Eating more fibre and whole grains lowers risk of death and disease, major study finds

Observational studies and clinical trials conducted over nearly 40 years reveal the health benefits of eating at least 25g or more of dietary fibre a day, according to research commissioned by the World Health Organization.

 

People who had higher intakes of dietary fibre and whole grains had lower rates of chronic diseases, such as heart disease, cancer and diabetes, compared to those with diets low in fibre and whole grains.

 

Main findings

Current UK guidelines recommend that people eat 30g a day, yet only 9 per cent of British adults meet the target. Fibre consumption is even worse in the US, with the average adult eating just 15g of fibre a day.

 

Higher fibre diets were associated with a 15 to 31 percent reduction in the risk of death and disease. That meant 13 fewer deaths and six fewer cases of coronary heart disease, per 1,000 participants in the studies.

 

People with diets high in whole grains saw similar benefits, with up to 33 percent reduction in risk, translating to 26 fewer deaths and seven fewer cases of coronary heart disease.

 

The study, published in The Lancet, one of the most prestigious and oldest medical journals, suggests eating at least 25 to 29 grams of dietary fibre per day to achieve these health benefits. Higher intakes could produce more benefits; however, the authors note that consuming copious amounts of it could have ill-effects for people with low iron or mineral levels.

 

The research consisted of analysing 185 observational studies and 58 clinical trials that were conducted over nearly 40 years.

 

The importance

This landmark study is important and timely because the Internet is a wasteland of deranged dietary advice. Quack ‘doctors’, self-proclaimed nutritionists, and – excuse my French – broscience baloney have infiltrated forums, social media and YouTube. In particular, there is a growing trend advocating the carnivore diet. This consists of consuming only animal foods. No fruits. No vegetables. But all the burgers, steaks and pork chops you want, which are often eaten raw by enthusiasts.

 

This dangerous and stupid dietary advice is gaining popularity, despite it being diametrically opposed to the robust, high quality empirical evidence that continues to emerge in the scientific literature.

 

Supporting evidence

For instance, another recent study, also published in The Lancet, showed that Tsimane people (forager-horticulturalist population of the Bolivian Amazon) have the lowest reported levels of vascular ageing of all populations yet studied. It turns out that their diet is largely carbohydrate-based (72%) and includes high fibre foods such as rice, plantain, corn, nuts and fruits. Protein constitutes only 14% of their diet, and they consume very low levels of fat. So much for the carnivore diet.

 

Conclusion

In summary, recent studies confirm that fibre and whole grain intakes are vitally important for longer term health. If your current diet is low in fibre, increase it gradually to help avoid bowel upset.

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How Accurate Is The ECG Function In The Apple Watch 4?

The new Apple Watch 4 comes with several features, but the one that’s received the most attention is the ability to perform an electrocardiogram (ECG). An ECG is typically performed by attaching sensors to the skin which detect the electrical signals produced by the heart each time it beats.

But is Apple’s new feature sufficiently accurate to do more good than harm?

 

Portable ECG devices are nothing new

‘We’ve added electrodes into the back-sapphire crystal and the digital crown, allowing you to take an electrocardiogram’, said COO Jeff Williams, eliciting one of the day’s biggest rounds of applause. ‘This is the first ECG product offered over the counter, directly to consumers’.

It turns out that Apple’s new watch is not the first direct-to-consumer ECG. There are several different monitoring devices on the market that allow you to conduct your own ECG. One example is the monitor from AliveCor. It costs £100 and connects to your smartphone via Bluetooth. The company even offers a KardiaBand, also £100, which works with the original Apple Watch to add the same ECG functionality.

But let’s not concern ourselves with the novelty claim. The bigger question is whether it’s a good idea in the first place. Healthcare providers usually use ECGs in hospitals to measure the heart’s electrical activity and detect abnormalities in its rhythm. But with the latest iteration of its smartwatch, Apple wants to put an ECG on your wrist that you can use ‘anytime, anywhere’.

It sounds like a great idea, in theory.

ecg-iphone-apple

Conducting an ECG

Not only are ECG readings notoriously difficult to grasp even among medical professionals, it usually involves a more complex setup. The standard test is known as a 12-lead ECG, which simultaneously records electrical activity from multiple locations in the body giving you 12 different views of the heart.

 

Contrary to this, the Apple Watch 4 is equivalent to a single-lead ECG. On the back of the watch, there are electrodes built into the digital crown. Touching the digital crown with your finger for 30 seconds will create a closed loop that will then generate an ECG waveform.

Although it gives only one view of the heart it can still be useful. Indeed, some monitors that outpatients wear over an extended duration also offer one view.

 

‘It will save lives!’

‘Do you wind up catching a few undiagnosed cases? Sure. But for the vast majority of people it will have either no impact or possibly a negative impact by causing anxiety or unnecessary treatment’, says cardiologist Theodore Abraham, director of the UCSF Echocardiography Laboratory. The more democratised you make something like ECG, he says, the more you increase the rate of false positives – especially among the hypochondriac set. ‘In the case of people who are very type-A, obsessed with their health, and fitness compulsive, you could see a lot of them over using Apple’s tech to self-diagnose and have themselves checked out unnecessarily’.

A false positive result is when the monitoring device identifies an individual as being at risk of having a heart condition and is subsequently diagnosed as not being so. Direct-to-consumer screening devices, in general, will naturally aim to give an excess of false positives for fear of possible legal action. This would result in hordes of frantic, yet otherwise healthy, individuals rushing to see a doctor, thus placing excess pressure on the health service.

Screening for diseases is only a sieve – it will not pick up all cases, and some will be missed or develop soon after. The concern is whether home screening devices, such as Apple’s new watch, can prevent enough people from developing a serious disease to justify the burden of false positives.

The American Heart Association (AHA) does not endorse the watch, or any other products – and had no role in Apple’s ECG app. Yet this did not prevent Ivor Benjamin, president of the AHA, to give his support during Apple’s official unveiling of the watch: ‘Products that seek to provide deeper health insights, like the Apple Watch Series 4, offer great potential in getting us there’.

It’s also worth noting that the FDA has approved the ECG feature on the Apple watch, albeit with caveats. As expected, the FDA report injected a bit more modesty into the product, stating, ‘The ECG data displayed by the ECG app is intended for informational use only. The user is not intended to interpret or take clinical action’.

 

Conclusion

The Apple Watch 4 starts at £399 for the GPS-only model and increases to £499 if you upgrade to the cellular model. It offers several useful applications besides ECG monitoring and heart rate measurement. It can track falls and call emergency services if it doesn’t detect movement after a minute, alert users to low heart rates, and offers a host of fitness tracking features.

Although the Apple Watch 4 may not be as accurate as some other ECG devices, it could still prove useful for flagging up an undiagnosed heart condition and prompting further investigation. The question is whether Apple’s new feature can prevent enough people from developing a serious heart condition to justify the expense. It’s doubtful. But with all the data collected it could, with your permission, make you a research subject.

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childhood-boy-child-Childhood Cancer Awareness Month

Go Gold Through Childhood Cancer Awareness Month

The internationally recognised symbol for childhood cancer is the gold ribbon. During Childhood Cancer Awareness Month (CCAM) each September, people ‘Go Gold’ and raise awareness of the need for more research that leads to safer treatments and cures. The following are some facts and figures for childhood cancers and some suggestions on what you can do to help raise awareness.

child-cancer

Incidence

4,000 children and young people are diagnosed with cancer every year in the UK. That’s ten every day. In children under 14, the incidence is rare – around 1,600 new cases are diagnosed every year in the UK. This means that around one child in 500 will develop some form of cancer by the age of 14 years.

 

Different types

Tumours that affect children are in two major groups. The first is the leukaemia, which are cancers of the blood and bone marrow. The second is the ‘solid’ tumours; the most commonly affected area is the child’s central nervous system (brain and spinal cord).

The most common type of childhood cancer is a type of leukaemia, known as acute lymphoblastic leukaemia (ALL). Normally the bone marrow makes stem cells that mature into blood cells over time. In ALL, too many stem cells turn into immature white blood cells (lymphoblasts) that don’t mature into the normal blood cells (lymphocytes) that fight infection by attacking germs and other harmful bacteria.

The most common solid tumours of childhood affect the brain and spinal cord, and they have the highest mortality rate of the childhood cancers. Types include medulloblastoma, PNET, germ cell tumours, low-grade and high-grade gliomas, ependymoma, and astrocytoma.

 

Survival

Choosing optimal chemotherapy is no longer done by the oncologist alone, but by a large team of oncologists, pharmacists, cell biologists, and trial coordinators, who analyse the results from previous attempts to treat cancers and alter regimens accordingly. New developments are tested in large-scale multicentre trials, which most oncology patients are enrolled into. In this way, there has been a dramatic improvement in the outcome for most childhood and adult cancers over the last 20 years.

Fifty years ago, 75% of children diagnosed with cancer died; today the average five-year survival rate across all childhood cancer types is 82%. However, survival rates vary considerably between different types of childhood cancer and by age and gender. For e.g., the survival rate for retinoblastoma (eye cancer) has now reached 100%. For ALL it is 92%. Brain and spinal cord tumours have an overall survival rate of 75%. However, because brain tumours are one of the most common types of cancer, it accounts for more than a third of all childhood cancer deaths.

 

Causes

The causes of most childhood cancers are not known. About 5% of all cancers in children are caused by an inherited genetic mutation (a mutation that can be passed from parents to their children). For e.g., around 30% of cases of retinoblastoma are caused by an inherited mutation in a gene called RB1. But this explains little about the overall aetiology as retinoblastoma accounts for only about 4% of all cancers in children.

Most cancers are thought to develop because of mutations in genes that lead to uncontrolled cell growth. If the mutations are not inherited, they can arise spontaneously in an individual (de novo). These gene mutations can be the result of exposure to environmental factors. But in children, these environmental risk factors have been proven difficult to identify. Several studies have shown that exposure to ionizing radiation can damage DNA, which can lead to cancer. Genetic mutations that initiate cancer development can also arise during the development of a fetus in the womb. Parental exposure to cancer-causing chemicals or x-rays could be a catalyst for this.

Mutations in DNA repair pathways have been implicated in the production of chromosomal translocations. The Philadelphia chromosome is a specific genetic abnormality found in approximately 30% of adult ALL cases and 10% of paediatric ALL cases. It is a mutated form of chromosome 22 resulting from a translocation with chromosome 9. The mix of genetic material causes the ABL1 gene of chromosome 9 to combine with the BCR gene of chromosome 22, resulting in the fusion gene BCR-ABL1. The resulting BCR-ABL1 protein is a tyrosine kinase signalling protein that is constitutively active (i.e. always switched on) and rapidly drives cell proliferation.

Clearly, more work needs to be done to identify the causes of childhood cancers, which would help to develop novel therapeutic modalities.

 

Be bold and go gold

This article will have hopefully familiarised you with some facts and figures about childhood cancer. There are plenty of resources online if you feel inclined to delve deeper.

One way to show kids with cancer that they are not alone is to do something brave and bold. Shave Your Lid for a Kid and join the growing movement of everyday heroes standing in solidarity with the kids who need it the most.

More modestly, you can help raise awareness by wearing a gold ribbon, which is the official symbol for CCAM. And of course, to help drive research forward you can fundraise. From bike-a-thons to golf tournaments and everything in between, hosting a fundraiser is a great way to raise awareness.

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A Spoonful Of Honey For That Cold

 

sick-cold-honeyHave you got a cough or cold?

Maybe you should think about treating it with good ol’ fashioned honey…that’s according to recent guidance by Public Health England (PHE) and the National Institute of Health and Care Excellence (NICE)

 

 

 

 

 

 

 

GPs like myself are being urged to encourage patients to use self care products to tackle those nasty bugs!

Self care products such as honey and over the counter cough mixtures including Beechams and Lemsip can be the key to tackle those nasty colds. They can help treat coughs and colds but also reduce the need for antibiotics.

Dr Tessa Lewis, a GP and chairwoman of the antimicrobial prescribing guidelines group, sums up the general management well.

 

“If someone has a runny nose, sore throat and cough, we would expect the cough to settle over two to three weeks and antibiotics are not needed.” 

“If the cough is getting worse rather than better, or the person feels very unwell or breathless, then they would need to contact their GP.”

 

So why is reducing the prescriptions of antibiotics a good thing, well its simple.

Taking antibiotics when you dont need them puts you and your family at risk of developing infections which are difficult to treat. It can have all sorts of nasty side effects including diarrhoea and nausea to name but a few.

You can also increase the likelihood of developing an antibiotic resistance. Which basically means when your older and genuinely in need of antibiotics to treat an infection, the antibiotics may not be as effective in treating the infection, if at all.

 

So that old saying you’ve heard over and over was right. Take a spoonful of honey for that cold.

 

 

 

 

 

 

 

 

 

 

By Dr Ashish Srivastava

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Yes Or No? Vaping From A Doctor’s Perspective

 

 

vapingThe debate continues to rage on over Vaping. Is it safe? Does it help reduce or even stop people smoking cigarettes??

Having not been a smoker myself, but with more of my patients asking me about vaping vs smoking, I decided to look into it a little more.

There is no definitive answer to the above, as NICE (our clinical regulator) has informed us: ‘it’s too soon to tell’. E-cigarettes and Vaping are fairly young in their lives at the moment have only been around for the last decade. This has meant that there is little in the way of testing or evidence to look back at to make any firm conclusions. Basically, people have not been Vaping for long enough for us to know the long-term effects.

 

  1. Vaping is the inhalation of a water vapour.

A battery operating coil heats a liquid which contains nicotine that has been extracted from tobacco. It also includes flavourings and ‘other chemicals’ which together form the vapour that is inhaled.

It is thought that there are less ‘toxic chemicals’ in the vapour produced compared to the approximately 7,000 chemicals in tobacco cigarettes, most of which are toxic.

   

     2. There is still Nicotine in the Vape: the addiction continues:

Nicotine is still present in the vapour which means that users are still at risk of these harmful effects. These can include: addiction, withdrawal symptoms, rise in heart rate and blood pressure.

     

     3. Does it help you stop smoking?

The evidence is patchy here, but it is thought that because you can control the strength of the nicotine you can gradually wean yourself off it. The school of thought is that generally speaking those that vape are more likely to stop smoking than those who go cold turkey.

     

     4. Will it ‘explode’?

There have been several stories about vapes exploding in pockets and bags. This has been put down to misuse of the equipment. There is a standard regulated battery and coil length that is used. People who modify this e.g elongate the coil (allows for more vape), cause the battery to be overworked and can cause it to explode.

 

So – is it safe?  This would depend on the person asking it:

Ask me: a non-smoker, no addiction to nicotine, I would say – no it’s not safe.

Ask a smoker trying to quit – ‘yes, it is SAFER, than smoking a tobacco cigarette.’

 

 

 

 

 

By Dr Vibhu Kaushal

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Can An Espresso Regulate Blood Glucose Levels?

Coffee and healthA cup of coffee after a meal may soon be a way to adjust glucose levels in a person with diabetes.

 

 

 

 

 

 

 

 

 

 

 

What is diabetes?

There are two types of diabetes mellitus: type 1 and type 2. Both types are characterised by having higher than normal blood sugar levels, but the cause and development of the conditions are different.

Type 1 diabetes is an autoimmune disease, which means that the immune system mistakenly attacks insulin-producing beta cells in the pancreas. Patients with this condition need to inject themselves with insulin to compensate for the loss of their beta cells, rendering them insulin-dependent.

In contrast, type 2 diabetes is characterised by the body losing its ability to respond to insulin, which is known as insulin resistance. Diabetes affects more than 400 million people worldwide, and associated health costs amount to about 630 billion GBP per year.

Some people manage diabetes by taking frequent pin prick samples to measure their blood sugar levels. Type 1 diabetes is managed with insulin injections as well as lifestyle changes. Type 2 diabetes may be managed with non-insulin medications, insulin injections, or lifestyle changes.

However, scientists in Switzerland are developing a pioneering method that may render insulin injections unnecessary. Headed by Professor Martin Fussenegger, a biotechnologist at ETH Zurich, the researchers created genetically modified cells that are introduced into the body and release insulin as soon as they detect the presence of caffeine.

(Read more about the research)

 

Synthetic biology and gene circuits

The team took human kidney cells and engineered them to produce insulin. They did this by creating synthetic receptors on the kidney cells that sense caffeine. Once caffeine is detected, the cells produce synthetic human glucagon-like peptide 1 (shGLP-1), which stimulates the pancreas to produce insulin, thus lowering blood glucose levels.

Scientists introduced an implant with hundreds of thousands of modified cells under the skin of ten diabetic mice. After giving them caffeine with their food, they found that the experimental animals were now able to control their blood sugar levels, just as well as those mice that did not have diabetes.

Further, the automated bio-system seemed to safely keep the mice from accidentally overdosing on insulin. The risk of accidentally triggering insulin secretion is very low, as the only source of caffeine in our diet is coffee, tea or some energy drink. And if the insulin dose needs to be increased, it would be sufficient to increase the amount of caffeine, e.g. with a larger cup of coffee.

The cellular implant that responds directly to caffeine is estimated to last for six months to one year, before a replacement is needed. But it should be tested further on animals and humans before it is ready for use, which may take even a decade until it is safe and effective.

If, however, it works for humans just as well, then it is a candidate to replace insulin injections. Something particularly promising for the more than 400 million people around the world who have diabetes. Fortunately, as many people already drink some sort of caffeinated beverage, this therapy can be integrated with lifestyle, thus minimising the issue of non-compliance.

 

Conclusion

This work demonstrates a promising potential in the field of synthetic biology, which can improve healthcare with minimal disruptions to lifestyle. Drinking a cup of coffee after breakfast, lunch or dinner, depending on how much insulin is required, could be enough to bring blood glucose levels back within the normal range.

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Healthcare For International Students

International students can sometimes face problems seeking healthcare here in the United Kingdom and some are not even aware of help they can receive.

 

Medical Treatments For EU Students 

Students from the EU that hold a European Health Insurance Card (EHIC) are covered by the NHS which entitles them to free NHS treatment, but students outside the EU will have to seek alternatives.

If a Non-EEA student is studying on a course 6 months or more, they will have to pay an Immigration Health Surcharge that is part of their visa applications and cost £150 per year.

 

Non-EU Students

None EEA (European Economic Area) students that are studying on courses less than 6 months are not covered or entitled to free NHS treatment, therefore, private healthcare is the only option.

You can still get advice and treatment at a GP surgery as a temporary patient, but only receive primary care and must hold private medical insurance in order to be covered for medical treatment. You won’t be able to be referred to a specialist

 

 

Top 3 Ways Of Seeking Medical Treatments Or Advise For Non-EU And Non-EEA Students

 

Walk-in Centres:

These clinics provide treatment and advise for minor injuries and conditions. The term walk-in means that you can turn up on the same day and be seen, but with a wait time. Non-EU international students can visit these clinics for various health issues and medical advise.

Pharmacies:

Non-EU international students can visit their local pharmacy and seek medical advice for common conditions. The pharmacist can recommend medications and give general medical advise on common health issues.

Private GPs:

Private healthcare is a great alternative and can be the best option for international students that cannot get free NHS treatment or register with a local GP. Non-EU or Non-EEA students can book an appointment with a Gogodoc GP receive consultation anywhere, even at their universities. We offer medical help, advise, and prescriptions. We can even refer you to a specialist if needed.

 

 

 

 

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