Sugar, diets and healthy living

Just one...

Just one…

It’s pretty clear that diet has an impact on health. Exactly how much impact, and which bits of diet, is less clear. I analysed two studies this week for the excellent NHS Choices’ Behind the Headlines feature, which takes apart health studies in the news to see whether they stand up to the hype.

The first was one of those papers that gets the Daily Mail rubbing its hands with glee. ‘Obese people are in denial about the amount of sugar they eat,’ their headline ran. The study was intriguing. It questioned whether people who ate more sugar (as opposed to just more calories generally) were more likely to be overweight. The answer was yes, if you measured people’s sugar consumption by the sugar concentration in their urine. Or no, if you asked people how much sugar they ate, via a food diary.

We don’t actually know whether people were ‘in denial’. The researchers suggested the difference in outcomes was because overweight people under-reported how much sugar they ate. That’s one explanation; another might have been issues with the urine tests, or the food diary design. But it’s all too believable that people simply ‘forgot’ to mention that sneaky biscuit or chocolate bar when they reported their food intake to researchers. Here’s my analysis.

The second study was interesting – a rare randomised controlled trial of dietary guidelines. Most of our evidence about healthy diets comes from observational studies – basically, looking to see what healthy people eat, compared to less healthy people. That’s subject to all sorts of bias which can be avoided by an RCT.

The three-month study showed that people who followed healthy eating guidelines on salt, fat, vegetables, wholegrains and oily fish reduced their blood pressure by a significant amount, enough to cut their chances of having a heart attack or stroke. My only reservation with this study was that I couldn’t find the researchers’ calculations for the widely-reported headline figure of a one-third reduction in risk. I’m sure they were fine, but I like to see them. My analysis is here.

Fighting the stigma: mental health and medical students

‘Having a mental illness and being a doctor is OK.’ That was the final conclusion of one of the students I interviewed for this Student BMJ article on mental health and medical school, who had been through the mill of break-down and depression and worried silently for months that she would be thrown out of medical school if she admitted her illness.

Sometimes you write a feature that really touches you, and this was one of those. The courage and insight of the students who contacted me to talk frankly about their struggles with mental health were very moving. What struck me was how much unnecessary suffering is caused by the stigma around mental health, even (perhaps especially) among medical professionals and students.

Several students made the point that if you have a physical illness or trauma, like a broken ankle, you’re deluged with sympathy and offered help to juggle medical appointments with your education, to ensure that you have the support and adaptations you need. Depression or anxiety, however, feels like something to be ashamed of and hidden from a disapproving world. While help is often available, people find it very hard to ask for it.

‘We’re meant to be super-human – we’re not meant to get ill,’ said the students. Everyone had worried about being seen as weak because of their illness. But it takes immense courage to persist with a medical degree in the face of mental illness. There’s also great courage in challenging that stigma, especially for those who were prepared to speak openly to a medical magazine about their experiences. These are strong, strong people and I would love to have any of them as my doctor in future.

My thanks to everyone who helped with the feature. Do have a read, especially if you know anyone at medical school who may be struggling with their mental health.

What are we scared of?

Scare-devil figure to ward off evil spirits, India

Scare-devil figure to ward off evil spirits, India

By and large, those of us in the west live in the least dangerous conditions in human history. Most of us have the basics: food, shelter, safety. We’re unlikely to be killed by wild animals (even other humans) and fatal infectious disease is rare. Life expectancy is long and few of us die in childbirth.

So why are rates of anxiety disorder high and rising? There’s probably a whole book to be written in answer to that question. But having less to fear doesn’t seem to have made us less fearful. Perhaps our evolutionary responses haven’t caught up with our changing circumstances. Perhaps we don’t quite believe our luck. Perhaps the rate of change itself makes us fearful.

I’m not seeking to make light of anxiety disorder. I know from experience how crippling and exhausting it is. But I am interested in what lies beneath these fears. What is it we’re all so frightened of?

The Wellcome Collection had a go at finding out in a recent interactive exhibition. People were asked to write down their greatest fears on a piece of paper, which they then crumpled and put in a bin, in a symbolic act of letting go. The curators then rooted around among the hundreds of responses to find out the most commonly-cited fears.

I don’t think the top five will surprise anyone. People fear death, being alone, losing someone, failure. And spiders, the only fear I don’t share. What strikes me is that they’re not irrational fears (except maybe the spiders). All of these experiences are inevitable. No-one can avoid confronting them at some point in their lives, or at the end of them. Perhaps our longer, safer lives even make some of these things seem more frightening, because we have less experience of them.

The Wellcome team did find some surprising fears. Vaginas, for example, and automatic doors (not together). Writing in public, which I think I can cope with. A sudden wine shortage, though. That’s a new fear to keep me await in the early hours.

Image: Wellcome Images, with CCL.

From antidepressant prescription to tight glucose control: seven clinical controversies that keep on going

mental_health_in_the_media.jpg338x219.2775Some clinical stories become perennials – issues that never seem to get completely resolved and pop up year after year. What’s the betting we can see the end of any of these seven controversies in 2015?

1: Are antidepressants over-prescribed? To some, depression is under-diagnosed and under-treated. Others think we’re medicalising ordinary sadness.

2: Bariatric surgery for weight loss. A sensible approach to disease prevention, or a cop-out that means people don’t take responsibility for their own health?

3: Statins for over-50s. A worthwhile investment in preventing heart disease, or under-researched mass-medicalisation?

4: HRT for menopausal symptoms. Out of fashion since the shock research of 2003, but do too few women now benefit from their beneficial effects?

5: Should we stockpile Tamiflu against a flu pandemic? Or does the evidence now point to it being too little use, for too much cost?

6: Dementia diagnosis. Is there a good reason to increase early diagnosis of this devastating condition?

7: Tight glucose control for type 2 diabetes. The best way to avoid complications, or a short route to hypoglycemia?

I took a closer look at these questions in my January feature for Student BMJ, here.

Five top medical stories of 2014

The helplessness of modern medicine in the face of a deadly virus was the over-riding image of the year. It was a forceful reminder that we don’t have all the answers – especially not in countries where the medical service is degraded by years of civil war and poverty. At home, non-communicable diseases of lifestyle and ageing made the headlines.

Ebola: The WHO first warned of its concerns about the outbreak back in March. By the autumn the disease had rampaged through three West African states, with no sign of being brought under control. The international response was ramped up in October, although Medecins Sans Frontieres warn that facilities are still inadequate. Trials of new drugs started in December. While they come too late for the more than 6000 people who have died in this outbreak, they may prevent the disease from becoming endemic.

Fat and heart disease: Researchers writing in the Annals of Internal Medicine wrote that dietary guidelines urging people to eat less saturated fat to lower their risk of heart disease were not based on sound evidence. Their systematic review and meta-analysis looked at data from 18 countries. They found no clear link between saturated fat consumption and heart disease risk. But the battle isn’t over. Nutritionists claim the research was flawed and current dietary guidelines should not be abandoned.

Statin wars: NICE, the government’s health watchdog, recommended that people with a 10% or greater risk of getting heart disease in the next 10 years should be offered statins – a jump from its previous recommendations that statins should be offered to those with a 20% or greater risk. A group of influential doctors protested that this could mean 5 million more people taking the cholesterol-modifying drugs, with their potential side effects. In tandem, research published in the BMJ (and highly-publicised complaints about it) made it clear that no-one can say for sure how common these side effects actually are.

Diagnosing dementia: NHS England offered GPs a cash bonus for diagnosing elderly patients with dementia. The move raised plenty of eyebrows, not least because services for people diagnosed with signs of early cognitive decline are lacking and existing treatments are limited in effect. But the potentially deleterious effect on trust between GPs and their patients caused the greatest unease among the doctors who called for the payment to be withdrawn.

Spinal cord re-growth: In a year when good news was hard to find, the story of how Polish surgeons used a British-pioneered technique to regrow nerve cells from a paralysed man’s olfactory bulb to ‘re-grow’ his severed spinal cord was heartening. If the team-work, technical know-how and resources brought to bear in this case could be replicated around the world, who knows what triumphs 2015 might bring?

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