Experts review vitamin D advice

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24 January 2012 Last updated at 12:19 GMT Concerns over vitamin D deficiency - A quarter of toddlers affected

The chief medical officer for England, Dame Sally Davies, is to contact medical staff about concerns young children and some adults are not getting enough vitamin D.

Government guidelines recommend some groups, including the under-fives, should take a daily supplement.

However, recent research found that many parents and health professionals were unaware of the advice.

There has been an increase in childhood rickets over the past 15 years.

According to Dr Benjamin Jacobs, from the Royal National Orthopaedic Hospital, links to heart disease and some cancers are also being investigated.

Continue reading the main story

It is important to raise awareness of this issue, and I will be contacting health professionals on the need to prescribe and recommend vitamin D supplements to at-risk groups”

End Quote Dame Sally Davies Chief medical officer for England The consultant paediatrician told BBC Breakfast that the hospital saw about one severe case a month of rickets - softening of bones through lack of vitamin D in childhood.

He said: "There are many other children who have less severe problems - muscle weakness, delay in walking, bone pains - and research indicates that in many parts of the country the majority of children have a low level of vitamin D."

The Feeding for Life Foundation report, published in October last year, suggested one in four toddlers in the UK is vitamin D deficient.

However, this may be an underestimate as only vitamin D from food was included, and not any vitamin D obtained through sun exposure.

Vitamin D supplements are recommended for all people at risk of a deficiency, including all pregnant and breastfeeding women, children under five years old, people aged over 65, and people at risk of not getting enough exposure to sunlight.

Vitamin D is mainly obtained from sunlight. However, too much sun exposure increases the risk of skin cancer.

According to one recent study, nearly three-quarters of parents and more than half of health professionals are unaware of the recommendations.

The Department of Health has asked the Scientific Advisory Committee on Nutrition to review the issue of current dietary recommendations on vitamin D.

Dame Sally Davies: "We know a significant proportion of people in the UK probably have inadequate levels of vitamin D in their blood. People at risk of vitamin D deficiency, including pregnant women and children under five, are already advised to take daily supplements.

Free supplements

"Our experts are clear - low levels of vitamin D can increase the risk of poor bone health, including rickets in young children.

"Many health professionals such as midwives, GPs and nurses give advice on supplements, and it is crucial they continue to offer this advice as part of routine consultations and ensure disadvantaged families have access to free vitamin supplements through our Healthy Start scheme.

"It is important to raise awareness of this issue, and I will be contacting health professionals on the need to prescribe and recommend vitamin D supplements to at-risk groups."

It has long been known that vitamin D prevents rickets and children were once given food supplements like cod liver oil.

However, this practice was stopped in the 1950s because it was thought unnecessary.

In the last 10 years, doctors have been seeing more cases of vitamin D deficiency, leading to a debate over the use of food supplements and concern that many medical staff are unaware of the problem.

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Worried about vitamin safety? Experts offer advice

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In this Thursday, Oct. 13, 2011 photo illustration, multivitamins are poured from a bottle in Philadelphia. Two studies released in Oct. 2011 raised gnawing worries about the safety of vitamin supplements and a host of questions. Vitamins have long had a "health halo" - many people think they won't hurt and at worst might be unnecessary. The industry calls them an insurance policy against bad eating. But our foods increasingly are pumped full of them - even junk foods and drinks often are fortified with nutrients to give them a healthier profile - so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit. (AP Photo/Matt Rourke) In this Thursday, Oct. 13, 2011 photo illustration, multivitamins are poured from a bottle in Philadelphia. Two studies released in Oct. 2011 raised gnawing worries about the safety of vitamin supplements and a host of questions. Vitamins have long had a "health halo" - many people think they won't hurt and at worst might be unnecessary. The industry calls them an insurance policy against bad eating. But our foods increasingly are pumped full of them - even junk foods and drinks often are fortified with nutrients to give them a healthier profile - so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit. (AP Photo/Matt Rourke) The nutritional label of a box of multivitamins is photographed in Philadelphia on Thursday, Oct. 13, 2011. Two studies released in Oct. 2011 raised gnawing worries about the safety of vitamin supplements and a host of questions. Vitamins have long had a "health halo" - many people think they won't hurt and at worst might be unnecessary. The industry calls them an insurance policy against bad eating. But our foods increasingly are pumped full of them - even junk foods and drinks often are fortified with nutrients to give them a healthier profile - so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit. (AP Photo/Matt Rourke) The nutritional label of a box of multivitamins is photographed in Philadelphia on Thursday, Oct. 13, 2011. Two studies released in Oct. 2011 raised gnawing worries about the safety of vitamin supplements and a host of questions. Vitamins have long had a "health halo" - many people think they won't hurt and at worst might be unnecessary. The industry calls them an insurance policy against bad eating. But our foods increasingly are pumped full of them - even junk foods and drinks often are fortified with nutrients to give them a healthier profile - so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit. (AP Photo/Matt Rourke)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); Two studies this week raised gnawing worries about the safety of vitamin supplements and a host of questions. Should anyone be taking them? Which ones are most risky? And if you do take them, how can you pick the safest ones?

Vitamins have long had a "health halo." Many people think they're good for you and at worst might simply be unnecessary. The industry calls them an insurance policy against bad eating.

But our foods are increasingly pumped full of them already. Even junk foods and drinks often are fortified with nutrients to give them a healthier profile, so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit.

"We're finding out they're not as harmless as the industry might have us believe," said David Schardt, a nutritionist at the consumer group Center for Science in the Public Interest.

This week, a study of nearly 40,000 older women found a slightly higher risk of death among those taking dietary supplements, including multivitamins, folic acid, iron and copper. It was just an observational study, though, not a rigorous test.

Another study found that men taking high doses of vitamin E — 400 units a day — for five years had a slightly increased risk of prostate cancer.

As many as one-third of Americans take vitamins and nearly half of people 50 and older take multivitamins, surveys suggest. Americans spent $9.6 billion on vitamins last year, up from $7.2 billion in 2005, according to the Nutrition Business Journal. Multivitamins top the list, at nearly $5 billion in sales.

Yet there is no clear evidence that multivitamins lower the risk of cancer, heart disease or any other chronic health problems. No government agency recommends them "regardless of the quality of a person's diet," says a fact sheet from the federal Office of Dietary Supplements. And vitamins aren't required to undergo the strict testing required of U.S.-approved prescription medicines.

Some fads, such as the antioxidant craze over vitamins A and E and beta-carotene, backfired when studies found more health risk, not less. And studies that find more disease in people with too little of a certain vitamin can be misleading: Correcting a deficiency so you have the right daily amount is different from supplementing beyond recommended levels.

The best way to get vitamins is to eat foods that naturally contain them, said Jody Engel, a nutritionist with Office of Dietary Supplements. "Foods provide more than just vitamins and minerals, such as fiber and other ingredients that may have positive health effects."

Schardt adds: "It's virtually impossible to overdose on the nutrients in food."

Some folks may need more of certain nutrients and should talk with their doctors about supplements:

— Postmenopausal women regarding calcium and vitamin D to protect bones.

— Women planning on pregnancy regarding folate, or folic acid, to prevent birth defects.

— People over age 50 and vegans who may need vitamin B12. "As we get older, a number of us no longer produce enough acid in the stomach to extract the B12 in food," Schardt explained.

— Pregnant women, who may need extra iron.

— Breastfed infants and possibly other infants concerning vitamin D.

Vitamin D is a nutrient many of us may need to supplement. Last fall, the Institute of Medicine, a panel of scientists who advise the government, raised the recommended amount but also warned against overdoing it. People ages 1 to 70 should get 600 international units a day, older folks 800 units.

If you do need a supplement, beware: Quality varies. Consumerlab.com, a company that tests supplements and publishes ratings for subscribers, has found a high rate of problems in the 3,000 products it has tested since 1999.

"One out of 4 either doesn't contain what it claims or has some other problems such as contamination or the pills won't break apart properly," said company president Dr. Tod Cooperman.

For example, one gummy bear calcium product had 250 percent of the amount of vitamin D claimed on the label. Another liquid product made with rose hips had just over half the amount of vitamin C listed.

"You don't have to pay a lot. Price is not necessarily linked to quality," he said. "The quality doesn't really relate to where you're buying it. I know many people are surprised by that or don't want to believe it, but that is the case. We find good and bad products in every venue."

Mark Blumenthal, executive director of the American Botanical Council, suggests looking for "seals of approval" or certifications of quality from groups that spot-test supplements such as the USP, or United States Pharmacopeia; NSF International and NPA, the Natural Products Association.

Experts offered this advice:

— Keep it simple. The more ingredients there are in a supplement combo, the more chance that one of them will not be the right amount, Cooperman said.

— Consider a supplement combo tailored to your gender and age, the Office of Dietary Supplements suggests. Multivitamins often contain little iron, and ones for seniors give more calcium and vitamin D than products aimed at younger adults.

— Take vitamin D with dinner. A study found significantly more absorption of that nutrient when it was consumed at the largest meal, which tends to have more fat, than at breakfast, Cooperman said.

— Watch out for vitamin K — it promotes clotting and can interfere with common heart medicines and blood thinners such as warfarin, sold as Coumadin and other brands.

— Current and former smokers are advised to avoid multivitamins with lots of beta-carotene or vitamin A; two studies have tied them to increased risk of lung cancer.

— For cancer patients, "vitamins C and E might reduce the effectiveness of certain types of chemotherapy," Engel said.

— People having surgery should know that some vitamins can affect bleeding and response to anesthesia.

With any supplement — ask your doctor.

__

Online:

Vitamin facts: http://ods.od.nih.gov/factsheets/list-VitaminsMinerals

and http://ods.od.nih.gov/factsheets/MVMS-HealthProfessional

FAQs: http://ods.od.nih.gov/Health_Information/ODS_Frequently_Asked_Questions.aspx

Dietary advice: www.dietaryguidelines.gov

Vitamin E and prostate study: http://jama.ama-assn.org/content/306/14/1549

Video interview with author: http://jama.ama-assn.org/content/306/14/1549/suppl/DC1

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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New prostate cancer test advice overturns dogma

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In this Sept. 13, 2011 photo provided by the University of Chicago Medical Center, Dr. Gautam Jayram assists during prostate cancer surgery, watching an internal video of the patient’s body, at the University of Chicago Medical Center in Chicago. No major medical group recommends routine PSA (prostate-specific antigen) blood tests to check men for prostate cancer, and now a government panel is saying they do more harm than good and healthy men should no longer receive the tests as part of routine cancer screening. The recommendation by the U.S. Preventive Services Task Force, being made public on Friday, Oct. 7, 2011 will not come as a surprise to cancer specialists. The task force concluded there's little if any mortality benefit. But there is harm from routine screening: impotence, incontinence, infections, even death that can come from the biopsies, surgery and radiation, according to Dr. Virginia Moyer of the Baylor College of Medicine, who heads the task force. (AP Photo/University of Chicago Medical Center, Bruce Powell) In this Sept. 13, 2011 photo provided by the University of Chicago Medical Center, Dr. Gautam Jayram assists during prostate cancer surgery, watching an internal video of the patient’s body, at the University of Chicago Medical Center in Chicago. No major medical group recommends routine PSA (prostate-specific antigen) blood tests to check men for prostate cancer, and now a government panel is saying they do more harm than good and healthy men should no longer receive the tests as part of routine cancer screening. The recommendation by the U.S. Preventive Services Task Force, being made public on Friday, Oct. 7, 2011 will not come as a surprise to cancer specialists. The task force concluded there's little if any mortality benefit. But there is harm from routine screening: impotence, incontinence, infections, even death that can come from the biopsies, surgery and radiation, according to Dr. Virginia Moyer of the Baylor College of Medicine, who heads the task force. (AP Photo/University of Chicago Medical Center, Bruce Powell)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); WASHINGTON (AP) — Men finally may be getting a clearer message about undergoing PSA screening for prostate cancer: Don't do it.

They may not listen. After all, the vast majority of men over 50 already get tested.

The idea that finding cancer early can harm instead of help is a hard one to understand. But it's at the heart of a government panel's draft recommendation that those PSA blood tests should no longer be part of routine screening for healthy men.

The U.S. Preventive Services Task Force examined all the evidence and found little if any reduction in deaths from routine PSA screening. But it did conclude that too many men are diagnosed with tumors that never would have killed them and suffer serious side effects from resulting treatment.

That recommendation isn't final — it's a draft open for public comment. But it goes a step further than several major cancer groups including the American Cancer Society, which urges that men be told the pros and cons and decide for themselves.

The new advice is sure to be hugely controversial. Already some doctors are rejecting it.

"We all agree that we've got to do a better job of figuring out who would benefit from PSA screening. But a blanket statement of just doing away with it altogether ... seems over-aggressive and irresponsible," said Dr. Scott Eggener, a prostate cancer specialist at the University of Chicago.

In the exam room, explaining the flaws in PSA testing has long been difficult.

"Men have been confused about this for a very long time, not just men patients but men doctors," said Dr. Yul Ejnes, a Cranston, R.I., internal medicine specialist who chairs the American College of Physicians' board of regents.

He turned down his own physician's offer of a PSA test after personally reviewing the research.

"There's this dogma ... that early detection saves lives. It's not necessarily true for all cancers," Ejnes said.

That's an emotional shift, as the American Cancer Society's Dr. Len Lichtenfeld voiced on his blog on Friday.

"We have invested over 20 years of belief that PSA testing works. ... And here we are all of these years later, and we don't know for sure," Lichtenfeld wrote. "We have been poked and probed, we have been operated on by doctors and robots, we have been radiated with fancy machines, we have spent literally billions of dollars. And what do we have? A mess of false hope?"

Too much PSA, or prostate-specific antigen, in the blood only sometimes signals prostate cancer is brewing. It also can mean a benign enlarged prostate or an infection. In fact, most men who undergo a biopsy for an abnormal PSA test don't turn out to have prostate cancer.

Screening often detects small tumors that will prove too slow-growing to be deadly — by one estimate, in 2 of every 5 men whose cancer is caught through a PSA test. But there's no way to tell in advance who needs treatment.

"If we had a test that could distinguish between a cancer that was going to be aggressive and a cancer that was not, that would be fabulous," said Dr. Virginia Moyer of the Baylor College of Medicine, who chairs the task force, an independent expert group that reviews medical evidence for the government.

About 1 in 6 U.S. men will be diagnosed with prostate cancer at some point in their life. Yet the cancer society notes that in Western European countries where screening isn't common, 1 in 10 men are diagnosed and the risk of death in both places is the same. In the U.S., about 217,000 men are diagnosed with prostate cancer each year, and 32,000 die.

Why not screen in case there's a mortality benefit that studies have yet to tease out? The task force outlined the problem with that:

—Up to 5 in every 1,000 men die within a month of prostate cancer surgery, and between 10 and 70 more suffer serious complications.

—At least 200 to 300 of every 1,000 men treated with surgery or radiation suffer incontinence or impotence.

—Overall, Moyer said 30 percent of men who are treated for PSA-discovered prostate cancer suffer significant side effects from the resulting treatment.

Among the questions sure to be raised during the public comment period are how doctors should advise men with prostate cancer in the family or black men, who are at increased risk.

PSA testing also is used to examine men with prostate symptoms, and to check men who already have had prostate cancer. The new recommendation doesn't affect those uses.

Congress requires that Medicare cover PSA tests, at a cost of $41 million in 2009. Other insurers follow Medicare's lead, especially in light of conflicting recommendations.

Nor does the new recommendation mean that men who want a PSA test can't have one. If the rule is adopted — something the government will review once the task force hears comments and finalizes its guidance — it would just advise against doctors pushing it routinely.

"The truth is that like so many things in medicine, there's no one-size-fits-all," said Dr. Michael Barry of Massachusetts General Hospital who heads the Foundation for Informed Medical Decision-Making that backs ways to help patients make their own choices.

___

AP Medical Writer Lindsey Tanner in Chicago contributed to this report.

___

Online:

PSA decision guide: http://bit.ly/cXq1QE

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Alcohol limits advice 'confusing'

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7 October 2011 Last updated at 06:57 GMT By Debbie Bannigan CEO of Swanswell, Alcohol, Drug and Support Services People have little 'specific' idea of how much they can drink The advice on alcohol limits is too confusing according to Debbie Bannigan, head of the charity Swanswell. She says that 'units' mean nothing to many people - and the guidance should be clearer and easier to remember.

In this week's Scrubbing Up, she says that to have a daily "safe" amount is misleading and that some people - including pregnant women and drivers - should be told "no alcohol is best".

Most people think they have a rough idea of "how much is too much?", but ask them for specifics and they're not sure. Who can blame them, when the measure that is used to define safe limits - 'units' - is so hard to understand?

While 82% of adults claim to know what a unit of alcohol is, 77% don't know how many units are in a typical large glass of wine.

Ironically, 'units' become even harder to compute when we've had a drink, because the part of our brain that works that sort of thing out switches off.

And the concept of a daily safe amount may even encourage the idea that we should drink alcohol every day.

To add to the confusion, we're bombarded with new "scientific" findings about alcohol.

In the last couple of months alone, we've been told that alcohol damages the DNA of unborn children beyond repair, but that it's OK for pregnant women to have a couple of glasses of wine a week, which is pretty conflicting advice.

Reported health benefits from alcohol are rarely balanced with information about the risks, or the observation that the benefits can be achieved in other ways that don't carry any significant risks at all.

It's little surprise that people are confused about the impact alcohol can have on their lives.

But walk into any supermarket and you'll be encouraged to buy alcohol.

My local supermarket's "seasonal aisle" - one of the first things you see when you enter the store - has become a wine festival.

And the end of each aisle - the "impulse buy" space - is also stacked with cans of lager and cider, so selecting and purchasing alcohol is just part of the weekly shop rather than something that we have to think about doing.

Drink, anyone?

The people who come to us for help are just like you and me, but they've found that their choice to drink alcohol has been riskier than they expected.

What can be done about it? Official guidelines could be clearer. Other public health messages are short and snappy, like 'clunk-click every trip' or 'catch it bin it kill it'.

They are designed to be simple and memorable, so we learn and apply them without trying.

Units don't work this way, but a simple phrase like 'one or two, once or twice' gives us a simple yardstick that drinking one or two alcoholic drinks, once or twice a week, is a good limit.

Sometimes a clear, easy to understand and safe message is that no alcohol is best - for example, for children, in pregnancy or when driving.

Scientific evidence shows that even one drink can impair judgement when driving and that alcohol affects children disproportionately, especially before they are born.

A zero limit for drivers, pregnant women and children avoids confusion and helps us all to take responsibility.

We shouldn't be afraid of setting clear guidelines and sticking to them.

With co-operation between drinks manufacturers, supermarkets and the government we can judge the risk of alcohol use for ourselves.

Not only can we reach the point where hospital admissions are going down instead of up, we can create a society that is free from problem alcohol use altogether.

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Antenatal advice 'perpetuates C-section myths'

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30 September 2011 Last updated at 00:45 GMT By Leigh East Csections.org Caesareans can occur 'even after straightforward pregnancies' One in four births are by Caesarean section.

But in this week's Scrubbing Up, campaigner Leigh East - who has written a book about Caesarean births - warns pregnant women are not given a positive enough picture of C-sections - meaning many end up with "unnecessary" feelings of regret and failure if they need one.

Sit any group of women down to talk about Caesareans and you will hear all sorts of alarming 'facts'.

Common ones are: that you will have to have a Caesarean if your baby is breech; you cannot pick up your baby or drive for six weeks; bonding will be damaged and once you have had a Caesarean your next birth will have to be a Caesarean too.

What is really alarming about these "facts" is that not one of them need be true.

Hard as it may be to hear, antenatal education does little to disabuse women of these misconceptions.

Rather, it frequently perpetuates the idea that this important procedure is merely a last resort best avoided.

In reality, in addition to being lifesaving in emergency situations, Caesareans have significant benefits in certain pre-labour situations where attempting a vaginal delivery carries greater risks to mother or baby.

Add to these those women who view a Caesarean as preferable to the perceived fear and uncertainty of vaginal birth and there are a lot of women affected by Caesarean birth.

Preparation 'benefits'

Unfortunately the majority of women still understand so little about C-sections that it should come as no surprise to find that many find their experience, if they have one, extremely traumatic, so severe in fact that some go on to develop post-traumatic stress disorder, while those who want or need to plan a Caesarean are left totally unaware of the opportunities for making their birth feel special and personal.

One in four women in the UK will have a Caesarean, with unplanned sections accounting for two thirds of these.

It is a possible outcome of even the most straightforward pregnancy, yet is barely touched on in many antenatal classes.

This reluctance to talk positively about Caesareans has forced them to the periphery of antenatal education.

Books and classes are often biased, making it impossible for women to have open, rational discussions with those responsible for their care.

Most remain unaware of the huge benefits of preparing for the possibility of Caesarean birth, either planned or emergency.

It is well known that a woman's preconceptions can affect her labour and realistic expectations are significant in determining both how she ultimately perceives her birth and how she approaches her recovery.

But all too often the risks of vaginal birth are significantly downplayed while Caesareans are portrayed as an intervention to avoid wherever possible, with those planning a Caesarean labelled selfish or "too posh to push".

This leaves women in the dark about what they face - and unable to develop a flexible approach to birth.

'Toxic combination'

With over half of UK births involving intervention, women need to know more about their options so they can assess the risks for themselves.

Feelings of distress and loss of control become associated with their birth and can have a significant impact both physically and emotionally on mother and baby.

While some would prefer to leave things in the hands of their carers, many more would prefer to play an active role in making decisions about the birth.

To achieve this they need realistic information about the experience they face.

In the case of Caesareans, knowing how to prepare for the procedure, being aware of the opportunities open to them during surgery, learning alternative positions for breastfeeding and ways to improve recovery can all radically improve the experience for many women, even if a Caesarean was not their original preference.

Fortunately the National Institute of Clinical Excellence (NICE) is starting to address the issue, saying women should be presented with "evidence based information" so they can make an "informed decision".

This is a huge step forward, but it is still entirely reliant on those individuals providing the care also providing balanced information.

Unfortunately the toxic combination of out of date or inadequate information and biased advice means that women will continue to face their birth with huge gaps in their knowledge leading to unnecessary trauma.

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Antenatal advice 'perpetuates C-section myths'

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30 September 2011 Last updated at 00:45 GMT By Leigh East Csections.org Caesareans can occur 'even after straightforward pregnancies' One in four births are by Caesarean section.

But in this week's Scrubbing Up, campaigner Leigh East - who has written a book about Caesarean births - warns pregnant women are not given a positive enough picture of C-sections - meaning many end up with "unnecessary" feelings of regret and failure if they need one.

Sit any group of women down to talk about Caesareans and you will hear all sorts of alarming 'facts'.

Common ones are: that you will have to have a Caesarean if your baby is breech; you cannot pick up your baby or drive for six weeks; bonding will be damaged and once you have had a Caesarean your next birth will have to be a Caesarean too.

What is really alarming about these "facts" is that not one of them need be true.

Hard as it may be to hear, antenatal education does little to disabuse women of these misconceptions.

Rather, it frequently perpetuates the idea that this important procedure is merely a last resort best avoided.

In reality, in addition to being lifesaving in emergency situations, Caesareans have significant benefits in certain pre-labour situations where attempting a vaginal delivery carries greater risks to mother or baby.

Add to these those women who view a Caesarean as preferable to the perceived fear and uncertainty of vaginal birth and there are a lot of women affected by Caesarean birth.

Preparation 'benefits'

Unfortunately the majority of women still understand so little about C-sections that it should come as no surprise to find that many find their experience, if they have one, extremely traumatic, so severe in fact that some go on to develop post-traumatic stress disorder, while those who want or need to plan a Caesarean are left totally unaware of the opportunities for making their birth feel special and personal.

One in four women in the UK will have a Caesarean, with unplanned sections accounting for two thirds of these.

It is a possible outcome of even the most straightforward pregnancy, yet is barely touched on in many antenatal classes.

This reluctance to talk positively about Caesareans has forced them to the periphery of antenatal education.

Books and classes are often biased, making it impossible for women to have open, rational discussions with those responsible for their care.

Most remain unaware of the huge benefits of preparing for the possibility of Caesarean birth, either planned or emergency.

It is well known that a woman's preconceptions can affect her labour and realistic expectations are significant in determining both how she ultimately perceives her birth and how she approaches her recovery.

But all too often the risks of vaginal birth are significantly downplayed while Caesareans are portrayed as an intervention to avoid wherever possible, with those planning a Caesarean labelled selfish or "too posh to push".

This leaves women in the dark about what they face - and unable to develop a flexible approach to birth.

'Toxic combination'

With over half of UK births involving intervention, women need to know more about their options so they can assess the risks for themselves.

Feelings of distress and loss of control become associated with their birth and can have a significant impact both physically and emotionally on mother and baby.

While some would prefer to leave things in the hands of their carers, many more would prefer to play an active role in making decisions about the birth.

To achieve this they need realistic information about the experience they face.

In the case of Caesareans, knowing how to prepare for the procedure, being aware of the opportunities open to them during surgery, learning alternative positions for breastfeeding and ways to improve recovery can all radically improve the experience for many women, even if a Caesarean was not their original preference.

Fortunately the National Institute of Clinical Excellence (NICE) is starting to address the issue, saying women should be presented with "evidence based information" so they can make an "informed decision".

This is a huge step forward, but it is still entirely reliant on those individuals providing the care also providing balanced information.

Unfortunately the toxic combination of out of date or inadequate information and biased advice means that women will continue to face their birth with huge gaps in their knowledge leading to unnecessary trauma.

View the original article here

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Diets fail 'because advice is wrong'

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22 September 2011 Last updated at 02:58 GMT By Michelle Roberts Health reporter, BBC News Weighing and measuring yourself regularly helps track your weight-loss progress Eat less and you will lose weight.

This simple piece of advice is true, but it's one that many of us struggle to follow.

It is easy to blame a lack of willpower or a penchant for sugary, fat-laden snacks. And often weight does pile back on because people revert to their old way of eating too much of the wrong foods.

But researchers say the reason so many of us relapse and fail on diets is because we have unrealistic expectations.

And this is not our fault but that of experts, because the advice they give us is flawed.

Long slog

Most people start dieting with the notion that they will start to see results fast.

Experts tell us that if we cut around 500 calories from our daily diet, or burn them off exercising, then we can expect to lose 1lb (0.5kg) in weight every week.

Continue reading the main story

Studies show that somewhere between 50% and 80% of dieters will put weight back on”

End Quote Dr Kevin Hall of the US National Institutes for Health The British Dietetics Association, the NHS and the American Dietetic Association all say losing weight at this rate is "about right" and that if you stick at it for 12 months, for example, you will shed about 52 lb (26kg).

But US researchers from the National Institutes for Health say this is a gross overestimation because the calculation used is flawed.

They say it takes much longer to lose the weight - around three years to be precise, according to their work published in The Lancet.

For example, a year of dieting will result in only half of the amount of weight loss that experts currently predict.

Dr Kevin Hall and colleagues say this explains why many of us give up within months, because we expect unrealistic results that cannot be achieved.

Studies of outpatient weight loss programmes show most dieters peak at six months with the pounds starting to creep back on after this.

Continue reading the main story The recommended daily calorie intake for men is 2,500 and for women is 2,000The lowest intake per day recommended for men is 1,500 and for women is 1,200 calories, unless they are in a medically supervised settingSome, incorrectly, attribute this to the body getting used to having less food and metabolism slowing down. The dieter then feels that the regime is no longer working and often gives up altogether.

Alternatively, as the slimmer begins to see the weight falling off in the early months they are so pleased with their achievement that they begin to relax and the diet slips. But because weight loss is slow there is a lag phase where weight continues to drop even though the person is now eating more. The dieter then mistakenly concludes that they don't need to be so rigid with their diet in order to lose weight.

But eventually, the weight will catch up with them and they may well find they are now heavier than they were when they first started the diet.

Dr Hall explains: "The slow timescale for weight change is responsible for the gradual weight regain over many years despite the fact that the original lifestyle was resumed within the first year.

"Studies show that somewhere between 50% and 80% of dieters will put weight back on."

He says professionals need to change the advice that they give to dieters so they don't fall into this trap.

Continue reading the main story

We all recommend it - it's what we are taught. But I don't know what the scientific evidence for it is”

End Quote Helen Bond from the British Dietetic Association "If you can give a realistic picture, that can inform people and help them make choices."

Dr Hall says the error occurs because the "500 calorie-cut a day" sum fails to take account of how metabolism changes as we diet.

The mathematic equation relies on the assumption that one pound of fat contains 3,500 calories, so to lose one pound a week a person should consume approximately 3,500 fewer calories a week, or 500 fewer calories a day.

But in fact, weight loss is not this steady.

Natural fluctuations

Using knowledge about how the human body responds to changes of diet and physical activity, Dr Hall's team have created a computer program that they say gives a more realistic and reliable prediction of weight loss.

Their calculations reflect the fact that one person may lose weight faster or slower than another, even when they eat the same diet and do the same exercise.

For example, heavier people can expect greater weight change with the same change in diet, but it will take them longer to reach a stable body weight than people carrying less fat.

Plus the body adapts rapidly to a reduced calorie diet, regardless of the type of food eliminated to get this reduction.

This means that all diets with similarly reduced energy content will have the same effect in the short term, whether the food cut out is fat or sugary carbohydrates.

Habits can be hard to break

Dr Hall said: "We tested it on about 100 people and it gave a good fit. It was pretty accurate, whereas the old rule does not fall anywhere near.

"This means we can use it to make realistic predictions.

"The rough rule of thumb to go by is 10 calories per day per pound. And it takes a year to lose half of the excess weight and three years to get to 95%."

It's not clear why the advice was adopted in the first place.

Helen Bond, from the British Dietetic Association, admitted: "We all recommend it - it's what we are taught. But I don't know what the scientific evidence for it is.

"It stems from how much energy it takes to burn fat. A lot of diets are not proven by science."

She said some dieters might find it depressing to be told that it takes far longer to get weight down than previously thought.

"It's not very motivating to tell someone that if they cut their intake by 10 calories a day every day for the next three years they will lose a pound of weight.

"But saying 'cut out your daily habit of a 250-calorie chocolate bar and you will lose about 25 pounds and, if you stick at it, the weight will stay off' - that is."

However, Dr Hall says the computer model also shows how people can achieve more rapid weight loss if that is what they desire.

For example, someone could follow a very strict diet for the first year to get rid of a large bulk of their excess weight and then switch to a less restrictive diet to continue and maintain the weight loss. Adding in extra exercise will also have an impact.

At the end of the day, it still boils down to willpower. There is no quick fix to dieting and if you want it to work you need to stick at it, says Dr Hall.

A healthy diet is for life, not just post-Christmas.

View the original article here

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Diets fail 'because advice is wrong'

AppId is over the quota
AppId is over the quota
22 September 2011 Last updated at 02:58 GMT By Michelle Roberts Health reporter, BBC News Weighing and measuring yourself regularly helps track your weight-loss progress Eat less and you will lose weight.

This simple piece of advice is true, but it's one that many of us struggle to follow.

It is easy to blame a lack of willpower or a penchant for sugary, fat-laden snacks. And often weight does pile back on because people revert to their old way of eating too much of the wrong foods.

But researchers say the reason so many of us relapse and fail on diets is because we have unrealistic expectations.

And this is not our fault but that of experts, because the advice they give us is flawed.

Long slog

Most people start dieting with the notion that they will start to see results fast.

Experts tell us that if we cut around 500 calories from our daily diet, or burn them off exercising, then we can expect to lose 1lb (0.5kg) in weight every week.

Continue reading the main story

Studies show that somewhere between 50% and 80% of dieters will put weight back on”

End Quote Dr Kevin Hall of the US National Institutes for Health The British Dietetics Association, the NHS and the American Dietetic Association all say losing weight at this rate is "about right" and that if you stick at it for 12 months, for example, you will shed about 52 lb (26kg).

But US researchers from the National Institutes for Health say this is a gross overestimation because the calculation used is flawed.

They say it takes much longer to lose the weight - around three years to be precise, according to their work published in The Lancet.

For example, a year of dieting will result in only half of the amount of weight loss that experts currently predict.

Dr Kevin Hall and colleagues say this explains why many of us give up within months, because we expect unrealistic results that cannot be achieved.

Studies of outpatient weight loss programmes show most dieters peak at six months with the pounds starting to creep back on after this.

Continue reading the main story The recommended daily calorie intake for men is 2,500 and for women is 2,000The lowest intake per day recommended for men is 1,500 and for women is 1,200 calories, unless they are in a medically supervised settingSome, incorrectly, attribute this to the body getting used to having less food and metabolism slowing down. The dieter then feels that the regime is no longer working and often gives up altogether.

Alternatively, as the slimmer begins to see the weight falling off in the early months they are so pleased with their achievement that they begin to relax and the diet slips. But because weight loss is slow there is a lag phase where weight continues to drop even though the person is now eating more. The dieter then mistakenly concludes that they don't need to be so rigid with their diet in order to lose weight.

But eventually, the weight will catch up with them and they may well find they are now heavier than they were when they first started the diet.

Dr Hall explains: "The slow timescale for weight change is responsible for the gradual weight regain over many years despite the fact that the original lifestyle was resumed within the first year.

"Studies show that somewhere between 50% and 80% of dieters will put weight back on."

He says professionals need to change the advice that they give to dieters so they don't fall into this trap.

Continue reading the main story

We all recommend it - it's what we are taught. But I don't know what the scientific evidence for it is”

End Quote Helen Bond from the British Dietetic Association "If you can give a realistic picture, that can inform people and help them make choices."

Dr Hall says the error occurs because the "500 calorie-cut a day" sum fails to take account of how metabolism changes as we diet.

The mathematic equation relies on the assumption that one pound of fat contains 3,500 calories, so to lose one pound a week a person should consume approximately 3,500 fewer calories a week, or 500 fewer calories a day.

But in fact, weight loss is not this steady.

Natural fluctuations

Using knowledge about how the human body responds to changes of diet and physical activity, Dr Hall's team have created a computer program that they say gives a more realistic and reliable prediction of weight loss.

Their calculations reflect the fact that one person may lose weight faster or slower than another, even when they eat the same diet and do the same exercise.

For example, heavier people can expect greater weight change with the same change in diet, but it will take them longer to reach a stable body weight than people carrying less fat.

Plus the body adapts rapidly to a reduced calorie diet, regardless of the type of food eliminated to get this reduction.

This means that all diets with similarly reduced energy content will have the same effect in the short term, whether the food cut out is fat or sugary carbohydrates.

Habits can be hard to break

Dr Hall said: "We tested it on about 100 people and it gave a good fit. It was pretty accurate, whereas the old rule does not fall anywhere near.

"This means we can use it to make realistic predictions.

"The rough rule of thumb to go by is 10 calories per day per pound. And it takes a year to lose half of the excess weight and three years to get to 95%."

It's not clear why the advice was adopted in the first place.

Helen Bond, from the British Dietetic Association, admitted: "We all recommend it - it's what we are taught. But I don't know what the scientific evidence for it is.

"It stems from how much energy it takes to burn fat. A lot of diets are not proven by science."

She said some dieters might find it depressing to be told that it takes far longer to get weight down than previously thought.

"It's not very motivating to tell someone that if they cut their intake by 10 calories a day every day for the next three years they will lose a pound of weight.

"But saying 'cut out your daily habit of a 250-calorie chocolate bar and you will lose about 25 pounds and, if you stick at it, the weight will stay off' - that is."

However, Dr Hall says the computer model also shows how people can achieve more rapid weight loss if that is what they desire.

For example, someone could follow a very strict diet for the first year to get rid of a large bulk of their excess weight and then switch to a less restrictive diet to continue and maintain the weight loss. Adding in extra exercise will also have an impact.

At the end of the day, it still boils down to willpower. There is no quick fix to dieting and if you want it to work you need to stick at it, says Dr Hall.

A healthy diet is for life, not just post-Christmas.

View the original article here

Peliculas Online

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HEALTH MANAGEMENT. Parent sleep advice can raise children shut-eye

Geneva Pittman
NEW YORK | 9. September 2011 4: 08 pm EDT
NEW YORK (Reuters Health) - screening children to the sleep problems and sleep strategies discuss with parents could teenagers at school with better night-time rules, routines help, suggests new research from Australia.
Researchers found that if they had sleep-related consultations have with parents, children, the tend to be less sleep problems and to get better bedtime as children whose parents do not advise habits.
The study was small and not to demonstrate that the sleep improvements to changes in academic achievements of children this year.
Still, the results show that "sleep disorders in school children are treatable using... a short behavioral intervention", said study author Jon QUACH, at the University of Melbourne, Reuters Health in an e-Mail.
"Consult parents should sleep for your child if they are concerned," he added.
In five and six-year-old, that related behavior, most sleeping children on researchers say.
"Some of them have poor sleeping habits, where become too late to bed, they have a good-night routine nor many of them have even parents for them to stay, when they go to sleep at night", said Pediatric sleep specialist Jodi Mindell, St. Joseph's University in Philadelphia, which was not involved in the study.
"In this age group some night, fear" said they, and fear may increase as the children start school.
The current study on this back-to-school timeframe, including children, who were led in their first year of primary school. This is an important window for the treatment of insomnia, Quach said, since children, who sleep well might not more trouble, the transition to the school, that school performance and poorer relations puts it later for worse.
Quach and his colleagues studied about 1,500 parents of children from 22 different elementary schools in Melbourne. These parents 161 said her child had a moderate or severe sleep and 108 were recruited for the study. Children with serious breathing problems sleep-related, for example were excluded.
Half of the participating parents had followed a private consultation in College, by a telephone call of two weeks later behaviour to discuss sleep strategies based on their child problems. The other half were not additional help offered.
Next year, the researchers investigated parents over their children shut-eye again. Six months after the first consultation, they all gave children learn an assessment.
Sleep problems tend to dissolve in both groups, reported researchers in Pediatrics. Yet children, whose parents had sleep-related advice in General, better.
After six months or 26 percent of children in the consultation group and in the no-Consulting Group 47% of moderate or hard sleep disorders. By a year but there was no difference, and about one-third of children in both groups had insomnia.
Children in the consultation group less resistance before going to sleep and less time had to go to bed, parents reportedly. But there was no difference in how well she determined on scientific tests to measure, reading, mathematics and spelling skills have.
Quach and colleagues found that the study was small and a follow up with more children among other things, the students for more than a year tracking needs be-. It may be that improvements translate sleep better in academic abilities would take, she said.
Mindell said: "There is no question" that this type of program with school Advisor or nurses the sleep consultation in the U.S. schools could work. "I think this is a wake up call for teachers and school psychologists, they need to always on the lookout for sleep disorders," said Reuters Health.
For now she had to have some important tips for parents of young children, who sleep problems.
The "really simple changes," she said, are: "for your child to bed goes, before nine - we know that this is the turning point;" including reading as part of the bedtime routine-it helps calm children down, there is a focus on them, it helps with writing, it's all good; "then children encourage to fall asleep on their own."
Finally, make sure that there are no unwanted electronics in the nursery, she said. "The game boys will be go on, the computer Los, mobile phones become los."
Source: bit.ly/pXdFNv Pediatrics, online 2. September 2011.

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