Why Did Steve Jobs Die?

John McDougall

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Dr. John McDougall presents "Why Did Steve Jobs Die?" from the McDougall Advanced Study Weekend, February 2012.

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Why Did Steve Jobs Die?

What’s the best time to take your pills?

What’s the best time to take your pills? From heartburn to heart disease, swallow your medicine at the wrong time of day and it may not work

By David Hurst

Last updated at 10:25 PM on 27th February 2012


While millions of us take medicine daily, few pay much attention to the time of day we take it.

Yet a growing number of health experts say this is much more important than patients think — indeed when it comes to conditions such as arthritis, osteoporosis and heartburn, the time you have your medication can have a significant impact on its effectiveness and how well it protects you.

New U.S. research, published last week, seems to support this. A study of mice, published in the journal Nature, identified why heart rhythm problems are more common in the morning.

A growing number of health experts believe the time you have your medication can have a significant impact

Experts believe this understanding means patients who are on anticoagulants to prevent heart attacks and strokes could maximise the effect by taking the pills when they wake up.

It’s thought the key is the circadian rhythm, our 24-hour internal body clock driven by the brain’s hypothalamus gland. This controls not only the immune system but also blood pressure, body temperature, hormone production, bowel movements and tiredness.

So what’s the best time to take your medication? We asked the experts...

OSTEOPOROSIS

The most commonly prescribed drugs for osteoporosis are bisphosphonates, which prevent the loss of bone mass.

‘The key thing with bisphosphonates is that they are poorly absorbed,’ says Sarah Leyland, senior nurse at the National Osteoporosis Society. This is because they do not dissolve well, especially in oils and fats. ‘So you need to take your pill first thing in the morning with water on an empty stomach after a night of not eating. Then patients must wait up to hour to eat or drink.’

Many osteoporosis patients have to take calcium and vitamin D but these too can disrupt absorption, so patients should also wait at least an hour after taking their bisphosphonates, she adds.

‘If you eat or drink something other than water, or take another medication, it could mean you won’t get any benefit from it, so it could be a total waste of time taking it.’

HIGH BLOOD PRESSURE

Taking blood-pressure tablets at night may better control hypertension and greatly reduce the risk of heart attack and stroke, research published last year suggests.

While millions of us take medicine daily, few pay
much attention to the time of day we take it

The results of the five-year Spanish study highlighted the importance of reducing blood pressure at night. In healthy people blood pressure dips at night between 10 to 20 per cent — those whose blood pressure doesn’t fall as it should are more likely to suffer from heart attack and stroke, the researchers said.

In the study of 2,156 men and women with high blood pressure, those who routinely took at least one of their blood-pressure medicines at night had a 33 per cent lower risk of angina, stroke and heart attack than those who took all their blood-pressure pills in the morning.

‘This study confirms sleep-time blood pressure as the most relevant predictor of cardiovascular risk,’ says lead researcher Ramon Hermida of the University of Vigo. ‘Sleep-time blood pressure is best reduced when medication is taken at bedtime.’

However, those who now take their pills in the morning should not begin taking them at night without speaking with their doctor, says Hermida. ‘There’s a risk for nocturnal hypotension (abnormally low blood pressure) which could increase the risk of stroke,’ he adds.

ARTHRITIS

Osteoarthritis patients are likely to find their joint pain is worst in the afternoon, according to a recent Texas Tech University study. The researchers concluded that the optimal time for taking a non-steroidal anti-inflammatory drug such as ibuprofen would be around noon to mid-afternoon, so that it takes effect as symptoms begin to build up.

They also found that rheumatoid arthritis patients generally experience the greatest pain in the mornings, so taking painkillers just after their evening meal may be the most effective way to prevent pain developing overnight.

HIGH CHOLESTEROL

It is now recommended that cholesterol medicines be taken at bedtime instead of first thing in the morning. Studies at the University of Sunderland found that when patients taking simvastatin, one of the most commonly prescribed statins, switched from evening to morning, there was a significant increase in ‘bad’ LDL cholesterol.

Another study published in the International Journal of Clinical Practice in 2008 revealed that taking another commonly prescribed statin, atorvastatin (brand name Lipitor), in the evening was better than taking it in the morning — it was associated with fewer heart attacks, blockage of the arteries as well as greater improvements in total ‘good’ cholesterol and better blood vessel function. Experts think this may be because most cholesterol is produced at night, while we are not eating.

UNDERACTIVE THYROID

As many as three million people in Britain are said to suffer from an underactive thyroid — the majority of them women. Most thyroid medicines contain levothyroxine, a synthetic version of the thyroid hormone T4.
The T4 hormone needs to be first converted to the active form of thyroid hormone T3 for it to be effective. This takes a long time to occur inside the body.

Traditionally, many doctors suggest that taking thyroid medication first thing in the morning is best. But two recent Dutch studies have found that taking medication at bedtime rather than the morning results in ‘higher thyroid hormone concentrations’. The researchers suggested that as the bowel is slower at night, it takes longer for the levothyroxine tablet to move through the intestinal system.

This results in longer exposure to the intestinal wall, and so better absorption of the medication. Other studies have shown that the key is taking thyroid medication consistently at the same time each day. To ensure quick absorption, doctors also advise avoiding calcium and iron supplements, high fibre foods, antacids and antidepressants for at least two hours after taking a thyroid pill.

HEART MEDICATION

For some time it’s been known that heart attacks and strokes are three times more likely to happen in the morning than any other time, but until now it’s not been clear why. But research published last week by Case Western Reserve University School of Medicine in Ohio has identified a protein called KLF15 that is crucial in regulating the heart’s rhythm.

The researchers found levels of the protein rise and fall in a 24-hour cycle. The heart’s electrical impulses are slowest from 6am to noon. ‘As the duration between impulses slow down, this makes the heart more likely to go out of rhythm, to short circuit or for electrical storms to occur,’ says Professor Mukesh Jain, who led the research.

This increases the risk of a heart attack — which means that the best time to take heart medication is first thing in the morning.

‘This realisation will be one of the most important innovations in medicine in the next 20 years,’ says Professor Russell Foster, a circadian rhythms specialist at the University of Oxford. ‘Certainly, if I was taking anti-stroke medication I know at what time of the day I’d take it. It should be delivered before you properly wake up. You should lie there calmly and take it, then get up.’

HEARTBURN

The general advice is to take proton-pump inhibitors (PPIs, drugs which suppress acid production) 30 minutes before the first meal of the day.
However, a recent study by the University of Kansas found the drugs were more effective against acid reflux when taken in the evening. More than 70 per cent of patients with gastro-oesophageal reflux disease who took a commonly prescribed PPI, rabeprazole, in the afternoon or evening found their symptoms were eased, compared with 42 per cent who took it in the morning.

They suggested this could be because the drug will act throughout the night, when heartburn can be exacerbated by lying down. They concluded that before the evening meal would be the preferred time for patients to take their medication, particularly those who suffer at night. However, Marcus Harbord, gastroenterologist at the Chelsea and Westminster Hospital, suggests splitting the daily dose, providing half in the morning then half in the evening, to keep symptoms at bay at all times.


http://www.dailymail.co.uk/health/article-2107287/What-s-best-time-pills-From-heartburn-heart-disease-swallow-medicine-wrong-time-day-work.html

New Drug for Rheumatoid Arthritis

NHS given go-ahead to prescribe new drug which eases agony of rheumatoid arthritis

By Jenny Hope
Last updated at 10:29 AM on 22nd February 2012


A drug that could ease the agony of thousands of rheumatoid arthritis sufferers has been given the go-ahead for many more NHS patients in England and Wales.

RoActemra, which is the first innovation in the field for ten years, is being recommended for patients who have failed on standard treatments.

It is the first time RoActemra has been approved for NHS patients in England and Wales with moderate to severe rheumatoid arthritis who are at an early stage in the disease.

Hope: The NHS given go-ahead to prescribe RoActemra which eases the agony of rheumatoid arthritis

The drug has been available for early use in Scotland for two years.

At present in England and Wales it is used by only 1,200 patients at later stages of the disease. The decision by the Government’s rationing body, the National Institute for Health and Clinical Excellence (Nice), means up to 40,000 more patients will be eligible.

The £9,000 annual cost of RoActemra, also known as tocilizumab, is the same as other advanced ‘biologic’ drugs already being used, but a discount scheme has been agreed with manufacturers Roche.

Trial data shows almost half of patients on RoActemra are in remission – with virtually no symptoms – after a year compared with 8 per cent on a commonly used drug called methotrexate.

The rate of remission is almost six times higher than on methotrexate alone.

Trial data shows almost half of patients on RoActemra are in remission ¿ with virtually no symptoms

The new drug is a laboratory-manufactured antibody that blocks the activity of interleukin 6 (IL-6), an important immune system signalling molecule that underpins many inflammatory processes.

Because RoActemra works in a completely different way to existing drugs it is likely to be effective in some patients where the other drugs don’t work or have stopped working.

John Isaacs, professor of clinical rheumatology at Newcastle University, says it vital sufferers have options

John Isaacs, professor of clinical rheumatology at Newcastle University, said: ‘Rheumatoid arthritis is an unrelenting disease and it is vital that patients have options available to them when they are no longer responding to, or can no longer tolerate, their current treatment.’

The disease occurs when the body’s immune system attacks the joints causing pain and swelling, most commonly in the hands, wrists and feet.

NHS figures suggest it affects 400,000 people in England and Wales, striking three times more women than men. It is most common between the ages of 40 and 70. Half of victims are unable to work through disability within ten years.

Professor Isaacs said it was vital to treat people as early as possible with the most effective drugs. He added: ‘We have evidence that if you can stop the disease early, you can change the way it progresses for the rest of the patient’s life.

‘This is particularly important when it strikes at a young age – women can be affected in their 40s and 50s but it can start in the 20s and younger.’

Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society, said: ‘We are delighted with Nice’s decision, as there are so many patients with rheumatoid arthritis in need of tighter disease management.

‘This decision is most welcome as it is vital that patients have effective options available as soon as one treatment approach fails.’

Professor Carole Longson, director of the health technology evaluation centre at Nice, said: ‘Rheumatoid arthritis can have a huge impact on quality of life and for many it’s a disabling condition, so we’re pleased to recommend tocilizumab at an additional stage in treating the condition.’

The drug was also approved in December for children with systemic juvenile arthritis, a severe inflammatory disease that can affect those as young as 18 months.

Around 2,500 children in Britain are living with the disease, which can persist into adulthood and cause significant disability.

http://www.dailymail.co.uk/health/article-2104499/NHS-given-ahead-prescribe-new-drug-eases-agony-rheumatoid-arthritis.html

The great cereal scandal

The great cereal scandal: One of Britain’s leading consumer experts reveals the shocking truth about sugary breakfast cereals

By Joanna Blythman

Last updated at 11:58 PM on 27th February 2012


The food industry’s biggest con trick is one you’re probably falling for every day of the week. Even worse, the victims are your children.

Visit any supermarket and wander down the aisle of breakfast cereals. The message from the packets couldn’t be more encouraging.

This one is ‘the sunshine breakfast’. That one is made from ‘wholesome corn, oats, rice and wheat’. Pretty much all are ‘fortified with vitamins and minerals’. The contents of the attractive colourful boxes can form ‘part of a balanced diet’.

Health hazard? According to Which? many breakfast products are laden
with so much sugar they ought to be sold alongside chocolate biscuits

For decades, we have been sold the story that a bowl of cereal is one of the healthiest things a caring mother could feed her children every morning.

But many cereals hide a horrible secret: the large amounts of sugar the manufacturers have pumped into them.

The research group Which? recently investigated the sugar content of 50 breakfast cereals. The results should shock you.

Products we are led to believe are healthy are, in fact, laden with so much sugar they ought to be sold alongside chocolate biscuits, said Which?, not marketed as a recipe for a healthy life.

SO HOW MUCH SUGAR IS IN YOUR CEREAL?

We asked Jacqui Lowdon, of the British Dietetic Association and a specialist in children’s nutrition, for her verdict on leading breakfast cereals. The calculations are for a 40g serving, with and without 125ml skimmed milk. A teaspoon is equivalent to 4.2g sugar.

COCO POPS

• Teaspoons of sugar per serving: 3½.
• Teaspoons of sugar when you add milk: 5¼.
• Calories with milk: 233.
• Fat per 100g of cereal: 2.5g.
• Salt per 100g: 0.75g.
• Sugar per 100g: 35g.

VERDICT: Marketed as being so chocolatey it ‘turns the milk brown’, this cereal is sweetened with sugar and chocolate to provide a huge 35 per cent sugar content. This is as much as you would get in an average sized chocolate bar, so you are effectively having a Dairy Milk bar in every bowl. The energy rush and plummet you would get from something this sugary means you’d be hungry again by mid morning.

READY BREK HONEY

• Teaspoons of sugar per serving: 2.
• Teaspoons of sugar when you add milk: 3.
• Calories with milk: 208.
• Fat per 100g of cereal: 6.6g.
• Salt per 100g: 0.2g.
• Sugar per 100g: 20.4g.

VERDICT: Unlike plain porridge oats, all varieties of Ready Brek are fortified. One serving provides almost a third of the recommended adult daily amount (RDA) for the B vitamins, vitamin D and iron and 50 per cent of a child’s calcium intake. However, compared with original, unsweetened Ready Break, this has 20 times more sugar. Stick to the plain stuff and add a teaspoon of honey.

FROSTIES

• Teaspoons of sugar per serving: 3½.
• Teaspoons of sugar when you add milk:
• 5¼. Calories with milk: 245.
  
• Fat per 100g of cereal: 0.6g. Salt per
• 100g: 0.9g. Sugar per 100g: 37g.

VERDICT: Frosties were considered the worst offender in the Which? report and it’s little wonder with their whopping 37 per cent sugar content. A 40g bowl contains around 15 per cent of the guideline daily amount of sugar. Though this cereal is fortified with vitamins and minerals, you’d be far better off eating a couple of pieces of toast with honey. Frosties are no better for you than cake and custard for breakfast.

DORSET CEREALS HIGH FIBRE FLAKES

• Teaspoons of sugar per serving: 3.
• Teaspoons of sugar when you add milk: 4½.
• Calories with milk: 185.
• Fat per 100g of cereal: 2.6g.
• Salt per 100g: 1g.
• Sugar per 100g: 29.7g.

VERDICT: This healthy looking combination of cereal flakes with dates, raisins and apple flakes is high in fibre — but it’s also high in sugar, partly because of the dried fruit. However, much of the sugar in the cereal is fructose, or fruit sugar, which in some studies has been shown to provide a longer-lasting energy boost. It’s not added during the manufacturing process. Still, it is better to stick to an unsweetened, high-fibre cereal such as Shredded Wheat with fresh fruit.

RICE KRISPIES MULTIGRAIN SHAPES

• Teaspoons of sugar per serving: 1¾.
• Teaspoons of sugar when you add milk: 3.
• Calories with milk: 245.
• Fat per 100g of cereal: 2.5g.
• Salt per 100g: 0.4g.
• Sugar per 100g: 18g.

VERDICT: These rice, oat and maize shapes appear to be a healthy choice because they contain ‘a natural prebiotic to help keep kids’ tummies healthy’ (prebiotics fuel the growth of healthy gut bacteria). But you’d be far better with a bowl of porridge, which does the same without the added sugar. A bowl of these shapes contains more sugar than two chocolate digestives.

SHREDDED WHEAT

• Teaspoons of sugar per serving: 0.
• Teaspoons of sugar when you add milk: 1¼. Calories with milk: 189.
• Fat per 100g of cereal: 2.2g.
• Salt per 100g: Trace.
• Sugar per 100g: 0.7g.

VERDICT: Since the only ingredient is wholegrain wheat, it is naturally low in sugar, salt and fat. It contained the least sugar of the 50 cereals analysed by Which? It is also a good source of fibre, with two Shredded Wheat providing almost a quarter of your daily amount.

WEETABIX MINIS FRUIT AND NUT

• Teaspoons of sugar per serving: 2.
• Teaspoons of sugar when you add milk: 3½.
• Calories with milk: 207.
• Fat per 100g of cereal: 4.1g.
• Salt per 100g: 0.18g.
• Sugar per 100g: 23.2g.

VERDICT: Sugar is the second ingredient after wholewheat in these mini biscuits, despite the fact they are naturally sweetened with dried fruit. You would be better off sticking with the original Weetabix biscuits, which contain almost six times less sugar per 100g (4.4g) and have more fibre.

HONEY LOOPS

• Teaspoons of sugar per serving: 3½.
• Teaspoons of sugar when you add milk: 4¾.
• Calories with milk: 206.
• Fat per 100g of cereal: 3g.
• Salt per 100g: 1.75g.
• Sugar per 100g: 34g.

VERDICT: This cereal contains sugar, honey and glucose syrup, giving it 34 per cent sugar content. I’d see this as a sweet treat rather than a healthy start to the day for children.

PETA BEE

The worst offenders in the Which? report were Kellogg’s Frosties, with 37 per cent sugar; Tesco Choco Snaps, with 36 per cent; and Sugar Puffs, with 35 per cent. According to the Food Standards Agency, a sugar content above 15 per cent is considered to be high — these cereals have double this.

Perhaps it’s not such a surprise that Frosties are sugary — after all, the sugar is visible on every flake. However, even Rice Krispies contain 10 per cent sugar, while Kellogg’s Corn Flakes have 8 per cent.

Does it matter? The answer is ‘Yes’. It is now accepted scientific fact that eating too much sugar increases your chances of suffering from obesity, diabetes, heart disease, cancer and liver problems.

A recent article in the highly respected journal Nature claimed that an excess of sugar contributes to 35 million deaths a year worldwide.

It not only makes people fat, but also changes the body’s metabolism, raises blood pressure, throws hormones off balance and harms the liver, said the authors of the report, The Toxic Truth About Sugar.

‘A little is not a problem, but a lot kills — slowly,’ they said. They have called for sugar to be regulated like cigarettes.

The biggest risk of a high-sugar diet is obesity. This is not only because sugar is high in calories, but also because it acts like a drug on your system. Eating too much sugar leaves you craving more sugar. It becomes a vicious circle.

You’ve probably heard about the glycaemic index. This is a measure of how quickly foods release their sugars into your bloodstream.

Breakfast cereals have a high GI, which means they break down quickly during digestion and your blood sugar level surges. Then it quickly recedes — leaving you hungrier, sooner.
That’s why people who have had cereal for breakfast can feel tired and hungry by 11am and unable to hold out for lunch.

Eating a bowl of Frosties is like throwing a newspaper into a fire. Whoosh, and then you need more fuel. The problem is that once the fuel has been used up, you need something sweet. Something right now. If you’re not careful, you’re soon into a spiral of obesity.

A breakfast consisting of an unsweetened yoghurt and a handful of fruit and nuts is like putting slow-burning coal on a fire: it will sustain you for longer and you won’t crave the hit of a sugar fix.

So, if sugar is so bad for us, why do the cereal manufacturers pack their products with it?

To understand that, you need to know the economics of the industry. Breakfast cereals are a miracle of modern capitalism.

You take ultra-cheap ingredients — corn or rice, for example — put them through a simple manufacturing process and then sell them to the public at a huge mark-up. A 750g box of Kellogg’s Frosties will cost you around £2.70. The corn will have cost Kellogg’s just a few pennies.

However, there are two problems with this manufacturing process. It removes much of the nutritional benefits from the raw ingredients; and stripping grains of rice or pieces of corn, crushing them or puffing air into them leaves you with a product that is about as appealing in taste terms as eating newspaper.

This is where sugar comes in (and salt, but that’s another story). Adding it in large amounts is the only way people can be encouraged to eat the end product.

But this poses another problem for the manufacturers. How can you get away with marketing a product at children — the core customers for many breakfast cereals — if it’s packed with all this sugar? The answer is as simple as it is dishonest: bestow the cereals with the illusory gift of health.

Enter the word ‘fortified’. Emblazoned on pretty much every cereal packet, it’s a subliminal and sneaky message to the consumer. This food may taste sweet, and sweet foods may seem unhealthy — but not this one!

By adding synthetic vitamins to your flakes, krispies or loops, the manufacturer can shout about the fact that a bowl of Kellogg’s Coco Pops contains thiamin, riboflavin, niacin, vitamin B6, folic acid, vitamin B12, iron and calcium, without drawing attention to the fact 35 per cent of what you are eating is sugar.

That’s around 3½ teaspoons of sugar in one 40g serving (assuming you measure out a serving, unlike most people, who pour until the bowl is full).

And if you add 125ml of semi-skimmed milk, which packs its own carbohydrate punch, that’s a total of 5¼ teaspoons of sugar in your breakfast bowl. Marketing breakfast cereals as ‘fortified with vitamins’ is not against the law.

No outright lies are being told — those vitamins are there (though all the vitamins and minerals in fortified cereals are found in greater quantities in other foods, such as eggs and meat). But they’re a smokescreen to distract attention from the real story.

Another ruse, which is used for cereals aimed at adults, is to label them as low-fat (the Special K packet declares: ‘Less than 2 per cent fat’).

Yes, cereal grains are by their very nature low in fat. But it’s another red herring to distract you from the salt and sugar content. (And anyway, contrary to what we have been led to believe, there is scant evidence to support the nutritional mantra that fat is automatically bad for you.)

So there is nothing illegal in this marketing, but in my opinion it’s dishonest. What’s worse is when manufacturers plaster packets with cartoon characters and use cuddly creatures — the Honey Monster, Tony the Tiger, the Coco Pops monkey — to appeal directly to children.

The problem is that most of us don’t understand the nutritional information on food packets. I have been a food investigative journalist for more than 20 years and it took me a while to get the hang of it.

When it comes to sugar, the key is to ignore the ‘per serving’ figure — the food company’s bowl size probably will not equate to your children’s portion — and look instead at the table marked ‘typical values per 100g’.

Then look down to the figure next to ‘sugars’. More than 15 per cent is deemed to be a high-sugar product — even Special K, which claims on its website ‘you can be sure you are helping yourself look good and feel special’ consists of 17 per cent sugar.

What should be done to end the scandal of sugary cereals? I think the Government should impose a sugar tax to discourage firms from lacing their products with the stuff.

But it would take a very brave government to pick a fight with the corporations that have built such lucrative businesses on the back of our addiction to sugar.

So, if you care about your children’s health, you need to serve them something else for breakfast. I never gave my children sugary breakfast cereals: they had Weetabix served with a spoonful of fruit.

Other healthy starts to the day include a poached, boiled or sometimes fried egg, which provides every major vitamin you need apart from vitamin C; porridge, which is delicious and healthy; or a slice or two of wholemeal toast plus unsweetened yogurt mixed with fresh fruit and a handful of nuts.

Now grown up, my daughters won’t touch foods that are packed with sugar — they find snacks and treats such as cupcakes to be too sickeningly sweet for their liking.

Thanks to a healthier breakfast, you can put your new-found energy to good use.

Read nutritional labels and learn how to understand them. And then get angry about the great cereal swindle.

Joanna Blythman is author of What To Eat: Food That’s Good For Your Health, Pocket And Plate (Fourth Estate, £16.99), published on March 1.

http://www.dailymail.co.uk/health/article-2107361/Sugary-breakfast-cereals-1-Britains-leading-consumer-experts-reveals-shocking-truth.html

Dementia - Types, Symptoms, Treatment

The Royal College of Psychiatrists

Dementia is a brain disease which often starts with memory problems, but goes on to affect many other parts of the brain.

Dr Gill Jenkins last medically reviewed this article in November 2009.

It causes changes in mood, judgement, personality, and makes it difficult to communicate or cope with day to day tasks. It usually gets worse over time, which means that you have to rely on other people more and more.

Dementia can rarely start as early as 40 and affects about one in every 20 people over-65 have dementia. By the age of 80 about one in five are affected.

 

 

Types of dementia

Alzheimer’s disease is the most common dementia. Damaged tissue builds up in the brain and forms deposits called ‘plaques’ and ‘tangles’ which cause the cells around them to die. It also affects chemicals in the brain which transmit messages from one cell to another.

Vascular dementia, where the arteries supplying blood to the brain become blocked which leads to small strokes when parts of the brain die as they are starved of oxygen.

Lewy body dementia is caused by small protein deposits in the brain, and symptoms closely resembles Parkinson’s disease

Fronto-temporal dementia is caused by damage to the front of the brain and is more likely to cause personality change

Many other illnesses can cause dementia. Physical illnesses which cause memory problems include:

• Kidney, liver or thyroid problems.
• Shortage of some vitamins (although this is rare).
• Chest or urine infections can lead to confusion and can be treated with antibiotics.
• Rarer conditions such as Huntington’s disease, which causes dementia in younger people.

Depression can cause a “pseudo-dementia” which can get better with antidepressants and talking therapy.

 

 

Symptoms of dementia

The condition usually develops slowly. Three main types of symptoms can appear:

• Cognitive problems – it gets harder to understand, remember, think, do sums, learn new things, talk or make judgements
• Functional problems – it gets hard to do complicated tasks. As time goes on, it gets harder to do the basic task of looking after yourself, like washing and dressing.
• Emotional problems – your mood can change, you may lose control of your emotions, stop doing things that you enjoy and stop seeing people.

 

Treatment of dementia

If you are worried about your memory, see your doctor. He or she can carry out a simple memory test, examine you physically and order blood tests. You can be referred to a specialist team to test your memory in more detail and arrange a brain scan if needed.

There are no cures, as yet, for many of these conditions and treatment depends on the diagnosis. A group of drugs called acetyl cholinesterase inhibitors may slow the progression of Alzheimer’s dementia and Lewy Body dementia and another drug called memantine, a glutamate blocker, may protect brain cells against damage.

In Vascular dementia and possibly Alzheimer’s, other drugs may be of use in slowing the damage to brain cells and hence brain function, including:

• Aspirin
• Medication to control high blood pressure
• Cholesterol lowering treatments such as statins

There is a small amount of evidence that the herb gingko biloba and possibly also vitamin E may help delay progression of the disease It’s also important to stop smoking, eat healthily and take exercise.

Discuss any concerns you have with your doctor, mental health nurse or social worker. Charities such as the Alzheimer’s Society are also a very useful source of advice. They can help you understand more about the illness with advice about medication, care options, benefits and legal issues.

Disclaimer

All content within BBC Health is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. The BBC is not responsible or liable for any diagnosis made by a user based on the content of the BBC Health website. The BBC is not liable for the contents of any external internet sites listed, nor does it endorse any commercial product or service mentioned or advised on any of the sites. See our Links Policy for more information. Always consult your own GP if you're in any way concerned about your health.


http://www.bbc.co.uk/health/emotional_health/mental_health/disorders_dementia.shtml

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Can Fasting Stop Dementia?

 Can fasting for two days each week stop dementia? It sounds far-fetched, but scientists think slashing calories may combat a host of illnesses
By Jerome Burne

Last updated at 10:54 PM on 27th February 2012

Fasting was a common medical treatment in the past,
but now there may be good reason for it to make a comeback

One day in the not-so-distant future, you may find yourself receiving some unusual health advice from your GP: fast two days a week to prevent your brain shrinking with age.

You might be given the same advice to lower your risk of heart disease and diabetes — and even tackle cancer.

Fasting was a common medical treatment in the past, but now new research suggests there may be good reason for it to make a comeback. This is because it seems to trigger all sorts of healthy hormonal and metabolic changes.

Researchers have long known that cutting back animals’ calories over an extended period can make them live up to 50 per cent longer — it’s been harder to prove benefits in humans because few people can stick to this restrictive regimen.

But there’s now emerging evidence to show occasional fasting — which is much more manageable — also carries benefits. Fasting days involve eating between 500 and 800 calories (the usual daily intake for a woman is 2,000 calories, for a man, 2,500).

This intake appears to cause a drop in levels of growth-factor, a hormone linked with cancer and diabetes, as well as a reduction in ‘bad’ LDL cholesterol and triglycerides (fats) in the blood.

 

Meanwhile, free radicals — the damaging molecules linked to disease — are dampened down. Studies also suggest that levels of inflammation can fall. And now there is the suggestion that fasting protects the brain, too.

 

‘Suddenly dropping your food intake dramatically — cutting it by at least half for a day or so — triggers protective processes in the brain,’ explains Professor Mark Mattson, head of neuroscience at the U.S. National Institute On Ageing.

‘It is similar to the beneficial effect you get from exercise.’ This could help protect the brain against degenerative diseases such as Alzheimer’s and Parkinson’s.

Professor Mattson is one of the pioneers of research into fasting — a few years ago he made a breakthrough when he found rats could get nearly all the benefits of calorie restriction if the scientists only cut back their calories every other day. On the next day the rats could eat as much as they liked and yet they showed the same benefits as rats on a low-calorie regimen all the time.

According to experts protective processes in the brain are triggered when food intake is dramatically cut

Suddenly it looked as if humans could benefit from a form of calorie restriction regimen that, unlike daily restriction, is feasible to follow. Now results of other trials are revealing the benefits.

In one study, reported last year in the International Journal of Obesity, a group of obese and overweight women was put on a diet of 1,500 calories a day while another group was put on a very low 500-calorie diet for two days, then 2,000 calories a day for the rest of the week.

Both groups were eating a healthy Mediterranean-style diet. ‘We found that both lost about the same amount of weight and both saw a similar drop in biomarkers that increase your risk of cancer,’ says Dr Michelle Harvie, a dietitian at Manchester University who led the research.

‘The aim was to find which was the most effective and we found that the women in the fasting group actually had a bigger improvement in sensitivity to insulin.’ Improved insulin sensitivity means better control of blood sugar levels.

Last year researchers at Newcastle University reported that they had reversed diabetes in a small number of overweight people by putting them on an 800-calorie diet for eight weeks.

It’s possible that eating small amounts of calories every other day, as Dr Harvie’s study allowed, is not only more bearable, but may be particularly effective at getting diabetics’ blood sugar under control. Now Professor Mattson has been investigating the benefits of various fasting regimens on the health of our brain cells.

According to an article that will be appearing in the leading science journal Nature Neuroscience next month, calorie restriction can protect the cells from damage and make them more resistant to stress.

 

‘Part of this effect is due to what cutting calories does to appetite hormones such as ghrelin and leptin,’ he explains. ‘When you are not overweight, these hormones encourage growth of new brain cells, especially in the hippocampus.’

This is the area of the brain which is involved in laying down memories. If you start putting on weight, levels of ghrelin drop and brain cell replacement slows. ‘The effect is particularly damaging in your 40s and 50s, for reasons that aren’t clear yet,’ he says. ‘Obesity at that age is a marker for cognitive problems later.’

The good news is that this brain-cell damage can be reversed by the two-day fasting regime, although so far Professor Mattson has shown this only in rats. A human trial is starting soon. There is reason to think it should work. Fasting every other day had a striking effect on people with asthma in a small study he ran a few years ago.

‘After eight weeks they had lost eight per cent of their body weight, but they also benefited from the ability of calorie restriction to reduce inflammation. Tests showed that levels of inflammation markers had dropped by 90 per cent. As levels came down, their breathing became much easier,’ says Professor Mattson.

But he cautions that patients have to stick to the diet, as symptoms began to return two weeks after giving it up. Not everyone will find fasting intermittently is something they can manage. In Dr Harvie’s recent study of overweight women, more patients in the continuous dieting group (who had to stick to 1,500 calories a day) wanted to continue with it than those on the two-day fasting regimen.

‘It’s going to suit some people more than others,’ she says. ‘For some, being able to cut out 3,000-4,000 calories in two days and then eat normally for the rest of the time is much more attractive than cutting back a little every day; for others it’s too drastic. It gives us another option. My experience is men seem to adapt better to it than women.’

But Professor Mattson believes these new fasting regimes could help tackle our failure to live more healthily. ‘This research shows that successful brain ageing is possible for most individuals if they maintain healthy diets and lifestyles throughout their adult life,’ he says.

The trouble is, we don’t — our diets are too high in calories and we don’t do enough exercise, which is why, he says, brain diseases such as Alzheimer’s are on the rise. Dr Susan Jebb, head of diet and population health at the Medical Research Council agrees that losing weight is about the healthiest thing many of us can do. ‘If this approach can help people do that I’m all for it,’ she says.

But whether fasting could be used as a way of treating people at raised risk of heart disease or dementia, it is really too early to say, adds Dr Jebb.


‘There needs to be more trials with more people for longer to work out all the possible effects.’

So is there any harm in trying a little intermittent fasting ourselves? As a result of his research, Professor Mattson now keeps his own calorie intake down.

‘I aim for about 1,800 calories a day, nothing drastic,’ he says. ‘During the week I don’t have any breakfast or lunch but I have a good evening meal. I know it’s not what most dietitians would recommend but it works very well for me.’

However, Dr Jebb advises against fasting. ‘We don’t know what it does to the metabolism over time and it could also have a damaging effect on people’s eating patterns. If people have been heavily restricted for a couple of days they might feel that gave them a licence to over-eat.’

Meanwhile the British Dietetic Association has warned that frequent fasting could raise the risk of osteoporosis and infertility. There is still much scientists don’t understand about the effect of fasting. If the benefits are as big as the research suggests, there may be many willing to try it.

But experts advise always speaking to your doctor before embarking on such a regimen.

Jerome Burne recently won the prestigious Medical Journalists’ Association award, Explaining Medical Science, for Good Health.

http://www.dailymail.co.uk/health/article-2107299/Can-fasting-days-week-stop-dementia-It-sounds-far-fetched-scientists-think-slashing-calories-combat-host-illnesses.html

Dementia patients to Avoid Certain Drugs

Dementia patients twice as likely to die if they take certain drugs, researchers warn

By Jenny Hope

Last updated at 9:44 AM on 24th February 2012


Elderly people in nursing homes with dementia run double the risk of dying from certain ‘chemical cosh’ drugs, warn researchers.

Alarm bells have been sounded about the dangers of premature death caused by antipsychotic drugs in recent years, but a new study shows some are more risky than others.

It found people over 65 taking haloperidol had double the risk of death compared with those taking a newer drug called risperidone.

 study has found that people over 65 taking haloperidol, pictured, had double the risk of death
compared with those taking a newer drug called risperidone

A

Those taking highest doses of antipsychotic drugs - often known as the ‘chemical cosh’ because they are wrongly used to sedate elderly patients - were at greatest risk.

The Harvard Medical School study, the largest ever undertaken among US nursing home residents, looked at 75,445 older nursing home residents between 2001 and 2005.

The drugs investigated in the study are all used in nursing homes and on general hospital wards in the UK.

A Government-commissioned review in 2009 found 180,000 people with dementia were prescribed antipsychotics, of which 144,000 were given them inappropriately.

Research suggests this could mean 23,500 people dying prematurely each year.

Haloperidol, which was originally licensed for schizophrenia and other psychiatric conditions, is one of the oldest used, while newer antipsychotics include risperidone and quetiapine.

A Government-commissioned review in 2009 found 180,000 people
with dementia were prescribed antipsychotics, of which 144,000 were given them inappropriately

In the six-month study published in bmj.com - the online edition of the British Medical Journal - researchers found 6,598 nursing home residents died, almost nine per cent.

Patients treated with haloperidol had double the risk of death compared with those taking risperidone, the most commonly prescribed drug which was used for comparison with the other five drugs.

The effect of haloperidol was strongest in the first 40 days of treatment, while those taking quetiapine (sold under the brand Seroquel) had a slightly reduced risk of death.

There was no significant effect on death rates from the other drugs, aripiprazole, olanzapine (marketed as Zyprexa) and ziprasidone.

Almost half of deaths were recorded as due to circulatory disorders, 10 per cent due to brain disorders and 15 per cent to respiratory disorders.

The experts concluded ‘The data suggest that the risk of mortality with these drugs is generally increased with higher doses and seems to be highest for haloperidol and least for quetiapine.’

The Daily Mail has long called for an improvement in the care of dementia sufferers as part of our Dignity for the Elderly Campaign.

Manchester University academics earlier this week found more than a quarter of elderly patients with dementia were receiving antipsychotics, sometimes for years even though they are supposed to be used for a few weeks at most.

Most antipsychotic drugs are not licensed for treatment of dementia but are frequently prescribed to control agitation and aggressive behaviour, making life easier for carers and nursing home staff.

But Dr Anne Corbett, research manager at the Alzheimer’s Society charity, said the practice must stop.

She said ‘This research supports existing studies that have shown antipsychotics can raise the risk of death, particularly when used over the longer term.

‘As many as 150,000 of the 180,000 people with dementia who are on the drugs in the UK have been prescribed inappropriately. For a minority of people with dementia antipsychotics should be used, but then only for up to twelve weeks, and under the correct circumstances.

‘People with dementia are currently having their lives put at risk because of dangerous antipsychotic medication. Too often we hear about an over-reliance on medication as a response to distressed reactions of people with dementia, when a person-centred approach is what is required.

‘This needs to stop now. There has been some progress but good care rather than antipsychotics must become the norm. Staff need to be trained and supported to be empowered to provide person-centred care.’

 
http://www.dailymail.co.uk/health/article-2105678/Dementia-patient-twice-likely-die-drugs-researchers-warn.html

The Waste of Prescription Drugs

Would you throw away a week in the Bahamas?

By Lin-Nam Wang
The Pharmaceutical Journal

10 February 2012 Last updated at 01:27 GMT

Knowing the cost of drugs might prompt different behaviour, Ms Wang suggests

Would you throw away a week in the Bahamas? It is estimated that in England £300m of medicines are wasted each year, and that half of this is avoidable.

In this week's Scrubbing Up, Lin-Nam Wang, community pharmacist and senior contributions editor at The Pharmaceutical Journal, says that current strategies to reduce medicines waste are not enough and explains why she believes NHS patients need to be told how much their medicines cost.

Last month, a man came into my pharmacy and handed me a black bin-bag.

Inside was £2,250.

Ok, so it wasn't in cash, it was in medicines.

Among the stash were 30 unopened boxes of a drug that would have lasted the patient seven months at her prescribed dose. But this was no windfall for the pharmacy - since we can't guarantee how medicines have been stored in patients' homes, they have to be sent for incineration.

Such events make me despair.

And they make me angry that, when we face cuts to services, and over a year since the publication of a Department of Health commissioned report on medicines waste, our system is still letting things like this happen.

'Time to talk'

I admit that in my 15 or so years in pharmacy this "patient return" has taken first prize, but talk to any community pharmacist and he or she will tell you that having to dispose of hundreds of pounds' worth of unwanted medicines is not uncommon.

In this case, the patient, who had died, had been dispensed repeat prescriptions again and again. Some bags had not even been opened.

There are so many holes in the net this patient could have slipped through and the reasons for waste can be complex but in a recent poll of members of the Royal Pharmaceutical Society 57% thought patients are to blame for medicines waste.

Various strategies have been proposed to prevent waste, including limiting prescribing to 28 days (a policy that some primary care trusts have introduced, but which can cause patients inconvenience).

And, since 2006, over 120 campaigns have been run, asking people to "only order what you need". But clearly this is not enough.

It's time to talk about the money

The crux of the problem is that most people don't have a clue how much their medicines cost. I doubt that this patient was aware of the value of what she had been hoarding.

Human nature is such that when no value is attributed to something people take it for granted - when something is free, people behave more irresponsibly.

We're so lucky to have a system that allows free medicines - and long may it continue - but I'm told by colleagues in countries where people have to pay for medicines that they don't see this sort of waste.

'Luxuries?'

The debate on prescription charges will continue but, in the meantime, we need to take a different approach and make individuals aware of exactly how much their medicines cost.

Telling people that saving £300m could pay for 80,906 hip operations is water off a duck's back - the amount is too huge for most people to comprehend and a hip op is something many can't relate to.

Pharmacies could print some extra wording on medicines labels. Something like:

"This box of medicine costs the NHS £XX. Please look after YOUR NHS: don't keep more than two months' worth of medicines."

And perhaps pharmacists should be saying things like: "These tablets need to be taken every day for you to get the best from them. And, just so you know, each box is worth £28".

Will it work? Here is what was in the bin-bag -

Imagine it sitting in your home. 

Now picture, instead, the latest 17in, 2.4GHz MacBook Pro, or a Cartier Love ring in pink gold and diamonds, or tickets for a week on Paradise Island in the Bahamas.

Some might class these items as luxuries so let me put it in perspective: we're talking half a years' worth of food and alcohol for the average family of four.

Would you want to hand any of these to your pharmacist for incineration?

We can only truly have "no decision about me without me" in the NHS if people are fully informed. And that includes telling them how much their medicines cost.

http://www.bbc.co.uk/news/health-16962465

BBC Cancer Resource

One in three people will be affected by cancer at some stage in their life. We've more information on the most common types affecting people in the UK along with the general treatment, diagnosis process and care you'll receive if you're diagnosed.

 

 

 Treating cancer

The diagnosis, treatment and care available will be different with each individual case, but we've a general outline of some of the stages you may go through and things you should consider.

• What is cancer? - cancers harm the body’s health in a number of ways
• Cancer screening - the most common screening programmes available in the UK
• Smear tests - regular testing for cervical cancer is essential for all women
• Tests to diagnose cancer - find out what's involved when testing for cancer
• Chemotherapy - explaining this common treatment for cancer
• Radiotherapy - treating and managing cancer through radiation
• Cancer surgery - the most frequently used and successful cancer treatment
• Drug trials for cancer - the positive and negative points of taking part
• Who's who in cancer treatment - the different professionals involved
• Cancer recovery - understanding what cancer recovery can involve

 

Types of cancer

The most common types of cancer, their potential causes, main symptoms and possible treatments.

• Bladder cancer - signs of this common cancer can be spotted at an early stage
• Bone cancer - most cases are caused by a primary cancer elsewhere in the body
• Bowel cancer - with early diagnosis bowel cancer is one of the most treatable
• Brain cancer - treatments depend on the type and location of the tumour
• Breast cancer - the most common form of cancer in women in the UK
• Breast cancer in men - this condition affects men too
• Cervical cancer - regular smear tests can detect the early stages
• Colorectal cancer - with early diagnosis bowel cancer is one of the most treatable
• Endometrial cancer - cancer of the womb rarely occurs before the menopause
• Kidney cancer - blood in the urine is an early symptom
• Laryngeal cancer - cancer of the larynx commonly develops on the vocal chords
• Leukaemia - a term used to describe a number of cancers of the blood cells
• Lung cancer - nine out of ten cases in the UK are caused by smoking
• Childhood lymphoma - this disease attacks the system that helps the body fight infection
• Adult lymphoma - what is a lymphoma and how is it treated?
• Multiple myeloma - a cancer of the bone marrow
• Oesophageal cancer - signs and symptoms of this cancer are often related to swallowing food
• Oral cancer - cases are on the increase, particularly among people under 40
• Ovarian cancer - this cancer is difficult to diagnose, but there are symptoms
• Pancreatic cancer - has few signs or symptoms
• Prostate cancer - a healthy, low-fat diet may help prevent prostate cancer
• Retinoblastoma - a malignant tumour that develops at the back of the eye
• Skin cancer - most types of skin cancer are easily avoided
• Stomach cancer - it's more common in men, particularly in late middle age
• Testicular cancer - self-examination is key to early diagnosis and treatment
• Vulval cancer - is most common in women over the age of 50
• Womb cancer - the majority of cases, if caught early, are successfully treated by surgery

 

Cancer care and support

Discovering you've got cancer can be devastating. We've got practical advice about the support you might be entitled to and the organisations who are there to help you cope.

• Dealing with a cancer diagnosis - finding the way forward after diagnosis
• Dealing with a terminal cancer diagnosis - coming to terms with such a difficult situation
• Cancer support groups - the help and advice support groups can give you
• Cancer and your rights - find out about your rights
• Financial help for people with cancer - the benefits you may be entitled to
• Supporting someone with cancer - how to support someone with cancer
• Physical health care for cancer - the professionals who can help with your cancer care
• Emotional support for cancer - where to go to get the support you might need

 

Cancer - useful contacts

Find details of organisations who can provide further information or support.

Go to Cancer - useful contacts

 

 

See also

• Cancer: useful contacts
• Treating cancer
• Radiotherapy
• Chemotherapy
• Financial help for people with cancer
• Cancer and your rights
• Supporting someone with cancer
• Physical health care for cancer
• Emotional support for cancer

 

Around the BBC

• News: Beta blockers 'may halt cancer'
• News: Warning of cancer cost 'crisis'
• News: Cancer spreads with sharp elbows
• News: Cancer patients 'must exercise'
• News: Being tall 'raises cancer risk'
• News: Cancer rate rising in middle-aged
• News: Four in ten get cancer - charity
• Science & Nature: The body

 

Elsewhere on the web

• Cancerbackup
• Cancer Research UK
• Macmillan Cancer Support

http://www.bbc.co.uk/health/physical_health/conditions/in_depth/cancer/index.shtml

India no longer polio endemic says WHO

27 February 2012 Last updated at 14:46 GMT

Fergus Walsh Medical correspondent

• More from Fergus

27 February 2012 Last updated at 14:46 GMT

Article written by Fergus Walsh Medical correspondent

• More from Fergus
• Follow Fergus on Twitter

India has not had a polio case for more than a year due to effective immunisation campaigns

 

India has been officially removed from the list of polio endemic countries. The announcement was made in Delhi at a polio summit. It was a decision that was widely trailed in my coverage of polio from India last week and confirms the remarkable achievement the country has had in tackling the disease.

The Prime Minister of India, Dr Manmohan Singh said "It is a matter of satisfaction that we have completed one year without any single new case of polio being reported from anywhere in the country. This gives us hope that we can finally eradicate polio not only from India but from the face of the entire mother earth. The success of our efforts shows that teamwork pays".

India will need to go another two years without a case of the disease before it is formally regarded as polio-free. It leaves three countries - Pakistan, Afghanistan and Nigeria as polio endemic - which means the virus is circulating freely and transmission of the disease has never been stopped.

Chad, DR Congo and Angola have also had cases of polio this year.

A group of international experts who are monitoring the efforts to eradicate polio have said the plan to stop global transmission by the end of 2012 remains "far off track". The team, headed by Sir Liam Donaldson, England's former Chief Medical Officer, has painted a stark picture of what will happen if eradication is not achieved soon. The Independent Monitoring Board, in its latest report says: "An annual expenditure exceeding one billion US dollars is currently containing polio cases at low levels. If the eradication effort does not succeed soon, this funding will dry up. Country workers risk becoming increasingly fatigued. Failure would unleash the virus, paralyzing hundreds of thousands of children. This prospect seems unthinkable."

The report says the quality of the immunisation programme is too variable and says the people who carry it out are often overlooked. The report concludes: "Too many of these workers are underrated, rarely thanked, frequently criticised, often under-paid, poorly motivated, and weakly-skilled. Being an excellent vaccinator means being well-organised, a good communicator, and having the tenacity to track down every last child."

One issue that will have to be resolved is when to stop using the oral polio vaccine and switch to the injectable version. This is because the oral vaccine contains a weakened live form of the polio virus and this can, in rare cases, mutate sufficiently so that it can spread in the community, triggering outbreaks. This is known as circulating vaccine-derived poliovirus (cVDPV).

Most developed countries switched to the injectable, inactivated polio vaccine (IPV) some years ago. Unlike the oral vaccine this contains an inactivated or killed version of the virus.

But any risk from the oral vaccine is tiny compared to the wild virus. The WHO says that 10 billion doses of oral polio vaccine have been given to more than 2.5 billion children in the past decade. It estimates this has prevented at least 3.5 million polio cases. In the same period there have been 18 outbreaks of cVDPV resulting in 510 cases.

Although the type 2 wild polio virus has been eradicated, Nigeria has seen outbreaks of type 2 cVDPV. Dr Bruce Aylward Director of Global Polio Eradication Initiative said: "If these vaccine-derived strains are not dealt with they can spread and cause paralysis like the wild virus. But they can be stopped in their tracks by immunisation."

The entire world would need to be polio-free for three years before the disease could be regarded as eradicated.

http://www.bbc.co.uk/news/health-17178226