Red meat - what's the beef? Dr Christian Jessen

Red meat is again arousing strong - and conflicting - passions in those with opinions about what's good for us. On the one hand, the Department of Health is warning Britons to cut down on our red meat consumption because it increases our risk of developing bowel cancer.

Under its new guidelines, adults are advised to eat no more than 500g a week. On the other hand, last week the British Nutrition Foundation claimed that most adults ate "healthy amounts" of red meat and the link to cancer was "inconclusive".

Finally, nutritionists have got in on the act and declared that lean red meat such as steak is healthy and one of the best sources of iron, and that women in particular are shunning it at the risk of developing anaemia.

So what should we eat? Well, I side with the nutritionists on this one. We need red meat, we evolved to eat it, and women in particular benefit from including it in their diets. The great flaw in all the above arguments is that taking a single food group in isolation and reporting on its benefits or deficiencies is nonsensical.

Foods work together, in combination, to provide their benefits. It's why we advocate a balanced diet with plenty of variety. There is a good reason why we drink a glass of orange juice with our breakfast cereal in the morning. The vitamin C in the juice helps our guts absorb the iron in the cereals.

The truth is that some foods people have traditionally believed to be iron-rich, such as spinach, are not. Despite Popeye's claims, spinach is one of the poorest sources of iron I can think of. Not only does it start with low levels in the first place but it also contains a compound called oxalic acid, which inhibits iron absorption by the gut.

If you add the fact that high-fibre foods such as fruits and vegetables contain chemicals called phytates that can slow down iron absorption, you can see how people avoiding red meat and relying on plant sources of iron are at significant risk of becoming anaemic. In fact, iron deficiency is the commonest nutritional deficiency in Britain.

Red meat isn't perfect. The problems come from two main sources. Its fat content, particularly saturated fat, does increase the risk of heart diseases and cancers, and the chemicals produced when the outside of the meat is charred during the cooking process are indeed carcinogens.

So the solution is very simple: buy lean cuts of meat, don't burn it when cooking, and eat it in moderate amounts. It's an important and nutritionally valuable part of our diets.

Hypnosis is the new way to give birth painlessly

In the middle of huge cutbacks and extensive NHS reform any newly emerging techniques that promise to save money will be welcomed with open arms.

One such proposal seems sound enough: hypnobirthing. An 18-month NHS trial study aims to teach expectant mums how to hypnotise themselves before giving birth as an alternative to painkillers. This will involve learning how to attain a trance-like state during labour in the hope that they will not need costly treatments such as epidurals. First started in the US, it uses self-hypnosis, relaxation, visualisation and breathing techniques to prepare for birth.

Currently as many as 60 per cent of mothers have epidurals and many more use other forms of pain relief, the safety of which has often been questioned. Many mothers enter the delivery suite intending to have a "natural" birth, then understandably demand drugs when the true might of their contractions kicks in.

Hypnosis is successfully used in many other areas of healthcare, including dentistry, well known for its association with pain and fear, and fear here seems to be the key. Most mums experience anxiety and fear about the impending birth, in part due to our society's highly medicocentric approach to birthing, implying that it is a dangerous, painful and scary experience.

Hypnotherapists believe that a lot of the pain of childbirth comes from fear acting on the body to cause tension and muscle constriction. If women can relax and release muscle tension, this causes less pain, more effective contractions and often a shorter labour. It certainly sounds plausible, and the feedback from women who have used it has been consistently positive.

It's even been backed up by several relatively large-scale studies, one of which found that self-hypnosis during childbirth eased some of the pain of labour, lowered the risk of medical complications and reduced the need for surgery. Another study found that hypnotherapy shortened the first and second stages of labour. For women having their first babies, the first stage was reduced from an average of 9.3 hours to 6.4 hours, and the second stage from 50 minutes to 37 minutes on average. The differences for women having their second or later children were less dramatic, and it is here the financial benefits may be seen.

I can certainly see the downsides; this technique will not work for all women. I also worry that medical staff may attend less often seemingly self-sufficient labouring women, so putting them more at risk of complications going unnoticed.

But in general it's harmless, proven in studies, and empowers women to have more control over the birthing process, unlike other ill-thought-out proposals the NHS comes up with.

Marathons can hurt you in the long run

Every year around this time several of my habitually unfit patients march in to my clinic and proudly announce that they have decided to do the London Marathon to get fit. My heart sinks. Running the marathon will not make them healthy, it will probably do quite the opposite.

People forget that the marathon is an extreme event. Even running intensely for an hour a day puts your body under so much stress that it will begin to break down. There is a very good reason why so many committed marathon runners look like they are suffering from fatal diseases.

The intensity of some training regimes, and the lack of efficiency of others, mean that the body will either be seriously damaged during training or totally annihilated by the main event. Here's an analogy: drinking water is a generally healthy thing to do, drink too much and it can kill you.

Some people are built for long-distance running and others aren't, but this is never taken into account. They may be able to push themselves by training and just about manage to finish the course, but will do their bodies no good at all in the long term.

Researchers from the Heart and Stroke Foundation will back me up. By MRI scanning hearts of runners they found that without proper long-term training marathons damaged the hearts of less fit runners. The exercise-induced injury is reversible over time, but could take up to three months.

Poorly prepared runners were also found to become more dehydrated and show greater loss of function of important areas of their hearts.

I fully expect to be bombarded with criticism for writing this, so let me just make what I'm saying absolutely clear: if you want to run a marathon, then do so, especially if you can raise some money for good causes along the way. But make sure that your training regime is suitable or you will almost certainly do yourself more harm than good.

Simon Cowell lacks the pecs factor

Recent photos of Simon Cowell on the beach have been less than flattering, mainly down to the emergence of a bust many women would be proud of.

Surprisingly, given his alleged vanity, his man boobs, or moobs, don't appear to bother him but, according to new research, he is in a minority.

The latest figures show that men are queuing up to get rid of their moobs - in fact, the operation to remove them was the second most popular cosmetic procedure last year, showing a 28 per cent increase on 2009.

Only nose operations had a greater appeal among men.

Men get a drubbing in the media - not to mention down the pub - if they undergo cosmetic procedures but the fear of mockery seemingly isn't putting them off.

Clinics reported a seven per cent increase in men signing up for cosmetic operations last year, compared with five per cent in women.

And moob removals are among the most popular treatments - so what exactly are they?

There are two sorts of moobs. One sort is caused by a condition called gynaecomastia, commonly seen in teenage boys. Firm, tender glandular breast tissue grows under the nipples, under the influence of hormones, and is usually caused by rising oestrogen levels that occur during puberty.

These moobs disappear without treatment within a couple of years. In adults, however, their occurrence is not normal. They are often caused by the conversion of testosterone into oestrogen via the enzyme aromatase.

Affected men may also notice a reduction in muscle mass, a more feminine fat distribution, tiredness and loss of libido. Taking anabolic steroids, certain medicines or using cannabis can also upset hormone levels, causing gynaecomastia, and occasionally it may be due to a tumour or hormonal disease of the pituitary gland, liver or testes.

The more common type of moob is something entirely different, most frequently observed in the middle-aged male.

They are, to be blunt, just fat, caused by poor diet, lifestyle and lack of exercise. This "false gynaecomastia" does not involve any real breast gland growth, and none can be felt. The breast tissue simply feels as it looks: loose and flabby.

Moobs are the stigmata of modern working life, ushered forth by the all-too-commonly encountered combination of stress, booze, lack of exercise and poor diet, and can be tackled by a good overhaul of lifestyle.

But there is a certain degree of crossover between the two types of moobs because testosterone is converted to oestrogen primarily in the fat cells, so the fatter you are the more likely you are to
develop them.

It can all seem very amusing and if you want some alarming examples of man boobs, look at the top 10 page at manboobs.co.uk. If yours look anything like these, it really is time to do something about them.

Moobs can actually signal the impending onset of heart disease, stroke, high blood pressure and diabetes. So it's not that funny at all really.

GP patients have to be seen

The NHS has been in the news a lot recently. Big changes are afoot, and about time too. While I am very aware that it is blasphemy to say so, the NHS no longer works well in many areas, and needs to change. It's a constantly evolving being and the way it is managed needs to evolve along with it. Unfortunately this hasn't happened.

I think some of the new proposals are very sensible. Surely if anyone is going to know where money is most needed and best spent it is the GPs on the front line? I hope this plan works and I welcome it.

There is another idea being touted, however, that I don't think is sensible. In fact, it makes me very concerned indeed. The Government is planning to offer patients email consultations with GPs. People will be able to directly email their GP through a new Communicator tool, part of the secure personal health organiser website originally set up to allow patients to view their records online. Remember what a disaster the NHS IT system was to set up? Doesn't bode well, does it?

It's a move the Government claims will improve access to primary care. The word to pick up on is "access". It may well be improving access but it is certainly not improving care. It may possibly work for issuing repeat prescriptions to those with chronic but well managed conditions, or getting results from home test kits such as blood sugar or BP, to update records, but beyond this? No chance.

There is a very good reason why tradition has dictated that doctors bother to see their patients in person, to talk to them, ask them salient questions and maybe even lay on a hand. It's because patients are not generally very good at telling you what is wrong with them. They need help, and it is not always what they say that gives you the answer. Being able to see them, to read their body language and hear the tone of their voice are vital parts in diagnosis. I'll give you an example: chest pain. "Dear doc, I have pain in my chest, comes and goes, maybe a bit goes to my left arm as well. Should I be worried?"

Chest pain can have many causes, heart attack being one, acid reflux another, but it could also be a simple chest infection or even depression manifesting as a pain. Never could this be worked out from an email without either much back-and-forth correspondence (taking up at least as much time as a face-to- face consultation) or a very informed, educated and impartial patient relating the exact relevant symptoms correctly. It won't happen.

I have had good personal experience of this long before any pilot schemes were tried out. Since my TV shows have aired I have been inundated on a regular basis with emails from people all over the world wanting help, advice and diagnoses. I can confidently say that few are easily or quickly answerable, and few give enough information for any sort of useful reply to be given other than "Better go and see your doctor".

Given that the public is spending £2 billion a week on the health service I think it a very sad state of affairs for medicine if a face-to-face appointment with a GP becomes not a right but a luxury.

Cash for eggs: there are so many issues

Fertility and its management is always an emotive subject that polarises opinion. The views of the public are currently being sought on surrogacy - in the spotlight again following Nicole Kidman's announcement that her second daughter was carried this way - as well as the use of donor eggs and sperm to enable infertile couples to have a baby. More ethical issues are being explored, including whether close relatives should donate eggs or sperm to each other, and if it is acceptable for a baby to be born, through egg donation, to a woman who is also its grandmother.

The debate follows a high court ruling that may have opened the way for surrogate mothers to be paid, a practice which had been banned. If the public concede, then women could be set to receive thousands of pounds for donating their eggs. Currently, British clinics are banned from paying for eggs and sperm directly but can pay up to £250 in expenses - which hasn't exactly filled potential donors with a desire to go through with the process of donation.

The problem with the "cash for eggs" proposal will not be with the well-meaning majority but the unscrupulous few, who will lure in women by making egg donation seem like an easy way to earn money - without any explanation of what actually is involved. Worrying, too, is the possibility of "designer genes" being offered to couples prepared to pay exorbitant fees for the perfect combination of brains and beauty; the higher your exam marks and the better your bone structure, the more your eggs could be worth.

I'm not sure money is the main issue, however. While it's mainly the small amount of cash currently offered to donors that has been blamed for the shortage of eggs, I suspect a greater problem is the recent change in UK law which requires the identity of sperm or egg donors to be revealed to their children - the idea of a load of "surprise" children showing up years after donation undoubtedly puts off many would-be donors.

Maybe the issue is being looked at from the wrong angle, in London at least. The stats for maternal age show that in the UK London has the lowest number of births per 1,000 women aged 25 to 29, and the highest birth rate for women aged 35 to 39. This implies London women are leaving pregnancy until much later, a known risk for fertility issues and the need for donor eggs or even surrogacy. Many have argued that more should be done to cure infertility and to encourage women to have children when they are young and their eggs are still in good condition, instead of worrying about turning body parts into tradable commodities.

Flu is a threat but simple measures can keep it at bay

Last year I wrote rather scathingly about the panic surrounding the predicted flu epidemic that never was. This year I'm going to be more cautious as I feel things have changed. Flu is back but this time it affects a new demographic of hitherto unaffected people, which could have profound implications on our future approach to managing flu.

The number of flu victims has been rising steadily, which isn't unusual, but these victims are mainly professional, young middle-aged and middle-class, which is. What is worrying some virologists is the newly proposed theory that these current unlikely flu victims are stricken down because last year's flu jab may have made them more vulnerable to this year's attack by the H1N1 swine flu virus.

As it has been estimated that a serious outbreak of flu could kill 65,000 people in Britain and, according to one study, could knock out nearly 40 per cent of all health professionals — doctors, nurses and paramedics — in the first 10 days then this theory, if true, is a disaster. Already swine flu is spreading faster in the UK than in Europe, and the figures are likely to climb even more steeply now that we are back at school and work and mingling with each other again.

But we have had vaccine scare stories frequently in the past and few have been legitimate. In fact many have been very damaging, like the MMR scare.

This is still very much a theory, totally unproven, so I would advise everyone, whatever age or state of health, still to have a flu jab this year, as it will help reduce the chances of a pandemic that could kill far more than the vaccine will ever adversely affect.

This year I have also seen more chest infections in my clinic, always with the same story: “It started off as a bit of a cold, then developed into something much worse, doctor.” Viral illnesses and flu can be common precursors to pneumonias so getting your flu jab will help stop this. Not smoking, a healthy diet, and getting plenty of exercise and rest will too. If you seem to be regularly affected ask your GP about pneumococcal pneumonia vaccine. It's effective in 80 per cent of healthy adults and helps high-risk groups lower their odds of getting pneumonia.

Finally, given the chances of catching flu this year seem so much greater, consider taking antiviral drugs if you do get ill. The side effects can be dreadful but they can make illness milder and last for a shorter duration.

The sound solution for breast cancer

We have long known that breasts change with age. It is a perfectly natural process but one that women have been fighting for generations. Gravity always wins in the end, particularly over women with large boobs who have had several pregnancies. Joggers can suffer particularly badly. But whilst this age related sagging might not be desirable from an aesthetic point of view, it does have a very useful property from a medical one. The older you get, the less dense your boobs get and the easier it is to image them for lumps. This is the reason why we don’t offer mammograms to young women. Currently on the NHS screening is offered from the age of 47, and this is not just to do with money. It really is more effective after this age. Young boobs just don’t x-ray well. But now the results of new studies show another property of breast density, but this one is not so good. There is increasing evidence that density is a key factor in breast cancer. Women with more tissue than fat in their breasts are up to five times more at risk because they have more cells. Those involved in the research have suggested that all women should be advised of their breast density, and all should be offered ultrasound scans, to pick up tumours that mammography may have missed. The theory is that denser breasts hide their lumps from x-rays, but may reveal them to ultrasound. Of course since this information has been released the usual loud clamouring has started, demanding that the already overstretched NHS offers this extra screening test to all women.
Our current screening program is great. Mammography lowers breast cancer mortality by 15% to 20%. But if ultrasound can further improve this then surely it should be added to the program too? The problem is that it is very operator dependent, and in multiple trials comparing the accuracy of mammography plus ultrasound to that of mammography alone in women with denser breasts who were at high risk for breast cancer, the addition of ultrasound to mammography did result in detection of additional cases of cancer, but at the expense of a roughly fourfold increase in false-positives. This means that four times as many women would have to undergo an invasive biopsy procedure that they do not need if this method of screening was introduced. This would cause a level of anxiety that may be acceptable in a high-risk population, but certainly would not be in lower-risk patients. An unobtainable number of extra man-hours would also be needed to cope with the increased counselling involved.
Neither can ultrasound consistently detect certain early signs of cancer such as tiny deposits of calcium in the breast that cannot be felt but can be seen on a conventional mammogram. Nor does it have good spatial resolution like mammography, and therefore cannot provide as much detail as a mammogram image.
What is not being publicised is the fact that the combination of mammography and ultrasound still missed one out of every five cancers. So ultrasound is certainly not a silver bullet for breast cancer screening and shouldn’t be hailed as such. Perhaps rather than shouting that women are being denied ‘life saving cancer tests’ we should be a little more measured in our approach and look for ways to improve the uptake of mammography itself. Still too many women do not attend. Also, ensuring all screening programs offer digital imaging, which is more accurate still, may be a better use of time and money, and will avoid creating a cohort of worried and confused women.

Breaking the migraine barrier

New research looking into the causes of migraines has produced what may be one of the most important and useful medical findings of the century. Scientists have found a gene that regulates how pain is felt in the brain, a gene that can be turned up or down. Called TRESK, the gene controls the sensitivity of pain nerves in the brain and it is thought that migraine sufferers may have a fault in their gene, causing the extreme sensitivity to light, noise and touch experienced during a migraine.

It’s an exciting discovery as it may lead to the creation of a new generation of drugs that can simply turn up the threshold at which the body feels pain making migraines a thing of the past. It not just migraines that will benefit however, as it could potentially lead to a new form of painkiller being developed as well. As the gene is susceptible to being switched on and off with drugs it means that it could be altered to increase the threshold to such an extent it eliminates the feeling of pain altogether.
Migraines cause a considerable burden to sufferers and their work. In the UK around 18 per cent of women and 8 per cent of men get migraines resulting in the loss of more than 25 million working days a year. The World Health Organisation has named migraine as a leading cause of disability worldwide and it has been estimated to be the most costly neurological disorder in Europe.

Sadly migraines are often very badly managed by the medical profession, many of whom still continue to promote ideas like its cheese, or chocolate that cause migraines. Actually the situation is more complex, and it is necessary for more than one trigger to be present, possible more than 48 hours before the onset of headache, in order to cross the threshold that leads to an attack. Contrary to popular belief migraines are not caused by food allergy either, and no specific antigen-antibody reaction has ever been identified although certain foods may be one of a complex of triggers. Actually, missing meals (resulting in a drop in blood sugar) and dehydration are far more important triggers. Changes in sleep pattern, hormonal changes, head and neck pains and stress are all other culprits. Very little time is spent explaining and helping to identify these interacting triggers and existing treatments are often not taken early enough. There is currently no cure for migraines but many different treatments are available which can be effective if used correctly. The problem is that it can require quite a bit of personal experimenting with different types and combinations of medicines before the most effective one is found. Even simple painkillers can work well, but many people only take painkillers when their headache becomes very bad. This is usually too late for any benefit to be felt.


My top 5 tips if your migraines are poorly controlled are:

1) Identify prodromal symptoms like changes in mood or behaviour to help identify as early as possible when a migraine may be imminent.
2) Keep a diary of all the details of what you were doing for the few days before an attack to help you better understand them.
3) Identify your specific triggers and gradually cut them from your life, if possible.
4) Take treatment early –by identifying the warning signs this should usually be possible.
5) Always carry treatment with you and ideally a little food and drink too.

If you feel your migraines are not under control then ask your GP for a referral to a specialist migraine clinic for further advice.

Teen Sexual Health

As a sexual health doctor the recent visit of the Pope made me angry for an obvious number of reasons. In rebellion I want to announce that the 26th September this year is World Contraception Day and we should all mark it. It’s not a day I expect many to have ever heard of, and it is perhaps considered a little too Hallmark for some, but given the statistic that approximately a third of the 205 million pregnancies that occur each year worldwide are unplanned, the need for such a day can be clearly seen. To mark the event a multi-national survey looking at attitudes towards contraception has been undertaken. The results are depressing although pretty unsurprising. They highlight a significant disconnect between what young people know they should be doing for contraception, and what they are actually doing in their day to day lives. It also shows that highly unreliable contraceptive methods, such as the ‘withdrawal method’ are still being viewed as effective by almost a third of young people. Perhaps most depressing of all is the news that that the highest reported rates of STIs are found among young people aged between 15 and 24. Nearly half report that they prioritize personal hygiene, including showering, waxing and applying perfume, above contraception, and teens in the UK reported that the reason why they failed to use condoms was because they were often too drunk to remember.
Straight from the school of the bleeding obvious, this apparently earth-shattering revelation that the appalling STI and pregnancy rates amongst UK teenagers maybe linked to the significant increase in binge drinking observed over the last few years has grabbed headlines but I find it truly hard to believe that no one has made this observation before. Experts quite rightly describe the findings as alarming, but disagree over whether the solution lies in providing more contraception or better efforts to rein in binge drinking. I think improving sex education would be a better starting place, by including more focus on relationships, feelings, emotions, confidence and respect. The British media could also do a lot to help, by stopping its prudish campaign of being deliberately and mischievously resolved to undermine any sexual health/education initiative aimed at helping young people and their parents. I can but dream. I personally find the results alarming because sadly I cannot now see a truly effective solution actually being implemented. The problem is that until the government addresses its ludicrously hypocritical drug and alcohol laws things are only likely to get worse. Making legal (and, let’s be honest, frankly encouraging the use of) the one drug that causes considerable self-destructive behaviour and affects judgement in the way that alcohol does is absurd. It gives such a confused message to our young people that I weep for the future. Yes, alcohol is responsible for many a condomless encounter because that is the one property of alcohol that we most embrace –its ability to make us relax and forget. Teens are no more going to stop drinking than the Catholic Church is going to repeal some of its insane views on sex and contraception.