of Henry VIII th popping up in the popular stereotypes hemisphere of your brain. You know the one – where he’s looking portly and middle-aged with a pot belly, a haunch of venison on a gold platter and a goblet of fine wine in his hand.

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CAPTION:Does a Henry VIIIth style diet really give you gout?

Yes, most of us think gout is a joke – although quite why and at what point in history this was decided I’m not sure. I’m pretty certain though most gout sufferers have not been spreading that particular rumour – such is the agony they suffer. Doctors say a gout attack is the most painful thing a human can live to tell the tale about – bar childbirth and kidney stones that is.
But gout is actually no laughing matter; it’s a form of arthritis caused by high concentration of uric acid in the blood. This leads to the formation of tiny needle like crystals in the joints and kidneys (where they form kidney stones) and less commonly in other parts of the body including the spinal cord and the vocal chords.Gout is as painful as rheumatoid arthritis – but does anyone laugh when you say you’ve got that? Exactly.

Why gout can be so serious
If left untreated or uncontrolled gout can form chalky lumps called tophi, which can severely damage joints, making walking and using the hands extremely painful. In extreme cases joint replacements and even amputation is necessary (although the latter is virtually unheard of).
The serious complications of gout hit the national news headlines in January when it was revealed that Mark Cahill ,52, the UK’s first hand transplant recipient needed a new hand because his old one had been destroyed by gout.
But even when the-gout-is-serious message gets across – there’s still this misconception that gout is entirely self-inflicted and just down to an appetite for booze, steaks and oysters. In fact, although a diet rich in purines – proteins found in foods such as red meat, offal, seafood, shellfish,alcohol, (particularly beer)and vegetables including cauliflower and lentils – can raise uric acid levels in the blood and lead to crystal formation in the joints – it’s not the whole story. Gout is actually down to how your body processes and eliminates uric acid from your body and not on how much rich food you eat. In people who don’t suffer from gout – eating purine–rich foods can raise uric acid levels but their kidneys are efficient at eliminating it from the body in urine. People with gout actually have a defective mechanism for eliminating uric acid from the body – and this is thought to be a genetic predisposition

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CAPTION: Red meat is rich in purines

Funny and self-inflicted
When I was interviewing gout sufferer Neil Pert for this feature I wrote for the Daily Mail Good Health section
section http://www.dailymail.co.uk/health/article-2273436/Gouts-laughing-matter-So-dont-GPs-seriously.html#axzz2K6t6jDCn this week, he told me the worst aspect of coping with the disease is the sneering and sniggering he has to put up with from others. ‘They think gout is a big joke,’ Neil recalls. ‘My doctor seems to feel its all self-inflicted too, but I haven’t touched booze in eleven years and follow a strict diet – to avoid purines which can break down into uric acid and cause gout. I avoid red meat, offal, seafood, shellfish, oats and a whole host of other foods to try to control it.’

Unfortunately though, Neil, a postman, now has daily joint pain in his feet and has had to transfer to a desk job and is worried about his long-term health. His doctor did offer him treatment with a drug called allopurinol – but he didn’t like the sound of the side effects and tried to control his uric acid levels with diet alone.Despite losing six stone in weight though (down from nearly 23 stone) – he now has joint pain in his feet and elbows.

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CAPTION:Gout can affect any joint but an inflamed big toe is the classic symptom

Gout destroys joints

Neil’s situation is typical of how gout can if left untreated or under controlled can then destroy joints. Professor George Nuki medical adviser to the UK Gout Society though says joint damage is entirely preventable if uric acid levels are controlled by drugs but the condition can be poorly managed.
The main drug for preventing gout is allopurinol which works by reducing uric acid levels in the blood by blocking the activity of the enzyme that converts purines to uric acid. GPs are supposed to start patients off on a low dose and then gradually adjust it upwards until blood tests reveal that uric acid levels have been reduced to such a level that the crystals dissolve and new crystals stop forming. But research has revealed less than 10 per cent of patients receive the follow-up blood tests – so many people stay on the low dose that does not reduce their uric acid levels sufficiently and crystals continue to grow and can damage their joints.
If patients can’t tolerate allopurinol(possible side-effects include skin rashes, headaches, indigestion and diarrhoea), or they can’t be prescribed it because they have kidney problems, the alternatives include febuxostat – which acts in the same way but is broken down by the liver instead of the kidneys – and benzbromarone, which works by stimulating the kidneys to excrete uric acid.

Dr Alex Brand , consultant rheumatologist at the Chelsea and Westminster Hospital and the private Lister Hospital says joint damage from gout can be very severe .’It can make walking difficult and painful and severely limit the use of the hand. Very elderly people tend to have reduced kidney function and higher uric acid levels. Certain drugs such as diuretics and other drugs used to control blood pressure as well as aspirin – which are commonly prescribed in the elderly can also raise uric acid levels.’
New treatments
When it comes to treating tophils, this used to involve surgery, ‘but this is rarely necessary these days because aggressive management with high doses of drugs can dissolve them,’ explains Professor Nuki .Krystexxa (peglioticase) is available for patients with severe, disabling gout which has caused joint damage, who have failed to respond to other drug treatments, on a case by case basis only in the UK. The drug hasn’t yet got a licence from the European Medicines Agency, however in October (2012) the EMA issued a positive opinion – seen as the first step towards this.

Charles Dickens
Charles Dickens

CAPTION : Charles Dickens was also plagued by gout

Neil’s message to you

Neil Pert worries about his future. He says:’Perhaps diet alone is not enough and I do need drugs as well after all – I just didn’t have enough information. I’m really worried about what is happening inside my joints now – I don’t want to end up in a wheelchair or heaven forbid having an amputation.
‘I also want people to know that you don’t have to have a Henry VIII th style lifestyle to get gout. It certainly isn’t funny. People just don’t realise how serious and painful gout can be.’

http://www.ukgoutsociety.org/

Here’s another article I’ve written about gout that you may like to read
http://www.dailymail.co.uk/health/article-1267311/Shelley-eats-healthily-hardly-drinks-women-battling-gout.html#axzz2JxMsf3YV

 

ALL IMAGES: SHUTTERSTOCK

You’ve been told you have IBS but could you have BAD ?

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CAPTION: Always on the loo?

Until a few weeks ago I’d never heard of bile acid diarrhoea (let’s call it BAD). Despite writing about all manner of tummy upsets for quite a while now – including Irritable Bowel Syndrome (IBS), Crohn’s disease and ulcerative colitis to name but a few – I’d never come across this particular gut nasty.
But then I spoke to Professor Julian Walters, professor of gastroenterology at Imperial College, London, and learned that up to 500,000 people in the UK who have been diagnosed with Irritable Bowel Syndrome – may actually have BAD instead.
Why does it matter? Well, according to Professor Walters, BAD is comparatively easy to treat and there’s a diagnostic test and effective medicine you can take for it – where as the diagnosis and treatment for IBS is far more complicated and seems (to a layman like me at least) to be a more let’s suck-it-and-see-if-it-works approach.

Why don’t more people know about BAD?

I can’t be the only one who is wondering why BAD is not on the radar of more doctors(and patients). By contrast, coeliac disease has become fairly well-known now as has Crohn’s disease. But BAD affects potentially far more people, so why is there is no information about it?
‘Most patients – and doctors – are unaware that bile acid diarrhoea even exists and that there is a diagnostic test and effective drug treatment available,’ explains Professor Walters.
‘IBS is estimated to affect four million adults in the UK; of those 1.3 million have diarrhoea as the predominant symptom. However, its cause is often difficult to diagnose and patients may undergo several investigations, including those for inflammatory bowel disease, colonic cancer, coeliac disease and chronic infections, without a definitive cause being identified or effective treatment.’

Freedom after 48 years

Judith Fulton who I interviewed for the Daily Mail Good Health section http://www.dailymail.co.uk/health/article-2255492/Bile-acid-diarrhoea-For-40-years-doctors-said-I-IBS-In-fact-hormone-problem-cured-simple-pill.html suffered from unexplained daily bouts of watery diarrhoea for over 40 years. She had countless tests including the invasive kind most of us would rather avoid if it isn’t absolutely necessary – doctors just said it was IBS though -and they offered her no treatment.
When Judith read about Professor Walters’ research though it was a light bulb moment and she tracked down his email on the internet and asked him for a consultation. She was later diagnosed with BAD and after treatment with the drug cholestyramine (Questran) her symptoms disappeared within a few weeks. After forty-eight years of suffering she is now free to leave the house without researching where the nearest toilet is. That’s what I call a result and partly why Judith was willing to be interviewed about such an embarrassing health problem – she wants more of us to know about it.
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CAPTION: FREEDOM TO GO OUT WITHOUT RESEARCHING THE NEAREST LOO

A bit about bile acid (before we go on)

I won’t bore you with a full blown biology lesson, but in a nutshell: bile acids are essential for digestion and absorption of fats and fat-soluble vitamins in the small intestine. The liver produces large amounts of bile acids which flow into the intestine every day, but only relatively small quantities are lost from the body. This is because approximately 95 per cent of the bile acids are recycled back to the liver from the ileum (part of the small intestine). But in bile acid diarrhoea – bile acid is overproduced and the excess bile passes into the colon causing watery diarrhoea.
Bile acid diarrhoea is also associated with Crohn’s disease, a chronic severe condition characterised by inflammation, ulcers and bleeding that may affect any part of the gastrointestinal tract, including the terminal ileum (the end of the small intestine). This is because Crohn’s causes inflammation and reduces absorption of bile in the intestine and this sometimes necessitates removal of the ileum. This is referred to as bile acid malabsorption as bile is not as absorbed as well in the intestine.
‘In idiopathic bile acid diarrhoea though – patients don’t have a problem with absorbing the normal amounts of bile produced, explains Professor Walters.’Their diarrhoea is triggered by a hormone disorder which causes overproduction of bile and it is this excess bile which causes the diarrhoea – this is an important distinction,’ explains Professor Walters.

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CAPTION: Bile acid is produced in the liver

Hormone deficiency is the cause

Professor Walters conducted research which found that the trigger for idiopathic BAD (from an unknown cause not related to Crohn’s disease) is a deficiency in a hormone called FGF19, which normally switches off bile acid production when bile acid is reabsorbed.
‘At the moment we don’t know why this happens – it doesn’t appear to be genetic although some patients report their symptoms started after a gastrointestinal infection.’

Symptoms
Unfortunately the symptoms of BAD can be hard to distinguish from diarrhoea caused by IBS.These include up to ten watery bowel movements every day, usually with an urgent need to go and frequently resulting in accidents or faecal incontinence. There is also some bloating and abdominal discomfort.

Diagnosis and treatment

Unlike IBS though, there is a diagnostic test available for BAD. It’s called the SeHCAT test(which stands for selenium-labelled synthetic bile salt) and involves two full body scans seven days apart. In a person with normal bile acid production more than 15 per cent of bile is detectable in the body after seven days, but in people with BAD this figure can be as low as one to five per cent.
Once diagnosed with BAD patients can be prescribed cholestyramine and around two-thirds of patients are reported to respond – although this admittedly may take some time until the correct dosage to control symptoms is found.
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CAPTION: What’s really causing your upset tummy?

Hang on a minute though…..
As with many things in medicine though, not everyone agrees. The National Institute for Clinical Excellence, for instance, recently decided although it was’promising’ there was insufficient evidence to recommend the SeHCAT test. Professor Carole Longson, NICE health technology director, said there was also little evidence of the clinical effectiveness of the drugs used to treat the condition and also whether bile acid diarrhoea is a primary or secondary condition.

Professor Nick Read,a gastroenterologist and adviser to the IBS Network is somewhere in between the two camps. He doesn’t believe BAD is a medical condition in its own right – just a symptom of IBS diarrhoea, but on the other hand he says he prescribes cholestyramine frequently to people with IBS where diarrhoea is their predominant symptom and it works really well. He told me:’I find that cholestyramine is an effective drug which mops up bile acid in the intestine. I’ve seen patients who have had diarrhoea for years dramatically improve using this treatment.’

Whatever the mechanism – the upshot is if you’ve had diarrhoea for years and been given an IBS diagnosis and told to live with it, you might want to ask about getting a SeHCAT test. Just like Judith the test (and the treatment) might give you your life back.

Watch Professor Walters here: http://www.youtube.com/watch?v=-O3uR0iDObw

ALL IMAGES:SHUTTERSTOCK

Here’s some more of my articles about gut health you may want to read.
http://www.dailymail.co.uk/health/article-2194464/My-doctors-orders-Crisps-doughnuts-strictly-veg.html
http://www.dailymail.co.uk/health/article-1350238/Feel-bloated-Cramps-The-problem-BRAIN.html
http://www.dailymail.co.uk/health/article-1313821/For-TEN-YEARS-Lucy-told-worry-stomach-cramps-In-fact-chronic-disease-eating-away-gut.html

Could a laser fat zapper trim 3.5 inches off your waist by New Year?

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IMAGE: SHUTTERSTOCK

I don’t write about beauty stories much – but recently I  received an invite to a press launch that intrigued me.   Would I like to witness a  “live demonstration”  of  the Zerona body contour laser? Er… maybe. Zerona is the latest fat-busting treatment to come out of the USA – non-invasive, painless, it causes no swelling or bruising – and  is especially good for bingo wings (the stubborn arm fat that is the scourge of  women of a certain age).  Its unique selling point is that it is a device for removal of circumferential fat (that means evenly around your waist, hips , thighs or arms), so you’re not left with uneven, lumpy areas. It  literally shrinks your fat cells.

Melissa McCarthy wants it…..

 

More than 600,000 people in the US have already been treated with Zerona and as with most things , what goes down well in the States usually takes off here too, sooner or later. Their marketing guy told me they sponsored the Emmy Awards and their room was full of celebs queuing up for free treatments (although not actually on the night I’m guessing). One of them was Melissa McCarthy (above)  star of the cult  Bridesmaids  2011 movie. The marketing man also  said the treatment is  particularly popular with men and the company is positioning itself in  gyms attached to day spas in the US – apparently because blokes like the idea of combining the fat zapping with exercise ( maybe they’re just in denial though and like to kid themselves it’s just the exercise that has trimmed their waists?).

Is it just lipo  under another name?

If it all sounds  a bit like  a 21st century reinvention of  liposuction – actually it’s not. The problem with liposuction (apparently) is that it can lead to weird , lumpy, disfigurement – you suck out fat in one area and the area looks unnatural and fat clumps around the  sucked-out  area. Liposuction is also an invasive procedure – you have an incision and fat is sucked out .It can give rise to complications – including infections ,  numbness, scarring and in rare cases life threatening thrombosis.Not so with Zerona. Over 600,000 treatments have been completed in the US with no reported adverse events and there’s no recovery time – so you could literally have the treatments in your lunch hour(s).

How strong is the  evidence?

Another thing caught my eye. Zerona  is the first body sculpting  ‘ cool’ laser to be cleared by the US Food and Drug Administration .To get this approval by the FDA, the cool laser actually had to undergo  a randomised double-blind clinical trial (as you know  this is the best quality research evidence as it compares interventions with having no treatment and patients don’t know if they are having the real thing or a fake treatment). I took a look at the study – published in 2009. There were only 67 participants admittedly, but of those 35 had active treatment with Zerona and 32 were randomised to the sham treatment.  All the participants agreed to make no changes to their diets or exercise regime for the duration of their two weeks of treatment. The researchers concluded that Zerona was  effective at removing 3.5 inches of circumferential fat on three areas – the waist, hips , and the thighs – compared with only 0.684  of an inch loss in the sham group who didn’t have Zerona but a fake treatment. This was achieved in two weeks – which sounds impressive.  I have read one blog from an American plastic surgeon which is sceptical about the paper to say the least though.The company have 17 other clinical papers  published in peer-reviewed journals too (I haven’t read them all, though).

The cynic in me though, is asking is it just a temporary effect, similar to those funny body wrap things in beauty parlours which draw out water and make you look less bloated for a few days – just so you can look slimmer for a wedding or party? Well, the research did find that after two weeks the participants who’d had the Zerona treatment had regained 0.31 inches on all three sites – so clearly it’s not a totally permanent solution. I’d be interested in the long-term follow-up  figures to see if those inches remain off for six or 12 months  or more .If they do  I can see there would be some eager takers for it in the UK.

What’s the science behind it then?

The laser triggers a photochemical reaction which causes the  fat within fat cells to melt and then the fat is released through a pore in the cell created by the laser and then eliminated by the body (you’re  advised to drink lots of water to help flush out the by  products).

UK plastic surgeon Mr  Christopher Inglefield from the London Bridge  Plastic Surgery and Aesthetic Clinic describes it as a “natural biological reaction in the fat cell” – and is offering it at his clinic (it’s also available at Urban Retreat in Harrods). In the UK the treatment is being licensed for use under medical supervision only. He predicts that devices such as Zerona which complement natural science are the future of medical aesthetic procedures.

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                                                                The Zerona  laser in action

Who does it work best for?

The experts say Zerona is best for  people  of average weight who have stubborn areas of fat they have  found hard to shift. Think post-baby tummy weight for example, love handles, bra strap fat bulge,post menopause thick waist, lumpy thighs  or bingo wings.They wouldn’t recommend it for people who are gaining weight though.

There are reports that Zerona is even more effective if you combine it with a ketogenic diet (that’s a high fat/low carb /controlled protein diet) and exercise – but that’s hardly a surprise is it?

How many treatments do you need?

This depends on your weight and age; the older and heavier you are the more sessions you’ll need. Zerona say you’ll need six 45 minute treatments over two weeks (a minimum of 72 hours apart). It will cost you between £900 and £1,500 in the UK but you’ll need no time off work for recovery – unlike after some more invasive procedures. You can literally have it done in your lunch hour(s).

If you are obese though it’s likely you’ll need at least 12 treatments – so that’s up to £3,000. You might want to try dieting first and then resort to Zerona if you can’t shift those stubborn wobbly bits… it  would be cheaper.

What of the “live demonstration” I hear you ask? Well, a volunteer laid down in front of 25 journalists at the W Hotel and was dutifully lasered for 45 minutes whilst we talked amongst  ourselves. Allegedly she had “stubborn  post-baby fat” – although I have to say if she did, it was incredibly well hidden. Anyway, it looked painless and dare I say it, quite relaxing. When the PR asked if anyone would like to trial it – everyone raised their hands. Always the acid test. Expect to be reading about it in  all the beauty pages soon ….

Are you allergic to your chicken tikka?

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Britain is a nation of takeaway lovers, and chicken tikka masala is now apparently more popular than roast beef. Until now spice allergies have been comparatively rare – accounting for just  two per cent of food allergies. But now US experts are predicting they could rise as more of us become exposed to spices – in foods, household products and fragrances.

Yorkshire nurse Christine  Caudwell experienced spice allergy at first hand when –  out of the blue – she developed itching and hives after eating her favourite takeaway chicken tikka dopiaza. This was a dish she’d eaten at least once a week for 20 years or more and yet, suddenly in her forties it became a problem . Her allergic reactions became progressively worse until she eventually suffered a life threatening anaphylactic reaction and needed a shot of adrenaline. She was later later diagnosed with allergies to 26 different spices including chilli, turmeric and paprika.You can read more about Christine’s story in my article for the Daily Mail Good Health section http://www.dailymail.co.uk/health/article-2242522/Did-eating-chicken-tikka-deadly-allergy.html

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Avoiding spices

Christine says she now has to follow a restricted diet because spices are added to so many processed foods including sausages, cheesy puffs and even Easter eggs – and often the label does not specify which spices are ingredients.

But if Christine finds it a nightmare to avoid spices though it’s even more difficult for mother of four Nasiba Mansor, a care worker, 42, who is Asian and lives with her husband Ayub, 45, also a care worker in Leeds. Her son Musa, 11, has been having allergic reactions to spices since the age of six and has to avoid the spices she uses daily in family meals.

‘Musa will sometimes beg me for a samosa but if eats one his mouth will instantly start tingling and he will come out  in red hot welts all over this body.  Sometimes his blood pressure drops too. He’s ended up in hospital many times and has to carry an EpiPen because of the risks he faces.

‘He has to eat plain food with no spices – I can’t use anything with spices or artificial flavourings in his meals – and understandably he feels left out. He wants to be like the rest of the family – but if we go to an extended family get together he has to eat his own packed lunch. I make him non spicy versions of Indian dishes – chicken flavoured with lemon juice and coriander rather spices, cheese, roti bread, plain rice and samosas without the spices.

It took Nasiba a year to work out what was triggering Musa’s severe allergic reactions – he had an EpiPen of adrenaline prescribed – but doctors didn’t know what food was responsible for the reactions.

‘Musa’s lips started to swell and tingle one day after we’d just finished a family meal. Then he came out in small red weals which were red hot to the touch.

‘The food did contain spices but nothing we hadn’t eaten before. I couldn’t work out what was wrong – we have no family history of allergies in our family and had no experience of anything like it.

Nasiba took Musa to hospital and he was given anti-histamines and his symptoms died down – but she still worried because she didn’t know what had provoked the reaction.

‘I carried on giving Musa spicy food – it just didn’t occur to me that spices could be causing the reactions. Spice allergy is unheard of in the Asian community so it didn’t enter my head.’

Although skin prick tests didn’t prove positive for an Ig E reaction – Musa’s specialist believes anything that causes his body to heat up triggers his reactions – including spices. He also reacts if he gets hot from exercising or has too many bedclothes on at night.

‘We think its mainly garam masala spice and chilli which trigger his reactions – but as garam masala is a blend of six spices  and each blend is slightly different it’s  almost impossible to isolate which one is responsible.

‘Better food labelling would definitely help me identify which foods are safe for my son to eat. He’s eleven now and wants to be independent and eat out with friends – it is getting so difficult for him.’

Lindsey McManus, deputy chief executive of the charity Allergy UK, says specific spices don’t have to be listed on ingredient lists on food products in the UK.

‘Spices are also used in a wide range of  non food products – for instance cinnmaldehyde the chemical which gives cinnamon its flavour is used in some toothpastes and can cause skin rashes – they  are increasingly very difficult to avoid.

‘As a charity we are constantly campaigning for clearer and more detailed food labelling.’

Why are more of us becoming allergic as adults?

Allergy consultant Dr Pierre Dugue, from the London Bridge Hospital, says adults developing allergies  was unheard of when he left medical school in the 1970s and yet now it is becoming increasingly common. Why? The truth is nobody really knows, although Dr Dugue says it’s probably something to do with the modern Western lifestyle. One theory is that there’s a window in the development of an infant’s immune system when exposure to good old fashioned dirt can help protect against allergies in later life. He says although spice allergy is rare at the moment it is likely that is  under diagnosed because not many people are aware that spices can trigger allergies, and it can be hard to pinpoint which spice exactly is triggering the response.

Christine Caudwell told me she was dying for a curry – but knows that nothing is worth putting her life at risk.  But  thanks to the vagaries of our food labelling regulations – avoiding spices just isn’t that easy.

Now sag aloo and lamb pasanda are as commonplace  as fish and chips and hot dogs in the UK,  it’s something that food manufacturers  might have to  consider a lot more when they  review how specific  ingredients are listed on packaging.

For more information on allergies call Allergy Uk on 01322 619 898 or visit allergyuk.org

5 minutes with Vinnie….

Five minutes – that’s how long I got on the phone  with  footballer-turned-film star VINNIE JONES the other week to talk about his new Staying Alive Heart Start Campaign for the British Heart Foundation.  Not long – but  long enough  though to catch his drift about the importance of learning cardiopulmonary resuscitation (CPR) techniques.

A paramedic once told me that for every minute that passes after someone’s heart has stopped their chances of  survival drop 10 per cent and yet many of us are too terrified of attempting CPR because we’re worried we won’t do it right and will inflict more harm than good, (incidentally I’ve always been shocked to learn that schools aren’t legally obliged to have defibrillators on the premises – although football stadiums and shopping centres are – but that’s a subject for another blog).

What difference does CPR make?

The latest ambulance trust figures, published this month,  reveal that in June 18.5 per cent of witnessed cardiac arrest casualties attended by paramedics survived to leave hospital –  that’s just 58 out of 314 casualties. In May 2011, survival rates peaked at 28 per cent but have since deteriorated and not risen above 20 per cent this year.
 
But teaching CPR to more people can make a big difference. In Seattle, for instance, where over half of the population are now trained in CPR, survival rates stand at 52 per cent. In some parts of Norway, such as Stavanger where CPR is part of the school curriculum, survival from witnessed shockable cardiac arrest is also as high as 52 per cent.
 
The BHF Campaign is all about persuading people CPR is  dead simple and worth having a go at and you don’t need to do the kiss of life but just concentrate  on chest compressions. It really can save a life.

Last year Vinnie, 47,  starred in a video showing how CPR can be performed  to the beat of the Bee Gees  disco classic Staying Alive – and it received 2.4million views on YouTube. Take a look below.

The BHF say 28 people have contacted them since last year  saying their lives were saved as a direct result of Vinnie’s video – something Vinnie is extremely proud of. He told me: ‘It’s quite incredible – and that’s just the 28 we know about. I actually got to meet three people last month who were each  saved by someone who had watched the video. One man was actually saved twice – once by a friend who performed CPR and by his fiancée when he suffered a second cardiac arrest. He went on to have a heart transplant and is now doing really well which is amazing.’

Alan Linton was saved by his mates when he collapsed on the golf course – they’d seen CPR on Vinnie’s Staying Alive video and remembered to pump the chest to the beat of Staying Alive.

This year’s video features some ‘mini-Vinnies’ –  showing how CPR  really is so simple kids can do it too – got to be worth a shot anyway.

Vinnie’s wife Tania had a heart transplant 25 years  ago so the BHF is a charity close to his heart. He looks after his own heart by having yearly checks (no problems with blood pressure or cholesterol so far he says), ditching “Geezer”  fried food and taking exercise. He says: I’ve always been fit because I was a sportsman and did lots of training – but now I work on action films – I’ve just been filming Tomb with Sylvester Stallone and Arnold Schwarzenegger, which  is due to be released in September 2013 and do my own stunts so it’s very important for me to stay in good condition.

‘I also take long walks – power walking is really effective. I also work out in the gym,  I do some weights, treadmill and boxing. I love to play golf and fish. I’m a very outdoorsy type.’

If you want to find out more about CPR – sign up for a British Heart Foundation Heart Start course http://www.bhf.org.uk/heart-health/how-we-help/training/heartstart-uk.aspx.

How old are YOUR bones?

How old are your bones?

When Conservative MP Sarah Newton, 51, was diagnosed with the fragile bone disease osteoporosis  after falling outside the House of Commons she was stunned.

Mrs Newton had broken her hip in a simple fall and told newspapers how shocked she was to have an “old women’s disease”.

Osteoporosis is a fragile bone disease which can cause the bone structure to become weak and porous, making bone prone to fractures.

Like most people with osteoporosis, Mrs  Newton was only diagnosed after suffering a fall and breaking a bone. It’s a common scenario; most women (and men) diagnosed with osteoporosis in the UK  are over 50, there are three million people with the disease in the UK. Between them they suffer around 230,000 painful fractures every year. There’s no routine screening for osteoporosis in your 50s and beyond  as there is for breast cancer – even though osteoporosis affects such huge numbers.

                       Not just an “old women’s disease”

Fractures mainly happen in the over 65s but  did you know the damage that causes bones to weaken can start years before – even as far back as your teens? And that women in their 20s, 30s, and 40s, can actually have the bone ages of  much older women?

Although the main risk factors for developing osteoporosis are age (one in two women over 50 have the disease), and losing the protection of the bone strengthening hormone oestrogen after the menopause , there are other risk factors too. These include having a mother with a history of hip fracture, suffering fractures yourself from minor falls/incidents, early menopause or hysterectomy, lack of calcium in your diet, vitamin D deficiency, eating disorders , rheumatoid arthritis, side effects of steroid drugs, over training (to the extent that your periods stop), thyroid problems  and  lack of weight-bearing exercise , as well as coeliac  disease.

                                                                                                How old are YOUR bones?

I’ve been writing about the risks  of  developing osteoporosis in  younger women in a feature in today’s Daily Mail Good Health section  http://www.dailymail.co.uk/health/article-2235473/Brittle-bones-Are-bones-older-Brittle-bones-arent-just-problem-old-age-As-women-discovered-damage-start-DECADES-earlier.html We  sent six women in their thirties and forties for a DXA bone scan to test their bone density – and in some cases  got some very surprising results. Three of the women actually turned out  to have  osteopenia – a low bone density condition that can lead to osteoporosis – something they were completely unaware of. All of them said they were  grateful they’d found out now before it was too late to do something about it.

I’m not suggesting  for a minute that  all  healthy younger women start storming  their GP practices demanding bone scans; but greater awareness of the risk factors so you can take  positive steps to strengthen your bones before it’s too late,  is surely a sensible punt.   Consultant rheumatoloigst Dr Alex Brand  from the  NHS Chelsea and Westminster Hospital and  private Lister Hospital , Chelsea, says it’s just like realising you have high cholesterol or high blood pressure in your 40s and  then taking steps to bring both down to prevent heart disease in later life.

How can you strengthen your bones?

Although pre-menopausal women can’t be prescribed bone strengthening drugs – what they can do is take more  weight-bearing exercise (that’s any exercise which supports the weight of your own body and includes brisk  walking, jogging, tennis, aerobics, dancing and lifting weights), to help strengthen their bones.

Younger women can also eat a calcium-rich diet;  calcium is found in milk, yoghurt, cheese, leafy greens, bony fish and dried fruit), stop smoking (which has a toxic effect on bone), moderate their alcohol consumption to within safe limits and make sure they get exposure to the sun to ensure their body makes enough vitamin D ( vital for calcium absorption). They may even consider taking a calcium and vitamin D supplement. If they’ve had a premature menopause or early hysterectomy they can take Hormone Replacement Therapy to strengthen their bone density.

If you’re under 50 and  are worried you have some of the risk factors for osteoporosis though – it’s probably worth checking out this quiz on the National Osteoporosis Society website http://www.nos.org.uk/page.aspx?pid=1157&srcid=263.

If you’re scoring high for risk factors  have a chat with your GP – they now have a computerised  screening tool  called FRAX (http://www.shef.ac.uk/FRAX) developed by the World Health Organisation  and the University of Sheffield ,which calculates your risk of having a fracture within the next 10 years. If your risk score for  a fracture is high you may need a DXA bone density scan.

Bones  get porous as you age … so start taking care of them now.

Click here to read another article I’ve written about osteoporosis http://www.dailymail.co.uk/femail/article-2053545/Fatal-toll-fragile-bones–women-suffer-osteoporosis.html