Vitamin B

Next in our quick series of Vitamin FAQ’s we look at vitamin B (if you missed Vitamin A – you can read it here).

There are actually lots of different types of vitamin B, but for our bodies the main ones are:

  • B1 – thiamin
  • B2 – riboflavin
  • B3 – niacin
  • B5 – pantothenic acid
  • B6 – pyridoxine
  • B7 – biotin
  • Folate (folic acid)
  • B12

 

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In general, they all aid the process of breaking down key aspects of our food, releasing much needed energy into our system, as well as helping keep our eyes, skin and nervous system healthy.

Vitamin B6 has a specific role in using and storing the protein and carbohydrates we take in as part of our diet and helping our body to produce haemoglobin. Haemoglobin is what makes our blood look red and critically carries oxygen around the body.

Folic acid – most well known as the supplement that is needed in pregnancy – is crucial for reducing the risk of developmental defects of the central neural tube of unborn babies. The neural tube is the early form of our central nervous system. Developmental problems at this crucial stage of a baby’s growth can lead to problems such as spina bifida. However it’s not just pregnant women – it also helps all of us to make healthy red blood cells.

Perhaps the most well known is vitamin B12. This actually helps us to use folic acid. It also is vital in keeping the nervous system healthy and plays a key role in making red blood cells.

With so many types of B vitamins, the ways we can get this into our diet are varied. Importantly, some of these vitamins cannot be stored in the body – so we need a daily supply in our diet. Thiamin cannot be stored – and it’s recommended that men need around 1mg/day and women around 0.8mg/day. Similarly we need daily riboflavin at around 1.3mg for men and 1.1mg for women. Niacin also cannot be stored and men should aim for around 16.5mg and women around 13mg.

A word of caution about niacin – too much for a long time can lead to liver problems and cause skin flushes. Similarly B6 in excessive amounts  (e.g. more than 200mg) can lead to a problem called peripheral neuropathy. This is a problem of the nervous system where we can develop loss of sensation in our limbs (peripheries). Men should aim for around 1.4mg/day of B6 and women around 1.2mg.

Many foods are rich in a number of B vitamins including: eggs, fresh/dried fruit,  leafy green vegetables, broccoli, wholegrain bread, fortified cereals, milk (cow’s), nuts,

Some specific diets e.g. vegetarians and vegans can sometimes struggle with B vitamins, and B12 in particular. B vitamins are in abundance in animal products – meats, fish, eggs, cows milk etc. However with careful planning, it is possible to get all the recommended amounts in your diet without additional supplementation. However, a multivitamin can be a helpful addition to more restrictive diets and might be worth discussing with your doctor.

Folic Acid

As we have already learned, folic acid (or folate) is pivotal in a baby’s development and throughout our life by helping us produce red blood cells. The average adult needs 200micrograms of folic acid/day and it cannot be stored meaning you need a daily amount. An additional supplement is provided to pregnant women – either 400mcg of 5mg depending on their medical history. Caution is required with additional supplementation – too much can possibly cover up an existing B12 deficiency.

This is found in vegetables such as asparagus, peas, sprouts and broccoli. It is also prevalent in liver but this should be avoided in pregnancy.

B12

The most well known of all B vitamins is B12. A deficiency of B12 is something that has been in the media more of late. This is the vitamin that those who avoid animal products in their most struggle with – as it is only found naturally in animal products – meats, milks, eggs.  It is some fortified cereals however.

We need around 1.5micrograms/day and this is something we can store in the body.

Deficiency in B12 causes wide ranging symptoms including low mood, changes in mental state, altered or abnormal sensation, fatigue, irritability, anaemia and reduced fertility. Whilst some changes can be reversed with treatment, if left unchecked and untreated, some of the damage can be permanent.

“All that I am, or ever hope to be, I owe to my Mother”

It’s Mother’s Day today in the UK and this gives us a chance to show our mums how much they mean to us – whether they are still with us or not. There is an undeniable connection to your mother, no matter what is going on in life.

As babies we are conditioned to bond to the person who provides us with the most care – this can be our mother, father or anyone that provides us the majority of our care. This bond is what psychologists call ‘Attachment Theory’. It’s a biological instinct where we equate our safety with being close to this person and that this person will take away our discomfort and protect us.

We don’t know about you, but that definitely describes our mums.

 

Me and Mum 2

In honour of our mums, we wanted to share some of the most valuable lessons we have learnt from them:

 

“Grant me serenity to accept the things I cannot change, courage to change the things I can and wisdom to know the difference”.

This was something we had on an ornament in our house growing up – and it followed us from house to house and has always stuck with me. Learning to let go and move on, or dig in and work hard are crucial life skills we all need.

 

“When driving, you don’t have to run a race”

When someone approaches in your rear view mirror, whether it be in the car or in life in general, you can choose to put your foot down or carry on at your own pace. Life is not a race or a competition. Enjoy the journey and don’t put your foot down and miss the beauty and opportunities around you.

 

“Never let the sun set on an argument”

A quote taken from Ephesians 4:26, in the heat of a disagreement it can be hard to reach resolution. Feelings of anger or resentment can be destructive if not handled properly, both to our physical and emotional health, but also can have a wide reaching impact on our relationships and careers.

 

“You are in charge of your own feelings”

This would often come during a typical teenage temper tantrum and mum would tell me that I was in charge of how I felt. At the time, I never understood it, but as I have got older it makes sense. Yes, a certain event or circumstance may trigger emotions e.g. an argument might make us angry, but we are in charge of how we deal with that anger. Do we bottle it up, or do we move on and resolve and forgive? You are in control of how you handle and react to your feelings.

 

“If you can’t do it, learn to do it”

If there was something I wasn’t able to do, mum would always work out if there was a way to learn it. She always believed education, in all it’s forms, was the way to improve oneself. As doctors, we are somewhat infamous for our poor handwriting, but even growing up my handwriting was questionable. So mum would keep buying me handwriting books to try and practice and improve. When we come up against something we struggle with, we are faced with two options: we can give up, or we can adapt and work through it, and it was my mum taught me that we didn’t give up.

 

“One day you’ll thank me”

They were right. We’re incredibly thankful for all they have done and taught us. Abraham Lincoln told us that “All that I am, or ever hope to be, I owe to my Mother”, and we’re inclined to agree.

 

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Why am I so tired all the time?

“Doctor, I’m just exhausted. All the time. I’m so tired, there must be something wrong with me”

Pretty much every GP or family doctor will hear this several times a day. Tiredness is ubiquitous with our fast paced modern lives, but at what point is it more than just our lifestyle and an indicator that something is medically wrong?

Feeling tired all the time, that feeling that even after a long sleep you don’t feel rested. It’s feeling like you could nap at pretty much any time of day. It’s draining for patients and can have a real knock on impact on their quality of life.

 

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There many medical explanations for tiredness such as hypothyroidism, anaemia and depression but it’s important to also examine your own habits and patterns to work out if it’s anything you might be able to change.

 

In my clinic I tend to try approach both the biological and the behavioural aspects of tiredness simultaneously. Lets get you looked at, examined and tested if relevant, but lets take pause to look at you as a whole – how are your stress levels, are you worried about anything, whats happening with your weight and your appetite, when do you go to bed – to get a sense of anything else we might be able to improve upon.

Stress, anxiety and depression can all impact upon our sleep. Often it might be one of the first signs that you might be suffering one of these conditions. Whether it be that your mind is racing over the days events when you try and go to bed, or thinking about the events of tomorrow or the future. Some patients with anxiety report increased palpitations (a sense of the heart racing in the chest) in the evening/night time which enhances their difficulty sleeping. Patients with depression might experience ‘early morning wakening’ when they are unable to stay asleep and wake in the early hours.

Sleep hygiene is often overlooked in the 21st century, we’re more connected than ever with a myriad of devices and with the increasing advent of flexible working we’re checking work emails in the evening and working later and later at home. There is also some misunderstanding about how much sleep we actually need.

Our sleep pattern is regulated by something called a circadian rhythm, an evolutionary clock that tells us to be up when its light and sleep when it’s dark. In the days of our ancestors, this helped us to be productive in the hours when there was light and to rest to in the dark when light sources would have been limited.

Stimulants such as caffeine, alcohol and nicotine as well alarm clocks and devices plus the addition of later working and shopping hours can all interfere with our natural sleep/wake cycle.

How much sleep do we need?  How do you stack up to the numbers below?

  • Newborns (0-3 months ): 14-17 hours each day
  • Infants (4-11 months): 12-15 hours
  • Toddlers (1-2 years): 11-14 hours
  • Preschoolers (3-5): 10-13 hours
  • School age children (6-13): 9-11 hours
  • (14-17): 8-10 hours
  • Younger adults (18-25):  7-9 hours
  • Adults (26-64): 7-9 hours
  • Older adults (65+): 7-8 hours

Sleep is a priority, we need that time to allow our brains to hit the reset button.  Simple but effective techniques for a better night include: sticking to a schedule – set yourself a bed time and try and stick to it, if you are someone who runs through to-do lists for the next day, make a list before you go to bed and put it to one side, getting exercise daily will help to naturally tire you out, make your bedroom as restful as possible – limit those electronic devices and televisions in the room and turn off your phone
Techniques such as deep breathing or meditation can help to quieten your mind to prepare your body for sleep. Try inhaling for three seconds and exhaling for six. Repeat this five times. Then try to tense your toes as tight as possible, then relax, work up your body – tense and relaxing groups of muscles in turn. This helps to give the body a sense of relaxation.

When is tiredness caused by more than a few late nights? We’ve looked at a few of the more common reasons we see in clinic:

Iron deficiency anaemia.

This is the most common nutritional deficiency in the world and is common in women having regular, heavy periods. Blood loss causes us to lose iron, and if we are not able to get enough iron back in through our diet, we can build up a deficit. Besides tiredness, symptoms can include skin that appears more pale, feeling cold,  feeling dizzy or lightheaded, hair loss and brittle nails. Picked up on a blood test, your doctor can advice on a cause of replacement and may recommend further testing to discover the cause.

Hypothyroidism.

The thyroid, a small gland in the neck, is responsible for producing hormones required in many different bodily functions. Symptoms include an inability to tolerate the cold, weight gain, constipation, low mood and of course, tiredness. Again, picked up on a blood test and treatment involves replacing the deficient hormone – usually as a daily tablet.

Chronic fatigue syndrome

Something that has divided medics for years. A condition that causes long-term fatigue, it’s cause is not known. It is thought that it starts with a flu-like illness and there have been suggestions is can have links with mononucleosis, lyme disease and chlamydia. There are no definitive tests to confirm this, so often the process will start by looking for other conditions that might cause tiredness.

Coeliac Disease.

A gluten intolerance that can cause weight loss, bloating, bowel habit changes as well as tiredness. Gluten is found in foods such as breads, cakes and cereals. It’s thought around 1 in 100 people in the UK have coeliac disease, but 90% of those affected do not know they have. Diagnosis involved blood tests and biopsies and is most often managed by avoiding gluten in the diet.

Sleep apnoea.

More common in people with a higher body mass index, where the breathing tube is compromised when patients are lying down, but can also be linked to alcohol intake and smoking.  In sleep apnoea patients will have periods of interruption in their breathing when asleep. Partners might report snoring – or evening being able to hear the moments when breathing is interrupted. Testing involves sleep studies and oxygen monitoring during sleep. Patients with confirmed sleep apnoea will be given advice about how to reduce their risk factors and in more extreme cases a machine (CPAP – continuous positive airway pressure) to wear overnight which helps to move air into the lungs and keep the airways open.

 

We could all do with taking stock of our sleeping habits and taking steps to improve our sleep hygiene. But if you think that there might be something underlying the tiredness, you should always discuss this with your own doctor.

Vitamin A

In a series of short posts we will be looking at crucial vitamins for our body – today we’re looking at Vitamin A.

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Mango

You might know Vitamin A as retinol, and is helpful for your body’s natural defence against illness as well as keeping our skin healthy. It’s also important in aiding us see in low light.

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Eggs

 

Men need around 0.7mg a day and women around 0.6mg, mango and apricots as well as eggs and cheese are good sources for vitamin A to include in your diet.

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Apricots

It may be possible to have too much vitamin A with studies suggesting that sustained high doses might lead to increase risk of osteoporosis – where bones break more easily.

 

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If you’re pregnant, larger amounts of vitamin A can also harm your unborn baby so it’s best to avoid foods that contain liver as these are particularly high in vitamin A.

What makes you happy? Mindfulness, Hygge and beyond.

It’s International Day of Happiness, a good time to think about what makes us happy and steps we can take to improve.

Our emotional wellbeing can have an impact, both positive and negative, on our physical health. It’s a fact backed by countless studies including the annual World Happiness Report.

In 2017, Norway topped the polls of the World Happiness Report. They’re joined in the top four by Denmark, Iceland and Switzerland. The rankings look at the main factors that are considered to support happiness: caring, freedom, generosity, honesty, income and good governance.

The 2017 report also examined the social foundations of happiness and it’s importance and demonstrated how work is also a big part of our happiness with unemployment being linked to lower scores.

Within countries, differences in happiness appeared not to be explained by discrepancies in income, but by difference in mental health, physical health and personal relationships.

Patients with chronic illness and chronic pain have higher rates of depression and we know that depression can worsen our experiences of illness and pain – the physical and the psychological are intrinsically linked.

When faced with troubles – stress at work or home, financial worries or health worries, it can be easy to focus on these and lose sight of what keeps us happy. In psychiatry sometimes these are referred to as protective factors – unique facets our lives that keep us safe and happy. For some, it might their family, their spouse, pets – to be honest it can be anything, as long as it works for you. Imagine the scene from Harry Potter – where he has to visualise a happy memory that Harry Potter before he could fly a broom – it’s the same principle! By understanding those principles that truly make us happy, we can call on them in times of need.

Not losing sight of those factors, or the bigger picture, are similar to concepts explored by mindfulness. A Buddhist philosophy that promotes the focusing on the here and the now, and quietening our minds to the external stressors. Mindfulness is gaining popularity in and outside of medicine and it’s ability to help with problems such as anxiety are becoming more apparent. There are lots of really useful online tools for mindfulness and if you’re someone who has anxious tendencies, they are worth exploring.

One way to naturally boost those happy feelings are exercise. There is a unique sense of wellbeing that comes after a work out or after exerting yourself. The process itself promotes the release of endorphins that boost our mood. Not to mention the added benefits on the body, the heart, improved sleep etc.

In honour of International Happiness Day, I have been reading about Hygge.

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A cosy, bubble of good feelings that has come from our Danish cousins – it might not be that much of a coincidence that they made into the runner up position on the World Happiness Index after all.

Hygge, which has been open to some speculation, has saturated our media – newspapers, blogs, insta posts, of late. So popular, the Oxford Dictonary short-listed it as a word of the year in 2016 (it lost out to ‘post-truth’). But what is it all about? In short, it’s an approach to living that embraces the positive and enjoyment in everyday experiences which are thought to be core in the attitudes of Scandinavia.

Whether you choose to follow the teachings of mindfulness, the concepts of Hygge, you work it out in the gym or another path to happiness, remember this: your emotional health is as important as your physical health. We are well when we are holistically well, our body and mind working well together.

 

 

 

 

18th Century teeth in the 21st Century

Today is World Oral Health Day. The main aim is to raise awareness of the impact that oral health can have on overall physical health and well being. Unfortunately for us, Britain seems to have given up on its dental health.

To be specific, successive governments appear to have decided that our dental health no longer has the same level of importance and slashed the availability of free dental care. Britain has one dentist for every 2000 people (WHO 2010) which sounds reasonable. However, seeing a dentist on the NHS has become something of a fabled miracle in many parts of the country.

 

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The NHS is happy to clean up your vomit if you get drunk every night, hold your hand if you inject yourself with too much heroin and help you cough up black phlegm if you spend your days chain smoking. If you don’t brush right though, the NHS is not necessarily your friend.

It is now almost impossible to find an NHS dentist. Even if you are lucky enough to secure one of the prized places, people are still charged up to 80 per cent of the cost of treatment. Being a child, being pregnant or being on social welfare and benefits are the main groups that are entitled to free treatment.

 

This has left us with a two-tier dental system. The upper tier pays to see a dentist privately and these patients have the unenviable privilege of paying the highest prices in Europe. The second tier scrambles for an NHS dentist and waits so long for partly subsidised treatment that their teeth can crumble or cause agony in the meantime. There is a third tier who have their own pliers and bits of string! Shockingly, more than one in 20 have said that they resort to DIY surgery.

 

Having bad teeth is not without consequences. For the young and middle aged, bad teeth can make it more difficult to find a good job or a successful relationship. It has been years since I’ve seen a TV presenter without a perfect set of white, straight teeth and as a country, we now spend £360 million on cosmetic dentistry a year.

For the elderly, poor dental health can leave them unable to eat properly or in pain. Gum disease also increases the risk of mouth cancer, and pancreatic cancer in men.

So how can we make sure we care for our teeth? Here are our top tips for a healthy smile:

 

  1. Brush your teeth twice a day with toothpaste that contains fluoride, this will prevent tooth decay, gum disease and bad breath. Brush your teeth for two minutes each time. Some electric toothbrushes now have timers and apps to help make sure we are covering all our teeth for long enough.
  2. Teach children at young age about healthy oral hygiene habits and supervise them until around the age of seven. The earlier this becomes part of their life, the more likely it is to become an engrained routine that will stay with them. Children should start seeing a dentist when their baby (milk) teeth first appear. Baby teeth are thinning and less able to withstand the bacteria that cause tooth decay. Decaying baby teeth can have a negative impact on adult teeth and needing extractions (removal of teeth) can lead to problematic adult teeth.
  3. Health diets which minimise sugars will minimise oral health problems. Fruit juices can be deliciously refreshing but can be high in sugars, try to get into a habit of reading your food labels.
  4. See your dentist! This might sound a bit obvious but just we get an MOT and service on our car by an expert mechanic, it’s also important to have an MOT on your mouth. Your dentist will advise you on how often you need to be seen, it can vary depending on your dental health.
  5. Flossing. Using floss or the small interdental brushes can get to the edges of the teeth that brushing can’t. Think about the last time you washed your car, you wouldn’t get wash the bonnet and the boot (trunk) and leave the doors dirty would you?

Healthy teeth used to be a marker of a modern first world society. If Britain doesn’t make changes soon, our lack of investment in dental care will leave us with 18th century teeth.

World Glaucoma Week: Shining a light on glaucoma

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By 2020, the number of people in the world with glaucoma is expected to reach 76.0 million. That is more than the entire population of the UK. Glaucoma is one of the leading causes of blindness in the world. Fortunately, it is highly treatable with the right medications and intervention if detected early.

This week is the 7th World Glaucoma Week. This was launched back in 2010 and the aim has been to increase awareness of the disease. The key to managing glaucoma is early diagnosis. Glaucoma generally involves high intraocular pressure (high pressure within the eye) which causes damage to the optic nerve. This is the main nerve that helps us to see.

Your optician can check the pressure in your eye with a simple painless test. By looking in your eyes they can also look for signs of damage to the optic nerve caused by glaucoma. As with high blood pressure which damages our blood vessels, the aim is to keep the pressure down. Early detection allows use of appropriate eye drops which reduce the eye pressure and minimise/stop damage to the optic nerve.

This year, the particular aims are to get national health authorities across the world (such as the NHS) to design strategies to combat glaucoma blindness. Educational materials about glaucoma should be delivered to those people at risk via all mediums including social networks. Resources should be focussed on those patients least likely to access eye care.

Thousands offer their time for free to support World Glaucoma Week and much has been achieved by the previous years. The aim is now to build on this work and reduce the effects of this potentially blinding disease. You can find out more on at the  World Glaucoma Week website.

–Nitin