Stay Home and Protect The NHS

28th April 2020

As part of the NHS myself, I can’t stress enough the importance of staying home so that we can reduce the spread of Covid -19 save lives and protect our NHS.

The latest government advice is as follows (03.04.20)

Stay at home

  • *Only go outside for food, health reasons or work (but only if you cannot work from home).
  • *If you go out, stay 2 metres (6ft) away from other people at all times.
  • *Wash your hands as soon as you get home.
  • *Do not meet others, even friends or family.

You can spread the virus even if you don’t have symptoms. Source - gov.uk

If anyone in your household has a continuous cough or a high temperature, then you must stay home for the advised period.

From a gastroenterologist point of view, the other symptoms of Covid 19 that might be present include;

  • Loss of smell
  • Loss of taste
  • Loss of appetite
  • Sickness Diarrhea

If you suspect that you have Covid 19 you must not go to your GP and you must not leave your home. If you are unable to cope with your symptoms, then you should call 111.

Stay Home and Stay Safe.

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Is it necessary to take any extra vitamins or supplements? – A Gastroenterologists View.

2nd March 2020

Vitamins and minerals are essential nutrients that help your body function and keep you healthy, so as a gastroenterologist I recognise their importance. They assist with digestion, maintain your metabolism, help your bones and so much more.

The NHS advises that “most people do not need to take vitamin supplements and can get all the vitamins and minerals they need by eating a healthy, balanced diet. Many people choose to take supplements but taking too much or taking them for too long could be harmful” Source - https://www.nhs.uk/common-health-questions/food-an...

Yet, if you walk down the medical aisle in the supermarket you will undoubtedly see a whole range of Vitamins stocked up on the shelves. With their widespread availability coupled with their marketing on TV, Magazines and even Social Media, it comes as no surprise that many people choose to add a selection of vitamins and supplements to their daily routine… but is it all really necessary?

Most people will recognise the importance of taking vitamins but what most people aren’t aware of are the recommended guidelines, what your daily intake should be and how you can get them naturally.

Vitamins can be a costly addition to your monthly shopping bill and as there is limited research to suggest that they are actually benefitting you, it might be worth rethinking your shop.

The 13 essential vitamins your body needs are vitamins A, C, D, E, K and the B vitamins: thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyroxidine (B6), biotin (B7), folate (B9) and cobalamin (B12). Here are some of the Vitamin rich foods you might want to consider buying instead that contain these vitamins mentioned above.

  • Vitamin A – Salmon, cold water fish, egg yolks.
  • Vitamin D – Milk, butter, egg yolk, fatty fish
  • Vitamin E- Nuts, seeds, cereal
  • Vitamin K – Spinach, broccoli, leafy greens
  • Vitamin C – Oranges, peppers, broccoli, potatoes
  • Vitamin B1 – Legumes, nuts, seeds, grains, cereals
  • Vitamin B2 – Lean meat, grains, dairy products
  • Vitamin B3 – Poultry, seafood, milk, eggs, legumes
  • Vitamin B5 – Sweetpotatoes, egg yolk, broccoli, chicken, milk, yoghurt
  • Vitamin B6 – Meat, fish, poultry, bananas, leafy greens
  • Vitamin B7 – Egg yolks, nuts, grains, soybeans
  • Vitamin B9 – Leafy greens, legumes, orange juice
  • Vitamin B12 – Animal Products

Having said this, although the average healthy individual does not need to take vitamins, for some people vitamin and mineral supplements contribute to good health in the cases where they are vitamin deficient. For example, a proportion of the population will be deficient in B12, a vitamin that is vital for healthy nerve function and the production of blood cells. With B12 deficiency, some people might be unable to absorb the nutrients from their foods. Therefore, in this instance it would be necessary for an individual to take B12 supplements. This might be prescribed as an injection course by your GP or through vitamin tablets.

There are a lot of illnesses that might cause a vitamin deficiency or be the result of a vitamin deficiency, therefore, it really is important that if you suspect you are deficient in any vitamins or minerals you speak to your GP. They may well be able to test vitamin levels, and advise the best way for you to manage your deficiency or health issue once diagnosed (although not all vitamin levels can be tested).

One thing to bear in mind is that if you are not vitamin B12 deficient or deficient in any other vitamins taking a supplement probably will not have any positive effect and this is the case for many of the vitamins out there. So, before you start taking supplements and vitamins a simple change in your diet might be all you really need!

Two particular vitamins can be toxic if taken in excess. These are Vitamin A and Vitamin D. A standard amount of these is unlikely to be harmful, but excessive dosing could lead to problems.

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12 Ways You Can Look After Your Digestive System in 2020

22nd January 2020

We are inundated with advice on eating healthy, watching what we drink and exercising regularly, and yes although these are all aspects that contribute to good digestive health, there are some other factors that should also be given some consideration! In this blog entry we take a look at those factors that haven’t quite been given the awareness that they should have done, so here are our 12 less known ways you can look after your digestive health.Looking after your digestive system is imperative to your overall health and wellbeing.


Blood Transfusions Before 1991

If you had a blood transfusion before 1991 (or later in other countries), or have ever injected drugs (even once), you are at some risk of carrying Hepatitis C. This can be asymptomatic for many years but can eventually cause serious liver disease. There is now simple and highly effective treatment for this illness. So, if you think there is even a small risk that you could be a carrier, ask your GP, or a sexual health clinic, to arrange a blood test for Hepatitis C.

Hepatitis B Vaccination

There is now a national programme for vaccinating young children against Hepatitis B, but it will take a long time for the whole population to be immune. While the carriage rate of Hepatitis B in the UK is low, it is highly infectious via sexual intercourse without condoms. Therefore, if you want to be completely protected, ask your GP, or a sexual health clinic to be vaccinated. This particularly applies to those 'starting out’ on their sexual journey, if you have many partners, if you are a man who has sex with men, or if you are thinking of having ‘holiday sex’ abroad.

Weight Watching

Watch your weight. It is now clear that a prolonged period of being overweight not only increases the risk of Diabetes, but also of various cancers, and of Fatty Liver Disease which is an increasing cause of Cirrosis, liver failure and liver cancer.

Screen for Bowel Cancer

If you get an invitation to take part in the Bowel Cancer screening programme, then take part. This will either be a single lower bowel examination aged 55, or regular stool testing kits from aged 60. You should take part in both. Bowel cancer is very curable if diagnosed early, particularly before symptoms start, and the screening may show up polyps, which are not actually cancers, and by removing them you are preventing them from changing into cancer.

Monitor Indigestion

General indigestion is common. However, if it is new for you, persistent, and if there is vomiting or difficulty swallowing, see your GP. This could be the earliest sign of gullet or stomach cancer

Poo Health

‘Blood in poo’ is common. Haemorrhoids (piles) are the commonest cause. However, if the bleeding is persistent, darker red, or mixed with the stool, tell your GP who will make an urgent referral for Colonoscopy. Bowel cancers can present this way, and early diagnose confers major benefits.

Change in Toilet pattern

Similarly, if there is a change in your bowel/toilet pattern, on the looser side, lasting for more than three weeks, tell your GP who will make an urgent referral for a Colonoscopy. Bowel cancers can present this way, and early diagnose confers major benefits.

Increase Dietary Fibre

Solid scientific data that increased dietary fibre is good for us is lacking, but it is certainly not harmful, and most Westerners eat much less than those in developing countries. Make a conscious effort to increase your daily intake of dietary fibre.

Stay Hydrated

There is no set amount of water that we should drink. However, you should avoid long periods of thirst, or feeling weak and light headed due to some degree of dehydration. Your urine should be reasonably plentiful and not too yellow. It is reasonable to aim at between 1.5 and 2 litres of fluid daily.

Drink mindfully

England’s Chief Medical Officer has set a ‘safe drinking limit’ of 14 units per week for men and women. There are many on-line and App sources to calculate and keep track of your weekly intake. Many people find these useful, because, when asked, most people under-estimate their consumption. Even if you feel that 14 units is too restrictive for you, it is good to know what is your regular amount.

Up Your Vitamins

For most healthy people, vitamin and mineral supplements probably do not confer much benefit. However, many of us are short of vitamin D, particularly in winter (less sunlight to manufacture vitamin D in the skin) and people with darker skin. Women contemplating pregnancy or actively trying to get pregnant should take an extra 400mcg Folate daily to reduce the risk of spinal defects in the baby. There is some evidence that extra B vitamins in the over 50’s reduces the Dementia risk and extra Lutein reduces the risk of macular degeneration in the eyes.

Aneurysm Screening

In the UK, there is a screening programme in men, at the age of 65, to see if they have an Aortic Aneurysm (a potentially dangerous swelling in the main abdominal artery). It involves a simple, painless and harmless ultrasound scan, done by an operator skilled in Aneurysm screening. If you have not been called for this, look on-line and make contact with your local center (the Aneurysm risk is much lower in women which is why they are not screened).

If you are concerned or need help with anything mentioned in this blog entry, do not ignore it and get in touch with your local GP or seek the help of a Gastroenterologist like myself.

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Alcohol and the Liver

23rd December 2019

Heavy drinking has been on the rise for years and as we enter the festive period it’s one of the most popular times of the year where people drink too much. A few too many to you, might just resonate with yourself as a niggling hangover that lasts a day or two, but as a Gastroenterologist and Hepatologist I can’t ignore the unwanted effects that drinking can have on the body and in particular the liver.

The Drinkaware guidelines suggest that the weekly recommendation is no more than 14 units and anything above this can be considered as a risk to health. Unfortunately many people aren’t actually aware of what they are drinking. This limit has been calculated based on the health risks that alcohol gives you, including liver disease, but also risks if various cancers.

There seems to be a general lack of awareness in the general population to recognise and accept the damage that alcohol can have on the liver, and health in general. However, the facts are that alcohol is essentially a poison, and so it comes as no surprise that it can have some pretty unwanted and damaging effects on our organs, particularly our liver.

The liver is the organ that metabolises alcohol that is consumed. As the liver is breaking down the alcohol it can lead to toxic metabolites which in turn can damage the liver. If you exceed the capability of your liver to metabolise alcohol safely, that is when problems can arise.

The first sign of damage is the accumulation of excess fat in the liver. This can then go on to cause inflammation, which in turn can lead to scarring. When the liver is completely taken over by scar tissue, Cirrhosis is said to be present, and Cirrhosis can be due to a variety of issues that damage the liver, not just alcohol. The whole of this process can take many years, during which time there may be no symptoms, although abnormalities may show up on blood tests or Ultrasound scans, being done for other reasons. The first sign of trouble can be when the scarring gets even worse and the liver’s capacity seriously declines. At that stage you can become jaundiced (yellow), swell up or start bleeding internally. These are very serious complications from which there may be no recovery.

Interestingly, different people can be more or less susceptible to liver injury e.g. women have a lower amount of a certain enzyme used to breakdown the alcohol in the liver, so damage may occur with less consumption. Other risk factors that play a role in the development of liver disease include obesity and family history. The livers of two people who drink exactly the amounts at the same frequency could react completely differently because of such factors. In addition, the carriage of viral Hepatitis (B or C), which can be undetected and asymptomatic for many years, will leave the liver more susceptible to the effects of alcohol.

We don’t want this blog to put you off your festivities, but being aware of what can happen is half the battle. The liver does have great powers of recovery and repair, if allowed to do so, and if no scarring has yet occurred. Just remember, long term damage may have no symptoms, and might not be reversible. If Cirrhosis is already present the forgotten effects of drinking suddenly become very real. If you are concerned about your drinking, talk to your GP, ask for simple liver tests (blood and Ultrasound scan), and if necessary seek help with trying to cut down or be completely abstinent.
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