Some Frequently Asked Questions, first published in SAGA Magazine (5)
Professor George Lewith
Is it true that drinking tea can help to lower the risk of heart disease and if so, what kind is best?
This is a really complicated question. There is some suggestion that green tea can help and there is some vague suggestion that tannin in ordinary Indian tea can help, but the evidence is weak and flimsy, and I think the arguments are so complex and so unsure that it is best not to address this.
I’ve read about a new supplement called 5-HTP that claims to raise levels of the hormone serotonin and counter any tendency to depression. Is this worth taking?
5-hydroxytryptamine is a naturally occurring chemical, which is closely related to serotonin. What that actually means is that if you have high levels of 5-hydroxytryptamine in the brain you are likely to overcome any deficiency in serotonin, because 5-HTP is what is know as a “precursor” of serotonin.
We think that low levels of serotonin are associated with depressed mood, which is why we use drugs like Prozac, which are selective serotonin reuptake inhibitors (SSRI). These stop serotonin being degraded by the brain, so there is more of it around brain tissue and that is associated with an increase in positive mood and happiness. St John’s Wort acts in a very similar way to SSRIs, increasing the production of serotonin and also selectively blocking its uptake. This dual mechanism has a very similar effect to the artificially manufactured SSRIs.
Unfortunately, there have been very few clinical trials on 5-HTP, but certainly, theoretically, it is a sensible thing to use. It should prime the manufacture of serotonin thus helping mood in serotonin deficient individuals. The general feedback from rather descriptive “clinical experience” is positive, and because it is a naturally occurring product available in food, the chances of adverse reactions are relatively small, although one never knows whether high doses of a particular foodstuff are likely to cause problems.
The idea of eating particular, refined, natural food products to deal with health problems, is something that is becoming increasingly recognised. For instance, athletes need very specific diets to deal with the demands they make on their bodies, so those with a tendency to depression may do well eating certain foods with high concentrations of products such as 5-HTP. This new, and increasingly recognised, area of therapy spans both conventional and complementary medicine, and the products are usually termed neutraceuticals.
I have been taking cod liver oil to protect my joints, but I recently heard a news item saying this can be dangerous if you also eat liver regularly. Should I stop one or the other?
I am not sure where the myth that cod liver oil and liver don’t mix came from, but there is no evidence that taking essential fatty acids, like cod liver oil, will be affected by eating ordinary amounts of liver. Cod liver oil really is good at lubricating the joints; there is now lots of evidence that essential fatty acids, such as fish oils, are really important in improving a whole range of different chronic symptoms. There are those who claim that fish oils are very valuable in helping menopausal symptoms, and there is really quite a lot of information that fish oils help with both osteoarthritis (wear and tear to the joints) and rheumatoid arthritis (actively inflamed joints).
The one thing that can happen with fish oils is that they may sometimes upset your tummy by causing a bit of gastritis and possibly some diarrhoea. It is usually wise to take about a gram, or possibly 2 grams of omega 3 oils (this is the formal chemical name for fish oils) most days. You want to be sure that the fish oils you take are properly manufactured and aren’t themselves contaminated, so go to a good quality supplier whom you know is manufacturing high quality medicines, ideally in the United Kingdom so the production process is controlled.
Liver, on the other hand, is an excellent food, particularly for vitamin Bs and a number of other trace elements. As always with red meat or offal, one wouldn’t recommend eating liver every day, but the odd bit of liver isn’t going to harm you at all.
Is there any evidence that reflexology works? My friend says it has helped her IBS symptoms, but I can’t see how foot massage can make any difference.
The concept of “what works” is really very different when you ask different people. Your friend will no doubt have had irritable bowel and the reflexology massage that she had will have helped her, that’s why she feels “it works”. What she is telling you is that it has worked for her, which is a perfectly valid point. If you were a doctor, however, what you would want to know is whether pressing the right points for irritable bowel works better than the wrong points for irritable bowel, and that is a much more complicated question.
Reflexology works on the principle that different areas of the feet represent different organs or tissues. That’s never been well proven, although the assumed basic principles of reflexology may be up in the air, but that doesn’t mean it doesn’t work. There are lots of medicines we use in conventional medicine that we thought worked one way and have discovered that they now don’t, but nevertheless they provide effective and safe treatment. For instance, it has taken us ages to work out how Aspirin works and we are still not completely certain.
We don’t yet understand totally how general anaesthetics work, but that doesn’t mean there haven’t been a lot of theories about how they might work. It doesn’t mean that general anaesthetics don’t work, neither does it mean we don’t understand the risks. Just because reflexology might not work in the way that reflexologists “think it works” is an entirely separate debate to whether it is effective.
Unfortunately, because we don’t know how reflexology works, it is really difficulty to design placebo controlled trials, so working out whether there is a difference between a theoretically correct reflexology treatment and a theoretically incorrect reflexology treatment is fraught with difficulties. It is very difficult to evaluate interventions when we don’t understand their basic mechanisms. So little research has been done with reflexology that it is very difficult to know whether “it works” in a medical context, in other words whether it works better than placebo, and whether we have any ability to design a placebo for reflexology. My view would be that if half an hour, or an hour, of foot massage has helped your friend with irritable bowel, and it is a perfectly harmless treatment, why not give it a go for two or three sessions, it might just help.
I always feel rather jaded and below par by the end of winter – can you recommend any natural approaches to restore my energy levels?
Northern European winters aren’t much fun. I find by the time I get into the last weeks of January I am dying for bit of sunshine and really want to be able to get home when it is light, rather than spending my whole life travelling to and from work in the dark.
There are, however, some simple things that you can do to try to make yourself feel better. The first is to take regular exercise, that probably means getting out in the middle of the day and going for a walk, jog or bike ride. Riding to and from work also helps. Not drinking too much, and certainly not eating too many carbohydrates is a wise move. They make you feel overweight and jaded, so eat lots of fresh vegetables and resist the temptation to overeat stodge, and keep fit.
If you are still feeling fed up in spite of that, a week in the sunshine can work wonders, but sometimes people just feel jaded because they have a low mood. I suspect a lot of us suffer from a mild seasonal affective disorder, where we all feel a bit grumpy and fed up during the winter months. Small doses of St John’s Wort can be really effective. Sometimes visiting an acupuncturist, or a homeopath, can work. The way to start, however, is simply by looking after yourself and making sure you eat well, keep fit and don’t drink too much, that’s almost always a very good start.
I suffer from reflux disease and when it's bad I get a horrible taste in my mouth. Worse still, I get very bad breath. My doctor is unconcerned but I'm not - can you recommend any complementary treatment.
Reflux is quite common and people take lots of antacids to stop the burning and the indigestion. There is a school of thought in complementary medicine that reflux occurs because you have too little acid, rather than too much, so one of the treatments that is often used is a mixture of very, very, very dilute hydrochloric acid with pepsin, which is an enzyme that helps digestion. There are various products on the market that contain small amounts of pancreatic enzymes and small amounts of hydrochloric acid, so it might be worthwhile trying this.
You might also find that particular foods cause this; some people always complain of acid reflux after they have eaten cheese or too much wheat. Occasionally a food “intolerance” can cause upper digestive symptoms like reflux, so it is a good idea to think about whether there are any particular foods that consistently seem to trigger the problem. Sometimes as you get older the digestive enzymes seem to work less well, and this can be quite independent of whether or not you had enough stomach acid.
Preparations of digestive enzymes are often available in various different formulations in many health food stores, and it might be worthwhile trying them for a period of time. The bad breath is simply because the fermentation in the upper part of your digestion isn’t working terribly well. Sometimes this can be caused by an overgrowth of yeast in the upper part of the intestine; this is sometimes called “candida syndrome”. If you think you might have a candida syndrome then it is wise to see somebody who is skilled at diagnosing and sorting this out, rather than just going on a very severe and restrictive diet.
The British Society for Ecological Medicine contains a number of individuals who have real expertise in this area (http://www.ecomed.org.uk/). They will consider using quite restricted diets, a variety of herbal or conventional medicines that may actually reduce fungal growth, and they will also consider recolonising the gut with good gut bacteria. Sometimes, just watching your yeast, sugar and alcohol intake, and using lots of good probiotic bacteria will help this kind of indigestion enormously.
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