Tag Archives: Dr Kathleen Thompson

Cholesterol Egg-splained by Dr Kathleen Thompson

Posted on by

egg-24404_640

When I was a child, eggs were definitely good for us – We were encouraged to ‘go to work on an egg’ and boiled eggs with runny yolks and toast soldiers were a healthy meal.

Then in the 1970s everything changed. We were warned that eggs raised blood cholesterol. This caused atherosclerotic plaques (fatty deposits), which narrowed our arteries and reduced blood flow, resulting in heart attacks and strokes.

Cholesterol Egg-splained by Dr Kathleen Thompson

Overnight the egg was recast from hero to villain.

These changes were based on some small studies of animals which were fed high-cholesterol diets, plus large trials involving people who regularly ate cholesterol-rich foods such as eggs.

Forty-years on, we understand that the conclusions reached were flawed.

Dietary studies are always difficult. It is relatively easy to compare a group of patients who are given a new drug with a group who aren’t. In contrast, one can hardly make a group of people eat copious daily eggs for several years, to see whether they suffer more heart attacks than people who don’t.

So, usually people with a certain eating pattern of interest (eg high egg consumption) are followed, and their rates of disease are compared to those with different eating patterns.

However, confounding factors can influence these results. The people who ate lots of eggs in the cholesterol studies often also consumed more saturated fats and trans fats too, in red and processed meat. Other important factors which can affect blood cholesterol, such as physical activity and exercise, were also different between the two groups.

Consequently, eggs were wrongly blamed for blood cholesterol increases.

One should always be wary of facts based on research. Studies are very powerful tools, and numerous important advances have resulted, but the accuracy of data is dependent on the design of the study and interpretation of the results, and can be misleading.

The reality for cholesterol is more complicated than people thought. Our body makes most of our cholesterol itself. Food sources only contribute slightly in most people. Even then, eating eggs raises (protective) high density lipoprotein (HDL) cholesterol, rather than the harmful low density lipopoprotein (LDL) type.

Diabetics handle cholesterol differently, and some people are sensitive to cholesterol. These, in addition to people with familial hypercholesterolaemia (an inherited condition) may need to limit dietary intake.

For most though, blood cholesterol is best controlled with exercise, not smoking, weight control and avoiding saturated and trans fats.

Eggs are an excellent food source. Egg protein provides all the amino acids needed to build healthy muscle. The fat in eggs is mainly monosaturated (44%) and polysaturated (11%). They provide vitamin D and other important nutrients and a medium egg only contains 80 calories.

Free-range chickens can eat worms, insects and other natural foods, which could theoretically improve the quality of their eggs, but all eggs are good.

So, why not go to work on one?

Further Information and References:

http://www.bmj.com/content/346/bmj.e8539

http://www.webmd.com/heart-disease/guide/heart-disease-lower-cholesterol-risk

Note: These articles express personal views. No warranty is made as to the accuracy or completeness of information given and you should always consult a doctor if you need medical advice

 

 

Plantar Fasciitis by Dr Kathleen Thompson

Posted on by

With all those modern-day labour-saving devices, can we put our feet up and enjoy life? No, we are told to shed our sedentary life-style and get fit. But at what cost?

Having spent many Sunday afternoons, patching up sports injuries in A&E departments, the price often seems high.

Besides acute injuries acquired on rugby pitches or tennis courts, our new-found fitness enthusiasm can have more insidious effects, particularly if we dash out, after sitting at a computer for eight hours, to pound the tarmac in our new go-faster runners. We often forget to allow our bodies to gradually adjust and strengthen, pushing ourselves to train too fast and for too long.

This can all take its toll on our fascia. Which is …?

Fascia is an unsung hero. Much of our body is held together by fascia—fibrous sheets and cords under skin, around muscles and organs, forming a framework and providing structure.

Normally it has a smooth surface, allowing muscles to glide over each other. However if strained, it becomes sticky, lumpy and tight. That’s when we start to notice it.

The plantar fascia lies underneath our soles, connecting our heel bone to our toes, and supporting our foot arch. Plantar Fasciitis by Dr Kathleen Thompson3

We usually neglect our poor feet, which carry our weight and absorb intense and rapidly changing forces during many sports.  The plantar fascia struggles to support and maintain foot shape during these activities, but if it is strained, it develops small tears and becomes inflamed.

The first sign is pain under our heel, which, counter-intuitively, is usually worse on getting out of bed, and paradoxically improves when warmed up by exercise. However don’t be fooled. You need to rest your foot to recover. If you don’t you could have chronic problems.

It is most frequent in women, aged 40-60 years, and is induced by long-distance running, walking or dancing,
 obesity and occupations involving standing or walking.

Importantly, the root cause may be elsewhere in the leg, the plantar fasciitis being a manifestation of poor biomechanics and abnormal walking/running movement.

Besides resting, anti-inflammatories, such as ibuprofen help. Most people recommend stretching the plantar fascia, and, importantly, also the Achilles tendon and the calf, as tightness in these may aggravate the plantar fascia. Night splints can maintain stretching whilst you sleep. Others advise against stretching the fascia itself whilst it is inflamed.

Ice massage is useful, for example, rolling your foot on a frozen orange.  The massage is quite painful, and the ice has a numbing effect. Personally, I recommend buying a quarter bottle of Prosecco. Drink the contents, half-fill with water and freeze, then roll your sole on the frozen bottle (the Prosecco takes your mind off the pain).

Shoe arch supports ease the fascia, or your therapist may use strapping.

The fasciitis will eventually settle, but may take up to two years. Steroid injections, give temporary relief but weaken the fascia in the long-term.

So what inspired me to write about this? Let’s just say, I’m rolling my foot on a frozen Prosecco bottle as I write.

Further Information and References:

http://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/basics/definition/con-20025664

http://www.runnersworld.com/tag/plantar-fasciitis

http://www.kttape.com/instructions/plantar-fasciitis/

Note: These articles express personal views. No warranty is made as to the accuracy or completeness of information given and you should always consult a doctor if you need medical advice

 

 

 

Do Medicines Cost Too Much? By Dr Kathleen Thompson

Posted on by

The UK Cancer Drug Fund, which funds non-NHS cancer treatments, has removed twenty-five drugs off its list recently, to combat a £100 million (and rising) overspend. This highlights a recurring dilemma of modern healthcare.

Medical science is advancing with cosmic speed. Patients with desperate diseases have new hope. Genetic advances allow personalised medicine for enhanced individual benefit.

However, drug costs are becoming frighteningly high, and, as people live longer, health budgets rise further. To be cynical, it was cheaper when people simply didn’t survive.

In response, many governments have attempted to force medicine prices down. Politically a quick win. But what are the consequences?

Let’s examine the drug development process. 

picture2drugarticle180915

First a drug target is chosen – often a protein molecule (receptor) on the surface of some of our cells.

Thousands of chemicals are then screened. If they bind to this receptor, they could influence how that cell works, and hence affect disease activity.

Chemicals which do bind are further narrowed down to those with additional potential drug properties—those likely to be well-absorbed, lack toxicity, and remain in the body long enough to work.

A lead candidate is chosen, and then modified further, optimising its chances of success.

Next, as required by government regulations, it is tested in animals and in the test-tube, for potential safety, effectiveness, and suitable dose.

Finally, clinical trials can begin. Often in healthy volunteers first, then small numbers of patients and finally in many patients. Thousands of people are usually tested before a drug can be marketed, and the size and duration of clinical trials has increased, as regulatory requirements have increased1.

Consequently, the typical cost of a new drug development is US$350 million according to a recent study by Forbes2.

But it’s worse than that—the development path is littered with booby-traps and precipices. Fledgling drugs frequently fail, and the Tufts Centre study found that, even those medicines which make it as far as clinical trials, have only  approximately a 12% chance of eventually reaching the market3.

Thus, including the costs of failed developments, the actual cost for each successful drug is nearer US$2.6 billion3, and for many smaller companies, if the roulette wheel isn’t kind, the cost is failure and liquidation.

Pharmaceutical companies are not angels, nor are they demons. To survive, they must make enough profit from their marketed drugs to fund their development pipeline, in addition to returning some profit to shareholders. Long drug-development times, mean they may only have a few years of patent-protection left to achieve this. If governments force prices down, companies sometimes react by reducing development risk – choosing drugs more likely to succeed in preference to innovative but riskier developments for difficult diseases.

A typical drug development takes around ten years – so we won’t see this effect immediately, and when we do, it will be too late – it could take another ten years to correct.

So there’s the problem – health bills cannot continue rising exponentially, but forcing drug prices down has serious consequences too. What to do?

Further Information and References:

1. http://www.phrma.org/sites/default/files/pdf/rd_brochure_022307.pdf

2. http://www.forbes.com/sites/matthewherper/2013/08/11/how-the-staggering-cost-of-inventing-new-drugs-is-shaping-the-future-of-medicine/

3. http://csdd.tufts.edu/files/uploads/Tufts_CSDD_briefing_on_RD_cost_study_-_Nov_18,_2014..pdf

Note: These articles express personal views. No warranty is made as to the accuracy or completeness of information given and you should always consult a doctor if you need medical advice