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Five Questions with Paul Brice, author of COPD Innovative Breathing Techniques

Paul Brice and patients

What was the inspiration behind COPD?

I had been working with COPD patients for nearly 7 years when I first considered writing this book. Initially this was because patients kept on telling me that they felt so much better using the techniques I used, and even people who had previously undertaken pulmonary rehabilitation told me that they had not been shown these exercises before. I did not think I was doing anything special until I researched what other pulmonary rehabilitation programmes delivered to their patients.

Without realising it, the skills and knowledge I had acquired as an athlete and a high-performance sports coach had helped me recognise how to use posture and movement to modify breathing and exercise capacity. I had found a way to communicate this to my patients in what they told me was clear, simple and logical.

I had developed a series of techniques to show my patients how they could use their bodies to breathe in a more natural and relaxed state, and a system to help them become more aware of the things that made them breathe poorly.

Only once patients had become more aware of how they could help themselves to breathe and move comfortably, would I introduce them into what could be called real exercise. The style and the intensity of exercise were staged and the rate of progress depended upon the individual patient.

Patients tell me they appreciate this gradual approach to their treatment, and I reiterate the fact by threatening to break into the song: ‘It ain’t what you do it’s the way that you do it….That’s what gets results!”

I started to write the book aware of the fact that the emphasis on posture and natural breathing meant that other conventional COPD techniques I had been taught were either no longer needed or were no longer relevant. It is with this in mind that I named the programme the ‘Brice Method’. I am very much aware that my method is likely to challenge some aspects of the conventional wisdom of breathing and exercise for COPD patients.

I had to write this book as I am passionate about helping other people with COPD benefit from the simple and effective techniques that my patients have benefitted from.

What was the most challenging part of writing the book?

There were two challenging aspects to writing COPD Innovative breathing techniques.

The first challenge was to ensure that the book was written at a level that would be suitable for patients with COPD, their friends and their families and not at a level for health professionals or practitioners.

When I started out writing the book, I was aware that other health professionals might skim read the book and look for evidence, references and a bibliography at the end of each chapter, all standard practice for medical/ health books. Quickly I realised that referencing the book in this way would make it totally unusable for the people who would gain the most from the book.

I was however, aware that because some of the postural techniques used at the start of the book can so dramatically modify the shape, size and mechanics of the patient’s lungs, there are a number of breathing techniques that follow, which would challenge the standard practice, and might stir up a bit of a furor amongst fellow professionals. In truth, I now welcome that latent debate.

The second challenge was to make patients aware that their COPD may not be the most restrictive health condition that they have. A high percentage of my patients find that once they have modified their postural habits and their breathing techniques, that their lungs are not the limiting factor when it comes to physical activity, but it is another health issue. Arthritis, chronic back or neck pain, acid reflux, shoulder immobility, and poor balance are all issues that can often restrict the patient’s ability to exercise. I believe that relaxed, natural breathing can only be done when the whole body is in a relaxed state and when it is relatively pain free. The unfortunate truth is that moving when you have not exercised in a while is going to be uncomfortable, so there is a section on identifying the difference between discomfort and pain, which is referred to at stages throughout the book.

What has been the most satisfying part of the writing process?

Having spent quite a lot of time on my own writing the book on my apple mac, taking the pictures and working with my daughter Lucy to adapt the images, the most enjoyable part of the book has been witnessing my simple word document morph into what I could recognise as being a proper book.

Before I started the project, I had a vision of how the book would look, and working with the publishing team has been a real eye opener as to the amount of work and expertise that goes into producing a completed book.

Surprisingly, having written the book, it has been particularly rewarding to search the top online book stores and see that the book is ready to order. I have searched for so many books over the years, wanting to learn things from other people, and to be referred to as an author on the likes of Waterstones, Amazon and Foyles will a take a little time getting used to.

What sort of people would benefit from reading the book?

The book is aimed fairly and squarely at the person who has been diagnosed with COPD, or a friend or family member. COPD is an overarching term that comprises many chronic lung conditions such as chronic bronchitis, bronchiectasis and emphysema, plus many more.

In reality there are a large number of people who have problems with their breathing, who might benefit from the techniques used in the book. The techniques are split into specific sections and even if a person has physical imitations that mean they cannot do the more active, later chapters in the book, most people seem to benefit with their breathing with the postural exercises and breathing techniques that make up the first half of the book.

Paul Brice and patients

Try this simple exercise to see if the book might help you.

You sit down comfortably on a dining chair and take a deep breath. If you can listen to where you feel the air going into the chest. If you feel any of the following…..

  • That you have to suck hard to get the air in
  • That the breath is short and unsatisfying
  • You cannot feel your chest expand
  • You only feel the air going in the top of your chest
  • You use your shoulders to lift the chest

…then the likelihood is you will get some benefit from the exercises and techniques in the book

I believe that breathing should be as natural and relaxed as possible, and the whole aim of the book is to help anyone with COPD breathe more easily.

How will people benefit from reading the book?

The aim of the book is to help show people with COPD how to get the most out of the lung function that they have remaining.

The book is structured so that the reader can learn what they need to do using a tried and tested step-by-step approach. They are encouraged to take things at their own pace, and only move forwards to the next stage once they feel they have mastered the section before.

Firstly the book shows the reader how they should use their lungs, and help them recognise what bad habits they might have developed that could prevent them from breathing more naturally.

I explain what they need to do to help overcome their bad habits using basic changes to their posture and make them aware of how simple body movements can be sequenced with the breath to help the body find a more natural breathing pattern.

The book explains how you can learn to maintain these new breathing techniques, using a homework plan, these are essentially micro workouts of 4 or 5 exercises that last between 3 and 5 minutes that can be done up to 4 times a day. This is how my patients overcome decade’s worth of inactivity, poor posture and bad breathing patterns within weeks or sometimes within days!

The book then goes on to suggest a range of exercises to improve the readers stamina and strength, whilst explaining what pitfalls to look out for along the way.

There is a landmark test that the reader can take at several stages throughout the book to help them monitor their progress and check that they are on the right path before moving on to the following stages.

If you would like to learn more about COPD, the first chapter of Paul’s book is available to read here

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Thunder Dragon Half Marathon in Bhutan: A recap by Max Tuck

Finish line Thunder Dragon

This post was written by Max Tuck, author of The Fatigue Solution: my astonishing journey from medical write-off to mountains and marathons, published by Hammersmith Health Books. 

“It’s all perfectly runnable.”… or so I was told in the pre-race briefing. And I’m sure it would have been – right up until the time that the Indian tectonic plate smashed into the Eurasian plate 50 million years ago and created the Himalayas.

I consider myself to be a reasonable runner, and I’d put in a hard winter of training in the lead-up to this race, the Thunder Dragon in Bhutan. A week earlier I was competing in a half marathon on the Great Wall of China – 5126 steps into history, and I felt every one of them. I somehow came second in my age category, despite it taking me nearly an hour longer than pretty much every other half marathon I have run, with the 30 degree temperature sapping my energy like you could only imagine.

But the Thunder Dragon – this was something entirely different. At 11 miles, my pace had slowed to a crawl. Perfectly runnable? It might have been for the organiser, a former London Marathon winner in a time of 2 hours 9 minutes. But for me, a recreational runner who 28 years ago had been deemed incurable by the medical profession – this wasn’t running, it was survival. I was at 2500 metres, feeling sick, dizzy and gasping for breath. I poured water over my head so that my mouth could focus solely on the act of breathing. It didn’t help.

My pace slowed to a walk. I faced a long uphill on a stony track at 8200 feet. Hard enough at lower altitudes, the sharp stones particularly cruel for a barefoot runner like me, whose only acclimatisation had been a hike to the famous Tiger’s Nest monastery at 3600 metres two days previously.

Yet somehow I finished, even managing to run the last mile (mainly, I’m sure, because it was downhill). It was the hardest half marathon I had ever done, reflected in my very slow time.

A major surprise came later that day at the prize-giving ceremony. An American runner was announced as the winner of the over 40 age category. “That can’t be right, Max,” she said as she went up to collect her prize. “You were about half an hour ahead of me!”

I smiled and congratulated her. Immediately afterwards, I was announced as the winner of the over 50s age group. We were both amazed – I because I had won my age category in that savage race, and she because she thought I was about 42, not 55. This anti-ageing lifestyle certainly has its benefits!

Max Tuck was in China and Bhutan raising money for Dogs Trust.

See www.justgiving.com/fundraising/maxagainstthewall to donate.

Max’s latest book The Fatigue Solution: my astonishing journey from medical write-off to mountains and marathons, is published by Hammersmith Health Books.

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The Fatigue Solution: From Medical Write-Off to Mountains and Marathons

The Fatigue Solution by Max Tuck

I used to like filling in forms. What could be more satisfying than taking a blank document and experiencing the joy of completing it to someone else’s exacting standards? Does this make me odd? Maybe you’re just not with me on this one. And today, I’ll confess, I’m not feeling the love either. There are so many other things I’d rather be doing on a Saturday afternoon.

The form in question is a visa application to enter the People’s Republic of China. If someone had told me 28 years ago that in May 2018 I would be embarking on my biggest running challenge in years, involving a half marathon on the Great Wall of China, followed by a race of the same distance at altitude in Bhutan in the Himalayas, I would have replied that they were clearly wrong, because I wasn’t expected to live that long. Never mind not only still being alive, but to be taking on that kind of physical challenge? Definitely a case of mistaken identity.

The reason for my disbelief would be simple. In 1990 my body was wasted and exhausted. As a vet, if I’d had a patient with as few white blood cells as I had, I would be looking down a microscope at a blood film to check, because the machine must have got it wrong. My desperately low white blood cell count was mirrored by my startlingly low bodyweight and complete muscle wastage. I was so weak that even getting into my car to drive to work involved significant effort. As for the idea of running races for charity in challenging conditions – forget it.

But here I am. In my book The Fatigue Solution, I explain how I went from medical write-off to mountains and marathons; how I rejected exhaustion and rediscovered life. It sounds like a dramatic turnaround. It certainly was.

What had happened to me? I was overworking myself, never taking breaks, cramming far too much in, never saying no, refusing to give up… and ultimately I lost my most precious possession. No, not my house, my job or my car – my health. You never fully appreciate what you have until you lose it. And at the ripe old age of 27, I lost that completely. It disappeared in a fog of exhaustion, muscle degeneration and viral attack. Hello Epstein-Barr virus and chronic fatigue. Goodbye life.

Or… so the doctors believed, based upon other patients similarly affected. Not me. I’m tough. I’m stubborn. I take huge delight in proving people wrong. As you’ll read in The Fatigue Solution, I never give up. Tell me I’m incurable? I’ll show you. Don’t tell me I can’t.

And prove them wrong I did. Not only am I still alive at the age of 55, I’m thriving. I’m fitter, stronger and have more energy than most 25 year olds (or so my personal trainer tells me anyway). My muscles all came back, and then some. Drastic turnaround? You bet. Was it easy? No. Did it take hard work, dedication and determination? Of course it did. Was it worth it? Hell yes!

The Fatigue Solution by Max Tuck

How, you might wonder, did I do it? After all, if you’re in a similar exhausted situation, running to the next lamp-post might seem impossible. Step by step, that’s how. As I explain throughout The Fatigue Solution, by upgrading every aspect of my lifestyle. By researching and implementing all the factors that are known to make a difference. Applying the information and using it to fuel my recovery, consistently, every day. By believing that I could, and that I was worth it. I did it for me. Armed with the right knowledge and a will to succeed, you can do it too.

There’s now only one thing standing between me and my tough far-eastern running challenge – that wretched visa application form.

Max Tuck’s book The Fatigue Solution: my astonishing journey from medical write-off to mountains and marathons is available in print and e-pub versions from Hammersmith Health Books.

For more information visit www.thefatiguesolution.co.uk

To support Max in her charity fundraising, visit www.maxagainstthewall.com

 

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Natural Health Worldwide’s Registrar system – improving access.

For those of you who have read my previous Blog*, you will understand that the philosophy behind NHW is to connect patients from all around the world with doctors and health care practitioners, also from all around the world. So, a patient in Scotland may connect with a practitioner from Croatia.

Appointments are booked through the website, consultations are carried out by Skype, ‘phone call or email and then patients use NHW’s 5-star rating system to give feedback on their experience. This feedback is public and so informs not only the practitioner where they might improve but also the wider patient population of what their peers think of the practitioner in question. NHW puts the patient back in control of their own healthcare. This really is the path to a patient centred future**

The feedback from some patients has been very humbling. One practitioner recently received this email from a patient:

“Thank you so much for giving me your time and advice. I do appreciate it. It’s like a tangled ball of wool is being straightened out into some order and clarity. The detail in your notes is quite remarkable. You haven’t forgotten one thing we discussed.”

Excluding costs of tests, this patient has so far spent £30.

Dr Sarah Myhill (author of Sustainable Medicine, Diagnosis & Treatment for CFS/ME, Prevent & Cure Diabetes and The PK Cookbook) is the founder of this site and is also an NHW practitioner herself. This site is her gift to the patient community, and in particular, a gift to the ‘forgotten patient community’, those whom, like the patient above, have often been left to their own devices at a time when they feel at their most vulnerable. This site truly is a gift – Dr Myhill has funded the site’s development and its marketing and has simultaneously divested herself of any financial interest in the site.

And now we have a new exciting development – the NHW Consultant-Registrar system. One reason why Dr Myhill wanted to launch NHW was to cater for all those thousands of patients who have approached her for help in the past but who sadly she was unable to accommodate, simply because of time pressure. The NHW Consultant-Registrar is a further mechanism for reaching out to these patients.

This is how it works:

  • An NHW patient is consulting with an NHW practitioner
  • The patient and practitioner encounter a health issue on which the practitioner has little or no experience or perhaps just feels on shaky ground
  • By mutual consent between the patient and practitioner, the practitioner [the registrar] consults with Dr Myhill [the consultant] about this issue
  • Dr Myhill gives her views to the practitioner FREE OF CHARGE
  • The practitioner gets back to the patient with this advice and they can then carry on with their shared journey of discovery and improving health

As an example, one NHW practitioner recently was taking an initial medical history of a new NHW patient and had identified the following possible areas of concern:

  • Adrenal fatigue
  • Possible thyroid issues
  • Mitochondrial dysfunction
  • Potential workplace poisoning event

Both patient and practitioner agreed to pursue all avenues of concern. However, the practitioner felt that he needed guidance on the potential mitochondrial and workplace poisoning issues. So, by mutual consent, he consulted with Dr Myhill.

The upshot is that, as of now:

  1. The practitioner is helping the patient with her adrenal and thyroid issues
  2. Dr Myhill has referred the patient for a Mitochondrial Function Profile test and also a Comprehensive Toxic Urine test and will interpret both of those tests for the patient

So, this patient now has a ‘health-team’ supporting her and so far, excluding the cost of tests, she has spent £20. Also, in the process, the practitioner consolidates their base of understanding and often learns new techniques and skills. It really is a WIN-WIN.

In summary then, NHW has the aim of bringing high quality, affordable and supported healthcare to those forgotten patients who need it the most, and also to the population in general, with the ‘bolt on’ option of consulting, free or charge, with Dr Myhill via an NHW practitioner.

This really is a patient-centred future for healthcare, with access to health practitioners and lab tests all available at the click of a button, with that button being firmly placed at the end of the PATIENT’S finger.

 

Craig Robinson

 

Please see here for NHW’s Home page – naturalhealthworldwide.com

Please see here for the list of NHW Registrars – https://naturalhealthworldwide.com/news_content.php?chanel=14

References –

*My previous Blog on NHW can be found here – https://www.hammersmithbooks.co.uk/2017/06/22/natural-health-worldwide-changing-healthcare/

**My Blog on Sustainable Medicine can be found here – https://www.hammersmithbooks.co.uk/2015/07/23/sustainable-medicine/

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Sweets, treats and choco-mania

Just because you have diabetes doesn’t mean you have to go without sweets and desserts. My experience is that sweets, chocolate, ice cream and other treats can be included in a healthy diet that still allows you to keep your blood glucose under control. For instance, when I went on holiday to Cornwall at Easter, I was able to have an ice cream in Padstow because I was about to cycle back along the Camel Trail. And, at my friend’s birthday party, I was allowed a slice of birthday cake because I had an extra unit of insulin to deal with it. And, every so often, a cake or choc ice after dinner is not a problem at all.

Everyone knows that sweets aren’t the healthiest thing ever; it would be much easier if we all craved broccoli and Brussels sprouts rather than choccies and sugar-coated E-numbers. Sweets may be a totally delicious treat, but they’re full of sugar. And – for everyone, not just people with diabetes – too much sugar is bad.

So, how do you eat sweets and treats and avoid hypers? It’s simple. Try to save sweets for after lunch or dinner, because this way the starch in your other food slows down the sugar in the sweets, and the effect on your blood glucose is much less. Also, think about the types of sweets you eat. Chewing gum and chocolate are far better for your blood sugar than sherbet or lollipops. This is because the sugar in chewing gum is released from the gum slowly (that’s how it keeps its flavour) and the fat in chocolate slows down the emptying of the stomach so that the sugar gets into your system more gradually; whereas sherbet and lollipops are both virtually pure sugar, which doesn’t have to be broken down or refined once inside the body, so it can get into the bloodstream straight away. Another way to enjoy sweets and chocolates is by eating them whilst you are playing sport, doing other exercise or taking part in a P.E. lesson.

So being diabetic doesn’t mean you can’t have sweets or desserts, but you do have to think about their effect on your blood sugar, and there are instances where eating sweets would just be out of the question (for instance if you are hyper). It can be really annoying, and as ridiculous as it sounds, it can become a kind of psychological barrier. I’ve experienced this myself.

A couple of months after I was diagnosed, I was starting to become used to the idea that I had a condition that would not go away. It was hard to get it into my head, though, that I’d have to have injections every day just to stay alive. I used to get upset almost every time I did my Lantus (glargine), then get angry with myself for being so miserable, and try to justify my anger by thinking up all the things I hated about diabetes: I had to stick needles in myself every mealtime, which hurt; I was always going hypo or hyper and it made me feel ill; I was constantly having to worry about my blood sugar and I could never just go and help myself to sweets or chocolate.
I told Mom about the way that I felt so angry a lot of the time. “Think about it,” she said, “What are you actually missing out on? Is there actually anything you used to do that you can’t do any more?”

There was only one thing I could think of: I couldn’t just have sweets whenever I felt like it. I picked up on this and felt really annoyed about it. It may seem like a really sad thing if you’ve never experienced this yourself, but I became practically obsessed with chocolate.

Dad tried to rationalise it by pointing out that I wouldn’t be allowed to just go and help myself to sweets whenever I wanted to anyway. It didn’t make a bit of difference, though. The thing is, I wouldn’t be allowed, but I could have. Now not only would I get in to trouble for gorging on sweets, but it would actually make me ill. And there was no point in arguing that I’d still feel sick after eating loads of chocolate anyway – I may have felt sick but I wouldn’t have actually been medically ill. Now I would be.

I decided that this was the thing that diabetes actually stopped me from doing and quickly became fixated on sweets and chocolate; I used to feel depressed if I missed a P.E. lesson and therefore couldn’t have my chocolate exercise snack, and I used to get what I can only call cravings for sweets. Chocolate, chewing gum, mints, ice cream, even dextrose tablets; as long as I had something sugary to eat I’d be okay. But when I couldn’t have anything sweet I’d get annoyed or upset, and feel like I simply had to have something. I turned to sugar-free gum. I bought massive multipacks of the stuff with my pocket money and often had three or four packs on the go at one time. At my worst point, I was chomping through four pieces of gum daily – and that was on a good day.

The gum worked well, but although I always tried to make sure I was stocked up, I sometimes ran out. I usually managed okay for the day or so until I could go to the shops and buy some more, but sometimes I ended up sneaking an extra exercise snack in P.E., or serving myself slightly more ice cream with dinner than I was supposed to have.

And gum didn’t stop me wanting sweets forever.

Once, I had had a really boring day at school and got home feeling really fed up. I wanted some chocolate – but I knew that I wasn’t supposed to have any between meals. I wanted it anyway, so I tiptoed into the kitchen and took a bag of mini chocolate eggs, rummaged around the bag to find one that had broken in half so that I could just have part of it and not go hyper; then I ate it.

I wanted more. I tipped a few chocolate eggs out into my hand and ate them all in one go. Then, still craving more, I took another few and tried to keep them in my mouth and savour the chocolate. A minute or so later, they’d melted and dissolved. But I still wanted more.

I knew that my brother would be able to tell I’d had some of his sweets if I took any more, so instead I took the packet of dextrose from my blazer pocket and ate a couple of the tablets. I suddenly realised I was going to go really hyper if I didn’t have any extra insulin.

So I found my insulin and injected another half unit. But while I was holding the needle in my stomach I remembered that too much insulin would make me go low, too – and I had no idea how much insulin I needed for what I’d just had because I couldn’t remember how much I’d eaten. I pulled the needle out of my stomach before I’d counted ten seconds. Now I had no idea how much insulin had actually got into me either. I got really upset and into a real panic.
Then Mom and my brother came into the kitchen and I burst out in tears and told my Mom what I’d just done. I knew all along it wasn’t really sensible, but all that had mattered at the time had been that I wanted the chocolate.

Half an hour or so later, my blood sugar went up a bit to about 13 mmol/l, but it came down quickly, dropping to 4 mmol/l about another hour on, because of the insulin peaking. I had a snack at this point and then my blood sugar stayed okay for the rest of the day.

After this experience, I started to think that perhaps I had a mental problem or was developing a literal addiction to sugar. I felt really bad about myself and thought I seriously could be going mad. Now I know I wasn’t going mad – I’m sure other people are like this when they feel like they’re not allowed sweets any more…

Unfortunately, there’s no substitute for willpower. The thing that made me stop chewing so much gum was when I was sorting out my bag ready to go on holiday and found that I had (I’m not joking) about six packs of gum on the go. In the cupboard I found a brand new pack that I’d just bought, and I realised just how much I was getting through. I’d also spent most of my pocket money for the last few weeks on chewing gum. I decided it was getting ridiculous and made a pact with myself that I would take one pack, and one pack only, on holiday. I wouldn’t buy any more while I was away, and if I still had some left by the last day, I could keep the rest that I‘d left at home. If I didn’t manage it, I thought, it could possibly mean that I was actually addicted to chewing gum, in which case I would throw away every last piece of gum in the house and never buy any again. I would have to stop the habit.

I did actually manage it. However, when I got back, I’d pretty much stopped feeling like I had to have gum or sweets. I finished off what I had left – but this time it lasted much longer. Since then, I have continued to buy gum, but only occasionally – and because I want to, not because I feel I need it.

If you crave sweets…

  • It’s important to remember that you can still eat sweets. And if you eat only a reasonable amount with meals or exercise, they will cause you no problems.
  • If you’re a chocoholic or have a serious sweet tooth, try sugar-free gum instead of your usual sugary stuff.
  • When you’re out with your friends, you might find it less tempting to eat sweets if you keep a pack of sugar-free gum in your pocket. You can offer it to your friends, too, so you’re not the only one having gum rather than sugary stuff.
  • Bubblegum containing sugar is better than sweets that are swallowed, too, as one piece will not affect your blood sugar nearly so much as a pack of chewy sweets or a tube of sherbet. It also has the advantage that it lasts for longer – a piece of bubblegum can be chewed for an hour or so until it loses its flavour, but a chewy sweet of the same size and weight satisfies your sweet tooth for only a minute or so, and then you want another one.
  • Be aware, though, that most brands of sugar-free gum can cause laxative effects if you get through loads and loads of it, so if you find yourself getting through half a pack every day, try to cut down a bit.

This blog is an extract taken from Fibi Ward’s book, No Added Sugar – A chatty but practical guide to coping with a diagnosis of type 1 diabetes in your teens, by a teenager, for teenagers

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Understanding BRCA: The breast cancer gene

BRCA (pronounced ‘bracka’) stands for BReast CAncer susceptibility gene. There are two BRCA genes – BRCA1 and BRCA2. These genes function as tumour suppressors, helping to prevent the formation of cancer. When either of these genes carries a mutation, a woman has a high risk of developing breast and ovarian cancer, and men with these mutations are also at increased risk of breast and prostate cancer. Mutations in these genes have also been associated with a small increased risk of several additional types of cancer.

At the age of 35, I was found to carry a harmful mutation in the second breast cancer (BRCA2) gene and statistics suggested that I had a 45-85% chance of developing breast cancer and a 10-30% risk of developing ovarian cancer during my lifetime, which is much higher than in the general population.

Finding out that you carry a BRCA mutation is hard, and if this happens to you, you will have a great many questions that you will feel desperate to find the answers to. I felt overwhelmed and scared of the future that lay ahead. I desperately wanted to connect with other women who were going through the same thing as me and to find answers to my many questions. I looked for a BRCA support group locally, but there were none. I also looked for a book but none seemed to offer what I was looking for. I was eager to meet with the consultants that I had been referred to, but this process takes time and it was frustrating waiting for these appointments. I hoped they would be able to answer all of my questions but, in reality, even the consultants didn’t have all the answers as we do not yet fully understand the BRCA genes and their impact.

I felt very frightened, alone and frustrated that there seemed to be so little help and support and I wanted this to change. I decided, therefore, that once I had come through my own journey, I would write a book with the aim of helping others.

This book aims to improve your understanding of BRCA gene mutations and the various ways in which a carrier can manage his/her mutation, including screening, risk-reducing surgery and chemoprevention, with reference to relevant research. In the last part of this book, I share with you my own personal journey of undergoing risk-reducing surgery, including the removal of my ovaries and fallopian tubes (known as a bilateral salpingo-oophorectomy, pronounced oo-for-ek-tuh-mee) and the removal of my breast tissue while retaining my nipples (known as a bilateral, nipple-sparing mastectomy).

I detail, openly and honestly, the emotions I felt before, during and after my surgeries, along with the physical experience of undergoing these operations and the surgically-induced menopause which follows the removal of both ovaries. I will share the effect, if any, that these operations have had on my body image, identity and sexual functioning.

This book aims to answer the many questions that I personally had, including those that you may feel are simply too uncomfortable to ask. I felt anxious about so many things but, having come through my own journey, I realise now that I needn’t have worried anywhere near as much as I did. I really wish I had known then what I know now; it would have spared me a lot of fear and anxiety.

If you have been found to carry a BRCA gene mutation, I hope that by sharing my journey with you, you will see for yourself that this journey, albeit very tough, may not be as terrifying and as insurmountable as you may be feeling right now. You will get through this – I did and you can too. And, while I appreciate you may not be feeling this way now, you may even be nicely surprised by the positive ways in which this journey may change you as a person.

I am an Advanced-level Human Biology teacher and have experience of teaching both GCSE and Advanced-level (A-level) Human Biology. I also have experience of medical writing and have drawn from both of these skills throughout the writing of this book. My desire to help others has inspired me not only to write this book, but also to set up a website to offer my support to women and men worldwide who have been found to carry, or who believe they may carry, a BRCA1 or BRCA2 gene mutation.

 

This blog was taken from Clarissa Foster’s new book Understanding BRCA: Living with the breast cancer gene is now available on the Hammersmith Health Books website.

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Why Diets Fail You

Nowhere is hope over experience more prevalent than in the world of the multimillion-dollar diet industry.

There is a growing amount of evidence suggesting that for many people going on a diet which restricts what you eat as a way of achieving enduring weight loss does not work and is not sustainable in either the mid or long term.

If restrictive or calorie-controlled diets worked, then by now one ‘super diet’ would have emerged and it would work for everyone, but this is definitely not the case. Hundreds of diet books are published every year and no doubt this trend will continue.

Any diet that encourages you to eat fewer calories, or to radically cut out whole food groups, in order to achieve weight loss is scientifically flawed. Denying yourself food to the point of going hungry convinces your subconscious mind that you are living in a time of food shortage or famine and passes messages to your body to hold onto its fat as your mind is not sure for how long the food shortage will continue. As you can imagine, this is counter-productive to good health as the body feels under stress.

If you have dieted in the past, and most people have, your mind will have a ‘memory’ of experiencing those periods of reduced food intake. Periods of self-induced calorie reduction where you experience hunger pangs are very difficult to maintain and are often the trigger for a stint of bingeing or excessive eating. This is what is meant by ‘yo-yo dieting’. Yo-yo dieting like this can negatively affect your metabolism, making it even harder in the future to regulate your weight. If you recognise you have a pattern of dieting and bingeing, then it is even more vital that when you commit to eating real food as part of nutritionally balanced meals that leave you satisfied, and that you do not go hungry, as this will quickly plunge your metabolism back into fat-storing mode.

A holistic, all-body approach to eating real food means that there is no advantage to going hungry or feeling deprived. This approach is diametrically opposed to the usual diet model. In How to Feel Differently about Food, we encourage a way of eating that promotes reassuring your mind that nutritious food is available to you and that your body is no longer under threat of impending food shortage. This reassurance enables habitual stress levels around food to be reduced and when the stress symptoms of emotional eating are reduced, your body reduces its production of cortisol – the stress hormone that can also inhibit weight loss. Feeling less stressed also ensures that the nourishment in the foods that are eaten becomes more ‘bio-available’ and advantageous. Later in the book we explain how stress shuts down many of the processes of digestion, leaving sufferers deprived of essential nutrition.

Our methodology promotes resetting your metabolism into fat-burning mode instead of fat-storing mode and this is achieved through selecting appetising and tasty foods that encourage satiety. In addition, this approach HOW TO FEEL DIFFERENTLY ABOUT FOOD 10 focuses on the effect of refined sugar as a key cause of weight gain. Sugar and simple carbohydrates are rapidly absorbed into your bloodstream and affect your body’s production of insulin. Rapid spikes in blood sugar cause insulin levels to rise and take sugar out of the bloodstream and into storage in the liver, muscles and (if they are full) fat cells; the high glucose level is therefore followed by a rapid drop in blood glucose levels. This in itself can be the cause of sugar cravings and the trigger for compulsive eating. The cumulative effect of eating in ways that spike insulin production eventually leads to what is called ‘insulin resistance’. This is a condition in which the cells of the body become unresponsive to increasingly high levels of insulin and this is a key predictor of diabetes.

The latest figures from the Centers for Disease Control (CDC, 2014) in the US show that almost 10 per cent of the US population has been diagnosed with diabetes. The equivalent figures from Diabetes UK (2015) show figures approaching 3.5 million in 2015 and all predictions expect these numbers to grow year upon year. In addition, many, many more people the world over have ‘pre-diabetes’ (also known as metabolic syndrome) and remain undiagnosed until their health deteriorates with associated serious health problems – heart, circulation, eyesight and kidney damage – that bring them to medical attention and the confirmation of type 2 diabetes. Going back to health risks associated with being overweight, the incidence of pre-diabetes and diabetes itself is higher in patients who are classed as obese.

There are two other important hormones found to affect a person’s ability to manage his/her weight. The first is called leptin. It is made by fat cells and works to decrease appetite. This can become unbalanced in response to insulin resistance caused by spikes in blood sugar levels. Leptin is responsible for sending messages to your brain that you’ve eaten enough and feel sated. When leptin’s signalling goes awry, the hormone stops being produced so the messages that you have eaten enough are no longer sent, which leads to an inability to determine satiety. This is called ‘leptin resistance’. Medical professionals are now focusing more on the part leptin plays in the development of obesity, and how the hormone responds may actually be the result of obesity.

The second key involved with appetite is called ghrelin and its job is to signal to you that you are hungry. It also influences how quickly you feel hungry again after eating. Ghrelin naturally increases before meal times and is then designed to reduce after eating for around three hours until it once more naturally increases to signal the need to eat again. However, this hormone too can become unbalanced and send hunger signals more frequently, encouraging a reduction in the time between meals or even promoting the habit of constant grazing on food. One way that ghrelin becomes out of balance is through stress, which disturbs sleep patterns. This can affect workers who work unnatural hours such as night shifts. Not getting enough sleep has been shown to increase levels of ghrelin and cause an increase in appetite.

In simple terms, the hormonal responses that help manage appetite and weight are like a house of cards that are all interdependent on each other to maximise your health, weight management and wellbeing. Although designed to be perfectly in balance, a key element that can cause the whole house of cards to collapse is the eating of sugar and simple carbohydrates. It doesn’t take long before sugar spikes begin to undermine the complex hormonal interactions.

The good news is that by reducing stress levels, improving sleep patterns and changing the types of food eaten it is possible to re-calibrate the hormones’ signals to the brain to promote a feeling of fullness and enhanced wellbeing. On the food front this is achieved by cutting out refined sugars, simple carbohydrates and processed foods and replacing them with real foods, including plenty of good fats, such as olive oil, oily fish and nuts that your body can naturally process.

 

This blog was taken from Sally Baker and Liz Hogon’s book How to Feel Differently About Food

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Rethinking Type 2 diabetes

Type 2 diabetes has always been defined by high blood glucose levels. Most people now think of Type 2 as a lifelong battle against high blood glucose levels, usually beginning with tablet treatment, then more tablets, and finally possibly insulin. After twenty years of basic scientific research and some recent clinical trials, we’re now in a good position to understand what drives Type 2 diabetes, and to start using more logical approaches to the basic abnormalities of the condition – and perhaps to change this standard, and feared, course of diabetes towards ever more treatment.

The real problems lie in the liver and pancreas, the two key organs that process our food after it’s absorbed from the intestine. We know that both these organs have been struggling for ages, perhaps as long as 30 years, before the fasting glucose level peeps above 7 mmol/l, the blood glucose definition of diabetes. They’ve been struggling because of overeating, especially carbohydrates. Although they’re robust organs, they weren’t intended to cope with patterns of modern eating, which floods them with food every 4 hours or so during the usual working day, often with snacks between. The liver and probably the pancreas respond to the food-carbohydrate overload by accumulating fat. Eventually the liver can’t store carbohydrate efficiently, and starts breaking it down into glucose again which escapes into the circulation, especially during the night. The pancreas struggles too, by not producing insulin efficiently enough to bring glucose levels promptly down after meals. The heroic liver and pancreas have been battered for years before they finally fail to keep blood glucose levels normal.

Overeating is the problem, but as with most of the population, individuals developing diabetes are usually overweight. But they aren’t necessarily obese. However a combination of genetics and a strong family history of Type 2, low (or high) birth weight, and many other factors, all contribute to their being more easily overloaded with the same amount of food compared with others. Years, before blood glucose levels climb into the diabetic range, important conditions, intimately linked to Type 2 diabetes, can come to light, though they aren’t sufficiently recognised as such: these include fat in the liver that we’ve just mentioned, but also hypertension, gout, polycystic ovarian syndrome in women and obstructive sleep apnoea – all linked to inefficient insulin action and grouped together as the metabolic syndrome. Because we are so focused on blood glucose levels, these conditions are considered separate from Type 2 diabetes: but they are much more sensitive indicators of metabolic abnormality than blood glucose levels, which at this stage are likely to be completely normal.

Recognising that the roots of Type 2 are in our internal organs becoming fat overloaded has stimulated some remarkable research, especially by the team in Newcastle. They stopped thinking about Type 2 as a blood glucose condition, and focused on the liver and pancreas. They used a simple approach. Reduce over-nutrition by restricting calories to 600-800 a day, compared with our usual intake of 2000-2500, see whether fat in the liver and pancreas also reduce, and as a result expect to see blood glucose levels fall, and all the other complicated metabolic blood tests improve as well. As predicted, after 8 weeks of the very low calorie diet, which resulted in about 15 kg weight loss, all the metabolic machinery was rebooted back to near-normality, nobody needed any diabetes medication, and not surprisingly they felt hugely better. Of course, this radical approach didn’t work in everyone, especially if diabetes had been around for a long time, but a recent report found that everything remained stable for at least a year, even when the liquid diet had been replaced by normal food containing the same low calories.

Type 2 diabetes is therefore not a condition of high blood glucose, but one of fat accumulation resulting from long-term overeating that eventually can lead to high glucose levels, by which time the associated high blood pressure and abnormal cholesterol levels may already have caused serious complications – for example heart attack or stroke. Focusing mainly on glucose levels means that we don’t always concentrate on these other factors, which are more important in causing the long-term complications of diabetes.

The second major recent research theme is the type of diet we should adopt. There is no topic more controversial, but there is now encouraging clinical research to guide us. The PREDIMED study showed that a true Mediterranean diet with added extra-virgin olive oil (or nuts) had a huge effect in reducing cardiovascular disease, whether or not you had diabetes. Because most people in this study didn’t have Type 2, there was no particular focus on blood glucose levels, nor actually on weight reduction – but the Mediterranean portfolio reduced the medical complications that really matter – stroke and heart attacks. The earlier DASH diet which has a lot in common with the Mediterranean diet also nicely reduced blood pressure – an opportunity for Type 2s to reduce their blood pressure medication with support from their healthcare team.

Sadly, no individual ‘superfood’ (current hero is the avocado) has any long-term beneficial effects except on the bank balances of people promoting the latest one. Though there’s no shortage of candidate herb and spice extracts that have shown real potential for treating glucose levels in Type 2 they haven’t had big enough trials. Exercise? There’s no doubt that the recommended weekly 2½ hours of moderate exercise improves cardiac and respiratory health, and that after losing weight, this level of exercise might help reduce the tendency to regain weight. Exercise itself doesn’t prevent prediabetes developing into Type 2, and doesn’t help much with weight loss, but fatty liver seems to respond well to structured exercise. Gentle walking is fine for taking in the view, but in clinical trials people with Type 2 needed to do moderate or vigorous exercise to reduce long-term complications of diabetes – and if they managed that, the heart attack rates were much lower.

In summary: too much fat in the liver and pancreas caused by years of food overload can be detected way before blood glucose levels rise to ‘diabetic’ levels, and is associated with the health problems associated with the metabolic syndrome. Weight loss of 15 kg in weight often reverses these abnormalities. We need to focus as much on blood pressure and cholesterol levels to reduce the long-term complications of diabetes as we do on blood glucose measurements. Evidence-based portfolio diets such as the Mediterranean and DASH approaches will reduce diabetes complications: superfoods don’t.

David Levy, physician at the London Diabetes Centre, was formerly consultant physician at Whipps Cross University Hospital (Barts Healthcare NHS Trust) and Honorary Senior Lecturer at Queen Mary University of London. He has written extensively on diabetes for healthcare professionals, most recently the Hands-on Guide to Diabetes Care in Hospital for trainee doctors (Wiley Blackwell, 2016), which was highly commended at the 2016 British Medical Association Book Awards, and the 4th edition of Practical Diabetes Care (Wiley Blackwell, 2018). His book on Type 1 diabetes (Oxford Diabetes Library, Oxford University Press) is now in its 2nd edition (2017). Get Tough With Type 2 Diabetes (Hammersmith Publications) is his second book for people with Type 2 (Available Spring 2018).

 

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The Health Benefits of Going Alcohol Free for Dry January

To coincide with the public health campaign ‘Dry January’, which urges people to abstain from alcohol for 31 days, we bring you three brief extracts from Hammersmith Health Books which touch upon just a few of the reasons for avoiding alcohol:

Drug and alcohol misuse

Drug and alcohol abuse can cause great distress, leading to social isolation, low self-esteem, loss of work or school, and estrangement from family and friends – all events that can build a core of stresses that may lead to suicidal thoughts and contemplation. Substance abuse also can increase impulsiveness and decrease inhibitions, making the teenager more likely to act on suicidal thoughts.

Overcoming Self-Harm and Suicidal Thoughts: A practical guide for the adolescent years
By Liz Quish

Alcohol always leaves an acidic residue in the body and aggravates many conditions. It has no place in the health seeker’s diet. Alcohol has been proven over time to be a potent destroyer of bone structure. Alcoholics have a four-times greater incidence of osteoporosis than the normal population. In addition to rotting the bones, it causes considerable damage to liver and brain cells.

Make no mistake: alcohol is a drug, and a rather dangerous one at that. In addition to destroying liver and brain cells via its breakdown pathway which produces acetaldehyde (chemically similar to formaldehyde), it has been demonstrated to be exceptionally damaging to bone health. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), alcohol interferes with calcium and bone metabolism in several ways. Acute alcohol consumption can lead to a transient parathyroid hormone deficiency and increased urinary calcium excretion, resulting in a loss of calcium from the body.

Love Your Bones: The essential guide to ending osteoporosis and building a healthy skeleton
By Max Tuck

Hazards to Human Health – Alcohol

‘Alcohol’, or rather ethyl alcohol (ethanol), refers to the intoxicating ingredient found in wine, beer and spirits. Alcohol arises naturally from carbohydrates when certain micro-organisms metabolise them in the absence of oxygen, in the process called fermentation.

Recent studies show that moderate use of alcohol, especially red wine due to its reservatrol content, may have a beneficial effect on the coronary artery system. In general, for healthy people, one drink per day for women, and two drinks per day for men, would be the maximum amount of alcohol consumption to be considered moderate. This is pretty impossible to implement, because most people drink for the relaxing effect, which generally takes more than one or two glasses to work.

Nature Cures: The A-Z of ailments and natural foods
By Nat H Hawes

 

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‘Tis the season: Two festive paleo pudding recipes

Festive-paleo-pudding-recipe

Christmas can be a tricky time to try and stay healthy. Author and naturopathic health practitioner Eve Gilmore puts a paleo twist on a couple of classic festive rice pudding recipes, guaranteed to be a favourite with all the family this Christmas.

‘Rice’ pudding with hot cherry sauce

This is a traditional Christmas pudding in Germany and Scandinavia.
Ingredients:
Serves 6–8 depending on the size of your ramekins

  • 2-3 packets konjac ‘rice’ noodles
  • 1½ tins/600 ml/150g coconut cream
  • 1 tsp vanilla extract or seeds from 1 vanilla pod
  • ½ tsp Luo Han Guo, stevia or maple syrup, or 1 dsp Palmyra Jaggery, to sweeten
  • Large bag of fresh cherries, stones removed
  • 1 dsp kuzu

Method:
Rinse and drain the konjac ‘rice’ as directed and place in a serving dish.  Mix the vanilla and sweetener into the coconut cream and stir into the noodles. Place the mixture in the fridge to chill.  Stone the cherries and place them in a saucepan with a little water and sweetener, into which you have stirred enough kuzu to thicken the mixture. Bring to the boil and simmer, stirring occasionally, for 15 minutes, until glazed and thickened. Serve the cold rice pudding in the ramekins and spoon the hot cherry sauce on top.

Aromatic ‘rice’ pudding

Ingredients:
Serves 6

  • 4 packets Miracle Noodles ‘rice’
  • 2 tins/800ml/200g coconut cream
  • Seeds from 10-12 cardamom pods, crushed in a pestle and mortar
  • Seeds from 1 vanilla pod
  • 1 cinnamon stick, broken into three
  • 1 tsp nutmeg
  • 4 free-range egg yolks
  • ½-1tsp Luo Han Guo or stevia,   or 1dsp Palmyra Jaggery or maple syrup, to sweeten
  • Ghee, goat’s butter or coconut oil, to taste – makes it creamy

Method:
Using a heavy-bottomed pan, warm the spices together, including the vanilla seeds but using only half the nutmeg. Whisk the egg yolk, butter, sweetener or stevia, fat, rose water and coconut cream together and add to the spices. Bring to boiling point, stirring until thickened into a custard. Rinse and drain the ‘rice’ and pat dry. Mix the ‘rice’ into the pan.

This extract was taken from “The Urban Caveman” by Eve Gilmore.