The Clinic Magazine - Issue 3 by ClearVision Marketing

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CLINIC HEALTH | FITNESS | WELLBEING | BEAUTY ISSUE 3 | 2014 | e5.95 | ÂŁ5.20

Not just Skin Deep Behold the Power of Botox

Creating Dangerous Curves Buttock Augmentation

5 Things YOU NEED

to Know to improve your digestion

Eye opener

BROW & LID LIFTS EXPLAINED

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CONTENTS 08

Healthy Living 08 Five Handy Tips to Improve Your Digestion 12 Is Raw Food the Way To Go? 16 Calorific Coffees 18 Not-So-Healthy ‘Health’ Foods 23 Coconut - The Latest Superfood 26 The Great Juice Cleanse Debate

31 SUPPLEMENT NEWS 36

Mother & Baby 36 Simple Tips to Keep Babys Skin Healthy 40 Breast is Best - Isn’t It? 42 Breast v Bottle 44 Choosing a Formula

49 Health News 54

You & Your Health 54 Metabolic Syndromes 57 Intestinal Issues 62 Pancreatic Cancer - Awareness Month 64 IBS and Your Diet 71 Meals that Heal

Remodelling 76 The Non-Surgical Eye Brow Lift 78 Not Just Skin Deep 82 Bright Eyes 84 Restoring a More Youthful Appearance 88 Beauty or the Beast

92 Creating the Perfect Pout 97 Buttock Enhancement Surgery 102 Rise of the Intimate Nip & Tuck 108 Innovative Hair Implants 113 A History of Harley Street

118

MEN’S HEALTH 118 Hair Today, Gone Tomorrow 122 Top 10 Anti-Aging Solutions 131 The Perfect Smile

136 SPA WORLD 136 One & Only Cape Town, South Africa 141 Champneys Spa Resorts 149 PRODUCT & TREATMENT NEWS

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PUBLISHER Simply Media Group S.L. MANAGING DIRECTOR & EDITOR Stan Israel stan.israel@simplymedia-group.com CREATIVE DIRECTOR Sherelisa Bossi sherelisa.production@ simplymedia-group.com DESIGN & LAYOUT Jackie McAngus jackie.production@ simplymedia-group.com ASS. EDITOR & PRODUCTION MANAGER Lisa Brown decor@simplymedia-group.com CONTRIBUTING WRITERS Dawn Gudgin Stephanie McGraw With special thanks to: Quiron Hospital Group, Zanet and Cirumed DISTRUBUTION John McAngus clinic@simplymedia-group.com SALES Lola Gomez lola.gomez@simplymedia-group.com COVER SHOT COURTESY OF One & Only Spa Resorts SIMPLY MEDIA GROUP S.L. T: +34 951 127 200 DEPOSITO LEGAL NO MA 386-2014

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CLINIC HEALTH | FITNESS | DENTAL | BEAUTY

The saying goes “you are what you eat” and this statement is never truer than if you are a sufferer of IBS or IBD. With a rise in the levels of patients suffering with intestinal issues we take a look at the health implications of irritable bowel syndrome & irritable bowel disorder. We investigate the Metabolic Syndrome also known as Syndrome X, and offer helpful solutions to improve your diet. We shine our spotlight on the “must have” cosmetic procedure right now- buttocks implants and report of one of the fastest growing areas of cosmetic surgery – The intimate nip & tick If that wasn’t enough we also bring you our regular features on the latest; cosmetic news, supplement news and health news from around the world.

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HEALTHY LIVING

5 Five handy tips to improve your digestion

o you inhale your food? Are you so busy that even chewing seems like a luxury? Or are you just a gannet? Here are some helpful tips on improving digestion.

Nº1: Cover the Basics CHEW, CHEW, CHEW • Take smaller bites.

• Put your fork down in between bites.

• Try using chopsticks - it forces you to slow down. • Thoroughly chew each bite of food.

• Carbohydrate digestion begins in the mouth - chewing grains thoroughly allows amylase, the digestive enzyme present in saliva, to digest the grains.

GET ENOUGH WATER

Insufficient water intake is a primary cause of constipation. Constipation then causes an imbalance in bacteria, promotes inflammation of the intestinal lining, and can even lead to the absorption of larger molecules, a condition known as intestinal permeability. • Constipation Food • Flatulence

• Stomach Treatment • Stomach Gas Relief • Intestinal Gas

INCREASE YOUR DIETARY FIBRE Good sources of dietary fibre include:

• Dried fruit, such as dates, figs, and prunes

• Beans and legumes- if you don’t have time to cook dried beans, buy canned, but make sure you rinse them thoroughly before cooking. Lentils and split peas are less gas-forming than other legumes.

• Bring an apple with you to work as a snack

• Ground flaxseeds are a gentle laxative. They can be useful for chronic constipation, damage to the intestine wall from laxative use, irritable bowel, and to soothe inflammation. Sprinkle ground flaxseeds on rice, grains, salads, or any other meal of your choice.

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handy tips to improve digestion

Nº2: Practice Mindful Eating

Nº 4: Increase Good Gut Bacteria

A pilot study at Indiana State University found that mindfulness, including specific instructions to slowly savour the flavour of food and be aware of how much food is enough, helped to reduce eating binges from an average of four binges per week to one and a half.

Not all bacteria is bad! There are over 400 different kinds of bacteria and yeasts in the digestive system. Of these, the bacteria Lactobacillus acidophillus andBifidobacterium bifidum are considered good “probiotic” bacteria because they can help to maintain intestinal health. Acidophilus and Other Probiotics.

• Eat in the moment. Savour every bite, enjoying the flavours, textures, and smells of your meal. • Buy fresh flowers to put on the dining table. • Use smaller cutlery so that you eat less with each bite. • Create a beautiful atmosphere - dim the lights, play music and light candles.

Although good bacteria can be found in some yogurt, there is a wide variation in the quantity and quality. Look for good quality organic yogurt that adds the active cultures after pasteurization, because this heat process destroys both good and bad bacteria. Supplements containing acidophilus and bifidobacteria can be found in health food stores. They are especially helpful for the following conditions: • Irritable bowel syndrome • Diarrhoea • Gas, bloating, flatulence • Recurring vaginal yeast infections • Bad breath

Nº3: Address Food Sensitivities and Allergies Food sensitivities are behind many digestive disorders. For example, between 33% and 66% of IBS patients report having one or more food intolerances, resulting in bloating, gas, and pain. The most common culprits are milk and dairy (40-44%) and grains (40-60%). A trained practitioner can supervise an elimination diet. Many foods are removed from the diet for a brief period of time, and then re-introduced sequentially to isolate the body’s reaction to the offending foods.

Nº 5: Supplement to Restore Digestive Health Give your body a helping hand with useful supplements: • Enteric-Coated Peppermint Oil - Peppermint oil can reduce abdominal pain, bloating, and gas. • Digestive Enzymes - Enzyme supplements are believed to support the body’s own digestive enzymes to aid digestion and help with other disorders stemming from poor digestion.

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In pursuit of healthy living:

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is raw food the way to go?

he raw-food lifestyle has become the newest nutrition trend, with followers claiming all sorts of health and lifestyle benefits. It is based on the belief that the most healthful food for the body is uncooked. Cooking food is thought to denature the enzymes naturally present in food. According to raw foodists, enzymes are the life force of a food, helping us to digest food and absorb nutrients. If we over consume cooked food, our bodies are forced to work harder by producing more enzymes. Over time, a lack of enzymes from food is thought to lead to digestive problems, nutrient deficiency, accelerated aging, and weight gain.

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• Sprouting After germination, seeds, beans, and legumes can be sprouted. After they are drained during the final step of the germination process, place them in a container for sprouting. Leave them at room temperature for the recommended time. The seed, bean, or legume will open and a sprout will grow from it. Rinse the sprouted nuts or seeds and drain well. They can be stored in an airtight container in the refrigerator for up to 5 days. • Dehydrating Foods can be heated, never above 118 F, using a piece of equipment called a dehydrator to simulate sun-drying. They are enclosed containers with heating elements to warm at low temperatures. A fan inside the dehydrator blows the warm air across the food, which is spread out on trays. Dehydrators can be used to make raisins, sundried tomatoes, kale chips, crackers, breads, croutons, and fruit leathers. • Blending Foods can be blended or chopped using a food processor or blender, to make recipes for smoothies, pesto, soup, hummus.

Gazpacho shots

Others include: Fermenting, Pickling & Juicing

Cooking food can diminish its nutritional value. For example, the cancer-fighting compounds in broccoli, sulforaphanes, are greatly reduced when broccoli is cooked. Certain vitamins, such as vitamin C and folate, are destroyed by heat. Other foods, however, become more healthful after cooking, because the fibrous portion is broken down. For example, cooked tomatoes contain three to four times more lycopene than raw tomatoes.

Besides cooked food, what else should i avoid?

Cooking also promotes the formation of potentially harmful compounds in food during high heat cooking, such as advanced glycation end products and heterocyclic amines.

• • • • • • • •

What do I eat on a raw food diet? There are different ways that people follow a raw food diet. Most people who follow a raw food diet are vegan. Some consume raw animal products, such as raw milk, cheese made from raw milk, sashimi, ceviche (raw fish), or Carpaccio (raw meat). Some people eat only raw foods, while others include cooked food for variety and convenience. The percentage of raw food is usually 70 percent or more of the diet. Raw food detox diets or cleanses are entering the mainstream. People typically go on a detox diet for 3 to 21 days. After the detox diet or cleanse, they may continue a raw food diet, return to their regular diet, or try to improve their daily diet by consuming more raw foods

Some raw beans can be eaten after they have been soaked and sprouted, but others are considered unsafe to eat, such as kidney beans, soy beans, and fava beans. Other foods that are avoided include: Buckwheat greens Mushrooms Peas Potatoes Rhubarb leaves Taro Cassava and cassava flour Parsnips

On a raw food diet, people usually avoid food grown with pesticides or made with preservatives, additives, food colour or food dye.

Lasagne How is raw food prepared? • Soaking and Sprouting Raw beans, legumes, nuts, and seeds contain enzyme inhibitors that are normally destroyed with cooking. The nutrients can be released by soaking them (germination) or sprouting them. Germination involves soaking in water for a specific amount of time. Although the recommended germination times vary from 2 hours (for cashews) up to one day (for mung beans), some raw foodists say that soaking overnight is sufficient and more convenient. It’s important to start with dried, raw, preferably organic seeds, beans, legumes, or nuts. Rinse beans, nuts, legumes, or seeds and place in a glass container. Add room temperature purified water to cover and soak at room temperature overnight. Mung beans, however, require a full 24 hours. Rinse a couple of times prior to use.

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Benefits of the raw food diet

Tasty salad

People who follow a raw food diet believe it has numerous health benefits, including: • Increased energy • Clearer skin • Weight loss • Reduced risk of disease The raw food diet contains fewer trans-fats and saturated fat than the typical Western diet. It is also low in sodium and sugar and high in potassium, magnesium, folate, fibre, vitamin A, and healthpromoting antioxidants. These properties are associated with a reduced risk of diseases such as heart disease, diabetes, and cancer. For example, a study published in the Journal of Nutrition found that consumption of a raw food diet lowered plasma total cholesterol and triglyceride concentrations. The raw food diet is also thought to have a favourable acid-alkaline balance, being low in acid-forming food. Too much acidity in the body is thought to result in disease.

Fig, vanilla, chocolate, and ginger cake

Besides the immediate benefits, the raw food diet may theoretically slow the aging process and reduce inflammation, because it contains fewer advanced glycation end products and other potentially damaging compounds.

One of the main concerns people have with the raw food diet is the risk of nutritional deficiencies, such as vitamin B12, iron, zinc, and omega-3 fatty acids. For example, one study found that people on raw food diets have higher levels of homocysteine and lower HDL cholesterol levels, due to vitamin B12 deficiency. Both are risk factors for heart disease. Supplementing with a multivitamin may help prevent nutritional deficiencies. Eating a variety of foods may also help. People with hypoglycaemia or diabetes should use caution on the raw food diet. Although the antioxidants, vegetables, and fibre can be helpful, if done improperly (over-consuming fruit juices) may worsen the condition.

Steak Tartare

People with a history of eating disorders or those who are underweight should consult their health care provider before trying the raw food diet. According to other alternative diet theories, such as Ayurveda and traditional Chinese medicine, a raw food diet may not be appropriate for people living in colder climates or for people with certain constitutional types. Possible side effects of the raw food diet Some people experience a detoxification reaction when they start the raw food diet, especially if their previous diet was rich in meat, sugar, and caffeine. Mild headaches, nausea, and cravings can occur but usually last only for several days.

Top Tip

Ease into the diet. Start with 50 percent raw and go from there. Don’t be focused on going 100 percent raw. Instead, find the balance that works best with your lifestyle and consider it an evolving process. THE CLINIC

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And the cons

Calorific Coffees

or many of us, our mornings aren’t complete without a cup or two of coffee to get us fuelled for the day ahead. Some people, after waking up, reach for a cup before doing anything else. Simply, we are becoming obsessed with coffee.

But why are we obsessed: is it the flavour, the caffeine kick or simply habit? According to the International Coffee Institution world coffee exports amounted to 8.65 million bags in January 2014, this high demand has resulted in pop up cafes taking over our high streets . And to ensure each coffee shop is one step ahead of the other they have started to offer more than just coffee—coffee with shots of hazelnut, coffee laden with cream, coffee frozen into yogurt you name they’ve got it. But while these new concoctions may taste delicious, many are not so beneficial for your waistline. Here’s a look at some of the most popular choices and their calorie content: • Dunkin’ Donuts Frozen Mocha Coffee Coolatta with Cream 32 ounces: 1,050 calories, 53 grams fat, 127 grams sugar • Dunkin’ Donuts Frozen Caramel Coffee Coolatta with Cream 32 ounces: 1,050 calories, 52 grams fat, 130 grams sugar. • Starbucks Iced Peppermint White Chocolate Mocha with Whipped Cream 20 ounces: 700 calories, 26 grams fat, 101 grams sugar • McDonalds Frappe Mocha 22 ounces 670 calories, 50 grams fat, 88 grams sugar • Starbucks Tazo Green Tea Frappuccino Blended Crème with Whipped Cream 20 ounces 560 calories, 18 grams fat, 89 grams sugar

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Not-So-Healthy ‘Health’ Foods

alad, bran muffins, fat-free foods - they’re good for you, right? Well not always. Here we reveal some surprisingly unhealthy foods that we have taken for advantage.

MULTI-GRAIN AND WHEAT BREADS Terms like multi-grain, 7-grain, and wheat sound healthy, but they may not actually contain heart-healthy whole grains. Many types of bread labelled “multi-grain” and “wheat” are typically made with refined grains, so you’re not getting the full nutritional benefit of the whole grain. How can you be sure? Read nutrition labels carefully. If the first flour in the ingredient list is refined (it will typically say “bleached” or “unbleached enriched wheat flour”) you are not getting a 100% whole-grain bread.

Baked Potatoes Sure, a baked potato in its natural state (that is, sin toppings) is a very healthful food. Potatoes are naturally rich in vitamin C, potassium, and fibre. Plus, a medium-sized baked potato contains only about 160 calories. But don’t assume that by eating a baked potato its the healthiest choice – WHY! Because once you have loaded it with butter, sour cream, cheese, bacon bits, and other goodies that can add up to around 600 calories and 20-plus grams of fat.

Prepared Salads

Sports Drinks

Don’t assume that anything with the word “salad” in it must be healthy. Prepared tuna salads, chicken salads, and shrimp salads are often loaded with hidden fats and calories due to their high mayonnaise content. While a lot depends on portion size and ingredients, an over-stuffed tuna sandwich can contain as many as 700 calories and 40 grams of fat. If you’re ordering out, opt for prepared salads made with low-fat mayonnaise, and keep the portion to about the size of a deck of cards.

If you’re going for a leisurely stroll or doing some light housework, skip the sports drinks. While most sports drinks do contain important electrolytes (like potassium and sodium) that are necessary for intense workouts or endurance training, you don’t need a sports drink to fuel light activity. Many sports drinks contain 125 calories or more per 20-oz. bottle, so spare yourself the extra calories and opt for plain water or a calorie-free beverage to keep you hydrated.

Foods Labelled “Fat-Free” Fat-free does NOT mean calorie-free. Just because a food contains no fat, that doesn’t make it a health food. (Think gummy bears.) Of course, there are many very healthful fat-free foods (like most fruits and vegetables), but always check the nutrition labels when buying packaged foods to be sure you’re getting a nutritious product and not just one that’s fat-free. Calories, sodium, fibre, and vitamins and minerals are all aspects you should consider in addition to fat.

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Bran Muffins Most bran muffins, even those sold at delis and coffee shops, are made with generally healthy ingredients. The problem is portion size. Many muffins sold in stores today dwarf the homemade muffins made a generation ago. A random sampling of some coffee and restaurant chain bran muffins showed that many topped 350 calories apiece, and that’s before any butter or jam. The bran muffins at one popular chain bakery contain 600mg of sodium―roughly one-third of a day’s maximum

“Energy” Bars Energy bars are the perfect pre-workout snack, right? Not always. Many energy bars are filled with high fructose corn syrup, added sugar, and artery-clogging saturated fat. Plus, some bars (particularly meal replacement varieties) contain more than 350 calories each - a bit more than “snack size” for most people. It is a good idea to fuel up with a mix of high quality carbs and protein before an extended workout or hike.

Smoothies Even in most smoothie chains and coffee bars, smoothies start out pretty healthful. Most have a base of blended fruit and low-fat dairy. But disproportionately large serving sizes (the smallest is often 16 oz.) combined with added sugar, ice cream, or sherbet, can add up to a high-calorie treat. Some chains serve smoothies that contain up to 500 calories. A smoothie can be a great way to start the day or to refuel after a workout. Just remember to account for the calories you drink when considering what you’ve consumed in a day.

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the wrap experts™

Coconut

Is the latest superfood all it’s cracked up to be?

oconuts used to be a demon, or at the very least an indulgence: a fluffy-cake topping, a gooey candy-bar filling, the second-best ingredient in a poolside drink. For years, the biggest coconut-based troublemaker was its oil, which is loaded with saturated fat — even more than butter. But in the past few years, there’s been a great deal of rethinking about the fruit and its many edible parts. Today the humble coconut’s is now being touted as not just a superfood but a miracle superfood. A saturated fat that gets burned like a carbohydrate can increase your metabolism and lower your cholesterol and taste good too. Sold in many guises - from water to oil, yoghurt to milk - food experts claim that this tropical fruit can help cure everything from heart disease to Alzheimer’s, but with so much conflicting health information, we reveal what coconut products we really should be putting in our shopping baskets.

COCONUT WATER The juice found in the middle of a cracked coconut is now marketed as a highly hydrating fluid. It has less sugar than fruit juices and more minerals such as potassium, sodium, magnesium and calcium. These properties are great as a post-workout drink if you’ve only been doing moderate exercise, but there isn’t enough protein or carbohydrate if you’re undergoing vigorous exercise of over 1 hour. Ultimately, coconut water contains calories - do you need these? If you’re drinking purely for hydration, water is always the better choice.

COCONUT OIL This is becoming more and more popular and can be bought from supermarkets now. It can be used for roasting and baking. It has a similar nutritional profile to butter in that it has a high saturated fat content which is currently being discovered to be less harmful to health than initially thought, particularly the type of saturated fats which are found in coconut oil: Lauric acid and Myristic acid. Coconut oil also contains some poly- and monounsaturated fats which bring additional health benefits. It is still an energy-dense food so should be used in moderation.

FRESH COCONUT AS A SNACK Fresh coconut flesh is delicious, full of vitamins and minerals and goes really well in a smoothie. Enjoy as a snack but go easy on your portion sizes - a typical snack pack (100g) of fresh coconut pieces contains 271kcal compared to just 50kcal in a 100g fresh fruit pot. Just a few pieces should be enough to get you through to the next meal.

COCONUT SUGAR

COCONUT YOGHURT

This can be used instead of sugar in baking. It has a lower GI than standard granulated sugar, however a similar kcal content per gram. It may be a healthier alternative to traditional granulated sugar however it is still an energy-dense foodtype which should only be used on special occasions.

This is a fairly new dairy-free alternative, great for those who are lactose-intolerant and who fancy a change from the soya varieties! It is much higher in fat than both natural dairy yoghurt and soya yoghurts, but also much lower in carbohydrates; research is now beginning to find that a diet higher in fat than carbohydrate can aid weight loss efforts. Steer clear of the flavoured varieties, as with all yoghurt types in fact, as theyâ&#x20AC;&#x2122;re packed with lots of sugar.

COCONUT MILK (DAIRY SUBSTITUTE USUALLY MIXED WITH RICE MILK) There are two types of coconut milk widely available - one is about 8% coconut cream mixed with water, sugar and preservatives, the other is mixed with rice milk without the need for sugar and requires less preservatives. Both have a similar kcal content to soya milk (about 1/2 that of semi-skimmed milk) but a much lower protein content than both soya and semi-skimmed milk. Choose one with added calcium and vitamin D which cannot be naturally found in this product.

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The great juice cleanse debate

o matter their colour, Green, Orange, Red or somewhere in between – Juice cleanses seem to be the secret to shedding stubborn pounds and getting glowing skin. But with so many to choose from, how do you find the best one for you?

WHERE THE CRAZE CAME FROM: Juicing dates back to the 1930’s but todays craze began a few years ago in New York and Los Angeles. Juice cleanses have since become popular as an alternative to natural, healthy foods made even more popular by celebrity’s trying to stay in shape.

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HOW IT WORKS: Even with a well-balanced diet your body is still exposed to harmful toxins and chemicals that need to be flushed out and eliminated. If these toxins remain within your system they can lead to lethargy, disease, chronic inflammation and even cancer. - If toxins aren’t eliminated properly they circulate in the blood and tissue - Raw juices don’t contain preservatives or additives, nor are they pasteurized and are void of fibre – thus aids digestion

IS JUICING HEALTHY? Not everyone is jumping on the juice cleanse bandwagon. Some health experts feel it’s nothing but a fleeting fad - take look at the pro’s and cons

THE PROS:

Toxins are removed: As toxins are accumulated internally they can lead to inflammation, disease and a weakened immune system. Fruit & vegetables help release these trapped toxins and flush them from our systems.

Energy Levels are increased: You may feel more alert and focused because there are fewer artificial additives and chemicals raging through your body. Many juicers also tend to sleep better.

Skin looks more radiant and clearer: As the liver is detoxed, there are fewer chemicals in the body. This means the skin is purged and looks better.

- Some believe that the lack of fibre enables enzymes and nutrients to be absorbed directly into the bloodstream allowing the liver to act quicker at detoxifying the body.

WHEN TO DO IT: Juice cleanses are a great way to give your body a lift when it’s feeling sluggish and need of a lift. Ideally they should be done for three days since this is the amount of time It takes the body to eliminate toxins

THE RIGHT WAY TO-DO-A JUICE CLEANSE: To reap the benefits of a cleanse you need to ensure you do it right it’s a pointless exercise of your going to cheat – so be warned! STEP 1: Before you start the body needs to be prepped so it isn’t overloaded by too many fruits and vegetables. Cut out processed foods, dairy, refined carbs, meat, coffee and alcohol for a few days before you start. Stick to whole grains, greens and drink plenty of water.

STEP 2: During your cleanse stay away from solid foods, but drink as much water as you want – herbal teas are ideal for getting that sugary sweet taste. STEP 3: After the three days slowing introduce clean, solid organic foods and begin with those with a high level of water content like apples, cucumbers, and watermelon after a day or two introduce lean protein. Try and incorporate juices as a snack so avoid the temptation of returning to fizzy drinks and caffeine.

A strengthened immune system: Immunity is said to be boosted so its thought that you’re less susceptible to allergies and becoming sick

THE CONS:

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Cravings for sugar and carbs: Changing your diet so dramatically even for a few days can make you crave sweet things. A withdrawal from caffeine will also induce headaches You may feel bloated or constipated: A lack of fibre in the diet can make the stomach feel full and uncomfortable – Plus you may become prone to excess wind!

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CLINIC SUPPLEMENT NEWS

For Colds & Flu

Vitamin C Sustained Release 500mg Vitamin C plus 5mg Zinc Vitamin C is an essential vitamin however the body does not store Vitamin C, so a regular daily intake is required. Each 500mg tablet is made using a special process that â&#x20AC;&#x2DC;meshesâ&#x20AC;&#x2122; the vitamin with a plant cellulose so that it breaks down gradually to release vitamin C. Zinc is also included as it contributes to the normal function of the immune system. Because Vitamin C is a water-soluble vitamin, it is not stored in the body for very long. This means that a regular intake is needed to keep the levels topped up. The benefits of Vitamin C are many and varied, they include; the support of the immune system, the reduction of tiredness and fatigue and the normal function of the nervous system. For more information visit: www.healthspan.co.uk

Xtra Zinc Tablets, 15mg eProtein Xtra Zinc Tablets contain on average 50mg of zinc citrate providing you with 15mg of this important mineral. Zinc is an essential mineral that provides a host of benefits to the body. Zinc is required for the activity of many enzymes and is essential for normal bodily function and growth. Zinc can be found in high levels in foods such as oysters, beef, lamb, spinach, peanuts but can be difficult to intake without a well-tailored diet. By supplementing Zinc you are not only reaching your daily requirement in one easy step, you are supporting your body in many ways. Zinc is known for its ability to level out and maintain normal test levels in the blood, contributing to normal protein synthesis, and more. Maintaining the correct level of zinc is important for those in fitness as your body uses more resources in times of physical activity. Supplementing this essential mineral is a must. For more information visit: www.eprotein-direct.com

Full Spectrum Andrographis, 400mg Andrographis paniculata is an herb commonly used in China, India, and other countries in subtropical and Southeast Asia. Both the fresh and dried leaves, as well as the fresh juice of the whole plant, have been used in a variety of cultures. In traditional Chinese herbalism, andrographis is used to support healthy digestive, cardiovascular, and urinary systems. In Sweden, andrographis has been used for more than 10 years as a primary herb for the winter season. For more information visit: www.swansonvitamins.com

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Echinacea 3200mg

Echinacea is a purple coneflower native to North America. The flower naturally contains several beneficial compounds, including polysaccharides, glycoproteins, alkamides, volatile oils and flavonoids. At Simply Supplements all our products are manufactured in the UK to EU standards that guarantee quality and potency. We have rigorous quality control systems in place to test all products at every stage, from the sourcing of raw materials to the finished products. For more information visit: www.simplysupplements.net

Nature’s Answer, Sambucus, Black Elder Berry Extract (Nigra), 5000 mg,

BONESET HERB – EUPATORIUM PERFOLIATUM TABLETS Boneset supplements are made from a North American plant in the Aster family. Boneset is a traditional Native American remedy for many ailments, including colds and flu. Boneset in a supplement, a tea or a liquid extract can be dangerous, especially if used in large amounts. The leaves and flowering parts of the boneset plant contain compounds that may be toxic to the liver, especially if it’s taken with other herbs that have potentially liver-damaging effects, such as comfrey. Pregnant women should avoid boneset. People allergic to ragweed also may be allergic to boneset. And high doses can cause diarrhoea and vomiting. For more information visit: www.mountainfresh.co.uk

Sambucus nigra L. is the latin name for Black Elder. The dark blue/ black berries of this plant have many naturally-occurring nutritional substances such as Rutin, Quercetin (flavonoids) and Anthocyanins. Current research supports the long held beliefs about Elderberry’s health benefits on the body. Elderberry syrup has been traditionally used to help support the immune system, especially during the winter season or when experiencing extra stress. An added advantage to the use of Elderberry is its record of safety for all ages. For more information visit: www.iherb.com

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Increased energy levels & mental aler tness Decreased a ppetite & unhealthy cravings Accelerated meta bolism & fat bur ning Increased lean muscle mass

MO R E S C I ENTI FI CALLY PR OV EN R ES ULTS • • • • • • • • • • • • • • • •

Restores the HGH hor mone Maximize testosterone output Increased bone density & rever sal of osteoporosis Enhanced sexual dr ive & perfor mance Increased energy levels & mental aler tness Improved cholesterol profile Drama tically strengthen the immune system as well as improve protein synthesis Improved sleep rhythms improve restorative sleep & alleviate insomnia Enhance the male libido Decrease a ppetite & unhealthy cravings Stimulates HGH production by blocking the secretion of somatostatin Regeneration of organs: hear t|kidney|liver|lungs Decreased bodyfat & reduced cellulite Increase lean muscle mass Lower blood pressure Improved skin texture

P l e a s e v i s i t W W W. G H B U R N . C O M fo r m o r e i n fo r ma t i o n / p u rc h a s e

MOTHER & BABY

Simple Tips to Keep Baby’s Skin Healthy

here’s nothing quite like the soft, delicate skin of a baby. And nothing like a cranky infant irritated by diaper rash, cradle cap, or another skin condition. While your baby is perfect, your baby’s skin may not be. Many babies are prone to skin irritation in the first few months after birth. Here’s how to spot and treat common baby skin problems.

New-borns are prone to rashes The good news about your new-born’s rashes: Most cause no harm and go away on their own. While caring for baby’s skin may seem complex, all you really need to know are three simple things: Which conditions can you treat at home? Which need medical treatment? And how can you prevent baby from experiencing skin problems to begin with?

Avoiding nappy rash If baby has red skin around the diaper area, you’re dealing with diaper rash. Most nappy rashes occur because of skin irritation due to diapers that are too tight; wet diapers left on for too long; or a particular brand of detergent, diapers, or baby wipes. Avoid it by keeping the diaper area open to the air as long as possible, changing your baby’s diaper as soon as it’s wet, washing with a warm cloth, and applying zinc oxide cream

Pimples & Whiteheads Baby “acne” is not really acne, like the kind teenagers get. In fact, recent research suggests that it may be related to yeast, not oil production. Pimples on baby’s nose and cheeks usually clear up by themselves in a few weeks. So you don’t need to treat baby acne or use lotion.

Atopic Dermatitis or Eczema Eczema is an itchy, red rash that may or may not occur in response to a trigger. It is common in children who have a family history of asthma, allergies, or atopic dermatitis. Eczema

may occur on baby’s face as a weepy rash. Over time it becomes thick, dry, and scaly. You may also see eczema on the elbow, chest, arms, or behind the knees. To treat it, identify and avoid any triggers. Use gentle soaps and detergents and apply moderate amounts of moisturizers. More severe eczema should be treated with prescription medicine.

Baby’s dry skin You probably shouldn’t worry if your new-born has peeling, dry skin -- it often happens if your baby is born a little late. The underlying skin is perfectly healthy, soft, and moist. If your infant’s dry skin persists, talk to your baby’s paediatrician.

Excess oil causes cradle cap Cradle cap can show up during baby’s first or second month, and usually clears up within the first year. Also called seborrheic dermatitis, cradle cap is caused in part by excess oil and shows up as a scaly, waxy, red rash on the scalp, eyebrows, eyelids, the sides of the nose, or behind the ears. Your paediatrician will recommend the best treatment for cradle cap, which may include a special shampoo, baby oil, or certain creams and lotions.

New-born skin: white bumps (Milia) As many as one in two new-borns get the little white bumps known as Milia. Appearing usually on the nose and face, they’re caused by skin flakes blocking oil glands. Milia are sometimes called “baby acne,” but baby acne is related to hormonal changes. In this case, baby skin care is easy: As baby’s glands open up over the course of a few days or weeks, the bumps usually disappear, and need no treatment.

Skin Care Management Baby Skin Care Products When shopping for baby skin care products? Less is more. Look for items without dyes, fragrance, phthalates and parabens - all of which could cause skin irritation.

Avoiding Skin Problems at Bath Time Remember, new-born skin is soft and sensitive. Keep baby’s skin hydrated by bathing in warm water for only three to five minutes. Avoid letting your baby sit or play or soak for long in soapy water. Apply a baby lotion or moisturizer immediately after bath while skin is still wet, and then pat dry instead of rubbing.

Prickly heat causes irritated skin

Baby yeast infections

Baby Massage

Showing up as small pinkish-red bumps, prickly heat usually appears on the parts of your baby’s body that are prone to sweating, like the neck, diaper area, armpits, and skin folds. A cool, dry environment and loose-fitting clothes are all you need to treat prickly heat rash which can even be brought on in winter when baby is over-bundled. Try dressing baby in layers that you can remove when things heat up.

Yeast infections often appear after your baby has had a round of antibiotics, and show up differently depending on where they are on your baby’s skin. Thrush appears on the tongue and mouth, and looks like dried milk, while a yeast diaper rash is bright red, often with small red pimples at the rash edges. Talk to your paediatrician: Thrush is treated with an anti-yeast liquid medicine, while an antifungal cream is used for a yeast diaper rash.

If rashes or other skin conditions are making your baby irritable, try baby massage. Gently stroking and massaging baby’s skin can not only help boost relaxation, but it may also lead to better sleep and reduce or stop crying, according to a recent study.

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From gentle bubbles to loving cuddles Our pure, gentle and mild cleansers and moisturizers safely clean and protecr baby;s senitive skin during bathtime, but it;s your loving touch that makes the biggest splash.

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Breast is best – isn’t it?

ew study suggests feeding babies from breast over bottle ‘doesn’t have impact we once thought it had!

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New study suggests feeding babies from breast over bottle ‘doesn’t have impact we once thought it had! Everyone knows that breast is best, not a day goes by without more evidence being fed through media channels telling us how great it is:

l “Breastfeeding for 20 months decreases risk of ovarian cancer by 50%.” l “Breastfeeding is proven to lower risk of Alzheimer’s in mothers” l “Breastfeeding boosts IQ’s of babies” l “Breastfeeding reduces infant mortality by 15%.”

These are just a few stories splashed across the internet, but is breastfeeding far and away the best thing? Or have we done women a disservice by overstating its benefits? According to a new research published in the journal Social Science & Medicine, breastfeeding babies may not actually have the wide-ranging long term health outcomes we once thought. Dr Cynthia Colen, a sociology professor at Ohio State University in the US, looked for the first time at a sample of families where one or more siblings had been breast-fed while others had been bottle-fed. In apparent contrast to perceived wisdom and international health advice, she found that, if anything, those who were breastfed suffered more from long-term health issues. Explaining why previous studies have consistently found that breast-fed babies end up being healthier on average, Dr Colen said these projects suffered from “selection bias”. Factors like a mother’s employment, age and family income skewed the figures, she said, because a mothers who breastfeed statistically have greater than average education, resources and wellbeing themselves. Dr Colen stressed that her findings do not oppose the view that breastfeeding, in the short term, has clear health benefits for young children, but with the issue of breast versus bottle proving “statistically insignificant” in the long term for children with the same family background, she said her results showed it was

time to focus on other, more important factors. “I’m not saying breast-feeding is not beneficial, especially for boosting nutrition and immunity in newborns,” Colen said. “But if we really want to improve maternal and child health, let’s also focus on things that can really do that in the long term – like subsidised day care, better maternity leave policies and more employment opportunities for low-income mothers that pay a living wage, for example.” Dr Colen’s research analysed 8,237 children, 7,319 siblings and 1,773 “discordant” sibling pairs, in which at least one child was breast-fed and at least one other child was bottle-fed. When the sample was restricted to siblings who were differently fed within the same families, scores for each child on 10 of 11 health indicators like BMI, hyperactivity, math skills and reading recognition were not statistically different. The only outlying indicator was asthma – in every sample, children who were breast-fed were at higher risk for asthma than those who weren’t. Dr Colen said that by comparing within families, scientists were able to take into account “all of those characteristics – both measured and unmeasured – that differ by family, such as parental education, household income and race/ ethnicity. If breast-feeding doesn’t have the impact that we think it will have on long-term childhood outcomes, then even though it is very important in the short-term we really need to focus on other things,” she said.

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Feeding Your Baby:

Breast Many new mothers struggle with the decision to breastfeed or bottle feed their new baby often stressing and feeling guilty about the choice they have made, worrying whether there choice is correct. Here’s we offer some guidance to help you choose what’s right for you.

Breastfeeding baby Breast milk is the perfect food for any baby, offering numerous advantages over baby formula, especially in the first four months or so and here’s why: • It’s always available

Bottle

big decision every new mum must make is how to feed their little one will it be breast or formula. Some people can be uncomfortable around women while they are breastfeeding. However, if you pull out a bottle of formula, there are those who may criticize you for not feeding your baby what they might consider “nature’s perfect food” - breast milk.

• It’s free • It contains active infection-fighting white blood cells and natural chemicals that give increased protection against infections in the first months, when these can be the most serious • It contains the perfect proportion of nutrients that your baby needs, including protein, carbohydrates, fat, and calcium • It is easily digestible • It may protect against allergies and asthma in the future • It may decrease a baby’s risk of obesity in the future • It may contain some fatty acids that promote brain development • Breastfeeding can help new mothers lose weight more easily • It enables mother and baby to bond more effectively. Additionally, there probably are other beneficial components of breast milk that we are not aware of and so are not added to formula.

Bottle feeding baby With all these advantages of breast milk, should you feel guilty if you choose not to breastfeed? Absolutely not! • Over the last few years infant formulas have gotten better and better at matching the ingredients and their proportions to that of human milk

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• While breastfed babies may have relatively fewer infections, the vast majority of infants won’t get a serious infection in the first months whether breast- or bottle fed. A happy, unstressed mother is the best mother. If you feel that bottle feeding best fits your needs, then it’s the best for meeting your baby’s needs as well.

Tips for Bottle Feeding Baby with Formula • A classic misconception is that formula should be heated. There’s no need to heat the formula for your baby. Drinking it at room temperature is fine • Once a baby has sipped from formula, it should be discarded. You can, though, save unused formula that baby hasn’t sipped from for the next feeding.

Tips for Choosing a Formula • Don’t hesitate to pick a less expensive brand of formula if finances are a factor. Most formulas are pretty much the same. More expensive does not necessarily mean better • Avoid low-iron formula. Most formulas on the market have adequate iron. Just be sure to check that it’s iron fortified when you buy a formula. There is a lot of evidence that iron deficiency in the first years adversely affects brain development. And side effects from iron (gas, constipation, discomfort) while much discussed, are actually very rare • Pick whichever type of formula - powder, concentrate, or ready-to-feed - best suits your needs. There is no nutritional difference between them. You may want to keep in mind that powdered formula is the least expensive, though • Choose cow’s milk formula over soy to start with.

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Choosing a Formula for bottle-fed infants

ou’ve decided that formula is the nutritional option for your baby. Today most infant formulas are made from modified cow’s milk and contain: Vitamins, minerals, and other nutrients which are added to make them as close to breast milk as possible, to help give your baby the healthiest possible start in life. But there are some babies who just can’t tolerate some of the ingredients in cow’s milk. Or, they may have a medical condition that requires different nutrition than a regular formula can offer. If your baby can’t eat regular formula, there are other options created for babies with special nutritional needs. Before you switch formulas, check with your paediatrician. The doctor can help you find the product that’s best for your baby.

Soy Formula Soy formulas contain soy protein along with: • Carbohydrates • Amino acids • Vitamins • Minerals They’re an option for babies who: • Are lactose-intolerant -- meaning their bodies can’t break down a sugar called lactose in cow’s milk

Partially Hydrolyzed Formula Partially hydrolyzed formulas contain proteins that have been partly broken down to make them easier for babies to digest. They are sometimes recommended to prevent allergies in babies who are at high risk because they have a lot of family members with allergies. There’s no evidence that partially hydrolyzed formula can prevent babies from getting allergies. But these formulas might offer some protection against the skin disease eczema.

Lactose-Free Formula Lactose-free formula is an option for babies who can’t eat cow’s-milk formula because they’re lactose-intolerant. This is, however, pretty rare. Although this formula is made from cow’s milk, the lactose has been removed. Babies who have been sick with diarrhoea may also find lactose-free formula easier to digest. You can try this formula while your baby is getting over a stomach bug, and then switch back to regular formula once he feels better.

Preterm Formula

• Have galactosemia -- a disorder that keeps them from breaking down a sugar called galactose in milk

Babies who were born too early (before 37 weeks) need more nutrition to help them catch up on growth. Special preterm formulas have the extra protein, calories, calcium, and other nutrients these babies need.

• Are allergic to cow’s milk (however, about half of babies who are allergic to cow’s milk are also allergic to soy)

Anti-Reflux Formula

Although some parents try soy formula to ease their baby’s tummy problems, there is no evidence it can help with issues like colic or a stomach bug.

In babies with reflux, the valve that keeps acid in the stomach hasn’t developed enough. As a result, acids back up into the oesophagus -- the tube that connects the throat with the stomach. Babies with reflux may: • Spit up

Hydrolyzed Formula

• Act cranky

A small number of babies are allergic to cow’s milk or soy protein. If they drink cow’s milk, they will have symptoms such as:

• Have trouble eating

• Blood in the stool • Diarrhoea • Irritability • Skin rash • Vomiting • Wheezing These babies need special pre-digested formulas - also called hydrolyzed or hypoallergenic formulas. The milk proteins in these formulas have already been broken down so baby doesn’t have an allergic reaction to them.

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Anti-reflux formulas are made especially for babies with reflux. They contain rice starch to thicken them and make them easier for babies to keep down. Sometimes this is not enough. If your baby is having reflux symptoms, be sure to speak with your doctor.

Formulas for Babies with Special Health Needs Babies who are born with certain medical conditions have special dietary needs. Metabolic diseases like PKU (phenylketonuria) prevent the baby’s body from breaking down proteins. Fatty acid diseases like MCAD (medium-chain acyl-CoA dehydrogenase) make it harder for the baby to break down fats. Many different formulas are made to meet the nutritional needs of babies with these conditions.

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the

CLINIC HEALTH NEWS

Is prevention better than cure? Doctors now have another weapon against HIV/AIDS in their arsenal, and it’s a potent one. For the first time, the U.S. Food and Drug Administration (FDA) have approved a drug treatment that will prevent infection in healthy people. The drug, called Truvada, which is already approved for the treatment of HIV in infected patients, works by lowering the amount of virus circulating in people’s blood. But clinical trials show that it can also protect uninfected high-risk people from acquiring the virus, if they take the drug daily before and after exposure. The approval is controversial. Some public health experts argue that allowing the drug to be used for prevention will foster a false sense of security among users, leading people to believe mistakenly that they are immune to the virus and reduce their use of condoms. However, the FDA determined that the benefits of expanding the pool of people who may use Truvada to protect against HIV made it worth approving. Here’s what you need to know.

Who can take Truvada? The drug, made by Gilead Sciences Inc., is approved for healthy, uninfected people who are at high risk of contracting HIV through sex. These include sex workers and people with partners who are HIV-positive

or engage in high-risk behaviours, such as using IV drugs.

How effective is the drug in preventing HIV? In one study, healthy gay and bisexual men who took Truvada daily and were counselled

about safe sex practices lowered their risk of becoming infected by up to 42%. In another study involving heterosexual couples in which one partner was HIV-positive, the uninfected partner had a 75% lower risk of contracting HIV if they took Truvada.

Does Truvada cure AIDS? No. The drug can treat people who are infected with HIV by lowering the amount of virus in their bodies and slowing down the progression of the disease. In healthy, uninfected people, the drug can thwart HIV’s ability to take hold in healthy cells and start an infection, by blocking the activity of an enzyme that the virus needs to replicate.

Why is the approval important? Approving a drug to prevent HIV marks a big step toward controlling the spread of HIV and AIDS, not just in the U.S. but worldwide as well. Once Truvada is used as a preventive measure domestically, the U.S.backed AIDS programs in the developing world may also begin to roll out the pill for healthy people who are at high risk of contracting HIV. Public health experts are eager to build up all effective prevention strategies, noting that the only way to stop the epidemic is by preventing new infections as well as treating existing ones.

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the

CLINIC HEALTH NEWS Cold potatoes could counter health effects of red meat

Botox blitz against Cancer Could the destroyer of wrinkles also work on cancer? Gastric cancer is the fifth most common cancer in the world and can be hard to treat. Chemotherapy is often not enough to stop tumour growth, but it seems that botox injections could help. One method for treating stomach cancer is to sever the branches of the vagus nerve that innervate the stomach, a procedure known as a vagotomy. That’s because the nervous system influences how certain cells behave, in some cases encouraging tumour growth But a vagotomy is a very invasive procedure. Timothy Wang of Columbia University, New York, and his colleagues wondered whether the same effect could be achieved with a drug. One way nerves are thought to stimulate cancer is through the release of signalling chemicals. To prevent nerve fibres from doing this, Wang’s team used botox, which upon entering the nerve cells prevents them from releasing the signalling chemicals that can influence tumour growth. The team injected botox into mice with gastric cancer and compared their tumour growth with that in mice that had received a vagotomy. They found that the botox was as effective at limiting tumour growth as surgery when used in early stages of the disease. For advanced gastric cancer, botox cannot reduce the size of tumours that have already developed. It can, however, stop new growths from increasing in size, so the team tried combining botox treatment with chemotherapy. While botox and chemotherapy on their own had a small effect on new tumours, mice that received both treatments had tumours that were about half the size of those that received no treatment at all. Wang’s team now plan to test the use of botox in advanced gastric cancer patients who have shown resistance to chemotherapy – watch this space!

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People who eat a lot of red meat have a higher risk of developing colorectal cancer. But previous work has suggested that a type of starch that doesn’t get digested – called resistant starch – can have a protective effect by raising levels of a chemical that dampens some of the genetic changes that precede such cancers. In the first, small human trial, Karen Humphreys and her colleagues from Flinders University, Adelaide, Australia, gave 23 healthy volunteers a high redmeat diet for four weeks. They then took cell samples from the volunteers’ guts. These showed an increase in the number of micro RNA molecules – short lengths of genetic material that can silence genes - called miR17-92 and miR21. These elevated micro RNAs are associated with the survival and growth of colorectal cancer cells, and with poorer outcomes for people with that type of cancer. Next they gave the same volunteers the same diet for another month but this time supplemented with resistant starch. This

is found in foods including cooked potato that has been left to cool, and bananas, though the researchers gave it in the form of a drink. After this time, cell samples showed that the volunteers’ levels of miR17-92 had, on average, reverted to their original level before the high red-meat diet was introduced. The starch-supplemented diet had no impact on the levels of miR21. The changes are indicative of much more going on, says Humphreys. “Red meat is likely to be having other cellular effects aside from changing micro RNA levels, such as damage to DNA,” she says, adding that she and her team are now looking at whether resistant starch also moderates other effects. “Red meat should be eaten in small amounts only and foods that contain fibre or resistant starches should be an important part of the diet,” says John Cummings, a gastroenterologist at Dundee University, UK.

UK push to put warning labels on alcoholic drinks If finger wagging doesn’t put you off drinking, maybe a photo of a diseased liver will, or of a bulging beer belly. Putting warnings on alcoholic drinks has been proposed by a group of British parliamentarians as part of a manifesto of 10 measures to reduce alcohol misuse in the UK. “We’re really not in the stages of knowing what the labels would look like yet,” says Cara Barrett of Alcohol Concern, the charity that helped to launch the manifesto. “At the moment it’s a call to display the nutritional content, including the calories and sugar, as well as the alcohol units, so people are aware of what they are consuming.” The All-Party Parliamentary Group on Alcohol Misuse wants evidence-based health warnings on all alcohol labels, but whether they deter drinkers may depend on how grim they are. Research into tobacco warnings shows that the most gruesome images have a greater deterrent effect on smokers than written warnings. The manifesto states that liver disease in those under 30 has more than doubled over the past 20 years, and puts the annual cost of alcohol to the UK economy due to accidents and ill health at £21 billion.

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CLINIC HEALTH NEWS

Food influences body clock and may ease jet lag

Arthritis drug shows potential to stall Alzheimer’s DESPITE decades of work and hundreds of trials, Alzheimer’s disease remains an end-oflife trauma for millions. Could that be about to change? Although there is still no way to reverse or cure the condition, a small clinical trial in 33 people with Alzheimer’s suggests that a drug already widely used to treat rheumatoid arthritis might be able to delay or even halt its progression.

Food could be a new weapon in shaking off the effects of jet lag after research in mice showed that the insulin released as a result of eating can be a key factor in restoring a disrupted body clock. Miho Sato and her colleagues at The Research Institute for Time Studies at Yamaguchi University in Japan did experiments in mice and tissue cultures to show, for the first time that increases in insulin affect circadian rhythms. These daily rhythms affect alertness, sleep patterns, and mediate many other physiological processes. Your biological clock is regulated by two broad factors: first, the central rhythm is reset daily by light, as sensory input from the eyes is processed by a small part of the brain called the suprachiasmatic nucleus. The rise and fall of hormones linked to sleep, for example, match this rhythm. But circadian rhythms are also present in peripheral “clocks” in a wide range of cell types in the body. Some of these can be influenced by food. Sato demonstrated the role of insulin by shifting the peripheral body clock in the livers of mice by feeding them only at night. They then split the mice into two groups, supressed insulin levels in one group, and returned all the mice to daytime feeding. Four days later, the livers of the non-supressed mice had readjusted to a normal daily rhythm, as revealed by the daily rise and fall of liver-gene expression. The livers of the insulin-suppressed mice had still not returned to normal.

Jet lag tip: If human body clocks are similar to mouse ones, Sato’s study suggests that people suffering from jetlag could adjust their eating patterns to get their internal clocks back to normal more quickly. “During jet lag, our bodies on their own may adapt very slowly. But we can make use of the knowledge of our study. If you were flying from London to Japan, you’d have an eight-hour phase-advance. So from our study using mice, the correct time to eat more would be earlier in the day.” Biologist Urs Albrecht at the University of Fribourg in Switzerland welcomes the research. “In the orchestra of the human body – where every cell has a clock running – the conductor is the suprachiasmatic nucleus in your brain. But the environmental signal of food also has an impact on the circadian patterns scattered across the body. Somehow, no one had looked at it in this way before. “We now have the detailed biological explanation for why our bad habits of sitting in front of the TV and eating something before we go to bed are pretty silly,” Albrecht added. “Enjoy your restless sleep!”

A new therapy is desperately needed. A 2012 report by the World Health Organization estimated that, by 2030, 70 million people worldwide will have dementia. The few existing treatments only ease symptoms and slow the progression of the disease, and new candidate drugs are failing clinical trials. Between 2002 and 2012, 413 trials of drugs for Alzheimer’s disease were conducted, but 99.6 per cent of them failed (Alzheimer’s Research & Therapy, doi.org/tqh). Now, preliminary results from a pilot trial suggest that a drug used to treat arthritis could have the potential to halt the progression of Alzheimer’s. Over six months, people with mild-tomoderate Alzheimer’s taking a placebo showed expected cognitive decline, but those taking the drug, called etanercept, had similar scores in some tests for cognitive function at the end as they did at the start of the trial. In other tests for cognition, behaviour and coping, the symptoms of those taking the drug either stabilised or declined to a lesser degree than those of people taking a placebo. Etanercept works by sponging up and disposing of a protein called TNF-alpha, which ramps up and sustains inflammation following infections or as a result of metabolic or inflammatory diseases including diabetes. The drug is prescribed as a weekly injection for people with arthritis. “It’s certainly worth following up with a larger study,” says Eric Karran, director of research at the charity Alzheimer’s Research UK. “Considering the small size of the trial, it’s very promising to see positive effects on measures of memory and thinking, behaviour and dayto-day activities, and for these to get stronger with time.”

YOU & YOUR HEALTH

Metabolic Syndrome

s a complex medical condition metabolic syndrome is becoming increasingly common in todayâ&#x20AC;&#x2122;s society. Although it was only identified less than 20 years ago, metabolic syndrome has become as widespread as pimples and the common cold, and occurs when a range of metabolic risk factors such as obesity and insulin resistance come together. Indeed, metabolic syndrome seems to be a condition that many people have, but no one knows very much about. So what is this mysterious syndrome - which also goes by the scary-sounding name Syndrome X - and should you be worried about it?

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UNDERSTANDING METABOLIC SYNDROME

who continue to gain five or more pounds per year raise their risk of developing metabolic syndrome by up to 45%.

Metabolic syndrome is not a disease in itself. Instead, it is a group of the most dangerous heart attack risk factors - high blood pressure, high blood sugar, unhealthy cholesterol levels, and abdominal fat.

While obesity itself is likely the greatest risk factor, others factors of concern include:

Obviously, having any one of these risk factors isn’t good. But when they’re combined, they set the stage for grave problems. These risk factors double your risk of blood vessel and heart disease, which can lead to heart attacks and strokes. They increase your risk of diabetes by five times. The good news is that metabolic syndrome can be controlled, largely with changes to your lifestyle.

HOW COMMON IS METABOLIC SYNDROME? Metabolic syndrome is quite common. Approximately 32% of the population in the U.S. has metabolic syndrome. Around 25% of adults in Europe and Latin America are estimated to have the condition, and rates are rising in developing East Asian countries. Within the US, Mexican Americans have the highest prevalence of metabolic syndrome. The prevalence of metabolic syndrome increases with age, and about 40% of people over 60 are affected.

n women who are post-menopausal, n smoking, n eating an excessively high carbohydrate diet, n lack of activity (even without weight change), So it probably has many different causes. Some risk factors are: n Insulin resistance. Insulin is a hormone that helps your body use glucose - a simple sugar made from the food you eat - as energy. In people with insulin resistance, the insulin doesn’t work as well so your body keeps making more and more of it to cope with the rising level of glucose. Eventually, this can lead to diabetes. Insulin resistance is closely connected to having excess weight in the belly. n Obesity - especially abdominal obesity. Experts say that metabolic syndrome is becoming more common because of rising obesity rates. In addition, having extra fat in the belly - as opposed to elsewhere in the body - seems to increase your risk.

WHAT CAUSES, AND WHAT ARE THE RISK FACTORS AND SYMPTOMS OF METABOLIC SYNDROME?

n Unhealthy lifestyle. Eating a diet high in fats and not getting enough physical activity can play a role.

As is true with many medical conditions, genetics and the environment both play important roles in the development of the metabolic syndrome.

n Hormonal imbalance. Hormones may play a role. For instance, polycystic ovary syndrome (PCOS) - a condition that affects fertility - is related to hormonal imbalance and metabolic syndrome

Genetic factors influence each individual component of the syndrome, and the syndrome itself. A family history that includes type 2 diabetes, hypertension, and early heart disease greatly increases the chance that an individual will develop the metabolic syndrome. Environmental issues such as low activity level, sedentary lifestyle, and progressive weight gain also contribute significantly to the risk of developing the metabolic syndrome. Metabolic syndrome is present in about 5% of people with normal body weight, 22% of those who are overweight and 60% of those considered obese. Adults

WHAT ARE THE SYMPTOMS OF METABOLIC SYNDROME? You may recognise some of the following symptoms of metabolic syndrome: n Tiredness - particularly after meals n Inability to focus properly - ‘brain fog’ n Acanthosis nigricans - browning (hyperpigmentation) of folds of skin such as on the neck, armpits, groin and between the buttocks

RISK FACTORS FOR METABOLIC SYNDROME According to the National Heart, Lung, and Blood Institute, there are five risk factors that make up metabolic syndrome.

Large Waist Size

For men: 40 inches or larger For women: 35 inches or larger

Cholesterol: High Triglycerides

Either 150 mg/dL or higher or Using a cholesterol medicine

Cholesterol: Low Good Cholesterol (HDL) Either For men: Less than 40 mg/dL For women: Less than 50 mg/dL or Using a cholesterol medicine High Blood Pressure

Either Having blood pressure of 135/85mm Hg or greater or Using a high blood pressure medicine

Blood Sugar: High Fasting Glucose Level 100 mg/dL or higher

If you’ve just been diagnosed with metabolic syndrome, you might be anxious. But think of it as a wake-up call. It’s time to get serious about improving your health. Making simple changes to your habits now can prevent serious illness in the future.

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Intestinal Issues

nflammatory Bowel Disease (IBD) can affect anybody and has once again been propelled into the spotlight because of the recent diagnosis of Sam Faiers (right) star of The Only Way is Essex (TOWIE). But what exactly is IBD, what are the symptoms and how do you get it? Here we take an in-depth look. Inflammatory bowel disease (IBD) refers to two different chronic conditions or diseases that may be related, Crohn’s disease and ulcerative colitis. Both diseases consist of inflammation of the wall of the bowel or intestines - hence the name - leading to bowel that is inflamed, swollen and that develops ulcers. The inflammation and its consequences are different in Crohn’s disease and ulcerative colitis. The inflammation results in various degrees of abdominal discomfort, diarrhoea, and intestinal bleeding. Both diseases can result in serious digestive problems.

Types of IBD: CROHN’S DISEASE Crohn’s disease is a chronic (slowly developing, long-term) inflammation of the digestive tract. It can affect any part of the digestive tract from the mouth to the anus but usually involves the terminal part of the small intestine, the beginning of the large intestine (cecum), and the area around the anus. The inflammation causes uncomfortable and bothersome symptoms and may produce serious damage to the digestive tract. One of the characteristics of Crohn’s disease is that involvement of the bowel may be discontinuous, that is, several areas may be inflamed but intervening segments may be normal.

ULCERATIVE COLITIS Unlike Crohn’s disease, in ulcerative colitis the inflammation involves only the superficial layers of the wall of the bowel, the innermost lining. Involvement is limited to the colon and rectum without skipped areas. Inflammation may be limited to the rectum (referred to as ulcerative proctitis), but usually is more extensive, extending variable distances to involve the sigmoid, descending, transverse, and ascending colon.

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general, each manifestation is more common in one or the other disease. For example, sclerosing cholangitis is much more common in ulcerative colitis than Crohn’s disease.

WHAT CAUSES IBD? The cause of IBD is unknown. What is known is that a combination of genetic and environmental factors result in ongoing inflammation localized mostly to the bowel that for some reason is not controlled. The continuing inflammation results in the local destruction of the bowel as well as manifestations outside of the bowel. Therefore, treatments are directed towards controlling the inflammation.

WHO CAN GET IBD? IBD occurs equally in men and women. Although it usually begins during the teens or early adulthood, it may develop at other times, even among infants and the elderly. Early observations were made that relatives of patients with IBD were approximately 10 times more likely to have IBD (usually the same type as the patient, i.e., either Crohn’s disease or ulcerative colitis). If the patient is a twin, the other twin is even more likely to have IBD, and identical twins are more likely to share IBD than even fraternal twins. IBD is more common among Caucasians and people of Jewish descent.

IBD SYMPTOMS Although the symptoms of Crohn’s disease and ulcerative colitis are similar, they are not identical. Abdominal pain and diarrhoea are common to both diseases as is loss of weight and fever. Ulcerative colitis tends to be associated with more bleeding due to the extensive erosion by inflammation of the blood vessels supplying the lining of the colon. On the other hand, symptoms of obstruction of the bowel (pain, nausea and vomiting, and abdominal distension) are more common in Crohn’s disease because the entire wall of the bowel is inflamed. The more extensive inflammation causes more swelling than the superficial inflammation of ulcerative colitis that can obstruct the flow of digesting food through the bowel.

OTHER IBD SYMPTOMS Manifestations of IBD may occur outside the digestive tract. Several types of skin conditions (erythema nodosum, pyoderma gangrenosum) are seen as is uveitis, an inflammation of the eye that can affect vision. Arthritis, including sacroiliitis of the pelvis, may occur. More serious but less common is sclerosing cholangitis, an inflammation of the bile ducts draining the liver. Although each manifestation can occur in either Crohn’s disease or ulcerative colitis, in

IBD IS NOT THE SAME AS IBS IBD is sometimes confused with irritable bowel syndrome (IBS). The cause of IBS, as for IBD, is not known. The striking difference between the two diseases is that there is no identifiable inflammation in IBS. Some symptoms may be similar - abdominal pain, diarrhoea - but the other symptoms and signs of IBD are not seen - bloody stools, fever, and weight loss. The cause of IBS is believed to be dysfunction of the intestinal muscles, nerves, and secretions and not inflammation. Signs of inflammation in the intestine as well as symptoms outside of the abdomen are not seen in IBS.

CONDITIONS THAT MIMIC IBD The bowel has only a few ways in which it can respond to diseases that affect it, so it is not surprising that the symptoms of IBD can overlap with other intestinal diseases. The similarity of some symptoms with IBS already has been mentioned. Other common abdominal diseases that can mimic IBD are diverticulitis, celiac disease, and colon cancer.

DIAGNOSING IBD:

BARIUM X-RAY

COLONOSCOPY

Although to a large extent replaced by endoscopy, barium X-ray studies still are used for the diagnosis of IBD. In the case of ulcerative colitis, the barium enema examination is most helpful since it examines the colon. In Crohn’s disease the small bowel series is most helpful since the small bowel is where the disease most commonly occurs. These X-ray studies can identify ulcerations, narrowing and skipped areas, which can help to differentiate Crohn’s disease from ulcerative colitis.

Endoscopy is the best method for diagnosing IBD. Among endoscopic procedures, colonoscopy is most effective since it can examine the entire colon as well as the terminal ileum and is able, therefore, to diagnose most cases of Crohn’s disease and ulcerative colitis. Colonoscopy is able to recognize more subtle signs of inflammation than barium studies, and also provides the opportunity to biopsy the lining of the colon and ileum. Biopsies can be useful in differentiating between Crohn’s disease and

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ulcerative colitis and also differentiating these diseases from other less common inflammatory diseases of the bowel. When Crohn’s disease affects the small bowel, but not the terminal ileum, the colonoscope may not be able to reach the involved area of the small intestine. In this situation, enteroscopy, a type of endoscopy, or a swallowed video capsule, both of which examine the small bowel, can be used.

WHAT TO EXPECT WHEN YOU HAVE IBD There is a great range in the severity of the symptoms of IBD, and the severity may vary over time even without a change in treatment. Long periods of months to years may occur with minimal symptoms, referred to as remissions. Remissions may be followed by episodes of increased symptoms, referred to as flares that may require temporary or prolonged changes in treatment. In ulcerative colitis, only 5% to 10% of patients have symptoms all of the time. Interestingly, even when there are minimal symptoms, colonoscopy and biopsy may show continued inflammation though the inflammation usually is of a milder degree than the inflammation seen during a flare.

IBD AND STRESS Stress makes almost every symptom of every disease seem worse, but it is a cause of vary few diseases. The situation is the same in IBD. Stress makes the symptoms seem worse, and unfortunately, stress is a part of most peoples’ lives. Therefore, it is likely just by chance alone that a period of stress may precede a flare of IBD, Although it is possible that stress, because it causes many hormonal and neurological changes, may actually increase the degree of inflammation in IBD or at least the perception of symptoms, but there is no proof of this. Stress does not cause IBD, but it always is reasonable to reduce stress during flares if possible.

COMPLICATIONS: OBSTRUCTION The inflammation of Crohn’s disease involves the full thickness of the bowel wall. There is a lot of swelling that occurs with the inflammation. The swelling can narrow the lumen (passage) within the intestine. In addition, part of the inflammatory process is the laying down of scar tissue. Once scar tissue is laid down, it contracts. In the bowel, this contraction also can result in a narrowing of the lumen. Whether by inflammation or the formation of scar tissue, the narrowing of the bowel can obstruct the flow of bowel contents. The contents back up and lead to bowel distension and pain, nausea, and vomiting. The abdomen often becomes swollen due to the distended bowel and secretion of intestinal fluids. Eventually, the bowel may cease to function altogether (ileus). Obstruction usually is treated in the hospital with treatment directed at either the inflammation, the scar tissue, or both.

ABSCESS OR FISTULA Crohn’s disease, because of its characteristic involvement of the full thickness of the bowel wall, can lead to deep ulcers which can turn into abscesses, pockets of infected pus, causing pain and fever of even obstruction of the bowel. The infection can spread throughout the body (sepsis). The ulcer also may penetrate the bowel wall and enter other nearby organs, for example, the urinary bladder or the vagina. The fistulas also may erode through the skin to the outside of the body. The resulting tracts from the bowel to the organs are known as fistulas. Such fistulas may result in chronic bladder infections or drainage of bowel contents into the bladder and vagina. Fistulas and abscesses usually are treated surgically, though some of the more potent treatments for Crohn’s disease may allow fistulas to heal spontaneously without specific treatment.

HEALTHY

ULCERATED

CAN IBD CAUSE COLON CANCER? Cancer of the bowel is a later complication of IBD. It is more common in ulcerative colitis than Crohn’s disease, and much more commonly involves the colon. The risk of colon cancer begins to increase after eight years of disease and increases in frequency with increasing extent of inflammation. Thus, patients with colitis involving the entire colon are more likely to develop cancer. Endoscopic screening for colon cancer in ulcerative colitis usually is recommended. It is important to remember, however, that the vast majority of patients with IBD do not get colon cancer.

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TREATING IBD: MEDICATIONS Treatment of IBD depends on the type of IBD - Crohn’s disease or ulcerative colitis - the location and extent of the disease, and the severity of the disease. For mild disease activity, anti-inflammatory drugs (aminosalicylates) that work locally on the bowel may be used either orally or as enemas. For moderate activity, particularly during flares, corticosteroids, another type of anti-inflammatory drug may be used either orally or by enema or even by injection. More severe activity is treated with other types of drugs that also target inflammation, the immunomodulators and biologics.

COMBINATION THERAPY Two types of medications are used for more severe IBD or IBD that is unresponsive to other medications. One type of drug includes immunomodulators, drugs that reduce the activity of the immune system and thereby inhibit the stimulus provided by the immune system that causes inflammation. The second type of drug includes what is referred to as biologics. Biologics are man-made antibodies that block the action of some of the protein molecules released by the immune system that stimulate inflammation and injure cells. Immunomodulators are used both in Crohn’s disease and ulcerative colitis. Biologics are mostly used in Crohn’s disease. In Crohn’s disease, a combination of immunomodulator and biologic drugs seem to be particularly effective.

SURGERY Patients with IBD commonly undergo surgery. In ulcerative colitis, surgery may be used for treating severe disease, disease that does not respond to treatment, and to prevent the development of cancer. Almost always, the entire colon is removed since ulcerative colitis frequently involves the entire

colon and can spread to other uninvolved parts of the colon after the diseased part is removed. Whereas in the past removal of the colon meant that patients would need a bag to collect the small intestinal contents directly, it is not possible to surgically create a reservoir for the contents out of small intestine and allow patients to have normal bowel movements. Surgery in ulcerative colitis has a major benefit; it cures the disease since it removes the entire organ (the colon) that can be involved. In Crohn’s disease, surgery also may be used for treating severe or unresponsive disease, but other reasons include the treatment of complications, for example, fistulas, strictures. Surgery rarely cures Crohn’s disease because of the tendency for inflammation to return in new sections of the bowel after the diseased portions are removed.

LIVING HEALTHIER WITH IBD IBD often is a lifelong disease; except for individuals who have their colons removed for ulcerative colitis and are cured of their disease. Appropriate and adequate treatment is critical, but because of the relapsing nature of the disease, it is important to learn how to deal with the flares with lifestyle changes, and stress management. The goal is to keep the symptoms from interfering with day-to-day life.

MANAGING IBD: FOODS TO WATCH

LOW-RESIDUE DIET

The inflammation of IBD involves the bowel, the primary digestive organ. It is not surprising; therefore, that IBD has effects on the digestion of food (for example, maldigestion and some vitamin deficiencies). It is not clear, however, whether the reverse is true, i.e., that foods have an effect on IBD. It is generally recommended that patients eliminate foods that seem to aggravate their symptoms, though there are no foods that should be specifically prohibited. It is reasonable to test for the effects of milk on symptoms since the symptoms of lactose intolerance (a common problem) can aggravate the diarrhoea of IBD. However, if there is no intolerance to lactose, continued elimination of milk is unnecessary. Gasforming foods such as beans also may aggravate abdominal symptoms.

A low residue (fibre) diet often is prescribed for patients with Crohn’s disease on the assumption that if there is less indigestible matter, there will be less bulk within the bowel, and the contents of the bowel will pass more easily particularly if the bowel is narrowed. Since the contents of the small intestine are already and remain in liquid form and should pass easily even through narrowed areas, it is not clear whether reducing bulk is important. If a low residue diet is prescribed, it probably should be prescribed only during flares. If there is concern about major obstruction, a liquid or even clear liquid diet may be a better choice.

NUTRITIONAL NEEDS If Crohn’s disease involves a large portion of the small intestine or surgery has removed a large portion, there may be malabsorption of vitamins and/ or minerals, particularly those absorbed primarily from the terminal ileum (for example, vitamin B12), a section of bowel that is frequently diseased or removed in patients with Crohn’s disease. To avoid deficiencies, supplemental vitamins and minerals often are prescribed as is a well-balanced diet. It accomplish the latter, it may be helpful to consult a dietician. Loss of weight also may occur if disease or resection is extensive enough to reduce the absorption of fat and protein. Loss of weight and vitamin or mineral deficiencies also may occur because of a poor appetite or the provocation of symptoms by eating. Caloric supplements may be necessary.

STRESS REDUCTION As previously discussed, reduction of stress may improve symptoms of IBD or at least their perception, but probably does not affect the underlying inflammation. Individual or group therapy may help to reduce stress as may yoga, meditation, or exercise.

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We provide information, support and hope to anyone affected by pancreatic cancer Speak to the specialist nurses on our Support Line:

020 3535 7099

Or email:

support@pancreaticcancer.org.uk *calls are charged at your standard network rate

Registered Charity No. 1112708

www.pancreaticcancer.org.uk

â&#x20AC;&#x153;One phone call can make a huge differenceâ&#x20AC;? Chris Support Line User

ancreatic Cancer is one of the most challenging diseases physicians face today because it responds poorly to treatment and quickly spreads to surrounding organs.

NOVEMBER AWARNESS MONTH Pancreatic cancer is the 10th most common cancer in the UK. Around 8,500 people a year are diagnosed with the disease. That’s around 23 people every day. Estimates suggest that the lifetime risk of developing pancreatic cancer is 1 in 77 for men and 1 in 79 for women in the UK. This is why November is so important: to raise awareness around early detection and prevention as well as highlight current research to help find a cure for pancreatic cancer.

Stomach

Liver

Gallbladder PANCREAS Duodenum

So what is pancreatic cancer? Pancreatic cancer occurs when abnormal cells in the pancreas grow out of control, forming a mass of tissue called a tumour. It can occur in the head, body or tail of the pancreas.

Jejunum

What are the Signs and symptoms of pancreatic cancer?

• Exocrine tumours start in the cells of the exocrine pancreas that make pancreatic juices containing enzymes to help digestion. This digestive juice flows through a series of ducts (tubes) into the main pancreatic duct which runs the length of the pancreas. Over 95% of pancreatic cancers are classified as exocrine tumours and about 90% of these are called pancreatic ductal adenocarcinomas (PDAC) (tumours arising from the lining of the pancreatic ducts).

Pancreatic cancer doesn’t usually give rise to any symptoms or signs in the early stages. This is the main reason why it can be so difficult to detect and diagnose. As the cancer grows the symptoms it causes will depend on the type of pancreatic cancer and where it is in the pancreas.

Within these two main groups there are different types of pancreatic cancer. However, the most important distinction is between exocrine and endocrine tumours. This is because they produce different symptoms, are diagnosed using different tests and are treated differently

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Most common symptoms of exocrine pancreatic tumours Most pancreatic cancers are exocrine tumours (95%). Their symptoms can be very vague and depend on whether the tumour is in the head, body or tail of the pancreas. Abdominal pain

Pancreatic cancers are divided into two main groups - exocrine and endocrine tumours.

• Endocrine tumours (also called neuroendocrine tumours or NETs) start in the hormone producing cells and account for less than 5% of all pancreatic cancers.

you for tests to explore what is causing them. It can help to note down the frequency of your symptoms and mention anything unusual you are experiencing, even if it seems unrelated. If your symptoms get worse or you develop any new symptoms suddenly you should always get in touch with your GP.

Any symptoms people do have can be quite vague and may come and go at first. An example is abdominal pain, which may start off as occasional discomfort before becoming more painful and more frequent. The symptoms can also be a sign of other more common illnesses such as pancreatitis, gastritis, gallstones or hepatitis. This means that people may end up seeing their GP several times or being sent for a number of different tests before pancreatic cancer is even considered. It is important to remember that any of the symptoms described here are common for lots of illnesses and may not be a sign of pancreatic cancer. But if you have persistent unexplained symptoms it’s important for your GP to refer

Pain is a symptom in about 70% of pancreatic cancer cases. It often starts as general discomfort or pain in the abdomen (tummy) which can spread to the back. It can be worse after eating or when you are lying down. Sitting forward can sometimes relieve the pain. At first the pain may come and go, but over time it may become more constant. If any of the organs (pancreas, liver or gall bladder) in your abdomen are inflamed or enlarged the area may also be tender to touch. Pain is caused by the cancer affecting nerves or organs near the pancreas. It can also be a result of a tumour causing a blockage in the stomach or duodenum (top part of the small intestines). Jaundice Jaundice occurs in about 50% of pancreatic cancer cases. The most common signs of jaundice are that the skin and the whites of the eyes turn yellow. Other signs include dark urine, pale stools (poo) and itchy skin. Jaundice develops when there is a build-up in the blood of a substance called bilirubin. The substance is a by-product of red blood cells

breaking down and is always present in the blood. It usually gets removed from the body in the bile fluid produced by the liver which empties into the small intestines through the bile duct. Cancer growing in the pancreas can block the bile duct so that bile and bilirubin keep building up in the body. This is known as obstructive jaundice. Jaundice can be caused by other non-cancerous conditions, such as a gallstone blocking the bile duct, so it’s important for all the obvious causes to be explored. Weight loss Losing a lot of weight for no particular reason can be a sign that something is wrong. People may also notice a loss of appetite or changes in what they feel like eating. Pancreatic cancer can affect the ability of the pancreas to produce digestive enzymes that help to digest food, especially high fat food. This means that the body can’t digest food properly or get the nutrients it needs, leading to weight loss.

Other common symptoms of pancreatic cancer These symptoms are also common, though not everyone will have every symptom. People may have these symptoms before a diagnosis, develop them later on, or perhaps not get them at all. Bowel problems A condition called steatorrhoea (stools that are large, pale, oily, floating and smelly) is a common symptom of diseases of the pancreas. It happens because the cancer affects the production of the enzymes needed to digest food, particularly high fat food. Undigested food passing quickly through the body can also cause diarrhoea and subsequent weight loss. Nausea and vomiting Nausea (feeling sick) and sickness can occur for several different reasons. A tumour can block the bile duct or press on the duodenum, which obstructs digestion. It may also cause inflammation around it in the pancreas, or jaundice. Both of these can lead to a chemical imbalance in the body which can make people feel sick. Indigestion/heartburn New, unexplained and persistent dyspepsia (indigestion/heartburn) can be a symptom of pancreatic cancer, particularly in older people.

Diabetes is particularly associated with pancreatic cancer in older people. If someone over 50 has developed type 2 diabetes within the past two years, with no other explanation, their GP should consider the possibility of pancreatic cancer. Back pain Pain in the upper back (not the lower lumbar region) can occur if the cancer spreads to the nerves around the pancreas. Other symptoms can include • Extreme tiredness/fatigue • Feeling unusually full after food • Venous thromboembolism (VTE) (blood clots that form in a vein) • Unexplained acute pancreatitis (inflammation of the pancreas).

Symptoms of endocrine pancreatic tumours Less than 5% of all pancreatic cancers are pancreatic neuroendocrine tumours, which develop in the hormone producing cells of the pancreas. They are divided into functioning and non-functioning tumours, depending on whether or not they overproduce hormones and peptides that cause a clinical syndrome. Most pancreatic neuroendocrine tumours do not produce a clinical syndrome (non-functioning) so they do not cause specific symptoms. However, some pancreatic neuroendocrine tumours overproduce certain hormones and peptides that cause a typical clinical syndrome (functioning). These give rise to different symptoms depending on the type of tumour and the hormone or peptide it produces.

• Gastrinomas overproduce gastrin, which causes peptic ulcers in the stomach or duodenum. Symptoms include severe pain, black tarry stools and diarrhoea. • Glucagonomas and scabbing), anaemia (lack of red blood cells), weight loss and inflammation inside the cheeks and lips • Insulinomas overproduce insulin, leading to hypoglycaemia (low blood sugar levels). Symptoms may include weakness, drowsiness, dizziness or lack of energy. • Somatostatinomas overproduce somatostatin, which causes gallstones, diabetes, diarrhoea and steatorrhoea. • VIPomas overproduce a hormone called vasoactive intestinal peptide (VIP). Symptoms include watery diarrhoea, high blood pressure and flushing of the face.

Treatment Options Your doctors will consider several different factors when working out the best treatment for someone suffering with Pancreatic Cancer. These include the specific type of pancreatic cancer you have, the stage of the cancer and where it is in the pancreas, as well as your age and your general health and fitness. The treatment options for pancreatic cancer fall into three main types: • Surgery - can be used to completely remove the cancer or surgical or other interventional procedures may be used to help relieve symptoms. • Chemotherapy - can be used after surgery to reduce the chances of the cancer coming back or without surgery to relieve your symptoms and to try to shrink or slow down the growth of the cancer. • Radiotherapy - can be used to try to slow down the growth of the cancer or to control and relieve pain.

Fever and shivering If the pancreas is inflamed or the ducts are blocked because of the tumour, this can cause a high temperature and shivering. Diabetes Diabetes can develop if a tumour interferes with the pancreas working properly. This is because the pancreas produces the hormone insulin which the body needs to regulate the amount of sugar in the blood. People with diabetes often feel extremely thirsty, pass more urine than normal, lose weight and feel weak and lacking in energy.

The celebrity faces of Pancreatic Cancer Patrick Swayze - Joan Crawford - Luciano Pavarotti - Steve Jobs

If you are a suffering of Pancreatic Cancer or wish to find out more information visit: www.pancreaticcancer.org.uk

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IBS AND YOUR DIET Dr. Sarah Jarvis www.patient.co.uk

rritable bowel syndrome (IBS) is a common gut disorder. The cause is not known. Symptoms can be quite variable and include tummy (abdominal) pain, bloating, and sometimes bouts of diarrhoea and/or constipation. Symptoms tend to come and go. There is no cure for IBS, but symptoms can often be eased with treatment. It’s unclear as to what exactly causes IBS in adults and a variety of factors are involved. These include sensitivity of the gut, inflammation of the lining in the digestive tract and disturbance of movements in the bowels. Many of those who have the condition report that making dietary changes can help them to manage their IBS, ease symptoms and improve quality of life.

Diet and lifestyle changes for treatment of IBS Diet and lifestyle management can be used as a treatment for irritable bowel syndrome (IBS). When looking to treat symptoms of IBS, using a staged approach is most useful. It may be as simple as eating healthily and changing lifestyle factors, or there may be slightly stricter and specific ways to manage symptoms. Before making any dietary changes, a food and symptom diary is a helpful way to identify foods that may be triggering a response in your body. Record all food and drink consumed for one week and any symptoms experienced. Try to record an approximate quantity eaten and the time of day. Symptoms may not always be caused by what you eat so consider other factors that may be involved.

Step one Healthy eating and lifestyle changes • Plenty of fruit and vegetables. • Plenty of starchy carbohydrates. Examples include bread, rice, cereals, pasta, potatoes, chapattis and plantain. • Some milk and dairy products (2-3 portions per day). If you are lactose intolerant include dairy alternatives such as soya, rice or oat milk and yoghurts that are enriched with calcium. • Some meat, fish, eggs and alternatives such as beans and pulses. • Limited amounts of foods high in fats and sugars. Limit saturated fat that is found in animal products such as butter, ghee, cheese, meat, cakes, biscuits and pastries. Replace these with unsaturated fats found in vegetable oils such as sunflower, rapeseed and olive oil, avocados, nuts and seeds. • Drink plenty of fluid - at least two litres daily, such as water or herbal teas.

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Lifestyle changes to improve symptoms • Have a regular meal pattern. • Take time when eating meals. • Try not to skip meals. • Sit down to eat, and chew food well. • Do not eat late at night. • Exercise regularly, such as walking, cycling, or swimming. If finding time is difficult, incorporate it into your day. For example, cycle to work, get off a train stop early and walk and use steps instead of lifts when possible.

De-stress If you have a hectic lifestyle, stress and anxiety may also be causing IBS symptoms. There are many complex connections between the brain and gut (small intestine). Psychological factors, the nervous system, and muscle contractions in the gut all interact with each other, causing IBS symptoms. This is known as the brain-gut axis. Therefore, stress management can be effective in easing symptoms. • Create time for relaxation. • Make the most out of leisure time. • Try relaxation therapies such as meditation. • Exercise - try yoga or taking a walk. • Get enough sleep. • Seek support or counselling.

Step two Symptom-specific changes to the diet Sometimes, a healthy balanced diet and lifestyle changes aren’t enough to improve symptoms. Therefore, it may be that more specific changes to the diet are needed. Many people report that diet affects their symptoms. Therefore, modifying what they eat can help to manage symptoms.

Reduce caffeine Caffeine can stimulate activity in the colon, which may worsen symptoms of diarrhoea. Limit tea and coffee to no more than three cups per day. Filter coffee contains higher amounts of caffeine (140 mg) compared to instant coffee (100 mg) and tea (75 mg). So, if filter coffee is included in your diet, you may want to limit this to two cups per day.

Reduce intake of resistant starches These are starches that are resistant to digestion in the gut (small intestine). Therefore, they reach the colon intact and are fermented by the germs (bacteria) in our gut. This produces gases and waste products, leading to symptoms of, bloating, wind and diarrhoea. People who have IBS react to smaller doses of resistant starches than those who don’t have IBS. Reducing resistant starches may also improve symptoms of diarrhoea.

Limit alcohol and fizzy drinks Fizzy drinks and alcohol can worsen symptoms of diarrhoea. Limit your intake of these drinks to improve symptoms. Aim to have at least two alcohol-free days each week and no more than two units each day.

Reduce intake of foods containing resistant starches • Processed foods such as crisps, oven chips, supermarket pizza’s, biscuits and cakes, breakfast cereals. • Foods that have been cooked and left out to cool - ef, cold potato/ pasta salads. • Ready meals. • Partially baked bread - eg, garlic bread or pizza bases. • Whole grains, pulses, sweetcorn, green banana and muesli that contains bran. • Dried pasta (use fresh instead). • Pastry. • Savoury snacks. Cook fresh food whenever possible and eat food that you’ve cooked straight away. This will help to reduce intake of resistant starches.

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Modify your fibre intake Fibre can be a confusing subject for many IBS sufferers. For some people, reducing high-fibre foods can help to improve symptoms. For others, increasing fibre can help to improve symptoms, so it is very much dependent on the individual. Adjust fibre intake according to personal symptoms. Use a food and symptom diary and monitor any changes.

intact. It absorbs water, adds bulk to stools, and allows waste to be passed through bowels more quickly. Reducing this type of fibre may help to improve symptoms of diarrhoea. Foods to reduce or avoid:

Firstly, it may help to clarify what exactly dietary fibre is and how it may affect symptoms. There are two types of fibre which work differently in the body. Generally, reducing insoluble fibre may help with symptoms but if an increase in fibre is necessary, this should be from soluble fibre.

• Nuts and whole grains

Insoluble fibre This type of fibre is not dissolved in water. It is not readily broken down, so it passes through the digestive system mostly

• Skin, pith and pips of fruit and vegetables • Wheat and bran • Corn (maize) Soluble fibre This type of fibre does dissolve in water and can be broken down by the natural bacteria in the bowels. It softens stools (faeces) and makes them larger. Increasing this type of fibre may help to improve symptoms of constipation. Foods to include are: • Oats • Barley • Psyllium and ispaghula • Nuts and seeds • Fruit and vegetables • Beans and pulses Whole grains (eg, wholemeal bread, brown rice and wholewheat pasta) may also help with constipation. Although increasing fibre may help to improve symptoms, it may also generate gas and cause pain and bloating. Monitoring is important to help identify this and to adjust your fibre intake according to your symptoms. If fibre intake is suddenly increased, this can cause symptoms of wind and bloating. Introduce high-fibre foods gradually to allow the gut to become used to the extra fibre. Introduce one new food over a 2- to 3-day period and monitor any symptoms. For example, have porridge for breakfast on the first day; then add beans or extra vegetables to a casserole two days later; then maybe have an extra piece of fruit 2 to 3 days later.

Drink plenty

Reduce fructose

Fibre needs water, so aim to drink at least 8 to 10 cups of water daily or other fluids such as herbal teas or sugar-free squash. People suffering from diarrhoea will need to make sure they are replacing these lost fluids. Drinking water will also help to improve constipation.

Fructose can cause diarrhoea in some people, particularly when eaten in large quantities. Sometimes fructose is not well absorbed, and can draw water from the body into the bowel, causing osmotic diarrhoea. If fructose is not well absorbed, it is fermented in the colon and gases are produced, causing wind and bloating in some IBS sufferers.

Include golden linseeds Including these in the diet may improve symptoms of wind, bloating, constipation and diarrhoea. They are a source of insoluble and soluble fibre, and can be added to casseroles, stews, soups, porridge, cereals, yoghurts and desserts. Include one tablespoon each day.

Reduce fatty foods Some people find that fatty foods are difficult to digest and can cause symptoms of diarrhoea; therefore, reducing fat in the diet may help: • Limit cakes, biscuits, chocolates and pastries. • Cut down on fatty meat products such as sausages, pies and pasties. • Use lower-fat dairy products - eg, low-fat yoghurt, cottage cheese, semiskimmed milk. • Choose tomato-based sauces rather than creamy sauces - although some tomato sauces can be oily so check the label. • Use small amounts of cheese (a matchbox size is a portion) - strongerflavoured cheeses may help you to use less. • Take care when using dressings and sauces such as mayonnaise and salad cream. Use small amounts and try the reduced-fat versions. • Cut off visible skin of meat and choose leaner cuts of meat. • Use minimal oil/butter when cooking (use an oil spray, or measure using one teaspoon of oil per person, per meal). • Try different cooking methods such as steaming, boiling, microwaving, roasting, grilling and poaching rather than frying.

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Try limiting fruit intake to no more than three portions each day. Only have one small glass (150 ml) of fruit juice per day. Having more vegetables will help to meet the recommendation of at least five portions of fruit and vegetables each day. A portion is about 80 g, or what might fit in the palm of your hand. A portion of dried fruit is about one tablespoon. It might be useful to limit honey, which contains fructose. Sometimes ‘highfructose corn syrup’ or ‘corn syrup solids’ are added to processed foods, so try avoiding or limiting these. Check the labels for these ingredients.

Step 3 Elimination diets Some people find that even after making these dietary changes, their symptoms are still not improving. Avoidance of single foods or following elimination diets might have some benefit for people with IBS. Such dietary regimes should only be followed under the assistance of a dietitian.

Food intolerance Some people with IBS may have a food intolerance. Testing and diagnosing a food intolerance involves a hydrogen breath test which can be arranged by a doctor. However, this is not always available or appropriate. Diets that exclude suspected foods can help to identify a food intolerance.

Avoid sorbitol Sorbitol is poorly absorbed and has a laxative effect when it enters the colon, so this can cause symptoms of bloating and diarrhoea. IBS sufferers may be sensitive to smaller amounts of sorbitol. Sorbitol is found in artificial sweetener, low-sugar sweets, drinks, mints and gum and often found in diabetic or slimming products. Also check the labels of these products for mannitol and xylitol, which have a similar effect.

If it is thought that particular foods are causing symptoms, a dietitian may advise you to exclude these foods for a certain time period. This is to monitor whether symptoms improve when these foods are taken out of the diet. After this time period (usually 2-4 weeks) the foods are gradually re-introduced to see if symptoms come back. Common intolerances include lactose (found in milk and dairy products), wheat (found in bread, cereals and pasta) and caffeine (found in tea, coffee or cola).

The low FODMAP diet There is a growing body of evidence that the low FODMAP diet is effective in improving symptoms of IBS. FODMAP stands for:

F ermentable O ligo Di M ono-saccharides A nd P olyols These are a group of short-chain carbohydrates that are not very well absorbed in the gut (small intestine). These carbohydrates are easily fermented and cause more fluid to enter the large bowel, leading to gas, bloating and diarrhoea. Reducing the total amount of these fermentable sugars may improve IBS symptoms. The low FODMAP diet should be done with the assistance of a dietitian.

Try probiotics Probiotics may be useful in improving symptoms of IBS, although they do not work for everybody. Probiotics can help to balance our gut bacteria. The ‘good’ bacteria in probiotics compete with ‘bad’ bacteria for space in the gut. This means that there are fewer ‘bad’ bacteria, making it a healthier gut environment. This can help with digestion and to improve symptoms of wind, bloating and diarrhoea. There are a number of probiotic products available, including yoghurts, drinks and supplements such as tablets, capsules or sachets. Some examples are Yakult®, Activia® and Actimel®. Probiotics need to be taken in the recommended dose every day for at least four weeks. Monitoring symptoms can help to identify any benefit. Other brands contain different mixtures of bacteria, so trying a different product may help if there is no success with one particular brand.

THE CLINIC

The largest private hospital network in Spain now, closer Quirón Marbella Hospital belongs to Quirón Hospital Group, the largest hospital network in Spain, formed by 21 hospitals and an extensive network of health centres located throughout the national territory. Quirón Marbella has a prestigious medical team, last generation technology, a complete portfolio of services and hospitalization located on the beach front and with sea views; a strategic enclave for the leading centre of private healthcare in the Costa del Sol. Quirón Marbella Hospital service is available for international patient care and has reached agreements with main health insurance companies.

Technology More than last generation health technology • Image Diagnostic o C-arm o Bone densitometry o Transthoracic and transesophageal echocardiography o 6 ultrasound machines o Portable radiology equipment o Mammography o Orthopantomography o Conventional radiology o Vascular and interventional radiology o 2 Nuclear magnetic resonance imaging machines (open and closed) o Computerized Axial Tomography (CAT) • Explorations and special treatments: o Holter, ergometry, tilt table o Laboratory of arrhythmias o Haemodialysis unit (20 machines) o Sleep disorder unit o Genetic testing laboratory o Surgical neuronavigator. o Laser surgery unit ENT o Hemodynamics Room o Electroencephalography o Electromyography o Digestive endoscopies and diagnostic and therapeutic colonoscopies

Professionals More than a team of professionals in exclusive, leaders in their speciality. Specialities: Allergy | Anaesthesiology and reanimation Angiology and vascular Surgery | Digestive system Cardiology | Cardiac surgery | Obesity surgery General and gastrointestinal surgery Oral and maxillofacial surgery Orthopaedic surgery and traumatology Paediatric orthopaedic surgery Paediatric surgery Plastic, aesthetic and reconstructive surgery

A benchmark for the private health of Marbella 21 Hospitals and an extensive network of health centres and outpatient consultations, including day hospital care, monographic centres of assisted reproduction, and ophthalmologic sports medicine; as well as centres of consultations and diagnosis. Thoracic surgery | Coloproctology Dermatology and veneorology | Dialysis Electrophysiology and arrhythmias Endocrinology and nutrition Digestive endoscopy | Gynaecology & obstetrics Haematology & haemotherapy | Speech therapy General medicine | Internal medicine Nephrology | Pulmonology | Neurosurgery Neurology | Neuropsychology | Nutrition Ophthalmology | Oncology | Otorhinolaryngology Childbirth preparation, and maternal education Paediatrics | Psychology | Psychiatry Rehabilitation and physiotherapy Traumatology | Sport Trauma Digestive oncologic unit | Back and neck unit Breast unit | Pelvic floor unit | Urology

Care More than a service and exquisite attention to ensure the maximum welfare of the patient. Patient care is our main priority. Your health and personal care guides our steps to always offer you a satisfactory stay. To this end, our staff will provide a personalised and warm service, which ensures the well-being of the patients and their relatives. This polite treatment is complemented by some services ranging from individual and comfortable rooms, self-catering and a personal and differentiated attention. • 66 individual rooms • Intensive care unit (6 machines) • Surgical area (5 operating theatres) • Obstetric area • Post- surgical reanimation unit (5 machines) • Clinical laboratory and pathological anatomy • Image diagnosis service

QUIRÓN MARBELLA HOSPITAL Avenida Severo Ochoa, 22, 29603 Marbella (Malaga) Tel.: (+34) 952 774 200 / 902 322 233 info.marbella@quiron.es

www.quiron.es

• Area of outpatient consultations (45 medical offices) • Area of functional tests for digestive, pulmonology, cardiology and neurology specialities. • Medical and oncohematologic outpatient hospital • Haemodialysis unit (20 machines) • Unit of rehabilitation and physiotherapy • Area of attention to patients who had a traffic accident. • Hospital pharmacy • With a surface area of 10,500 square meters distributed into six floors in the main building and three areas in annexed buildings. • Emergency service 24 hours (adult, paediatric and obstetric- gynaecology) Adult emergency unit o 4 medical consultations o Supervision area (4 boxes) o Area of outpatient treatment o Room of cardiopulmonary reanimation (CPR) o Dressing room o Gynaecology 24 hours Emergency Department of Paediatrics o 2 medical consultations o Supervision area (2 boxes) o Aerosol therapy area Quiron Fuengirola Medical Centre • 12 specialities consultations • Outpatient hospital • Functional examination room • Conventional radiology and orthopantomography room • Adults emergency service 24 hours

MEDICAL CENTER QUIRÓN FUENGIROLA Avenida Jesus Santos Rein, 19 29640 Fuengirola (Malaga) Tel.: (+34) 952 461 444

CY CMY

MEALS THAT HEAL

he recipes are not written by a celebrity T.V. chef or iconic actress turned cook. They are written by someone coming from the trenches: someone who has experienced the discomfort and embarrassment of living with digestive complaints.

They aim to inspire, inform and get you back in control of your own digestive health. For more support pick up a copy of Karen’s Cook Book, Meals That Heal or join her on a Live Meals That Heal Cookery Workshop.

Karen Maidment www.endibsnaturally.com

Smoked Haddock & Roasted Root Cakes Most fish cakes use salmon and white potato but using root vegetables for this recipe make a pleasing alternative. The sweetness of the carrots and butternut squash combine beautifully with the oak smoked fish and zesty lemon. Perfect for a summer evening. Ingredients serve 4: 4 oak smoked haddock fillets (undyed) 4 large organic carrots, scrubbed and chunky chopped ½ small organic butternut squash, peeled, deseeded and chunky chopped Handful fresh chopped organic parsley ½ organic lemon juice only Pinch of sea salt Twist of fresh black pepper Handful of organic chestnut flour for dusting 2-3 tbsp organic coconut butter for frying Method 1. Preheat your oven to 180°C 2. Using a small lidded saucepan, poach the haddock fillets in a small amount of coconut or nut milk until tender but not slimy 3. Whilst the haddock is poaching roast the veggies until tender 4. Once both are cooked decant the fish into a large bowl, discarding the skin, flake into small pieces using a fork. Mash the root veggies and add them to the bowl 5. Toss the seasoning in; lemon juice, parsley, salt and pepper and stir thoroughly to combine

6. Divide the mixture into 8 even sized balls, press each one between the palms of your hands to form a pattie/cake and set to one side 7. Pre heat a large frying pan until very hot and add the coconut oil, you want the oil almost smoking 8. Whilst the pan and oil are heating dust the patties/cakes in the chestnut flour on both sides, add each one to the pan of hot oil and fry for around 7 minutes on each side. Until golden and crispy but not burnt 9. Serve with a seasonal salad and mayonnaise (recipe overleaf).

THE CLINIC

Creamy Celeriac Soup

Mediterranean Shoulder of Lamb

Thai King Prawn Yellow Curry

A fabulous seasonal soup ready in under 20 minutes perfect for quick lunch time meals or a light supper. Buy yourself a soup flask and you can have a delicous gluten and dairy free soup that is super cheap any day of the week. Ensure you use homemade broth so that it is packed full of healing gelatin, and protein rich. Add an extra knob of cococnut oil for your gut healing fats and you are good to go! Serve it up with Caramelised Onion & Rosemary Muffins (recipe opposite).

This is a lovely alternative to a classic roast. Serve with seasonal greens such as asparagus and purple sprouting broccoli and hasselback sweet potatoes. You’ll love the infusion of flavours - it screams summer holidays on the Greek islands!

Everybody loves Thai food, the lightness yet creaminess of the sauce fused with only the best quality seasonal veggies. Yum. Ensure your prawns are the highest quality you can find, it really makes a huge difference in the taste and texture department! You don’t really need any accompaniment to this dish but if you wanted to it does work beautifully with Cauliflower Rice.

Ingredients serve 8: 1 large organic shoulder of lamb 12 medium organic vine tomatoes

Ingredients serve 4:

Ingredients

2 tbsp organic dried of fresh oregano, finely chopped if fresh

Aprox 5-7 wild, raw king prawns per person

1 large Organic Celeriac, outer layer removed and chopped

1 whole bulb of organic garlic, oak smoked if possible

3 medium Organic White Potatoes, peeled and chopped

2 large handfuls green lemon stuffed olives

1 large Organic Onion, thinly sliced

2 tbsp organic coconut oil, melted

Roughly 1 litre Chicken or Beef Broth Roughly 3 cups Coconut Milk

1 tbsp sea salt

Method

400ml tin organic coconut milk 1-2 tbsp organic Thai yellow curry paste (depending how spicy you like it) 2 medium organic sweet potato, scrubbed and chunky chopped 1 small organic cauliflower, washed and chopped into small florets 1 medium organic broccoli, washed and chopped into small florets

Freshly ground Black Pepper

1. Preheat your oven to 150°C,

1/2 tsp Organic Sea Salt

2. Now prepare the lamb. Make small slits in the meat front and back, peel the garlic cloves and insert into the slits using the hole bulb of garlic

1 large organic yellow pepper, washed, deseeded and chunky chopped

3. Next cover the front and back of the shoulder with the coconut oil and then scatter with the oregano and seas salt

Sea salt to taste

4. Pop into a large baking tray and scatter the tomatoes and olives across the top

Method

Fresh Parsley, shredded (optional) Juice of 1/2 Organic Lemon (optional) 2 tbsp Organic Coconut Oil Method 1. Melt your coconut oil in a large pan, add your onion and sautee on a medium heat until transluscent 2. Add your chopped celeriac and potato, coat with the oil and allow to cook for around 5 minutes

5. Place on the middle shelf of your oven and roast for 5hrs, covered loosely with baking parchment

3. Now add your broth, basically you want enough to come around 3/4 of the way up the side of your veggies. Pop the lid on your pan and allow to cook gently until veggies are soft

6. At 5 hrs begin to baste the lamb every 30 minutes with its own juices to keep it moist, leaving the parchment off

4. Now add your coconut milk and seasoning and blitz using a blender 5. Finally add a little more of your broth or coconut milk to get your desired consistancy, I like mine really think! Add the parsley and lemon juice if using and serve, or allow to cool and pop in the fridge.

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Large handful organic, fresh coriander, roughly chopped 1 tbsp organic coconut oil for frying

1. Heat a large skillet or frying pan on a medium heat and add the coconut oil. Once the oil is hot add the curry paste, stir and heat through for a couple of minutes 2. Now stir the sweet potato and cauliflower into the paste, ensuring all pieces are coated in the spices

7. Serve anywhere between hour 5 and 7. The meat will be falling off of the bone. Slice into chunky rustic slices and serve covered with the tomatoes, olives and its own juice

3. Put your coconut milk into the pan and bring the heat up until it starts to bubble. Drop the heat down to medium/low and simmer until the veggies are almost soft. This will take around 10 minutes

8. You can also do this in the slow cooker though I prefer the flavour of this one when cooked in the oven

4. Next add the broccoli and yellow pepper and cook until all the veggies are soft. This will take around 10 minutes 5. Finally add the prawns, cook until the prawns turn pink. Once pink throw the coriander in, season with salt and serve.

Blackberry & Apple Crumble

Spiced Baked Pears with Raspberries

Dairy Free Caramelized Pecan & Banana Ice Cream

Ingredients serve 4:

It can be challenging to find a sweet treat that doesn’t come loaded with sugar or caffeine rich chocolate and this one really hits the spot.

Ingredients serve 4

Ingredients serve 4:

2 tbsp Great Lakes gelatin hydro (optional)

3tbp organic honey 1 vanilla pod, split open 2 star anise 1 cinnamon stick, broken in half 4 firm pears, cored and quartered 1 punnet or raspberriesl

1 tbsp raw organic honey

2 medium seasonal organic apples 2 handfuls fresh foraged blackberries 1 cup organic chestnut flour 1 cup organic coconut flour ½ cup organic desiccated coconut 2 tbsp organic coconut sugar 1 cup chilled organic coconut butter/oil Method 1. Preheat your oven to 180°C, 350°F 2. Core and slice the apples and lay in the bottom of a small baking dish, top with the blackberries 3. Pop all of your ingredients into a food processor and pulse until it forms loose crumbs. It it looks too sticky add a little more chestnut flour or desiccated coconut 4. Optionally sprinkle with a little extra coconut sugar 5. Bake in the middle of your preheated oven for 20 minutes 6. Serve with coconut milk ice cream or coconut yogurt!

Method 1. Preheat the oven to a medium temperature 2. Put the pears in a small oven proof dish 3. In a small saucepan, gently heat the honey and spices with 250ml filtered water. Stir until the honey and spices have combined with the water

4 large organic bananas, sliced 2-3 tbsp raw organic pecan butter

1 handful organic pecans, crushed Method 1. Pop your sliced bananas in a glass lidded container in the freezer until solid, this will take around 2-3 hours 2.

Remove once solid and add to a food processor, along with the great lakes gelatin and nut butter. Whiz until smooth and creamy

4. Pour over the pears and back in the oven for 30 minutes or until just soft, turning half way through

3. Heat a small saucepan on a medium heat and add the honey, once it has melted slightly add the pecan pieces and stir to coat. Once sticky and caremelised remove from the heat

5. Remove from the oven and top with the raspberries.

4. Stir the pecan piece into the ice cream and either serve or refreeze for later.

Rosemary & Caramelised Onion Muffins

Speedy Homemade Mayo

Ingredients

3 Duck Eggs

240ml organic olive oil

2 tbsp Organic Coconut Oil, melted

1 organic egg

1/4 cup Organic Coconut Flour, sifted

1 tsp sea salt

1/3 cup Coconut Milk

1 tsp organic mustard powder

1/2 Organic Onion, thinly sliced

Juice of 1 organic lemon

1/4 tsp Organic Baking Powder 2 stems of fresh Rosemary, finly chopped

Method

Freshly ground Black Pepper, to taste

1. Crack the egg into a food processor and add the salt and mustard

Pinch Organic Sea Salt, to taste

2. With the motor running, pour the olive oil in, watch as the liquid begins to thicken into creamy mayo

Method 1. Whisk your eggs with all the ingredients apart from the onion 2. Pan fry your onion in a little coconut oil, on a low heat until transluscent

3. Now add the lemon juice with the motor still running 4. Voila it’s done. This will stay fresh for at least a week in the fridge

3. Once soft stir the onion into your batter mix 4. Divide your batter into 4 muffin cases and bake in a pre heated oven at 180 celcius, Gas Mark 4 for 20 minutes or until a skewer comes out clean 5. Eat whilst warm or allow to cool completely before storing or freezing.

THE CLINIC

SUNSEARCH MAGAZINE

New. Micro Essence

The Micro Revolution has begun!

remodelling

The Nonsurgical Eye Brow lift

he ‘Botox brow lift’, or chemical lift, is becoming an extremely popular anti-ageing procedure for men and women who have mild to moderate heaviness in the brow area and don’t want to undergo surgery. Brow elevation by Botox injection can improve the shape of brow arch and position of eye brows. Eyes appear more relaxed, refreshed and wider.

76 THE CLINIC

http://esngent.be

WHAT IS BOTOX ? Botox (Botulinum toxin) is a protein produced by bacterium Clostridium botulinum. It relaxes muscle by temporary block nerve impulses to the injected muscles. This reduces muscle activity that causes lines and wrinkles. The cosmetic effect of Botox was first documented as early as 1989 and was approved by the FDA in 2002. It is now regular used by many, both male and female, as it is less intrusive and less artificial in appearance, than traditional form of treatment such as plastic surgery.

HOW DOES THE TREATMENT WORK? The Botox brow lift works by relaxing the muscles above the delicate eye area, and smoothing away worry lines and deep grooves caused by frowning along the lower forehead. When the muscles around the tops of the eyebrows are relaxed, the skin appears smoother, more toned, the brows are lifted and youthful.

WHO CAN BENEFIT FROM THE TREATMENT? The Botox brow lift can be performed on all skin types, and may be particularly effective for people who have naturally drooping eyelids and low-hanging eyebrows. The brow lift literally â&#x20AC;&#x2DC;liftsâ&#x20AC;&#x2122; the skin tissues above and around the eyebrows so that the natural eyebrow arch is a few millimeters higher.

THE PROCEDURE Prior to treatment: the specialist doctor will examine and make sure you are suitable for the procedure. Topical aesthetic or ice pack may be applied to numb the area before the injection. Treatment: A small amount of Botulinum toxin will be injected at the area between and around eyebrows to relax the muscle that pull eyebrows down. The result will gradually appear and final result will be achieved 2 weeks after the treatment. Post treatment: avoid touching, rubbing, massage or apply make up on the treated area foe 4 hours. The procedure takes only 5-10 minutes, specific after care instruction will be given.

HOW LONG THE RESULT LAST? The result last 4-6 months. The longevity of the result is variable and each individual may obtain a different result. A plan for regular follow-up treatments to maintain the initial result can be created for you. Our treatment provides a long-lasting but not permanent result leaving you the option of refining your treatment in tune with changing taste and fashion

WHAT WILL HAPPEN IF I STOP HAVING BOTOX? Your eyebrows will go back to where they were. You can stop and start having treatment again whenever you prefer providing that you are suitable.

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What is Botox? BOTOX is a purified form of botulinum toxin, a nerve poison produced by the bacteria that cause botulism, a disease that paralyzes muscles and can be fatal. Injections of Botox act like minuscule poison darts that temporarily blunts chemical nerve signals to certain muscles or glands, reducing their activity. Discovered in 1987 by two Vancouver doctors, Jean and Alastair Carruthers, Botox has become a billion-dollar industry, and the inspiration behind a crowded new generation of fillers, intensepulsed-light and radiofrequency therapies, and other age-fighting products.

Not just skin deep!

ver the last decade, Botox has become a synonym for the eradication of wrinkles, and a miracle remedy in achieving a youthful appearance. But now, with the popularization of new medical uses, therapeutic applications of the drug are poised to outstrip the cosmetic treatment in both revenue and prominence.

In the hunt to discover the next blockbuster medical use for Botox, doctors have injected it experimentally into muscles and glands all over the body, making it medicineâ&#x20AC;&#x2122;s answer to duct tape. According to recent medical journals, physicians have used it to treat chewing problems, swallowing problems, pelvic muscle spasms, drooling, hair loss, anal fissures and pain from missing limbs.

Non cosmetic uses for Botox Migraines In 2010 Botox injections where approved to treat chronic migraine. It works by paralysing the nerve supply to muscles, thereby restricting their movement. The reasons why Botox might aid migraine are not clear, and several theories have been put forward. At various points it has been suggested that: n Botox might relax muscles around the head and thereby reduce blood pressure within the brain n Botox might reduce the nervesâ&#x20AC;&#x2122; ability to send pain signals during a migraine n Botox might prevent the nerves from sending signals that will lead to a migraine While the mechanism behind any effect is not clear, it is felt that the results of research indicate Botox should be considered as a potential treatment for migraine.

78 THE CLINIC

Tennis elbow A botulinum toxin injection may reduce the pain from tennis elbow.

Excessive sweating Heavy sweating (also known as hyperhidrosis) is a very real and embarrassing problem. Botox is often used as a treatment. It works by preventing the release of a chemical that signals the sweat glands to activate. You may need to have several Botox injections, but the results can last for almost a year.

Urinary incontinence An overactive bladder affects up to 20% of people - mainly women - over the age of 40. It is a type of urinary problem whose other symptoms include having to go to the toilet often (frequency), the need to get up in the night to use the bathroom (nocturia), and wetting accidents before reaching the toilet (incontinence). A 2012 study published in the journal European Urology found that injecting botulinum toxin A (Botox) into the wall of the bladder is an effective way of treating a debilitating condition in which people have a sudden urge to pass urine. So Botox injections are one option for treating this condition when other treatments have not been effective. Those treated with Botox in the study saw the number of times that they had symptoms fall from six a day to less than one a day. However, the benefits started to wear off after around six months.

Squint

Essential tremor

With strabismus, also known as crossed eyes or a squint, the eyes don’t look towards an object together. Botox may be injected into one of the eye muscles as a treatment option, usually if a squint develops rapidly without an obvious cause. The injection weakens the injected muscle for a period of time, which lets the eyes realign themselves.

Essential tremor is a nerve disorder causing uncontrollable shaking or tremors affecting different parts of the body. Botox injections have been found to be effective for vocal and head tremors.

Eye twitching Eye twitching is a repetitive, uncontrollable blinking or spasm of (usually) the upper eyelid. One common treatment recommended by the NHS for a type of eye twitch called benign essential blepharospasm is botulinum toxin injection. The treatment may relieve spasms for several months.

Suppresses emotions We all know that Botox when used for cosmetic reasons can reduce the ability to show emotions through facial expressions. But a surprising side effect of botulinium toxin treatment is the injections may also dampen the ability to feel emotions. A study published in the journal Emotions in 2010 suggested that if Botox takes away some part of the facial expression, some of the emotional experience may also be lessened.

MS and muscle spasms Botulinum toxin is used to decrease spasticity related to multiple sclerosis and other neurological conditions. Botox injections may help stop muscles contracting or twitching when the person doesn’t want them to.

Bell’s palsy Bell’s palsy causes the drooping of the side of a person’s face because of nerve problems. The effect usually goes after some months. However, Botox injections may be used in longterm Bell’s palsy to relax muscles that have become tight or to help reduce unwanted muscle movements or twitching.

THE CLINIC

ST.TROPEZ

THE ULTIMATE TAN

#OFFTOSTTROPEZ WWW.ST-TROPEZ.COM

yelid surgery, or blepharoplasty, can help revitalise a tired, heavy appearance. By lifting the eyelids, and removing excess fat and skin from either the upper or lower lid your face will appear more alert and youthful.

Sometimes blepharoplasty also can improve your vision by providing a less obstructed field of view, once droopy eyelids are improved. Blepharoplasty can remove excess skin, muscle and sometimes fat from the upper or lower eyelids. In some cases, you might need only skin removed but not muscle — or you might need the procedure done on both upper and lower eyelids. An upper eyelid blepharoplasty (sometimes called an “eye lift”) should not be confused with upper eyelid ptosis surgery, which is a procedure to raise the position of the upper eyelid margin by tightening the muscle and tendon that normally elevate it. Blepharoplasty surgery sometimes can elevate an upper eyelid margin slightly if the heaviness of the excessive skin actually is “weighing down” the upper eyelid, causing it to droop.

WHAT IS COSMETIC BLEPHAROPLASTY? Cosmetic eyelid surgery is a surgical procedure that is not medically necessary and is performed solely to improve one’s appearance. Unfortunately, as we age the upper and sometimes lower eyelids may become droopy or baggy. Your eyebrows may also begin to sag or droop as a part of the same process. The eyelid skin stretches, muscles weaken and fat pockets become more prominent as they bulge. This may be a hereditary condition that runs in your family. Cosmetically, such conditions may detract from the overall attractiveness of your eyes and face and cause a tired or older appearance.

WHEN TO CONSIDER EYELID SURGERY: - If you have excess, hanging skin covering the natural fold of the upper eyelids - If you have loose skin hanging down from the upper eyelids over the eyelashes - If your upper and lower eyelids appear puffy, making your eyes look tired and aged - If you have deep grooves under your eyes

82 THE CLINIC

www.drsidle.com

UNDERSTANDING THE SURGERY In upper eyelid surgery, the surgeon first marks the individual lines and creases of the lids in order to keep the scars as invisible as possible along these natural folds. The incision is made, and excess fat is removed or repositioned, and then the loose muscle and skin are removed. Fine sutures are used to close the incisions, thereby minimizing the visibility of any scar. In lower eyelid surgery, the surgeon makes the incision in an inconspicuous site along the lash-line and smile creases of the lower lid. Excess fat, muscle, and skin are then trimmed away before the incision is closed with fine

sutures. Eyelid puffiness caused primarily by excess fat may be corrected by a transconjunctival blepharoplasty. The incision in this case is made inside the lower eyelid, and excess fatty material is removed. When sutures are used to close this kind of incision, they are invisible to the eye. They are also commonly self-dissolving and leave no visible scar. Under normal conditions, blepharoplasty can take from one to two hours. A more refreshed look is often the result when eye bags are improved with blepharoplasty.

CONSIDERATIONS Pros

Cons

n You will eliminate the puffiness and bags under your lower lids and the hooded skin on your upper lids, making you appear younger and healthier.

n It will take time to see results after surgery.

n You may no longer have vision problems related to overhanging eyelids.

n Youâ&#x20AC;&#x2122;ll likely be bruised and swollen and your eyes may be itchy and dry following the procedure.

n Any scars from the eye lift will be hidden in your natural eyelid creases, making them almost indiscernible.

n If your eyebrows droop and you have creases in your forehead, you may also need a brow lift.

THE CLINIC

84 THE CLINIC

RESTORING A MORE YOUTHFUL APPEARANCE

A brow lift also known as forehead lift or browplasty reduces a heavy brow and forehead wrinkles

The eyebrow area can be especially influential in the appearance of ageing eyes, as the brow can descend and cast an aged, tired and often angry expression across the face. The brow and the forehead can be the first part of the face to show early signs of facial ageing. Deep creases across the forehead and between the eyebrows can appear, even when the face remains in a static position. The effects of gravity, sun damage and the natural ageing process all contribute to a gradual descent of the brow, giving a ‘heavy’ or ‘hooded’ look to the upper face, which can make a person appear angry, sad or older than their years. Also known as a forehead lift, a brow lift elevates a low or sagging brow to a more youthful position, minimises the creases and wrinkles that develop across the forehead, and improves frown lines that develop high on the bridge of the nose. It can also rejuvenate the upper eye area, reducing heaviness and sagging over the eyelid and at the outer edges of the eye. Brow lift surgery can be performed using several different techniques, depending on the patient’s individual requirements and the surgeon’s preferred method. Generally there are two commonly used methods of performing a brow lift: the traditional coronal open incision brow lift and the more recent endoscopic brow lift. Brow Lifts explained:

CLASSIC LIFT The classic lift involves one continuous cut beginning at the level of your ears and going up around your hair line. Depending on where your hair line is, the surgeon will work to avoid a visible scar. For the endoscopic lift, the surgeon makes a few shorter cuts in your scalp. He or she will insert a scope -- a small camera on the end of a thin tube -- into one of the cuts and use another device inserted in another cut to make the necessary changes.

ENDOSCOPIC LIFT In the endoscopic lift, the surgeon uses small anchors to secure the tissue. Because the cuts are smaller, this procedure is less invasive than the classic lift. You will have minimal scarring and a shorter recovery time.

WHEN TO CONSIDER A BROW LIFT n Sagging or low eyebrow position creates a tired, sad or grumpy appearance n You have deep horizontal creases across the forehead n You have frown lines or furrows between the eyebrows or across the top of your nose n You have excess skin or fatty tissue hanging over your eyes

CONSIDERATIONS Pros - Repositions a low or sagging brow that hangs over the upper eyelid - Raises the eyebrows to a more alert and youthful position - Makes you look happier, friendlier and more approachable Cons - Only a highly experienced board-certified plastic surgeon can determine if this procedure will achieve your goals. - Choice of brow-lift technique is very important to outcome, so this procedure is very clinician dependent. - You may also need blepharoplasty (eyelid surgery), as a forehead lift does not improve baggy eyelids or crow’s feet.

HOW LONG WILL MY RESULTS LAST? Usually, you can expect the final result from surgery to be evident after six months. By then, the scalp and hairline incisions will have healed completely and you should be enjoying your more youthful appearance. Gravity will take its toll as aging continues, but portions of the brow lift, especially wrinkle lines in the brow and the frown line area, should never be as severe again and may return only mildly over the years. Life-long sun protection and a healthy lifestyle will help to maintain and extend the results of your more youthful appearance. A brow lift is often combined with a facelift or blepharoplasty to provide a harmonious rejuvenation.

THE CLINIC

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88 THE CLINIC

Beauty or the Beast!

njectables and fillers can easily correct the signs of ageing, but these treatments as well as surgical procedures can also produce unwanted problems. With all types of procedures there are risks, these risks are greater in the hands of untrained practitioners who do not fully understand the anatomy of the face and body or those who simply lack adequate training. Avoid becoming the next statistic and arm yourself with the power of knowledge. Know the most common mishaps, why they happen and how to fix them.

Why it happens:

So many women have fallen victim to this procedure. Simply put too much filler is added to the lips or surrounding area. If too much filler is added to the upper white lip (the area directly under the nose) the lips appear shelf like. If too much filler is added to the cupids bow then it is lost. This is a procedure when less is defiantly more!

How to avoid it:

Explain to your doctor how much fullness you’re looking for but be realistic. A good doctor will advise how much filler is suitable to achieve a natural full look as opposed to a blow up doll effect.

How to reverse it:

If hyaluronic acid fillers were used, your doctor can reverse the effects by injecting hyaluronidase into the lips. But, if a more permanent filler was used, it most likely needs to be surgical removed but be aware it is usually impossible to remove all the permanent filler.

BAT BROW Caused by:

Poorly injected neurotoxins

What it looks like:

Over arched brows that lack natural softness and curve to them

Why it happens:

Bat Brow occurs due to poor injection techniques – too much Botox, Dysport or Xeomin is injected into the forehead muscles ( the muscles that pull the brows up and / or just the muscles that pull down the central part of the brow are treated). The activeness of the brow muscle needs to considered otherwise you may end up with the muscles contracting against each other causing a mountain peak.

How to avoid it:

Unless you are under the age of 35yrs both the muscles that pull the brows up and the muscles that force the brows down need to be injected. If just once set of muscles are injected you’ll have a forehead that is a smooth as glass but brows that are heavy looking

How to reverse it:

Unless your doctor feels they can balance out an over projected brow with a small amount of Botox or Dysport sadly you will have to wait until the neurotoxins wear away which takes approximately 3months

WIND TUNNEL FACE Caused by:

Outdated facelift techniques

What it looks like:

A really tight, unnaturally pulled face that appears as if you are stuck in a wind tunnel or have tied your hair up really tightly into a top knot.

Why it happens:

While still seen today, the wind tunnel look occurs for two reasons, overzealous lifting that pulls the skin back rather than up and ignoring volume loss.

How to avoid it:

Your plastic surgeon needs to take a three dimensional approach to rejuvenation and address both laxity and volume loss. Be sure to find a good doctor who is experienced in facial rejuvenation and don’t be afraid to ask for references from previous clients.

How to reverse it:

It depends on the severity of the “wind tunnel effect” sometimes by simply releasing the anchor points that where originally created. However in most circumstances more than one procedure is required, fat and fillers can sometimes be used to create volume to try and recreate the natural appearance.

TURKEY TUMMY Caused by:

Getting liposuction when a tummy tuck is really needed

What it looks like:

A lumpy, rippled, dimpled or saggy stomach

Why it happens:

When surgery is done on this area, both the amount of fat in the abdomen and the skin need to be respected, if the skin is not elastic, it can’t shrink back into place. The skin and muscles sit closely together so if fat is removed superficially it will be viable.

How to avoid it:

Ensure you use a qualified surgeon who understands the benefits or both liposuction and a tummy tuck. It’s about knowing how much fat to remove using the right techniques so that the body is proportionate.

How to reverse it:

Undoing a rippled tummy can be difficult to smooth out the rippled effect fat is taken from another part to fill in the empty sections. A mini or full tummy tuck is usually the only potion.

TROUT POUT Caused by:

Overdone lip augmentation with fillers, fat or implants

What it looks like:

Overinflated lips with a top lip that is usually larger than the bottom resembling a sucker fish! The lips can also feel hard to the touch.

THE CLINIC

ANIT has a workforce made up of more than 680 professionals, 250 of whom are doctors and experts recognised on a national and international level. These professionals are able to offer patients the most up-to-date diagnostic and therapeutic advancements. Furthermore, Xanit is an International Hospital. More than 40% of the patients are foreigners originating from 90 different countries. In order to care for the individual needs of these patients, there is an International Services Department where our professionals speak a total of 16 different languages, working closely with all areas of the hospital in order to offer patients and their families high-quality personalised care and excellent medical attention.

Xanit International Hospital is situated in the town of Benalmádena (Malaga), and is a private hospital of reference on the Costa del Sol

The Hospital constantly strives to improve quality issues, and is currently immersed in the process of receiving an accreditation by The Joint Commission. This organisation is recognised worldwide as a reference for quality in healthcare, and works to improve and protocolise standards. Xanit Hospital Internacional offers a wide and comprehensive directory of services with more than 40 medical and surgical specialities, with two particular areas of reference: The Xanit Oncological Institute and The Heart Unit. The Xanit Oncological Institute brings together all of the necessary components for the treatment of cancer. Xanit’s successful work structure is a replica of the best international oncological hospitals. The hospital has created five distinct departments to treat all pathologies. The Heart Unit is able to offer treatment for all types of cardiovascular illnesses with the most experienced professionals, and most relevant techniques and treatments. Amongst the other most important specialities are gynaecology, as well as births and paediatrics. The hospital is led by Mercedes Mengibar. With a wealth of experience in Change Management in hospitals, she began her managerial career in 1993 as Director of General Services in The Virgen del Roció Hospital in Seville. Five years later she was appointed as General Manager

of Antequera Hospital (Málaga), where she implemented a new strategic orientation Project, and introduced a new organisational culture. In 2003 she assumed the role of General Manager of The USP Hospital in Marbella, implementing a new managerial system in organisational change. This resulted in revenue multiplying by ninefold and the EBIDTA coming out 6.7 times greater over a period of 7 years. Her managerial leadership resulted in her being

awarded ‘Businesswoman of the year’ in 2009, an accolade organised by The Center for Tourism Initiatives in Marbella. Mercedes Mengibar is a specialist in The Management of Healthcare Companies. She studied Organisational Psychology, and is an expert in Human Resources Management as well as in Healthcare economics, and the management of Healthcare Organisations.

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Creating the Perfect Pout

92 THE CLINIC

ips exude sexuality and having full, plump lips is often considered a sign of good health, beauty and youth. Whether you were born with thin lips or your lips are thinning due to the natural ageing process, there are many ways to enhance them?

The science behind the Perfect Pout Many people view lips as the focal point of the face, and their shape and volume can speak volumes about you before you even open your mouth to speak. A womanâ&#x20AC;&#x2122;s lips are considered the most attractive part of the womanâ&#x20AC;&#x2122;s body serving as a biological indicator to health and fertility. Full lips have long been viewed at a symbol of beauty, sexuality and youth, so with the advent of fillers woman can now restore or enhance what nature has taken away of failed to give us!

THE CLINIC

LIP ENHANCEMENT Also known as lip injections lip augmentation or dermal fillers Lip enhancement is a cosmetic procedure that can give you fuller, plumper lips, today injectable dermal filler are the most commonly used method. There are many types of dermal fillers that can be injected in your lips and around your mouth. But the most common fillers today are products that contain substances similar to hyaluronic acid. Hyaluronic acid is a natural substance found in the body and helps increase the volume in your lips. These types of dermal fillers are sometimes called “hyaluronic acid fillers.” Collagen, once the most common dermal filler, is used less often today. The newer options are safer and the effects last longer. Fat injections and implants are other methods to plump lips. But they aren’t used as much today because the results vary and there is a greater risk of side effects. Uses of Hyaluronic Acid Fillers Hyaluronic acid fillers can improve the appearance of your lips by adding: • Shape

• Structure

• Volume

The effects typically last around six months. After that more injections are needed to keep the volume of your lips. There are several hyaluronic acid fillers on the market. Among them are these products:

CONSIDERATIONS Pros

• Restylane, Restylane-L, Restylane Silk

lip injections are temporary and 3 Some can be modified to your preference

• Perlane, Perlane-L

3 Implants and surgical enhancement

• Juvederm Ultra, Juvederm Volumna XC, Juvederm Ultra Plus, Juvederm 30, Juvederm 30HV • Belotero Balance

provide a permanent solution

3 Quick one-day recovery for injections and a week for most lip surgery

• HylaForm • Elevess • Prevelle Silk • Captique When to Consider Lip Enhancement • Your lips have always been thin and disappear when you smile • As you age, your lips have become thinner and less full

Cons fillers will require injections 7 Temporary every few months

7 Lip asymmetry is a possibility 7 Removal of implants is difficult

• You feel self-conscious about how your lips look • Having fuller lips will help balance out your face

THREAD LIFTING Thread Lifts have become a very popular procedure primarily because they are non-surgical and are considered to be a relatively quick and easy procedure. Thread lift uses specialised suture materials – or threads – to outline, lift and plump the lips. By using a hollow needle, a surgeon inserts a “feather-like” thread under the skin, starting near the cheekbone. As the threads are passed through the lip line, it creates a reaction within the body causing trauma to the underlying tissue this trauma stimulates the natural healing process thus resulting in the production of collagen. The thread lift incisions are minimal and shouldn’t leave any trace of scarring, the threads themselves usually dissolve within two years Thread lifts can actually take anywhere from a half hour to 2 hours to perform so are often referred to as the lunchtime facelift.

94 THE CLINIC

COSMETIC TATTOOING Lip tattooing can be an ideal option for women lacking a definitive lip shape by adding definition and improving lip colour.

• Visibly firms and regenerates the skin • Smoothes wrinkles • Gradually firms the contours of the face

Designed for dry and dehydrated skin

Firming lifting effect for dry and dehydrated skin

Firming lifting effect for all skin ntypes

LONGEVITY RESVERATROL B E A N T I OX I DA N T N I G H T C O N C E N T R AT E TO H E L P R E PA I R A N D P R E V E N T AC C U M U L AT E D DA M AG E ,

RADIANCE REIGNITED, ELASTICITY REBOUNDED, DENSITY RESTORED MAXIMIZED CONCENTRATION OF PURE RESVERATROL

A D VA N C E D

96 THE CLINIC

S K I N C A R E

B A C K E D

B Y

S C I E N C E

Buttock enhancement surgery the hottest new plastic surgery trend…

hanks to the curvaceous bodies of celebrities like Kim Kardashian and Jennifer Lopez, men are no longer afraid to say YES, when there partners asks “does my butt look big in this?”. While boosting the size or shape of the butt is not for everyone, it is one of the fastest growing and most in demand procedures because of the dramatic difference it makes to one’s appearance. Here we look at the different butt enhancement procedures

THE CLINIC

Buttock Lift A buttock lift (gluteoplasty) removes excess sagging buttock skin that has developed as a result of weight loss, aging, gravity or genetics much like other cosmetic lift procedures. A buttock lift is commonly part of a lower body lift that may include the abdomen and thighs. A buttock lift or lower body lift, which can include the abdomen and thighs, as well, can improve and/or remove excess skin and reshape your derrière. “Most frequently done in conjunction with a body lift or abdominoplasty, the buttocks lift improves shape and contour and tightens the skin. A butt lift is essentially a more extensive tummy tuck that uses incisions along the upper area of the buttocks as well as under the buttocks crease so your surgeon can lift and rejuvenate the area. A buttock lift improves and/ or removes excess, sagging buttock skin. “After surgery, you’ll wear a compression garment or have drains to

prevent fluid formation,” The buttock lift also can improve the lumps and bumps associated with cellulite. During a butt or body lift, the skin and underlying matrix are separated from the muscle and fat, thereby releasing the bands that cause cellulite

Brazilian Butt Lift The Brazilian Butt Lift, also referred to as fat grafting, either performed on its own or in conjunction with a butt lift, can fill out a flat, saggy butt. By creating an incision in the crease where the butt and leg meet, your own fat is first gently suctioned out with liposuction (from a fatty area like the stomach or hips) before it is injected into the butt to smooth, elevate and shape the area. You can also get a lot more volume with fat transfer as opposed to implants and the results are amazing when performed on someone with flat buttocks. During this procedure, your plastic surgeon uses liposuction to remove fat from where you don’t want it before reinjection to areas where you do. The result is a shapelier bottom with curves in all the right places—and the elimination of the fat bulges and volume loss that were standing between you, your ideal body. Depending on the areas to be suctioned, tiny incisions can be placed in the pubic region, belly button, buttocks crease and along the hipbone and lower back. The fat is removed under low vacuum to protect the cells, then treated with antibiotics to help prevent infection, and grafted into the target areas of the buttocks through tiny dot-like holes in the buttocks crease and possibly on the sides of the buttocks. A low-pressure suction needs to be used during the liposuction portion to preserve the fat cells; under high-pressure suction they can burst. The procedure is very lengthy because the fat needs to be put in drop by drop so that it can survive. “The biggest misconception about a Brazilian Butt lift is that this procedure is just about making the buttocks larger. In actuality, it’s more about shaping and contouring.”

Butt Implants Butt implants, are made of soft, solid silicone. The implants are inserted through an incision in the fold beneath each buttock cheek and placed between the muscle and the bone. The size of the implants will depend on your body shape and desired fullness.Using solid silicone implants can add significant dimension and contour to your backside. Unlike breast implants, which are soft to the touch, buttocks implants are firm. While the butt procedure results are permanent, the recovery can be difficult.

Butt Enhancement Liposuction One of the most effective and gratifying ways to re-sculpt your rear is through liposuction. During the procedure, which is performed under anaesthesia, a small incision is made in the crease of the butt that will be barely visible once you’re healed. Using a cannula, fat is suctioned out of the butt. Another technique commonly used when liposuction is performed on the buttocks is ultrasound-assisted liposuction. Liposuction is effective for treating localized pockets of excess fat and for people with healthy, elastic skin, inelastic or sagging skin will not conform well to new contours after surgery, and a saggy, rippled appearance may result. Even if you exercise like mad, it can be difficult to lose fat stored in the buttocks. Liposuction of the buttocks involves sculpting the buttocks themselves, and may involve treating surrounding areas like the outer thighs and lower back to create a more streamlined shape.

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T O M Á S D A R Í O Z A PATA curugía plástica - estética y reparadora

“Beauty is universal and an integral part of being human. We all have the right to improve our appearance and therefore our mood” Dr. Tomás Darío Zapata

www.tomasdariozapata.es http://stevenringlermd.com

Keeping IT Brief - The rise of the intimate nip & tuck

osmetic surgery used to be the dirty secret of the mega-rich, but these days itâ&#x20AC;&#x2122;s out in the open. A boob job is simply one step-up from buying a Wonderbra. A facelift is little more than an upgrade from Botox, and a spot of plastic rearrangement has become a badge of honour in some celebrity circles, to the point that you can hardly open a magazine or read the paper without finding a soap star showing off their new cosmetic procedure. Yet there is one area of surgery nobody shouts about: and that is genital correction.

Intimate surgery is one of the fastest increasing areas of cosmetic surgery in Britain today. According to a recent survey by The Cosmetic Surgery Guide, intimate procedures such as labiaplasty and vaginal rejuvenation are becoming more and more popular, with 24% of female readers saying they would be interested in hearing more about vaginal rejuvenation. This seems to be a universal trend, as WhatClinic reported a 109% increase in enquires for procedures like this earlier in the year. Intimate Surgery otherwise known as Female Genital Cosmetic Surgery (FGCS) or â&#x20AC;&#x2DC;designer vaginaâ&#x20AC;&#x2122; surgery as it is more affectionately known has captured the attention (and imaginations) of both the public and media but what exactly is involved?

102 THE CLINIC

JARGON BUSTING The term ‘designer vagina’ is an umbrella term used to describe female genital surgery. Strictly speaking the term defines procedures carried out for cosmetic reasons, but is often also used to refer to functional (medical) procedures. • Labiaplasty: Removing a section of labia tissue • Hymenoplasty: When the hymen (tissue lining the vaginal opening) is restored • G-spot amplification: Collagen is injected into the G-spot to increase its size, which is alleged to increase female sexual arousal • Vaginal Rejuvenation: When tissue of the vagina is strengthened

WHAT IS CAUSING THE RISE IN ‘DESIGNER VAGINA’ SURGERY? Most women trim, pluck, shave or wax their pubic hair these days so their labia are exposed in a way they never used to be, in addition female genitalia is often airbrushed in pornography magazines, which has fostered an unrealistic idea how the ideal woman should look.

DOES

According to a study published in the BJOG: An International Journal of Obstetrics & Gynaecology female genitalia does indeed vary hugely in size and shape, which can make it difficult to quantify what’s ‘normal’.

SO WHO IS HAVING THE PROCEDURE? It was recently reported that hundreds of girls as young as 14 have had ‘designer vagina’ surgery on the NHS (based on statistics from Dr Creighton’s study). However, the NHS refuted these claims and issued the following statement: “While the study does accurately quote NHS statistics showing more than 300 labiaplasties were performed by the NHS on girls aged 14 or younger in the last six years, there is no evidence that these operations were performed for cosmetic reasons (to create ‘designer vaginas’).” In a statement a spokesperson for the Department of Health denied that the NHS offers ‘designer vagina’ surgery:

“There is no such thing a designer vagina on the NHS. Of course there is cosmetic surgery carried out on the NHS, but this is only for patients who have a clinical need for it (such as reconstructive surgery after an accident) and absolutely not for those who would simply like to have it done.” Obviously altering the appearance of the vagina is- and will probably remain- a controversial decision. Since technically there is no ‘correct’ appearance for a woman’s private area, some people believe that encouraging this surgery just for the sake of appearances is not a positive thing. However, if you are embarrassed about the length of your labia, and/or it causes you pain, you have every right to consider your options. As with ALL cosmetic treatments and procedures, both surgical and non-surgical, the decision to go ahead is an entirely personal one. Do you research, choose your doctor or surgeon carefully, and only ever undergo a cosmetic procedure after serious consideration of the risks as well as rewards.

SIZE

REALLY MATTER?

Genital size has long been a source of anxiety for men throughout history. It has various social and psychological ramifications, such as social maladjustment, fear of relationships, and lack of self-confidence. Many men feel a need to enlarge their penis in order to improve their self-esteem, or to satisfy and impress their partners which seems pretty pointless, since recent research has shown that the majority of females couldn’t care less about the length of their partner’s organ. In recent years, surgery to augment penile length or girth has become increasingly common. Known as phalloplasty, penile surgery can help to increase both the length and the width of the penis. Typically during surgery the section of the penis that resides inside the body is extracted, about one third of the penis resides inside the body and, in most cases exposure of at least half can be performed during surgery. This is done by creating an incision and cutting the suspensory ligaments which hold back the extra penis length. To widen the penis, fat grafts are taken from the stomach or buttocks to widen the erectile cylinders of the penis underneath the skin.

• Escroplastia: A removal of the extra scrotal. When this happens it looks like a pendulum that hangs from the testicles and even the skin may be macerated. Intimate surgery corrects this problem with very satisfactory results. • Balanoplastia: The injection of bulking agents around the penis glands, when the size of it does not match the rest of the penis. For those with “micro penis” or “hidden penis” intimate surgery intervenes by using three procedures: liposuction of the pubis, the release of the suspensor ligament and fixation to prevent shrinkage of the penis. This surgery removes the problem and gives a great emotional stability to the individual.

INTIMATE SURGERY FOR HIM. THE MOST COMMON ARE: • Penis enlargement: This surgery is to counter the insecurity that many men have with respect to the size of their penis. This effect can be achieved by two ways: surgically cutting a ligament, which gives the impression that the penis is longer or placing a distracter, which is very discreet, and can, be placed or removed at any time. This treatment is aimed at the growth of penile tissues. The combination of these treatments can achieve an aspect ratio of 3 to 4 extra inches of penis. • Thickening of the penis: For this procedure fat is removed from another part of the body, and then it is enriched with platelet growth factors and then placed on the penis. Then the thickness of the penis, which was a shameful factor, becomes a reason of pride.

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ADVERTORIAL

The best kept secret of the most beautiful women in the world has been revealed to the rest of us mere mortals. Itâ&#x20AC;&#x2122;s called Massumeh, a leader in the cosmetics world. Celebrities such as the Empress Farah Diba, Queen Noor of Jordan, Isabel Preysler or the Royal families from Kuwait or Saudi Arabia have all admitted that they are big fans of these products. Massumeh has managed to combine to perfection, the more traditional knowledge about plants from ancient Persia with the most revolutionary scientific and dermatological advances which have been elaborated using exclusive Swiss biotechnology. By incorporating these bestselling products in your daily beauty routine you will visibly notice the results because the products are formulated based on aromatic essences and botanical extracts from the East that have been refined and developed with the highest technology and quality controls. Unique treatments combined with the most advanced

The secret of the most beautiful women on earth can now be yours The prestigious cosmetics company MASSUMEH arrives in El Corte InglĂŠs of Puerto BanĂşs, in Marbella. technology and secret formulas of the Royal Courts of ancient Persia, based on the merger of the mysteries of the Silk Road, the charm of the Eastern world and the latest developments of high cosmetics. Ancient potions and exclusive elixirs made with aromatic essences and botanical extracts from the East, perfected and elaborated in Switzerland using

an exceptional concentration of extracts of caviar, gold, Sapphire, Pearl, malachite, Amethyst, rhodochrosite, rock crystal, silk, Royal Jelly, DNA complex, hyaluronic acid, resveratrol, saffron, argan, sequoia, Blue Lotus, marine elastin, vitamins, rose water from Damascus, etc. These are only a few of the ingredients of these creams, used by the most admired faces of the Royal houses of East and West, not counting the numerous personalities of our country. More than 20 years of experience and research have resulted in these magic formulas that protect and regenerate even the most sensitive skin. Since it opened its aesthetic center 15 years ago, people from around the world arrive to Madrid to be left in the care of Massumeh and her daughter Nasrin, who besides their hospitality offer their customers a paradise of textures and smells that

transform the skin providing smoothness and luminosity. In addition to caviar or rose, Massumeh formulas introduce innovative ingredients in the world of current cosmetics, as the whole cells of Saffron, or the mixture of protein silk and gold increases the power of penetration of the active agents of these ingredients. In addition, there are other components, traditionally used in ancient Persia for the protection of the skin of the women, such as semi-precious stones. Massumeh products are suitable for all types of skins and ages. They are equally suitable for men, who are becoming more and more regular users of these treatments. Although the quality and effectiveness of these cosmetics is easily proved, undoubtedly their best endorsement is the trust placed from important personalities of the international social scene.

www.massumeh.com C/ GENERAL ARRANDO, 9 - BIS. BAJO. (MADRID) TEL.: 91 448 76 00/01 EL CORTE INGLÉS DE CASTELLANA (MADRID) EL CORTE INGLÉS DE PUERTO BANÚS (MARBELLA)

Dr Emmenegger, leading specialist of Clinic LĂŠmanic, Lausanne, Switzerland, reveals the secret of â&#x20AC;&#x153;Rapunzelâ&#x20AC;? hair.

Innovative hair implants without surgery! Doctor, could you tell us about Bio Hair Implants (BHI)? This great innovation with biocompatible hair represents the simplest worldwide solution for androgenic alopecia (female or male hair thinning or hair loss), scarring alopecia or whenever its needed to quickly increase the hair density. This easy, fast and nonsurgical treatment gives immediate and long-lasting results.

How does it work? Bio Hair Implants procedure is performed by special implanters that hook the reversible knot and insert the hair one by one under the anaesthetized scalp until the desired hair density is obtained. BHI are identical to natural hair; therefore, the risk of allergic reaction or rejection is minimal. After the treatment hair implants can be washed normally.

Will BHI look natural? Certainly! BHI are exclusively made with biocompatible materials; therefore the hair is soft, flexible, fine and very resistant. Advanced technologies used for BHI allow to choose the hair that will perfectly combine with your natural ones. Available in more than 20 colours, different length ans styles - straight, wavy and curly. BHI can also be ordered in particular colours upon request - to enable the best possible aesthetic results.

For more information visit www.cliniclemanic.ch 108 THE CLINIC

What results can be expected? Bio Hair Implants help solving hair loss problems with gradual aesthetic improvements. Patients are highly satisfied with the results gained. BHI can also provide you with higher hair thikening or permanent hair highlighting. All in all, BHI are a safe and effective technique for those who wish to have thick, healthy hair with natural look and long-term results. A medical consultation is required with the specialist in order to determine the right indications for the treatment.

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The power of hydration AQUASOURCE SKIN PERFECTION

The first 24 hour moisturiser for skin protection in high definition

HARLEY STREET GUIDE EXCELLENCE IN HEALTHCARE

The Harley Street Guide is aimed at patients from the UK and abroad who are seeking information about doctors, dentists, hospitals and medical and clinical services available in this centre of Londonâ&#x20AC;&#x2122;s medical expertise. For more information visit:

www.harleystreetguide.co.uk

www.members.architecture.com

A HISTORY OF MEDICAL PRESTIGE

owadays the very mention of Harley Street inevitably evokes a certain image; it has become a symbol of private medical practices, offering superlative healthcare. Undoubtedly one of the reasons for its considerable fame is its distinction from the National Health Service.

Whilst the NHS provides treatment funded by taxes, Harley Street has garnered international renown for its high quality private clinics. Furthermore the unique concentration of hospitals, clinics and over 3000 doctors and specialists in such a relatively small area adds to its prominence. But why does this street in London attract so many doctors? We delve into its history to find out...

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113

The History of Harley Street

The largest manor in the area was called Tyburn estate. Purchased in 1710 by John Holles, the Duke of Newcastle, it was then inherited by his daughter Lady Henrietta Cavendish Holles, who married Edward Harley, Earl of Oxford. She and the Earl noticed there was a need for fashionable housing in the area and commissioned a grid system of streets from an architect named John Price. They named many of the streets after family members, and Harley Street was born. By the 1800s Harley Street had become popular with doctors (but not yet psychotherapists, Western psychotherapy was yet to be birthed as a science). It was not just the central location, accessibility to

Notable Residents of Harley Street Many famous people have lived or practised on Harley Street, and if you walk along the street today you can spot the distinctive blue English Heritage plaques that show where these famous people resided or worked. Here are some of the most notable:

www.medicalliance.co.uk

At the beginning of the 18th century London was growing significantly with the start of the Industrial Revolution. The area already known as “Marylebone Village” – that Harley Street would become part of – benefitted by this era’s growth by becoming littered with the large, picturesque Georgian houses you still see today. As well as being known for its wealthy inhabitants the area was famed for the entertainments held in Marylebone gardens that included bear baiting and prize-fights.

public transport, and air of prestige the area had which drew them to relocate, but also that the houses were spacious enough that the doctors could use them both as surgeries and private residences. As more and more doctors moved to the area they invited colleagues to work with them and Harley Street began to be known as a centre of medical excellence, a reputation that solidified when the Medical Society of London opened nearby in 1873

government to tackle the poor conditions, and tended to the wounded soldiers, attempting to improve their nutrition and supplies and reduce overworking. She dedicated her life to improving healthcare, and is considered the founding of modern nursing. • If you watched the Oscar-winning movie The King’s Speech, then you will have seen the story of how the Duke of York and future King George VI (played by Colin Firth) was treated for a severe stammer by Lionel Logue (played by Geoffrey Rush), a Harley Street speech therapist. It was at 146 Harley Street that the Duke of York sought Logue’s help. In 1944, Logue became a founding fellow of the College of Speech Therapists, which became the Royal College of Speech and Language Therapists .

and the Royal Society of Medicine in 1912. In 1860, there were around 20 doctors practising in Harley Street, and by the time the National Health Service (NHS) was established in 1948 there were around 1,500 doctors living and working on or around Harley Street. Over the years the ownership of the area was inherited and passed through different families. Today Harley Street is owned by the de Walden family and managed by the de Walden Estate.

• Another famous doctor was Joseph Lister, whose work in antiseptics was vital to making surgery safer. Before his work, surgical operations were incredibly dangerous because of the high risk of infection. But his discoveries, along with new methods in anaesthesia, revolutionised surgery. Lister lived in London just round the corner of Harley Street at 12 Park Crescent, though he made his big discoveries earlier while working in Glasgow and Edinburgh. Without his work, neither life-saving surgery nor the cosmetic surgery procedures that we take for granted today would be possible. • Sir Henry Thompson (1870s). Specialised in surgery of the genito-urinary tract and was appointed surgeon extraordinaire to the King of Brussels. • Dr. Edward Bach (1920s). Specialised in vaccines and bacteriology before moving to the London Homeopathic Hospital, then developing the still famous Bach Flower Remedies. • Sir Frederick Treves (1853- 1923). Credited with performing the first appendectomy in England on June 29th 1888 and of saving the life of King Edward VII who suffered appendicitis just before his coronation. He is perhaps best known for his friendship with Joseph Merrick, the ‘Elephant Man’. • Sir Charles Lyell Geologist (1854- 1875) • Grantly Dick-Read Obstetrician (1890- 1959)

• Florence Nightingale, “the lady with the lamp”, began her medical on Harley Street at the Institute for the Care of Sick Gentlewomen from 1853. The following year she was sent to the Crimean War. She and her team of volunteer nurses found terrible conditions: short supplies, neglected hygiene and mass infections. Nightingale wrote to The Times calling on the

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Harley Street today Today Harley Street remains a centre for medical clinics, with over 3,000 people employed in the area. Of course, with universal healthcare and private medical clinics across the country, Harley Street doesn’t have the same pre-eminence it once did. But it still carries its reputation as a centre of medical excellence offering private medical solutions for all medical conditions.

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MENS HEALTH

HAIR TODAY GONE TOMORROW

ale pattern baldness affects over half of men to some extent over the age of 50 and most men at some stage in their lives.

WHAT IS MALE PATTERN BALDNESS? Male pattern baldness is the most common type of hair loss that develops in most men at some stage. The condition is sometimes called androgenetic alopecia. It usually takes 15-25 years to go bald. However, some men go bald in fewer than five years. Typically, at first the hair begins to thin (recede) at the sides (temples). At the same time, the hair usually becomes thin on the top of the head. A bald patch gradually develops in the middle of the scalp. The receding sides and the bald patch on the top (the crown) gradually enlarge and join together, leaving a patch at the front. The patch at the front eventually thins as well. A rim of hair is often left around the back and sides of the scalp. In some men, this rim of hair also thins and goes to leave a completely bald scalp.

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WHO GETS MALE PATTERN BALDNESS? Nearly all men have some baldness by the time they are in their 60s. However, the age the hair loss starts is variable. About three in ten 30 year-olds and half of 50 year-olds are quite bald. Some women also develop a similar type of hair loss, mainly at the crown. Baldness in women is much more common after the menopause. About 13 in a 100 women have some baldness before the menopause, rising to 75 in a 100 over the age of 65.

WHAT CAUSES MALE PATTERN BALDNESS? Hair is made in hair follicles which are like tiny pouches just under the skin surface. A hair normally grows from each follicle for about three years. It is then shed and a new hair grows from the follicle. This cycle of hair growth, shedding and new growth goes on throughout life. The following is thought to occur in men as they gradually become bald: • Affected hair follicles on the scalp gradually become smaller than normal. • As the follicle shrinks, each new hair is thinner than the previous one. • Before falling out, each new hair grows for much less time than the normal three years or so. • Eventually, all that remains is a much smaller hair follicle and a thin stump of hair that does not grow out to the skin surface. Male hormones are involved in causing these changes. The level of the main male hormone, testosterone, is normal in men with baldness. Hair follicles convert testosterone into another hormone called dihydrotestosterone. For reasons that are not clear, affected hair follicles become more sensitive to dihydrotestosterone, which causes the hair follicles to shrink. It is also not clear why different hair follicles are affected at different times to make the balding process gradual.

WHAT ARE THE TREATMENT OPTIONS FOR MALE PATTERN BALDNESS? To become gradually bald is a normal part of the ageing process for most men. No treatment is wanted or needed by most affected men. For some men, baldness can be distressing, particularly if it is excessive or occurs early in life. The following two treatments have been clinically proven to successfully treat hair loss in men to varying degrees. Finasteride was launched in the UK in 2002, although it has been available in the USA since 1997. It works by blocking the conversion of testosterone to dihydrotestosterone. The hair follicles are then not affected by this hormone and can enlarge back to normal. Some hair regrowth occurs in about 2 in 3 men who take a finasteride tablet each day. In about 1 in 3 men there is no hair regrowth but most do not have any further hair loss whilst taking finasteride. It has no effect in about 1 in 100 men. So, if you take finasteride, you have a good chance that hair will regrow, or at least stop any further hair loss.

The condition is hereditary (genetic); the location of the gene was identified in 2008.

Some points about finasteride include the following:

It is also not clear why only scalp hairs are affected and other areas such as the beard or armpits are not.

• It takes about four months for any effect to be noticed and up to 1-2 years for full hair growth.

ARE THERE ANY COMPLICATIONS FROM MALE PATTERN BALDNESS?

• The balding process returns if treatment is stopped. Therefore, if successful, you need to carry on treatment to maintain the effect.

Although male pattern baldness is a common and harmless condition, it can be linked to metabolic syndrome (the combination of obesity, diabetes, raised blood pressure and raised choleterol), resulting in an increased risk of heart disease. This link is most often seen in men who develop baldness at a relatively young age. Women with male pattern baldness should be checked for causes of raised male hormone levels, such as polycystic ovary syndrome (a condition in which cysts develop in the ovaries).

• Side-effects are uncommon. The most common is that about 2 in 100 treated men report loss of sex drive (libido). • It does not work in women with male pattern baldness. • You need a private prescription to get it from a pharmacy. Minoxidil lotion is a rub-on treatment that you can buy at pharmacies without a prescription. It is not clear how it works. The higher-strength solution (5%) is for men only and is more effective than the 2% solution. The 5% strength is now also available as a foam. There is debate as to how effective it is. Probably about half of men who use minoxidil delay further balding. About 15 in 100 users have good hair regrowth. There is continued hair loss in about a third of users. However, some reports claim much higher success rates. It seems that it is best used to prevent further hair loss but hair regrowth occurs in some users. Some points about minoxidil include the following: • It needs to be rubbed on the scalp every day. • It usually takes four months or more for any effect to be noticed. • Treatment needs to be continued indefinitely. Any new hair that does regrow falls out two months after treatment is stopped. • It is quite expensive. • It may work in some women who have male pattern baldness. • Side-effects are uncommon - for example, skin irritation or a rash sometimes occurs.

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