Dear Doctor with Dr Chris Steele

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Dear Doctor with Dr Chris Steele



Are you suffering the after-effects?

The best therapy?


Do you know how to protect them?




Dr Chris Steele, MBE Live a longer, happier life with ITV This Morning’s popular doctor

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12/10/2021 11:12

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CONVERSATION In conversation with Dear Doctor, the nation’s favourite TV celebrity doctor tells us his thoughts on the latest topics in health and better living

Today’s Serious & Common Conditions


News and developments in the world of serious and common health conditions including new products and health initiatives from around the globe

20 P ROSTATE PROBLEMS Considering its size, the prostate gland can cause a surprising number of problems for men. How is it supposed to work, and what can go wrong?

22 S POTTING THE SYMPTOMS OF LYMPHOEDEMA This condition, marked by a swelling of the limbs, has a number of possible causes and no certain cure, but there is a range of treatment methods that can help

27 D INING WITH DIGNITY Malnutrition is a surprisingly common health issue in the UK, particularly among the elderly. How do dieticians approach the problem of finding appropriate ways to improve intake?

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31 31 S ORE POINTS Persistent wounds can lead to infection, and it’s hard to prevent conditions such as pressure sores in some patients. Could a new type of mattress technology be the solution?

32 H EARTS AND MINDS Education about the causes and symptoms of coronary heart disease could be the most important way to fight back against this common killer

34 A GLEAMING FUTURE We should all be taking care of our teeth from birth, but new technologies are making it easier to treat problems when they inevitably arise

36 S TRAIGHTENING OUT On the subject of teeth, major advances in orthodontics mean that cosmetic problems can be treated in a number of ways – so what are your options for straightening out?

38 T HE LONG HAUL For some people, recovering from Covid-19 is not straightforward – a whole range of symptoms can persist, sometimes for months

40 THE BONES OF THE PROBLEM Osteoporosis, weakening of the bones, can have a seriously debilitating effect – but is it inevitable with age, and what can be done to prevent or treat it? 42 STROKE: WHAT’S THE STORY? Learning about the symptoms of stroke is the best way to be ready should this seriously life-threatening condition occur to you or your loved ones

Health and Fitness

44 H EALTH AND FITNESS NEWS News and developments in the world of health and fitness including new products and initiatives from the world of exercise and self-improvement

46 A RE YOU WHAT YOU EAT? Is the modern diet the cause of a number of common health conditions? Certainly it helps to know how your digestive system works and what makes it unhappy

HE CURE-ALL CONUNDRUM 48 T Antibiotics have saved millions of lives, but in order for them to remain effective, we must learn to cut down on their use – so what are the alternatives?

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86 D ON’T STRESS OUT Stress is the unseen factor in many modern health issues. But what causes it and what can we do to reduce it?

88 T HE GOOD, THE BAD AND THE FATTY According the NHS, high levels of cholesterol affect some 60 percent of the UK’s population. What is the danger and what can we do about it?

46 50 T HYROID THINKING The thyroid gland plays an important role in regulating body functions, which is why it can be connected with so many common disorders

52 T HE QUESTIONS ON ULCERATIVE COLITIS The causes of ulcerative colitis are still poorly understood and a cure seems a long way off, but with the right treatment the condition can be managed

54 T IME TO BREATHE Emphysema is a type of chronic obstructive pulmonary disease (COPD) that instigates breathing difficulties. But what causes it and how can it be treated?

59 S TIFF COMPETITION Male erectile dysfunction is a common problem, and one we should be able to discuss without embarrassment

63 T HE FEMALE PRINCIPLE Female sexual health is an issue which is not discussed as much as it should be – but researchers are now beginning to explore its mysteries

65 L ISTEN EAR Why we shouldn’t ignore ear infections, and how we can recognise the symptoms and deal with the causes

68 E YES ON THE PRIZE One of the most important yet delicate of the body’s organs, your eyes are subject to a number of threatening conditions, so they deserve the best of care

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70 B EATING DIABETES Is it possible to beat diabetes by changing your lifestyle? Increasingly this is the approach that is being taken in preference to medication

72 F INDING OUT ABOUT FOLATES What exactly are folates and why are they so important to our health? Find out here and you’ll never look at spinach the same again

74 I N THE GENES Awareness of genetic disorders can be a key to prevention of a range of conditions – so should we all be preparing for genetic screening?

76 T HE VITAL FACTS ABOUT VITAMIN D Vitamin D is a vital component in many body functions – so why do many of us suffer from a deficiency?

78 A PINCH OF SALT How much salt is too much? Can our favourite condiment be a health risk? We cast a critical eye over the evidence

80 S HAPE SHIFTERS The practice of yoga extends much further than stretching and breathing; learn how it can benefit your overall health

82 B REATHING EASY The lungs provide life-giving oxygen to the body, but are prone to being affected by the air they take in. How can we look after them?

90 E MOTIONAL RESCUE Feeling well is not just about physical fitness - your emotional wellbeing is equally important to your overall health

93 T HE PAIN FACTOR Chronic pain is consistent pain lasting for a prolonged period and resisting treatment. How can it be managed to reduce its effect on everyday life?

97 I S CBD THE ANSWER? CBD has been hailed as a ‘wonder drug’ in all sorts of treatment including pain relief – but what are the facts? 99 THE TRUTH ABOUT CBD CBD is being promoted as a health aid for all sorts of conditions – but where does it come from and what can it really do for you?

100 C OPING WITH MENOPAUSE The symptoms of menopause can be distressing and disruptive, particularly if you are a working woman. Of the therapies available, which will suit you best?

Life Starts at 60

102 L IFE STARTS AT 60 NEWS All the news, products and developments of interest to anyone who is approaching their golden years

104 A RE YOUR Ks OKAY? As we get older our metabolism changes and so do our ideal dietary balance and supplemental nutrients. So what’s the importance of Vitamin K in older life? dear doctor with dr Chris Steele  5

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128 PUBLISHER & CEO Kevin Harrington EDITOR Chris Jenkins STAFF WRITER Manny Berhanu DESIGN Friyan Mehta FEATURES WRITER Tom Glover

Incontinence, particularly in later life, is a problem we have to face without embarrassment – fortunately there’s plenty of help at hand

109 KEEPING IN TOUCH Living alone brings all sorts of problems, but for the elderly it can be hard to access the technological solutions

110 GETTING A HANDLE ON LIFE Coping with the problems of getting older can be as simple as looking for good solutions to everyday matters such as cooking and eating

112 ON THE MOVE AGAIN Joint replacement surgery can be an almost miraculous solution to mobility problems – but is there anything we can do to postpone it being necessary?

115 MOVING AND GROOVING Getting around the house can be a challenge when your mobility is limited. What can furniture and fittings designers do to help?


116 BEAUTY NEWS All the news, products and developments of interest to anyone who wants to make sure they look as good outside as they feel inside 6


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118 BEAUTY FROM THE INSIDE OUT It makes sense that what you consume can affect your outer appearance, so is a natural approach the best one for your health and beauty?

120 OUTSIDE AND IN Can dietary supplements contribute to overall health and beauty? We look at some of the natural ingredients that can give you a boost and brighten your look

122 HELLO, ALOE! Inside and out, aloe vera is promoted as a wonder product for health and wellness – but what exactly is it, and how should we use it?

126 TURNING ON YOUR HEELS Cracked or dry heels can develop due to insufficient moisture in the skin. What can be done about this unsightly condition?

128 THE NATURE OF BEAUTY Some cosmetics have a reputation for containing nasty chemicals, but a new move towards natural beauty stresses the importance of the pure and organic

129 WHAT’S IN THE SHELL? Coconut water is being promoted as a healthy alternative to sugary drinks and a general aid to well-being and beauty. But is there anything in it?

PRODUCTION DIRECTOR Joanna Harrington PRODUCTION ASSISTANT Delicia Tasinda DIGITAL MANAGER Amy Golding OFFICE COORDINATOR Shyla Thompson PUBLISHED BY Copyright © 2021, Celebrity Angels. All rights reserved COVER IMAGE Courtesy of ITV This Morning

Dear Doctor with Dr Chris Steele Celebrity Angels Suite 2 143 Caledonian Road King's Cross London N1 0SL Tel: 020 7871 1000 Fax: 020 7022 1694 For sales enquiries call: 020 7871 1000

Copyright © 2021, Celebrity Angels. All rights reserved. All material in Dear Doctor with Dr Chris Steele magazine is wholly copyright and reproduction without the written permission of the publisher is strictly forbidden. The views expressed in this publication are entirely those of the authors and do not necessarily represent those of Celebrity Angels. The information in this publication is carefully researched and produced in good faith, however, neither the publisher nor the editors accept responsibility for any errors. The Celebrity Angels Series is published in the UK under licence by Damson Media Limited. Damson Media Limited is registered in England and Wales under registration no. 07869300.

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IMAGES: ITV This Morning


e’ve all been through a difficult time with the coronavirus pandemic, and with the onset of winter and warnings about a possible ’flu outbreak, we may not be out of the woods yet. That’s why it’s important that we all do everything we can to relieve pressure on the NHS, by heeding health warnings and doing everything we can to keep ourselves fit and well. There’s plenty of health information widely available, and in Dear Doctor we aim to present it in an easy-to-swallow form that should keep you up to date on the latest developments without sounding like a lecture! We’re also keen to dispel the misinformation and flimflam sometimes found when discussing health matters. As always, there are basics we should all stick to – cutting out smoking, reducing alcohol intake, keeping an eye on our Body Mass Index and getting plenty of exercise. Lifestyle choices are the best way to make a difference to your wellbeing, and they have mental

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health benefits too. As we come out of a long and depressing period, we should pay just as much attention to our mental health as to the physical concerns. You’ll read in this issue about everything from common and serious conditions such as heart disease and osteoporosis to possibly stress-related conditions like depression and sexual dysfunction – all conditions which are the subject of important research, as skilled practitioners find more ways to help us with these common problems. We also have lots of advice on how to make the most of your later years – but remember that taking charge of your health and listening to your doctor is the first step to a longer, happier and healthier life for all of us.



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Keeping Fit and Well

with Dr Chris Steele MBE ITV This Morning’s Dr Chris Steele shares his thoughts with Dear Doctor on mental health, strengthening your immune system and notable medical breakthroughs

DD. Apart from the recent coronavirus pandemic, what are the most common medical complaints GPs find they have to deal with today? Dr Chris: I think overall, medical complaints that are presented to doctors today aren’t massively different to what they were 10, 20 years ago. People present with the same complaints; back-ache being the commonest, and throat infections, ear infections. I think patients are more willing to come to their doctor and talk to them about mental health issues like depression and anxiety and ask for help. That’s the important thing. The difference is, patients will come in and ask you about conditions that they’ve read about in the papers and magazines, and there’s a huge amount of interest in health stories and the newspapers and magazines know that health is a big issue. They may go on to the internet to search and find information

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(which often is incorrect with regards to their own complaints), then come in to the surgery, holding a printout from Google. And that’s a thing that didn’t happen 10 or 20 years ago! The internet has made a difference—I won’t say a huge difference— but people have gone on to the internet to find things out themselves. DD. Research suggests that a large number of people in the UK experience stress regularly. How far do you think stress contributes to physical illness and what can we do to alleviate these feelings? CS: Stress has always been around us. But these days, there are so many different causes of stress, it could be a marital breakdown, financial stress or the loss of a job. There ought to be more help available on the NHS, rather than just prescribing medication. And we know there are lots of effective interventions out there; there’s

one called cognitive behavioural therapy (CBT). It’s more talking therapy, talking to patients and teaching them how to try and cope with the situations that are bothering them, be it anxiety, be it depression or whatever. Relaxation techniques, like meditation, yoga. But you know, CBT, yoga and meditation—you can’t get these things on the NHS. We’re terribly short of CBT therapists and we know it’s effective in anxiety, it’s effective in depression. It’s a non-drug intervention that does work and we haven’t got the facilities to help patients with CBT or other relaxation techniques. And then another thing to overcome stress: get a hobby… a hobby is a distraction. I’ll tell you something again from my own experience. I went through a bad spell of depression, I was on anti-depressants and basically what I did, I took up pottery classes. Boy, did that help me, I could say it saved me.

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DD. While more and more people are speaking about their experiences with mental health and raising awareness, NHS funding and waiting times for mental health services are at an all-time low. Could you tell us your thoughts on this? CS: This has been a long-term problem in the NHS, and I could come up with one word: funding. When you talk to people, you know, they wouldn’t mind paying a little bit extra in their tax to improve the NHS funding process. Maybe you could name a part in income tax ‘NHS fund’. If there was more funding available, especially in mental health… because the thing with mental health is that people don’t talk about their mental health, there’s a stigma and mental health in men—oh my goodness! That’s a big problem. Sportsmen are now coming out and admitting that they’ve had anxiety 10  dear doctor with dr Chris Steele

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or they’ve had depression in the past. That does help because these guys are role models to some people. I think sports people coming out, sports men in particular, to help male patients [will help]. Men should not be ashamed of going to their doctor to say ‘I’m feeling depressed, doctor.’ DD. The multi-vitamin and supplement industry is massive and ever-growing, with just under half of all Britons admitting to taking a supplement daily. What are your thoughts on the consumption of extra vitamins? CS: I think for the majority of people who are buying these supplements, they are wasting their money, and in fact, there was a study published recently that came to that conclusion. For example, vitamin B and vitamin C are water-soluble so you

can’t store them in your body, you pass them straight out. So if you’re buying tablets that contain vitamin B and vitamin C, they’re going out into the toilet when you wee, you’ve wasted your money. I’d say this, except for one vitamin: vitamin D. With vitamin D, your body makes it in your skin when the skin is exposed to sunlight. It’s really accepted that most people in the UK are deficient in vitamin D. If it’s a sunny day, just get out for 10 minutes in the sun; 10 or 15 minutes in the sun will boost your vitamin D levels. So that’s one that you should certainly consider taking: a vitamin D supplement, especially during the winter months. With pregnant women and children, I think you need to ask your doctor, because the advice will be dependent on the individual and what is pertinent to their health status.

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Every year over a million older people are abused in the UK. For many years the general public has dug deep to support national charities that deal with the horrifying levels of child abuse, animal cruelty and rising instances of domestic abuse and sexual violence. However, in the background, one unique charity has been supporting the victims of an under-reported and growing crime. The abuse and neglect of older people. Hourglass is the only UK charity focused on this horrifying yet preventable form of abuse affecting around one million people over the age of 65 each year. But with numbers on the rise, how does a charity like Hourglass ensure more and more people are aware of the neglect, abuse and exploitation of older people? Hourglass delivers the UK’s only helpline dedicated to supporting victims of elder abuse and their families. Callers to 0808 808 8141 get expert advice and support - as well as signposting to other local and national organisations. It’s a bespoke service and has recently been bolstered by a new instant messaging service on and a confidential SMS service on 07860 052906. What remains staggering however is that the abuse of older people is still hidden and unrecognised by most of society. Yet in research produced by Hourglass last

year, more than a fifth of the UK public have personally experienced abuse as an older person (65+) or know someone who has been abused. So why do we have a blind spot when it comes to the abuse of older people? Is it because we simply value the lives of older people less than we do others? It is an indictment of our complacency on this issue that we currently know far more about the abuse and neglect of animals than we do older people in the UK Research from Hourglass reveals that more than 1 in 3 people do not believe that ‘acts of domestic violence directed towards an older person’ count as abuse. The charity’s unique work and analysis illustrates how the abuse of older people is nearing epidemic levels with nearly half of those polled believing that failing to attend to an older person’s needs in a timely fashion is not abuse. If you’d like to support the unique work of Hourglass please head to or ring on 0208 835 9280. More importantly, if you or someone you know has been affected by abuse please make that call and talk to the Hourglass team on 0808 808 8141.

Hourglass is the working name of Hourglass (Safer Ageing), a charity registered in England and Wales (reg. no: 1140543), and also in Scotland (reg. no: SC046278). Hourglass (Safer Ageing) is registered as a company in England and Wales under number 07290092.

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My advice is this: know your numbers. Everybody knows their waist size or their shoe size, but do you know your blood pressure? - Dr Chris Steele

long names of the bacteria that are in there. Having increased the population of those friendly bacteria, you then should feed them by taking pro-biotics which are found in foods such as beans and bananas. They are good, simple, cheap ways of boosting the food to your army of friendly bacteria. None of these measures can prevent you from getting infections, but it’s good to boost your immune system. DD. Deteriorating health becomes more and more of a worry for people entering later life. Is there anything we can do from an early age to help prevent serious illnesses like dementia or cancers from occurring later in life? CS: My advice is this: know your numbers. Everybody knows their waist size or their shoe size, but do you know your blood pressure? Do you know your cholesterol?

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DD. What else can we do to boost our immune systems and protect our health in the winter months? CS: As I said on This Morning, I’d suggest a simple three-point plan to protect your health and give your immune system a boost in the winter. In addition to staying indoors, regularly washing your hands and practising social distancing if you do need to go out to buy essentials, there’s are good, simple and cheap ways to boost your diet. Despite the vaccinations, there is still no way to prevent infection from viruses such as coronavirus and influenza, and the best way to avoid infection is to stay home and regularly wash your hands. Your immune system protects you against viruses and bacteria, and what I want to advise you to do is to increase the population of friendly bacteria by eating plain yogurts. Look at the label on your yogurt containers and you might see some

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Do you know your blood glucose levels? If you’ve got to the 40, 50 age group then you should go to your doctor or practice nurse and just say ‘I need to know my numbers.’ These are three important factors that don’t necessarily give you any symptoms until something goes wrong. Doing that, maybe once a year on your birthday, is a good time to take stock. See, by doing that, you’re addressing blood pressure, cholesterol and blood sugar, you’re addressing the major killers such as heart disease and stroke. And, of course, watching your blood sugar, you’re hopefully going to prevent diabetes which causes blindness, heart attacks, stroke, kidney failure and gangrene. The big health worry out there is obesity. Being overweight increases your risk of many, many different types of cancers and then you’ve got the strain on the heart. But the one thing that does cause me despair, is obesity. That’s through lack of exercise and incorrect diet.

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The other area is stem cell therapy. I’m no expert there, but that’s an area that has a huge amount of research and progress made there, so those two areas are very exciting.

There’s a huge amount of interest in health stories, and the newspapers and magazines know that health is a big issue - Dr Chris Steele

DD. Finally, what three top life mantras do you have for staying (and keeping) healthy and happy? CS: From my point of view: diet. I certainly try to have a healthy diet, my wife’s a nurse—she does all the cooking, I don’t. I can’t even boil water without burning it! So you know, diet is extremely important. I don’t smoke and I don’t drink because these are two big threats. There should be exercise in there. I’ve got to be honest, I don’t do a lot of exercise but I do walk when I can, but I think diet and no booze— and no fags! •

IMAGES: Shutterstock

DD. Do you have any predications in terms of medical breakthroughs in the coming years? CS: Yes, there are some exciting areas, and one of those is immunotherapy and the treatment of cancers. That’s making great leaps forward. There have been some very promising results in the treatment of lung cancer, which is not an easy one to cure, breast cancer and prostate cancer. Basically, with immunotherapy you’re sort of stimulating the patient’s own immune system to kill cancer cells rather than [using] toxic chemicals like chemotherapy. Chemotherapy is a toxic chemical; it kills cancer cells but it also kills your hair cells and your white blood cells. To move away from toxic chemicals to give a drug that stimulates a patient’s own immune system to attack cancer cells is dramatic.

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Common Conditions Looking at some of the health conditions we can all expect to be subject to, and how medical science is making strides in diagnosis and treatment CANCER


can be detected prior to symptoms appearing using a blood test being trialled by the NHS. The Galleri test will be tried on 140,000 volunteers in England, led by the Cancer Research UK and King’s College London Cancer Prevention Trials Unit. The test can detect around 50 types of cancers that are not routinely screened for, and pinpoints where the disease has appeared from with high levels of accuracy by focusing on the chemical changes within areas of the genetic code – cell-free DNA – that tumours spill into the bloodstream, with some tumours shedding DNA into the blood before symptoms can be felt.

will affect approximately one in 10 people within the UK by 2030, with obesity a key factor in the rise of cases according to a report. Currently in England, around 90 percent of diabetes patients have type 2, the condition which is more likely developed in those who are overweight. In the past 15 years, diagnoses of diabetes have doubled and according the Diabetes UK, around 5.5 million people will likely be living with the condition before the end of the decade. Diabetes UK chief executive said the nation is “at the tipping point of a public health emergency” and action is needed “to stop it in its tracks.”

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SICKLE-CELL DISEASE is a genetic disorder, affecting approximately 15,000 people in the UK, and is particularly common in people with an African or Caribbean background. Symptoms include severe pain, serious infections, anaemia and tiredness, with most requiring hospital admissions. Now a new treatment for sickle-cell disease has been announced in what has been described as a significant breakthrough. The drug, named crizanlizumab, delivered by a transfusion drip, is the first treatment for the disease in 20 years and is set to keep thousands out of hospital over the next three years, according to NHS England.

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DEPRESSION is being treated with an electrical implant that sits in the skull and is wired to the brain. US scientists have had promising results with a first patient, Sarah, who is 36, and had the device fitted more than a year ago. Having suffered from severe depression for her entire adult life, she says the treatment has turned her life around. The matchbox-sized pack in her head is always “on” but only delivers an impulse when it senses she may need it. The experimental study is described in Nature Medicine journal. The researchers, from University of California, San Francisco, stress it is too soon to say if it might help other patients, like Sarah, with hard-to-treat depression, but they are hopeful and plan more trials.

THE SENSE OF TOUCH has always been a bit of a mystery to scientists – now two of them have been awarded the Nobel Prize for helping to unravel how it works. Americans David Julius and Ardem Patapoutian shared the 2021 prize in Medicine or Physiology for their work on sensing touch and temperature. They investigated how our bodies convert physical sensations into electrical messages in the nervous system, starting with a study of how nerve receptors respond to the ‘hot’ element of peppers, the chemical capsaicin. The studies led to the identification of a range of sensors for heat and cold, one of which, called TRPV1, is also involved in chronic pain and how our body regulates its core temperature. The touch receptor PIEZ02 has multiple roles, from urinating to blood pressure. The findings could lead to new ways of treating chronic pain.

CORONAVIRUS cases worldwide were continuing to decrease by the end of September, with 3.1 million new cases and just over 54,000 new deaths reported in a week according to the World Health Organization (WHO). This was a nine per cent decrease in cases, while deaths remained similar, the WHO said in its weekly epidemiological update.  The largest decrease in new weekly cases

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was reported in Africa (43 percent), followed by the Eastern Mediterranean (21 percent), Southeast Asia (19 percent), the Americas (12 percent) and the Western Pacific (12 percent). The highest numbers of new cases were reported from the United States (760,571) and the United Kingdom (239,781 new cases; similar to the number reported in the previous week). The number of confirmed cases reported globally is now over 234 million, with fatalities just under 4.8 million.

COVID TOE may not be the worst symptom of coronavirus, but it’s one of the most baffling. Now scientists believe they may have pinned down the cause of the chilblain-like lesions on toes and fingers. For some it is painless, but the rash can be extremely sore and itchy, with tender blisters and swelling. Researchers say Covid toe appears to be a side effect of the body switching into attack mode to fight off the virus, and have

pinpointed the parts of the immune system that appear to be involved. The findings, in the British Journal of Dermatology, may help with treatments to ease the symptoms.

GASTRIC PAIN after eating is more common than we thought, according to a recent study which says that one in 10 people experience frequent meal-related pain. This includes 13 percent of women and nine percent of men, and is most common in 18- to 28-year-olds (15 percent), according to an online survey of more than 54,000 people in 26 countries. “The take-home message from this study is that people who experience meal-related abdominal pain more frequently experience other gastrointestinal symptoms,” said Belgian researcher Esther Colomier, who suggests that meal-related symptoms should be considered when diagnosing such disorders as irritable bowel syndrome and bloating — a category of health problems known as DGBIs, Disorders of Gut-Brain Interactions. • dear doctor with dr Chris Steele  19

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Prostate Problems The prostate is a small gland found only in men, which commonly causes issues over the age of 50.


TREATMENTS The main treatments for prostate enlargement are lifestyle changes, supplements, medicine and catheters. Some of the symptoms can be reduced if certain aspects of lifestyle are changed. Changes such quitting smoking, drinking 20


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fewer fizzy drinks and alcohol and eating more fibre can help the relieve the symptoms. In addition to lifestyle changes, natural supplements are also available to help ease symptoms. Products such as saw palmetto, Beta sitosterol, zinc and fish oils can all assist. If symptoms become more serious, medication including alpha-blockers, anticholinergics and diuretics can be prescribed. Alpha-blockers work by relaxing the muscles within the prostate gland and at the bottom of the bladder, reducing the difficulty of peeing. Anticholinergics aim to relax the bladder muscles if it becomes overburdened, while diuretics aim to accelerate urine production. If peeing becomes a constant issue, a urinary catheter, a soft tube which helps ease urine out from the bladder, may be recommended to help drain it. •

Did you know? Prostate cancer is the most common type of cancer in men in the UK as figures show that there are in excess of 47,000 new cases diagnosed each year. Diagnosis usually involves a PSA (Prostate-Specific Antigen) blood test - ask your GP about it.

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ocated between the bladder and the penis and covering the urethra, the function of the prostate is to make seminal fluid, but as this function deteriorates with age, the prostate can become enlarged or diseased, causing a range of health problems. The most common is prostate enlargement, usually age-related, which can put pressure on the urethra and cause problems with urination, either a weak flow or pain. Another condition, prostatitis, is inflammation caused by bacterial infection. Prostatitis can appear in men of all ages, although it is most frequently found in those aged between 30 and 50, with symptoms including pain in the pelvis and lower back area as well as pain during urination. Prostate cancer is the most serious condition, also age-related, with groups over 50 and particularly over 65 at most risk. The causes are largely unknown, but as it develops very slowly, there may be no symptoms for years, and indeed it’s often decided to ‘live with it’ rather than risk the side-effects of treatment. Ethnic origin and family history can be factors; prostate cancer is more frequently found in men of African and AfricanCaribbean descent. Initial symptoms of the condition are very similar to those of prostate enlargement, so it’s important not to put off investigation in case this more serious condition is present.

(Source – NHS)

15/10/2021 11:32

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Spotting the Symptoms of Lymphoedema

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Lymphoedema is a chronic condition that causes swelling in the body’s tissues, usually the arms and legs. But what causes it and how can it be treated?

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ymphoedema develops when the lymphatic system does not work properly. The lymphatic system is a network of channels and glands throughout the body that helps fight infection and removes excess fluid. It is key to treat lymphoedema as soon as it has been identified, otherwise the condition could worsen.


CAUSES AND SYMPTOMS The principal symptom of lymphoedema is swelling of any part of the body. This can cause difficulties when fitting into different clothes and wearing some types of jewellery. The swelling may occur repeatedly and could also worsen during the daytime but then improve overnight. However, if the condition is not treated, it will typically become more serious and cause increasing pain. There can be other symptoms including persistent skin infections, fluid seeping out the skin and folding developing within the skin. Lymphoedema can be caused by cancer or by cancer treatments. In certain cases, a cancerous tumour can get large enough for it to block the lymphatic system. In addition, surgery used to extract cancer from the body can also remove lymph nodes or some vessel that carry fluid, causing the tissues surrounding to be built up with more fluid. Obesity can also be a cause of lymphoedema, due to the extra fatty tissue building up and affecting lymphatic channels, decreasing flow of fluid. There are two variations of lymphoedema: Primary lymphoedema and secondary lymphoedema. Primary lymphoedema is usually a genetic condition affecting the lymphatic system and developing during infancy or early adulthood. Secondary lymphoedema is more common when there are issues with the lymphatic system caused by outside influence or if there are problems with the drainage of fluid in the system. This can cause infection, injury and the swelling of a limb.

TREATMENTS Lymphoedema has no cure, but controlling the main symptoms is possible. This is

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The LymphAssist Homecare compression system from Huntleigh has been designed specifically to compliment your traditional treatment in the comfort of your own home. The clinically proven and effective, LymphAssist comprises two parts, a simple to use, single key press pump and a range of inflatable garments or sleeves. LymphAssist can be used as an adjunct to traditional compression therapies in patients who may be immobile or are unable to tolerate pain from conventional therapy or have previously failed treatment with other modalities. The simple to use system is designed to provide each of its patients with maximum comfort and a treatment which delivers an effective outcome. LymphAssist Homecare can be used at home, clinic or hospital setting, its robust design ensures that the system can be handled, transported and stored safely and easily. LymphAssist is available with a choice of garments which can be applied to the patients’ upper or lower limbs.

achievable by procedures that can lower the amount of fluid build-up and restore the flow of fluid within the lymphatic system. The treatment recommended the most is known as decongestive lymphatic therapy (DLT). There are four main features of DLT. These comprise of wearing clothing or using

equipment that would compress the body, treating the skin, regular exercise, massages and healthy lifestyle measures. In addition to Manual Lymph Drainage (MLD) techniques which would be administered by a therapist, there are pump systems which can be used at home, gently inflating overlapping chambers in a pressure garment to delivers light pressure to the affected limbs. The pressure pattern clears the area by steering the accumulated lymph fluid into the functioning collecting lymphatic network where it can flow more freely. Treating your skin well will reduce the chances of infections such as cellulitis to develop. Exercising regularly will increase the strength in your muscles that are involved in the lymph drainage system. Your lymphoedema care team will help devise an exercise routine that fits you and your body the best, reducing your risks of suffering from the condition. Activities in your program could include walking, cycling and swimming. Adding this with compression stimulates the fluid to evacuate from the area affected.

MASSAGE Massages are also an important aspect of lymphoedema treatment. The specific type of massages given are called manual lymphatic drainage. This would usually be carried out by a specialist therapist. The massage helps shift the fluid within the swollen areas into lymph nodes that are functioning well. Including compression after a massage session will also aid in moving fluid. Learning how to control the condition is an important part of the treatment, as it can reduce hospital appointments and provide better control over when the time comes for the lymphoedema treatment, so you can life it your day-to-day life. In certain cases, surgery may be turned to as a treatment for lymphoedema. There are three main types; removal of excess skin and underlying tissue (debulking), the removal of fat from the limb that has been affected (liposuction) and the repairing of fluid flow around the area affected (lymphatic anastomosis). • DEAR DOCTOR WITH DR CHRIS STEELE


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Sponsored Editorial

The LymphAssist: an innovative, effective and easy way to optimise lymphoedema management in the comfort of your own home Lymphoedema: a common and debilitating condition Research suggests that as many as 6 in every 1,000 people in the UK may be affected by lymphoedema (LSN, 2019). What’s more is that the prevalence of lymphoedema is ever increasing as a result of factors such as people living longer, increasing levels of obesity and an increasing number of people surviving cancer treatments. The effects of lymphoedema are far reaching. Limb swelling can lead to pain, a feeling of ‘limb heaviness’ and frequent infections (known as cellulitis). Sufferers often experience low self-esteem with worries and concerns relating to body image which can lead to social avoidance. Lymphoedema Treatment Whilst there is no cure for lymphoedema, current treatment strategies aim to reduce swelling, prevent progression, reduce risk of infection and alleviate

Manual Lymph Drainage a form of massage to help move the fluid away from congested area towards healthy lymph nodes where it can be drained away more effectively. Performed by the patient, carer or therapist.

associated symptoms (Lasinski, 2013). The gold standard treatment for lymphoedema is Decongestive Lymphatic Therapy (DLT), which consists of four cornerstones of treatment (Wigg and Lee, 2014) The LymphAssist can help Whilst specialist lymphoedema nurses/ practitioners usually lead and determine a patient’s individualised lymphoedema management regime, the emphasis is on self-care. Patients need to dedicate time and effort to attending to each of the four aspects of care shown below on a daily basis. The LymphAssist is an adjunctive treatment, used by patients in the comfort of their own homes to help manage their lymphoedema. This technology is brought to you by Huntleigh Healthcare Ltd, a Cardiff based medical manufacturer and world leader in vascular assessment for over 40 years.

Skin Care To maintain a good skin condition

The LymphAssist can help with these aspects of lymphoedema management

Compression Therapy External support and compression using elastic compression garments help to prevent new lymph formation, they also help with lymph drainage

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Exercise A programme of exercise and movement can help to maximize lymph drainage

Simpler Self-Management In order for patient to effectively selfmanage clinical input is required, it takes time to teach a patient the correct techniques to perform Manual Lymph Drainage. With healthcare resources becoming more stretched due to ever increasing workloads and the restrictions of face-to-face appointments due to COVID, the ability of clinicians to provide this training is decreasing. The LymphAssist ensures that the patient is able to effectively self-manage with consistency when the clinician is unable to be there. What is the LymphAssist and how does it work? The LymphAssist is an Intermittent Pneumatic Compression (IPC) device. It consists of a garment which is made up of several inflatable sections and connected to a small pump. The sections inflate and deflate in a special sequence which gently massages the affected area leg and replicates the process of Manual Lymph Drainage, stimulating the flow of blood and lymph within the affected limb. Patients follow instructions provided by their lymphoedema specialist regarding the duration and frequency of use – a personal treatment schedule is used to record the treatment profile. A typical treatment session takes between 30-60 minutes to deliver. A major benefit of the LymphAssist is that it can applied and safely used by the patients themselves at home. The LymphAssist is clinically proven The LymphAssist has been proven to have clinical benefits for its users. In a recent study, a group of 20 patients

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Sponsored Editorial her independence and live with her lymphoedema despite having it for many years, “I have had lymphoedema for many years. I’m 75 and still work full time and will not allow it to ruin my life. Since I have had the LymphAssist machine, my leg always feels so much more comfortable after using it. I normally use it in the evening whilst lying on my bed prior to settling down for the evening. The machine is set up on a small coffee table at the side of my bed. It is so easy to pop my leg into it and do it up prior to switching on. Whilst the machine is working, I relax and watch the TV knowing that it is helping. I find it is comfortable to wear even when it puts pressure on parts of my leg. Since using the LymphAssist, I’ve been able to fit into a better choice of shoes than I ever could before and this has really made so much difference to me.”

with lower limb lymphoedema used the LymphAssist for five weeks alongside their compression garments. After their five weeks the group had an average leg volume reduction of 375 mls (Dunn et al. 2021). One participant lost a total of 552mls! Not only did the LymphAssist successfully reduce leg volume, it also had an impact on patient reported quality of life. The majority of participants reported significant improvements in pain, limb heaviness and skin tightness as well as an overall improvement in their quality of life following the use of LymphAssist. Many of the participants of this study saw the LymphAssist as a valuable lifelong investment with many going on to purchase their own. For more information visit our website at

What do clinicians say about the LymphAssist? Michelle Fishbourne (Lymphoedema Lead Nurse, Cwm Taf University Health Board’ stated, “We have had patients who have found the LymphAssist really beneficial in supplementing their compression garments. They often state that with regular use it has softened any hardness (fibrosis) to their limbs and their limbs feel less heavy which improves general movement and their quality of life.” What do patients say about the LymphAssist? Mrs Margaret Davies (Cardiff, UK) describes how use of the LymphAssist has helped her to keep

Lymphoedema Support Network (LSN) (2019). What is lymphoedema? Available at: [Accessed on: 25/08/21]. Lasinski, B., B. (2013). Complete decongestive therapy for treatment of lymphedema. Seminars in Oncology Nursing, 29(1), pp. 20-27. Wigg, J. and Lee, N. (2014). Redefining essential care in lymphoedema. British Journal of Community Nursing, 20(22), pp.24-7.

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A brighter future for patients with lymphoedema Until fairly recently, there were limited options for those with lymphoedema with many fearing they would just have to live with their condition unmanaged. However, continued efforts from healthcare professionals have led to effective treatments becoming much more widely available. With the help and support of healthcare professionals and self-applied, innovative treatments such as the LymphAssist, there is much that patients can do themselves in order to become an expert in managing their own condition. Further Information To find out more about the Lymphassist and to read other patient stories please visit our website at

15/09/2021 16:13

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Dining With Dignity You might be surprised to learn that up to three million people in the UK suffer from malnutrition, a particular problem for the elderly

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igures from the NHS suggest that there are three million adults, or one in 20 of the population of England, affected by malnutrition. With shops full of food (well, usually – there seem to be a lot of empty shelves at the moment!) – how does this come about? The fact is that for older people living alone particularly, it can be an effort to shop for food, prepare meals and clean up afterwards. Older people often lose their appetite, and tend to graze rather than eating full meals. The Association of UK Dieticians (www. suggests that these are the signs of malnutrition that caregivers and social workers should look out for: Tiredness and low energy Loss of appetite Unintentional weight loss

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Fatigue and lethargy Clothes or dentures becoming loose Falls Difficulty coughing Anxiety and depression Reduced ability to fight infection Malnutrition is also associated with psychological issues such as depression and anxiety, particularly in difficult times such as bereavement. Insufficient nutrition can lead to a downward spiral of reduced mobility, depression and reduced nutritional intake. Research by Nutrition Journal also shows that eating alone can lead to the consumption of less fruit and vegetables and other healthy foods. Some older people also have difficulty eating due to infirmity or conditions such as dysphagia (difficulty swallowing), which makes them more inclined to eat alone.

MUST adjust A useful tool for diagnosing malnutrition is the Malnutrition Universal Screening Tool (MUST) from BAPEN, the British Association of Parenteral and Enteral Nutrition. The MUST questionnaire is simple to complete with a few details, is useful for identifying if someone is malnourished or at risk of becoming so, and can guide towards the appropriate referral to a dietitian. Source:

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or microwave. Easier for the person with dysphagia to enjoy as part of a meal with friends or family, these are distinct from the frozen junk food found in supermarkets. But the Association of UK Dieticians stresses that while a ‘food first’ approach, often with additional use of oral nutritional supplements, is the cornerstone of treatment for malnutrition, there are several key social aspects to consider as well. Simple strategies like attending a local lunch club, encouraging eating with friends or family members or a visit from volunteers from services such as Age UK’s Befriending Service, can all have a positive impact on the amount an older person eats at mealtimes.

Social Malnutrition remains one of the most common challenges among older adults in the UK, and healthcare professionals have a key role to play in the recognition and prevention of this problem condition, as they often have close and regular contact with older adults in the community.

A multidisciplinary (MDT) approach is important for all aspects of care of older people, and this is no different for nutritional care. Regular contact between MDT members such as doctors and social workers can improve nutritional care of older adults, by alerting dietitians, who can treat the individual as necessary. When it comes to preventing and treating malnutrition, both clinical and social interventions can help. Dietitians are well placed to manage instances of malnutrition in the community, and an MDT approach can be the link between identifying more people who are at risk. Anyone who comes into close or regular contact with an older person has the potential to spot some of the signs and symptoms of malnutrition. As the Association of UK Dieticians points out, weight loss is not an inevitable part of ageing, and it is always worth asking an older adult some gentle questions about their dietary intake and any recent, unintentional weight loss if you are concerned. •

IMAGES: Dreamstime

Once the signs of malnutrition are identified, the common ones being loss of appetite and unintentional weight loss, it’s important to speak to a GP or a dietitian. In many cases the recommended treatment will include oral nutrition supplements, but the Association of UK Dieticians encourages a ‘food first’ approach focused on encouraging people to eat higher calorie and protein foods more often. This sounds straightforward, but if people have a small appetite, encouraging them to take in more nutrition can be a challenge. Adding energy-dense foods such as a slice of cake, cheese or full-fat milk to a meal can be a help, as the lack of appetite means that it can be hard to simply increase portion sizes. One solution to the problem is to buy ready-prepared meals, but with carefully nutritionally balanced content, and if necessary modified texture to make them easier to eat. In some cases these meals can be delivered to the door in frozen form, and just have to be heated in the oven

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03/09/2021 14:37


Sore Points

The body’s healing ability is marvellous, but what can we do to prevent the development of persistent wounds?

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he ability of the human body to heal itself after damage or disease is amazing – in some cases tissues (such as the liver) can regenerate fully after damage. The skin, too, has a marvellous regenerative capacity, with wounds such as cuts and grazes scabbing over the damaged area to protect the tissue beneath, as debris is cleared and cells regenerated. Swift regeneration of the skin (the body’s largest organ) is essential because it acts as a barrier against infection. But what happens when minor skin tissue injuries such as bites, stings, cuts, ulcers and burns, generally not dangerous in themselves, do not heal well, and act as a route to serious infection? The skin’s ability to regenerate becomes less effective as we age, as does the function of the immune system, so persistent

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wounds can become a big problem, both with bed-ridden patients at home, and in the healthcare system. It’s been estimated that in 2016, approximately 28,500 people in the UK died of infections in hospital, and it’s unknown how many die of infection each year in their own homes.

mattress technology One major challenge in wound care is bed hygiene. While we sleep, we perspire around 400l a year - and shed skin, much of which ends up in our mattresses, creating the perfect conditions for the development of bacteria. Conventional mattresses made of foam and wool or cotton fibre are almost impossible to wash internally, and even with the traditional advice to change them every seven years, you can’t get away from the fact that you are spending a third of your life

sleeping on a hotbed of infection. A new completely washable mattress technology uses thin plastic ‘noodles’ (seen above) , the surface of which is highly polished, so rather than absorbing liquids and creating a home for bacteria, it repels them. The inner core of these mattresses can be washed in the shower or bath, or hosed down in the garden, and can be disinfected using household laundry detergent, then left to air dry. Being able to wash out dead skin, which can feed asthma-causing dust mites, is a major health benefit, as is the noodle mattresses ability to circulate air and relieve pressure which can lead to bedsores. A breakthrough in sleep hygiene and wound care, the ‘noodle’ mattress may be the solution to a range of health problems – both in the home and in the wider healthcare sector. • dear doctor with dr Chris Steele  31

15/10/2021 11:36


Hearts and Minds Coronary heart disease is a major killer, but many people aren’t aware of the symptoms, causes or the ways to avoid it

Your risk of developing atherosclerosis is significantly increased if you: Smoke. Smoking is a key risk factor for coronary heart disease. The smoke 32  dear doctor with dr Chris Steele

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Research As cardiac conditions are so common, heart research is continuous, and charities such as the British Heart Foundation have done an incredible amount for our understanding and treatment of CHD. Since the BHF was established the annual number of CHD deaths in the UK has fallen by more than half.

contains nicotine and carbon monoxide, which puts a strain on the heart by making it work faster. They also increase your risk of blood clots. Other chemicals in cigarette smoke damage artery lining, leading to heart disease. Do not exercise enough. If you’re inactive, fatty deposits can build up in your arteries. If the arteries that supply blood to your heart become blocked, it can lead to a heart attack or stroke. Have high blood pressure. This puts a strain on your heart and can lead to CHD. Have high cholesterol. Whilst cholesterol is essential for healthy cells, too much in the blood is known to lead to CHD.

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oronary heart disease (CHD) is the most common type of heart disease, when coronary arteries become narrowed by a build-up of atheroma, a fatty material within their walls. The pain or discomfort felt from such narrowing is called angina and if a blockage occurs it can cause a myocardial infarction (heart attack). The build-up of atheroma makes the arteries narrower, restricting the flow of blood to the heart muscle. This process is called atherosclerosis.

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TODAY’S COMMON AND SERIOUS CONDITIONS Have diabetes. A high blood sugar level may lead to diabetes, which can more than double your risk of developing CHD. Diabetes can lead to CHD because it may cause the lining of blood vessels to become thicker, which can restrict blood flow. Have high lipoprotein(a). Like cholesterol, lipoprotein(a), also known as LP(a), is a type of fat made by the liver. You should routinely have its level measured as it’s a known risk factor for cardiovascular disease and atherosclerosis. You are also at risk of developing atherosclerosis if you are obese or overweight, or have a family history of CHD.

when you’re resting. During a heart attack, you may also feel pain in other parts of the body (it can feel as though pain is travelling from your chest to your jaw, neck, stomach, back, or arms), light-headedness, sweating, nausea, and breathlessness. If you experience pain lasting longer than 15 minutes, it could be the start of a heart attack. If you have CHD, it is possible that you could have heart failure. This happens when the heart becomes too weak to pump blood around the body, which causes fluid to build up in the lungs and makes breathing increasingly difficult. A number of medications are available to treat CHD and some of its causes, including high blood pressure. Usually, these are

taken for the long term, and include betablockers and ACE inhibitors, which control blood pressure; statins, which reduces cholesterol; nitrates, which dilate the blood vessels; and aspirin, warfarin, and clopidogrel, to prevent blood clotting. Before it comes to medicinal treatment, and you have been diagnosed with CHD, you should make some simple lifestyle changed to decrease the risk of having further cardiac episodes. Eating healthily, doing regular exercise, and especially quitting smoking, will greatly and quickly reduce the risk of having a heart attack. The good news is that chocolate and alcohol, which contain antioxidants, can be good for your heart - though only in moderation! •

SYMPTOMS Beating an average of 72 times a minute, your heart pumps oxygen and nutrientrich blood throughout your body, while simultaneously removing the waste products you don’t need. When blood flow becomes limited or stopped, through angina, heart attack, or heart failure, the organs shut down and - without urgent intervention – this can be fatal. If your coronary arteries become partially blocked, it can cause chest pain (angina). This can be a mild, uncomfortable feeling similar to indigestion. However, a severe angina attack can cause a painful feeling of heaviness or tightness, usually in the centre of the chest, which may spread to the arms, neck, jaw, back or stomach. Angina is often triggered by physical activity or stressful situations. Symptoms usually pass in less than 10 minutes and can be relieved by resting or using a nitrate tablet or spray. If your arteries become completely blocked, it can cause a heart attack (myocardial infarction) which can permanently damage the heart muscle and, if not treated straight away, can be fatal.

Angina Although symptoms can vary, the discomfort or pain of a heart attack is usually similar to that of angina. However, it’s often more severe and may happen

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A Gleaming Future New technology is bringing improvements to dental health, but there’s still a lot we could do to help our teeth shine

Lasers and scopes Digital bite scanning systems allows the dentist to have a better understanding of the dynamics of biting, chewing, speaking and other jaw movements, again offering more accurate treatment and reducing follow-ups, while wireless, handheld scopes which enhance normal tissue fluorescence can help to detect abnormalities such as oral cancers. The dreaded drill can in some cases by replaced by a dental laser, which can be used to treat hypersensitivity, tooth decay, and gum disease, as well as being used in tooth whitening. Another alternative to drilling is air abrasion, useful when surfaces have to be minutely treated, and calming or nervous patients who dislike the noise of the conventional drill. Operating microscopes and intraoral 3D imaging cameras can be used to give clearer diagnoses and better understanding 34  dear doctor with dr Chris Steele

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of what is happening in the patient’s mouth on an external screen, so the days of ‘open wide and say aaahhh’ may be coming to an end, while a process known as JVA (Joint Vibration Analysis) uses sound recording software to interpret problems with jaw movement and to identify problems with biting forces. For cosmetic dentistry, ‘digital smile designing’ using graphic software to create images of the likely outcomes of procedures such as straightening, gap narrowing or implants, can reassure the patient before committing to a procedure, and they can even have a ‘trial smile’ manufactured to test out before deciding.

Nerves and scalers

Dental Apps, a web-based platform and app, prompts patients to take images of their own teeth, which are then analysed by its AI technology to help identify potential issues. The patient can then be connected to a dental professional who, depending on the situation, will perform either a virtual or an in-person consultation.

For nervous patients, a combination of a light mask and a headphone system delivering electromagnetic frequencies to interrupt the release of adrenaline and cortisol can have a calming effect, while even basic processes such as scaling, the process of removing plaque and tartar from teeth, are benefitting from technological improvements. Manual teeth scaling with a handheld scraping instrument was standard in the past, but modern dentists and hygienists are increasingly using ultrasonic scaling devices instead. These devices use ultrasonic vibrations to knock plaque and tartar off and away from the teeth, in a process which is at least as effective as manual scaling at removing tartar from tooth surfaces, and which can also work in shallow gum pockets. The small tips of ultrasonic IMAGES: Dreamstime


ecent technological innovations have made visits to the dentist less painful and more effective—whether it’s for what they used to call a ‘scale and polish’ or serious surgery, digital developments offer more effective and comfortable treatment for everyone. Digital scanning, for instance, can produce high-definition 3D images inside the patient’s mouth, delivering low radiation imagery with exceptional diagnostic clarity. Accuracy in planning and treatment improves, hopefully reducing the number of follow-up visits required. For deeper imaging, digital X-ray systems can produce instant visualisations viewed using interactive software, so the dentists and patient can understand the condition with no delays to treatment.

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TODAY’S COMMON AND SERIOUS CONDITIONS scaling instruments can also clear deposits from deeper pockets, and dislodge accumulated plaque and tartar by spraying them with coolant. Another advantage of ultrasonic scalers is that they introduce oxygen bubbles into deep gum pockets, disrupting bacteria. Faster than manual scaling, ultrasonic scaling is also better for weaker teeth; unlike manual scaling, which requires a scraping force to be effective and can cause damage to enamel, ultrasonic scaling has been shown to create less tooth damage, and so is particularly suited to older patients where tooth enamel may be weak.

“Existing treatments for biofilms are ineffective because they are incapable of simultaneously degrading the protective matrix, killing the embedded bacteria, and physically removing the biodegraded products,” said Hyun Koo, one of the researchers of the study published in Science Robotics. “These robots can do all three at once very effectively, leaving no trace of biofilm whatsoever.” With other expected innovations such as long-distance examinations by ‘teledentistry’ and dentists learning using augmented reality, the future for our teeth has never looked so shiny. •

Printed Parts In dental labs, and increasingly in dentists’ own surgeries, 3D printing technology is being used to create dental models, aligners and night guards in a matter of hours rather than days, and 3D printing is also being used in the production of permanent crowns.

Smart and shiny In the home, the app-connected ‘smart toothbrush’ which monitors and corrects our brushing habits and offers different brushing modes, is expected to make progress in the home markets, while researchers in Pennsylvania State University are looking into “catalytic antimicrobial robots”, actually groups of tiny iron-oxide nanoparticles in a solution that can be controlled by magnets to scrape away at bacterial biofilms inside teeth.

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Brace for Action round a third of children in the UK end up needing orthodontic, or tooth-straightening treatment. In Britain, we are lucky enough to have free orthodontic care on the NHS for younger people under the age of 18. It is always advisable to get braces sorted sooner rather than later, not just because of the cost, but because the longer you leave your uncorrected teeth, the worse aligned they will become. While the most common form of orthodontic treatment is braces, there are many different types which are suite to different problems.

Cosmetic While the primary reason for orthodontic 36  dear doctor with dr Chris Steele

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treatment is dental health, it can also have a cosmetic aspect, as many orthodontic problems can affect appearance and correcting them can boost confidence. Braces for example, straighten teeth and provide an incentive to stay away from sugary foods, meaning teeth also remain whiter. Certain orthodontic treatments can also be used to treat a cleft lip or palate. Orthodontic treatment is usually only considered when all a child’s adult teeth have come through. This however, depends on the state of their teeth. If it is clear that, as adult teeth start coming through, there is a problem, dentists can refer children at an earlier stage. Treatment for adults can begin at any age, however the options are usually more limited and not included on the NHS.

Dentists will usually only refer you to an orthodontist if you have a good standard of general oral hygiene, as orthodontic treatment can often increase risk of gum disease and tooth decay. Treatment usually begins with an X-ray, plaster models of your mouth and taking photographs of your teeth to assess the situation. The four main types of orthodontic treatment available on the NHS are:

Fixed braces The most common and well-known type of orthodontic treatment, non-removable fixed braces are glued to the front of each tooth and linked with wires to help the teeth straighten up over a period of time. If you have fixed braces you should avoid toffee,

IMAGES: Shutterstock


Caring for your teeth is one thing, but what about improving them? That’s what the practice of orthodontics is all about

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TODAY’S COMMON AND SERIOUS CONDITIONS hard sweets and fizzy drinks, as they can damage the braces, and sugary foods as these can stain your teeth, leaving you with white spots where your braces were once they are removed.

correct the positioning of back teeth, and is only worn at night. Other orthodontic treatments may be useful to some people, however they can only be accessed privately.

Removable Braces


Used to correct minor problems, or as an additional part of fixed brace treatment, removable plastic braces cover the roof of the mouth and clip to some teeth. They can only carry out limited teeth correction and should usually only be taken out for cleaning or as a precaution during certain activities.

Wearing braces can make everyday tooth care more difficult, because as well as having to take care of your teeth, you also need to consider the effect cleaning will have on the brace. The main way you can effectively look after your braces is to clean them regularly and properly. To brush your braces, hold your brush at a 45-degree angle to clean around the wires and pins. Taking the time to brush each tooth individually will help ensure that no bits of food get stuck in your braces so that they do not get clogged up and cause more damage to your teeth. It is also important to visit the orthodontist regularly when you have braces. This is because you will often need adjustments made to your appliance such as tightening your braces. After a routine adjustment of your

Functional Appliances A pair of removable plastic braces joined together and designed to fit on both the upper and lower teeth, these are often used to treat positioning problems of the upper and lower jaw or teeth and are usually worn all the time.

Headgear Headgear is usually used with other orthodontic treatment, not alone, and to

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Cleaning Matters To clean your teeth while you have braces can be a bit trickier, but certain products are specially designed to make it easier, such as electric toothbrush heads that are designed specially to be gentle yet effective when going over braces. braces, you may feel tightness or slight pain. If this does not quickly fade or if it becomes extreme, you should consult your orthodontist as something may be wrong. It is also important to continue with regular checks at your dentist, as having braces can sometimes mean you are more at risk of gum disease and tooth decay. Visiting the dentist regularly can make sure you monitor your teeth and keep any infections at bay. •

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15/10/2021 11:43


The Long Haul

For some, COVID-19 can cause long-term effects to the body that last months after the infection has gone. What are the effects of ‘long COVID’ and what are the treatments?


There are a wide range of symptoms you can have when suffering from long COVID. The main symptoms include  Breathlessness  Severe tiredness and fatigue  Issues with memory and concentration  Loss of taste and sense of smell  A long-term cough. Other secondary symptoms can include chest pains, difficulty with sleeping, heart palpitations, pins and needles, joint pain, depression and anxiety, tinnitus or earaches, sickness and rashes. 38


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Support For more information and advice about long COVID and the recovery process, visit: support-for-you/long-covid/ what-is-long-covid

If you suffer any combination of these symptoms, contact your GP. For now, it is not completely clear what causes long COVID. However, one suggestion is that the infection causes the body’s immune system to react vigorously, attacking not only the virus but its own tissues. Impaired cells can trigger temporary cognitive decline and changes to key senses, such as taste and smell. Damaged blood vessels tend to cause cardiovascular, lung and neurological complications. Another suggestion made by scientists is that fragments of the virus could stay

IMAGES: Dreamstime

or the majority of people, after initially getting infected with the coronavirus Covid-19, it will take a couple of weeks for symptoms to show, and a couple more to recovery. But for others - and researchers have found it very hard to predict who - recovery from the primary infection can leave debilitating symptoms which last a lot longer, even for months - and in some cases there may be permanent symptoms of ‘long COVID.’ The first stage of COVID-19 infection, whether it is the original strain or the now common Delta variant, has symptoms which typically last from four to 12 weeks. Once the primary infection has gone, though, ‘long COVID’ symptoms can last a lot longer, and can also change over time. Since COVID appears to affect the immune system, researchers are working on the theory that ‘long COVID’ is a result of damage to the immune system; but it also appears that it might interact with underlying conditions. If you believe that you are suffering from long COVID, it is important that you contact your GP, who will be able to delve deeper into the issues and find out if there are any other possible causes.

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TODAY’S COMMON AND SERIOUS CONDITIONS within the body and eventually become reactivated. This can occur with other viruses such as herpes. However, there is not any clear evidence available for this or any other possible cause.

TREATMENT At the moment, there are no proven drug treatments for long COVID, and the main focus is on managing the symptoms and slowly increasing the levels of activity. To be provided with any treatment, it is important to contact your GP. You may need to be given advice about how to manage the issues of ‘long COVID’ and monitor the symptoms you may have, at home. In addition, 89 specialist long COVID assessment centres have been set up across England which you can also visit or contact if needed. The NHS has also launched a programme called Your COVID Recovery which aims to support your physical and

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emotional recovery if you have ongoing COVID-19 symptoms. To access this programme, you will need to obtain a referral from a health care professional. Professor Brendan Delaney, lead author of a study on long CIVID from the Institute of Global Health Innovation, said: “Long COVID is a brewing public health crisis, yet there is no consistent system for how to manage people affected in the UK, meaning that when patients go to their GP they often find themselves being bounced back and forth with different referrals and no clear answers. “There has therefore been an urgent need for clear guidance to help patients access the support they require.”

REPORT The report says that because long COVID can affect people in very different ways, there is no one-size-fits-all approach and management plans should be personalised to each individual’s experience. “Early

and holistic treatment of symptoms helps people get better sooner, and through this work we have identified treatments that can and do work,” said study author Dr Martine Nurek from the Institute of Global Health Innovation. “Our work highlights the importance of rest in the initial weeks following infection, as this can lead to a better outlook for people experiencing symptoms.” •

Older people more vulnerable King’s College London has suggested that 1-2% of people in their 20s who had the virus would develop long COVID, compared with 5% of people in their 60s.

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15/10/2021 11:39


The Bones

of the Problem Osteoporosis is a bone disorder which can have a debilitating effect. Find out about the causes, symptoms and treatments



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Around 33 percent of older adults become physically impaired and lose the ability to live independently one year after a hip fracture. Source:

impede daily living and can often restrict independence.While osteoporosis can affect anybody, women tend to develop it more frequently.

MENOPAUSE Women are especially susceptible during the first few years after the menopause; this is due to a lack of the hormone oestrogen, which helps to build bones. Males can also develop the condition, though it is far less common.

IMAGES: Dreamstime


he term osteoporosis describes the condition of bones which are weak and prone to breakage and injury. Though bones will weaken naturally over time, in an osteoporosis sufferer they will be especially thin and brittle for their age, and a fall or impact can easily cause injury. In severe cases, a sneeze or cough can cause damage to the body; for instance producing a rib fracture or partial collapse of one of the spinal bones. Repetitive bone fractures can

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TODAY’S COMMON AND SERIOUS CONDITIONS Some of the most typical injuries in people with osteoporosis include wrist, hip and spinal bone fractures. One of the problems with diagnosing osteoporosis is that it has no obvious outward symptoms, so it often goes undiagnosed and unmanaged. Often it is not diagnosed until a fall results in a bone injury. As the condition worsens, sufferers may notice pain in their back as a result of changes to the vertebrae. This is a common cause for chronic pain and may also result in a change in posture. If a doctor suspects that a patient is suffering from osteoporosis, they will usually suggest a Dual Energy X-ray Absorptiometry (DEXA) test as an effective means of detection.

Treatments If the diagnosis of osteoporosis has come as a result of a low impact fracture, the first priority will be to treat that injury. Most fractures will be treated in an A&E; doctors will usually apply a cast or splint to allow the body part to heal. In some cases the breakage may need to be manipulated by

a specialist before the cast is fitted. Warm baths and cold packs are known to aid the recovery of a fracture. Another common method for coping with a fracture includes transcutaneous electrical nerve stimulation (TENS), a small battery-operated device that stimulates the nerves and reduces pain. Alternatively, your doctor may suggest relaxation methods to make recovery more comfortable.

Managing risk Lifestyle changes can reduce the possibility of developing osteoporosis and can manage the dangers of injury. This may involve tweaking your lifestyle or adapting your daily routine. Above all, try to take regular exercise and consume a healthy diet that is rich in calcium and vitamin D, both of which work to nourish bones. You may even choose to take supplements in order to keep your vitamin levels topped up. Another recommended preventative would be to give up smoking, which is associated with an increased risk of osteoporosis.

Having frequent eyesight checks can prevent unnecessary accidents from occurring in people with frail bones. Installing handrails in the house and living areas can also make moving from room to room safer and easier.

WOD World Osteoporosis Day (WOD), on October 20 each year, marks a year-long campaign dedicated to raising global awareness of the prevention, diagnosis and treatment of osteoporosis. WOD aims to make osteoporosis and fracture prevention a global health priority by reaching out to health-care professionals, the media, policy makers, patients, and the public at large, with the headline “Take action for bone health”. The key messages of World Osteoporosis Day 2021 are; Osteoporosis is the underlying cause of painful, debilitating and life-threatening broken bones – known as fragility fractures. Osteoporosis is a growing global problem: worldwide, fractures affect one in three women and one in five men over the age of 50. Osteoporosis affects families – family members often bear the burden of care If one of your parents had osteoporosis or hip fracture, this may increase your own risk of developing the disease. Take the IOF Osteoporosis Risk Check to identify your risk factors. At risk? Be sure to request a bone health assessment – take early action for prevention! Bone health concerns the entire family - ensure your family maintains a bone healthy lifestyle. Advocate! Sign the IOF Global Patient Charter and join us in calling on healthcare providers to close the massive ‘care gap’ which leaves many patients unprotected against a cycle of disabling fractures. Find out more at: •

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What’s the Story? One stroke occurs every 3.5 minutes in the UK, but what is this life-threatening condition and what can we do to prevent it?

disability. A stroke occurs when blood supply to the brain is disrupted by an event affecting the circulatory system. Blood carries oxygen and essential nutrients to the brain and without them, brain cells can become damaged or die. The after-effects of the attack can vary greatly from person to person, ranging from loss of cognitive functions like reading, writing, speaking and language and

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Survivors One in eight strokes are fatal within 30 days. There are about 1.2m stroke survivors in the UK, and it’s estimated that in the next 20 years the number of stroke survivors aged 45 and over, will increase by 123 percent. Stroke is estimated to cost the economy £26bn each year. Source:

memory, to physical disabilities such as loss of bowel and bladder control, and vision problems. Prompt treatment of stroke is vital in minimising this damage, and therapeutic treatment after stroke is also crucial.

Causes & treatments There are two main types of stroke: ischaemic and haemorrhagic. Ischaemic strokes are by far the most common and are responsible for 85 percent of all incidents. This type of stroke occurs when a blood clot or other substances block blood flow to the brain. Blood clots typically appear in areas of the brain where arteries have been narrowed or blocked, usually because of fat deposits or plaque build-up, a condition otherwise known as atherosclerosis. Treatment for ischaemic stroke may include thrombolysis, whereby a drug such as Alteplase is administered to break the clot down to allow blood flow to the brain. According to the Stroke Association, 10 percent more patients who receive thrombolysis treatment in the hours following ischaemic stroke survive and live independently. More rarely, patients may receive a thrombectomy, an operation that physically removes the blood clot from the brain (suitable for just 12 percent of ischaemic stroke patients). Haemorrhagic stroke occurs because of a burst artery, causing bleeding within or on the brain. Although this type of stroke is not very common (occurring in just 15 percent of incidents), it is very dangerous and may even result in death. Haemorrhagic stroke can be caused by numerous things including high blood pressure, aneurysms (thin, weak artery walls that are more

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here are more than 100,000 strokes in the UK each year causing 38,000 deaths, making it a leading cause of death and

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susceptible to collapse, especially if sufferers have high blood pressure), and cerebral amyloid angiopathy, a condition whereby the amyloid protein builds up inside blood vessels in the brain. Haemorrhagic stroke patients may require medication to reduce blood pressure in the brain and to prevent further strokes from occurring. In some cases, surgery may be necessary to remove excess blood from the brain or to repair damaged blood vessels.

Risk factors Stroke can happen to anyone at any age, but research by the Stroke Association shows that the life-threatening condition most typically occurs in older people over the age of 55, with men at higher risk of stroke at a younger age than women. Statistics show that ethnic minorities and people from deprived areas have an increased risk of experiencing stroke than white people and those from wealthier areas. Medical predispositions such as high blood pressure, diabetes and atrial

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fibrillation (irregular heartbeat) are also risk factors for experiencing stroke.

Reducing risk There are many lifestyle changes you can make to improve overall health and reduce stress, which will in turn reduce the possibility of a stroke. Stopping smoking Eating a healthy, fibre-rich diet full of grains, pulses, wholemeal, fatty fish and fruits and vegetables to lower cholesterol a key contributing factor to stroke Reducing alcohol consumption to no more than 14 units per week spread over three days or more The NHS recommends that those who have been diagnosed with an underlying condition known to increase the risks of stroke to take medication as prescribed Visiting a doctor for routine health checks For useful information and support, get in touch with the charity The Stroke Association at •

Act F.A.S.T There are many warning signs and symptoms of stroke to look out for. F.A.S.T is an acronym that can help you to identify the symptoms and warning signs of stroke: Face. Has their face fallen or drooped on one side? Arms. Can the person raise their arms or do they feel numbness in one arm? Speech. Is their speech slurred or are they unable to speak? Time. If you notice any of the above symptoms, it is time to dial 999 immediately

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About Your Health All the news you need about products and projects designed to improve your fitness levels and boost your overall health

FOLIC ACID is set to be included in the most commonly bought flours in the UK to aid in the prevention of spinal conditions. Doctors recommend pregnant women take folic acid supplements, but with around 50 percent of pregnancies in the UK being unplanned, a lot of mothers-to-be may not have the chance to take them early enough. The government has stated that requiring flour millers to increase folic acid content in nonwholemeal wheat flour will help prevent around 200 neural tube defects within babies every year, lowering the annual UK total by approximately 20 percent.


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IMAGES: Dreamstime

levels have increased since the coronavirus pandemic according to a survey by PureGyms. People have been working out longer and have fitted exercise into their day-to-day routine better since the beginning of the coronavirus pandemic according to a surbvey of the one million members of PureGym who currently exercise 1.43 times a week on average, up on 1.21 before the pandemic. It’s also easier to get into a gym in peak times - “The traditional peak visit times of 5 to 8pm have quietened down and usage has spread much more across the day and late evenings,” said a spokeswoman. “As members work more flexibly and locally, they are able to avoid the traditional peak times of the gym and to squeeze in a workout when it suits them best.” And exercise rather than dieting should be your focus for a longer life, experts have concluded. People can be “fat but fit”, but in a review gathering data from various studies, researchers concluded that when it comes to obtaining a healthy body and aiming to live a longer life, exercising and improving fitness is essential and works better than

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HEALTH & FITNESS changing diets. The study published in the journal iScience said that applying a “weight-neutral” approach regarding health issues relating to obesity would also aid cutting the risks of yo-yo dieting.

PLANT-BASED MILK is becoming more popular according a to a report which says that one in three Brits now drink it. Consumers spent around £100m more last year on milk made from almonds, oats and soya, which in turn transformed it into a near £400m-a-year market. The report from market research firm Mintel states that 32 percent of those surveyed drank plant-based milk, up from 25 percent from the previous year. According to the study the uptake is higher amongst those aged between 25-44 at 44 percent. Senior food and drink analyst at Mintel, Amy Price, said that demand was driven by ‘health and environmental concerns’. •

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15/10/2021 11:41


Are You What

You Eat?

Is the modern diet the cause of a number of common health conditions? Certainly it helps to know how your digestive system works and what makes it unhappy…


he digestive system is a delicate and complex one involving a group of connected organs. The system works to break down food we eat and turn it into energy which we rely on for healthy activity and growth. However, with modern diets including a range of unessential sugars, fats and processed foods pushed on us by the food industry, sometimes our bodies are put off-balance, and digestive problems have become common. Fortunately there’s a growing awareness of causes of dietary imbalance and the natural remedies you can consider to aid your digestion.

of constipation as your body is unable to absorb the nutrients in your food. Probiotics, ‘friendly bacteria’ commonly found in certain types of yogurt, have all sorts of digestive health benefits. Digestive conditions can be serious enough to affect quality of life, and it’s not always clear what causes them or how they should be treated. So what are the most common?

INDIGESTION is where your body struggles to digest food, either because of poor eating habits such as excessive seed or amount, or due to an underlying medical condition. Symptoms can include ‘heartburn’ or acid reflux, stomach acid travels up towards the throat and causes a burning sensation. If this happens frequently, it could be a sign of gastro-oesophageal reflux disease (GORD). Indigestion can often be treated by dietary

Digestion Diet

IMAGES: Shutterstock

The ideal diet for your digestive system includes plenty of leafy green vegetables, fruits and whole-grain foods. Foods high in fibre are essential for good digestion. Fluids are also essential. Plenty of water helps the fibre in your diet work properly. Without enough water, there is more risk

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Fill up with Fibre It’s a good idea to try to eat more fibre or roughage, as most people in the UK do not get enough. A diet rich in fibre can help digestion and prevent constipation. Aim for the recommended dietary intake of 30g of fibre a day. For a healthy bowel, you need fibre from a variety of sources, such as wholemeal bread, brown rice, fruit and vegetables, beans and oats.

changes such as cutting out coffee, alcohol, chocolate and spicy foods for example. IRRITABLE BOWEL SYNDROME or IBS is a common digestive condition which effects around 1 in 5 people in the UK, more women than men. Symptoms often develop around the age of 20 to 30, and include constipation or diarrhoea, along with bloating, trapped wind and cramps. Unfortunately, there is no cure for IBS, but your GP will usually advise some diet and lifestyle changes in order to your help your digestive system process food less painfully. COELIAC DISEASE is diagnosed in around one percent of the UK population, though it’s thought that around 24 percent could be undiagnosed. The disease is basically an allergy to the protein gluten, found in grains including wheat and barley, and causes inflammation of the small intestine. Depending on the severity of the condition, complete avoidance of gluten in the diet can be necessary.

NATURAL REMEDIES Some natural remedies are recommended to balance your digestive system. None of them can do any harm in sensible amounts, so they’re perhaps worth a go if you want to avoid medical treatments. PEPPERMINT taken as an oil or tea is said to

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relax the digestive system when absorbing food, easing discomfort. CHAMOMILE has anti-inflammatory properties that can ease cramping or bloating that occurs when your body is having trouble digesting foods. Chamomile can, in particular, help with acid reflux, because the herb can assist in lowering gastric acidity. It is believed that chamomile tea can be used with as much effectiveness as a supplement, and has even been considered to hold the same benefits as taking more recognised medical compounds such as paracetamol or ibuprofen. GINGER is used in both Eastern and Western tradition as a culinary ingredient and a digestive aid. It’s regarded as effective in easing stomach pain by acting as a carminative, soothing the intestinal tract by eliminating excessive gas. A study from the European Journals of Gastroenterology and Hepatology found that ginger stimulates saliva, bile and gastric enzymes to aid

digestion and helps speed up the movement of food from the stomach moving to the small intestine. Ginger supplements are available, however you can also take it in forms of tea, tonics and food additives. So if your digestion isn’t what it should be, you may benefit from eating a more natural diet and testing the benefits of traditional solutions. •

Did you know? A Mintel survey in 2016 suggested that 86 percent of Brits suffer from gastrointestinal problems, with 30 percent attributing them to stress, 26 percent to poor diet, 17 percent to lack of sleep, and 14 percent to alcohol consumption or viruses.



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The Cure-All Conundrum


ntibiotics are vital medicines for treating bacterial infections in both humans and animals. However, bacteria can adapt and find new ways to survive the effects of an antibiotic. For those seeking a quickfix solution to their healthcare needs, antibiotics can seem like an efficient way to quell nasty infections—or even fight off a cold. But misuse of this medicine is contributing to resistance, which means it is 48  dear doctor with dr Chris Steele

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Did you know? Global failure to address the problem of antibiotic resistance could result in 10 million deaths by 2050 costing £66 trillion. Source: World Health Organisation

losing its effectiveness at an increasing rate. Driven by overuse and inappropriate prescription, antibiotic resistance is one of the most significant threats to patient safety in the developed world. To slow down this trend, it is essential to use antibiotics in the right way - to use the right drug, in the right dose, at the right time and for the right duration. “Antibiotics should be taken as prescribed and never saved for later or

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Antibiotics have saved millions of lives, but in order for them to remain effective, we must learn to cut down on their use – so what are the alternatives?

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TODAY’S COMMON AND SERIOUS CONDITIONS shared with others,” says the NHS Choices website. “The inappropriate use and prescribing of antibiotics is causing the development of resistance.”

The problem Antibiotic resistance is just one strand of antimicrobial resistance—a global concern according to the World Health Organisation (WHO). “New resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases, resulting in prolonged illness, disability and death,” WHO states. “Antimicrobial resistance increases the cost of healthcare with lengthier stays in hospitals and more intensive care required.” According to Public Health England (PHE), antibiotic consumption increased by 6.5 percent between 2011 and 2014 in England. PHE says many patients have been inappropriately prescribed an antibiotic to treat minor ailments, such as coughs, colds or sore throats.

Act now According to government statistics, a failure to address the problem of antibiotic resistance could lead to an estimated 10 million deaths by 2050, costing £66 trillion. Already across Europe, an estimated 25,000 people die each year as a result of hospital infections caused by antibiotic-resistant bacteria. In England, E. coli is the most common cause of bacterial infection in the blood. Global concern around the issue is exacerbated by the fact that discoveries of new classes of antibiotics are at an alltime low. Only three of the 41 antibiotics in development can protect against the majority of the most recent bacteria. For this reason, the UK government takes the issue of antibiotic resistance as seriously as a coronavirus pandemic or major flooding.

Prescription One of the principle actions we can take is to encourage responsible prescription of antibiotics. The vast majority - 74 percent of these drugs are prescribed by a GP. There are a number of incentives in place to help healthcare professionals reduce antibiotic

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prescribing. In 2015, PHE advised NHS England on the development of a Quality Premium for antibiotic use, which would encourage Clinical Commissioning Groups (CCGs) to reduce prescribing of antibiotics by at least one percent. As patients, we can think twice before we ask our doctors to prescribe us antibiotics, especially for minor ailments like the common cold (which antibiotics cannot cure anyway). If your body can fight off an infection on its own, it’s always better to let it. Seek advice from your pharmacist about how you can treat minor illnesses before going to your GP.

Awareness European Antibiotic Awareness Day (EAAD) is held every year on November 18th. The Europe-wide public health initiative encourages the responsible use of antibiotics. PHE is responsible for coordinating all EAAD activities in England. Antibiotic Guardian, an antibiotic resistance awareness campaign (https://, invites visitors

to its website to become ‘antibiotic guardians’ and make a pledge about how they plan to make better use of antibiotics. Without effective antibiotics, many routine treatments and procedures will become progressively more dangerous, the campaign explains. From chemotherapy to basic broken bones, a host of ailments and treatments rely on access to functioning antibiotics. For those who want to take steps to help save these important medicines from becoming obsolete, the Antibiotic Guardian website offers a series of pledge messages to choose from. One reads: ‘For infections that our bodies are good at fighting off on their own, like coughs, colds, sore throats and flu, I pledge to talk to my pharmacist about how to treat these symptoms first rather than going to the GP.’ By encouraging people to become antibiotic guardians, we can go beyond simply raising awareness and encourage people to take just one concrete personal action, leading to much wider changes in behaviour. • dear doctor with dr Chris Steele  49

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Thyroid Thinking

The thyroid gland plays an important role in regulating body function, which is why it can be connected with so many common disorders

Hyperthyroidism The condition of Hyperthyroidism refers to a thyroid gland that produces too much of its hormones. This can cause several 50  dear doctor with dr Chris Steele

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symptoms including restlessness, a racing heart, irritability, anxiety, shaking, brittle hair and nails, thin skin, muscle weakness, weight loss and increased sweating. A blood test is the preferred method for diagnosing hyperthyroidism. The test measures the level of T4 and thyroidstimulating hormone (TSH). High T4 levels and low TSH levels indicate an overactive thyroid gland. Antithyroid drugs such as methimazole are prescribed to stop the gland from producing its hormones. Other treatments, like large doses of radioactive iodine, aim

to destroy or damage the thyroid gland. Surgery can also be performed in order to remove the thyroid entirely. Medical practitioners usually prefer the first option; damaging or removing the thyroid can lead to a hormone deficiency and may require supplements to be taken on a regular basis.

Hypothyroidism Hypothyroidism is the opposite of hyperthyroidism, and is much more common. In this case, the thyroid cannot produce enough of its regular hormones. Common symptoms of the condition

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he thyroid is a small, butterflyshaped gland located at the base of the neck. It manufactures hormones that control the body’s metabolism and growth such as triiodothyronine (T3) and thyroxine (T4). If it isn’t working as it should, several problems can arise – but many of them are easily treated.

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TODAY’S COMMON AND SERIOUS CONDITIONS include dry skin, constipation, fatigue, depression, memory problems, intolerance to cold, weight gain, weakness, slowed heart rate and, in severe cases, coma. Hypothyroidism can trigger other serious medical complications such as high cholesterol and atherosclerosis (clogged arteries), leading to a higher risk of angina or heart attack. Like hyperthyroidism, the condition is detected through a blood test. The test will track T4 and TSH levels; a high TSH reading and a low T4 reading indicate an underactive thyroid. The main form of treatment for hypothyroidism is a prescribed course of medication such as levothyroxine, available as tablets or a liquid. This replaces the missing thyroid hormone, but doesn’t actually cure the disorder, so it is likely to be a lifetime treatment. It can take experimentation with dosages to work out the correct levels of levothyroxine.

Goiter Goiter is a noncancerous enlargement of the thyroid gland; its main cause is an iodine deficiency in the diet. Goiter is conversely both caused by and a symptom of hyperthyroidism. Mild cases of goiter may not reveal any symptoms. Progressed cases may involve swelling or tightness in the neck, coughing, wheezing, difficulty swallowing and hoarseness of the voice. A routine physical examination will identify a case of goiter. This may involve the practitioner feeling the neck or swollen gland area. An ultrasound of the thyroid can reveal swelling or nodules. A blood test is another way to monitor hormone levels and confirm a diagnosis. While goiters aren’t usually a huge cause for concern, they can lead to more

serious conditions if left untreated. If iodine deficiency is the cause, doctors may prescribe small doses of iodine to resolve the problem. Radioactive iodine can be used as a way of shrinking the gland in more serious cases. •

Catching it early Around one in 20 people in the UK suffer from thyroid disorders. All babies in the UK are screened for congenital hypothyroidism using a blood spot test when they are around five days old. Source: British Thyroid Foundation

Hashimoto’s disease Hashimoto’s disease, also known as chronic lymphocytic thyroiditis, is the most common cause of hypothyroidism. The condition can occur at any time, although it’s most frequently seen in middle-aged women. It involves the body’s immune system mistakenly attacking the thyroid gland, impeding its ability to produce hormones. Symptoms of the disease are often subtle at first - they include fatigue, depression, enlarged thyroid, constipation, pale and puffy face, mild weight gain, irregular menstruation and dry skin. A blood test is the most accurate way to confirm Hashimoto’s disease. Increased levels of TSH combined with low levels of T3 or T4 will help to indicate the problem. Because Hashimoto’s disease is an autoimmune disorder, the blood test will also indicate if there are any abnormal antibodies attacking the thyroid. Hashimoto’s disease cannot be cured but its symptoms can be treated. Usually, doctors will recommend taking thyroid hormone replacement medication. In rare circumstances, surgery may be deemed necessary if the swelling is uncomfortable or cancer is suspected.

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The Questions on

Ulcerative Colitis


lcerative colitis (UC) is a chronic condition that is characterised by bouts of abdominal pain, diarrhoea and urgency to use the toilet. UC is one of the two main forms of inflammatory bowel disease—the other being Crohn’s disease. With this long-term disorder, small ulcers can develop in the large intestine (bowel) and the rectum. These ulcers can sometimes bleed and produce mucus, proving to be very painful for the sufferer. Other symptoms include loss of appetite, rapid weight loss, excessive tiredness, high temperature and general

52  dear doctor with dr Chris Steele

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feelings of being unwell. People with UC often experience long periods of good health, known as remission, as well as relapses - also known as ‘flare-ups’ - where symptoms are amplified or more frequent.

Common causes Although there has been vast research into the topic, it still isn’t completely clear what causes UC. UC is thought to be an autoimmune condition caused by irregularities in the immune system—the body’s natural defense against infection. This theory stipulates that the immune

system mistakenly identifies harmless bacteria inside the colon as dangerous and proceeds to attack the healthy tissue causing inflammation. The reason behind this reaction still remains unknown, although most believe it’s a combination of genetic and environmental factors. According to the NHS, more than one in four people with UC have a family history of the condition.

Who is affected? UC can start at any time, though it often appears between the ages of 15 and 25 or

IMAGES: Dreamstime

The causes of ulcerative colitis are still poorly understood and a cure seems a long way off, but with the right treatment the condition can be managed

15/10/2021 12:23


Star name

International pop star, Anastacia, was diagnosed with Crohn’s Disease when she was 13 and has been proud to show off the scar on her stomach from surgery ever since. Despite other serious health conditions, Anastacia is keen to raise awareness of Inflammatory Bowel Disease. She said on “I suffered the embarrassment and challenge of being a teenager and dealing with a disease that held a stigma of shame. I have been very lucky to have long periods of remission with this disease and am aware that this is not the norm. “Crohn’s and Colitis UK is a wonderful organisation which is available to anyone. It has an amazing network of up-todate research, treatment and support. “I believe that connecting with others who have this condition can make a huge difference in living with, as opposed to suffering silence with, these illnesses. “With 1 in 210 people in the United Kingdom suffering from Crohn’s or Colitis, I hope to raise awareness and an ability to help those suffering in silence in the knowledge that there is help and support available.”

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1 in 420

The estimated proportion of people affected by ulcerative colitis in the UK, which equates to roughly 146,000 sufferers Source:

in later life—between the ages of 55 and 65. Medical sources tend to agree that the condition affects men and women equally. The risk of developing UC is said to be greater if a close family member also suffers from it, making genetics a considerable factor. The significance of genes is further supported by the fact that UC is common in white people of European descent and rarer in people of Asian backgrounds. UC is predominant in urban areas and developed countries, although the number of those affected in developing nations is steadily increasing.

 Irregular heartbeat  Shortness of breath  Fever  Blood in the stool

TREATMENT OPTIONS There is no definitive cure for UC; but treatments are designed to relieve symptoms and stop them from returning—this is known as ‘maintaining remission’. For most patients, maintaining remission can be achieved through certain medications such as aminosalicylates (ASAs), corticosteroids and immunosuppressants. Mild to moderate symptoms can be treated at home with these medicines, while severe flare-ups may require treatment in hospital. Serious cases of UC can cause the colon to stretch, become enlarged or develop a hole; in such cases, close medical attention will be necessary. If a person’s quality of life is being affected and medications aren’t tackling the problem effectively, a portion of the intestine may be removed via surgery.



When UC flare-ups appear, other parts of the body can be affected, too. Common signifiers of a flare-up include:  Painful or swollen joints  Sore and irritated eyes  Mouth ulcers  Patches of painful or swollen skin

If you suspect that you are suffering from UC, contact your doctor as soon as possible in order to get a definitive diagnosis. A blood or stool sample will help to determine the verdict. If necessary, you may be referred to a hospital for further testing. Once diagnosed, your specialist will guide you on a treatment plan that is appropriate for your condition. •

In more severe cases, flare-ups may also include symptoms such as:



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Detecting and Treating IMAGES: Dreamstime


Emphysema is a type of chronic obstructive pulmonary disease (COPD) that instigates breathing difficulties. But what causes it and how can it be treated? 54  dear doctor with dr Chris Steele

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mphysema develops when the elastic walls of the air sacs (alveoli) within the lungs are damaged. These air sacs can weaken and break, creating bigger air spaces rather than the numerous small ones usually found in healthy lungs. This is the region where oxygen is stored in the body and also where carbon dioxide is removed. So, larger air spaces mean that surface area is reduced, reducing the amount of oxygen that reaches the bloodstream.

Causes and Symptoms The main cause of this condition is the lengthy exposure to airborne substances including cigarette smoke, chemical fumes and dust. Emphysema can develop for a long time without expressing any obvious symptoms. When it is evidenced, the primary symptom is shortness of breath, even during rest. Other symptoms of emphysema include wheezing, build-up of mucus, continual fatigue and a long-term cough.

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Emphysema usually develops in people aged over 50 years old, with those who suffer from the condition also having an increased risk of developing bronchitis, pneumonia and other lung-related infections. Often, symptoms may not be noticed up until 50 percent of the lung tissue has disintegrated.

Treatments Though emphysema is incurable, there are various treatments that can lessen the impact of the symptoms. If you are a regular smoker, one of the best ways you can reduce the risk of emphysema getting worse is to stop smoking. Despite the fact that damage cannot be reversed, it will prevent the damage to the air sacs getting worse. If breathing is affected, a doctor will prescribe you with an inhaler. An inhaler will direct medicine straight into your lungs when you breathe in. There are different types of inhaler which you could be

prescribed, the main types being shortacting bronchodilator inhaler, long-acting bronchodilator inhaler and steroid inhaler. Others with severe emphysema may need to be treated with a nebuliser. This is a device which delivers medication in the form of mist inhaled directly into the lungs. Certain people suffering from emphysema may be treated by surgical methods, specifically a lung transplant. However, new non-surgical techniques of treating emphysema are being developed which promise good outcomes for certain patients. •

BLF The British Lung Foundation is the only UK charity dedicated to lung care. Last year it invested £1.8m in lung disease research. Find out more at

dear doctor with dr Chris Steele  55

15/10/2021 12:24


Are you ready to get back to doing what you love?

Discover a breakthrough treatment option for severe emphysema — a form of COPD Introducing the Zephyr Valve® The Zephyr Valve® is not another medication or surgery that requires cutting or incisions. It is a minimally invasive procedure that uses a bronchoscope to place tiny valves in your airways. The Zephyr Valve allows trapped air to escape until hyperinflation is reduced.

Oxygen Therapy, Corticosteroids, Bronchodilator

Pulmonary Rehabilitation


This leaves room for the healthier parts of your lungs to expand and take in more air. Zephyr Valves are proven to help patients breathe easier, be more active, and enjoy a better quality of life.1 See if the Zephyr Endobronchial Valve treatment is right for you.

Zephyr Endobronchial Valves

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Brief Statement: The Zephyr® Endobronchial Valve is an implantable bronchial valve intended to control airflow in order to improve lung functions in patients with hyperinflation associated with severe emphysema and/or to reduce air leaks. The Zephyr Valve is contraindicated for: Patients for whom bronchoscopic procedures are contraindicated; Evidence of active pulmonary infection; Patients with known allergies to Nitinol (nickel-titanium) or its constituent metals (nickel or titanium); Patients with known allergies to silicone; Patients who have not quit smoking. Use is restricted to a trained physician. Prior to use, please reference the Zephyr Endobronchial System Instructions for more information on indications, contraindications, warnings, all precautions, and adverse events.

1 Criner et al. A multicenter randomized controlled trial of Zephyr endobronchial valve treatment in heterogeneous emphysema (LIBERATE). Am J Respir Crit Care Med, 2018; 198, 1151–1164. Caution: Federal law restricts this device to sale by or on the order of a physician. 2

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02/09/2020 14:25

COPD & Emphysema

Talk to your doctor

COPD (chronic obstructive pulmonary disease) is a progressive disease and gets worse over time. It is the second most common lung disease in the UK.2 Emphysema is a severe form of COPD. People suffering from emphysema live with severe shortness of breath, which often prevents them from carrying out activities of daily living without having to take breaks to catch their breath.

Confirm that you have been diagnosed with emphysema so you can discuss an appropriate treatment plan with your doctor.

Don’t simply get used to the symptoms and restrictions on your life. The right treatment can contribute to alleviating the symptoms, improving your quality of life, and slowing the progression of the disease.

Complications of the Zephyr Endobronchial Valve treatment can include but are not limited to pneumothorax, worsening of COPD symptoms, hemoptysis, pneumonia, dyspnea and, in rare cases, death.

It may be necessary to conduct additional tests — e.g., a lung function test or a CT scan to determine whether surgical treatment options and/or insertion of Zephyr Valves are possibilities.

Visit to learn more about Zephyr Valves. Pulmonx UK ltd | Highlands House, Basingstoke Road Spencers Wood, RG7 1NT Reading, Berkshire | United Kingdom Tel: (+44) 808 234 0376 | Email:

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© 2020 Pulmonx Corporation or its affiliates. All rights reserved. All trademarks are property of their respective owners. EMEA-EN-600-v1 (v1.1) – Print Ad - UK “Dear Doctor” Campaign - September 2020

02/09/2020 14:25



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erectile dysfunction, the condition can develop at any age. Research conducted in Italy showed that one in every four patients seeking help for erectile dysfunction is under the age of 40. Causes of MED can range from the psychological, ‘performance anxiety’, to more serious physical problems such as atherosclerotic heart disease, which affects the circulation, hypertension (high blood pressure), diabetes, obesity, hyperthyroidism, or overconsumption of alcohol. Some medicines can cause MED, as can stress and depression. In many cases, erectile dysfunction

can be reversed. A study published in the Journal of Sexual Medicine found a remission rate of 29 percent after five years. Even when ED cannot be cured, the right treatment can reduce or eliminate symptoms. Researchers identify two types of MED: Primary MED occurs when a man has never been able to have or sustain an erection. This is rare. Primary MED may require the more intensive and medicalbased treatments. Secondary MED occurs in people who

IMAGES: Shutterstock

art of the problem in dealing with male erectile dysfunction, the inability to achieve or maintain an erection, is the unwillingness of some sufferers to talk about it. But as there is a wide range of causes and solutions, this is an essential part of dealing with the problem. It’s a common problem. Studies conducted in China, the US, Germany, and Brazil show that erectile dysfunction affects 16 to 40 percent of the adult male population with approximately 150 million new cases reported every year. Though older men are more likely to develop

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Talk It Up Sometimes, counselling for couples or sex therapy can be useful in treating MED. Alternatively, you could try cognitive behavioural therapy (CBT), which is designed to help you stop negative thinking patterns. Ask your GP about your local IAPT (Improving Access to Psychological Therapies) service.

once had regular erectile function. This is the most common type, is often temporary and can often be reversed.

IMAGES: Shutterstock

STANDING PROUD MED is usually treatable with medication or surgery. However, it may also be possible to treat the underlying cause and reverse symptoms with no medication. Positive changes to diet and lifestyle, including giving up smoking and alcohol, getting more exercise, losing weight and practicing relaxation are the first steps to addressing the problem, and if these don’t help, an examination by your GP will identify or rule out any underlying causes such as high blood sugar levels. Getting an erection is a complicated business, starting with a mental or physical stimulus which prompts the central nervous system to release the substance cyclic GMP, widening the arteries that supply the penis with blood, which infuses the soft tissues lining the penis. A GP may prescribe sildenafil (the generic term for the treatment marketed as Viagra). Because of recent changes in regulations, you no longer need a prescription to get sildenafil, but you’ll have to have a consultation with the pharmacist to make sure it’s safe for you to take it. There are other similar medicines such as tadalafil (Cialis), vardenafil (Levitra) and avanafil (Spedra) that work in a similar way, blocking the action of a chemical called PDE5 which

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breaks down cyclic GMP, so it can make it easier to achieve and maintain an erection. None of them are guaranteed to work for everyone, or every time they are used, and there can be side-effects such as headaches and blurred vision. In very rare cases, an overdose has caused priapism - persistent erection - which can lead to permanent damage to the tissues of the penis. XIAGRA’s Intimacy Vitality Pills are a natural alternative to the synthetic pharmaceutical treatments available in the market place for ED.

PUMP IT UP An alternative form of treatment is the vacuum pump, which encourages blood to flow to the penis, causing an erection. They work for most men, and can often be helpful if medicine is not suitable or does not work. They’re not always available on the NHS, but you can speak to your doctor about where to get one. The penis is positioned inside the tube, and pumping periodically over a 1-3 minute period pulls blood into the penis creating a fully rigid erection. An erection

maintenance ring is then transferred from the device cylinder to the base of the penis against the body wall. In some cases a range of re-useable erection maintenance rings with choice of material types, ring pressures and dexterity requirements are provided to guarantee greater comfort, effectiveness and ease of use in maintaining the vacuuminduced erection. Removal of the cylinder allows full sexual intercourse to take place with the erection maintenance ring still in place. Vacuum pumps typically offer a range of cylinder sizing options so you can precisely find the diameter sizing option that neatly fits your fully rigid penis size. This prevents loose non-penile tissue from around the base of the penis (supra-pubic fat or scrotal skin) being drawn into the mouth of the cylinder during erection creation and being compressed uncomfortably with the transfer of the erection ring. As a non-invasive and non-medicinal treatment for MED, the vacuum pump has a lot going for it. It can also work out cheaper in the long term than continually using medicines or supplements. •



15/10/2021 12:27


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The Female Principle Female sexual health is an issue which is not discussed as much as it should be – but researchers are now beginning to explore its mysteries


hile it’s completely normal for females to experience fluctuations in levels of sexual desire throughout life, often due to hormonal changes, researchers such as BMC Women’s Health are now suggesting that a substantial or total loss of interest in sex, or difficulty responding to stimulation, may indicate a disorder they have labelled FSIAD, or Female Sexual Interest/Arousal Disorder. The term FSIAD first appeared in the American Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) in 2013. It refers to both reduced excitement, sensation, or pleasure during sexual activity and a lack of physical response to stimulation.

Symptoms The definition of FSIAD looks at several qualifying symptoms, including

IMAGES: Dreamstime

Reduced or no interest in, thoughts about or arousal during sex Infrequent or no initiation of sexual activity within a relationship Reduced or no sensations in the genitals Symptoms lasting six months or more Significant distress about their symptoms Symptoms not more accurately explained by a nonsexual health disorder. FSIAD can be generalized (involving symptoms that occur in any situation, with any partner, and during any type of sexual stimulation) or situational (more specific and only occurring in certain scenarios), and can be either lifelong, or acquired. Causes can range from relationship dissatisfaction to mental health issues such as negative self-image or lack of confidence in one’s body or appearance, stress, anxiety, and depression, or an abusive history.

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Research into drugs such as testosterone combined with sildenafil or buspiron, bremelanotide, BP101, and nasal testosterone (TBS-2) concluded that they may be helpful. XIAGRA’s Intimacy Vitality Pills are a natural alternative to the synthetic pharmaceutical treatments available in the market place for FSIAD.

But the 2018 review notes that sex education and feeling that sex is important in a relationship are both protective factors against sexual dysfunction, concluding “Given the multifactorial character of FSIAD, it may be important to integrate psychopharmacological treatment with sex therapy for optimal treatment efficacy.” • dear doctor with dr Chris Steele  63

15/10/2021 12:28

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13/09/2021 12:21


Listen Ear

Why we shouldn’t ignore ear infections, and how we can recognise the symptoms and deal with the causes

IMAGES: Dreamstime


ar infections can affect the inner, middle or outer part of the ear, and can affect people of any age, but are particularly common in children. Inner ear infection, known as labyrinthitis, is the least common of the three types. This type affects the part of the ear that is responsible for hearing and balance and is caused by viral or bacterial infection. Middle ear infection, known as otitis media, affects the Eustachian tubes responsible for the air flow into the middle ear cavity, and is caused by allergies or mucus build-up. This type of ear infection is

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more commonly found in children, because they have shorter and narrower Eustachian tubes than adults. Infants that are bottlefed have a bigger risk on suffering from an ear infection. Outer ear infection, also known as otitis media, affects the ear canal and is caused by bacterial or fungal infection. Risk factors for this type of infection includes smoking and sinusitis.

TREATMENT The types of treatment available depends on the type of ear infection and the seriousness of the infection. To tackle an inner ear infection,

ETD Blocked ears, known as Eustachian Tube Dysfunction or ETD, are often caused by air pressure increases, for example when flying, by allergies, sinus infection or a cold. Steam inhalation can often help clear it up, but if you suffer regularly, see your GP about a ENT (Ear, Nose and Throat) examination.

antibiotics would usually not be prescribed as inner ear infections often clear up on their own. A few days of rest will normally clear up the condition, though you should consult your GP for advice. Otinova Ear Spray is a medical device that treats ear canal inflammation/ otitis externa, sometimes known as ‘swimmers ear’. There are so few preparations as that are safe to use in ears, so choice is limited. Otinova is unique in that it contains Burow’s Solution; an astringent mixture of aluminium acetate, aluminium acetotartrate, acetic acid, and water. As early as the mid 19th century Karl August Burow used aluminium acetate to treat open wounds. For many years Burow’s solution was commonly used to treat insect bites, various skin lesions and ear canal inflammation. Now available in a preparation based on Burow’s recipe, this clinically proven antifungal and antimicrobial ear spray comes in a 15ml bottle (150 doses) and is available on prescription or over the counter. • DEAR DOCTOR WITH DR CHRIS STEELE


15/10/2021 12:50



EARLY TREATMENT AND INCREASED AWARENESS CAN DEFEAT THE UK’S LEADING CAUSE OF BLINDNESS By Mr Vik Sharma (MBBS BSc FRCOphth), Clinical Director, London OC, and a Consultant Ophthalmologist, Cataract and Glaucoma Specialist As a surgeon the most satisfying part of my job is creating a truly positive outcome for my patients – something that changes their lives for the better and gives them an improved quality of life. I must say that as an eye surgeon this is something that I am able to do daily. Working as a glaucoma specialist at The Royal Free Hospital and at The London Ophthalmology Centre (LondonOC) I see many cases of acute glaucoma and use the most sophisticated treatments that are available in the world to successfully treat people. I would urge anyone who is concerned about their eyesight to seek help as soon as possible as we want to see people early and get them treated. In recent years there have been advances in glaucoma detection, which means it can be treated earlier than ever and 95% of people who have glaucoma do not go blind. 1 in 50 people will develop Glaucoma over the age of 40. There are few obvious symptoms so people may not realise what is going on. However, glaucoma is a serious life changing disease that can threaten your vision and impact your daily life. It is the leading cause of blindness and can cause permanent damage to your eyes. Some people may have medical conditions and hereditary traits that can increase the chances of having glaucoma, disease that can strike anybody so it’s important to get your eyes checked at least once a year particularly if you’re over the age of 40. Glaucoma is caused by too much pressure on your eye, which then squeezes the optical nerve. When there is damage to the optical nerve, it can lead to

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a degrading of your eyesight, which can eventually cause blindness if not treated correctly. There are subsets of glaucoma that can be present without any extra pressure and can be difficult to detect. Having glaucoma may be daunting but having a diagnosis means that it can be treated. Even though there is no cure we can offer cutting edge detection and treatments with some of the most advanced glaucoma surgery in London. Mr Vik Sharma is one of the UK’s leading glaucoma and cataract Specialists

Lifestyle indicators we look for: • Poor vision or other eye conditions • Over the age of 40 • People with thin and sensitive corneas • Diabetes, high blood pressure or anaemia • Genetic vulnerability to glaucoma or myopia • Eye injury


Glaucoma is so dangerous because it rarely has symptoms, • Headaches • Red eyes • Tunnel vision • Dizziness • Blurry vision • Halo-rings in the line of sight • A vision that progressively worsens – initially in the peripheral vision, later centrally • Pain on and around the eye • Nausea and vomiting

15/10/2021 13:35


CASE STUDY MICHAEL ROSEN, FORMER CHILDREN’S LAUREATE Last year I saved the site of former Michael Rosen with a new, non-invasive technique for the application of Xen stent into the eye to treat acute glaucoma.

Vik Sharma treats former Children’s Laureate, Michael Rosen at the London Ophthalmology Centre (LondonOC)

Michael woke from a coma in hospital and the first thing he noticed was that he had a distinct fogginess in his left eye. I knew that if he was not treated in the next week or two, he could go blind. I used the Xen stent combined with a new technique to fit which creates a new pathway for the fluid to drain out of, but without the cuts and stitches, making it quicker and safer giving greater likelihood of a successful outcome for the patient.


TREATMENT WITH LENS REPLACEMENT Cataracts are very common; it’s estimated around 2.5 million people aged over 65 have cataracts and it’s the main cause of impaired vision worldwide. However, Lens Replacement, the optimal cataract treatment is now being used to correct several different eye problems and prevent cataracts developing at all in the first place. The surgery has benefited from the experience of millions of cataract surgeries, so it has evolved to become a simple yet sophisticated procedure. There is one incision, followed by a swift removal and replacement with the new synthetic lens. People don’t realise that lens replacement is permanent and for life. It means you could be 80 years old and have the same eyesight that you had as a child. No glasses, no contact lenses needed, just perfect vision near and far, for the rest of your life. You will not go on to develop cataracts if you have this done early in your life. If you have this done to treat cataracts you will go on to have near perfect vision.

The crystalline lens of the eye is a natural lens which produces one third of the eye’s total optical power and focuses light into an image on the retina (the light-sensitive tissue at the back of the eye). Over time however, the lens begins to harden as we first start to develop what will eventually become cataracts. We start to notice this in our forties as the muscles don’t work as quickly to focus and refocus, and we start to notice problems with our vision as those muscles weaken. Lens replacement switches out the old lens with a new synthetic lens designed to last for 100 years! Michael also had lens surgery at a later date. Lens Replacement is performed using local anaesthetic, so it is a day case surgery taking only 10-15 minutes, and a relatively painless procedure with a recovery time of around 3 days with optimum vision within 2 – 4 weeks. The results that I have seen make a startling and dramatic positive impact on people’s lives giving them back their freedom.

We are happy to advise you. Please contact us at the London Ophthalmology Centre (LondonOC) on 020 7000 3193 / 0800 7569993 or email and visit

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Eyes on the Prize ision contributes around 80 percent of the body’s sensory input, and is closely related to memory, spatial perception and the circadian biological clock, so any degradation of vision can have profound consequences. Yet the eye is a complex organ, subject to many forms of disorder, so it’s vital to check eye health regularly and to treat and disorder as early as possible. Some sight-threatening conditions do not produce any obvious early symptoms such as pain, emphasising the importance of getting frequent checks. 68  dear doctor with dr Chris Steele

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It is recommended that everyone should have their eyes checked at least once every two years, even if you feel that nothing about your vision have changed. Examinations can pick up on the early signs of a condition appearing before you notice any developments yourself. If regular eye tests are not taking place, it increases the risk of the eyes suffering from a serious condition.

Eye Conditions If the eyes are not looked after well, then can be susceptible to various conditions,

the most common of which are Macular Degeneration, Glaucoma and Cataracts. * Macular Degeneration is an eye disease which can affect people of all ages but is most commonly found in older people. It is the chief cause of vision loss in people over the age of 60. This condition affects the central vision of the retina known as the macula, wearing it down and distorting the eyesight. As time goes on, this can worsen, leading to a completely blank patch within the central vision of the eye. The causes of macular degeneration are incompletely

IMAGES: Dreamstime


One of the most important yet delicate of the body’s organs, your eyes deserve the best of care

15/10/2021 12:43


SUPPORT Every day, 250 people in the UK begin to suffer from sight loss. The Royal National Institute of Blind People (RNIB) is one of the UK’s leading sight loss charities and the largest community of blind and partially sighted people, campaigning for change and offering anything from practical and emotional support to reading services and products in an online shop.

understood, but poor diet and smoking are certainly contributory factors. * Glaucoma is a hereditary condition which can lead to complete blindness if not treated properly. This condition affects the optic nerve, as it becomes damaged due to a build-up of fluid in the front section of the eye, causing the pressure within the eye to increase. This can lead to loss of peripheral vision. This condition can develop without any symptoms but can be picked up by eye specialists. According to the International Agency for the Prevention of Blindness, glaucoma is the fourth largest cause of vision loss worldwide, with 3.6 million people blind from the condition. There is no complete treatment for glaucoma, but eye drops, laser treatment or surgery will usually control the condition. * Cataracts is a mainly age-related eye condition by which the eye’s focussing lens becomes clouded. Smoking alcohol use, diabetes and injury can be factors. Symptoms can include misty vision, changes in colour perception and sensitivity to light.

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The only effective treatment is surgical lens replacement, but this has become a fairly routine and reliable procedure. Certain people are more at risk of these eye conditions than others. It is known that those over the age of 60 are more likely to develop eye diseases. People from certain backgrounds are also more susceptible to conditions. People of Asian descent are more likely to suffer from diabetic retinopathy (deterioration of the light-sensitive layer at the back of the eye) while those of AfricanCaribbean descent are at a greater risk of developing diabetic retinopathy and glaucoma. Glaucoma also has an hereditary factor, so if you know there is a history in your family it is worth getting checked out early.

EYE CARE As well as booking regular eye tests at the local opticians, there are many other ways to keep your eyes healthy and reduce the risk of acquiring serious conditions. Eating healthily is key to preventing conditions including macular degeneration and cataracts from developing. Reducing

the consumption of foods with saturated fats and eating more green vegetables such as broccoli and spinach will help keep the eyes healthy. Protecting the eyes from the sun is also crucial, as looking directly into the sun can cause permanent damage to the eyes. The UVA and UVB rays in sunlight can increase the risk of getting serious long-term eyes conditions. Therefore, it is important to wear sunglasses as they are excellent ways to help protect your eyes from these rays. It’s not just on bright days that this is important - glare from snow or water can also present a danger to eyes. In addition so sunglasses, wearing peaked hats or caps can also protect the eyes from damaging sunlight. Smoking can double the risk of developing macular degeneration, so not smoking or giving up smoking will aid in reducing the risk of gaining the UK’s most common cause of slight loss. If your daily routine includes spending large amounts of time looking at a screen, make sure to take breaks and not to overstrain the eyes. Doings things as simple as looking around the room or going outside can help minimise strain. • DEAR DOCTOR WITH DR CHRIS STEELE


15/10/2021 12:43


Beating Diabetes Is it possible to beat diabetes by changing your lifestyle? Increasingly this is the approach that is being taken in preference to medication diabetes is present from birth or an early age, though it’s less common than type 2 diabetes.

There are two main types of diabetes, Type 1 and Type 2.

Type 2 diabetes This is a result of the body not producing enough insulin, or the body’s cells failing to respond to insulin, meaning glucose stays in the blood and is not used for energy.

Type 1 diabetes - This is caused when the body’s immune system attacks and destroys the cells in the pancreas that produce the hormone insulin, which breaks down sugars. Often, this type of

Type 2 diabetes is usually associated with obesity, and tends to be diagnosed in older people. Around 90 percent of the 4.7 million people with diabetes in the UK suffer from Type 2 diabetes. This number is rising

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rapidly in the UK and worldwide, with many not knowing they even suffer from it.

Symptoms People do not often realise they have type 2 diabetes because the symptoms do not necessarily make them feel unwell. The symptoms of type one and two are the same, so it is important to go to your GP if these problems persist. They include: IMAGES: Shutterstock


iabetes is a lifelong condition that causes blood sugar levels to become too high. This can be detrimental to many different organs and systems and can have severe health consequences.

Feeling very thirsty Peeing more than usual, often at night Feeling very tired Losing weight without trying

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Lifestyle Lifestyle changes recommended for people at risk of diabetes (‘pre-diabetic’) include:  Taking two and a half hours each week of moderate intensity physical activity or one hour and 15 minutes of high intensity exercise.  Losing weight gradually to achieve a healthy body mass index  Replacing refined carbohydrates with wholegrain foods and increase intake of vegetables and other foods high in dietary fibre  Reducing the amount of saturated fat in the diet

 Recurring infections such as thrush  Blurred vision  Cuts and grazes that are not healing While these symptoms can appear minor, they are the sign of long-term organ damage which can become progressively worse. Diabetes is the most common cause of vision loss and blindness in people of working age, so everyone aged 12 or over should be invited to have their eyes screened once a year for diabetic retinopathy, damage to the back of the eye. Diabetes is also responsible for most cases of kidney failure and lower limb amputation (other than accidents). People with diabetes are up to five times more likely to have cardiovascular disease, such as a stroke or a heart attack, than those without diabetes.

TREATMENTS It is essential that people with type one diabetes take insulin. Insulin is a hormone manufactured in the pancreas which helps your body use glucose (sugar) for energy. In type 1 diabetes the pancreas no longer

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makes insulin, so you have to inject it to control your blood glucose levels. There are different types of injectable insulin, taken at different times.  Basal insulin - long-acting, background or basal insulin is taken once or twice a day, and gives your body the insulin it needs whether you eat or not. Basal insulin should keep your blood glucose stable overnight and between meals.  Fact-acting insulin - taken with food or drink, fast-acting, mealtime or bolus insulin helps reduce the rise in blood glucose caused by eating or drinking. You usually take it before a meal, snack or drink with carbohydrates in it. There are many types of medicine for type 2 diabetes, and it can take time to find a medicine and dose that’s right for you. You’ll usually be offered Metformin first. If your blood sugar levels are not lower after taking Metformin, you may need another medicine or a combination of medicines. Your GP or diabetes nurse will recommend

the medicines most suitable for you. Insulin is not often used for type 2 diabetes in the early years, though it may be needed if other medicines fail to work.

CORONAVIRUS It appears that diabetics are no more vulnerable to coronavirus than anyone else, and if they do contract it, regardless of what type of diabetes you have, the majority of people will have mild symptoms and won’t need to go into hospital. However, as with anyone else, there is a small risk of people with diabetes being severely affected by coronavirus, though this is unlikely to happen with children. The problem seems to be that any severe illness can disrupt blood sugar levels, and this is of course crucial for diabetics. The body can try to fight the illness by releasing stored glucose (sugar) into the blood stream to supply energy, and if your body can’t produce enough or any insulin to cope with this, so blood sugars levels will rise. For advice on coping with diabetes and coronavirus, visit • DEAR DOCTOR WITH DR CHRIS STEELE


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Finding Out About Folates What exactly are folates and why are they so important to our health? Find out here and you’ll never look at spinach the same again

SUPPLEMENTS Surprisingly, considering how important they are to the body, the human organism can’t synthesise folates, so has to meet its needs through diet or supplementation. While foods with high folate content include green vegetables, eggs, milk and animal, food folates all exist in a reduced form and are very susceptible to oxidation—in other 72


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Yeast is Yeast The importance of folates was first recognised by English haematologist Lucy Wills in India in the 1930s. She examined pregnant women with different eating habits and discovered that diets deficient in certain foods caused changes in the overall health, revealed in blood tests. She found that both mother and child could be helped with a yeast extract, and in later years, the folates contained in the extract were identified and synthesised.

words, a large proportion is lost during storage and cooking. Dietary folates can also be polyglutamated (combined with glutamic acid), which makes conversion during digestion necessary. The folic acid often used in supplements, though, is a stable, oxidised form, of which only trace amounts are found in nature. Certain dietary supplements also provide additional intake of zinc and riboflavin which are minerals that help retain healthy vision. Vitamin B is essential for supporting normal homocysteine metabolism in the eye - this is because healthy eyes require substantial amounts of energy and oxygen. We all know that our eyesight is important. Without it, life can be a real challenge, and while there are plenty of options open to those of us who struggle to see well, from cataract surgery to laser

IMAGES: Shutterstock


he story of folates is a fascinating one which had a long-term effect on our attitude to diet and nutrition. Folates are vitamins, found most commonly in nature as Vitamin B9, and now manufactured in the form of folic acid. The function of folates is not entirely understood, but they are responsible for transporting basic chemical building blocks in plants, animals and humans. These building blocks are required most notably in growth phases (pregnancy) but also later in all of the organs. Folates are converted as required in many reactions controlled by enzymes, and are extremely important for proper functioning of the organism. Folate specifically reduce the risk of glaucoma, which can cause blindness and severe visual impairment. The concentration of folate varies greatly in individual organs, with three different organic receptors playing a part in transporting folates through membranes such as the blood/brain barrier. The delivery system is quite sophisticated, and so can easily be disrupted by folate deficiency. When deficiencies are not treated, they often cause chronic diseases or deformities during the growth phase, such as spina bifida.

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sight correction, it pays to do all you can to prevent eye problems early in life.

Eat Well While folates are essential for eye health, other substances such as omega-3 fatty acids, lutein, zinc and vitamins C and E can all help ward off age-related eye problems. Particularly good foods that help with eye health include green leafy vegetables such as spinach and kale, as well as oily fish, eggs, nuts and beans. Certain nutrients help maintain proper eye function as well as protecting your eyes from harmful lights and participating in reducing the risk of AMD (age-related macular degeneration).

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Deficiencies in micronutrients are still widespread in all ages and old and frequently cause illness. If the deficiency is not treated, costly operations or therapies will be effective only to a certain extent or for a short time. A diminished quality of life caused by impaired vision is an enormous problem for the affected person, not to mention a burden on the healthcare sector. Vitamin A is essential for your eyes’ lightsensing cells, known as photoreceptors. If the eyes do not get enough vitamin A, you may experience night blindness, dry eyes and other severe eye-related conditions. In fact, vitamin A deficiency is one of the most common cause of blindness in the world. The primary source of vitamin A in the

human diet is beta carotene, a type of plant pigment called a carotenoid that exists in many colourful fruits and vegetables. When carotenoids are consumed, the body converts the pigments into vitamin A – so maybe there is something in the old story that eating carrots is good for your eyesight. Antioxidants such as lutein and zeaxanthin are not so widely recognised, however they can play an important role in your eye health. They function as a natural sunblock and protect your eyes from harmful blue light. Studies have shown the intake of these antioxidants to be proportional to the amount in your retina, so they don’t go to waste! • dear doctor with dr Chris Steele  73

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In the Genes


ince the function of genes in inheritance and health was established, it’s become clear that the ability to study and analyse the genetic material that controls cell structure and inherited conditions could be the key to all sorts of health issues. It’s only in recent years, when analytic and computational technology has fully unlocked the chemical codes and functions of our DNA, that the full potential of genetic testing has become clear. DNA, (deoxyribonucleic acid) is a complex dual-spiral compound made up of four base chemicals. Most of our DNA is common to everyone; it’s what makes us human, rather than an ape or a sea cucumber. But variations in DNA give us our distinct characteristics, and if this DNA is faulty or damaged, we can inherit or develop an enormous range of health conditions.

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Genetic testing is the analysis of your DNA from a sample of saliva, blood or tissue, and can establish if you have certain gene mutations which are associated with particular diseases. Genetic testing can also predict how your body will respond to drugs and treatments, so, for instance, it can help oncologists plan a cancer treatment with a degree of confidence about its effectiveness greater than ever before.

Hereditary But not everyone is offered genetic testing. James Price, founder of Everything Genetic, says: “Genetic information is the key to prevention but 90 percent of people with genetic mutations are still not aware of their elevated risk. We can unlock that information swiftly and this could have a huge impact on both an individual’s health and the NHS’s ability to treat cancer. Currently, the NHS will only offer you a

genetic test if you have a high hereditary risk. We want the tests to become part of national screening, rather than people having such a high hurdle to access it.” You may be concerned about your risk of developing a particular disease or condition, perhaps because it’s in your family history, and genetic testing can have positive benefits whatever the result – if negative, it can remove stress and worry, and if positive, it can help you and your clinicians make decisions about your treatment, from diet and lifestyle to monitoring and therapies. A regular routine of screening can help to detect any disease at an earlier stage, improving the chances of effective treatment, recovery and survival. Genetic testing may be only the beginning of treatment, but it’s a breakthrough in diagnosis which may become the basis of a whole new approach to healthcare. •

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Awareness of genetic disorders can be a key to prevention of a range of conditions – so should we all be preparing for genetic screening?

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Providing innovative genetic screening at affordable prices In Europe, on average, one in two women and one in three men develop cancer during their lifetime. An individual’s cancer risk can be high, whether or not there is a family history of cancer. Currently many cancers are diagnosed at an advanced stage when the prognosis for life is already poor. New solutions are needed to change this situation. Knowing the personal cancer risks of individuals is the key to better cancer prevention and longevity. Everything Genetic Ltd is a consultative distributor of market-leading genetic testing brands to both healthcare providers and directly to patients. We have established partnerships with market-leading laboratories; supplying revolutionary genetic tests to healthcare providers and patients for the detection, diagnosis and treatment planning of cancer, heart disease and other illnesses.

Our CEO and founder, James Price said,

“Our vision is to democratise genetic testing by making it accessible, affordable, and easy to use. We’re innovators of new technology, with top geneticists and cancer specialists in our medical team offering a comprehensive clinical support to patients”. Our tests: • help detect problems at an early stage – when they’re most treatable. • provide a detailed analysis which helps to determine the most effective drugs and treatments for those already diagnosed.

Visit our website for more information about our range, prices and how to access our tests EGL1632_Aug 2021

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The Vital Facts About

Vitamin D

Vitamin D is a vital component in many body functions – so why do many of us suffer from a deficiency?


itamin D is crucial to the nutrition process, as it absorbs the minerals from your diet to maintain strong and healthy bones, muscles and teeth. Yes the human body is peculiarly designed when it comes to manufacturing Vitamin D, requiring sunlight as part of the process. If you don’t get enough sunlight on your skin – and if you spend a lot of time indoors, and during the dark winter months, that’s quite likely – you may be Vitamin D deficient. How does it work? Sunlight contains ultraviolet-B wavelengths which stimulate a protein in the skin called 7-DHC, resulting in the creation of vitamin D3. It is recommended that from April until the end of September, the body, specifically the forearms, hands and lower legs, need to be exposed to around 20-30 minutes’ worth of outside sunlight. People who have dark skin – for example people of African, AfricanCaribbean or Asian descent – may not be able to produce enough vitamin D from sunlight alone. Vitamin D can also be found in some foods, such as fish (Salmon, mackerel, sardines etc), red meats (beef and lamb), liver and fish liver oil and eggs (yolk). If you avoid these foods for dietary reasons, some fortified foods including breakfast cereals and fat spreads also have vitamin D added to them.

need supplements. Some medications can also affect Vitamin D production. Adults and children over the age of 4 are recommended to take 10 micrograms of vitamin D per day. For infants aged between 1 and 4 years old, they should be provided with a daily supplement of 10 micrograms per day all year round. Those aged under 1 are recommended to have a daily supplement of between 8.5 to 10 micrograms of vitamin D. Vitamin D supplements are widely available in pharmacies and health food outlets, and are sometimes combines with other vitamins in multi-vitamin

Web Doc For more information on vitamin D, visit the NHS website at vitamins-and-minerals/ vitamin-d/ supplements. It’s not impossible to overdose on Vitamin D, but it is unlikely – follow the dosage recommendations and you’ll get all the benefits of this vital nutrient. •

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SIGNS OF DEFICIENCY Symptoms of Vitamin D deficiency include the bone disorder rickets, and muscle weakness. Vitamin D production tends to reduce with age, so older people are likely to 76


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A Pinch of Salt How much salt is too much? Can our favourite condiment be a health risk? We cast a critical eye over the evidence


alt has been used in cooking since the first caveman said “this mammoth just need a little something…” A naturally occurring compound of sodium and chlorine, it’s highly soluble, which is why it is found in seawater, and is widely used in food manufacture as a seasoning and a preservative. Salt is most often found in the home in the form of refined ‘table salt’, mined from underground and highly processed to remove impurities, and often has added chemicals to prevent clumping. It also often has iodine added to promote thyroid health. An alternative is sea salt, manufactured by the evaporation of seawater and usually sold in crystalline form, without the additives, but otherwise nutritionally similar to table salt. Guidelines from the Food Standards Association (FSA) state that adults should consume no more than six grams of salt per day, approximately one teaspoon.

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to discern the amount of salt from a sodium reading, multiply the amount by 2.5. For example, one gram of sodium per 100 grams is equal to 2.5 grams of salt per 100 grams. Most people are aware of the high salt content in certain foods like crisps and dry-roasted nuts. What can come as a surprise, however, are the high levels of salt lurking in other everyday items such as cereal and jarred sauces. In fact, the British Heart Foundation states that ‘around three quarters of the salt we eat has already been added to our food before we buy it’. An extra 10 percent of our daily intake derives from the salt we add to our meals for seasoning. The final 15 percent comes from foods in which it occurs naturally. Foods that are always high in salt include anchovies, bacon, cheese, olives, pickles,

prawns, salami, smoked meats, soy sauce and stock cubes.

Shopping habits When food shopping, always check the label of products before buying. Even seemingly healthy goods can contain high salt levels. Look at the figure for salt per 100 grams. High traces of salt are more than 1.5 grams per 100 grams - these may be colour-coded in red. Medium traces of salt will involve between 0.3 grams and 1.5 grams of salt per 100 grams - these should be colour-coded in amber. Low traces of salt will fall below 0.4 grams per 100 grams - these will colourcoded in green. If you don’t feel confident interpreting food labels by yourself, try the NHS’ Change4Life Food Scanner app. Simply scan the product’s bar code and it

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Hidden salt Unfortunately, the average adult in the UK consumes 8.1 grams per day, according to the FSA. Eating too much salt has been linked to elevated blood pressure, which can lead to wider health problems like coronary heart disease. High blood pressure (hypertension) can also put you at higher risk of suffering a stroke. The World Health Organisation (WHO) recommends ‘a reduction in sodium intake to reduce blood pressure and risk of cardiovascular disease, stroke and coronary heart disease’. Salt and sodium shouldn’t be confused with one another. Some food labels may include the figures for both, while others may state the sodium content only. In order

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HEALTH & FITNESS will display the amount of sugar, saturated fat and salt of the everyday item in a straightforward manner.

Mindful cooking According to, salt makes your body retain water; this raises the pressure on your blood vessel walls. If you already have high blood pressure, too much salt will raise it further, and may mean that any blood pressure medicines you’re taking don’t work as well as they should. Cutting down on salt is one of the simplest ways to lower your blood pressure, and will start to make a

difference very quickly, even within weeks. Eating too much salt can lead to all the health problems high blood pressure causes, including heart disease, stroke, kidney disease and some types of dementia. Instead of adding extra salt to each meal, try to improve the flavour with other seasonings like fresh herbs and spices. Garlic, paprika, parsley, sage and lemon all work to transform the flavour of a dish. Over time, your palate will become attuned to your low-salt lifestyle and you will crave less salty seasoning. •

Did you know? As a nation, the UK consumes 183m kg of salt per year. This is equivalent to 240m standard 750g table salt containers or 18,000 double decker buses full of salt! Source: NHS Choices Salt Survival Guide

Guidelines The FSA recommended maximum daily salt intake for infants, children and adults are as follows:

Age 0-6 months 7-12 months 1-3 years 4-6 years 7-10 years 11+ years

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Target average salt intake (grams a day) <1 1 2 3 5 6

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Shape Shifters The practice of yoga extends much further than stretching and breathing; learn how it can benefit your overall health

Improved flexibility Consistently practicing yoga can improve flexibility, increase range of motion and lengthen muscles. As the body gradually 80  dear doctor with dr Chris Steele

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In the beginning Yoga’s origins can be traced to northern India over 5,000 years ago. It is mentioned in ancient sacred texts called the Rig Veda. Yoga was refined and developed by Rishis (sages) who documented their practices in the 100 or more books of the Upanishads

becomes accustomed to withstanding physical stress, you may notice that you become less prone to injury. Yet, being naturally flexible is not a prerequisite for participating in yoga; there are different styles and levels to suit all abilities. Iyengar yoga, for example, is a great alignmentbased practice that can help people striving for better flexibility, while Ashtanga yoga develops physical strength.

Stress response Many people turn to yoga to alleviate stress, with sessions often focusing on identifying key areas of pain and discomfort around the

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oga is an ancient Hindu practice, a discipline that promotes controlled breathing, simple meditation and the adoption of different bodily poses, otherwise known as ‘asanas’ in Sanskrit. This exercise has steadily become a worldwide phenomenon, where individuals practice to improve both health and a sense of relaxation. But why should you choose yoga?

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HEALTH & FITNESS body. A 2008 study by the University of Utah investigated yoga’s effect on natural stress responses. The study involved 12 people who were experienced in yoga, 14 people suffering from fibromyalgia - a condition characterised by a hypersensitivity to pain - and 16 healthy volunteers. The participants were subjected to varying levels of thumbnail pressure. The results revealed that the yoga practitioners had the highest pain threshold and the lowest pain-related brain activity.

ANXIETY RELIEF A multitude of studies and reviews indicate that yoga can help with anxiety and depression. Mindfulness techniques modulate a stress response system, which, in turn, reduces psychological arousal. This reduces the heart rate, lowers blood pressure and eases respiration. The meditation aspects of yoga have a similar effect as other self-soothing techniques like socialising with friends or listening to music. Deep breathing exercises can help to calm anxious thoughts and regulate the stress hormone cortisol.

WEIGHT LOSS Yoga may not be the first activity that springs to mind when it comes to weight loss, but it is in fact a valuable aid for strengthening core muscles and reducing body fat.

London-based Vinyasa yoga teacher Adam Husler says: “Yoga might not specifically target those surface-level muscles that get you washboard abs, but every pose does bring your awareness to ‘the core of the core’ – the muscles that interact with the pelvis, particularly the psoas muscle. Once you get to grips with activating these muscles in basic poses you’ll start to engage them as you lift or do calisthenics. To feel what I’m talking about, get in a plank position, then touch your right shoulder with your left hand without moving anything but your arm, then your left with your right. Keep alternating and go slow – no fly-swatting. It’s not as easy as it sounds.”

SURPRISING HEALTH BENEFITS The health benefits of yoga extend much further than you may think. Reducing stress levels can help regulate dietary intake, so you eat less and lose weight; yoga has also been applied by people undergoing radiation therapy to reduce fatigue, improve mental outlook and regulate their cortisol levels. For information on local yoga organisations, contact the British Wheel of Yoga, a charity which is recognised as the governing body of yoga by Sport England, at •

Popular poses For flexibility: Cow Face pose Enter this seated pose by reaching one arm up and over the shoulder, bending the elbow so that it reaches down towards the spine. Reach the other arm underneath and up towards the spine. Connect the hands if possible. Legs are locked over one another with toes facing backwards—feel it stretch multiple areas of the body.

For stress relief: Channel-cleaning Breath pose Sit with your legs crossed. Rest the arms gently on each knee with the hands facing upwards. Inhale gently through each nostril whilst sitting in the position. Repeat five times, then go back to regular breathing.

For abs: Plank pose Place hands flat on the floor directly beneath the shoulders and extend the arms. Lift the body using muscles in the legs and core so that the head is aligned with the feet and hold. The dolphin plank pose strengthens the core, arms and thighs; enter this variation by placing both hands and elbows on the floor before lifting.

For hip flexors: Lord of the Dance pose Stand straight on one foot and lift the opposite heel up towards the buttocks while bending the knee. Reach the arm opposite the bended knee back and hold the elevated ankle; reach the other hand out straight in front of you and balance.

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Breathing Easy The lungs provide life-giving oxygen to the body, but are prone to being affected by the air they take in. How can we look after them?


he lungs provide a simple but vital function, taking in oxygen from the air to be used in the respiration process, and expelling carbon dioxide created as a waste product. But lung function can decline with age, and can also be affected by a number of medical conditions, as well as being subject to damage by air pollution, smoking and other chemical compounds.

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So what can we do to maximise lung performance and protect against damage? The lungs are situated on either side of the heart, protected by the rib cage in an area of the body known as the thoracic cavity. Towards the bottom of the thoracic cavity is located the diaphragm. As you breath inwards, the diaphragm contracts and moves downwards. This produces a suction in the chest which inflates the

lungs as air enters the body. This causes the thoracic cavity to expand, lessening the air pressure within the cavity and directing air into the lungs. As you breath out, the diaphragm relaxes and expands and so the volume of the thoracic cavity reduces, and air pressure rises as the lungs contract and expel waste carbon dioxide, delivered to them by the bloodstream.

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Old Lungs There are many changes you can expect to your lungs as you age. This is due to certain parts of the body involved in the process of breathing deteriorating and therefore working inefficiently. Lung tissue will begin to become worn out as you age. The air passages within the lungs, formed by muscles which allow them to work efficiently, can weaken as you age, causing the passages to narrow and close. In addition, the air sacs inside the lungs can also become damaged and made to work inefficiently by conditions such as emphysema. Other bones and muscles involved in the breathing process, particularly those in the chest area, will also alter as the body ages. The diaphragm is a significant part of the process and just like the muscles within the lungs, this muscle can also wear out with age. This could affect the way you breath in and out. The bone structures of the rib cage can also change shape and get thinner, effecting the efficiency of lung expansion and contraction. The brain is also a crucial part of the breathing process, as the nervous system continually sends signals between the brain and the lungs. These signals can become weaker over time and the nerves in the lungs can weaken in sensitivity. This can affect the amount of oxygen taken in and the amount of carbon dioxide which is retained. The immune system can also deteriorate with age, working less efficiently in attempting to prevent any lung infections and recovering from possible exposure of harmful airborne substances which may damage the lungs.

chronic obstructive pulmonary disease (COPD). Stopping smoking is absolutely essential in preserving lung health. Movement and general exercise will reduce the risk of getting lung infections. Sitting for large amounts of time can build up mucus within the lungs putting the body at risk from infections, therefore regular movement and exercise will help reduce this risk as well as help increase your lung capacity. Air pollution caused by motor vehicles, mainly in the form of NO2 (nitrogen dioxide) and particulates, is a serious risk to lung health. The website at https://uk-air.defra. has an air pollution forecast monitor which will warn you of pollution blackspots and help you to steer clear of the worst areas for your lung health. If you suffer from a breathing condition such as asthma, the most common treatment is medication delivered via an If both the lungs were opened up, unfolded and stretched, they would cover an area as big as a tennis court. For more information on lung health as you age, visit the British Lung Foundation

inhaler. Drug-free devices such as AirPhysio can also be helpful in cases of asthma, COPD, emphysema, bronchitis and other conditions – used in sessions of around five minutes from one to three time a day, it works by creating an oscillating pressure which helps loosen and expel mucus, and is available in children’s, adult and sports versions. •

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Healthy Lungs Despite many aspects of the body changing and weakening naturally due to ageing, there are various steps you can take to take to lessen the number of negative effects this will have to the lungs and the efficiency of breathing. Needless to say, smoking can severely affect the lungs as it will cause them to age and deteriorate at a quicker pace. It is also one of the major causes of lung cancer and

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How Hot & Cold Weather Affects Asthma and COPD


hat's the weather going to be today?

It's a frequent question that many of us ask daily, but one that has much larger implications for those with lung disease and respiratory issues. Whether it's summer or winter, rain or shine, people with issues like COPD, Asthma, Bronchitis, Cystic Fibrosis and Emphysema should and often do pay critical attention to the weather report as there are a number of elements related to weather which affect our body. These include Air Temperature, Relative Humidity, Wind Chill Factor, Air Quality Index and Pollen Count. Our lungs comprise of mucus sitting on hairs called cilia. These hairs beat back and forwards to transport the mucus up and out of our lungs so we can cough it up. The key thing to remember is that all the changing weather conditions can cause inflammation. Our body then creates excess mucus as a means of protecting itself and that is why your lungs become clogged. It's difficult to clear the clogged lungs and subsequently, your breathing issues get worse!

Cold air is often dry air, and for many, especially those with chronic lung disease, that can mean a tough time is ahead. Dry air can irritate the airways of people with lung diseases which can lead to wheezing, coughing and shortness of breath.

Inflamed airways Inhaling hot air is known to promote airway inflammation and exacerbate respiratory disorders like COPD. Some consider the reason is due to dehydration of the airways. Unfortunately people with asthma have hypersensitive airways already, so this just further increases the breathlessness. Weather is more likely to have an impact during the Winter period. Colder air is heavier and can trap the pollution. Air pollution can also be a factor to those with respiratory conditions, as increased smog is often seen in the colder months.

Be Proactive and Be Prepared You can't control the weather, but you can reduce the effect it has on your lung disease symptoms. It’s best to monitor the weather forecasts and identify your triggers before going outside. Keep the following tips in mind so you can enjoy more of your outdoor life: y Warm Inside? Add air-conditioning to your home in the hot summer months to ensure you can regulate a consistent temperature y Cold outside? Consider a loosely wrapped scarf around your mouth and nose to warm the air before it enters your lungs. Breathe in through your nose and out through your mouth. y Air pollution can be very high both in winter and summer and those with asthma and other lung diseases are at higher risk for being impacted- monitor air quality forecasts. y Remember to take your prescribed controller medications another important way to reduce the potential impact of the changing weather conditions on your health. y If you have asthma or COPD, use an AirPhysio OPEP mucus clearance and lung expansion device to help reduce or prevent symptoms and clear airways, before triggers set in.

Cold and Dry Effects Cold weather, and particularly cold air, can also be problematic for your lungs and health.

To learn more about how to help manage and reduce symptoms of COPD or asthma, go to lifewellnesshealthcare. and explore the benefits of the AirPhysio devices.

Hot and Humid Effects Hot weather can be especially difficult for people with respiratory conditions. A study from the Johns Hopkins University reported in 2013, that for those 65 and older, there is a relationship between rising temperatures and the number of emergency hospital admissions for chronic obstructive pulmonary disease (COPD) and respiratory tract infections.

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Breathe Easier Live Better What is AirPhysio? AirPhysio is an Australian Made and Owned Oscillating Positive Expiratory Pressure (OPEP) Device. The device aids in clearing mucus and expanding the lungs and is used to assist sufferers of ailments such as asthma, COPD, Cystic Fibrosis, Bronchiectasis, pneumonia, infl uenza and many more. Why is AirPhysio Needed? Many respiratory conditions like Asthma, COPD, Cystic Fibrosis, Emphysema, Bronchitis and Bronchiectasis experience a condition called mucus dysfunction. Mucus dysfunction occurs when the airway walls either become infected or infl amed from foreign particles like bacteria, viruses, smoke, fumes, etc. The airway walls release an excessive amount of mucus into the airways to help protect the airway walls and it may take longer to clear the mucus, leading to a build-up of mucus which may lead to closed and semi closed airways from mucus plugs. AirPhysio is a mechanical medical device which uses an all-natural process called Oscillating Positive Expiratory Pressure or OPEP. This process is similar to the cough mechanism to help move the mucus up to the throat to be swallowed or coughed out, helping to clear the blockages and agitation in the airways which may be the cause of coughs and low lung capacity. This helps to improved hygiene of the lungs and assists to improve lung capacity.

How it works?

Vibration & positive pressure helps clear mucus naturally

PEP assists in lung expansion & opens up blocked or semi closed airways

Prevents pulmonary complications after surgery & increases lung volume

Approx. 5 - 10 mins 1 - 2 times per day

Multiple user filter available separately

Premium Quality

It is reliable, hand held & portable

Easy to Use

Contact us or visit our website |

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Stress can affect all of us, not just high-powered executives - but did you know that its psychological pressures can have implications for our physical health?


e’ve all heard of the idea of modern life as a ‘rat race’, a driving repetition of cycles of working, sleeping and eating, which can lead to psychological exhaustion and eventually physical as well as mental illness. The advance of technology seems to have done little to alleviate the problem – in fact for some of us, perhaps particularly the young, the pressure to be constantly ‘connected’ has just added to the burdens of everyday life. Certainly the way in which we are constantly expected to be scanning our 86


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e-mail and checking social media means that it’s increasingly difficult to ‘switch off ’. The problem is that the human mind and body aren’t designed to cope with this constant state of over-simulation, and eventually, health suffers. Stress is a physical response that occurs when the body feels threatened or under attack. When this happens, the body’s fightor-flight response is activated and the brain releases various stress hormones including adrenaline, cortisol and norepinephrine. Small doses of these hormones can be beneficial in terms of problem-solving and reaction, but when high stress levels remain

Wild idea So-called ‘eco-therapy’ refers to spending time in the outdoors and around nature. Numerous studies have indicated the beneficial and restorative potential of walking or exercising outside as a natural way to induce calm for those who suffer with stress, anxiety and even depression

in the body for prolonged periods time, they can actually suppress the immune system. Physical manifestations of stress include mood swings, headaches, lethargy and fatigue, a rapid heartbeat, chest pain and cold sweats. Stress may also be a prominent contributing factor in an increase in colds and infections and a loss of libido. A Perkbox survey in 2020 showed that 75 percent of employees felt some degree of stress at work, and recent Office of National Statistics surveys show that levels of stress and depression have risen during the coronavirus pandemic. A staggering 12.5 million working days were lost due to work-related stress, depression or anxiety in the year 2016/17, and the pandemic has made it almost impossible to calculate the equivalent figures now. But can stress make a person physically ill? The answer among the scientific community is a resounding ‘yes’. In a comment about the nature of stress in the workplace, an ONS Labour Force Survey said, ‘Systematic reviews have indicated that stress at work is driven largely by psychosocial factors and is associated with common conditions such as heart disease and anxiety and depression, and may play a role in some forms of musculoskeletal disorders.’

GUT FEELING Perhaps surprisingly, a good deal of research suggests that the relationship between the

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Don’t Stress Out

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brain and the gut can be affected by stress levels. Stomach or intestinal distress can be the cause or the product of anxiety, stress or depression, with symptoms such as cramps, bloating and disrupted bowel movements. To help reduce feelings of stress and anxiety, experts increasingly agree that a healthy gut microbiome is key. Enriching your diet with gut-friendly foods including kefir, live yoghurts and fermented foods like sauerkraut promotes the growth of healthy and beneficial gut flora, and improves the intestinal balance in a way which contributes enormously to overall health.

Causes Wellbeing charity the Mental Health Foundation released a survey of 4,000 participants in 2018 which found that the causes of stress are varied and dependent on both age and personal circumstances. Almost a quarter of those who reported

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feeling stressed during the past year cited debt as the primary cause. A large 49 percent of participants felt that comparing themselves to others contributed to high levels of stress. Perhaps unsurprisingly, 36 percent of women in that category felt that this was related to their appearance. The survey also found that 60 percent of 18-24 year olds have higher stress levels as a result of feeling pressure to succeed professionally compared to just 17 percent of 45 to 54 year olds and six percent of the over 55s. There’s no simple answer to the problem of stress, particularly when factors such as debt, living situation and work pressures can contribute so much to it. But by understanding how much stress can contribute to physical illness, at least we can begin to comprehend the root causes of some conditions and think about ways to address them. •

Log off A 2010 study by the Institute of Psychological Sciences at the University of Leeds found a close relationship between internet use and depression. The benefits of a ‘digital detox’ included improved sleep and concentration and reduced feelings of stress and anxiety. Try deactivating social media apps such as Facebook and Twitter for a month, or leaving your phone switched off completely while on holiday.

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The Good, the Bad and the Fatty According the NHS, high levels of cholesterol affect some 60 percent of the UK’s population. What is the danger and what can we do about it?

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Did you know? More than half of all adults in England have raised cholesterol (more than >5mmol/L). Healthy cholesterol levels sit below >5mmol/L. A simple blood test can measure your cholesterol levels. Adults aged between 40-74 living in England are eligible for a free NHS Health Check which includes a blood cholesterol check. Source:

circulation. So as we age, it’s important to undergo regular blood cholesterol checks and to keep our lifestyles in check to reduce the risk of cardiovascular disease.

Good and bad Cholesterol is regarded as having two types, commonly known as ‘good’ and ‘bad’ cholesterol. It’s when too much ‘bad’ cholesterol builds up in the body that it becomes potentially harmful to health. Cholesterol is carried to and from cells by proteins; when combined, they form lipoproteins. When medical professionals talk about ‘good’ or ‘bad’ proteins, they

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he fatty substance cholesterol, which belongs to the chemical groups lipids, is essential for good health and the normal functioning of the body. It’s a naturally occurring waxy substance within the cells in the body which forms a protective barrier within our cells, plays a key role in hormone production and aids the liver in producing bile, which is vital for healthy digestion. But above-average levels of cholesterol become increasingly common in people as they reach their 40s, 50s and 60s, and this carries the risk of diseases affecting the cardiovascular system, the heart and blood

15/10/2021 12:54

HEALTH & FITNESS are referring to the two major types of lipoprotein: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). HDL, the ‘good’ cholesterol, travels via blood cells to the liver, eliminating bad cholesterol along the way. HDL reduces the risk for serious conditions such as heart attacks, angina and stroke, a group of conditions collectively referred to as cardiovascular disease. LDL, on the other hand, can prove to be harmful if high levels build up in the body. LDL can cause plaque-like build-up in the walls of the arteries, subsequently restricting the blood flow to the heart, which can lead to heart disease. According to the British Heart Foundation, research shows that other bad elements of cholesterol, collectively referred to as non-HDL cholesterol, need to be taken into consideration when measuring cholesterol levels. Non-HDL cholesterol includes intermediatedensity lipoprotein (IDL), very low-density lipoprotein (VLDL) - which is produced in the liver and travels through the bloodstream to supply body tissue with triglycerides - and lipoprotein(a). High levels of all of these types of cholesterol provide a clear indicator for the risk of developing heart disease.


high levels of LDL) narrow the walls of the arteries, leading to heart disease. Increased amounts of triglycerides are often a result of consuming a diet high in fat and sugar, obesity and high consumption of alcohol.

Better diet Making positive diet changes can help lower cholesterol in the blood. Experts recommend significantly reducing the amount of saturated foods you consume and increasing your daily intake of fibre. Current guidelines state that adults should aim for at least 30g of fibre every day. Fibre can be found naturally in fruits, vegetables, wholemeal bread, beans, lentils, nuts, seeds and potatoes with their skins on. Try to avoid foods high in saturated fats such as cakes, biscuits, meat pies, sausages or fatty cuts of meat and dairy products like cheese and cream. Replace these ‘bad’ fats with unsaturated fats such as seeds, nuts, oily fish like salmon and avocados.

DANGER SIGNS There are many factors that can contribute to high blood cholesterol, including:  Eating an unhealthy diet. While some foods (such as eggs) naturally contain cholesterol, the levels found are unlikely to affect blood cholesterol levels as they are also low in saturated fats. Eating large amounts of saturated fat found in dairy foods and meat is what may contribute to significant changes in cholesterol levels.  Smoking. Smoking causes serious harm to health for multiple reasons; it is also a risk factor for increased levels of cholesterol. A chemical found in cigarettes called acrolein inhibits HDL from delivering cholesterol from fatty deposits in the body to the liver. This leads to atherosclerosis (the narrowing of the arteries).  Family history of heart disease. Statistically, those with close relatives who have suffered with coronary heart disease are more likely to have higher levels of cholesterol themselves. •

High levels of bad cholesterol tend to occur as a result of unhealthy lifestyle choices or as a symptom of ageing. However, in some circumstances, high levels of LDL may be inherited. This condition is called familial hypercholesterolaemia (FH) and according to the NHS, around 1 in 500 people in the UK are thought to be affected—that’s about 120,000 people. FH is caused by a faulty gene and effected people have an increased levels of cholesterol from birth as a result. If left untreated, individuals with FH are more susceptible to cardiovascular disease. Triglycerides constitute another fatty substance in the blood and are stored within the body’s fat cells. This substance can also be found in dairy products like milk and cheese, meat and certain cooking oils. High levels of triglycerides can (like

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15/10/2021 12:55


Emotional Rescue


s part of your overall fitness routine, you should make time to think about your emotional wellbeing. Feelings can be a burden, particularly in later life when we tend to reflect on the passing years – but what can be done to come to terms with these emotions and resolve them so we feel more centred and emotionally whole?

CREATIVITY Research by Age UK attempted to answer the question: ‘What makes later life worth living?’ Using a rich data source, the Understanding Society survey, along with statistical analysis techniques, the charity produced the ‘Index of Wellbeing in Later Life’. Perhaps unsurprisingly, the Index demonstrated that people with good social networks, good health and good financial resources are more likely to enjoy high levels of wellbeing. Overall, the research’s 90


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World Happiness The World Happiness Foundation (https:// supports global UN initiatives and undertakes to “help advance the dialogue on Public Policy towards an Economy of Happiness and Well-Being”.

strongest message is the importance of maintaining ‘meaningful engagement’ with the world around us in later life. A number of things, from social, creative or physical activities to work or belonging to a community group, can contribute to this sense of meaningful engagement. Most striking is the Index’s finding that

creative and cultural participation is the single biggest factor in older people’s emotional wellbeing. Age UK concludes that for those with low emotional wellbeing, having something creative to do can really help. The terms ‘culture’ and ‘creativity’ are, of course, a bit vague - for the purposes of Age UK’s investigation, data collected in the Understanding Society survey on the number of ‘cultural activities’ each respondent had attended was used as an indicator for both terms. The research makes the critical distinction between simply ‘visiting’ or ‘attending’ a cultural event and actually ‘taking part’ in it. So what is the relationship between participation and wellbeing in later life? Not unexpectedly, the investigation shows engagement in all activities is higher among people in the top 20 percent of the Index’s wellbeing spectrum. In other words, those who actively take part

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Feeling well is not just about physical fitness - your emotional wellbeing is equally important to your overall health

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Did you know? According to Age UK, 7.9 million people in the UK live alone, and 1.4 million of them often feel lonely. According to research, feelings of loneliness can be as harmful to your health as smoking 15 cigarettes a day. Source:

in cultural activities are more likely to benefit from them, emotionally. There is, therefore, a clear link between participation and wellbeing. ‘Creative and cultural participation is important to older people: we need to promote it, enable older people to access it, and increase the opportunities to take part,’ Age UK maintains.

with the internet and abundance of communication technologies, there really is no excuse for losing touch with family and friends. There are plenty of assistive communications providers specialising in technology for the older user. Keeping yourself busy is key in nurturing and upholding your emotional wellbeing. If you don’t have any friends or family nearby, you might have a local social group you can attend. In many areas, you’ll find friendship centres, which organise regular activities and outings. Many local organisations have classes specifically for older people—check your

local library, University of the Third Age or local council for details. You can also volunteer to use your experience to help others, which can be a doubly rewarding endeavour.

POSITIVE Regardless of how small, goals can help you feel a sense of achievement and motivation. Your goals could be as minor as completing a crossword puzzle, doing some gardening or reading one chapter of a book. Planning days out and activities will also give you something to look forward to and keep you feeling positive. •

Feed your soul What we eat and drink also has a direct impact on how we feel. To promote emotional wellbeing, eat plenty of fresh fruit and vegetables - try not to fill up on sugary or fatty foods. Many of us enjoy a drink every now and then, and it is tempting to think alcohol will make us feel better. But remember that alcohol is a depressant and can affect your mood. Try to limit the amount of alcohol you consume and keep at least two days a week alcohol-free. Lots of research highlights a clear link between physical activity and emotional wellbeing. Doing exercise releases endorphins, which can lift your mood and make you feel happy. Plus, you’ll do wonders for your physical health in the process. Remember, it’s never too late to get active. Start small by going on short walks and keep intensity levels to a minimum. You can always build up slowly. Whatever you choose, something is always better than nothing.

In touch Of course, it has been hard to maintain social contacts during lockdown, but

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SAFETY INFORMATION: Should not be used by women in the first trimester of pregnancy, by people fitted with a pacemaker or other implanted medical device, or anyone being treated for deep vein thrombosis (DVT). Always read the label and only use as directed. Please consult your doctor if you are unsure whether to use this machine or not or are uncertain about the cause of your symptoms. Quotes used in testimonials are real but we have changed names, locations and used models for privacy reasons. If you are returning then please do so in original packaging and undamaged where possible.

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The Pain Factor

Chronic pain is consistent pain lasting for a prolonged period and resisting treatment. How can it be managed to reduce its effect on everyday life?

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he different between normal pain and typical chronic pain is that with chronic pain, pain signals from the body’s central nervous system continue to be sent to your brain even following any treatment or medication administered. These signals are often strong and difficult to stop, occurring unpredictably and affecting quality of life. Chronic pain can affect mobility and limit strength and endurance even when completing the simplest of tasks. While chronic pain is defined as pain lasting for at least 12 weeks, in the most extreme cases, it can for several years. Among the

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most common types of chronic pain are headaches and lower back pain. Chronic pain has many causes, but one of the most common is an initial injury to a specific area of the body. The most likely cause of chronic pain is long-term nerve damage, which can cause particularly violent and long-lasting pain.

Living with Chronic Pain Chronic pain can also begin due to other underlying health conditions, such as diabetes, infections and arthritis, but in some cases it can appear with no history of an injury or obvious underlying condition.

Exercise, even if it’s a light routine like walking or swimming, is often beneficial in pain relief, and it’s advised that you should carry on work if possible, as inactivity contributes to pain and can lead to depression. Physical therapy sessions delivered by physiotherapists, chiropractors and occupational therapists can also help relieve pain. Support charity says that “Nearly all of the people that we talked to said that pain affected them emotionally. The worst time for many people was going through the frustrating and often dear doctor with dr Chris Steele  93

15/10/2021 11:34

Pain Relief is on the way

BioWaveGO is a new and revolutionary, 100% drug-free way of tackling pain. Our patented pain relief machine delivers therapeutic electrical signals that block pain at the nerve to offer clinically proven, long-lasting pain relief. More effective than outdated TENS devices or PENS therapy, our easy-to-use BioWaveGO device delivers electrical stimulation, which blocks pain at the source and prevents it from reaching the brain. Over 84% of patients report a significant reduction in pain after just one session. Our portable, pocket-sized device comes with its own set of non-invasive pain relief pads. Simply apply the pads to the area you feel pain, turn on the device and choose your intensity. One 30-minute session can provide deep relief for up to 24 hours. Whether you’re suffering from an acute sports injury, or from chronic pain connected to conditions like arthritis or endometriosis, BioWaveGO can help you forget about pain and get on with being you.

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Pain Source Around 34 percent of the population of England (15.5 million people) suffer from chronic pain. For more information on chronic pain and how to manage it, visit Pain UK at

unsuccessful process of searching for a diagnosis and treatment for their pain. In the early stages people were anxious about the cause of pain and frightened at the prospect of worsening pain, particularly when they experienced a flare-up.” “Isolation also came from a feeling that others, even friends and family, could not understand the pain. On the other hand people sometimes felt like they had pushed friends and family away because pain made them self-centred and they were often angry and aggressive towards others.” If you need psychological support for chronic pain, organisations such as Healthtalk, and painsupport. can help.

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TREATMENT While painkillers such as paracetamol are the main form of medication that will help reduce the amount of pain, making it possible for sufferers to be more active, it’s very important to use these as prescribed, as an overdose can have side-effects. Other types of medication such as anti-inflammatory tablets can also be used. These include ibuprofen, though these should be taken only if you do not have a condition that conflicts with them. These medications are best used before the chronic pain becomes severe, but ask your GP or pharmacist for advice. Opioids such as morphine and fentanyl are very good blockers for acute pain and pain at the end of life, but there is little evidence that they are helpful for longterm pain. Despite this, they are widely prescribed - opioid prescribing more than doubled in the period 1998 to 2018.

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This has been referred to as an ‘opioid epidemic’ in the UK, similar to but not at the same scale as the opioid crisis in the USA. The harms of using opioids in this way are now better understood, and the Medicines and Healthcare Products Regulatory Agency now ensures that packs of opioid medication carry clear warnings about the risks of addiction and dependence. Guidance from NICE (the National Institute for Health and Care Excellence) is clear that opioids are not indicated for chronic pain, and guidance from the Royal College of Anaesthetists (the professional body for doctors that specialise in pain) is clear about the harm that can be caused.

TECHNOLOGY Recent technological breakthroughs in the treatment of chronic pain often feature the use of electrical currents to interrupt the transmission of pain signals from the source to the brain. Some, such as the CirculationMAXX Reviver, use TENS (transcutaneous electrical

nerve stimulation) and EMS (electronic muscle stimulation) to target poor blood circulation and swelling, specifically in areas such as the legs, ankles and feet, relieving muscle pain and promoting blood circulation; others, such as the BioWave GO, are portable and topical, fitting in the pocket and using electrical contact pads applied directly to the source of the pain. One study saw 54 percent of participants experiencing a reduction in pain medication consumption after using this form of pain relief, while 98 percent said they would use this type of stimulation technology in the future. • DEAR DOCTOR WITH DR CHRIS STEELE


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CBD is the Answer – Now What’s the Question? CBD has been hailed as a ‘wonder drug’ in all sorts of treatment including pain relief – but what are the facts?


BD (cannabidiol) is a chemical derived from the cannabis sativa plant. It’s not to be confused with THC (Tetrahydrocannabinol), another cannabis derivative, which has psychoactive properties. While little detailed long-term research on CBD has been done, it’s believed that it positively affects the endocannabinoid system in the body, helping regulate certain functions including sleep, pain and the immune system. It has been suggested that CBD could be used for severe pain, depression, anxiety, insomnia, IBS and muscle spasm, but much evidence for its effectiveness is still anecdotal. As CBD is sold under regulations governing food rather than medicines, it can be marketed for a wide range of purposes so long as no specific medical claims are made for it. CBD can come in various forms including oils, sprays, and creams, and for pain relief is often sold in the form of patches to be applied to the pain point.

CBD Facts According to claims by the Centre for Medicinal Cannabis, six million people in the UK have tried CBD, and this year the industry has seen a particular acceleration in CBD product use, as lockdown has resulted in many suffering from stress and anxiety.

higher CBD doses but achieved the best pain control at lower CBD doses. In a 2015 animal study, researchers found

that topical CBD reduced arthritis-related joint swelling and pain in mice. According to the authors, effective doses ranged from 6.2 to 62 milligrams (mg) per day.

Dosage Most manufacturers of CBD products suggest that users should regulate their own usage, starting at a low level and building up until the desired effect is achieved. Pain relieving CBD products can often include ingredients such as menthol, camphor, and natural oils that may help relieve minor aches and pains, while others may contain moisturisers or antiinflammatories. Transdermal patches are often used in pain relief, having the advantage that they can be applied topically and left in place for several days. •

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Pain Relief CBD may interact with neurological receptors in the spinal cord that suppress chronic inflammatory pain, as one study on mice found. CBD may also strengthen the effects of AEA, a cannabinoid naturally found in the body that reduces pain. In a small 2018 study, researchers evaluated CBD’s pain-relieving effects in seven people who experienced chronic pain after having kidney transplants. Six of the seven participants reported improvements in pain. One of the participants experienced more pain at

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The Truth About CBD CBD is being promoted as a health aid for all sorts of conditions – but where does it come from and what can it really do for you?



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xtracts from the hemp plant, such as its fibres, seeds and oils, have been used for more than 10,000 years for various purposes. As one of the first plants to be cultivated, hemp was used to make clothing, rope, paper, and shoes, while its seeds and oils were used as food and medicines. Cannabidiol, or CBD, can be extracted from hemp, a fibrous, industrial form of cannabis. CBD is one of over sixty compounds found in the cannabis (marijuana) plant, and is classified as a natural dietary supplement. It is generally extracted from the resin glands of the marijuana flowers and buds. It’s important not to confuse it with the psychoactive chemical THC which can get you ‘high’. .

CONDITIONS More and more people are adding CBD into their diets, claiming that they have experienced positive effects with conditions

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from anxiety to arthritis to insomnia. Research has shown that CBD can have a positive effect on our endocannabinoid system, or ECS, a network of molecular receptors in the body’s cells, including the nervous system, brain, and immune cells. The ECS seems to be partially responsible for regulating our mood, pain, appetite, and memory, and it can quickly be tipped out of balance by ageing and stress. Some claim that CBD can counteract this by helping the body achieve a state of equilibrium, apparently through an antiinflammatory effect. Published research from reputable institutions includes studies on pain and inflammation, anxiety, nausea, neurological conditions, cardiovascular health and Alzheimer’s symptoms. If you are interested in trying CDB, it is available in various forms, including oils which are normally put under the tongue with a dropper.

Ready to try CBD? Discover Grass & Co. the highest quality and best-tasting CBD. Each drop is infused with complementary botanicals and vitamins that can help mental performance and relaxation. Keep joints and muscles moving throughout the day with the award-winning EASE range. EASE CBD Oil blends delicious CBD with zesty Ginger, Turmeric and Orange and Vitamins K & D to support bone and muscle health. Try Grass & Co. CBD today. Get 25% OFF the EASE, CALM & REST ranges with code DEARDOCTOR25 at For a better night and day.

Ideal dosage will vary from person to person depending on the reason that they are taking CBD, the concentration of the CBD product, and the individual’s body mass index (BMI) and body chemistry. So is CBD the universal wonder substance it is sometimes claimed to be? We won’t know for sure until more scientific research has been done into its functions and long-term effects, but if you want to be part of the experiment, you will be joining an ever-growing band of CBD users. • DEAR DOCTOR WITH DR CHRIS STEELE


15/10/2021 14:28


Coping with Menopause The symptoms of menopause can be distressing and disruptive, particularly if you are a working woman. Of the therapies available, which will suit you best?

100  dear doctor with dr Chris Steele

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suddenly, or, in around 1 in 100 women, before the age of 40. This is known as premature menopause or premature ovarian insufficiency. The menopause is caused by a change in the balance of the body’s sex hormones when the ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month. Premature or early menopause can occur at any age, and in many cases there’s no clear cause. Sometimes it can be caused by a treatment such as surgery to remove the ovaries (oophorectomy), some breast cancer treatments, chemotherapy or radiotherapy, or it can be brought on by an underlying

condition, such as Down’s syndrome or Addison’s disease.

SYMPTOMS Common symptoms include: Hot flushes Night sweats Vaginal dryness and discomfort during sex Difficulty sleeping Low mood or anxiety Reduced sex drive (libido) Problems with memory and concentration (so-called ‘brain fog’). These symptoms of menopause can begin months or even years before periods stop,

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enopause, the time of life when a woman stops having periods and is no longer able to get pregnant naturally, usually takes place over a few months or years, as periods become less frequent before they stop altogether. But this time, with the changes to hormone balances it involves, can be accompanied by a wide range of disruptive symptoms. Usually taking place between the ages of 45 and 55 years of age, with the average age in the UK being 51, the symptoms of menopause are the result of a woman’s levels of the hormone oestrogen declining. But the menopause sometimes happens

15/10/2021 12:57

HEALTH & FITNESS and can last up to four years or even longer after the last period. It’s worth consulting your GP if you have a combination of menopausal symptoms, particularly if you are under 45 years of age. In most cases menopause can be confirmed with a review of the symptoms, but a blood test to measure hormone levels may be carried out if you are under 45.

Treatments While there’s no treatment that can stop menopause itself, there are several different ways to treat the symptoms. There are also lifestyle changes that can help ease the most severe symptoms. Hormone Replacement Therapy (HRT), delivered in the form of tablets, skin patches, gels or implants, can relieve menopausal symptoms by replacing oestrogen

for a natural alternative therapy. As an ex-professional dancer, Adele had experienced severe joint pain in her late 40s, and had turned to CBD oil to help ease her joint pain. She found out that CBD also helped ease her hot sweats, and helped her sleep better. The breakthrough came when she combined the CBD oil with vitamin B12 to restore her flagging energy. “The combination transformed my life” she recalls. She started to feel more like her old self, returned to the gym and found that the hot sweats were a thing of the past. “I’m less short-tempered, and the brain fog has lifted” she says. Though not every woman’s experience will be the same as Adele’s, she says that the natural herbal supplement she and her daughters created can relieve the symptoms of menopause and peri-

menopause without the use of artificial hormones. Feminapause™ combines Britishmanufactured, laboratory certified CBD oil with vitamin B12, to combat insomnia, lack of energy, memory loss, fatigue, weakness an sleep deprivation; and Vitamin B6, for its hormone balancing effect.

Back to work Adele says that enquiries are flooding in as furlough ends and women return to the workplace; “Ladies are looking to natural products to help reduce the anxiety they feel about returning to work” says Adele. “Many women feel ashamed to admit they have symptoms because it was a taboo subject in the past. From being something no-one talked about, it’s something that is gaining greater awareness, and we are delighted to be part of that.” •

Vaginal oestrogen creams, lubricants or moisturisers can treat vaginal dryness Cognitive behavioural therapy (CBT) – a type of talking therapy can help with low mood and anxiety Eating a healthy, balanced diet and exercising regularly – maintaining a healthy weight and staying fit and strong can improve some menopausal symptoms Your GP may refer you to a menopause specialist if your symptoms do not improve after trying treatment or if you’re unable to take HRT.

Natural way Some women find that natural forms of selftherapy can be the most effective for them. One, Adele Wragg, co-founded company Feminapause™ with her daughters Monique and Juliette after finding herself becoming anxious and fatigued in her working environment. Putting her symptoms down to stress, Adele was surprised when a blood test diagnosed menopause, and as HRT patches were not then available, she started to look

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The Golden Years

Life really does start at 60, so here’s all the news and developments for people who have reached the senior years but don’t want health issues to slow them down FREE PRESCRIPTIONS



could be offered to people in the UK from the age of 66 rather than 60 under new plans, but analysis from Age UK suggests this could have a negative impact on the health of thousands of older people in the UK. In a joint letter pressing the government to scrap the plans to bring free prescriptions into line with retirement age, 20 healthcare companies expressed “deep shared concerns” that the change will leave many unable to afford the treatment they need and therefore have a devastating impact on their health and livelihoods. It’s estimated that 2.4 million older people could be affected. Those who have signed the letter include the Royal College of GPs and Age UK.

Every year in the UK more than one million older people are victims of neglect, physical, emotional, financial or sexual abuse. Hourglass believes this is a truly damning indictment of how society views and values older people and needs your support to create lasting change. Sadly, the abuse of older people is not a new issue, but one that has now reached a critical threshold that can no longer be ignored, nor tolerated. The Hourglass helpline is a lifeline for older victims and their families who often have nowhere else to turn. Call on 0808 818 8141 or visit :

can be difficult, particularly if you are alone. Psychotherapist Julia Samuel MBE, working with tech company PSYT, has developed Grief Works, a digital grief app and course. The culmination of Julia’s 30 years experience, Grief Works uses concepts from her best-selling book, Grief Works: Stories of Life, Death and Surviving, and covers subjects including ‘empty nesters’ coping with children leaving for university, coping with grief at Christmas, and how the Pandemic has changed grieving rituals. The app is designed to help grief sufferers and provide support to them 24 hours a day. For more information visit:

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NHS WAITING LISTS are forcing more people to turn to private medicine, according to research by the King’s Fund. On average, waiting lists have grown by 50 percent in the most deprived parts of England since the start of the pandemic, compared with nearly 35 percent in the most affluent areas. The research also shows that people on waiting lists in poorer areas are nearly twice as likely as those in wealthier areas to wait more than one year for treatment. The data looks at waiting lists from April 2020 to July 2021 (the latest available data) and includes planned hospital treatments such as knee and hip replacements, cataract surgery and other common procedures According to Anita Charlesworth, chief economist at the Health Foundation think tank: “The big worry about long waits leading people to have to go private is that it will increase inequalities, but also that many people will be forced to make awful tradeoffs over their finances in order to be able to get access to the care that they need when they need it. “And that goes against every grain of why we set up the health service,” she said.

Reliable Protection

IMAGES: Dreamstime/Attends

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AGE UK is supporting the idea of Meeting Centres to support older people living with mild to moderate dementia, along with their family and carers. Originally developed in the Netherlands and brought to the UK by the University of Worcester’s Association for Dementia Studies, at the heart of the Meeting Centre is a social club where people meet to have fun, talk to others and get help that focusses on what they need. Meeting Centres are based on sound research evidence on what helps people to cope well in adjusting to living with the

symptoms and changes that dementia brings. Age UK Herefordshire & Worcestershire runs a success meeting centre in Droitwich where members enjoy daily discussions on current affairs and activities like Zumba, hand therapy, singing, arts & crafts and more, and funding has now been received from Worcestershire County Council and district councils to open two new meeting centres in Kidderminster and Stourport. Age UK is calling for volunteers to help at the new centres, supporting with day-to-day activities and providing refreshments. Find out more at • DEAR DOCTOR WITH DR CHRIS STEELE


15/10/2021 12:58


Are Your Ks Okay? As we get older our metabolism changes and so do our ideal dietary balance and supplemental nutrients. So what’s the importance of Vitamin K in older life?


e all know that essential nutrients like Vitamin C and D are vital for health and life. What’s not always understood is that our requirements for vitamins and other nutrients can change as we age, and that other less well-known vitamins like K2 play an increasing role as we get older. One of the reasons vitamin K2 is more vital as we age is that it acts to prevent clogging of the arteries. Calcium is an essential mineral, provided that it does its job properly in helping to build bones and teeth. But when it gets into other parts of the system, specifically the arteries, it can cause blocking and damage, creating a plaque which restricts blood flow. 104


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Variations Vitamin K was identified in the early 1930s, and was mainly thought to be involved in blood coagulation. Both the K1 (phylloquinone) and K2 (menaquinone) forms of the vitamin were identified at the time, but they were thought to be simple structural variations. It’s only in the 21st century that the distinct nature of vitamin K2 was finally recognized.

It’s sometimes supposed that this calcification is an inevitable result of ageing, but with the proper intake of vitamin K2, this needn’t be the case. K2 helps your body to utilise calcium properly, guiding it to where it is needed and keeping it out of your arteries. Vitamin K2 prevents damage to the blood vessels as it activates matrix GLA protein (MGP), which inhibits calcification of blood vessels. Vitamin K2 deficiency can result in reduced MGP, leading to cardiovascular disease. Another role of vitamin K2 is in blood coagulation. K2 is required for the synthesis of specific proteins that take part in blood coagulation, which prevents internal and external bleeding.

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LIFE STARTS AT 60+ Vitamin K2 also helps to maintain the elasticity of blood vessels, reported to be beneficial in postmenopausal women in some clinical trials. According to one study, the intake of vitamin K2 supplements in these women also led to a slower agerelated decrease in bone mineral density. The problem is that many people do not get enough vitamin K2 in their diets.

Subtypes The two main types of vitamin K are vitamin K1 and vitamin K2. Both are vital for the maintenance of bone and cardiac health as well as in haemostasis, the body’s normal physiological response for the prevention and stopping of bleeding/haemorrhage. Vitamin K1 deficiency is rare and almost non-existent, but vitamin K2 deficiency is common, because although it is found in animal foods and preserved foods, it does not exist in junk food or in restrictive Western diets. Vitamin K2 may also be found in cereals, fatty meat, eggs and fish. Some bacteria in the large intestine are also known to synthesize vitamin K2.

K2 and Alzheimer’s Medical journal Nutrients recently published a review paper examining the evidence connecting vitamin K2 to factors involved in Alzheimer’s Disease (AD), concluding that this demonstrates K2 as having the potential to slow the progression of AD and contribute to its prevention. “We are gratified that Vitamin K2 is becoming a prominent part of this conversation, particularly as most of the world’s population expresses a K deficiency,” said Dr. Hogne Vik, Chief Medical Officer of NattoPharma.

Coagulant A final yet vital function of vitamin K2 is that it acts as a blood coagulant, so a deficiency can lead to fatal bleeding, particularly during accidents. For adults a daily intake of between 100-300 mcg vitamin K2 is recommended, ideally with vitamin D3 as both these vitamins are reported to have synergistic effects, inhibiting the osteoclast cells which are responsible for bone resorption, the excessive bone loss often experienced in the jaw when teeth are missing. To ensure a healthy heart and prevent complications due to calcification, a daily intake of at least 32mcg of vitamin K2 should be ingested through the diet. As children are more prone to vitamin K deficiency, the American Academy of Pediatrics recommends that it be given at birth. This can prevent complications such as intracranial haemorrhage, brain damage and death of the newborn. •

IMAGES: Dreamstime

Bone Health There’s more to optimising bone health than getting enough dietary calcium, vitamin D and magnesium. Vitamin K2 should be added to the list as this fat-soluble vitamin is required to activate osteocalcin, an important protein secreted by osteoblasts, the body’s bone-building cells. When vitamin K2 is activated, osteocalcin can draw calcium into the bones where osteoblasts then incorporate it into the bone matrix. Vitamin K2, when combined with vitamin D3, also helps to inhibit osteoclasts, the cells responsible for bone reabsorption. Osteocalcin is also known to trigger the formation of dentine, the calcified tissue in teeth, so vitamin K2 is also important for the maintenance of healthy teeth. The reason that vitamin K2 becomes more important with age is that one common symptom of ageing is that bone density reduces, leading to conditions such as osteoporosis. Vitamin K2 can inhibit this bone density loss, strengthening bone and making it less likely to fracture.

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15/10/2021 12:59


The Flow of Life

Incontinence, particularly in later life, is a problem we have to face without embarrassment - fortunately there’s plenty of help at hand

Treatments Lifestyle changes such as losing weight, cutting down caffeine or alcohol and doing pelvic floor exercises can often help, and there are also medical and surgical treatments. In any case, you should never have to work about not making it to the toilet again, as there are all sorts of products you can 106  dear doctor with dr Chris Steele

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use which will discreetly provide protection against all levels and types of incontinence. Incontinence pads for men and women come in a number of shapes and sizes, and some are fitted with belts for more secure fitting. Incontinence pants come in disposable and washable forms, again in designs for men and women, and also available are disposable and washable adult nappies. For the home, chair pads, waterproof mattress covers and disposable bed pads

cover all eventualities, and special cleaning products, skin wipes and disposal bags are available to clear up any accidents. Charity Bladder & Bowel UK has a national confidential helpline, staffed by a team of specialist nurses and a product information adviser. They can give specialist advice on bladder and bowel health issues, continence promotion and options for managing incontinence, as well as signposting to local services. See the website at •

IMAGES: Dreamstime


rinary incontinence, the unintentional passing of urine, is a common problem which affects millions of people, particularly in later life – but it has many different causes. Stress incontinence is when urine leaks out at times when your bladder is under pressure, such as when you cough or laugh, while overflow incontinence (chronic urinary retention) is when you’re unable to fully empty your bladder, which causes frequent leaking. Urge incontinence is when urine leaks as you feel a sudden, intense urge to pee, or soon afterwards, while total incontinence is when your bladder cannot store any urine at all, which causes you to pass urine constantly or have frequent leaking. You can also have a mixture of both stress and urge urinary incontinence. If you have any type of urinary incontinence you should see your GP, as there are many ways to treat the symptoms or in the short term to control its effects. A pelvic or rectal exam will usually help diagnose the problem, which can be caused by weakening of the pelvic floor muscles or those controlling the bladder, blockage in the bladder, spinal injury or a fistula (an opening in the tissue). Your GP may ask you to keep a diary of your fluid intake and how often you have to urinate.

15/10/2021 12:59

Incontinence protection for you

PRODUCTS FOR ALL LEVELS AND TYPES OF INCONTINENCE Millions around the world trust Attends for reliable incontinence protection. To compliment the continence products, Attends also have an extensive skincare range. Free eLearning for home carers and professionals available at:

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23/09/2021 17:31

No Isolation

Smartphones and tablets aren’t suitable for everyone. Komp is the one-button computer that bridges the communication gap between those that struggle to use modern day technology, and their more tech-savvy family, friends and care providers.

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Only one button.

Touchscreens are unsuitable for many due to health and physical conditions.

Limited functionality meaning all the user has to do is switch it on, off or adjust the volume.

Endless functionality, complicated user interfaces and navigation.

No usernames, passwords, manual updates or error messages.

Usernames, passwords, software updates and error messages.

Large, high resolution screen (21 inches).

Small screens that older people can find difficult to see clearly.

Loud, clear sound (full range speakers).

Compromised sound quality and speaker volume.

Stand on a surface or can be wall-mounted, and plugs into the wall (no charging required).

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Could you or your organisation benefit from Komp? Families can communicate all together in a secure, private network. Local authorities can innovate social care and tackle loneliness. NHS services can support care at home by digitising services. Care homes can simply and securely connect their residents to loved ones. Home care providers can innovate care planning and connect their clients to loved ones.

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29/09/2021 11:37


Keeping in Touch

IMAGES: Dreamstime


Living alone brings all sorts of problems, but for the elderly it can be hard to access the technological solutions

iving alone has its problems, particularly when you are elderly – it can become a daily effort to get up, wash, dress, prepare food, shop, clean and maintain the house in safety. Life can be easier if you have regular communication with family or loved ones, but many technological solutions to communications problems don’t seem to address the fact that many older people just can’t get to grips with technology. Surveys show that 87 percent of people aged 75 years and over have never been online. Operating mobile phones and tablets, laptops and desktop computers, which are great ways to communicate, can be a closed door to anyone not brought up with this technology and unable to get to grips with the basic concepts – let alone the fiddly controls of mobile phones, the complexities of operating a computer, or the expense of installing and subscribing to broadband.

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Dr Gemma Wilson says in a report for the Centre for Ageing Better: “There are an ever-growing number of older adults using the internet and social media, with notable increased use across the UK, USA, and Europe over the last decade. However, older adults remain less likely than younger generations to use the internet and social media. In the study we carried out, some participants experienced low confidence, perceiving themselves as being novices and not ‘technology minded’, and some lacked patience with technology.”

Misinformation “Some were fearful that they would break the devices, do something “wrong” that they couldn’t amend, or they were worried about privacy issues. We also know from existing research that older adults are more vulnerable to misinformation. “Some also experienced physical barriers. For example, for some the text

was too small, making it difficult to read, or the buttons were too small…. Finally, an individual’s social network was highly influential in getting them started with using technology and was important for ongoing support and maintenance of using digital devices and social media”. But there are examples where technology has been designed to suit the older user, such as Komp, a ‘one button’ digital tablet device from NoIsolation. Komp offers video-calling functions without needing to be activated specially, displays photos and messages when not in use, and offers security through a closed group Android or iOS app. It requires no touch controls, usernames, passwords or charging, and can use WiFi or a 4G SIM card to connect. Products like this could be the shape of user-friendly communications for the future, putting an end to isolation for even those most challenged by technology. • dear doctor with dr Chris Steele  109

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Getting a Handle on Life

Coping with the problems of getting older can be as simple as looking for good solutions to everyday matters such as cooking and eating incorporated into standard items. Where the user has difficulty using both hands to eat, plates can be produced with an inner slope which makes it easier to use cutlery; they can also have anti-slip functions so it’s easier to eat with one hand. For anyone suffering from stroke, Alzheimer’s, dementia, multiple sclerosis or Parkinson’s disease, these products are a godsend. Even conventional plates can be adapted with the help of a food bumper, a raised rim which makes it easier to push food onto forks or spoons.


e’ve looked elsewhere in this issue at the problems some of the older generation can face in getting to grips with modern technology. But for many people, age, or infirmity, can make it difficult to cope with much more basic tasks, particularly cooking and eating. 110  dear doctor with dr Chris Steele

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Fortunately lots of designers are thinking of these problems, and coming up with products which are easy to use if your grip isn’t as firm as it used to be, your hands are a bit shaky or you don’t have the strength to open that jam jar. Some of the solutions are so remarkably simple that it’s a wonder they aren’t

IMAGES: Dreamstime

Preparation Bowls can be designed with thermal insulation which keeps food hot for longer, so it doesn’t matter if a disability slows your eating; and the same non-slip and thermal principles can be applied to mugs. For cases where the user has neck complaints, dysphagia (difficulty eating or swallowing), unsteady or clammy hands or stiff fingers, mugs with spouts are also useful. Mugs can also be produced with internal cones so the head does not have to tilted back so far to drink from them, or with dual handles for easier lifting. Mugs are also available with non-spill lids, or lids can be fitted to existing mugs, in some cases incorporating spouts. Other eating aids can include special cutlery with adjustable non-slip grips, and knives designed to be used one-handed; conventional spoons can also be fitted with a ‘spoon guard’ which raises the rim to reduce spillage. For food preparation, nonslip boards with attachments to hold food steady while it’s chopped are also a boon. With these and other tools designed to help cope with infirmity, the little problems can be solved and you can concentrate on enjoying your food, and life! •

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12/07/2021 17:16


On the Move Again Joint replacement surgery can be an almost miraculous solution to mobility problems – but is there anything we can do to postpone it being necessary?


The Hip Kids Hip replacement surgery is usually necessary when the hip joint is worn or damaged so that your mobility is reduced and you are in pain even while resting. The most common reason for hip replacement surgery is osteoarthritis. Adults of any age can be considered for a hip replacement, although most are done on people between the ages of 60 and 80. A modern artificial hip joint is designed to last for at least 15 years.

procedure and isn’t something that has to be done unless your symptoms can’t be controlled with simpler measures.” While patients shouldn’t wait until their knees are entirely broken down before considering replacement surgery, deteriorating joints can be treated by making lifestyle changes to reduce strain on your knees in the short term.

Function The lower end of the thigh bone (femur) and the upper end of the shin bone (tibia) connect to form the knee joint. In a fully functioning, healthy knee joint, a smooth cartilage covers the ends of each bone

IMAGES: Dreamstime

or anyone whose joints are sore and creaky, loss of mobility can be a severe impediment to life. The prospect of regaining mobility by replacing the faulty hip or knee with a new, metal-and-plastic substitute can be enticing. Joint replacement surgery is often promoted as easy and without drawbacks, and able almost to restore lost youth. But of course all surgery has its risks and drawbacks, and in some cases is not 100 percent effective, so it should be undertaken unless there are no alternatives. “Kneereplacement surgery is not like getting a tyre change at a pit stop,” says orthopaedic surgeon David Lewallan. “It’s a major

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LIFE STARTS AT 60+ where they meet, allowing the bones to glide over each other, producing a smooth, easy, pain-free movement of the knee. If the cartilage experiences injury or wears away with time, movements of the knee can become stiff and painful. Without the cartilage there to smooth their movement, the two bones of the knee joint rub together, causing painful swelling of the joint. But one reason why surgeons calculate the need for knee replacement surgery, or arthroplasty, with great care is that replacement knee joints don’t last forever. If you have the operation done, say, at 45, it may need to be done again later in life While the number of surgeries performed has more than doubled in the past 20 years, there’s a move towards knee replacement being judged appropriate only for those whose arthritis or other conditions are at an advanced stage, causing severe pain, and impaired physical function like an inability to climb stairs, get out of a chair or walk without aids.

Options Make sure to monitor your pain and regularly consult with your GP about what’s right for you. Before you hop on the operating table, there are a number of non-surgical options and lifestyle changes that may help manage the pain that comes from natural wear and tear on joints over time, or from more serious conditions such as arthritis. Exercise, eating healthy and limiting alcohol intake are all important when it comes to managing stress on your joints. Regular exercise and managing your weight can build muscle mass that help your joints move more easily and reduce the amount they carry around. Eating a diet rich in fruits, vegetables and vitamins will manage inflammatory pain. Alcohol also plays a role in inflammation, so moderating your intake is important for those experiencing joint pain. Before resorting to surgery, doctors will also suggest trying anti-inflammatory medication, such as ibuprofen, to see if that will help manage the pain. Another option are hydrocortisone or steroid injections,

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which are used to treat swollen and painful joints after an injury or in arthritis. The hydrocortisone is injected directly into the painful joint and will help relieve pain and swelling. Their benefits can last for several months.

Preparation If you’ve consulted with your doctor and decided that the only way forward is surgery, prepare yourself by staying as active as you can in advance of the date of your procedure. Strengthening the muscles around your knee will aid your recovery. If you can, continue to do gentle exercise,

such as walking and swimming, in the weeks and months before your operation. You can be referred to a physiotherapist, who will give you a list of helpful exercises. After your surgery, be prepared for a gradual recovery and don’t expect to be running and jumping any time soon. You’ll usually be in the hospital for three to five days after the operation. Once you’re able to be discharged, your hospital will give you advice about looking after your knee at home. You’ll need to use a frame or crutches at first and a physiotherapist will teach you exercises to help strengthen your knee. • dear doctor with dr Chris Steele  113

15/10/2021 13:01




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28/09/2021 14:23


Moving and Grooving Getting around the house can be a challenge when your mobility is limited. What can household fittings designers do to help?


hen you can’t get out of your chair, get in and out of the bath, or get up and down the stairs, life can become impossible – yet this is the problem faced by many people, particularly if they have an age-related disability, and especially if they live alone and don’t have anyone to help them with these everyday functions. Fortunately there are many designs of furniture and fittings which can make everyday life easier, even if your grip isn’t as firm as it used to be, you are a bit unsteady on your feet, or you struggle to get up the stairs without getting out of breath.

IMAGES: Dreamstime

Chairs It seems to be the case that the deeper and more comfortable a chair is, the harder it is to get out of it. Certainly if you don’t have enough strength in your legs or grip in your hands, it can be a challenge. In many cases the solution is a riser chair, which, activated by a control button, will lift and tilt you into a standing position. These chairs often incorporate a leg lift which will raise your feet while you are sitting, relieving pain from a number of conditions. Beds Beds, again, can be designed to tilt you into an upright position, making it easier to rise, and if it’s a double bed, the sides can be adjusted independently. Accessories such as handrails make the process easier, and some beds feature heating or massage functions which can ease a wide range of conditions – though it might make you more reluctant to get out of bed! Baths There are several ways to aid the problem of getting in and out of the bath; one option

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is to replace the bath with a wet room/tray shower, with a seat and a grab rail. But if you really enjoy a good soak and want to retain your bath, there are side-opening options, so you can walk in rather than climbing in; or, if you want to retain your existing bath, a bath lift provides a sling mechanism, which you sit on, and are then lowered slowly into the bath, and lifted out again when you have finished. Together with stairlifts or elevators, which are the ultimate solution for negotiating your stairway, these furniture aids will make it easier to get around your house and enjoy the benefits of living at home for longer. • dear doctor with dr Chris Steele  115

15/10/2021 13:03


Looks, Looks, Looks! The recent British Beauty Week showed that the beauty industry is not only a huge one, but also one full of great new products and plans. We round up some of the hottest beauty ideas

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on animals.” Products that themselves are not tested on animals could also include ingredients that were, he stated.

include lumps or nodules, tissue damage, tissue death or necrosis and in some cases blindness.



and lip-fillers will be forbidden to under-18s under a proposed new law. Introduced in October, the Botulinum Toxin and Cosmetic Fillers (Childrens) Act makes it illegal to administer such products or book an appointment for people under 18. This law aims to protect younger people from the damages these such procedures can cause if administered by untrained operators. Complications that come out from these non-surgical procedures

in the UK is an untapped business according to research by Treasure Tress. Jamelia Donaldson, founder of Treasure Tress, described as ‘Europe’s first and largest natural hair product discovery box, where sisterhood connects over kinks and curls’, explains that Black British women spend £168 million per year on hair products; 59 percent of Black British women shop at independent retailers for hair products, compared to 18 percent of African American

IMAGES: Dreamstime

COSMETICS sold in the UK and Europe in many cases include ingredients that have been tested on animals in spite of bans prohibiting such testing, according to analysis by Center for Alternatives to Animal Testing Europe (CAAT-Europe), University of Konstanz, Germany and Johns Hopkins Hospital University. These banned tests were carried out on ingredients within products such as lipsticks, moisturisers and hair conditioner, with in excess of 100 experiments conducted on animals including rabbits and mice. Thomas Hartung, at Johns Hopkins Hospital University said “European customers can’t assume the products they buy are not tested

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Beauty women; but only one percent of black British women buy haircare products at supermarkets, compared to 35 percent of African American Women.

ALLERGIC REACTIONS to previously tolerated chemicals in cosmetics could be linked to Coronavirus, says the British Beauty Council. The Council is continuing to liaise with Public Health agencies in the UK regarding recent reports of adverse reactions to chemicals and dyes that could be linked to Coronavirus. Practitioners have reported cases of returning clients who have previously contracted COVID-19 having allergic reactions to products they have previously had no adverse reaction to. Victoria Brownlie, Chief Policy Officer at the British Beauty Council comments “Adverse reactions to chemicals and dyes on the skin within hair and beauty is something we must take seriously and mitigate to avoid where possible. This is why patch testing and following manufacturer instructions is so important for both professionals and consumers using products from home. In terms of understanding the science behind this and finding solutions, as more side effects emerge from those who have had Coronavirus, further investigation is urgently needed. Particularly, if this is likely to have ongoing implications for the sector and its clientele and therefore the sector’s recovery.”

you on a creative journey that is indicative of her pioneering practice. Alex Box’s work has helped establish makeup to be recognised as an art form, and this series establishes that.”

DELIVEROO will now deliver cosmetics to your door in as little as 20 minutes. Although not the first to organise a tie-up with the delivery company,

Boots is the biggest so far to offer a range of cosmetics. Fourteen Boots stores including several in London will be running a pilot scheme of 400 health and beauty products including makeup, skin care, baby care and toiletries from brands including No7, Soltan, CeraVe and The Inkey List. The tie-up with Deliveroo is in addition to Boots’ existing next-day click-and-collect and online home delivery services. •

ALEX BOX the internationally renowned makeup artist, has launched a range of Alex Box Archive Art Prints via their Instagram store. This iconic series is available for the first time as fine art prints, marking the moment the artist transitioned into creative direction, and allowing her work to become indicative of the contemporary discussions surrounding beauty and art. The five limited edition prints have been personally selected and created by Alex Box, created in response to a range of art movements – from Baroque, Cubism and Dadaism, to Post Modernism and Romanticsm. Alex Box says: “While always continuing to push the boundaries of innovative practice, the works will take

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Beauty From the

Inside and Out

It makes sense that what you consume can affect your outer appearance, so is a natural approach the best one for your health and beauty?


e all know that the nature of our diet can affect our overall health, but can it also have a bearing on our looks? Increasingly this is the argument of many companies who say that natural ingredients balance with the body’s systems rather than fighting against them. For skin health and beauty, a popular ingredient is marine collagen, also believed to be good for your hair, nails, joints, bones, ligaments and gut. Marine collagen is a protein containing three amino acids, glycine, proline and hydroxyproline, which make up 75 percent of the skin’s support structure, providing shape and support. The body’s collagen levels and quality tend to drop with age, and can be depleted by the sun’s UV rays, pollution and smoking. Marine collagen is sourced from fish and other sea life, such as jellyfish.

the different types of bacteria found in the gut, aid digestion, but are also often suggested as an aid to immune system and inflammatory problems. For energy and hormone balance, Vitamin B and C are recommended, often with other compounds. These can include inositol, a structural part of cell membranes; choline, a nutrient similar to the B vitamins which helps form cell membranes and aids nerve communications; and PABA (paraaminobenzoic acid), a chemical found in folic acid and in grains, eggs, milk, and meat.

For Urinary and Gut Health, the glucoserelated D-Mannose is often used to treat urinary tract infections, as it is believed to inhibit bacterial adherence to the lining of the urinary tract; and cranberry extract can offer some of the effectiveness of antibiotics without the side-effects. If you opt for cranberry juice, make sure to use the pure, unsweetened variety. Many of these treatments are based on home remedies which have been used for thousands of years, so if you feel getting back to nature would benefit your health and beauty, why not give them a try? •

For stress, insomnia and anxiety, organic ashwagandha is a recommended solution, commonly used in ayurvedic medicine. An evergreen shrub that grows in Asia and Africa, ashwagandha contains chemicals that may help reduce swelling, lower blood pressure, and alter the immune system. It’s also used to treat insomnia, ageing, anxiety and many other conditions. The active ingredient in ashwagandha is in the root products that source from the whole plant aren’t thought to offer the same potency or benefits.

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IMAGES: Dreamstime

For general wellness and improved immune function, combinations of the seven essential vitamins are recommended, often combined with probiotics to aid gut health. Probiotics, which help to balance

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Outside and In

Can dietary supplements contribute to overall health and beauty? We look at some of the natural ingredients that can give you a boost and brighten your look

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(difficulty swallowing), many supplements are available in the form of oral sprays. Integrative Medicine expert Tiffany Lester M.D. quotes studies saying that sublingual nutrients are absorbed in much higher amounts than capsules, and provide better bioavailability (ability of the body to absorb nutrients). “When you take a pill, it first has to be digested and metabolized through the liver or kidney through what is called the ‘first-pass’ effect,” Dr. Lester explains. “If any of these systems are off - like in someone with leaky gut syndrome - the supplement or medication can be even less effective.” Oral sprays can deliver nutrients swiftly to the bloodstream through the buccal membrane of the inner cheek, and have been shown in clinical trials to be just as effective as capsules at elevating vitamin D levels. Vitamin D plays a crucial role in supporting the immune system, and while it

can’t prevent infections such as coronavirus or influenza, it can boost the immune system to make it more efficient at fighting infections. A 2019 study showed that Vitamin D can improve immune response, help prevent respiratory infection and reduce antibiotic use.

Magnesium Another essential for everyday health, magnesium, is vital for healthy bones, and can aid with stress, stiffness, sleeplessness and nervous problems. Magnesium is widely available in tablets and capsules, but is also available in transdermal form, applied directly onto the skin and quickly absorbed through the epidermis into the blood vessels and muscles beneath. This bypasses the digestive system where many nutrients, including magnesium, can be poorly absorbed. •

IMAGES: Dreamstime


eeping up your intake of essential vitamins and minerals is one of the basics of maintaining optimum health and fitness. Many of us have an unsuitable diet relying on processed foods, often manufactured with too much salt and sugar, and find it difficult to get enough fresh, healthy food for the right dietary balance. In the winter months, we may not get enough sunlight and so need supplements to boost our Vitamin D levels, and an increasing number of people suffer from malabsorption of nutrients in the gut, due to autoimmune conditions such as IBS, Crohn’s, Colitis and Coeliac disease. Fortunately, when it’s essential to supplement your diet, there are lots of ways to find what you need in the form of tablets and capsules, and if you aren’t happy with taking them, say if you have dysphagia

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Hello, Aloe!


loe vera is a thick, shortstemmed, cactus-like plant which was originally native to the humid climate of the Arabian Peninsula. It’s now cultivated all around the world, particularly since its nutritive and health qualities have been more widely recognised. So what are the qualities of this ‘wonder plant’? Most of the important nutrients, vitamins and minerals are found in the leaves of the aloe vera plant. These include vitamins A, B, C, D and E, Vitamin B12, copper, magnesium, potassium and zinc. In total, aloe vera contains 75 different nutritive components. With all these health-giving substances found within the plant, it’s no wonder that aloe vera can now be found in all sorts of products such as gels, powders, juices, creams, soaps and other supplements. Two substances from aloe vera, a clear gel and a yellow latex, are used to manufacture commercial products. The gel is typically used to make topical medications for skin conditions, such as burns, wounds, frostbite, rashes, psoriasis, cold sores, or dry skin, while the latex is used individually or manufactured as a product with other ingredients to be ingested for relief of constipation. Aloe latex is sometimes supplied in a dried form called resin or as “aloe dried juice”. Aloe vera gel is used commercially as an ingredient in yogurts, beverages, and some desserts, and may be prepared as a lotion, gel, soap or cosmetics product for use on skin as a topical medication. Some people are allergic to aloe vera, and may experience contact dermatitis or swelling. Aloe vera is often used on facial tissues, where it is promoted as a moisturizer and anti-irritant to reduce chafing of the nose, and cosmetic companies commonly add 122


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Global The pharmaceutical, cosmetic and food industries use aloe vera extensively , with the plant having an estimated annual market value of $602 million in 2020, predicted to rise to $982.4 million by 2026. Thailand is the leading producer of aloe vera, producing more than a third of the total global output, while the Asia Pacific region represents the largest consumer of the product, accounting for the majority of the total global consumption.

sap or other derivatives from Aloe vera to products such as makeup, tissues, moisturizers, soaps, sunscreens, incense, shaving cream, or shampoos for its moisturizing emollient effect.

EAT YOUR ALOE The aloe vera plant is also edible, and can be found in many health drinks due to its vitamin, amino acid and mineral content.

It’s often combined with other healthy ingredients such as berries, spinach and cucumber as a general health booster. Because aloe vera on its own can have a bitter taste, many brands will add flavour or sweeteners to the bottle, so look at the bottle’s ingredients list to make sure the drink has not been loaded with sugar. One of the main commonly claimed health benefits of aloe vera is its use as a skin treatment. Typically found in the form of gels or creams, it can help keep skin hydrated and smooth, help treat spots and acne and help heal any wounds. Aloe vera has the ability to store vast amounts of water in its leaves because of the climate the plant is acclimated to. Because of this high water content, the gel found within the leaf, containing 99 percent water, is often used to help skin remain hydrated, cool and moisturised and overall keep the organ healthy. Aloe vera is also an anti-inflammatory, and is often applied in cases of skin conditions including acne and eczema, as well as to treat damage caused by sun burn and frostbite. It’s also often applied in cases of cuts and scrapes, as it’s claimed to have an anti-microbial action which aids in disinfection of wounds and helps speed the healing process. Another popular application for aloe vera is in hair care, mainly in smoothing and conditioning. But aloe vera products can work on different aspects of hair care such as calm itchy scalps, strengthening and repair strands of hair and cleaning oily hair. A 1998 study found that proteolytic enzymes in aloe vera reduce scalp inflammation that causes dandruff, while the vitamins in it contribute to hair strength. For oily hair, the plant has properties useful for removing the extra sebum oil and residue without damaging the strands of hair. •

IMAGES: Dreamstime

Inside and out, aloe vera is promoted as a wonder product for health and wellness – but what exactly is it, and how should we use it?

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TRADITION Aloe vera is used in traditional medicine as a skin treatment. It’s sometimes known as “burn plant,” “lily of the desert,” and “elephant’s gall”. Early records of its use appear from the fourth millennium, and it is also written of in the Juliana Anicia Codex of 512AD.

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Turning on Your Heels Cracked or dry heels can develop due to insufficient moisture in the skin. What can be done about this unsightly condition? Did you know? Wearing high heels contributes to women being four time more prone to heel problems than men. For more information regarding cracked heels and general footcare advice, visit The Institute of Chiropodists and Podiatrists at

due to cracks appearing and deepening. In extreme cases, the cracked heels may begin to bleed and if not treated, contract bacterial infections. Even if not painful or disabling, the condition is certainly unsightly – so how should you treat your cracked heels?


racked heels, or heel fissures, can develop when areas of dried, thick, yellow skin build up to protect the foot from injury. The underlying cause can be dietary deficiencies such as a lack of iron or zinc, pressure caused by long periods spent standing, and medical conditions such as eczema, psoriasis and thyroid disease. It’s said that the issue can be made worse by wearing shoes with an open back including sandals.

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In the early stages, the heel will start to feel tight when it is put under any strain or pressure. Itching and dryness are usually also preliminary signs of the issue. This is also the part of the stage where the problem area begins to change colour, turning into a yellow or brown colour as well as notably stiffening. In the later stages, the heel may become so dry that it will start to flake. Walking and running will become more difficult

IMAGES: Dreamstime

Treatments The main way to treat heels and keep them protected is to use moisturisers and cleansers regularly. This will help hydrate the affected area and help remove dead skin. It is important to keep moisturising regular after the cracked heel has improved to maintain the soft skin. Exfoliation will also help remove dead skin as well as preventing dry and thick skin from building up on the heel. Exfoliation products vary from electronic skin removers to loofahs. Soaking your feet regularly in warm water with natural ingredients such as honey or tea tree oil will help prevent the skin from cracking as well as keeping the skin soft and smooth. Other techniques including changing your diet - increasing the amount of calcium, iron and zinc intake will boost the general health of your skin, right down to your heels! •

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The Nature of Beauty Some cosmetics have a reputation for containing nasty chemicals, but a new move towards natural beauty stresses the importance of the pure and organic


t’s become pretty clear that a lot of the chemicals used in cosmetics aren’t good for us – they might be effective, but in the long term they could cause harm, and aren’t always good for the planet either. Chemicals derived from crops genetically engineered to be pesticidal, fillers such as parabens, artificial colours and fragrances, and even potentially irritant mineral oils are often found in cosmetics. But there are alternatives to these ingredients, and many more natural cosmetics are now using botanically derived organic ingredients without these health implications. The market for these natural cosmetics is growing faster than the general cosmetics market overall. An alternative to mineral oils, for instance, is the Omega 3 oil derived from the Sacha Inchi plant. This grows

in the Peruvian Amazon rainforest, and has been used locally for thousands of years, but has only recently been put to use in cosmetics. Seeds from the Sacha Inchi plant contain 90 percent Omega Fatty Acids, 54 percent of which is Omega 3, and also have high levels of protein and Vitamin E. Mineral oil can wrap the skin in a layer which prevents it from ‘breathing’, but this natural alternative, which used to be prohibitively expensive, is now more widely available through Fair Trade partnerships.

SUN DAMAGE Sacha Inchi oils are said to be good for all sorts of conditions from stretch marks and sunburn to wrinkles and scars. They are also suitable for use on babies, to treat conditions such as nappy rash and cradle cap. Omega oils are also said to be

particularly good at treating stretchmarks (striae), caused by weight gains, growth spurts or pregnancy. By improving elasticity the oils allow the skin to stretch without damage, and reduce the appearance of marks when skin contracts. Dry, leathery, or sun-damaged skin can also be treated successfully with Omega oils, which are also ideal for use on postsurgical scars to reduce inflammation and tenderness. Crucially, skin changes as it matures, losing elasticity as collagen levels reduce. The skin’s barrier functions also degrade, increasing water loss. Omega oils also contain fatty acids which can infuse the skin and help to improve its condition as it ages. So check the ingredients list next time you’re buying cosmetics, try to eliminate the synthetic chemicals, and look for the natural ingredients that work with your skin, not against it. •

Nature’s Gifts

IMAGES: Dreamstime

Other natural oils available include argan oil, derived from the kernels of the argan tree grown in Morocco; rosehip oil, pressed from the fruit and seeds of the rose plant; and avocado and olive oils, prized for their skin penetration and attractive scent.



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What’s in the Shell? Coconut water is being promoted as a healthy alternative to sugary drinks and a general aid to well-being and beauty. But is there anything in it?


oconut water is not only refreshing and tasty, but it also has a whole array of health benefits that have come to light in recent years. It’s loaded with important nutrients and minerals, helping many boost their immune systems and live a healthier lifestyle. Here are some of the main benefits of drinking coconut water.

Heart Health Coconut water may actually be helpful in reducing heart disease risk. A study by the National Institutes of Health found coconut water had reduced the blood cholesterol and triglycerides in those that drunk it. While scientists think that a great deal of coconut water will need to be consumed to

reduce your risk of heart disease to a great level, the risk will still be lower after drinking coconut water regularly.

Antioxidant properties Coconut water contains antioxidants that can protect your cells from damage. Free radicals are unstable molecules produced in your cells, which can increase risk of disease. More free radicals are produced in response to stress or injury, and when this happens on a regular basis, your body enters a state of oxidative stress, thus damaging your cells and increasing your risk of disease. Studies have found that coconut water can reduce levels of oxidative stress, which suggests that it contains powerful antioxidants that work to reduce production of free radicals.

Beneficial after exercise

Controls blood pressure Coconut water may actually be able to help lower blood pressure levels and potentially decrease the risk of a blood clots forming in your arteries. Studies have shown that in people with high blood pressure, coconut water improved blood pressure in 71 percent of participants. Coconut water is often described as more refreshing and enjoyable than regular water, and while it’s at its best when it comes directly from the coconut, you’ll find it stocked in many food and health stores, in a form without without any added preservatives – check the label for details, and enjoy! •

IMAGES: Dreamstime

Coconut water is considered to be the perfect drink for restoring hydration after exercising. When we exercise, electrolytes are lost, minerals that play important roles in the body such as maintaining fluid balance. It is thought that coconut water

can help replenish electrolytes quickly and effectively after exercise. Coconut water is very low in calories and carbohydrates, and is therefore a great source of hydration if you are looking to go on an exercise regime.

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DRIVE DOWN DISCOMFORT WITH VITAMIN D Introducing the new non-medicinal patches that offer topical and targeted relief for painful joints, nerves and migraines! Introducing To Better Days™, a new and innovative, non-medical way to help with healthy joint support and migraine recovery. Made in Britain and the first of its kind to be available in the UK, To Better Days™ have two types of patches; Active Joint and Migraine Recovery. They are both easy-to-use adhesive patches containing a patented combination of vitamin D and supporting natural ingredients to soothe discomfort.

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The main active ingredient in the patches is vitamin D, which is known to be essential for overall health. The vitamin D (cholecalciferol) is the same typeyour body naturally produces from the sun - but in this case, applied topically, it reaches the specific nerves that need it the most. Research shows that vitamin D acts as nerve cell food. Delivered directly to the damaged nerve areas (nociceptors) linked to pain, these nutrients can help prevent these nerves from flaring-up.**

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80% of testers using the active joint patch felt a reduction in pain within the first day of use.***

The almost invisible, round mini patches are perfect for your forehead, temples or neck when experiencing a migraine episode. The natural combination of vitamin D, chamomile, lavender and ginger can offer relief by shortening the length and severity of migraines and reducing recovery time. ACTIVE JOINT PATCHES

These fast-acting, discreet patches are perfect for nerve and joint discomfort. Research suggests vitamin D reduces the markers of inflammation, and that the delivery of vitamin D and a very small amount of dextrose together directly through the skin allows for high levels of vitamin D to be delivered to the nerve endings in a measured way, which is different from taking a supplement.

To Better Days™ patches are found to assist in the relief of discomfort within hours. In fact, during recent consumer testing*** conducted by the company, 80 percent of participants reported results within just the first day of usage. What’s more, over half surveyed stated they felt either the same or better than when taking other pain-relieving oral anti-inflammatory medicines such as paracetamol, aspirin and ibuprofen. To use, simply apply the patch onto clean, dry and unbroken skin at the source of the discomfort. The patches are free from gluten, lactose and latex and suitable for those who experience adverse effects from conventional medicines such as painkillers, have a dietary intolerance to lactose, have diabetes or suffer with IBS.


They come in two sizes; Small Joint (suitable for fingers, wrists, ankles and knees – 15 in a pack; £17.99) or Large Joint (suitable for back, legs and shoulders; £22.79). Alternatively, you can try the Trial Pack (containing three large and six small patches; £9.59). MIGRAINE RECOVERY PATCHES

The migraine patches are suitable for your temples, forehead and neck. The pack contains 15 oval patches for £15.59.

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Pill-free vitamin D Fast, effective immune support – in a spray

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