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Inflammatory Bowel Disease: The invisible illness

Inflammatory-Bowel-Disease-The-Invisible-Illness

What is inflammatory bowel disease?

Inflammatory bowel disease (IBD) is an umbrella term for diseases which cause either whole or part of the digestive tract to become sore and inflamed. It commonly starts in younger people aged 10 to 40, although younger and older people may be affected too. The two most common types of IBD are Crohn’s disease (CD) and ulcerative colitis (UC); the symptoms for both can be similar but with some distinguishing characteristics. In the 19th and 20th Centuries prevalence of IBD increased with industrialisation and the highest rates in the world are still in developed countries such as the UK, Canada, the USA and Western Europe – although cases are now increasing in China and India.
Crohn’s disease may affect the whole digestive tract from your mouth to your anus; ulcerative colitis affects only the colon. Crohn’s disease can be more serious as it not only affects the lining of the gut but can also extend deeper into the wall of the bowel and this sometimes results in severe complications. Both can be extremely painful and debilitating, leading to weight loss and fatigue, and have a great impact on your quality of life, affecting your ability to digest food and absorb nutrients from it, as well as the frequent trips to the toilet.

Why is IBD increasing?

Studies in the UK have found that the number of children affected by IBD has risen by 15%; in Scotland the number of childhood cases has risen by 76% since 1995, according to research by the University of Edinburgh. Experts are also worried because the average age of onset of symptoms is now much earlier in childhood rather than late teens/early 20s because, as I said before, the symptoms are more severe in childhood.
Although scientists have identified a genetic basis for IBD by pinpointing many different genes, especially the variants in a gene called NOD2 in Crohn’s disease – and a positive family history remains the strongest risk factor for IBD4 – genes are clearly not the whole story. Experts refer to IBD ‘as a complex genetic disorder that is influenced by environmental risk factors’. Certain genes may give you a susceptibility to IBD, but the prevailing theory is that IBD is caused by a combination of genes and exposure to environmental risk factors. It’s the interaction between these environmental risk factors and your normal (nonharmful) gut flora that is believed to lead to an increased immune response which results in chronic inflammation.

What are the symptoms of Crohn’s disease compared to ulcerative colitis?

The short answer is that many of the symptoms overlap (around 10% of IBD sufferers have a mixture of both and this is called indeterminate colitis). There are some key distinguishing characteristics your doctors will be able to tease out – see the table below.

Ulcerative colitis (just affects the colon) Crohn’s disease (can affect the whole gut)
Bloody diarrhoea and colicky abdominal pain, usually before passing a stool Abdominal pain and diarrhoea (sometimes with blood, pus or mucus). Pain is caused when food or faeces build up after eating in an area of the intestine damaged/ narrowed by inflammation
Some of or the whole colon is inflamed/ ulcerated, but other parts of the gut are usually unaffected Patches of the gut are inflamed and ulcers may develop but there are sections that are unaffected. It mainly affects the terminal ileum (the last part of the small intestine). Sometimes Crohn’s only affects the colon
Only affects the lining of the gut Inflammation may be confined to the bowel wall but can sometimes cause deep ulcers which also penetrate deeper through the muscle layers of the bowel wall causing fistulas (an abnormal connection between one area of the body and another). Often these are around the anus. Other complications include scarring and narrowing of the intestines, sometimes leading to blockages
Inflammation is usually continuous from the rectum Inflammation often skips segments of bowel which appear normal
 
Weight loss from inflammation

Weight loss from inflammation and reduced absorption
Tiredness and fatigue (anaemia is common) Tiredness and severe fatigue (anaemia and other deficiencies occur)
Feeling feverish Sometimes fever and night sweats can be caused by abscesses or collections of inflammation
Inflammation can involve the joints, skin, liver and eyes and cause mouth ulcers Inflammatory symptoms are similar to those of UC and may spread to other parts of the body causing mouth ulcers, red eyes, painful joints and rashes

Sources: Core charity and Crohn’s & Colitis UK

More about Crohn’s disease

Crohn’s disease affects around one in 1,000 people and in about one in five cases if you have Crohn’s disease you will have a family member who is also affected.

As discussed in the table above, Crohn’s disease may affect any part of the gut but most commonly causes inflammation in one particular area called the terminal ileum – this is the last section of the small intestine. The first part of the colon, called the caecum and the next, the ascending colon, are often involved. In many people only the colon is affected. Inflammation sometimes skips a segment of gut which is normal, rather than being continuous. Only a few people with Crohn’s will have involvement of the stomach or the upper intestine.
Mild forms of Crohn’s result in patches of inflammation – these look similar to mouth ulcers. In moderate to severe cases the intestine is damaged, and becomes thickened so it blocks the passage of digested food, causing cramp-like pain. Deep ulcers can also penetrate the bowel wall causing infection or even an abscess; this often happens around the anus. It is called a fistula when an inflammatory connection goes through the skin surface, the vagina, the bladder or another part of the bowel. When inflamed tissue heals, scar tissue may form, posing a further risk of blockages in the bowel.

More about ulcerative colitis

Ulcerative colitis is the medical name for when tiny ulcers form on the surface of the lining of the large intestine. It mainly affects the rectum and lower colon, but may affect the whole of the colon. It’s more common than Crohn’s disease, affecting an estimated one in 420 people. It seems to be more common in white people of European descent, particularly among Ashkenazi Jews who originated from Eastern Europe and Russia. It affects non-smokers and ex-smokers more than smokers, although doctors say the risks of smoking still far outweigh the possible benefits so do not take this as a licence to smoke! Men and women are affected by UC in equal numbers.

There are three types of ulcerative colitis:

  • Proctitis. This is where only the rectum is inflamed. Fresh blood in the stools is the main symptom, plus an urgent need for the loo (‘urgency’) and perhaps a feeling that you have not completely emptied your bowels. You may have normal stools, diarrhoea or constipation.
  • Left sided. This is inflammation that starts at the rectum and continues up the left side of the large intestine (the sigmoid and descending colon). Symptoms include passing diarrhoea with blood and pain on the left side of the abdomen, plus an urge to pass a stool even when your bowel is empty.
  • Total colitis. This is sometimes called pan colitis and is when the entire colon is affected to some extent. It causes very frequent bouts of diarrhoea, severe painful stomach cramps, weight loss and often fever and generalised illness.

This extract was taken from What’s Up with your Gut? By Jo Waters and Professor Julian Waters

 

 

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Prevent and Cure Diabetes – The blood-sugar roller coaster

The blood-sugar rollercoaster

Sugar is extremely damaging to the body for many reasons. It is damaging to the body in high levels, it is damaging to the body in low levels, and the swinging of levels between the two is additionally damaging because of the hormonal response to those rapid changes. I call this the blood-sugar rollercoaster – it is often described as a ‘hypoglycaemic tendency’ (‘hypo’ meaning ‘below’, from the Greek) – but it is the whole rollercoaster that causes metabolic havoc – not just the dips. If we constantly eat carbohydrate foods, this is a rollercoaster which just keeps on going, and along with the metabolic havoc, there are associated mood swings which mirror the ride. These emotions are very similar to those documented by Barry Ritholtz, in his financial writings on the rollercoaster ride experienced by investors in risky stocks. People who are regularly feeling these emotions, and in particular are experiencing them cyclically, are most likely already on the blood-sugar rollercoaster: Returning to the medical case in point, in metabolic syndrome and diabetes any or all of the following problems can result. In each case, a description of the problem is followed by symptoms and diseases that may result from that problem, thereby giving clues as to whether this may be an issue in a particular individual.

The financial rollercoaster ride

The blood-sugar rollercoaster

The blood-sugar rollercoaster, as I explained earlier, is my name for the process of rapidly rising levels of blood sugar prompting a release of insulin and the ‘happy’ brain neurotransmitters followed by rapidly falling levels of blood sugar causing a release of adrenaline. This combined effect switches on addiction. Wobbly blood sugar levels are highly damaging because of their hormonal effects. These hormonal effects I suspect relate to the rate at which levels of sugar rise and fall in the bloodstream. As we lose control of our blood sugar, then eating a high-carbohydrate snack or meal will cause blood sugar levels to spike, and as blood sugar levels make this rapid rise there is an outpouring of insulin in order to protect the body from this dangerous (but addictive) sugar spike. Insulin brings the blood sugar level down by shunting it into fat. However, if this occurs quickly, then blood sugar levels fall precipitously and that results in an outpouring of adrenaline. Adrenaline is responsible for all the symptoms that we call ‘hypoglycaemia’.

Hypoglycaemia comes from the Greek words ‘hypo’ meaning low, ‘gly’ meaning sugar and ‘aemia’ meaning blood, and hence has a literal meaning of ‘low sugar blood’.

However, the term hypoglycaemia I suspect is a misnomer that relates to at least two issues. Firstly, adrenaline is released in response to poor fuel delivery (lack of sugar and/or ketones in the bloodstream). This means that, in the keto-adapted, the adrenaline symptoms do not arise because these people can switch into fat burning mode. Secondly, in those who cannot make this switch, it is not just the absolute level of blood sugar that causes the symptoms but also the rate of change; this means that often people who complain of hypoglycaemia wil d their blood sugar level is normal from a ‘snapshot’ blood-sugar test result. What they need is a ‘video’ of their blood sugar level changing over time to make the diagnosis. Consequences of the rollercoaster spikes in insulin and adrenaline include the following:

a.) High levels of insulin put us into a metabolic state of laying down fat, and prevent fat burning – this is the major problem of
metabolic inflexibility. It is almost impossible to lose weight when insulin levels are high. Furthermore this effect can be sustained for hours.

b.) High levels of adrenaline make us anxious, irritable and sleepless. This adrenaline release is a major cause of high blood pressure. Indeed, it astonishes me that doctors appear completely unaware of this link so that hypertension is described as ‘essential’ (of unknown cause) or ‘idiopathic’ (again, of unknown cause). They may accurately describe it as due to ‘stress’, but fail to realise the cause of this stress is actually nutritional stress due to loss of control of blood sugar levels.

Sugar has immediate effects on the brain, by various mechanisms, and this is partly responsible for why sugar is so addictive. For people who have lost control of their blood sugar, in the very short term, a carbohydrate rush, or ‘hit’, will have a calming effect which allows them to concentrate. Inspector Morse used the carbohydrate hit of a pint of beer to solve his murder mysteries – but ended up diabetic and died prematurely. Falstaff too found that alcohol had an inspirational effect.

‘It ascends me into the brain, dries me there all the foolish and dull and crudy vapours which environ it, makes it apprehensive, quick, forgetive, full of nimble, fiery, and delectable shapes, which delivered o’er to the voice, the tongue, which is the birth, becomes excellent wit.’  Act IV scene iii of Henry IV, Part 2 William Shakespeare (1564–1616)

Any parent will report how their child’s behaviour changes abruptly with a sugar hit and, much more noticeably, when blood sugar dives and they become irritable and moody. My daughters were often tired and irritable when they came in from school – it was not until supper that their normal good humour and energy were restored.

Problems with sugar – hyperglycaemia

Symptoms of blood sugar rising rapidly (due to the sugar hit and insulin) Diseases of blood sugar rising rapidly (due to the sugar hit and insulin)
Brain function improves – better concentration, feel calm, relief from depression.
Satiety
Triglycerides in the blood are high as insulin shunts excessive sugar into fat. 
Obesity and Inability to lose weight. (It is important to recognise that obesity is not the cause of diabetes but may be a symptom of metabolic syndrome – indeed, many people with normal weight have metabolic syndrome and diabetes.)

Problems with sugar – the rollercoaster

Symptoms of blood sugar falling rapidly (due to adrenaline release) Diseases of blood sugar falling rapidly (due to adrenaline release)
Acute anxiety and low mood.
Panic attacks.
Insomnia.
Shaking.
Palpitations.
Fearfulness.
Hunger and intense desire to eat.
Weakness.
High blood pressure.
 
Chronic high blood pressure.
Premenstrual tension.
Chronic anxiety.
Depression.
Eating disorders (anorexia and bulimia). Obsessive compulsive disorders.
Increased tendency to addiction – caffeine, chocolate, nicotine, cannabis, ‘social highs’, gambling, sexual perversions, exercise.

You will again see the similarities between the mood changes here and those noted by Barry Ritholtz in his financial writings on the rollercoaster ride experienced by investors in risky stocks.

This extract was taken from Prevent and Cure Diabetes: Delicious Diets, Not Dangerous Drugs by Dr Sarah Myhill.

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The reasons behind Male Anorexia

The reasons behind male anorexia

Although the risk of anorexia nervosa is higher in females, boys and men are not immune. Interestingly, atypical eating disorders, such as ‘selective eating’ (very limited food choices) are more common in boys than girls before puberty. These are often related to developmental disorders, such as autism spectrum disorders, or to severe anxiety. However, very few of these eating problems develop into anorexia nervosa after puberty.

About 10% of people with anorexia known to health services are male. On the other hand, large community-based epidemiological studies have recently shown that as many as 30% of participants reporting a lifetime history of anorexia were male, but only a minority sought treatment. Eating disorders are associated with women and this may be an impediment to seeking treatment for men. John Prescott’s disclosure of his bulimia could be a typical example of this situation.

However, even if as many as 30% of sufferers were male, the imbalance towards the female sex is most extreme amongst psychiatric disorders. Interestingly, there is some evidence that homosexuality/bisexuality is a specific risk factor for eating disorders (particularly bulimia) in males. According to a recent study, attending a gay recreational group is significantly related to eating disorder prevalence in gay and bisexual men. The reason for the higher prevalence in non-heterosexual males is unknown at present. In some cases, the drive for weight loss may be an expression of the rejection of male sexuality, such as in men with gender identity disorders.

The motivation for initial weight loss is usually different for men than for women. Preoccupation with a muscular but ‘fat-free’ body is more common, sometimes resulting in excessive exercise and steroid abuse. This is consistent with male sexual attractiveness, but paradoxically, these strategies damage normal sexual functioning. Biologically, abnormally low weight does not allow muscle building, not just because of lack of nutrients, but also because testosterone levels fall during starvation. The low testosterone does not just affect libido and sexual performance, but also the body’s ability to build muscles. Steroids illicitly used for muscle building also interfere with normal sex hormone production, and can be harmful in the long run.

Illicit substance misuse has also been associated with anorexia in males, for a number of reasons. Firstly, amphetamines, heroin and cocaine all reduce appetite. Secondly, some underlying personality traits may present a risk for both conditions.

Research on anorexia in boys and men is limited. This is mainly because only a small proportion of clinic populations are male, so it is very difficult to recruit sufficient numbers of male participants into studies. Furthermore, the majority of research studies concerning anorexia nervosa exclude male patients from recruitment or the analysis in an attempt to keep the methodology simple. The Minnesota Semi-Starvation study, which will be discussed later, included only male participants. Hence, this study has provided invaluable information about the consequences of self-induced starvation in males.

Medical complications are more common in men than women during starvation. However, a recent study in Sweden showed that the long-term recovery rate of men hospitalised for anorexia was good. The same research group has also shown that the outcome of eating disorders in females has improved in Sweden (in contrast to many other countries). These findings may be true only for the Swedish populations, due to the effective screening programmes and early intervention in this country’s highly developed and equitable healthcare system. Finnish researchers also found better outcome for males in terms of weight restoration, but additional psychological problems were common.

 

This extract was taken from Anorexia Nervosa by Dr Agnes Ayton.

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Psoriasis: Natural Remedies

Natural remedies for Psoriasis

Psoriasis is a chronic skin disorder that affects 1% to 3% of the world’s population. It is characterised by periodic flare-ups of well-defined red patches covered by a silvery, flaky scale on the skin and the scalp. There are several variations of psoriasis, but the most common type is chronic plaque psoriasis. The exact cause is unknown, but it is believed that a combination of several factors contributes to the development of this disease. In a normally functioning immune system, white blood cells produce antibodies to foreign invaders such as bacteria and viruses. These white blood cells also produce chemicals that aid in healing and fighting infective agents. With psoriasis, though, special white blood cells called T-cells become overactive; they attack the skin and set off a cascade of events that make the skin cells multiply so fast they start to stack up on the surface of the skin. Normal skin cells form, mature and then are sloughed off every 30 days, but in plaque psoriasis the skin goes through this whole process in three to six days.

DAMAGE
Sometimes an injury to the skin can cause the formation of a psoriasis patch. This is known as the Koebner phenomenon, and it can occur in other skin diseases, such as eczema and lichen planus. It can take two to six weeks for a psoriasis lesion to develop after an injury. Types of damage that can trigger a flare include: abrasion – even mild abrasions; increased friction from clothing or skin rubbing against skin in folds, such as armpits or under breasts; sunburn; viral rashes; drug rashes and weather damage.

DIET
Alcohol, sugar, coffee, fatty meats, refined processed foods, additives and deficiencies in minerals and phytonutrients can induce attacks of psoriasis.

DRUGS THAT CAN INDUCE OR WORSEN PSORIASIS

  • Chloroquine – used to treat or prevent malaria.
  • ACE inhibitors – angiotens in converting enzyme inhibitors, used to treat high blood pressure. Examples include fosinopril, captopril, and lisinopril.
  • Beta-blockers – used to treat high blood pressure. Examples include metoprolol tartrate (Lopressor) and atenolol (Tenormin).
  • Lithium – used to treat bipolar disorder.
  • Indocin – an anti-inflammatory medication used to treat a variety of conditions, including gout and arthritis.

INFECTIONS
Infections caused by bacteria or viruses can cause a psoriasis flare. Streptococcal infections that cause tonsillitis, or strep throat, tooth abscesses, cellulitis, and impetigo, can cause a flare of guttate psoriasis in children. The human immunodeficiency virus (HIV) does not increase the frequency of psoriasis, but it does increase the severity of the disease.

PSYCHOLOGICAL STRESS
This has long been understood as a trigger for psoriasis flares, but scientists are still unclear about exactly how this occurs. Studies do show that not only can a sudden, stressful event trigger a rash to worsen; the daily struggles of life can also trigger a flare. In addition, one study showed that people who were categorised as ‘high worriers’ were almost two times less likely to respond to treatment compared to ‘low worriers’.

WEATHER
Weather is a strong factor in triggering psoriasis. Exposure to direct sunlight, which usually occurs in the warmer months, often improves the rash. On the other hand, cold, short days seen in the winter months can trigger the rash to worsen.

NATURE CURES FOR PSORIASIS
Raw juice therapy can effectively improve psoriasis. The best organic natural foods to juice are: apricot, beetroot, carrot, celery, cucumber, grapes, lemon, spinach and tomato.

EXTERNAL REMEDIES FOR PSORIASIS
The following can be used as external remedies for psoriasis: burdock root, Chinese rhubarb root, egg white (beaten to fluffy stage), mango, oats, parsley, pine needle tea bath and tamanu oil.

 

This extract was taken from Nature Cures by Nat Hawes. Check out her website at http://www.naturecures.co.uk/about.html

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The ‘D’ Word: Rethinking Dementia

When the brain is affected by dementia, logical thinking and reasoning ability are affected quite early on. However, the amygdala – the part of the brain that is the integrative centre for emotions, emotional behaviour, and motivation – is less affected. People with dementia (PwD) who have trouble processing logic and reasoning do not have a similar problem with their ability to feel emotion. Indeed, as far as research can show, people with dementia still feel happy, sad, afraid and so on, even after they can no longer speak or recognise people they know well, even when they need total support to live their lives. It seems, though, that most people – including many well-meaning carers – are unable to adjust their own behaviour and thinking to accommodate the continuance of emotional experience, along with the decrease in reasoning ability of the person they care for.

If someone has a broken leg we do not assume that they could walk on it ‘if they tried’. We do not suggest that they listen very carefully whilst we explain how to walk. We do not try to divert their attention so that they can walk without thinking. No. Instead we set the broken bone and maintain it in position with support (a leg-plaster). We allow them to rest the leg. We give them a crutch to aid movement and we accept that walking will be slow and difficult until the leg is healed. Similarly, if someone has part of their brain which is not functioning we should make allowances. We should try to keep the parts of the brain that do function in as good order as possible – by encouraging social interaction, physical exercise and general health. We should allow the brain to ‘rest’ when it needs to by not demanding actions which are no longer essential. We should supply a ‘crutch’ using memory aids, providing unobtrusive help and support. We accept that everything cannot be as it once was because this brain is not what it once was.

It is important, though, that society should recognise the relative importance of the emotions which come to predominate when logical thought and thought processing are deteriorating. Society in general does not much like domination by the emotions. ‘Civilised’ people should learn to control emotion and apply logic and reason to manage their everyday life, it is thought. But what if we can no longer use our logic and reasoning to help us come to terms with emotions? Suppose we are unable to understand and work out why we feel sad or happy? Imagine if we feel these emotions overwhelmingly, but we are unable to deal with them by a change of scene, by talking through our feelings, by taking actions to alleviate the misery or express the happiness. Imagine being no longer able to speak coherently enough to tell anyone how frightened you feel or how angry. What might you do? How might you try to express yourself? Perhaps you would try to hide somewhere, or to run away and escape. Or you might shout and get angry. Perhaps if no one made any effort to understand, you might try to use physical methods to show them how you feel.

This blog is taken from The ‘D’ Word: Rethinking Dementia by Mary Jordan and Dr Noel Collins

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Back Pain: Myths and Misconceptions

Chapter 4

Myths and Misconceptions

Back pain, as the statistics demonstrate, is extremely common. In the same way that everybody has a view and advice to give on the best way to cope with and eliminate the symptoms of a head cold, personal experiences of back pain also bring forth theories and guidance without necessarily the professional knowledge to support it. From this inevitably grow myths and misconceptions which, although given with good intention, give rise to a great deal of conflicting information and confusion.
There is also much evidence to suggest that the way in which we overwork our spines and the connecting muscles can do us a great deal of harm. Add this to the many misunderstandings about back care and we not only inhibit our ability to recover speedily from injury, but can also subject ourselves to unnecessary weakening of our back muscles. How to assess the risk involved in a manual task and carry it out safely is more fully discussed in Chapter 8; here I will tackle the most common misunderstandings about what is good and bad for backs.

‘Put your back into it’

Seldom do the sayings and proverbs of past generations convey anything but good sound advice but one such phrase, ‘Put your back into it’, can certainly be misinterpreted. This saying might suggest that increasing physical effort by using enormous force to push, pull or lift something, will help the desired task to be better achieved. It is more likely, however, to have the opposite effect and even give you an injury. Its inference, that the spine is always the strongest part of the body, sometimes leads us to undertake physical effort far beyond our safe capability.

The following commonly believed myths and misconceptions lead many of us to take the wrong sort of action. This is usually at a time when we most need to follow the best possible advice.

‘You should sleep on a hard mattress’

How often have we been enticed to purchase an extra firm ‘orthopaedic’ mattress, believing it to be good for our backs? A mattress that is too hard and does not yield slightly to the contours of our spine can put considerable strain on that small area in the lower lumber region which is left with no base on which to rest. The back muscles, when they should be completely relaxed, are therefore given the work of supporting the weight of the lower organs of the body throughout the night. This can result in stiffness and pain in the mornings. A slightly gentler mattress, therefore, will not only provide consistent support along the length of the natural curvature of the spine, but will aid more restful sleep.

It is important when buying a mattress to take plenty of time to try it out for comfort before making your choice. Lie on the bed. All good stores provide shoe protection on their display beds. Mattresses should be neither too hard nor too soft. Slide a hand under the small of your back and feel if there is a gap. Lie on your side or in the position which you normally find most comfortable at night to establish whether the whole line of your body is straight and will be adequately supported during the hours of rest and sleep. A mattress which sags is equally bad for you. Spending many hours curved like the shape of a slice of melon will mean that you will not only start the next day with a stiff, aching back but with lethargy as well from insufficient quality sleep.
It is a very good idea to try a range of beds from different manufacturers before making your choice. A bed should be one of our most important purchases, especially as we spend almost one third of our lives in bed, so don’t be afraid to be fussy. You will be spending many hours of every day either appreciating or regretting your eventual choice.

‘I hurt my back because I got tired’

One fact which often causes surprise is the time of day when you are most likely to strain your back. It is not always in the late evening when you are tired, but more likely to be in the early morning before the muscles have had time to warm up. The pain, however, may not be felt until later in the day or even when you eventually sit down to rest. Unfortunately, before embarking on household tasks or ‘DIY’ jobs, we seldom consider that we should ‘warm up’ our muscles like a sportsman. It may seem a little extreme to be stretching and carrying out a few exercises before hanging wallpaper or digging the garden, but it can be the difference between a successful day and one which results in misery.

‘I’ve put my back out’

Another misconception is that a sudden, severe onset of back pain is always as the result of a ‘slipped disc’. Intervertebral discs do not just carelessly slip out of position and in fact less than 5% of all back pain suffered is the result of a disc becoming displaced or squeezed between the bones of the spine. The vast majority of back pain is caused by the distressing spasm resulting from over-stretched muscles.

However, if the symptoms appear more serious than just muscle spasm with generalised aching, and involve leg pain, severe immobility or numbness/pins and needles down the legs, then the possibility of a prolapsed disc should be considered. This should be examined by a medical practitioner as the situation requires accurate diagnosis before embarking on any programme of rehabilitation. Very occasionally, as the result of severe trauma such as a fall or sporting injury, a fracture dislocation is possible, but this is a matter requiring urgent medical attention.

‘I need to lie on the floor for six weeks’

At one time, when back pain struck, it was common practice to lie on the floor for perhaps up to six weeks, or to go to bed and stay there until the pain subsided. Although initially rest and analgesics (pain-killers) for a day or two will help to relax the injured muscles and relieve spasm, prolonged bed rest has now been proven to worsen the pain and delay recovery. Walking and gentle exercise should be resumed as soon as they can be tolerated. If the spasm is so bad that walking is too painful, frequent stretching and rotation of your ankles will help to stimulate the circulation to your legs and lower part of your body.
‘I’m too young to get back ache’

A popular misconception held by young and fit individuals is that they cannot harm their backs because they are supple and their muscles well-developed. Although youth and fitness are of enormous benefit, nobody can be said to be exempt from a back injury. A single movement repetitively carried out, such as stooping to polish a car, or maintaining an awkward position, for example, sitting slumped in a chair, can bring about the first signs of weakness.

Contrary to common belief, back pain is not infrequent in 30-50 year olds. This is often a time when poor posture and inappropriate lifting techniques which have persisted during the earlier years eventually reveal a physical weakness in the back muscles. Good practice learned in childhood is the best protection against harm. In later years, although natural degenerative processes are responsible for a slight shortening of the spine, reduced muscle tone and decreased bone strength and thickness, elderly people are less likely to over-estimate their ability to move or lift a heavy item. Young men in particular are often reluctant to ask for assistance with a heavy load, perhaps fearing that to do so may appear weak in the presence of their peers.

‘I hurt my back once, so I know it is weak’

Back problems developed in youth or middle age do not have to be an indication that it is the start of a slippery downhill slide into a world of disability, walking sticks or wheelchairs. Strengthening exercises, improved posture and more accurately assessing the tasks to be carried out, will help to prevent recurrence.

‘If I ignore it, it will go away’

Back pain is not something in your imagination or which can easily be ‘worked off’ by persevering with a strenuous physical task. All pain is real and a symptom that something is wrong. By ignoring the pain and continuing with the activity in the hope that eventually it will go away, will more likely exacerbate the problem and delay healing of the strained tissues.

‘An operation is the only answer’

Unfortunately there is no ‘quick fix’ for back pain. Surgery to the back does not guarantee to cure all types of back pain in the long term. Statistics show that up to 30% of patients may suffer in some way from the effects of the surgery or may not even gain adequate relief from their original backache. Your orthopaedic surgeon will discuss both the need and implications of any kind of invasive procedure to make sure that you fully understand the anticipated outcome of such surgery. He will also want to be sure that all other more conservative treatments have been thoroughly explored first.

‘You can see that I am in pain’

There are very few signs, if any, to the casual observer that someone is suffering from constant, nagging back pain. Recovering from back pain can take anything from a few days to several weeks. This sometimes means that sympathy and patience can wear a little thin, even drawing accusations of laziness or being ‘workshy’. Back pain is not, however, a problem that you have to live with. There are many solutions, appropriate to individual circumstances, including both orthodox medical treatments and alternative therapies, which can be very helpful.

Positive conclusion

Back pain that is not actively challenged is unlikely to be a ‘once-in-a-lifetime’ event. It is important to keep that in mind – it is not a myth! However, when life is back to normal and full mobility restored, the whole event and its accompanying misery may be quickly forgotten. Do not drop your guard – it is a recognised fact that following one episode of back pain, you are three to four times more likely to suffer its wrath again. Therefore, as soon as full mobility has been restored is the time to make the conscious decision to improve your everyday posture and lifting techniques. This makes muscle-strengthening exercises (see chapter 12) all the more important to prevent that recurrence. First, however, we will look at the causes of back pain.

This blog is taken from ‘The Smart Guide to Back Care’ by Janet Wakley.

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Diagnosis of diabetes and its precursor, metabolic syndrome

Before getting to the testing stage we can get some very useful clues from a combination of the clinical picture together with commonly done routine tests. However, if you eat what is generally considered a ‘normal, healthy, balanced diet’ (ho! ho!) based on the intellectually risible food pyramid, then it is likely that you have carbohydrate addiction and are on the way to metabolic syndrome and diabetes.

In order of priority and ease, the diagnosis can be made from:

  • The contents of the supermarket trolley
  • Diet
  • Snacking
  • Tendency to go for other addictions
  • Obesity
  • The clinical picture

The contents of the supermarket trolley

  • Bread, biscuits, cake, pasta, cereals, sugar, waffles, bagels, dough nuts and other such
  • Fruit juice, pop, alcohol, “energy” drinks and general junk drinks
  • Fruit basket with tropical sweet fruits such as pineapple, melon, bananas, grapes. Apples and pears
  • Sweet dried fruits – sultanas, raisins, dates
  • Snack foods – cereal bars, ‘energy bars’
  • Sweets, toffees, fudges
  • Honey, fructose, syrups
  • Jams, marmalades, choc spreads
  • Artificial sweeteners
  • Ice creams and puddings, like cheesecakes and trifles
  • Low cocoa-percentage chocolate
  • Crisps, corn snacks, popcorn…you get the idea – we call it junk food!

Such a supermarket trolley is very indicative of a diagnosis of carbohydrate addiction, metabolic syndrome and/or diabetes.

“Indeed, I have just returned from a trip to the supermarket. The man in front was placing his purchases at the check-out. I felt myself sighing as the packets of chocolate biscuits, crisps, white bread and sweet drinks piled up. But what moved me to an intense desire to shout out were the final three items – paracetamol, ibuprofen and a box of antacids. He was poisoning himself with the carbs, then symptom-suppressing with the drugs. Addiction has blinded him to the obvious.”

Diet

Breakfast gives the game away. This is because no food has been consumed overnight and with carbohydrate addiction, blood sugar levels are low in the morning. The need for a carbohydrate-based breakfast indicates metabolic syndrome – typically with consumption of fruit, fruit juice, sweetened tea or coffee, cereals, toast, bread or croissants. ‘Oh, but surely porridge and muesli are OK?’ so many cry. Often they are not OK – the only way to really find out is to measure blood sugar levels.

“Even now my daughters can hear me groaning when the adverts on the telly for breakfast cereals come on. I really cannot stop myself. The Telegraph recently reported that, ‘Children’s breakfast cereals can contain as much as three teaspoons of sugar – the equivalent of two and a half chocolate biscuits,’ and so there are also ‘hidden’ dangers.”

Snacking

The need for a carbohydrate snack or sweet drink is often triggered by falling blood sugar. Many people comment that when they go on holiday and treat themselves to a fry-up for breakfast, they no longer feel hungry before lunch. Snacking is a disaster – it feeds the fermenting mouth and gut, prevents the glycogen sponges squeezing dry, spikes insulin and prevents fat burning.

Carbohydrates with every meal

The symptom of ‘not being satisfied’ with meat and vegetables is particularly indicative of carbohydrate addiction, with the need for a sweet pudding to ‘hit the spot’.

Tendency to go for other addictions

Also highly indicative of carbohydrate addiction is the tendency to have other addictions … such as alcohol, smoking, coffee, chocolate, prescription drugs (yes – many of these are addictive), and ‘legal’ and illegal highs.

Obesity

Obesity is not the cause of metabolic syndrome and diabetes, but may be a symptom of both. Many people with type 2 diabetes have metabolic syndrome and normal weight and vice versa – obese people may have no signs of metabolic syndrome. It is the constant sugar spikes in the portal vein, the effect of which eventually spills over into the systemic (whole body) circulation, when the liver is overwhelmed, this characterises metabolic syndrome and diabetes. We cannot measure these spikes because the portal vein is buried deep in the abdomen and links the gut to the liver. Interestingly, it is the fatty liver which is highly correlated with metabolic syndrome and diabetes – not the fatty rest of the body. Fat in the liver can be measured with MRI scans, but this is an expensive test not routinely available.

The ability to gain and lose weight is an essential survival ploy for all mammals. Think of the hibernating female brown bear who has to survive months of intense cold, pregnancy and breast feeding with no food intake. She achieves this on autumn fat together with the ability to switch into fat burning. She remains completely healthy throughout.

Share your story for Diabetes Week by using the hashtag #knowdiabetes.

This blog was originally published in Prevent and Cure Diabetes: Delicious diets, not dangerous drugs by Dr Sarah Myhill and Craig Robinson.

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A gentle introduction to IBS for IBS Awareness Month

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is an invisible, fluctuating disease and as such it is often difficult for family members, friends, colleagues, health service professionals, welfare insurance administrators and others who encounter people with the disease to understand the suffering of the individual.

People with IBS are often faced with troublesome and sometimes severe physical symptoms that in different ways obstruct or challenge their everyday life. The disease is by its nature potentially shameful. In our modern western society some of our most fundamental bodily functions, like flatulence and defecation, are considered to be private and nothing you would want others to know about. Hence, for many persons with IBS, sharing their illness experience does not come easily.

Among healthcare professionals, knowledge about IBS is quite often insufficient and it is regarded as a low-priority disease. Sometimes IBS patients find that their troubles are dismissed or belittled, for example, in healthcare encounters or by family members. Not being taken seriously – at home or by healthcare professionals – can be a devastating experience which affects self-image. For some people getting the diagnosis is affirming, providing a legitimate passport to the healthcare system. For others, however, being diagnosed means nothing but being a ‘closed-case’, and they feel left with insufficient information, advice and support. They find they have more questions than answers. In the jungle of potential self-management suggestions (available through various websites, blogs and chat forums) about what to eat, when to sleep or how to behave if you get urgent bowel movements and start to panic on the bus, it is easy to get confused. Being on your own, having to figure out how to live the rest of your life with an illness that won’t go away, and a disease for which there is no treatment or clear and certain ‘rules’ to follow but learning to know one’s own body and what works best, is not an easy task.

Literature about IBS has until now tended to be either too medically orientated, complex and difficult for lay people to understand, or to be like a pamphlet, too brief to be useful. Irritable Bowel Syndrome is therefore a very much welcomed contribution for all laypersons – people with IBS, family members, colleagues, neighbours and others who for some reason need to learn more about the disease, what life with IBS is about and what help is out there. The book offers a thorough explanation of the mechanisms and (as far as there is scientific evidence) likely causes of IBS, and of available pharmacological and non-pharmacological treatment options. It also portrays life with the illness from the perspective of those who live with the disease, and linked to this, a variety of self-care strategies are described. The book can of course be read as a whole, but it also forms a very useful reference book for certain aspects or topics of particular interest to the reader. I am certain that anyone who is interested in knowing more, or has specific questions, about IBS will find useful information and answers to their questions.

Cecilia Håkanson RN, PhD is a researcher and senior lecturer at the Palliative Research Centre and the Department of Health Care Sciences at Ersta Sköndal Bräcke University College, Stockholm, Sweden. She is also an affiliated researcher at Karolinska Institutet, Department of Neurobiology, Care Science and Society, in Stockholm, Sweden.

This extract is taken from Irritable Bowel Syndrome: Navigating your way to recovery By Dr Megan Arroll and Professor Christine Dancey

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Eat to beat depression

Eat to beat depression for World Health Day

Tackling depression naturally for World Health Day

Nutrition-related health issues seem to take an age to become part of accepted medical practice. The medical establishment requires comprehensive scientific evaluation, randomised trials and peer review before a new drug can be licensed, for instance. The pharmaceutical company has to weigh up the costs of research and development versus the potential profit to be made from launching a successful product that can earn a good return on their investment. (When you add in the factor that 80 per cent of their budget goes on marketing, it is clear the stakes are high indeed.) As real food is simply real food and can’t be licensed, branded or patented, there is little impetus for the medical community to fund costly research.

Medical research over the last couple of decades has, nevertheless, highlighted how an unhealthy gut can contribute to many physical diseases and these findings are becoming more accepted in mainstream medicine. Clinicians increasingly agree that the gut-brain axis also plays a crucial part in emotional wellbeing, including the development of conditions as diverse as chronic fatigue syndrome, depression and autism.

The Gut-Brain Axis

The gut-brain axis is a way of describing the interrelationship between gut health and brain health. The various aspects of digestion are controlled via the vagus nerves by a complex set of neurons embedded in the oesophagus, stomach, intestines, colon and rectum. The brain sends messages to all the nerves in your body, including the neurons that control digestion. All work efficiently enough until a person is anxious or stressed on an ongoing basis. You perhaps know for yourself that if you are feeling nervous your stomach can feel upset and queasy. The reason for this is that strong negative emotions, stress and anxiety increase cortisol and adrenaline, which then stimulate the sympathetic nervous system and shut down the parasympathetic system, which includes control of the gut. This causes a physical chain reaction:

* Reduction in pancreatic enzyme production

* Reduction in gall bladder function

* Reduction in the production of stomach acid

* Slowing down of peristalsis – the involuntary muscle movements essential for moving food efficiently through intestines for the absorption of nutrients

* Reduction in blood flow to the intestines

* Suppression of the intestinal immune system

In the short term, this allows the body to focus its resources on ‘fight or flight’ – a good survival mechanism. However, with ongoing stress and anxiety, this cumulative slowing down and suppression of the digestive process can, over a prolonged period, lead to a condition called ‘small intestinal bacterial overgrowth’ (SIBO). As the digestive process is compromised by stress and anxiety, the lack of stomach acid allows the stomach and small intestine – which should both be pretty much microbe free – to be colonised by unhealthy bacteria, and yeasts, causing foods to be fermented rather than digested. In addition to gas and bloating, compromised digestion leads to declining absorption of nutrients, which contributes to the loss of the co-factors needed for good digestion, and consequently further gut problems.

Now consider this situation lasting for extended periods of time. The integrity of the gut lining may be compromised, contributing to gut permeability (‘leaky gut’) that may be sufficient to produce chronic low-grade inflammation.

Chronic Inflammation

The inflammatory process includes the production of cytokines, chemical signals of inflammation that are carried by the blood to the brain. The cytokines can activate cells – so that the inflammation originating in the gut thereby causes widespread inflammation in the rest of the body, including the brain.

The impact of brain inflammation is that the brain has reduced nerve conductance which – guess what – shows up as depression, anxiety and stress.

This vicious circle can self-perpetuate and requires long-term changes to heal the gut, which in turn will help to heal the brain. This is done through changes in behaviour and improving levels of nutrition through changes to food choices. To improve your natural resilience to stress it is important to increase the amount of healthy polyunsaturated omega-3 oils in your diet, so look for oily fish, grass-fed meats and butter made from the milk of grass-fed dairy herds. Good plant sources include hemp seeds, linseeds, chia and some nuts and nut oils (macadamia, almond).

If you consider yourself to be depressed it will be helpful for your recovery to manage your stress levels, improve your sleep patterns and add nutritious and gut-healing foods into your regular eating plan.

Do bear in mind, however, that you may also need professional help if you have been suffering from this debilitating psychological disorder for some time. Please make sure you are accessing all the medical and psychological support you need. Try hard not to add isolation to an already challenging situation.

This blog has been taken from How to Feel Differently About Food by Sally Baker & Liz Hogon.

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The Science of Stress Hormones

Stress Awareness Month

Exploring the role of hormones for Stress Awareness Month

There are two main hormones governing the stress reaction: cortisol and adrenaline. They work together to exert the ‘fear, fight or flight’ response that was first described in the scientific literature as long as 1936. This response gives a temporary increase in energy production, at the expense of processes that are not required for immediate survival. The resulting biochemical and hormonal imbalances should ideally resolve as soon as the danger is over, due to a hormonally driven negative feedback loop. The following is a typical example of how the stress response is supposed to operate as a survival mechanism:

* An individual is faced with a stressor

* A complex hormonal cascade ensures, and the adrenals secrete cortisol

* Cortisol prepares the body for a fight-or-flight response by flooding it with glucose, supplying an immediate energy source to large muscles

* Cortisol inhibits insulin production in an attempt to prevent glucose from being stored, favouring its immediate use

* Cortisol narrows the arteries whilst adrenaline increases heart rate, increasing the blood pressure and delivering more oxygen rich blood to the tissues

* The individual addresses and resolves the situation

* Hormone levels return to normal

Unfortunately, with our over-stressed, fast paced lifestyle, our bodies are pumping out cortisol almost constantly, which wreaks havoc on our health. In times of high stress the body will break down amino acids to form glucose through the process of gluconeogenesis (a physiological process via which proteins and amino acids are utilised, instead of glucose), to produce energy. Cortisol is the major stress hormone that promotes this process. Collagen, being a structural tissue made from protein, is one of the target areas for spare amino acids; the muscles are another. Chronically elevated stress levels increase collagen breakdown. Since collagen is the matrix upon which our bones are built, anything that is likely to break it down will have potentially serious consequences for the strength and integrity of the bones.

Cortisol primarily acts on the outer layer of the bone, known as the periosteum. Research has shown that elevated cortisol levels interfere with the formation of osteoblasts and cell proliferation. This dramatically decreases bone building and lowers bone density. Without adequate rest and repair, bone mineralisation and collagen formation will be reduced for the duration of the elevated stress.  The absorption of vitamin D is also adversely affected by high cortisol levels. This gives a double whammy in favour of bone loss.

Stress can rot your bones faster than a can of fizzy drink. Stress and the negative emotions that accompany it have been shown to have a chemical structure in our bodies. And guess what? That chemical structure is acidic! With all the emphasis I place on ensuring appropriate intake of alkaline minerals in earlier chapters, and the fact that increased acidity causes increased urinary calcium excretion, is it any wonder that for prevention and reversal of osteoporosis we absolutely have to take stress reduction seriously?

The power of exercise

My favourite way of combating the stress that often accompanies a bad day at work is to get out and go for a run, or go to a karate class. Both are also excellent ways of not only de-stressing the body but also improving bone strength. Exercise is a surefire way to de-fuse. It boosts the level of endorphins in the brain, morphine-like ‘happy hormones’ which are often depleted by our daily lives. Relaxation classes and guided meditation are well worth doing, as is a meditation based on love and compassion. Thoughts of love and compassion stimulate the production of a hormone called oxytocin, whose effects in the body work in the opposite way to those of cortisol. Oxytocin lowers the blood pressure and relaxes the walls of the arteries.

This blog is taken from Love Your Bones: The essential guide to ending osteoporosis and building a healthy skeleton by Max Tuck.