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by James Thomas, Saturday, 05 November 2016 | Categories: General Health

It’s a feeling nearly everyone can relate to; you’ve just eaten a delicious meal at a posh restaurant and when you get home to bed, you find yourself clutching your chest and gulping down water to try and alleviate that horrible burning sensation.

No, you’re not having a heart attack – but heartburn (which is caused by stomach acid leaking into the oesophagus) is certainly an unpleasant thing to experience. And you’d be in the minority if you haven’t been through it at least once in your life. Unfortunately, for some Brits, heartburn is a daily reality, just one symptom of a chronic condition known as gastro-oesophageal reflux disease (or GORD, for short).

In 2011, a Norwegian study found that cases of GORD were on the rise, and suggested a link between this and rising body weights. At the time, the Daily Mail reported on this study, interpreting the results as an indication that obesity caused by a fatty diet is a direct cause of heartburn and acid reflux. As shown here, the NHS dismissed the Daily Mail’s take on the results, as the study did not show a link between diet and symptoms.

In fact, while it is true that obesity puts you at greater risk of GORD the foods that most commonly cause heartburn are not those you might expect. According to the experts at WebMD, some of our favourite healthy foods can be a high risk for triggering an attack of heartburn.

If you find yourself regularly battling with heartburn, it’s worth visiting a doctor, as you may be suffering from GORD and may require medication. If you aren’t diagnosed with GORD, or if it’s only causing moderate symptoms, you should be able to manage the condition at home by making some adjustments to your diet and lifestyle.

Foods to Avoid

There are a number of different foods and drinks that can trigger heartburn and acid reflux:

  • Acidic foods such as citrus fruits or juices, and tomatoes
  • Garlic and onion
  • Spicy food containing lots of pepper and/or chilli
  • Peppermint
  • Alcohol
  • Caffeine
  • Chocolate
  • Carbonated drinks

Though the Daily Mail’s condemnation of a fatty diet was a little slapdash, they weren’t totally wrong – as you’ll read here, foods that are high in fat (avocado, cheese, nuts and steak) can also cause heartburn. This is because high-fat foods cause the stomach to empty more slowly, meaning it is more likely to swell, putting pressure on the muscles that keep it closed and allowing for acid to leak out.

Having said that, it may not be necessary to completely cut out the foods and drinks listed above – particularly the healthier ones. However, eating them in moderation, and not in combination with one another, is advised.

Lifestyle Changes

As well as looking out for foods that can trigger your heartburn, you should avoid eating very large meals – instead, eat several small, light meals over the course of the day, and leave several hours between dining or drinking alcohol and going to bed.

Raising the head of your bed by around 20cm can also help to alleviate symptoms. This is because, for stomach acid to leak into the oesophagus, you have to be lying flat or bending over. Lying at an angle should help prevent this from happening. To raise your bed you should insert blocks underneath the bed – simply propping yourself up with pillows will not work.

Losing weight and quitting smoking are also advised.

Medical Treatment for Heartburn

If you are suffering from persistent heartburn, it may be appropriate to start using medication. There are various types available, ranging from over-the-counter antacids to prescription-only proton-pump inhibitors (PPIs) and H2-receptor antagonists (H2RAs). Antacids neutralise the effects of stomach acid, while PPIs and H2RAs actively reduce the amount of acid produced by your stomach.

In rare cases, surgery may be the most suitable course of action. Most commonly, GORD is resolved through keyhole surgery in which the ring of muscle between the oesophagus and the stomach is tightened. This prevents the leakage of stomach acid.

To find out more about medical treatments for heartburn, consult our dedicated heartburn page.

by James Thomas, Saturday, 15 October 2016 | Categories: General Health

For many people, there’s something irresistible about the idea of a midnight snack or a movie night packed with popcorn and sweet treats. But though we all know indulging in biscuits, brownies and crisps is bad for our health at any time of day, how many of us are aware of the toll these foods can take when they’re eaten after 7pm?

If recent findings are to be believed, then we all need to start making our evening binges a thing of the past. As reported here, the European Society of Cardiology has found that people who eat large meals after 7pm experience dramatic increases of blood pressure overnight.

This is worrying because high blood pressure (also known as hypertension) is associated with all kinds of health issues, including heart disease and stroke. It’s also concerning because most of us consider 7pm an ideal time to eat dinner!

If the research is accurate, and eating late really can cause problems with our blood pressure, then what is the best way to stay healthy? Well, it isn’t as simple as eating dinner at 6.30pm.

Current Guidance for Healthy Eating

According to the NHS, there are several factors that go into a healthy diet. The first recommendation is that men consume 2,500 calories and women 2,000 calories a day. This will differ slightly depending upon your age, fitness, health and weight. However, if you get into the habit of eating significantly more or less than this, you could be putting your health at risk.

The calories you consume should also be nutritious, and not simply made up of sweets and junk food. Your daily diet should include:

  • 5 portions of fruits and vegetables
  • Starchy carbohydrates, preferably wholegrain or high fibre
  • Protein in the form of lean meat, fish, eggs, pulses and/or beans
  • Low fat dairy
  • 6 to 8 glasses of water

Red meat should not be eaten too regularly; however, in small portions it does have health benefits, as it is packed with protein, iron and zinc. If you are eating more than 90g a day you are advised to cut down.

Sugary drinks, chocolate, sweets and snack foods that are oily, fatty or salty are not strictly off-limits. However, they should be restricted; eat this kind of junk food in small portions, and not on a regular basis.

The newest research also suggests that eating at the same time every day is also important. Heart expert Dr Ebru Özpelit advises that we should eat a good breakfast, avoid skipping lunch, and keep our evening meal small, light, and ideally before 7pm.

Avoiding High Blood Pressure

It’s not always easy to avoid developing high blood pressure. This is because it is related to age, genetics and family history, and even sleep deprivation.

If you think you may be at risk of high blood pressure, you should visit your doctor for a blood pressure test. A normal blood pressure measurement is anything between 90/60mmHg and 120/80mmHg. High blood pressure is considered anything over 140/90mmHg. However blood pressure between 120/80mmHg and 140/90mmHg is considered prehypertension – this means your blood pressure could continue to rise and pose a risk to your health. If your blood pressure is in this range, you may wish to start making some changes to your diet and lifestyle.

Things you can do to limit your risk of (or lower existing) high blood pressure include:

  • Eating less than 6g of salt a day (roughly one teaspoon)
  • Cutting down your alcohol intake, and avoiding alcohol "binges"
  • Losing weight
  • Exercising (the NHS recommends at least 150 minutes of moderate activity every week)
  • Cutting down on caffeine
  • Quitting smoking
  • Getting a good night’s sleep

In some cases, this won’t be sufficient, and medication will be required.

Medical Treatments for High Blood Pressure

There are several different treatments for high blood pressure. The five most common are:

These medications are prescribed depending upon your age, health and family history. Find out more about pursuing a healthy lifestyle and avoiding high blood pressure by visiting The Online Clinic’s hypertension information page.

by James Thomas, Saturday, 10 September 2016 | Categories: General Health

Who handles pain better, women or men? This simple question is hotly debated in the medical community and, indeed, many social circles. There’s the argument that women naturally handle pain better, because they have to experience menstrual cramps and childbirth. This is fairly convincing until you consider the fact that in a recent study of 11,000 patients, women were consistently found to have elevated clinical pain scores in comparison to men.

Pain is, of course, a totally subjective thing, and there are many different factors that must be called into account when examining the way one person handles it. A man may understate the severity of his pain in an attempt to seem more masculine. Two women may experience the same injury, but experience it differently due to one of them living with a pre-existing condition that causes chronic pain.

What is undeniable is that, for doctors, fairly evaluating a patient’s pain level is no easy task. And if recent reports are anything to go by, this is leading to unfair treatment of female patients. According to research carried out over the past few years, women’s pain is – by and large – taken less seriously than men’s. Abdominal pain is just one instance where men and women are treated very differently, with men waiting an average of 49 minutes in A&E and women an average of 65 minutes.

Some may argue that doctors are more likely to downplay abdominal pain in women, because they make the assumption it is related to menstrual cramps (which are agonising but otherwise harmless). But in this worrying story penned by journalist Joe Fassler, we see an example of a potentially life-threatening condition ignored by hospital doctors and nurses for many hours. Recently, coverage of endometriosis – a condition in which cells similar to those in the womb lining grow outside of the uterus – has also revealed how women suffering with this debilitating condition are often dismissed by doctors.

Regardless of what pain may indicate, it’s important as a patient to feel as though your suffering is acknowledged and understood. The question is: how should women go about seeking medical help for pain when doctors are more likely to dismiss it?

What to Do If You’re Experiencing Pain

The hard and fast rule for any health-related issue is to trust your instincts. If you begin to experience pain that you have never felt before and that doesn’t go away on its own, it is always worth seeking medical help.

There are also certain symptoms that, according to medical advice, should never be ignored. These include:

  • A sudden, severe headache, especially if it is accompanied by visual aura. This could indicate a number of acute conditions that require immediate medical attention.
  • Bad toothache where the tooth throbs or twinges. If left untreated, a damaged nerve can become infected, and this infection can spread through the body causing serious complications.
  • Severe, stabbing abdominal pain that travels to your lower right-hand side and becomes worse as time goes on. This could indicate appendicitis, but it could also be a sign of an ovarian cyst. In either case, do not ignore the pain.
  • Constant back pain and numb feet. This is an indication of a problem in the spine, caused by a spinal disc slipping or rupturing and pressing on the spinal nerves.
  • Chest pain, shortness of breath and a feeling of tightness or pressure in the chest. This can indicate a heart attack.

Living with Chronic Pain

In some cases, pain is not something that requires urgent medical treatment. For people who suffer from conditions that cause chronic pain, it’s simply a part of everyday life.

There are many different ways of managing chronic pain, but some things that are known to help include exercise, physical therapy and painkillers. The psychological aspect of chronic pain can also be very damaging; for that reason, it’s advised that you try and live as normal a lifestyle as possible. Staying in work, continuing to see friends, and making sure you leave the house every day are all key to maintaining a positive outlook.

The NHS has further resources dedicated to living with pain, which you can explore here. Otherwise, speak to your GP or visit The Online Clinic’s Pain Management centre, where you can learn more about managing pain and request safe prescription painkillers.

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by James Thomas, Saturday, 10 September 2016 | Categories: Womens Health

Emergency contraception is something that most sexually active heterosexual women end up using at least once in their life. No matter how well prepared we are, accidents happen; whether it’s a condom splitting or slipping off, a missed pill, or simply getting caught up in the heat of the moment.

The good news is that the morning after pill and the emergency IUD (coil) are now widely available in the UK from NHS centres, private clinics and high street pharmacies.

In a shocking turn of events, though, the most popular form of emergency contraception has been challenged by a new study, which claims that the morning after pill Levonelle is ineffective in women over a certain weight. Recent research by an American university has shown that emergency contraception containing levonorgestrel (the active ingredient in Levonelle) is less effective in women considered obese. More specifically, the amount of levonorgestrel in their bloodstream after taking the morning after pill was 50% lower than in women of a healthy weight.

The woman leading the study, Alison Edelman, spoke to Women’s Health about her findings, and discussed how doubling the dose of levonorgestrel for obese women seemed to be an effective solution to this problem. However, she felt she could not recommend this as an appropriate course of action until further research was carried out.

Misleading Information

While this new research is cause for concern, it’s important to bear a few things in mind. First of all, this study only looked at ten women – a very small sample size. Secondly, many press outlets are conflating Edelman’s results with an entirely different story which originated in 2013.

Three years ago, European morning after pill Norlevo hit headlines when it released packs printed with a new warning. According to this warning, Norlevo (which contains the same dosage of levonorgestrel as Levonelle) was:

  • Less effective for women weighing 75kg (165 pounds/11st 11lb)
  • Ineffective for women weighing over 80kg (176 pounds/12st 8lb)

This warning was later removed from packs, following advice from the European Medicines Agency which found that: "the data was [sic] not robust enough to conclude with certainty that contraceptive effect is reduced with increased bodyweight".

Despite this retraction, many press outlets reporting on Edelman’s research have incorporated Norlevo’s statistics into their stories – presumably in a bid to create better headlines! In actual fact, the weights suggested by Norlevo would not indicate obesity in the average woman.

Using the NHS BMI calculator, you’ll find that a 25-year-old woman who is 5’5’’ tall, weighs 165 pounds (11st 11lb) and is moderately active has a BMI of 27.4. This puts her firmly in the category of overweight – but not obese. Even a woman weighing 176 pounds (12st 8lb), who is similarly 5’5’’ tall and moderately active, has a BMI of 29.2. This is still classed as overweight, and is only just on the cusp of clinical obesity.

If Edelman’s research is to be trusted, a woman would have to have a BMI of over 30 for the morning after pill to be ineffective. Coupled with the other characteristics listed above, that works out to a weight of 181 pounds (12st 13lb).

Is it still safe to take the morning after pill?

Yes, it is still safe to take the Levonelle morning after pill as a means of preventing pregnancy. If you have had unprotected sex and you do not want to get pregnant, it is still better to use Levonelle than nothing at all – even if you are overweight. However, if your BMI does place you in the category of obese, and you are concerned that Levonelle may not work, you can always speak to a doctor about using an alternative form of emergency contraception.

There is currently no evidence to suggest that the efficacy of the morning after pill EllaOne is affected by weight. Unlike Levonelle, EllaOne can be taken up to five days after unprotected sex (Levonelle only has a window of three days).

You can also have the emergency IUD (coil) fitted up to five days after unprotected sex. This can only be done by a medical professional, but it is free from NHS clinics.

by James Thomas, Thursday, 21 July 2016 | Categories: Smoking

Is There Really an "Easy Way" to Stop Smoking?

It’s a question that thousands of smokers around the world ask themselves every day: Is there an easy way to stop smoking? Something that will prevent withdrawal symptoms and eliminate all those pesky cravings?

The short answer is no – but that doesn’t mean you should lose hope. Quitting smoking is a complex process that differs hugely from person to person, and how difficult you find it depends upon factors that include how much you smoke, and what kind of lifestyle you live.

Today, many "stop smoking" treatments are available – as well as other options, which are not treatments as such, like e-cigarettes. And unsurprisingly, all have been subject to various criticisms from both users trying to quit and the medical community trying to protect their health.

The E-Cigarette Argument

There’s been a great deal of controversy surrounding the safety of e-cigarettes. In 2014, the World Health Organization called for e-cigarettes to be banned indoors and advised that manufacturers not be allowed to market their devices as smoking cessation aids. But then last year, Public Health England declared that e-cigarettes were 95% safer than regular cigarettes, and recommended that the UK’s eight million smokers switch over to vaping.

Unsurprisingly, this was met with criticism, and earlier this year the British Medical Association echoed the advice of the WHO by recommending that vaping be banned indoors, a statement that has in turn been criticised by tobacco control experts keen to encourage smokers to quit.

Like any hot issue under debate by the medical community, the discussion around e-cigarettes is unlikely to die down for some time – and until more studies are carried out into the long-term effects of vaping on our health, we won’t have any firm answers about whether or not it’s a safe alternative.

Smoking Cessation Treatments Approved by the NHS

If you’re looking to quit smoking but you feel dubious about using e-cigarettes there are some other ways to kick-start the process.

*Nicotine Replacement Therapy*

Nicotine replacement therapy (or NRT) is available over the counter in any high street pharmacy. As most of us are aware, the addictive ingredient in cigarettes is nicotine; by substituting cigarettes with skin patches, chewing gum, inhalators, tablets or sprays that contain nicotine (but none of the other poisonous chemicals) you can start to break your smoking habit.

Taking nicotine replacement therapy regularly after you stop smoking helps to minimise cravings and withdrawal symptoms, and allows your body to adjust slowly. Normally NRT lasts eight to 12 weeks before the dose of nicotine is reduced, allowing you to wean yourself off.

Champix and Zyban

Two other stop smoking treatments are Zyban and Champix. Both these medicines come in the form of a tablet, taken daily, and work by breaking down your addiction to nicotine.

It is not completely understood how Zyban works; however, Champix is known to prevent nicotine from binding to the parts of the brain that respond to it. This helps to slowly diminish the pleasant "reward" feeling you get from smoking.

For treatment with Zyban or Champix to work, you should start taking your tablets seven to 14 days before you quit smoking. A full course of Zyban normally lasts for seven to nine weeks, and a full course of Champix normally lasts 12 weeks – however, further courses can be prescribed if you are at risk of starting smoking again.

The Online Clinic does not prescribe Zyban.

Additional Stop Smoking Tips

Other tips that can help you quit for good include:

  • Downloading a "quit smoking" app to your phone that keeps track of your progress
  • Avoiding foods that make cigarettes taste good when you’re having a craving (that means swapping out meat for cheese, fruit and vegetables)
  • Avoiding drinks that make cigarettes taste better when you’re having a craving (that means avoiding fizzy drinks, alcohol and caffeine – sorry!)
  • Creating an action plan for dealing with your worst cravings
  • Exercising to combat cravings, withdrawal symptoms and low moods

Lastly, remember that asking for help is the best way to stop smoking for good – according to the NHS, smokers are four times more likely to quit if they use NHS services and resources.

You can also start your smoking cessation journey by requesting a prescription for Champix tablets through The Online Clinic. Click here to find out more.

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