The liver is the largest organ in the body, Gallstones

The liver is the largest organ in the body, Gallstones

Gallstones; raised liver enzymes

The liver is the largest organ in the body, and one of the most important.  It has many vital functions relating to the blood, and others relating to the digestion, absorption and storage of nutrients.  The gall – bladder nestles below the liver and supports it in the digestion of far: it acts as a reservoir for bile, the fat – digesting fluid produced by the liver.  The gall – bladder stores the bile until it is discharged during digestion into the duodenum, the first part of the intestine.  The majority of people don’t realize they have a gall-bladder until they are hit with the excruciating pain that accompanies gallstones and inflammation of the gall bladder.  It has been estimated that ten per cent of the Western population suffer from gallstones.  Gallstones are pebble – like balls of cholesterol – rich crystals which form within the gall bladder.

There may be one walnut – sized gallstone or hundreds of them, smaller than grains of rice.  Problems occur when they block the route of the bile to the intestine and irritate the lining of the gall-bladder, causing it to become inflamed (cholecystitis).  If the bile’s exit is blocked, its yellowish pigment will be returned to the blood via the liver, and the body can become jaundiced (the skin and whites of the eyes turn yellowy orange).  Jaundice requires medical investigation and treatment, along with specific dietary advice from your doctor.  Since the major function of bile is to help the body digest fat, the lack of bile causes fat malabsorption, which leads to other symptoms bloating, nausea, diarrhea and steatorrhea (fatty. Smelly stools) Nutritionally, the best way to prevent and treat gall – Bladder disease is to make sure that you eat plenty of high fiber foods, as these help your body rid itself of unwanted fat.  Having said this, some people seem to have a genetic predisposition to developing gallstones, however healthy and well balanced their diet is.

 Prevention of gallstones

Understanding your nutritional needs explains the elements of a balanced, healthy diet.  The general principles apply to anyone who wants to maintain good health

and prevent disease. While high fat, low fiber diets have been linked with the formation of gallstones, there is little evidence to say that you need to avoid fat completely.  You need a certain amount of fatty provide and metabolize nutrients within your body.  However, many people in Western society eat far too much fat.  If you eat a lot of fried foods, takeaways, high fat snacks such as crisps and chocolate, butter and cheese.  I suggest you think seriously about your eating habits.  Take things gradually: grill or bake rather than fry, plan a big healthy salad instead of a takeaway, make crisps and chocolate an occasional treat rather than an everyday snack.

Many people would also benefit from boosting their fiber intake.  Fruits and vegetables, beans and lentils, wholegrain cereals, bread and rice should all feature in your daily or weekly eating plan.  Make sure you drink plenty of water to help the fiber work efficiently in your body.  Some studies have suggested that coffee and tea can reduce the production of gallstones, but do not take this to mean that copious consumption will dissolve the stones, it will not.  The disadvantages of excessive tea and coffee drinking far outweigh the benefits, so enjoy two to three cups a day, but no more.

Dealing with gall – bladder problems

Managing gall – bladder disease is all about discovering which foods upset you and which foods you can tolerate.  To investigate how different foods affect your symptoms, try keeping a food diary: for a couple of weeks.  Some people think that fat will upset them, but when they keep a note of everything, they eat they find that there is no correlation between fat and their symptoms.  The reason why fat can cause pain and nausea is that the presence of fat in the stomach stimulates the gall – bladder to contract and release bile.  If there are stones in the gall – bladder or the gall – bladder ducts are inflamed, this contraction can bring about pain.

Many patients diagnosed with gall-bladder problems think they need to shop for low fat products.  I do not generally recommend these because they don’t really contribute to a healthy diet: they can be very high in sugar, artificial additives and preservatives, and the taste often leaves a lot to be desired.  It is much better for you to stick to natural fats like olive oil and butter, but cut down on the amount you use.

The gall-bladder does not react any differently to saturated fats (found mainly in meat, butter and other dairy products) and unsaturated fats (found in vegetable fats such as olive oil, and in oily fish).  However, if you have a raised cholesterol level consider choosing olive oil rather than butter.  Women with gallstones need to be particularly careful when cutting out dairy products, because these provide such a significant amount of calcium.  Calcium is vital for maintaining healthy bones, and lack of it can increase the risk of osteoporosis, a common condition in women after menopause.  Younger women should be aware that they need to maintain bone density throughout their lives.

The best way to approach this and prevent gall – bladder discomfort is to avoid having large lumps of cheese or glasses of full cream milk on an empty stomach. Instead, incorporate small amounts of dairy products – semi – skimmed or skimmed milk, yoghurt, cheese – within meals.  these foods.  It is usually the large load of fat that causes problems.  Instead, stagger your intake of fat throughout the day, and combine it with high fiber foods, for instance having butter on whole meal bread or a light vinaigrette dressing on salads.  People sometimes forget that if you eat a lot the stomach may swell and press against the inflamed gall bladder and cause pain.

It may be nothing to do with the fat content of your meal, but simply the sheer volume of food in your stomach.  Small meals are often the best eating style, as this not only limits the pressure on the gall-bladder, it also allows the body to digest the food most efficiently.  Of course, if you are carrying excess body weight, a gall – bladder problem may be the spur you need to lose weight by reducing the amount of fat and other concentrated sources of calories in your diet.  But as with all weight loss programs it is best to lose weight gradually and to find an eating style which doesn’t make you feel deprived (see Achieving your ideal weight).

The majority of my patients with gall-bladder problems find that, if they increase their intake of high fiber foods, this has a cushioning effect which stops the fat within the meal setting off any pain.  Some patients notice that certain high fiber foods such as cauliflower and broccoli have a tendency to produce wind and bloating, which can set their gall-bladder pain off.  This is nothing to do with the fat content of the diet.  In this instance I suggest experimenting with different types of high fiber foods, drinking plenty of water and protecting the healthy bacteria in your gut. Some people find that excess tea and coffee can cause bloating, which can trigger pain, so limit yourself to two or three.  cups a day.

Removal of the gall – bladder

in the past the majority of people with gallstones had to have surgery to remove the gall – bladder, but now there are simpler, non – invasive treatments which can either dissolve the gallstones or smash them up with ultrasound.  The symptoms usually disappear almost immediately, although the gall bladder may remain inflamed for a few days after the procedure.  Some patients come to me having been told by their surgeon to lose excess weight before they can have the operation to remove the gall-bladder.  It is tempting to go on a crash diet to lose the weight so you can be relieved of the pain, but it is better to try to lose it gradually by adjusting you’re eating habits.  so that it stays off after the operation.

You should be able to lose weight while managing your symptoms by adopting a higher fiber, lower fat diet, so that the overall efficiency of your treatment is good.  If you have your gall – bladder removed, you will need to address the fat content of your diet if you are to remain symptom – free.  There is no reason why Your body cannot digest fat, as it is the liver that produces the bile, not the gall bladder.  So, when you have your gall – bladder removed the liver will still produce bile, but your body won’t have a reservoir on which it can draw if you have a fatty meal.  Most people find that keeping their intake of fat at a healthy level helps their digestive system to cope.

Try to have small amounts of fat regularly, taken with high fiber foods, such as a slice of cheese on whole meal bread with a bunch of grapes, rather than gorging on a plate of cheese on its own.  This eating pattern will enable your liver to judge how much bile to produce.  Don’t go for long, relatively fat – free periods and then expect your liver to produce a large amount of bile to digest a fatty meal, as the liver takes time to respond.  People who have the stone dissolved or smashed by ultrasound shouldn’t have any further problems digesting fat, but I suggest you keep a food diary for a few weeks to check your overall nutritional balance.

Raised liver enzymes

Routine blood tests can occasionally show raised liver enzymes.  The presence of abnormally raised enzymes in the blood suggests that the liver is working at a reduced capacity.  This can occur for many reasons and your doctor will need to investigate further.  The most common causes are infections such as those caused by the hepatitis virus (hepatitis A, B or C), or the side effects of certain drugs.  In some cases, a cancerous tumor will produce significantly higher enzyme levels.  Often there is no underlying cause for the raised enzymes other than that the liver is not coping with your eating and drinking habits.

In these cases, raised liver enzymes are a warning that you need to take your body seriously and start looking after it.  Your doctor will be able to tell whether the Gamma GT level is raised, which usually suggests that you are drinking too much alcohol.  However, some livers are just more sensitive than others.  There are people who, despite leading a healthy lifestyle, always show raised liver enzymes.  This may happen because of an earlier illness or as an unexplainable phenomenon, which many doctors don’t worry about unless the levels change significantly.

If you have been diagnosed as having raised liver enzyme levels and your doctor reassures you that all you need to do is start looking after your liver there are several nutritional issues you can address which will allow your liver to recover and stay healthy.  This is definitely in your best interest, as liver failure is one of the most debilitating illnesses.

DISCUSS ALL MEDICATION WITH YOUR GP

Remember that everything you put into your body is metabolized by the liver.  This includes nutritional supplements and homeopathic remedies, so don’t take any medication, whether wholly natural or over-the-counter drugs, unless you have discussed them with your GP.  It is important not to overload your liver with substances, be they food or drugs, that might compound the problem.

TAKE YOUR DOCTOR’S ADVICE ABOUT ALCOHOL

Your doctor may suggest that you abstain from alcohol until your liver enzymes return to normal.  There are plenty of alcohol – free drinks, such as sparkling and fruit – flavored waters, elderflower cordials, apple, cranberry and other fruit juices, that are quite delicious.  Remember that you are saving your liver.  In other circumstances you may simply be advised to cut down your alcohol intake.  Many people find that spirits – whiskey, brandy gin, vodka – hit the liver harder than wines, probably due to their high alcohol content.

I advise that you stick to wine and don’t drink on an empty stomach, as this causes a rush of alcohol into your system, which your liver has to work overtime to deal with Drinking a small amount of wine with food is the best plan.  Beware of dessert wines such as Sauternes and Taraji, as these tend to be hard on the liver.  Beers seem to be reasonably well tolerated, their main drawback being that you tend to drink them without food, which can cause your liver to complain.

CUT DOWN ON CAFFEINE

caffeine irritates the liver, so cutting down on caffeine – containing drinks – tea, coffee, cola, hot chocolate – to no more than two cups a day will help your liver recover more quickly.

BE FOOD WISE If

you have raised liver enzymes but no other medical problem such as hepatitis, a well-balanced, healthy diet, as discussed in the chapter on Understanding your nutritional needs, will enable your liver to recover as quickly as possible.  There is one area to which you should pay particular attention: fats.  Fat is one of the hardest foods for the body to break down and metabolize, and it is often even more difficult for people with raised liver enzymes.

They may suffer from indigestion, bloating, wind and a general feeling of heaviness when they eat fatty foods.  It is therefore best to avoid fried foods, cream, butter – rich pastries and large pieces of cheese on their own.  Keep food simple.  Chargrilled fish, roast lean meats, steamed, baked or roasted vegetables can all be flavored with herbs for plenty of variety: they don’t need to be cooked with lashings of oil, butter or cream.

Eat pasta with a tomato sauce rather than a creamy one, look to desserts based on fresh fruits.  If your body weight is on the low side and you are worried about cutting such a rich source of calories out of your diet, step up your intake of starchy foods (carbohydrates) such as pasta, rice, potatoes and bread, as well as pulses and lean proteins, to give your body the energy it needs.  Some people with raised liver enzymes get indigestion from certain foods such as bread or pasta.

If you suspect a particular food, keep a diary of your food, drink and symptoms If one item seems to be responsible, avoid it for a week or two, replacing it with an equally nutritious food, and see if there is any difference. I suggest you also read the Managing allergies.

Arthritis and Gout, arthritis means inflammation of a joint

Arthritis and Gout, arthritis means inflammation of a joint

Arthritis and gout

While heart disease and cancer are the biggest killers in the Western world, arthritis remains a major cause of disability. The term arthritis means inflammation of a joint. Painful, swollen, contorted joints can be a severe handicap, especially when these are the joints of the hand or wrist. Arthritis is not confined to the elderly , there are several types that affect people of all ages , from the juvenile arthritis known as Still’s disease , sometimes found in babies just a few months old , to ankylosing spondylitis , osteoarthritis , psoriatic , rheumatoid and crystal arthritis , also known as gout , which often begins when men are between forty and fifty Correct nutrition can bring tremendous relief to many arthritis sufferers , but it must be undertaken with care , as the different types of arthritis require different nutritional manage mint . It will also take time – anything from a few days to weeks – to calm your body down from any food – related inflammation, and you should allow a couple of months to glean the full benefit from the foods you eat.

You may be used to seeing quicker results from medication, but keep reminding yourself that in the long run your whole body will benefit. Of course, some people cannot cope without medication, but the side effects of some of the powerful drugs used to treat arthritis range from chronic loss of appetite and mild indigestion to more serious gastric or intestinal irritation, even bleeding and subsequent anemia. In this chapter I shall concentrate on rheumatoid arthritis, osteoarthritis and gout, as these are most common in Western society, but will begin with some general advice. The guidelines are much the same as for any healthy person: they play an important role in both the treatment of arthritis and the prevention of complications.

First of all, follow a healthy eating plan. By this I mean that you should eat as wide a variety as possible of fresh foods: vegetables and pulses, fruit, cereal products (bread, rice, pasta etc.) dairy products, eggs, fish, poultry, meat. Vitamin and mineral intakes in arthritis sufferers are often low. This is partly because it can be difficult to shop. cook and care for yourself, and there may be days when you don’t feel like eating much. Medication also has a number of side effects: some drugs take your appetite away or make you crave sweet foods, which don’t tend to be high in vitamins and minerals.

Others interfere with the metabolism of vitamins and minerals, or increase the amount of protein, calcium and zinc the body excretes. Lack of these essential nutrients can cause your body to become more susceptible to colds, infections and other health problems. You should have small meals at least three times a day, rather than skipping meals or having one large, blow – out meal, especially late at night. A regular eating pattern will give your body a steady intake of nutrients.

Water is necessary to keep your body functioning efficiently and enable it to glean nutrients from the food you eat. Aim to drink two and a half liters / four to five pints a day. The following points apply to most arthritis sufferers:

• Keep your caffeine and tannin intakes low. Coffee, tea, hot chocolate and cola – based drinks contain caffeine and tannin, which inhibit the absorption of vitamins and minerals from the gut. Caffeine can also make the gut more sensitive to the irritating effects of anti – inflammatory medication and can increase fluid retention, both of which can cause disability and pain. Ideally keep your intake down to two or three cups a day. Try herb and fruit teas for caffeine – free alternatives.

Watch your weight. Excess weight puts stress on the joints, causing pain and discomfort. Remember it’s much easier to stop weight piling on than to try to lose it later. Unfortunately, it is very easy for arthritis sufferers to put on weight, especially if they are prescribed steroids to reduce the inflammatory process. The balance between calorie intake and expenditure goes against you when it is painful to move around and exercise. You also have to contend with the emotional aspect of being in pain and unable to do anything about it. We would all admit to comfort eating at times, and people with arthritis have more reason than most to turn to food for solace. When you are in pain it is tempting to grab something quick and easy – there are plenty of healthy foods which fit this description.

• Try to keep organized. Most people with arthritis go through good and not so – good periods. Use the periods when you are feeling better to stock up your cupboards and fridge and cook meals which can be frozen in small portions, so that when your joints are extra painful you have plenty of healthy food to. fall back on.

• Any doctor or physiotherapist will agree on the merits of regular exercise. It is important to keep your joints moving, so that in the long run they will be more flexible and less painful and disabling. You need to include stretching and strengthening exercises as well as cardiovascular aerobic exercises. There is a fine balance to achieve, though while you need to exercise the joints, you also need to give them time to recover and rest. If they are particularly inflamed and sore, see if things get better with a day or two’s rest. Once things improve, build up gradually with some exercise.

• Feeling tense, stressed or guilty about resting are arthritis – aggravating emotions. To help you relax, consider aromatherapy oils, such as comfrey. lavender, enroll, votive and benzoin. Comfrey is particularly good at reducing inflammation. These oils can be used in a burner, dropped into your bath, or diluted in a carrier oil (such as grapeseed) and used in massage. It needn’t be a whole-body massage; a foot, hand or back massage can relieve an affected area.

• If you suspect that your arthritis is aggravated by additives and preservatives, I suggest you avoid ready – made, convenience and fast foods for a couple of weeks instead eating simply cooked fresh foods. Replace your chilled or frozen ready to cook dinners with pieces of chicken or fish which are just as easy to pop in the oven or under the grill. Instead of sweets or a bar of chocolate, treat yourself to some grapes, strawberries or other seasonal fruit. Taking this one step further many of my patients feel much better when they eat organic produce and hence reduce their exposure to pesticides and other artificial food additives.

• Take your anti – inflammatory and painkillers with or after food. Many of the anti – inflammatory are particularly fierce on the stomach and intestine, taking them with food helps to minimize gastrointestinal discomfort. However, there are alternative ways of administering pain – relieving drugs, including suppositories, so discuss these options with your doctor.

Rheumatoid arthritis

Rheumatoid arthritis usually starts with swelling, pain or stiffness in the joints, especially the wrists, hands and feet, which is usually worse in the morning. With time the body becomes more and more riddled with pain. In the severest of cases the body can become so disabled that it picks up lung infections easily which can lead to breathing problems and even pneumonia.

The skin. liver and kidneys can also be badly affected. Rheumatoid arthritis plagues many elderly people to the extent that they become physically dependent on others, and this loss of independence, when their mind is still active, puts a strain on their relationships. In this situation food can be very empowering, choosing what to eat and how to manage your meals can have a positive effect on your life. You are making the decisions, instead of relying on doctors and careers.

Diet is very important in the treatment of rheumatoid arthritis. In addition to the good eating habits outlined above there are several modifications which help some people reduce their symptoms:

• People with rheumatoid arthritis frequently find that a diet rich in oily fish significantly reduces inflammation and pain. Oily fish, such as mackerel. salmon, herrings and kippers, tuna, sardines and anchovies, are rich sources of omega 3 fatty acids. These fatty acids have a range of benefits, besides reducing inflammation they have been shown to protect against thrombosis and strengthen the immune system. Some people find oily fish a little heavy on the palate and digestion.

The traditional way to cut the oiliness is to marry the fish with a sharp fresh flavor a wedge of lemon or lime, ginger, horseradish, or a tangy fruit sauce such as gooseberry or rhubarb. Eating some fiber, such as whole meal bread or a portion of spinach, can help your body deal with the fat, my patients seem to experience maximum benefit when they take these fatty acids in food, but if you really dislike oily fish you could take a supplement The optimum dosage would be 600 mg omega 3 fatty acid a day, check that your supplement has this level of omega 3 oil and not just any fish oil.

• If you are a vegetarian and cannot eat fish oils, evening primrose oil has a similar beneficial effect. It contains gamma linoleic acid (GLA), an omega 6 fatty acid which, like the omega 3 fatty acids, seems to reduce the inflammation process. The current recommended dosage of evening primrose oil is 2000-4000 mg a day, usually taken in 500 mg tablets. There does not appear to be any equivalent dietary source of GLA.

• One important point to remember when you are boosting your intake of omega 3 or omega 6 fatty acids is that you need to keep your animal fat intake low as part of a healthy eating plan. If you eat too much animal fat, such as butter, cream cheese and fatty meat, the omega 3 fatty acids and GLA cannot work effectively, and therefore their potential healing power is lost. Many people are swallowing tablets with no chance of success.

• People suffering from rheumatoid arthritis may be the exceptions to my general advice that everyone should eat the equivalent of a daily small pot of yoghurt containing bifid us and acidophilus (bacteria that are beneficial to the digestive system). Sometimes these cultures can cause your symptoms to flare up. I suggest that you keep a food and symptom diary for a few weeks. Take a couple of spoonsful of a yoghurt containing these cultures regularly, then avoid yoghurt for a few days, and note how your body responds. If you can tolerate them, they will help your overall health. Yoghurts containing lactobacillus cultures should not upset you.

Copper, zinc and nicotinamide supplements are sometimes advocated. Without further medical research, I wouldn’t recommend taking any tablets containing these ingredients. A copper wrist band is a traditional arthritis remedy that cannot do any harm, so if you feel it helps, by all means wear one. It may be that a small amount of copper which seeps through the skin in some way reduces the inflammatory response.

FOOD INTOLERANCE

When you are in pain, it is tempting to try anything that might help, and you will hear of lots of remedies, many of them involving exclusion diets: no red meat or no citrus fruit for example. Before you cut anything out, take the time to ensure that your diet is well balanced, sometimes it is what you are not eating that can aggravate symptoms. It would be a pity to worry about avoiding foods if all you need to do is eat a healthy diet.

I suggest you keep a food diary to help you explore the relationship between food and your symptoms. Scientists disagree as to whether food intolerances have any role in the cause and hence treatment of rheumatoid arthritis. While not scientifically supported. some specific dietary modifications can make you feel better.

There are those that suggest excluding all meat, eating no cooked foods or grains, no citrus fruits, or drinking whole milk before meals, the respective theories being that meat (or wheat) causes arthritis, raw vegetables cleanse the body, citrus fruits create too much acid, milk helps to lubricate the joints. While these theories are not proven, it may be the case that the altered intake of nutrients beneficially affects the immune system, or the changes cause you to shed some excess weight.

Even if it’s just the placebo effect (. e. if you believe that the diet is helping the power of your mind helps you feel less pain and stiffness), it is always important to feel that you are doing something to help yourself. In order for any food therapy to help rather than hinder your body, it needs to be carefully executed.

A patient of mine was advised by a so – called nutritionist to cut out wheat, dairy products, meat, fish and of all things water from his diet. Without these sources of essential nutrients his body weight dropped dangerously low and he became seriously weak. While the severity of this outcome is extreme, there are thousands of people eating inappropriately in the hope of curing their arthritis symptoms.

If you decide to explore food intolerances you should go about it in a controlled manner, keeping detailed notes of your food and symptoms. Sometimes it is simply a matter of quantity: your body may be able to take a small amount of a specific food, but develops symptoms when you overstep the mark. Try reducing the quantity of a suspected food and see how your body responds. For instance, if you suspect wheat, have just one meal based on wheat (bread, pasta) in a day.

I suggest you allow a couple of weeks before you reach any conclusions, as the body needs a while to show any changes. Some people need to eliminate the food completely to experience any relief. In this case, it is important to replace the food with an alternative source of nutrients. For instance, if you cut out bread, get your carbohydrates from rice or potatoes. If you cut out dairy products you need to find another source of calcium if you cut out red meat you need another source of iron Food can be the most amazing healer, but finding the right foods for your body takes time and care.

ANAEMIA

Anemia is one of the most common secondary conditions affecting people who suffer from rheumatoid arthritis. This may arise as a result of a poor dietary intake of iron, folic acid or vitamin C. Those following exclusion diets can easily miss out on essential nutrients. Additionally, many of the anti – inflammatory and strong painkilling drugs interfere with the metabolism of vitamins and minerals, in particular the B group of vitamins, folic acid, vitamin C and vitamin E. Anemia can also result from gastrointestinal bleeding, which can occur when you take a lot of non – steroidal painkillers.

You can reduce the likelihood of intestinal bleeding by eating something before taking painkillers. If you are feeling continually tired you should see your GP to ascertain the cause. If it is anemia, there is a lot you can do to help yourself.

Osteoarthritis

Osteoarthritis is a degenerative condition which is more common as you get older – although I have patients as young as ten years old. Osteoarthritis develops as the cartilage around the joints – especially weight – bearing joints such as hips and knees – wears away and new bone material grows beneath the worn cartilage. With the growth of bone tissue, the joint cannot move as smoothly as it is meant to and inflammation occurs. The joints become distorted, which leads to further pain, as muscles are strained and nerves get trapped.

CAN FOOD HELP?

Unlike rheumatoid arthritis, there is no special diet which greatly affects the progression and symptoms of osteoarthritis. However, some of my patients experience relief when they increase their intake of fish oils or evening primrose oil. A copper bracelet also seems to help some people. One unusual ingredient that is currently being investigated is the green – lipped mussel from New Zealand; results are suggesting that it may be able to relieve osteoarthritis.

EXCESS WEIGHT

The issue of weight is particularly relevant with this form of arthritis, since it commonly affects ‘ load – bearing joints such as the knee and hip; if you are carrying excess weight you will place an enormous strain on these joints. Many surgeons advise that patients who need surgery to replace joints should reduce their body weight before undergoing surgery. Losing excess weight increases the success rate of the operation both short and long term. However, as I constantly reiterate, crash diets are not the answer; their effect is only temporary – the weight will soon come back, which will not help your new joint. You can continue to enjoy your food and still lose weight by approaching it sensibly. Read Achieving your ideal weight.

DON’T SUFFER UNNECESSARILY

Your physiotherapist and / or occupational therapist can help make your life easier to manage. Ask for advice about exercises and modified or specially designed household utensils and machines. Some patients don’t like to make a fuss, but if you are suffering pain, don’t be afraid to ask your doctor to review your medication. There are so many different types of painkilling drugs that there should be one that can relieve you of the majority of pain and discomfort.

Some patients find that a change of temperature can reduce the pain. Experiment with heat and cold: hot water bottles, warm baths, ice packs for a bag of frozen peas) on the joints. You can also get special sound wave machines. called TENS machines, which help your body to produce natural painkilling substances. Ask your doctor or physiotherapist about these.

  Gout

Gout, according to a friend of mine, is excruciatingly painful. ‘ It’s as if someone is ramming a huge hot needle into your toe! ‘ It generally affects men of middle age and older, although this particular friend is in his thirties, and women are not immune Gout has traditionally been labelled as the disease of the heavy drinker and the rich but not all sufferers fall into these categories. The cause is usually genetic, but occasionally gout is a side effect of certain diuretics.

Gout arises when crystals of uric acid deposit in the joints, causing them to become swollen and inflamed. It is most common in the toes, but also affects other joints. Gout is also known as crystal arthritis or hyperuricemia.

Drug therapy using Allopurinol has largely replaced the need for dietary restriction in the treatment of gout, but as a second line of defense many men choose to restrict their intake of purines, the main dietary ingredient that causes the formation of uric acid crystals. Bear in mind that if you suffer an attack of gout it usually takes about five days for the body to rid itself of the dietary sources of uric acid. You should ensure you are drinking enough water to help your body excrete unwanted substances.

PURINES

Many men think that they need to avoid all types of red meat. This is not totally necessary: the richest sources of purines are game, offal and meat extracts (for example Oxo), and of course products made from them such as pâtés, sausages and pies. If you want to make gravy or soups, I suggest you use fresh stock rather than meat stock cubes. Meat such as beef, lamb and pork, as well as poultry is lower in purines.

Some fish are rather rich in purines: anchovies, herring, mackerel, sardines, sprats and whitebait, as well as fish roes and shellfish such as crab and prawns. This leaves the whole range of white fish open for your enjoyment, from cod and plaice to turbot and Dover sole. Smoked and pickled fish and meat are also high in purines, as are other salty foods, dried fruits, dried beans, peas and asparagus.

While it is good to steer clear of these items, there is no need to avoid them altogether. Instead, I suggest you look out for them, and avoid too many purine sources in one day. For example, by all means enjoy asparagus when it is in season, but follow it with chicken or white fish.

WINE

Red wine is traditionally associated with gout, since it can produce uric acid. However, you do not need to exclude all red wine. It is usually a question of quantity, as some men can tolerate more red wine than others. Some people find the lighter Beaujolais – style wines suit them better than port, mature claret and burgundy. The best way of finding the wines you can drink without painful symptoms is to keep a food and drink diary

Anemia affects many people at some time in their lives

Anemia affects many people at some time in their lives

Anemia

Anemia affects many people at some time in their lives.it is most common in people who smoke, in women who have heavy periods, people who have an eating disorder such as anorexia, elderly people with poor appetites, people who suffer from intestinal bleeding and those with malabsorption conditions such as Crohn’s and coeliac disease. It is defined as a Reduction below the norm of the blood concentration of a protein called hemoglobin which enables the red blood cells to carry oxygen around the body.

There are many different sorts of anemia: Including folate deficiency and pernicious anemia but the most common form is iron deficiency anemia. It is believed to affect between fifteen and twenty per cent of women in their child bearing years and between six and nice per cent of elderly people. It is also becoming increasingly common in young children.

One of the reasons why the incidence of iron deficiency anemia is on the increase is that people are eating less red meat, which is one of the richest Sources of iron. Their motivations Are varied. Some people are frightened about the health risks associated with the consumption of red meat, such as the increased risk of heart disease and certain kinds of cancer. Some people find that eating red meat aggravates their irritable bowel symptoms, another condition that is becoming more prevalent Others are apprehensive about the risk of ‘mad cow disease or BSE, the way that meat is produced and the conditions in which animals are reared are also a growing concern the symptoms of anemia includes tiredness.

irritability, Loss of appetite. pallor and a general feeling of being run down Severe iron deficiency anemia can lead to breathlessness. headaches and an inability to complete even simple tasks. One of the most common causes of hair loss in women is lack of iron in their diet.

If you have any of these symptoms, it is wise to go to your doctor in order that he or she can check the cause it is important to establish which sort of anemia you have before you embark on any self-help programmed – don’t just diagnose yourself or your child. Irun deficiency anemia is relatively easy to correct through changing the foods you eat and your general lifestyle. but the other sorts of anemia are a little trickier Iron deficiency anemia can usually be attributed to one of four factors.

YOU HAVE AN INCREASED DEMAND FOR TRON

The body may at certain times start to require a little more iron than it previously needed. In childhood the body rapidly uses iron as it builds the body, which is why you need to make sure your child has an iron-rich diet. Your demand for iron is drastically increased during pregnancy and breastfeeding, when extra iron is needed to satisfy both the baby’s growth requirements and the blood loss you experience at childbirth The body also needs increased Iron if you are being physically active. for example, training for a serious athletic event, when your muscles, heart and lungs are pet under greater strain.

LOSS OF BLOOD

For many women this occurs when they are experiencing heavy or lengthy menstrual periods. Other causes include intestinal bleeding, such as a burst ulcer or piles. The strong anti-inflammatory drugs prescribed for conditions such as rheumatoid arthritis can erode areas of the stomach lining, which also causes internal bleeding.

FOODS AND DRINKS THAT INHIBIT THE ABSORPTION OF IRON

The chief culprits are tannins and caffeine, found chiefly in coffee, tea and cola based soft drinks, Chocolate contains oxalates which also inhibit iron absorption.

INSUFFICIENT VITAMIN C

Vitamin C helps your body absorb the iron within the food. If you lack vitamin C the iron will stay in the gut and won’t be absorbed. People who either don’t eat many fruits or vegetables that contain vitamin C or who smoke, are particularly susceptible to developing iron deficiency anemia People often make the mistake of boosting their iron intake but forgetting about vitamin C.

Dietary solutions

For the majority of people iron deficiency anemia is a question of negative iron and vitamin C balances, you retain less than you lose through menstruation or through internal bleeding or you fail to absorb efficiently the iron from your die These negative balances mean that you do not have enough iron to form sufficient hemoglobin to carry the oxygen needed for energy creation and tissue formation.

The usual response of people who are diagnosed anemic is to buy a supplement, but it is much healthier to look at your diet and explore the reasons why it has occurred, and work through the practical ways in which you can use foods to correct and prevent it from reappearing Supplements have their place, but only when other issues have been explored. It is important once you have embarked on an anemia correcting eating plan to keep in touch with your doctor.

ANAEMIA IN INFANCY

Babies born at full term have laid down stores of iron that will last them for four to six months. Pre – term babies, however, have not always had the chance to acquire sufficient stores of iron and because of this can easily become anemic. For this reason, pre term babies are usually given extra iron and folic acid and may in certain cases be given top – ups of fresh donor blood. Breast milk contains very little iron, so if you have not weaned your baby on to formula by the age of six months, it is important to talk to your doctor about the possibility of either iron supplements or providing sources of iron through baby’s first foods.

BOOST YOUR IRON INTAKE

There are two sorts of iron in food. Haim iron, found in animal foods such as lean red meat, liver and other offal, is easily absorbed by the body. Non – harem iron is derived mainly from non – animal foods, such as dark green vegetables (spinach, broccoli. Savoy cabbage, curly kale, watercress), pulses and nuts sources of iron). The exception to the animal link with harem iron is eggs, which are considered in the same way as vegetable sources. Non – harem iron foods contain substances that hinder the absorption of iron. meaning that your body cannot absorb the iron from these sources as efficiently as it can from foods containing harem iron. You therefore need to eat a lot more of them to derive sufficient iron.

As with all nutrients, iron relies on a healthy gut to absorb it. Some people with digestive problems such as irritable bowel syndrome, chronic constipation, Crohn’s disease or ulcerative colitis, can have slightly disrupted iron absorption. If you have a specific bowel problem see your dietitian or doctor for advice a change in your diet could trigger the condition to relapse.

Generally, however, to prevent or correct anemia I suggest you eat a rich source of iron two or three times a week. If you are not inspired by a chop or a steak. what about spaghetti bolognaise, beef Stroganoff grilled calves’ liver, lamb, venison and other game meats such as grouse and pheasant? These are all rich in iron. Pregnant women should avoid offal, as its vitamin A content is very high, which can lead to problems during pregnancy. Children may say they don’t like the texture of meat – it’s too chewy ‘ – but can be coaxed to eat it in lasagna, homemade hamburgers or shepherd’s pie. Meat dishes can be frozen. as long as you have begun with fresh meat, and not frozen.

In addition to red meat, you should eat plenty of non – harem sources of iron most days – a substantial portion of green leafy vegetables, or eggs, or a lentil. bean or nut – based main course. A surprising source of non – harem iron is black treacle, which can be deliciously made into parkin or ginger biscuits – perfect mid – afternoon iron boosts! Dried fruits such as apricots and figs also contain good levels of iron; include them in muesli for breakfast and fruit compotes for snacks and desserts. If you are a vegetarian or just don’t like red meat, it is essential that you eat some of these foods every day.

BOOST YOUR VITAMIN C INTAKE

In addition to looking at the iron content of foods, it is also important to address the vitamin C issue. You need to concentrate on having plenty of oranges, grape fruits, kiwi fruits, cranberries and other berries, and potatoes. Dark green leafy vegetables contain vitamin C as well as iron.

Aim to have a source of vitamin C with every meal, perhaps a glass of freshly squeezed juice or a fresh fruit salad to finish. (The only exception here is for people with high blood fat levels, who should wait until lunchtime before they drink fresh fruit juice, as fresh juice on an empty stomach in the morning can increase production of blood fats. If you cannot eat citrus fruits (perhaps because of an allergy) you should include some green vegetables with each of your main meals this could be in the form of a soup, a salad or a lightly cooked vegetable accompaniment.

Freshly squeezed juices are the best. Some cartons of drink labelled ‘ fresh will have very little vitamin C left by the time you drink them, because the vitamin C content diminishes with time. Others can be quite high in vitamin C because artificial vitamin C (ascorbic acid) is added. Although some fruit squashes contain added vitamin C, their sugar contents are so high that they can cause extreme mood swings, tooth decay and excess weight.

There is very little difference between the vitamin C content in raw versus cooked foods, as long as you don’t overcook them. Experiment with vegetables stir – fried, steamed, baked, or boiled for a very short time, so they retain a lot of their crisp texture. There can also be a lot of vitamin C in frozen and tinned fruits and vegetables, but organic or home – grown produce is the ideal.

CHOOSE ALCOHOLIC DRINKS WITH CARE

One of the great myths is that stout contains a lot of iron. A more accurate statement would be that it contains a small amount of iron, not enough to have magical, health – giving properties, and not enough to make you drink it if you don’t particularly like it. Champagne is relatively high in iron because of the limestone soil in the Champagne region of France. Wines grown in the lime stone areas of southern Britain are rich in iron for the same reasons. Some red wines are even higher in iron, containing virtually twenty times as much iron as champagne. I am not suggesting you down pints of champagne, but a glass or two of champagne or red wine can do wonders for your iron levels.

AVOID FOODS AND DRINKS THAT INHIBIT THE ABSORPTION OF IRON

The worst offenders are coffee, tea and cola – based drinks. Also remember that chocolate contains caffeine and other substances that hinder iron, so don’t over indulge, especially if you are feeling tired. A healthier energy boost would be a fruit shake, a bowl of fruit compote or a piece of fresh fruit. Keep your tea, coffee and cola drinks intake down to a maximum of two or three cups a day and allow at least one hour between drinking tea or coffee before or after meal. This elapse of time should allow your gut to absorb the iron from the food more efficiently Other hot drinks to try include herbal or fruit teas, mugs of warm milk, hot water with slices of lemon, or the drinks.

 KEEP THE BULK DOWN While

you are trying to boost your iron and vitamin C intakes, try to keep the amount of cereal fiber such as wholegrain cereals and wholegrain bread low. This is because oxalates and aphyllies, two substances that naturally occur within these high fiber foods, can inhibit the absorption of iron. This is especially important for growing children and people with small appetites, as the last thing you want is fill them up with fiber and stop their body from absorbing the iron, I don’t mean that you should cut fiber out completely, but try not to hide the red meat or vegetable source of iron in mounds of cereal fiber,

IRON SUPPLEMENTS

If you are unable to eat as much iron as you need, perhaps because your iron status is too low to be corrected by diet alone, you may need to take a supplement. I recommend that you discuss the issue with your doctor or dietitian. There are plenty of supplements on the market; some contain just iron; others contain iron with vitamin C and / or folate. It is generally a good idea to choose a supplement that incorporates vitamin C.

The majority of women should be fine on a supplement that provides 15 mg iron along with 500-1000 mg vitamin C: men need mg iron a day. Children need 7 mg a day up to the age of six, 9 mg a day until ten and then they join the adult requirement. Herbal iron supplements contain an easily absorbed source of iron. Some iron supplements can cause indigestion, diarrhea or constipation. Avoid taking them on an empty stomach as this can make the problem worse. If you experience any of these symptoms, use the information in the Digestion. If nothing seems to do the trick, ask your doctor or pharmacist about changing the supplement. Some supplements are better tolerated than others.

Lifestyle considerations

In order to help your body replenish its store of iron and produce healthy blood cells, it is also important to make changes in your day – to – day life. I commonly see people who receive a diagnosis of iron deficiency anemia, take an iron supplement and expect their body to recover overnight. It cannot happen this way. Your body needs time to recover, and I usually estimate three to four weeks to make any substantial improvements.

Get plenty of rest and try to reduce the amount of stress you are under. If your lifestyle normally demands a lot of physical exertion, you should try to cut this down. While a little gentle exercise helps keep the mood high and the heart going, strenuous exercise will make you feel lousy, because you won’t have sufficient oxygen to feed your muscles. If you have anemia, you need to slow down

What is diabetes? diabetes is easily managed

What is diabetes? diabetes is easily managed

Diabetes

Today diabetes mellitus. the most common form of diabetes is easily managed professional sports people cope, and even young children go about their day-to-day lives without any fuss lust question of understanding how your body can compensate for its inability to control blood sugar levels Experiences and lifestyle challenges differ, depending on age and the severity of diabetes. but the more normal you consider the situation the less over protective you are of your child or a diabetic partner, friend or relative, the more likely you all are to buy and healthy life.

What is diabetes?

Diabetes mellitus takes three forms distinguished by the treatment protocols. Some diabetes controls their diabetes simply by monitoring their diet others need cables to stimulate the body to produce more Insulin: some diabetics require insulin injections

The condition is characterized by an increased amount of sugar in the blood. This happens because there is a lack of insulin the hormone the body needs to process sugar effectively After you have eaten foods containing sugar, your blood sugar level rises, whereupon the pancreas releases insulin help the cells absorb and use the sugar the blood sugar level should then return to normal. With diabetes there is not enough insulin in the body to help the absorb the sugar. The sugar is present, but the body cannot use it.

This happens for two main reasons. In some people the pancreas is incapable of producing at insulin, as is most commonly found in children and young adults. In this case they need to have insulin injections This type of diabetes is called insulin-dependent diabetes mellitus IDDM) In other people the pancreas can produce some insulin, but not enough for the Body’s needs. This type. non-insulin-dependent diabetes mellitus is more common in older people, especially those who are overweight Either the pancreas gets tired for the cell particularly fat, cells, seem unable to take up the sugar.

Some diabetes in this category can control their blood sugar levels by losing excess weight fin particular, fat). as this takes the strain off the pancreas arid improves the body’s ability to utilize the small amounts of insulin produced. In some cases, the pancreas is capable but seems unable to produce the install when Who needed; it needs a kick start from tablets

Abnormally high quantities of sugar in the blood can cause potentially serious problems. In the long term, if the sugar levels continually run high state called hyperglycemia, several tissues in the body start to suffer, especially the eyes kidney and blood vessels leading to the arms and legs. But once the sugar level is corrected and controlled diabetics lead normal healthy lives One of the first symptoms noted by diabetes is an excessive, unquenchable thirst. often associated with frequent passing of urine most effective way for the body to get rid of excess sugar is by passing urine).

This can be coupled with fatigue, headaches and nausea: Children appear listless and tetchy. Some people feel unusually hungry, because even though your body has excess sugar in the blood it cannot utilize it without insulin Many people do not recognize the symptoms of diabetes and go to the doctor reporting a different complaint for example, men go to the GP believing they have a prostate problem, only to find that they are diabetic Other people are diagnosed as diabetic by accident, a routine blood test can reveal a raised blood sugar level.

Every year around 60,000 people in the UK are diagnosed with diabetes: 1,500 of these are children Some children are diagnosed at birth other develop diabetes a little later, or even in their late teens.

Treatment

Many factors determine the type of treatment that will be effective. It is usually the case that the younger you are where you develop diabetes, the more likely you are to need insulin Older people are often able to control their condition with a few adjustments to their diet and lifestyle.

Diabetics lives have changed profoundly over the past decade Tablets cat how stimulate the pancreas to produce more insulin, arid synthetic and animal Insulins have become so efficient that they can act both on a short- and long-term basis, which gives those of you who need insulin injections a greater flexibility with eating and lifestyle. Injections are now administered by pen like needles which are so fine they can be popped into the body through clothes making them almost fuss free Equally, gone are the days when it was almost a foregone conclusion that you would have to eat at set times, measure all carbohydrates,

and banish all sweet foods, including fruit, from your diet with young children it is sometimes necessary to measure foods to begin with a they can get an idea of how much food they need to take and at which times For others, It may be necessary to sick to same sort of schedule until the insulin and diet balance is achieved. Same doctors find that the best way to control a diabetic diet is to measure the blood sugar levels. However, not all diabetics need to do this, it is usually suggested only for insulin dependent diabetics and uncontrolled diabetics whom the doctors want to stabilize.

Tablet takers may be asked to monitor their blood sugar levels from time to by testing their urine for sugar. Insulin dependent diabetics are often encouraged to monitor their blood sugar level regularly by taking small samples of blood from a pinprick to the thumb Accurate and easily available devices offer precise blood sugar level measurements and so assist in making adjustments to the insulin or diet. This should always be overseen by your doctor and dietitian .

Diet and diabetes

In terms of what diabetes need to ear the principles are the same as for a non-diabetic person: a healthy, balanced diet that includes a regular intake of high fiber foods, plenty of water, some fresh vegetables and fruit some lean proteins and dairy products, and a small amount of fat The only differences are that you need to be extra diligent about balancing your diet with your medication, if you take it, and that you need to be more regular in your eating habits. While non- diabetic people can go for days before a bad diet catches up with them, diabetics don’t have this flexibility,

A diabetic diet is a healthy diet There are foods such as chocolate gateau in which you shouldn’t overindulge – Out neither should con diabetics. As long as you are aware of the elect the food will have on your body and act appropriately you should be able to enjoy birthday party, restaurant meals and all foodie occasions There is no need to include special diabetic product in a diabetic diet. Not. only do many of them taste very unlike their non-diabetic equivalents, they often contain unnecessary substances that have no part in a healthy diet.

For example, many diabetic products contain sugar substitutes such as sorbitol and mannitol which car have a laxative effect the calorie content is sometimes higher than the non-diabetic. normal equivalent, which can lead to weight gain the last thing you need. There are two major targets to achieve with your diet:

to achieve and maintain control of your blood sugar level

to regulate your body weight within the deal range the key points of a healthy diabetic eating plan are as follows.

HIGH FIBRE CARBOHYDRATES

Your body needs sugar for energy, and when you are diabetic, it’s a question of regulating the amount. The best way of maintaining a steady release of sugar into your blood is from high fiber carbohydrates, such as whole meal bread, whole-wheat und out cereals, brown rice, potatoes. The fire in these foods slows down the release of sugar into the blood. This makes it easier to keep the blood sugar level within the desirable range.

Try to keep to roughly the same amount of carbohydrate in each of your meal with the help of your doctor and dietitian, work out how much carbohydrates you need to maintain good blood sugar and energy levels and maintain your weight at a comfortable level. The majority of people will find they need toughly the same amount they would choose had they not been told they were diabetic.

The advantage of high fiber carbohydrates is their satiety value – they make you feel appropriately full and contented which can help you judge when you have eaten enough Don’t think that high fiber foods are all heavy dry and boring. These days you can buy delicious wholegrain and seeded breads with nuts, sun-dried tomatoes, herbs and spices.

Look for the dark German rye breads, or Irish whole meal soda breads Serve strawberries or poached pears with your porridge, or try homemade apricot muesli recipes for high fiber desserts.   Having said this, various groups of diabetics need to moderate their consumption of high fiber carbohydrates. For example, children – and diabetic people with other medical conditions such as cancer need a combination of high fiber and low fiber foods.

If they just eat high fiber carbohydrates, they may not receive enough energy and essential vitamins and minerals from their food. People with digestive complains such as irritable bowel syndrome or Crohn’s disease may have a problem balancing a diabetic high fiber diet with their other medical requirements Seek the advice of your doctor or dietitian If you need to include some lower fiber carbohydrate in your diet, you should regulate the portion size of the lower fiber carbohydrate and boost the fiber content of the meal with vegetables, pulses or fruits. There are no more calories or carbohydrates in white bread or rice than in the wholegrain versions, it’s just that they release their sugar into the bloodstream more quickly: you are aiming to slow down that release by including some non-corral fiber in the meal.

FRUIT AND VEGETABLES

As with any healthy diet, try to have live portions of fresh vegetables or fruits every day – not only does their fiber content help to regulate your blood sugar levels they are also high in health-giving vitamins and minerals Some people mistakenly believe that fruit is too high in sugar for diabetics to enjoy. Although fruits do contain some sugar, mainly fructose, the fiber within the fruit helps to slow down the release of the sugar and therefore poses few problems for diabetics.

It is good to get into the habit of having a portion after and in between meals, A portion would be a whole pear orange, apple, a large plum, half a paw (papaya), about ten grapes or fresh strawberries or rasp berries the water fruits such as pineapples, mangoes. Gallia or Charente’s melons, bananas and figs have a little more sugar than apples and oranges.

so, I would suggest that you just have one of these a day as well as puddings or toppings for breakfast cereals, serve melon or figs with Parma ham as a first course. or make fruit shakes strawberry and passion fruit or raspberry and orange are just two delicious ideas. Tinned or frozen fruits are fine, as long as they are stored in their natural juice rather than sugary syrups. Aim to have at least two helpings of vegetables during the day.

This could be a main course salad, a bowl of vegetable soup, or salad in your sandwich at lunchtime and then vegetable main course or selection of vegetables with your evening Frozen or tinned vegetables can be fine on occasion they often contain as many if not more vitamins and minerals as fresh not count potatoes as part of you of vegetables they should be treated.

FATS

are more prone to developing heart disease because their blood contains more sugar than in non-diabetics, causing the blood cells to become and more likely to pick up circulating fats that can obstruct the blood vessels. It is therefore important to keep your intake of saturated fats down to the same advice is given to non-diabetics. Avoid large amounts of butter and cream, as well as hydrogenated oils (found in bought pastry biscuits and many other manufactured products). Instead, use just a small amount of vegetable oils such as olive oil and choose lean fish, game and lean cuts of meat.

DAIRY PRODUCTS

Dairy are a valuable source of which is particularly important for women and children Calcium is needed when you are for healthy teeth and bones, and also when you are going through the menopause and have an increased risk of developing osteoporosis. Men rarely develop but anyone taking medication that interferes with the balance of calcium in the such as strong should pay attention to their calcium intake.

The elderly or bedbound, and people who don’t do much exercise, should also take care to include some dairy products in their diet – exercise helps to build and maintain strong Generally the advice is the same as for try to include a certain amount of skimmed or calcium enriched soya milk in your daily eating plan together with a small pot of live yoghurt containing acidophilus and bifid us From age frays and cottage cheeses are lowest in fat: small amounts of other cheeses are fine for most people. Dairy products don’t adversely affect blood sugar levels, unless they are sugary products such as ice cream or sweetened.

ALCOHOL

If you have diabetes, there is no reason why you shouldn’t continue to drink alcohol, unless your doctor has told you not to. The only difference is that once you are a diabetic you need to modify the way that you and drink only in Drinking to excess can make the control of diabetes problematic because of the way it affects your blood sugar levels. In the of a hypoglycemic attack are very similar to those experienced when you have had too much alcohol to drink, so your friends may not distinguish from the other.

This is potentially It is essential to accompany alcohol with some food, especially if you take insulin. Choosing wine with its meat is fine but drinking on an empty stomach the pint after work or six o’clock whisky – should be avoided. This is because alcohol causes your blood sugar level to drop by inhibiting the breakdown of sugar from the glycogen stores within the liver. Don’t be fooled into thinking this is advantageous, because the level drops in an uncontrolled, unhealthy way All alcoholic drinks are metabolized in a similar way, so choose one you like and drink a small amount of it.

The ones to watch are, firstly, sweet wines such 2s Sauternes These contain a lot of sugar, so are best left for very special occasions and only when you have eaten plenty of high fiber foods, Spirits combined with mixers should be kept to a minimum, ideally you should choose diet mixers as these contain less sugar Low sugar Pills) beers were created for diabetics. but this was long before current thinking on the management of diabetes. These beers tend to be high in alcohol, so avoid them for this reason.

WATER

As with other people, adults should drink at least two and a half liters/four to five pints of water a day. This amount of water helps excess sugar to be excreted from your body, helps to keep your kidneys and other organs healthy, and allows the fiber in your diet to regulate your blood sugar, as discussed above.

SWEETS AND SUGARY FOODS

Sweet foods are high in a type of sugar which very rapidly enters into the blood stream. If they are eaten on an empty stomach, they can cause your blood sugar to rise very high by sweet foods I mean the obvious candidates such as cakes, biscuits, sweets, liquor ice and chocolate, honey and sugar-coated cereals, ice creams, canned drinks, squashes and fruit juices.

Try to wean yourself off sweetening tea or coffee with sugar or honey However, sugary foods can be enjoyed on occasion, as long as you have them in small amounts within meal times, making sure some fiber is present to cushion the effects of the sugar. For example, instead of having a large chocolate bar in the middle of the afternoon, wait until your evening meal and have a small amount of a good quality, high cocoa bean chocolate after the main course Choose cakes and biscuits made with whole meal flour or oats (see the Taste Good section for recipes for fruity malt loaf, apple flapjacks and brownies).

or fruit-based desserts such as whole meal or oat crumbles, fruit kebabs or fig and orange boats which all contain some fiber. Instead of sweet ice creams, consider fresh fruit sorbets made with less sugar Be aware that even when a boiled sweet or other candy contains no sucrose or glucose, just fructose. in a low fiber setting the fructose will increase your blood sugar level in the same way as the other types of sugar. They are all best avoided.

Lifestyle concerns VEGETARIANS AND VEGANS

Vegetarianism or veganism can be easily integrated with diabetes as long as you Follow a healthy, balanced eating pattern Because a vegetarian diet can be bulky, diabetic children need to have their diets carefully planned so that they still receive enough energy as well as other fiber-containing foods.

MILK INTOLERANCE

People with milk intolerance should be aware that some say milks have added sugar, frequently labelled sucrose, so choose an unsweetened one.

PREGNANCY

If you’re a healthy woman there is no reason for diabetes to stand in the way of a very happy and healthy pregnancy the better controlled you are prior to conceiving the better as this helps prevent any unnecessary complications cropping up during the pregnancy You may need to change the pattern of your meals and snacks while you are pregnant as your hormone levels change, which can make you feel sick, starving at unusual times of the day and prone to strange cravings. If you know your body and diabetes well enough you should be able to work found these, but if in doubt ask your dietitian or doctor for their advice Bear in mind that when you’re pregnant, the baby will take and use some of your sugar this should help you to realize the importance of eating regularly and keeping an eye on your sugar and medication levels,

EXERCISE

As with non-diabetic people you should include some aerobic exercise in your daily routine. Exercise helps keep the body tissues supplied with oxygen, the muscles toned, the heart healthy and the mind content. The only thing to remember is that exercise lowers your blood sugar level, as the muscles use glucose as a form of fuel. You therefore need to make sure that you have enough carbohydrate to keep your sugar level normal Insulin dependent diabetes should have a sugary snack before any strenuous exercise.

It is important to stress to diabetic children that they can and should partake in sports, point out famous sports people who are diabetic, to reassure them that the two are compatible. Provide them with a sugary snack to eat before they have a sports event at school and make sure that their teacher is fully aware that they are diabetic, so that they give them plenty of time to have a snack before doing any sport.

The teacher should also know how to spot the signs of hypoglycemia, just in case the sport is more energetic than expected, Same older people seem to find that delaying the taking of insulin can help athletic performance, but you should discuss this with your doctor before you change your routine. This is only advisable for people whose diabetes is well controlled and who are mature enough to juggle the insulin and their bodies For non-insulin-dependent diabetics, exercise should not pose any problems and indeed can bring down excess body weight, which can help your body regulate the sugar levels more efficiently.

ILLNESS

When you are ill your metabolism slightly changes. The body naturally produces more glucose so blood sugar levels tend to rise. It is therefore vital if you’re an insulin-dependent diabetic that your insulin is taken, regardless of whether or not you eat anything. Even if you don’t fancy eating something solid. you should have a regular intake of carbohydrates, such as glasses of milk, fruit juice, soup, ice cream or yoghurt. When you have a temperature, your body loses a lot of water through sweating, so it is extremely important to drink plenty of clear water If you have a young baby with diabetes, I suggest you contact your GP and dietitian when they are unwell so that you can discuss the issue of their blood sugar control .

Hypos and hyper

Blood sugar levels change all the time, according to what you have eaten and what you have been doing to use up the sugar, such as exercise. If your sugar level goes too low because there is too much insulin in the body and too little sugar, you may suffer from hypoglycemia (also called a hypo”) If there is too little insulin and too much sugar, the condition is referred to as hyperglycemia Both of these scenarios can on the whole be avoided by eating properly and taking medication if necessary. If you are unfortunate enough to experience them, they can be easily rectified.

HYPOGLYCAEMIA

Hypos are episodes when your blood sugar drops too low Symptoms include dizziness, headaches, extreme hunger, blurred vision, odd behavior such as crying, sweating pins and needles, trembling, paleness and inability to speak. The symptoms can come on extremely quickly, sometimes in a matter of minutes, but the condition is easy to correct.

It can arise for various reasons most often if you haven’t eaten enough carbohydrates, if you’ve left too long a gap between your injection of insulin and eating: or if you have done some energetic sport that has used more of the body’s sugar reserves than you’d anticipated. Once you’ve worked out how your body responds to exercise and how much carbohydrate you need to get through the day, you shouldn’t occur.

The best way of avoiding them is to be aware of what is happening in your body, for example if you are feeling slightly sweaty or dizzy, and don’t push your body to the limit. Remember to have a mid-afternoon snack if this is what you normally do: don’t think your body can hang on until you have journeyed back from the office, it won’t. Always play safe. Your doctor will explain what to do when you have a hypoglycemic attack. but the first thing is to have something sweet as quickly as possible. To stop a little hypo from escalating into a big one always carries a sugary snack around with you. This is especially important for children, and their careers should be notified as to where it is.

Good portable snacks include bananas, biscuits, places of cake or chocolate, bottles or cartons of fruit juice, milk or milk shakes, or full- calorie fizzy drinks. Diet drinks won’t help as they don’t contain the right sort of sugar Follow your sugary snack with a nourishing meal. Containing some high fiber carbohydrate as soon as possible.   You should contact your doctor immediately if you don’t feel any better. If you’re treating a friend whose blood sugar has dropped so low that she has lost turn her on to her left side consciousness, you should.

• make sure that her airway is clear by tilting the chin up slightly.

• check that the tongue hasn’t rolled back, as this could obstruct the throat.

• then call the doctor or ambulance Never give anyone who is not fully conscious anything to eat or drink If you are having frequent hypos and you’ve checked that you are taking the correct dosage of medication and eating properly, consult your doctor Non-insulin dependent diabetics should not have hypos See your doctor for advice, as your symptoms may indicate something else Always inform your diabetic child’s friends, parents, playgroup organizers and school teachers.

Make sure that they know the basic things to do Asking them to be diligent and flexible when it comes to your child’s eating habits can save a lot of unnecessary worry.

HYPERGLYCAEMIA

The opposite to a ‘hypo’ is a hyperglycemic attack. Hyper are commonly experienced when you have not taken enough insulin, you have eaten something too high in sugar, or you haven’t done the sport or activity you planned. Mild hyper, which you detect by testing your urine or taking a blood sample, can be easily corrected by avoiding very sugary foods and taking the correct amount of insulin on time.

Sometimes diabetics can have severe hyperglycemic attacks, if for example they are ill or unable to take their insulin. The symptoms are similar to the experienced before diagnosis, including extreme thirst, lethargy, weight loss and frequent urination. It is important to realize that these symptoms are different to ‘hypo symptoms – you must seek medical advice immediately and not treat it yourself by taking a hypo correcting sugary food. This will make your sugar level go even higher.

blood pressure why worry about high blood pressure?

blood pressure why worry about high blood pressure?

High blood pressure

High blood pressure, or hypertension is a well-documented risk. factor in heart attacks, strokes and angina, most people with high blood pressure have no symptom but it is commonly observed during company and routine medical checks. The development of high blood pressure is one of the first signs that the body is riot coping with some aspect of use; it could be excess weight, smoking, stress, lack of exercise poor eating habits While many people are told that they have high blood pressure, how know what it means and how food and lifestyle changes can help then correct it.

Blood pressure is the force exerted by the flow of blood through your blood vessels Blood pressure readings are expressed as one number over another the upper (systolic) measurement selects the force when the heart is pumping blood around the body the lower linoleic reading is the pressure which exists in the blood vessels when they’re relaxed between heart beats Normal blood pressure readings are in the region of 120/80.

The latter figure, representing diastolic pressure is the important one in terms of establishing whether you have hypertension. There with a diastolic   between 90 and 105 are considered to be mildly hypertensive 105 to 120 represents moderate hyper aeration severe hypertension (high secret pressure when the pressures above 120. Hypertension can be caused by heart or kidney problems, but in nine out of tent cases there is no known cause.

Hypertension tends to run in Families, and blood pressure usually Increases as we get older. If there are underlying problems you may need to take medication but for the majority of people who suffer from simple hypertension, you can help yourself by few modifications to your lifestyle reducing stress taking exercise, quitting smoking looking at the way you eat and choosing foods and drinks that help rather than hinder your body.

Why worry about high blood pressure?

If hypertension is ignored it can lead to problems such as heart disease, strokes or kidney problem. Some people need to take medication to help control their blood pressure. but most doctors suggest exploring all of the non-drug Remedies first Remember that all drugs have side effects in the case of antihypertensive these may include weight gain chronic: tiredness, feeling low, and in some cases lack of libido and impotence. In much better to see What you can do within your diet and lifestyle to help bring your blood pressure down.

How to correct hypertension

The most common contributory factors to hypertension are excess weight, stress and high blood fat levels Smoking is a strong risk factor in the development of hypertension and of course in many forms of heart disease and cancers. If you smoke try to give up.

TRY TO KEEP YOUR WEIGHT WITHIN THE IDEAL RANGE

In particular excess fat around the middle of the body presses on the important blood vessels leading to and from the heart and hence aggravates blood pressure Women with pear-shaped figures with more weight round the hips – have less of a problem than apple-shaped women and men, who commonly tend to stack the weight around their middles. If you are carrying excess fat in this area you may well find that if you reduce it your blood pressure will improve and may even cease to become a problem. Some people become obsessed with their body weight.

hopping on the scales every day This is unnecessary, and is not really telling you anything you cannot see for yourself in a mirror. The scales may put you within your ideal weight range, but fat around the middle will still aggravate hypertension Be honest with yourself and if necessary, read the chapter on Achieving your ideal weight Do not crash diet as this can put your body under stress. Never take drugs to help you lose weight as they can cause dramatic rises blood pressure.

TRY TO REDUCE STRESS

Build time into your daily schedule to allow yourself to relax There are many excellent courses tapes and books designed to help you reduce stress so hunt them out Some people learn to meditate or experiment with aromatherapy. others play a musical instrument. paint. or take yoga classes .

TAKE REGULAR EXERCISE

One of the easiest ways to reduce stress and also improve your general feeling of well-being is taking physical exercise. Try to get into the habit of doing some regular aerobic exercise throughout the week Good aerobic exercise includes brisk walking, swimming, running cycling and roller blading (Exercise such as weightlifting and squash is not as effective in bringing blood pressure down although you may think you thrash out stress on the court These exercises that use short bursts of power tend to increase blood pressure: gentler, longer lasting Exercises are the ones to go for).

Always check with your doctor before you embark on any exercise programmed, as he or she will be able to advise you as to the type and level at which you should train. Some people fall into the trap of trying to force exercise to fit into their schedule Workers rush from the office to work out at lunch time and then rush back to the office feeling shattered. Treating fitness as a military exercise creates stress and will not help lower your blood pressure. Neither will pushing your body to the limits on the running machine. You would be much better off exercising in a more relaxed manner, perhaps only managing twice a week in the gym and taking a brisk lunchtime walk or roller blading in the park on the other days.

How food can help

Many of the points made in the previous chapter about how to improve the balance of the different types of fat in your blood are relevant here. If excess fat is deposited in the blood vessels, it reduces the space through which blood can flow and causes the pressure within the blood vessels to rise. If you have a high cholesterol level do everything you can to keep it as low as possible.

Keep your Intake of animal fats such as butter cream and cheese low, and boost your intake of fiber and water Some exciting research has recently shown that a diet rich in fresh fruits and vegetables can significantly reduce blood pressure. This is independent of their cholesterol lowering effects but may be linked to both their antioxidant content and their potassium content. Everyone should try to eat at least five portions of fresh fruits or vegetables every day.

First of all, make sure your diet is well balanced besides plenty of fresh fruits and vegetables, you need plenty of high fiber starchy foods and water smaller but regular amounts of lean proteins and dairy products, with minimal amounts of fat, sugar and caffeine (coffee, tea and cola drinks). Consider organizing a family health day as this will give you the time to take stock of your life and encourage you to instigate the necessary changes in your diet. In addition to a generally healthy lifestyle a few specific areas of your diet may be particularly effective in reducing blood pressure.

A PINCH OF SALT

As well as watching your fat Intake you need to make sure that you are not consuming too much salt. Salt (sodium chloride) can increase fluid retention and blood pressure Sodium naturally exists in small amounts in many foods including vegetables and fruits, but it is found in far greater quantities in pre pared foods. Salt acts as a preservative, helping to keep food free of harmful bacteria and also enhances flavor.

Rather than avoiding all processed foods, you can reach a sensible compromise by including small quantities of them in your weekly eating plan alongside. plenty of fresh foods Keep very salty foods down to a minimum. Your tongue and taste buds will usually tell you which these are, but they include olives salted nuts, pickles, and cured and tinned fish and meats such as kippers and Parma harm. (Occasionally your taste buds can be fooled conflates have a greater salt concentration than the Atlantic Ocean!) Another step in reducing your salt intake is to get out of the habit up adding unnecessary salt in cooking.

Try to wean yourself off this habit, as the more salt you have, the more your body thinks it needs before it recognizes the salt taste Look for the Natural flavors of fresh fish meat and vegetables first, then think about enhancing them rather than making them with copious amounts of salt Experiment with other flavors, such as herbs and spices or marinate foods in wine before cooking Mix vegetables and fruits to create different tastes. Always taste food before adding salt at the table. If you cut down your sodium intake your blood pressure should improve.

BOOST YOUR POTASSIUM INTAKE

The best way to reduce the sodium level within your body is to increase the amount of potassium. These two minerals work together like a pair of scales – you should aim to get the balance right. By boosting your intake of potassium rich foods your body should be able to maintain a healthy sodium level. It is usually people who overindulge in salty foods and don’t cat a generally healthy diet who run into problems with salt-induced hypertension. You should not take any form of potassium supplement unless prescribed by your doctor.

They are potentially very dangerous Potassium is found in abundance in most fresh (not canned) fruits and vegetables. The following are especially rich sources Fruit: apricots, bananas, blackcurrants, dates, grapes, grapefruit, kiwi fruit, Cantaloupe melons, oranges passion fruit paw (papaya), peaches and plums, being even higher in the dried versions such as prunes, apricots, sultanas and raisins. Vegetables avocados, broad beans, peas, potatoes tomatoes, squash such as courgettis and pumpkins, cook vegetables without salt, and taste them before you add salt.

INCLUDE SOME DAIRY PRODUCTS IN YOUR DAILY DIET

Milk and natural yoghurt are rich in potassium and, along with other dairy products are also the major source of calcium in the Western diet. Calcium has been found to be helpful in correcting high blood pressure. Of course, some dairy products (cheese, buttercream are high in saturated fats, so you should not go overboard with them or you risk an increase in blood fat levels but dairy products in moderation can help improve blood pressure. You can easily obtain sufficient calcium if you incorporate skimmed and semi skimmed milk in drinks and naturally lower fat dairy foods such as yoghurt and fromage frais in your everyday cooking.

GARLIC

Several studies suggest that garlic contains substances which help reduce high blood pressure. Get into the habit of including garlic regularly in savory dishes. sauces and dressings.

OILY FISH

Mackerel, fresh herrings, sardines, pilchards, salmon, trout and tuna are all rich in omega 3 fatty acids, beneficial oils that help prevent cholesterol from depositing in your blood vessels Eating a meal based on Olly fish two or three times a week can help control your blood pressure.

ANTIOXIDANTS

Antioxidants help reduce blood pressure as well as helping to prevent blood fats from depositing in your blood vessels. A healthy, well balanced eating plan will include foods rich in natural antioxidants (especially beta-carotene and vitamins C and E), found chiefly in fresh fruits and vegetables. Try to have five pieces of fruit or helpings of vegetables every day Don’t forget that there are also antioxidants in red wine One or two glasses a day can be beneficial unless there is another reason why you are unable to take red wine. There is no need to take antioxidant supplements. Not only are they unnecessary, they can cause the balance of nutrients within your body to become unbalanced

High blood cholesterol live healthily is most important

High blood cholesterol live healthily is most important

There is a lot of confusion about cholesterol

Most people know that it is linked to heart disease and fat- but that’s about the extent of their knowledge Cholesterol is a whitish fatty   wax like substance. that is both produced in the body and found in food. Excess cholesterol in the bloodstream can clog and narrow the arteries Increasing the risk of heart attack stroke and kidney disease. Hyperlipidemia is the technical name for the presence of abnormally high levels of lipids cholesterol and triglycerides within the blood A high level of the fats is a risk factor in heart disease, which kills 83.000 men and 20.000 men in Great Britain every year but the positive news is that evidence strongly suggests that improving the blood fat profile helps reduce the risk of heart disease.

As many as two in every three men and increasingly more women. have unhealthy levels of blood fats. Symptoms include yellowish nodules of fat in the skin beneath the news knees and in the tendons, or in some cases a whitish ring around the eye. The majority are unaware of these symptoms – opticians may be the first ones to notice People may discover that they have hyperlipidemia when they undergo a routine blood test.

Astonishingly we are now finding children as young as eight or nine with raised lipid levels and even the first signs of atherosclerosis, furring of the arteries This is a trend we need to stop. Encouraging your child to eat and live healthily is most important.

 CHOLESTEROL

Cholesterol is produced by the body, primarily in the liver. It is also present in certain food. The cholesterol we eat is known as dietary cholesterol. and has little relationship with the cholesterol in the blood. Cholesterol is not all bad news It plays an apart in the production of sex hormones involved in the synthesis of vitamin D and is also needed for the production of the myelin sheath, the protective substance which surrounds the nerves.

Cholesterol only creates a problem when you have too much of it in your body: then, a can promote the production of a fatty plague which can clog up your arteries If this happens the blood flow is interrupted, which in a main heart vessel can cane a heart attack or in the blood vessel leading to your brain, a stroke. Blocked arteries also cause circulation problem numbness and pain in your hands and feet.

The cholesterol made within the body needs to be broken down to usable form and delivered to the cells which need it. The liver repackages cholesterol as low-density lipoprotein (LDL). As LDL flows through the blood, latches on to receptor sites on the cells which need the cholesterol. When the bells have had enough cholesterol, they stop producing the receptor sites. When this happens, the unused LDL stays in the blood and can irritate the blood vessel lining, which in turn causes a forty plaque to form.

Other factors can irritate the cells in the lining of the blood vessels animal them more susceptible to developing a plaque. The nicotine from cigarettes, and abnormally high sugar levels, such as are found in uncontrolled diabetics are two such factors Fundamentally, however the plaque would not be able to form if there was no LDL around. If you have too much LDL in your Blood this is usually referred to as having bad cholesterol The good type of cholesterol is high-density lipoprotein (HDL). HDL carries the excess LDL cholesterol from your blood back to your intestine, where it is excreted.

TRIGLYCERIDES

These are another type of blood fat, produced in the body in response to alcohol. hormones and sugar. Although they are different from cholesterol, they too hue been linked with heart disease and pancreatic cancer so it is important to keep them within the ideal range.

Blood fats may increase with age, consequently a cholesterol value in the reference range of 7.0 mmol/l would be much more noteworthy in person of 25 years than one of 55 years.

• Triglycerides are generally higher in men than women; HDL levels are higher in women than men. Up until a woman enters her menopausal years, the female hormone estrogen alters the metabolism of cholesterol and helps to keep LDL levels low.

After the menopause, when estrogen levels drop considerably, the effect is last, which explains why women’s risk of heart disease and strokes increases at this paint. Nowadays more and more women are sidestepping the menopausal years by taking hormone replacements for various reasons Hormone replacement therapy can lower LDL and increase beneficial HDL. levels, but so far this has been demonstrated only among women who take a pure estrogen-based hormone replacement, which is prescribed only to women who have had their womb removed Other hormonal medication, such as the contraceptive pill, can increase LDL. and lower HDL levels, which is one of the reasons why doctors need to make regular checks on women taking the pill, For men there does not appear to be any hormone-related change in their life risk of developing heart disease.

TESTING YOUR BLOOD FATS

As I have already said, many people are unaware that they have a blood fat problem. In this case, ignorance is not bliss, high blood fats present a serious risk of heart disease, but the risk can be reduced through modifications to your diet and lifestyle. Your doctor can give you a blood test or you can buy accurate self-testing kits at pharmacies Since the food you ear can raise your blood fat levels; doctors recommend that you take a fasting sample this is best done first thing in the morning. because you must not eat anything for eight to ten hours before the test. Look at the results in conjunction with the previous paragraph to see whether or to what extent, you need to alter you’re eating habits.

WHY DOES IT MATTER?

To reduce the risk of heart disease you need to make sure your LDL and triglyceride levels are low and your HDL level is high to excrete as much LDL as possible. Every case of hyperlipidemia is slightly different, but the best way to see your way through the jungle of advice is to understand how to build up a good blood profile. If you have high blood fat levels, you can decrease them by 25 per cent by adopting a healthy diet. Your body produces 75 per cent of your blood fats.

regardless of what you eat. However, the 25 per cent reduction can significantly reduce your risk of developing heart disease and therefore should be taken seriously It is never too late to change your blood profile for the better. If you don’t have raised blood fats, this is the point at which you should pay most attention, as the longer you can save them off the healthier your life should be. Equally, those of you with children should remember that hyperlipidemia is not confined to adults, young people die of heart disease, so the sooner you begin to protect your child’s blood vessels the better.

How to build up a good blood profile

There are several nutritional measures which can change your blood fat profile Some people believe that eggs, shellfish and offal (liver, kidneys) should be banished from their diet and margarine should replace butter. This is not strictly correct. Although these foods contain cholesterol (as do all animal derived foods, including cream cheese chicken and fish), they do not have a significant impact on blood cholesterol levels.

The cholesterol from the food we eat is broken down quite efficiently Obviously, if you have a lot of these foods and few of the cholesterol lowering foods your blood cholesterol level may be a little high but in the majority of people, I see this is riot the situation. So, lobster, prawns, liver and eggs need not be banned from the table (they all contain plenty of other useful nutrients), they just need to be eaten in moderation and in a way that allows the body to metabolize the food efficiently This normally means combining them with some fiber. The major principles in building a healthy blood scenario are.

• to keep your intake of saturated fats low

• to keep the HDL level high enough to excrete the LDL

.to prevent excess LDL from depositing in your blood vessels

• to avoid exposure to any other heart disease risk factors.

You need to know which foods to eat more of and which are the foods to watch .

KEEP YOUR INTAKE OF SATURATED FATS LOW

The major influence on the level of LDL in the blood is not the intake of cholesterol-rich foods, but the intake of saturated fats. Sometimes these are found in the same foods – butter, cream cheese – but prawns and offal, although high in cholesterol, are low in fat. Saturated animal fats stimulate the liver to produce more LDL, therefore keeping the intake of these foods low is the best way to keep your blood cholesterol level down. Choose lean meat rather than Tatty cuts, and have small amounts of butter, cream and cheese because you enjoy the taste: not just out of habit.

I do not suggest that you avoid all cheese, not only is it delicious, it is also a good source of calcium and other nutrients. Interestingly, the creamier cheeses Such as Brie and Camembert contain slightly less fat than the harder varieties Also, if you cut off the white rind, you virtually halve the fat content. Saturated fat is also found in some margarines, especially hard margarines Even if you do not buy them as such, remember that they are used in many top-bought cakes, biscuits and pastry products. For cooking stick to using a small amount of vegetable oils such as olive or sunflower.

One trap that some of my patients fall into is to think they can cure their high cholesterol levels and then go back to their old ways. They go for weeks replacing butter with margarine, cheese with low fat’ cheese substitutes, avoiding eggs, shellfish and offal, and feeling deprived and desperate for the day when the results come back from the lab saying that their cholesterol level has come down, so that they can get back to eating the real foods they love. It is much better to adjust to a generally healthier lifestyle which can include butter cheese and other delicious foods, as long as they are eaten in moderation and in a way that helps the body deal with fats efficiently – with some fiber and water.

INCREASE YOUR INTAKE OF FIBRE

The best way to control the amount of LDL in the body is to change the balance between foods that produce LDL and those that allow the body to excrete LDL. Fiber helps your body in two ways. Firstly, the fiber produces substances that help to clear the blood of LDL and secondly the presence of fiber in your meals acts as a buffer. Less fat is brought into contact with your blood vessels, which means that less fat is absorbed and more LDL is kept bound within the gut and then excreted.

A Healthy, well balanced diet rich in high fiber foods such as wholegrain breads and cereals, pulses, vegetables and fruits enable the body to excrete more LDL. Eating the recommended five helpings of fresh vegetables and fruits and a selection of other high fiber foods every day really helps to bring your blood fat profile within the ideal range:

Oats are a particularly good form of fiber for reducing cholesterol so begin your day with porridge or an oat cereal have oatcakes as snacks and use oats in main meals such as fruit or vegetable crumbles Oats are useful for people who have a limited tolerance of gluten the gluten content is far lower than in wheat products such as bread and pasta. Oatcakes are a perfect partner for cheese, the oat fiber reduces the intake of saturated fat from the cheese and helps your body produce more HDL, which will enable LDL to be excreted.

INCREASE YOUR INTAKE OF HDL PRODUCING FOODS

Two foods that have been the subject of much research are oily fish and garlic Olly fish such as herrings, mackerel, tuna and salmon contain beneficial types of fat called omega 3 and omega 6 fatty acids. These fatty acids encourage your body to produce HDL, which helps to remove LDL Garlic also contains a substance which raises your HDL levels. Both garlic and oily fish contain other substances which reduce your risk of developing a blood clot or thrombosis. A clot is a collection of blood cells which can block a blood vessel in a similar way to a deposit of fatty plaque so the more we can do to prevent this, the better.

Try to use garlic and oily fish in your weekly eating plan Garlic could be included almost every day, and I recommend that you aim to have two or three fish-based meals every week. Many of the soups and savory recipes in this book contain garlic, and for your fish suppers you could try seared tuna on a bed of spinach or simple barbecued sardines or grilled herrings. If you worry about the aftertaste and smell of garlic, chewing a sprig of parsley or sucking a coffee bean are said to reduce the effects.

GOOD OLD ALCOHOL

Another foodstuff which has been shown to increase HDL cholesterol and therefore reduce LDL levels, and also reduce the risk of thrombosis, is alcohol – in moderation Alcohol in excess of the recommended maximum of 28 units for men and 21 units for women can increase not only the total amount of cholesterol and LDL but also blood triglycerides all of which increase the risk of heart disease. Excessive alcohol also increases the risk of cardiomyopathy disease of the heart muscle and liver damage.

Wine drinkers seem to enjoy better cardiovascular health than either beer drinkers or teetotalers, provided they have no more than two glasses of wine. a day. The next best drink seems to be cloudy sediment on yeasty) beer, but all forms of alcohol are better for the blood fat levels than abstention Red wines are also rich in antioxidants (see below), substances that prevent

LDL from depositing in the blood vessels. Recent studies suggest that a couple of glasses of red wine, a day can reduce the risk of heart disease because of high levels of the antioxidant’s anthocyanin and tannin For those of you who don’t like red wine the darker beers contain there beneficial antioxidants than paler beers, but not as many as red win Do check with your doctor before you drink any alcohol in case any medication you are taking is likely to interact adversely or indeed there may be another contraindication in your health.

KEEP UP YOUR INTAKE OF ANTIOXIDANTS

There is little harm in fat circulating around the body, unless it starts to deposit. In order for far to deposit it needs to oxidize Nutritionally we can stop this by eating plenty of foods containing antioxidants, as well as drinking a moderate amount of alcohol (see above).

The most powerful antioxidants found in food are beta carotene (which the body converts to vitamin A, vitamin C and vitamin E. Good sources of these are discussed in more detail in the section on Understanding your nutritional needs, but basically if you eat at least five portions of fresh fruits or vegetables every day you should cover your needs, By a portion. I mean a piece of fruit such as a whole orange or kiwi fruit, a large helping of spinach broccoli or carrots, or a bowl of vegetable soup.

I suggest you have three pieces of antioxidant-rich fresh fruits and include a salad or vegetable portion at your two main meal Besides green leafy vegetables and avocados (a particularly rich source), vitamin E is also found in nuts such as almonds and hazelnuts, seeds such as sunflower Seeds and therefore sunflower oil – and oil wholegrain cereals.

There has been so much interest surrounding antioxidants in connection with reducing heart disease and cancer that many people wonder whether they should be taking a supplement I do riot believe that this is necessary as long as you are eating a well-balanced diet with at least five portions of fresh fruits or vegetable every day, don’t smoke and don’t bombard your body with Junk food.

HOW GUT BACTERIA MAY HELP

Two bacteria found in the intestine, acidophilus and bifid, are thought to produce substances which encourage the body to excrete more LDL and possibly raise HDL levels. Research is still in its early days, but I suggest you eat a small pot of live yoghurt containing these bacteria every day.

EAT SMALL MEALS OFTEN

Leaving your gut without any food for hours and hours and then putting a large meal into it is not healthy. This habit not only puts a strain on your digestion. It is also thought to raise your LDL levels.

Other risk factors

Besides the above nutritional measures, you can take to improve your blood fat profile. there are other influences to consider. Some are hormonal but other factors seem to affect men as well as women, these include smoking being over-fat, and lack of exercise. Diabetics are prone to suffer from heart disease, but hopefully as we come to understand more about controlling blood sugar levels (see the chapter on Diabetes) this will cease to be such a risk factor.

• Caffeine and nicotine both irritate the blood vessel linings, making them more likely to develop fatty plaques. Try to keep your caffeine intake down to no more than two or three cups of coffee, tea or cola a day, and stop smoking.

Exercise, particularly aerobic exercise, helps to reduce blood fat levels and also helps reduce your risk of developing heart disease in other ways Three times a week try to include a twenty-minute session of an aerobic exercise such as running, jogging power walking or brisk walking, swimming or cycling Always check with your doctor before you take up any form of exercise.

• In addition to the lipid lowering effects of aerobic exercise, exercise is a good Stress reliever Stress can cause your liver to produce more fat, in particular LDL cholesterol. Since stress is also a risk factor in many other diseases, you should take steps to reduce the stress levels in your life.

Excess weight, or more specifically excess fat, especially around the middle is bad news for your heart in two ways. Firstly, obesity and you reduce the levels of the good HDL cholesterol in your blood and secondly it leads to an increased risk of high blood pressure It is the fat which fills the stomach area and puts pressure on the major blood vessels to the heart that causes most concern.

This tends to be more common in men than women Cutting down on your intake of saturated fats and increasing the number of vegetables, fruit and high fiber foods will encourage healthy weight loss. If you need more advice, Achieving your ideal weight. Don be tempted to crash diet, and this can place undue strain on your heart High cholesterol is a risk factor not a disease. If your lifestyle is healthy and your lipid levels remain slightly above the ideal don’t worry too much