Spirit level which is level

Why calorie counting does not work

Why calorie counting does not work

The standard exercise myth is that you will lose weight if you eat less and exercise more. That is true to a certain extent especially if you are eating significantly more than your required calories to begin with. But overall it is recipe for failure. Let us see why calorie counting does not work.

1st Law of thermodynamics

The first law of thermodynamics goes something like this:

Perfectly logical so far. ‘Energy in’ is easy, that is the food and drink that you ingest. ‘Energy out’ is quite a different matter. We think of energy out as exercise; something that is within our control. However, 70% of the energy we use daily is actually our Basal Metabolic Rate (BMR) which is not in our control. The other 30% of the energy we use daily is a combination of passive energy use (walking, fidgeting, cleaning) and active energy use (exercise).

Therefore, most of our energy expenditure is not in our control and is the reason why burning a few hundred calories in the gym makes little difference to our weight. In addition, for the rest of the day your body then tries to conserve energy. Read on and you will discover why it makes even less difference than you think.

What decides our obesity risk?

The popular misconception is that fat people are fat because they are lazy and eat too much. In fact, free will or personal choice only accounts for a small percentage of our weight. The obesity risk is:

  • Hereditary predisposition (genes): 75%
  • Free will: 15%
  • Home environment / parental influence: 10%

That means that our genes account for most of our obesity risk. Everybody has a particular body type that we inherited, but a hundred years ago most people were a normal weight. Sure, people would come in a range of sizes but they would mostly be in the normal weight range. Fast-forward to the modern day and again we have a range of sizes but now two-thirds of people are in the overweight and obese range. The genes have not changed in such a short period of time. The only thing that has changed is our environment, especially our food environment, chronic lack of sleep and increasing stress.

BMI Calculator

BMI CALCULATOR

The ideal BMI is between 18.5 and 24.9 for most people.

1st law of thermodynamics is true only for machines

Let us put the energy in and energy out equation to the test.

If we eat 100 kcal more than we need each day (1 banana, or a few plain biscuits, or half a chocolate bar), then after 1 year we would have consumed 365 x 100 = 36,500 kcal extra.

1 Kg of fat = 7,000 kcal

So, we would expect to gain 36,500 divided by 7000 = 5.2 Kg of fat over a 1 year period.

Does that make sense to you? Let me put it another way. If we continue to eat 100 kcal extra for 5 years, then we would gain 26 kg. That is 57.3 lb or 4 stone 1.3 lb. Believe me when I say that does not happen and here is why.

The Vermont Overfeeding Study 1971

Prison volunteers, with the promise of an early release, were overfed in this experiment to reach a 25% increase in their weight over a 3 month period. At the start of the experiment they were eating around 2,200 kcal daily.

The scientists calculated that they would need to feed the prisoners approximately 3,000 – 4,000 kcal daily to help them achieve the 25% weight increase. In fact it took 8,000 – 10,000 kcal per day! Even then, many of the prisoners never managed to achieve the target weight whilst eating such a massive calorie load.

All the subjects returned to their pre-study weigh within 3 months after returning to their previous eating pattern.

A clue to why it took so many calories to achieve the weight gain comes from the observation that the prisoners were hot to the touch. They were literally burning up as their bodies ramped up their Basal Metabolic Rate to try and burn the extra calories. Their metabolic engines were running hot!

The Minnesota Starvation Experiment 1944

Another experiment performed earlier in the last century tried to study how the human body would cope with starvation. The Minnesota Starvation Experiment was performed in conscientious objectors who volunteered to make themselves useful during the Second World War.

The study subjects were fed a calorie-restricted diet of 1,500 kcal daily for 24 weeks. During this time, they lost an average of 25% of their body weight. However, their Basal Metabolic Rate dropped by 50%. Their heartbeat and breathing became slow and they were cool to touch as they had developed low body temperature. They suffered from depression, anxiety, hypochondria, poor concentration, and low libido. Unsurprisingly, they were preoccupied by thinking about food and especially fantasised about high calorie foods. Why would anyone want to this to themselves, but this is what dieters around the world do to themselves every day.

Refeeding of the subjects caused rapid weight gain and overshoot; i.e. they weighed more afterwards than they did to begin with. They lost muscle mass during their weight loss phase but this was never regained. The weight they gained was almost entirely fat.

It is surprising that this study is not more widely publicised. Low calorie diets are harmful. We have known this for more than 70 years. Why are NHS dieticians and diet companies allowed to propagate this disproven method of weight loss?

The weight set point

The two studies above highlight the important principle that the human body is very good at regulating itself, i.e. homeostasis. For example, we do not need to think about regulating the amount of fluid in our bodies. Our thirst mechanism takes care of our fluid intake, and our kidneys remove any excess.

In the same way, our brain has a weight set point which it tries to maintain. This is regulated through our Basal Metabolic Rate. As soon as we start overeating, our BMR speeds up to get rid of the excess. That is why the Vermont study subjects were hot to the touch; their BMR was high. When we reduce our calorie intake to less than we need, then the opposite happens and our BMR immediately slows down to conserve energy. This is why the Minnesota study subjects started feeling cold.

Just like any living organism, the survival instinct is powerful in human beings. Our bodies work hard to maintain homeostasis and try to overcome our efforts to cause imbalance. When we under-eat and lose weight this threatens our survival and our weight then rebounds afterwards. It then settles at a higher weight set point just in case we decide to starve ourselves again. During the weight loss and then weight regain, we lose muscle mass and gain fat. Our BMR, which relies on our muscle mass, then declines and we find it even harder to control our weight in the future.

The result of yo-yo dieting is a progressively higher weight set point and a body composition of more fat and less muscle that makes weight control difficult.

Hormones control our weight

Our weight is controlled, not by calories, but by the interaction of various hormones acting on the weight set point to maintain homeostasis. What disrupts this balance is the obesogenic environment that we live in. When body weight goes over a certain amount then we become insulin and leptin resistant and our brain becomes deaf to the signals that our hormones are trying to give it. We become permanently hungry despite our high intake of calories.

How to normalise weight

The calories in/calories out mantra has been going on so long that people cannot understand how they can possibly lose weight. Calorie restriction involves misery, going against our survival instinct and is unnatural. The best way to normalise weight is to target the weight set point.

That means:

  • Stop counting calories; not only the ones we eat and drink, but also the calories we burn on the treadmill. Our bodies adjust our BMR immediately to conserve energy if we eat too little or exercise too much.
  • Start thinking long term and not day-to-day. Any drastic cut in calories or over-exercising will be seen as a threat to your survival and will raise the weight set point for the future. The weight set point will take time to settle at a lower level, typically months or years depending on how much your weight is out of step with your optimal weight. You did not become overweight overnight and you will not reduce your weight overnight.
  • Eat real food like people used to eat before the processed, high calorie, high sugar, high fat, high salt, and low fibre food revolution came around. Processed food disrupts your normal weight control mechanism. Your body has not evolved to deal with processed food in a healthy way yet.
  • Sleep 8 hours per day. Lack of sleep increases insulin resistance, increases stress and raises your weight set point.
  • Reduce stress. The stress hormone cortisol raises the weight set point.
  • Your body is made to move. Tone your muscles with activities you enjoy (reduces cortisol and increases insulin sensitivity to reduce the weight set point). You do not need to run a marathon.

Some people may be at the point where their metabolism is completely dysfunctional and the will need the help of medication or weight-loss surgery to help them. That typically happens when the BMI goes over 30-35. Their bodies are telling them that they are always hungry despite getting more than adequate calories.

In all cases, it is best to seek the help of a clinician with an interest in obesity in order to get personalised advice and treatment.

Click here to read about weight loss injections

Diagram showing pain within the brain

No painkillers recommended in NICE guidelines for chronic pain

Photo by freestocks on Unsplash

The NICE guidelines on chronic pain NG193 were published in April 2021 and may have left you scratching your head. That is because they do not recommend any painkillers. That means no paracetamol, NSAIDs (e.g. ibuprofen, naproxen) or opioids (e.g. codeine, morphine).

To understand why, you need to understand the phenomenon of chronic pain and how NICE makes its recommendations.

Chronic pain is any pain that has lasted 3 months or more. It does not include acute pain that lasts hours, days or a few weeks. Therefore you can still take painkillers for your headache and sprained ankle, for example. Pain in these cases is a symptom of the underlying problem and when that heals then you can stop your painkillers. Chronic pain is a much more complicated phenomenon and should be seen as a chronic disease that affects not only a particular body part but the whole person including their nervous system and mood.

NICE makes its recommendations based on hard evidence. That means they found absolutely no scientific evidence that showed painkillers were effective in treating chronic pain. In fact, there were numerous studies showing evidence of harm from painkillers including addiction and deaths from opioids such as morphine.

What did NICE recommend?

NICE recommended the following treatments for chronic pain:

  • Exercise programmes and physical activity
  • Psychological therapies such as Cognitive Behavioural Therapy and Acceptance and Commitment Therapy
  • Antidepressants
  • Acupuncture
Acupuncture

Not much has changed

Since the chronic pain guidelines came out 8 months ago medical practice has not changed. That is not surprising since we are in the middle of a global pandemic and the health service has other more pressing issues. However, the NICE guidelines on chronic pain also lay bare the limitations of the current medical system.

Appointments with doctors are difficult to get and are brief when they do manage to get one. Chronic pain is a complex problem and takes time to solve, not 10 minutes that the government gives for a GP consultation. Painkillers are not allowed so what do doctors do. They are only armed with a prescription pad and an exercise sheet that they can print off for patients. They can prescribe antidepressants but many patients are resistant to this approach as they fear that their doctor thinks it is all in their head.

Physiotherapy waiting times are long and done increasingly by telephone or video that patients do not trust. Patients fear movement because it can make their pain worse so are less likely to engage in it. The result is that they become more disabled and their pain becomes worse.

Specialist appointments are even longer and even less likely to result in any successful treatment. However, specialists do an important job in organising tests and scans that a GP does not have access to in order to rule out serious causes of pain. What they rarely offer is cure which is what patients expect from them.

The psychological services have long waiting times that are even longer now during the pandemic as people try to cope with the psychological consequences. To make matters worse, few psychologists specialise in pain psychology. Numerous pain management services across the UK do not even have a pain psychologist so there is essentially zero access to CBT and ACT that NICE have recommended.

That leaves acupuncture. The majority of medical professionals have a strong bias against acupuncture despite strong evidence of its efficacy. That is despite that fact the NICE applied its same rigor to the evidence base. The medical profession are arrogantly continuing to ignore it despite offering ineffectual, non-evidence based therapies themselves for decades. Even if they do overcome their bias there is no way to offer acupuncture under current NHS provisions. As past President of the British Medical Acupuncture Society I have a bias towards acupuncture, We have done our best to give guidance on how best to introduce acupuncture services in the NHS to commissioners.

Where does that leave patients?

Chronic pain is best treated using a holistic framework instead of a hope of cure by a particular medicine or procedure. Patients should co-ordinate their care from a clinician specialising in pain management. They should avoid all habit-forming drugs which do more long-term harm than good. There are many facets of a person’s life that contribute to them suffering from chronic pain and these should each be addressed. Take a look at this video:

coronavirus-covid-19-test tube

Should you have a test for coronavirus (COVID-19)?

coronavirus-covid-19-test

Among the failures of the UK government in handling the COVID-19 pandemic is the lack of testing. Successful countries starting testing right at the beginning of the crisis in combination with contact tracing. We might have been able to lessen the mountain of deaths had we done the same.

Until now, there does not seem to be a sensible policy on COVID-19 testing. The government seems more concerned with showing they have tested a lot of people than actually saving lives. There does not seem to be a plan to use testing as a way of combating the virus.

Types of coronavirus test

There are 2 main types of coronavirus test. The first is the PCR test in which nose and throat swabs are taken. This test is used in people who have symptoms to find out if they currently have the infection. PCR tests are being done at NHS testing centres and community “Hot clinics”. Anyone who has symptoms suspicious of coronavirus should call 111 or their own GP, both of whom can refer to these testing centres.

The second type of test is the IgG antibody test. It tells you if you have had coronavirus infection sometime in the past. The IgG antibody test should be done a minimum of 3 weeks following the start of symptoms or after being in contact with someone suspected of being infected. Antibody levels have been found in one study to start decreasing after 2-3 months.

Most people will have had mild symptoms of coronavirus or no symptoms at all. Testing people with the IgG antibody test can tell people for sure if they have had the infection or not. This may be important for some as a form of reassurance. Past experience shows that having a virus infection does give that person some protection against future infection. However, we do not know for certain if having a coronavirus infection gives people any immunity. If it does provide immunity, then we do not know what level of antibodies is needed to provide protection or how long that will last.

A more important use of COVID-19 IgG antibody test may be to facilitate getting people back to work after self-isolation ends. Employers will therefore be particularly interested in getting their workforce checked.

Reliable coronoavirus tests now available

Fortunately, reliable COVID-19 tests are now available to the public. The most reliable tests are processed in the laboratory after the samples are taken.

You can now order UK MRHA approved and CE marked home coronavirus (COVID-19) antibody test kits online that use a sample of your blood taken through pinprick. The sample is then posted back to the laboratory and results received by email.

Alternatively, you can get a blood sample taken at a private clinic. Two antibody tests are currently approved by the UK government. These are the Abbott and the Roche COVID-19 antibody tests. I am pleased to say that we now offer the Abbott test at Prime Health.

The accuracy of the a test is determined by its specificity and sensitivity. The specificity of the Abbott test is 100%. That means that if you get a positive test, there is little or no chance of it being incorrect. The sensitivity of the Abbott test is 97.5% which means that there is a false negative rate of 2.5%. That is very reasonable for such a test.

Update 15/04/2021

We also now have the Roche COVID-19 antibody test for the ‘s’ or spike antibody which can measure antibodies from people having vaccinations to see if they have been effective.

You can book a test by calling 01932 50499 for an appointment.

How about a vaccine?

I personally had the antibody test a few weeks ago. I thought that I might possibly have been exposed to coronavirus because of the numerous patients I see with coughs and colds. Unfortunately, my test was negative. I guess I will have to wait for the vaccine to come out like everyone else. Preliminary indications are that it will give immunity for at least a few years and gives better protection than having had the infection. In this new and rapidly changing landscape, we shall have to wait and see.

I would also recommend that everyone should have the influenza vaccine this year. The reason for this is to protect people from influenza that has very similar symptoms to COVID-19 infection. New vaccines come out at the beginning of October. Most people with influenza usually manage it by themselves at home. However, any such symptoms may now trigger contact with with the healthcare system. The ideal scenario would be to get vaccinated for influenza and COVID-19 in the same appointment.

I hope that a new COVID-19 vaccination will be available by the Autumn when there is a risk of another wave of infection.

Person sneezing

Hay fever is nothing to sneeze at!

hay-fever
Photo by Edward Jenner from Pexels

Hay fever is nothing to sneeze at!

Hay fever sufferers may have noticed that 2020 has been a particularly bad year for symptoms. This is certainly the first time that I have actually ‘suffered’. In previous years I have had mild symptoms or none at all.

The worsening symptoms are thought to have been caused by the driest May on record. Lockdown has also resulted in car pollution levels becoming very low. Both rain and diesel pollution cause pollen to be pulled down out of the atmosphere. The absence of both has resulted in very high pollen levels.

Hay fever can present with sneezing, a runny nose, itchy eyes and nose, and watery eyes. Some people get severe symptoms such as wheezing and difficulty in breathing especially if they have a history of asthma. That is because hay fever and asthma are strongly related. Hay fever can, in fact, trigger wheezing in the absence of any history of asthma and I have seen many patients with this pattern.

What is the treatment?

Hay fever treatment is generally straightforward. Many people have learned to manage the problem themselves with over-the-counter medication.

Medication falls into 3 main categories:

Antihistamines

Antihistamines are available as syrups for children and tablets for adults. Their advantage is that they can help with both eye and nose symptoms and are easy to take. You can divide them into 2 types; short-acting and long-acting antihistamines.

Short-acting antihistamines typically last 6-8 hours and have to be taken 2-3 times per day to get symptom-relief to last all day. These are the older type of antihistamines and can make you feel drowsy so you should be careful if you are driving or operating machinery. However, the drowsy effect can be helpful at night as it can help you get off to sleep. Examples include:

Chlorphenamine (Piriton): Syrup. Tablets.

Diphenhydramine (Benadryl): Syrup. Tablets.

Long-acting antihistamines typically last the whole day and have the advantage of once daily dosing. In general, they are non-sedating and can even be taken by pilots. Examples include:

Loratadine (Clarityn)

Cetirizine (Piriteze)

Fexofenadine: this is prescription-only

Nasal sprays

Many people do not like the effect of taking syrups and tablets because they have other effects on the body such as drowsiness and lethargy. Steroid nasal sprays offer the advantage of having an effect on the nose without the side-effects on the rest of the body. They can help nasal symptoms such as itching, running, sneezing and blockage. With regular use they also help to control eye symptoms.

Most nasal sprays for hay fever can be bought over-the-counter. These include:

Beconase nasal spray: This needs to be used twice a day.

Pirinase nasal spray: This has the advantage of only needing to be used once daily.

One important thing to note is that a nasal spray is a device and should be used correctly to get the best results. Check out the video below:

Eye drops

Hay fever eye drops are a good option if you only have eye symptoms such as itching and watering. They can also be used if antihistamines or nasal sprays do not give sufficient relief of eye symptoms.

Sodium cromoglycate eye drops: These are the only eye drops available without a prescription.

Sinus rinse

A sinus rinse is not a medication as such. It is a way of treating your nose using a salt solution. Numerous studies have shown that it is effective for reducing symptoms of colds, nasal allergy and sinus symptoms.

A sinus rinse can be used alone or in combination with any of the above treatments that are mentioned. Many of my patients prefer to use it because they can avoid taking medication and they like the fact that it is natural.

It is not known exactly how a sinus rinse works but people think that flushing the nose in this way clears away mucus, pollens and bacteria.

I have found that the easiest to use is Neilmed sinus rinse. It is available for adults and children.

A sinus rinse can take a little getting used to because water is squirted up one nostril and comes down the other. You then change sides. Watch the video below for instructions.

A sinus rinse can be a great natural way to manage nasal symptoms. Once you have the bottle, there is no need to keep buying the sachets as you can make up the mixture yourself using salt and bicarbonate of soda (baking soda) that you can buy from the supermarket. The mixture should contain twice as much salt as baking powder (2:1 mixture). Just make sure that you use boiled water that has been cooled. Click here for a guide from Guy’s and St Thomas’ Hospital.

Some people find it difficult to tolerate a high volume sinus rinse. If so, they might find a saline nasal spray much easier to use. The most popular one is Sterimar.

Combining medications

You may only need eye drops if you have eye symptoms, or a nasal spray if you have nasal symptoms. Antihistamines will treat both eye and nose symptoms and are convenient. Alternatively, you can use a combination of eye drops and a nasal spray.

In severe cases, you can use all three: an antihistamine, a nasal spray and eye drops together although this is rarely needed. Always seek medical advice if you are unsure especially if you have other medical conditions or are taking other medication. In particular, do not use two different antihistamines together unless you have been advised to by a doctor.

Wheezing or difficulty breathing

A minority of hay fever sufferers start to get wheezing or difficulty in breathing as well as the eye or nose symptoms. For some people, wheezing may be the only symptom.

In this case, it is important to seek medical attention. Using an asthma inhaler is often all that is required to relieve the wheezing. This can be used whenever needed and stopped when the hay fever season is over.

Summary

Hay fever can be a troublesome problem and interfere with your day to day activities. Most symptoms can be resolved using one, or a combination of, over-the-counter medications. There are also natural methods, such as using a sinus rinse, that can help. If you are wheezing or short of breath, then always seek medical advice.

pill bottle saying miracle cure

‘Cure’ your high blood pressure

“Cure” your high blood pressure

Can you really “cure” your high blood pressure? Conventional wisdom says not. Once you are taking medication then you are on it for life. But let us step back a little and take stock of the problem.

Life expectancy has gradually increased over the past 100 years. In the past, people had generally shorter lives because of a lack of effective medicine and poor sanitation. They often died from infections especially in early childhood. The discovery of antibiotics and use of childhood vaccinations has changed all that. Improved sanitation and waste disposal was also a major factor in reducing these types of infectious diseases. Modern healthcare with new medicines and surgical techniques means that we do not need to worry about these old causes of death and disease.

However, we now live in a new era of chronic diseases such as high blood pressure, diabetes and heart disease. Even HIV is now a chronic disease instead of the killer it used to be. We manage these conditions rather than cure them. That means life-long medicine for most people affected by them.

Many chronic diseases such as high blood pressure are caused by lifestyle choices which we discussed in the previous section. You can therefore manage them better by improving some of your habits.

However, what if you want to reverse these changes so that you no longer have the disease or need to take medicine? In that case, it follows that you will need to make more dramatic changes. This is because you are not trying to manage something but actually trying to undo all of the unfavourable changes in your body.

Dr Dean Ornish showed that you can reverse heart disease changes with the lifestyle heart trial and the intensive lifestyle trial. The principles he used can also be used to ‘cure’ your high blood pressure. He describes this really well in his book ‘Undo it’ in which he emphasises 4 things:

– Eat well

– Move more

– Stress less

– Love more

Arguably the most important of these is maintaining a healthy diet that is plant-based. I would strongly recommend this book to anyone thinking about making dramatic changes that can actually reverse disease processes.

A plant-based diet

In the previous section you read about the DASH diet. The DASH diet is based on the fact that vegetarian populations have generally better (lower) blood pressure than those consuming a standard Western diet. The DASH researchers assumed that people would not be able to make such a big change to their diet to become completely vegetarian. The DASH diet was therefore a compromise diet which contained elements of both. However, the main effect of the DASH diet is from the addition of fruits and vegetables, not the low fat or white meat.

Does that sound paternalistic? It should do, because that’s exactly what it is. Why not tell people that the best diet for blood pressure is a plant-based diet and then let people make up their own minds? They did not give people a choice.

There is no doubt that changing what you eat is one of the most difficult things you can do. However, it does not need to be done all at once and is easier if done gradually especially if you have been eating one way all your life. Your taste palate changes as you try different foods and become easier the longer that you do it.

Changing what you eat to a more plant-based diet is the most beneficial thing that you can do to improve your health. A number of studies have shown that you do not need a different type of diet for every type of disease. One of the most important of these was The China Study, the biggest nutritional study done in humans. Whether it is high blood pressure, diabetes, heart disease or cancer; in all cases, a plant-based diet is best.

What is a plant-based diet?

A plant-based diet is rich in vegetables and fruits, legumes (beans and pulses), whole grains and nuts/seeds.

Vegetarians and vegans are defined by what they exclude rather than what they include in their diets. A vegetarian does not eat meat or fish. A vegan does not, in addition, eat eggs and dairy products.

However, a plant-based diet is defined by what it includes. So you might be plant-based 60% of the time or 80% or 95%. The main thing is that you are trending in the right direction of eating healthier food. This is not only good for your blood pressure but also for virtually every other disease!

obesity

Weight loss

It is possible to reverse and cure high blood pressure just as it is with type 2 diabetes. I witnessed it myself 15 years ago when I saw the first patients undergo weight-loss surgery. As they lost weight, I had to reduce and stop their blood pressure and diabetes medicines as the underlying disease improved.

Now, I am not advocating that everyone with high blood pressure should have weight-reduction surgery. But it does proves a principle, that weight loss can aid in blood pressure control for those who are overweight.

Changing to an unprocessed, plant-based diet makes weight-loss much easier. That is because processed and animal foods are generally high in calories. You can lose weight without feeling hungry or calorie-counting on a plant-based diet.

natural-remedies

Natural remedies

Many people will advise you to eat this food or that supplement to help your blood pressure. However, occasionally eating certain foods or taking supplements is never going to undo the damage of a bad diet.

The main principle is to eat a healthy plant-based diet to begin with. Then, certain foods can act as the fine tuning to improve your blood pressure further. We have scientific evidence for the following foods.

Eat whole grains

Most people know about the harmful effects of sugar. However, fewer are aware that eating refined carbohydrates is almost just as bad. By this, I mean white bread, white rice and white pasta. Some people have made the switch to wholemeal/brown bread, but much fewer have made the switch to wholegrain rice or pasta.

Why is this important? It is because refining these starchy foods to their ‘white’ form removes all the fibre. Fibre helps to reduce the rate at which the carbohydrates are absorbed into your bloodstream as sugars making it more metabolically healthy.

We have sound evidence that eating 3 portions of whole grains per day reduces heart disease and stroke risk by lowering blood pressure. In fact, it reduces the risk by the same amount as taking blood pressure medicine. Making the switch to whole grain foods is a no-brainer!

Flaxseed

Regular intake of flaxseeds has been shown in one study to improve blood pressure even better than some blood pressure medicines. That is powerful.

Make sure to take them in their ground form. You will need to take 2-4 tablespoons per day.

Hibiscus tea

Hibiscus tea comes from the flower of the same name. It is bright red in colour and has a sharp taste like cranberry.

The beneficial effects of hibiscus tea are thought to come from its strong anti-oxidant content. Studies have shown improvements in cholesterol but the most powerful effect is on reducing blood pressure.

Nitrates

Nitrate medicines are used to open up blood vessels in the treatment of heart disease. However, nitrates are also found in common foods and have been shown in studies to have benefits in lowering blood pressure.

The most useful foods in this category and beetroot and greens.

Beetroot juice has been found to reduce blood pressure within hours and the effect lasts all day. Furthermore, drinking beetroot juice regularly has been shown to continuously improve blood pressure over a number of weeks. The right amount to drink seems to be 125ml per day.

However, beetroot juice might be difficult to find and adds up to quite a lot of beetroot. How about other foods that contain nitrates. It turns out that the leafy greens contain even more nitrates than beetroot with the most being found in rocket. That should not be surprising because we have known for a long time that eating greens reduces risk of heart disease.

For more information on proven natural remedies, I would recommend Dr Michael Greger’s book with the tongue-in-cheek title “How not to die”.

Summary

To reverse the changes in your body that have caused high blood pressure over many years, you will need to make a big effort. The most important thing is to change to a more plant-based diet. After that, certain foods can also help as much or even better than some blood pressure medicines.

sofa-surfing

High blood pressure: Lifestyle changes

sofa-surfing

High blood pressure: Lifestyle changes

High blood pressure is a lifestyle condition

You might be surprised to learn that there is no underlying disease process causing high blood pressure in the vast majority of people. High blood pressure is mostly due to lifestyle factors and this is why doctors call it Essential Hypertension.

Some people also have a family history of high blood pressure and this might increase their susceptibility. At the same time, and contrary to popular belief, our DNA is not our destiny. We inherit not only our parents’ genes, but also their way of living and eating. Lifestyle factors, especially what we eat, have a strong effect on how our genes behave. If you have inherited ‘bad’ genes then it just means that you may have to make bigger changes in your lifestyle.

Medication is the treatment for high blood pressure, but it does not treat the underlying condition. It just treats the symptoms; the high blood pressure. That is why medication needs to be taken life-long to be effective.

If high blood pressure is caused by lifestyle choices, then it makes sense that the solution is to make changes to that lifestyle.

In essence:

Cause = lifestyle choices

Cure = lifestyle change

The DASH diet

DASH stands for Dietary Approaches to Stop Hypertension.

The DASH diet became popular after a number of studies showed that dietary changes can improve people’s blood pressure. The studies were based on the observation that vegetarian communities have the lowest blood pressures of any dietary group. Several studies since then have shown this to be true; i.e. that vegetarian diets are best for blood pressure.

The DASH diet consists of:

– Eating fruit, vegetables and whole grains

– Including fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils

– Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils

– Limiting sugar-sweetened beverages and sweets.

You can find out more written information about the DASH diet here.

Here is a great video which explains what this means in practical terms:

salt

Lay off the salt

Most people know that excessive salt increases your blood pressure. But what is excessive? There are certain limits to salt intake that are advised such as in the DASH diet. However, I would guess that this is too difficult to calculate in real life, not to mention a huge hassle.

Most salt is found in processed foods and these are best avoided for many reasons. The general rule is that you can add a little salt when cooking your food but avoid adding extra at the table.

Exercise regularly

Exercise is medicine and has been proven to reduce blood pressure. Too often, though, the word exercise tends to put people off as they imagine sweaty, muscle-bound men in the gym. Perhaps a better way of putting it might be to become more active or move more.

You do not have to do a great amount of exercise to get benefit. Follow the FITT principles.

– Frequency: Try to be active at least 5 days per week.

– Intensity: Exercise at a ‘moderate’ level. This varies from person to person so try using the ‘talk test’. ‘Moderate’ exercise level means that you will be a little out of breath and will still be able to talk, but will find it difficult to hold a conversation. You can think of it as the pace you might walk if you are late for an appointment. ‘Moderate’ intensity is therefore the same as a brisk walk. If you are exercising too hard, then you will not be able to talk at all. This would be called ‘hard’ and not ‘moderate’ exercise, and is not necessary to get benefit.

– Time: Try and be moderately active for at least 30 minutes per day. This does not have to be all at one time and you can break this up into three 10 minute sessions. There is even an app from the NHS called Active 10 to help you. You do not need to do 10,000 steps as this is a misunderstanding based on a Japanese marketing strategy, and is not based on evidence. The equivalent distance to 10,000 steps is 5 miles for most people. This is difficult to do in a typical working day.

– Type: Aerobic exercise has been studies most in the management of blood pressure. The main principle is that you should use the large muscles in your legs. Examples include brisk walking, swimming, or cycling. If you get bored doing one thing, then try walking or cycling different routes. You can also do different exercises on different days.

Whatever exercise you choose to do, it would be best to do something that you find easy. Too often I have found people starting with long and intense workouts and then stopping completely as their enthusiasm wanes. Start small and do it life-long.

Reduce weight

Diet and exercise are often mentioned in the same breath when talking about weight loss. For some reason, people mainly think of exercise as the main way to reduce weight, and that includes many doctors. Perhaps that is due to all the fitness videos that are advertised in which fat celebrities become slim and toned. They are selling a lie. It is impossible to lose significant weight using exercise alone.

Healthy eating is responsible for 80% of weight loss with exercise contributing the other 20%. A combination of the two is best. Remember that you can out-eat any exercise.

Exercise is great for physical fitness, toning your body and burning calories. However, some people can actually gain weight initially as they gain muscle mass. Increased muscle mass results in a higher metabolic rate. That means you will be burning calories even when you are sedentary.

The most important part of weight loss is healthy eating. That means avoiding sugar and processed foods. This is common to all weight-loss diets. The main thing is to develop good lifelong eating habits.

What usually happens is that people lose weight by being good. They then gain the weight back when they return to the same way of eating that made them overweight in the first place. The best way to lose weight is to make small changes to your diet and make them permanent.

Prohibition

Reduce or stop alcohol

Alcohol increases blood pressure.

The maximum recommended weekly alcohol intake is 14 units for men and women. This limit was designed to reduce heart disease risk. However, there is no safe alcohol limit for cancer.

Alcohol is high in calories. As a rule, we should avoid drinking our calories in order to maintain a healthy weight.

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No smoking

Stop smoking

It should not come as a surprise that smoking causes high blood pressure. This is just one of the many ways in which it increases the risk of heart disease.

There is widespread awareness of the harmful effects of smoking and no need to go into details. It is sad that awareness itself is not enough to stop people from smoking.

‘Cure’ your high blood pressure

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COVID-19 Combat Kit

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Imagine this. You develop a cough and a fever and worry that you have COVID-19 infection. So you call your GP who asks you how high your temperature is. You do not have a thermometer in the house and cannot give a definite answer. You feel hot but do you actually have a fever?

Your GP asks you if you feel short of breath. Your chest does feel a little tight but is that due to the infection or is it because you are feeling a little anxious about having COVID-19?

It has been estimated that 40-70% of us are going to get a COVID-19 infection. All UK GPs have now moved to telephone and video consultations. If you have a cough, fever, runny nose or sore throat, they will not be asking you to attend the clinic for assessment. That means that they cannot make the same accuracy of diagnosis that they are used to when they were able to see patients face to face.

If your symptoms are severe, your GP will ask you to call 111 or go to the Accident and Emergency department of the local hospital. You do not really want to go to the hospital unless you really need to. You will be putting yourself at greater risk of infection and further burdening the health service.

In this situation, having some basic medical devices at home can allow you and your doctor to get a more confident assessment of your condition.

Every house should have a thermometer

A body temperature over 37.5 C (99.5 F) is a fever.

There are a number of thermometers that you can purchase which are inexpensive and will do the job perfectly well.

Ear thermometers

The ear thermometer that you are used to seeing in your GP surgery is used because it has disposable covers. That avoids cross-infection from one patient to another. This type of thermometer can be purchased for home use and can be used for different family members. However, in this crisis it is becoming increasingly difficult to find.

Digital thermometers

A more practical solution may be to use a standard digital thermometer. It is widely available and much more cost-effective for an item that you are going to use only occasionally.

The way to use this thermometer is to place the tip beneath the tongue until it beeps. However, you will need one thermometer for each household member because of the risk of spreading infection.

The other, less reliable method, is to place the tip of the thermometer in the closed armpit. Remember you will need to add 1 C to the reading if you are going to do it this way to get the correct reading.

Forehead thermometers

The infrared forehead thermometers are newcomers to the market and are accurate if used properly. These are the ones that you may have seen used in airports. The are used by scanning people’s foreheads from a distance of a few centimetres.

Advantages are that they can be used for more than one person and can be used in babies

The other type of forehead thermometer is the strip that is used for babies. It works by direct application to the baby’s forehead. The colour change of crystals in the strip tells you the temperature.

Consider getting a pulse oximeter

People who have severe COVID-19 infection get a severe type of chest infection that worsens their breathing. A pulse oximeter is vital to check oxygen levels in the body to assess the severity of that infection. This is more important for people who already have longstanding chest problems such as asthma.

A pulse oximeter is a device that measures the percentage of oxygen in your blood. It also shows your pulse or heart rate.

Everyone should have an oxygen saturation of 100%. However, the standard pulse oximeters only have 2-digits so they will give a maximum reading of 99%.

Normal heart rate is between 60 to 100 per minute.

Adult patients with severe COVID-19 infection will have an oxygen saturation of 93% or less. Their breathing rate (number of breaths per minute) will also be 30 or more per minute. Please note that these figures are different for children and a doctor should be notified more urgently in their case.

Of course, you should not wait until your oxygen saturation reaches such a low level of 93%. You should seek medical attention for any level of 95% or less, or if you feel that your breathing is getting worse.

The price of these devices has also gone up in recent weeks from an average of £35 to ridiculous prices of £90 or more from profiteering. Waiting time for delivery has also gone up.

Most asthma sufferers are already familiar with using peak flow meters to assess their breathing ability. These simple devices can give an indication from day to day if your asthma is deteriorating.

The best way to use a peak flow meter is to check your level when you are feeling well and note it somewhere. Then when your breathing feels worse, you can compare it your normal levels. Click here to read how you can use a peak flow meter effectively.

Paracetamol or ibuprofen?

I was in a supermarket a couple of weeks ago when I came across the over-the-counter medication section. It was completely empty, except for shelves of ibuprofen!

This is another sign of the times and the power of social media. It was after the French health minister made the claim that ibuprofen worsens the condition of COVID-19 patients.

Thankfully, we now have real evidence to the contrary rather than one person’s opinion. King’ College London have conducted research showing that ibuprofen is perfectly safe to use. So you can now go and get some medicine which is in good supply!

Should you be wearing a mask?

At the current time, there is no government advice for everyone to wear a protective mask. Such advice is only for those at high risk such as health and social care workers.

For everyone else, the standard advice remains:

Stay at home

– Only go outside for food, health reasons or work (but only if you cannot work from home)

– If you go out, stay 2 metres (6ft) away from other people at all times

– Wash your hands as soon as you get home

– Do not meet others, even friends or family.

– You can spread the virus even if you don’t have symptoms.

Summary

Many of us are likely to get COVID-19 infection. For most of us, we will get mild to moderate symptoms. Only a minority will get severe infections needing hospital admission. There also a proportion of us who will have infection without any symptoms at all.

Primary care doctors are working remotely so they are not in the best position to assess your symptoms as they used to be. It is, therefore, important that we all take more responsibility for our health. By taking sensible measures we can put ourselves in a better situation to take care of our health in this new environment.

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5 inspiring movies about healthy eating

Photo by Cecilia Par on Unsplash

Most of us have got much more time on our hands as a result of the COVID-19 pandemic. What better use to make of it than to try and improve our health.

How about taking a break from the latest COVID-19 news updates and from binge-watching box-sets. Over the years there have been a number of great documentaries which I have found really inspiring.

The interest in making them has no doubt been triggered by the spiraling rate of obesity, and diabetes in the World. There is certainly no better way to reduce your weight and improve your risk factors for all disease than healthy eating.

Here’s my list of top 5 healthy eating documentaries.

1. Eat, fast and live longer (BBC iPlayer)

We have known for decades that eating less calories makes us live longer!

In this documentary, Dr Michael Mosley travels to USA to see the latest in research about weight reduction and extending lifespan and healthspan. It focuses on different methods of fasting to do this.

Following this trip he wrote about and made famous the 5:2 diet which has become the rage all over the World.

2. The Game Changers (Netflix)

The Game Changers is a professionally-made documentary espousing the benefits of a plant-based diet on elite athletes. It is produced by Jackie Chan, and also Arnold Schwarzenegger who also makes a short appearance.

The documentary is full of interesting facts and dispels some of the myths about the inferiority of plant-based protein compared to animal protein. Did you know that the gladiators ate a mainly plant-based diet? Neither did I.

Well, if it’s good enough for Arnie, then it’s good enough for me.

3. Forks over knives (YouTube)

Forks over knives is the best of the documentaries that show how our current health problems are due to what we view as normal eating.

It features two scientists; Dr Colin Campbell who took part in the longest nutritional study in humans (The China Study); and Dr Caldwell Esselstyn, a cardiac surgeon who showed that you can reverse heart disease by changing your diet.

You would be well-advised to listen to what these gentleman have to say!

4. Super Juice Me! (YouTube)

What happens when you put 8 people with 22 different health conditions on nothing but freshly extracted juice for 28 Days?

Why not find out by watching this very entertaining and inspiring documentary about the benefits of fresh juice on sick individuals.

It is made by the UK juice master Jason Vale and is based on his life experience rather than hard science. Even so, the film is based on sound underlying principles. It gives a message of hope that there is an alternative to medicine to treat chronic disease.

5. How not to die (YouTube)

How not to die is the tongue-in-cheek title to Dr Michael Greger’s book on how to prevent, treat and even reverse chronic disease with a plant-based diet. This video is a presentation that he gave to a medical audience and presents the scientific evidence for his claims.

Michael Greger is an excellent speaker who will entertain you with his banter throughout this presentation. If you want to know the science behind a plant-based diet, then this is the film for you.

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How to manage your blood pressure

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How to manage your blood pressure

You might like to read ‘Blood pressure basics’ before reading this article.

You have been diagnosed with high blood pressure

It is well known that once you start medication for high blood pressure (hypertension), it is usually lifelong. That holds true unless you do something to reverse the underlying cause.

The reason for life-long treatment is to reduce your risk of the complications of high blood pressure. These include heart attack, stroke, kidney damage and worsening of your eye sight. So it is really important to have your blood pressure controlled to avoid premature death and disability.

Medical treatment

Target blood pressure

The aim of treatment is to achieve a clinic blood pressure of 140/90, or a home blood pressure of 135/85 or better. For people aged 80 or more the targets are slightly higher at 150/90 and 145/85 respectively.

Any blood pressure reading of 180/120 or more is potentially dangerous and you should seek urgent medical attention.

Which medicine to start with

Doctors are really good at adjusting medication to normalise your blood pressure. Most of the time this is easy to do.

At the time of writing, there are five main families of medicine that are used to treat high blood pressure. Any of them can be used to start treatment but the current recommendations go something like this:

If you are a diabetic or your age is less than 55, then you should take medicine called an ACE inhibitor. ACE stands for Angiotensin Converting Enzyme. These medicines end in -pril. Examples include ramipril and lisinopril. Sometimes, patients have side-effects with these and they may be changed to a similar medicine called an ARB (Angiotensin Recptor Blocker). These drugs end in -sartan. Examples include losartan and valsartan. Patients taking ACE inhibitors and ARBs should have blood tests for kidney function at regular intervals. The first test is usually 2 weeks after starting the medicine. Your kidney function is then usually tested every 6 months to 1 year once you are on a stable dose.

If your age is 55 or more or you are an Afro-Caribbean, then it would be better to start treatment with a medicine called a calcium-channel blocker. These drugs mostly end in -pine. Examples include amlodipine and felodipine.

Other blood pressure medicines include diuretics (‘water tablets’). Their names usually end in -ide. Examples include bendroflumethazide and indapamide. Regular blood tests to check kidney function are also important if you are taking these as potassium levels may drop.

The 5th family of drugs are called beta-blockers. Their names end in -olol. Examples include bisoprolol and propranolol. Any of these can also be used as first-line medicines to treat high blood pressure. However, nowadays they are mostly used as add-on drugs when the first medicines do not bring the blood pressure into control.

When one drug does not control your blood pressure

There is a tendency for the dose of blood pressure medicine to be increased over time in order to keep your blood pressure under control. Other medicines may also be added over the years. This is more likely to happen if you are not doing enough to change your lifestyle to fix the underlying problem.

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When is the best time to take your blood pressure medicine?

In a word, bedtime!

A large study of 20,000 people showed that taking blood pressure medicine at bedtime gave the best blood pressure control. It also reduces risk of future heart attacks and strokes.

Monitor your blood pressure

Blood pressure is silent

Studies have shown that blood pressure patients think that they can feel symptoms if their blood pressure is high . Common beliefs that people have are that it causes headaches or dizziness. However, we know that high blood pressure causes no symptoms in most people. You cannot feel it. This is important to know because people sometimes stop taking their medicines because they feel okay. Others take medicine only when they feel that it is high.

Once you start taking blood pressure medicine, it is important that you always take it regularly. You may not feel it but constantly high blood pressure is damaging your body without you knowing it.

Get yourself a blood pressure machine

Since you cannot feel high blood pressure it is important to monitor it. Nowadays this is easy to do with the help of modern blood pressure machines. The type of machine you should purchase is discussed in ‘Blood pressure basics’. Click here to take a look.

Monitoring your own blood pressure will give you more awareness and confidence in your blood pressure control. It will also save you trips to see your doctor.

Work with your doctor

Doctors like to check your blood pressure more frequently when they start you on a new medicine, when changing the dose, or when adding more medicines. They check less frequently when you are on a stable combination and dose of drugs. This might typically be every 6 months or once per year.

You can work with your doctor and save yourself the time and effort of attending the clinic by sending in a home blood pressure diary. The clinic can then store the diary in your electronic medical record so that your doctor can view it.

Click here to download a home blood pressure diary.

Medical consultations are being increasingly done over the telephone and by video. You can really make your life more convenient by having the ability to check your own blood pressure. It may save you many face-to-face clinic visits and car parking problems!

What causes high blood pressure?

Lifestyle

There is no underlying disease process causing high blood pressure in the vast majority of people. It is purely due to lifestyle and this is why it is called Essential Hypertension.

What about genes?

Genes do matter. The Framingham Heart Study showed that you have an increased risk of having high blood pressure only if your parents had high blood pressure before age 55. The risk was found to be double if one parent had high blood pressure, and 3 and a half times if both parents had it.

However, your DNA is not necessarily your destiny. First of all, you not only inherit your genes from your parents but also their way of living, especially what you eat. Secondly, the expression of your genes and how they affect your body can change with your lifestyle especially your diet. What this means is that if you have inherited unfavourable genes, then you will need to change your lifestyle to a greater degree.

High blood pressure in pregnancy increases risk

Some women develop high blood pressure during their pregnancy. This usually returns to normal up to a few months after giving birth. However, about one-third of these women then go on to develop high blood pressure later in life. This can be even as soon as 1 year after having their baby. The main risk factor for developing high blood pressure after their pregnancy is obesity.

We cannot change our genes, but we can change our lifestyle. The next article is all about the things that you can do that will help.

High blood pressure: Lifestyle changes

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DIY Health

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DIY health

As far as technology is concerned, medical practice is very much behind. In UK general practice, we have been using electronic medical records for more than 25 years. Comparatively, UK hospitals are yet to catch up and their medical records are still handwritten.

Still, we can still do much to bring ourselves up to date in general practice. We have been doing telephone consultations for some time, but video consultations are far from the norm. This is about to change with the COVID-19 pandemic as all UK general practices have been asked to make this a reality as soon as possible.

What this means for doctors

All UK general practices have been forced to have mostly telephone and video consultations in order to limit the spread of the COVID-19 virus. For doctors that means dealing with more uncertainty and risk as we are unable to examine patients. However, you might be surprised to learn that for many conditions an examination is not absolutely necessary. The most important part of the consultation is the history itself. This is what the great Professor William Osler meant when he said:

Listen to the patient, he is telling you the diagnosis.

William Osler

An experienced doctor can therefore make a good diagnosis over the telephone. Video consultations can give the added benefit of seeing the patient when needed and reduces uncertainty and risk further. Prescriptions can also be sent electronically to the most convenient pharmacy and further reduce the need for direct contact.

Disadvantages include diagnostic error, unnecessary or wrong medication or over-prescribing. This is most detrimental in the case of antibiotics as increasing antibiotic use can lead to greater antibiotic resistance. It could also cause the appearance of ‘superbugs’, something we really do not need right now!

What this means for patients

Research has shown that remote consulting is acceptable to most patients. Only around 25% actually want to have a face-to-face consultation. It offers great convenience especially for routine tasks for stable patients. Just think of the time and effort in having to make a trip to the clinic and then finding parking!

The COVID-19 crisis is likely to last about a year. As patients get used to the convenience of remote consulting, this genie is unlikely to go back into the lamp! This means that telephone and video consultations are likely to be the future norm, with face to face consultations only when absolutely necessary.

It also means that patients will need to take greater responsibility for their health. For example, a patient with high blood pressure is unlikely to be invited to the clinic just to have his blood pressure checked during the COVID-19 crisis. It would be ideal if the patient purchases his own blood pressure machine so that he can check this at home. If he needs to have his medication adjusted, then he can let his doctor know his home blood pressure readings. The doctor can then adjust the medication on the basis of these readings.

Over the coming months, self-care is going to be a necessity for many patients. Appointments in hospital are already being cancelled for outpatient visits and surgery. Clinical staff are being diverted from their own specialties to aid in the care of COVID-19 patients. In essence, routine medical care is being taken away and patients themselves will have to fill part of that gap with self-care.

The future

Over the coming year, I foresee a number of innovations in the delivery of healthcare. An increasing number of patients will be taking more responsibility for their own health. They will also be dealing with their own medical problems in partnership with their doctors like never before.

This can only be a good thing. It is the silver lining to the current cloud hanging over us all.