Making Informed Choices About Your Health Care

I love that we have the NHS in the UK. I can't really understand why american's get so distressed about the idea of free health care. No, it's not the same incredible standard of care that you would get in the best 5 star hotels privatised hospitals, but we have those too, for people who can afford them.

That said, it's no secret that our NHS is stretched to breaking point and can barely afford to run. The staff are exhausted and doing their best, but often dispense drugs based on protocol because let's face it, no doctor is an expert in every single condition that could possibly come up in your life, and with the hours they work, how could they possibly keep up to date with the latest advances in science on every condition?

That's why I firmly believe in empowering people to learn about their own conditions and make informed decisions about their own treatment plans.

David Cameron is complaining about doctors over use over antibiotics, but I can imagine how many doctors have been hassled by ignorant patients who desperately want a prescription for their virus, having no idea that the antibiotic won't help them get better any faster?

Despite the fact that most ear aches are viral, most parents will beg the GP for antibiotics because we've all heard the scare stories about untreated infections allowing ear drums to burst.

I'm fairly sure there must be doctors have to make a decision to prescribe prophylactic antibiotics because they aren't sure if the infection is going to get worse, but their appointments are all full for the next few days so they haven't got the luxury of asking the patient to come back and check in with them again.  Not only that, but the majority of antibiotics consumed by these patients aren't even prescribed by doctors - they're coming through the cheap CAFO raised meat that they consumed.

Every time your doctor offers you antibiotics, ask if it's necessary. You wouldn't believe how often my GP has looked relieved at that question and suggested that he would write the prescription, but ask that I only claim it from the pharmacy if the fever worsens/infection doesn't improve in the next 12 hours/whatever other useful advice they have.

But antibiotic resistance isn't the only concern.

In an excellent talk by Daniel Levitin on "How to Stay Calm When You Know You'll be Stressed" he talks about patients making informed consent about their treatment plans. How can you make informed consent if you don't know anything about your treatment?

Here's a long, but very relevant quote from the talk:

"And there's perhaps no more stressful a situation than when you're confronted with a medical decision to make. And at some point, all of us are going to be in that position, where we have to make a very important decision about the future of our medical care or that of a loved one, to help them with a decision. 

6:11And so I want to talk about that. And I'm going to talk about a very particular medical condition. But this stands as a proxy for all kinds of medical decision-making, and indeed for financial decision-making, and social decision-making -- any kind of decision you have to make that would benefit from a rational assessment of the facts. 

6:30So suppose you go to your doctor and the doctor says, "I just got your lab work back, your cholesterol's a little high." Now, you all know that high cholesterol is associated with an increased risk of cardiovascular disease, heart attack, stroke. And so you're thinking having high cholesterol isn't the best thing, and so the doctor says, "You know, I'd like to give you a drug that will help you lower your cholesterol, a statin." And you've probably heard of statins, you know that they're among the most widely prescribed drugs in the world today, you probably even know people who take them. And so you're thinking, "Yeah! Give me the statin." 

7:06But there's a question you should ask at this point, a statistic you should ask for that most doctors don't like talking about, and pharmaceutical companies like talking about even less. It's for the number needed to treat. Now, what is this, the NNT? It's the number of people that need to take a drug or undergo a surgery or any medical procedure before one person is helped. And you're thinking, what kind of crazy statistic is that? The number should be one. My doctor wouldn't prescribe something to me if it's not going to help. But actually, medical practice doesn't work that way. And it's not the doctor's fault, if it's anybody's fault, it's the fault of scientists like me. We haven't figured out the underlying mechanisms well enough. But GlaxoSmithKline estimates that 90 percent of the drugs work in only 30 to 50 percent of the people. So the number needed to treat for the most widely prescribed statin, what do you suppose it is?How many people have to take it before one person is helped? 300. This is according to research by research practitioners Jerome Groopman and Pamela Hartzband, independently confirmed by I ran through the numbers myself. 300 people have to take the drug for a year before one heart attack, stroke or other adverse event is prevented. 

8:23Now you're probably thinking, "Well, OK, one in 300 chance of lowering my cholesterol. Why not, doc? Give me the prescription anyway." But you should ask at this point for another statistic, and that is, "Tell me about the side effects." Right? So for this particular drug, the side effects occur in five percent of the patients. And they include terrible things -- debilitating muscle and joint pain, gastrointestinal distress --but now you're thinking, "Five percent, not very likely it's going to happen to me, I'll still take the drug."But wait a minute. Remember under stress you're not thinking clearly. So think about how you're going to work through this ahead of time, so you don't have to manufacture the chain of reasoning on the spot.300 people take the drug, right? One person's helped, five percent of those 300 have side effects, that's 15 people. You're 15 times more likely to be harmed by the drug than you are to be helped by the drug. 

9:15Now, I'm not saying whether you should take the statin or not. I'm just saying you should have this conversation with your doctor. Medical ethics requires it, it's part of the principle of informed consent.You have the right to have access to this kind of information to begin the conversation about whether you want to take the risks or not. 

9:32Now you might be thinking I've pulled this number out of the air for shock value, but in fact it's rather typical, this number needed to treat. For the most widely performed surgery on men over the age of 50,removal of the prostate for cancer, the number needed to treat is 49. That's right, 49 surgeries are done for every one person who's helped. And the side effects in that case occur in 50 percent of the patients.They include impotence, erectile dysfunction, urinary incontinence, rectal tearing, fecal incontinence. And if you're lucky, and you're one of the 50 percent who has these, they'll only last for a year or two."
Ask your doctor questions, be informed. Make good decisions for you and your family. Take your research with you to your doctor so that you can evaluate it together.

It's off the back of this that I'd also like to point you towards a charity called 'Yes To Life' that I recently discovered. They are the first cancer charity I've come across in the UK that provides support, information and financial assistance to cancer patients who want to use an integrative approach to thier medical care. As Daniel Levitin says, it's hard to make a decision when you are stressed. Having the information collated and people ready to support you is so important.

But all of these are just examples. There are far too many medical conditions to list in a blog post (or even for me to list!) Our bodies are so complex, so intricate, so well designed. That's why you need to put your big girl (or boy) pants on and take some responsibility for your own health.

Educate yourself. This is one of the reasons Restoration Health was born. We post articles about health daily, we try to answer questions and help people on journey's towards healthier lifestyles so that they don't need to see their doctor so often, hopefully relieving some pressure from the NHS. We're also hoping to start monthly healthy living and preventative medicine talks locally soon, so keep your eye out for those.

Remember: Your doctor is there to help you, but not to remove all responsibility from you.

Brewing Kombucha

Mostly when I've talked about fermenting it's been sourdough, kefir or yoghurt related, but some of you who have been to my house might have tried my 'Vinegar soda' or Kombucha. It's an interesting taste, but one you get more and more addicted to as you drink it. A bit like my fire cider recipe. Those of you who have ever had a care package from me when you've got the flu know what I'm talking about ;-)

Still, despite knowing how to make kombucha, I had NO idea how much activity went on in my jar. I used the continuous brew method and got a scoby from a friend, but Donna Schwenk has done an amazing time lapse video of her growing a scoby in a week and it's so awesome.

I'm seriously impressed with how much life there is going on in there. It's inspired me that I might do a time lapse of my Water Kefir some day. Those things are bubbling away the entire time you are watching them so I think they'd look incredible on high speed.

If you are looking for a jar for your continuous brew, this one is a pretty good price on amazon and it's a really good size. Watch out for the cheaper kilner jars, they are smaller than you expect, the big kilner jars are all £20-30.

    Happy fermenting!

Ketogenic Diets, Cortisol and Thyroids

If you've followed this blog for a while, you'll know that I already have a problem with the "diagnosis" of low functioning thyroid, but that I also suspected I had it for a while. I treated it and the symptoms improved. Hooray!

Photo credit
If you know me in real life you'll know that almost the whole of this last month has been written off as one giant headache. That's not a euphemism, I have actually had a 'migraine' that has lasted weeks, with a really high fever and doctors diagnosing everything from kidney infection, fluid in my lungs, respiratory infection, glandular fever (newsflash: I'm immune to that), then an overactive thyroid was suggested (due to swelling) and now an 'extremely low functioning thyroid' (due to blood tests).

Well, it's not that surprising. My body is incredibly stressed, of course it's going to be in an adrenal dominant state! Because it's so low I've agreed to start thyroxine temporarily whilst we run some more tests and I get the exact numbers so we can work out the problem.

In the meantime, I wanted to talk a bit about some myths surrounding these issues and the ketogenic diet; largely because I think when we accept them, we stop looking for the cause of the problem, and that means we'll never fix the problem, only manage symptoms.

Myth 1: The ketogenic diet is stressful for the body

This myth comes from a misunderstanding about cortisol. Cortisol is our body's 'stress hormone'. Most arguments for ketosis being stressful stem from the idea that gluconeogenesis (how your body makes the glucose it needs if you don't eat a lot of carbs) require cortisol. 

The reasoning goes like this:
On a ketogenic diet, because you get very little glucose from the carbohydrates in your diet, your body manufactures it's own through gluconeogenesis (so far so good). Gluconeogenesis requires elevated cortisol (that is not true - we'll come back to it though). Too much cortisol damages your body (not exactly true either - cortisol is your body's intelligent, protective, response to something damaging, but actually as it's not true that it's raised for gluconeogenesis it's a redundant point anyway).

When your blood sugar begins to get low, glucagon (the hormone responsible for ensuring adequate blood sugar) promotes gluconeogensis and prevents the blood sugar getting low enough to trigger cortisol production.

If the blood sugar get's below 55mg/dl (your glucagon should have kicked in at 65mg/dl) the you experience hypoglycaemia - with anxiety, palpitations, sweating, tremors, dizziness, tingling, blurred vision, difficulty thinking... so if you aren't experiencing these kind of symptoms, cortisol isn't regulating your blood sugar yet. These symptoms are rare for most people on a ketogenic diet, so it's reasonable to conclude that the diet is not affecting their cortisol levels.

If you are concerned about your blood sugar you should check in with your doctor, regardless of what diet you follow, and you can buy a cheap glucometer, which would allow you to alleviate any concerns. If your blood sugar is low, you may need to experiment with eating more proteins.

This quote from explains it better than I can:

"On a keto diet, your body makes the modest amount of glucose it needs out of protein in a process called gluconeogenesis (GNG). There is a widely-held misconception that for GNG to occur, there must be high levels of the stress hormone cortisol in the blood. This mistake comes out of the fact that cortisol stimulates GNG. Therefore, it is reasoned, whenever you rely on GNG, your body has to produce and circulate more cortisol. This, however, is like arguing that since a reliable way to make people laugh is to tickle them, that every time you hear someone laughing it means they are being tickled. It turns out there are other ways to make people laugh, and there are other hormones that induce GNG"  

Myth 2: Ketogenic diets are bad for your thyroid

This myth is spouted so often that you'd assume there was some research behind it, but the only thing close to evidence is the fact that T3 hormone is lowered in those on a ketogenic diet and to be fair, low T3 in someone on a high carbohydrate diet only seems to happen in cases of severe illness. When you are in a period of rapid weight loss, starvation, or protein deficiency lower T3 is an adaptive, intelligent response from the body to prevent lean muscle mass loss

In other words, the more ketogenic our weight loss is, the healthier it will be because we won't be losing muscle mass with it.

Low T3 hormone is also associated with longevity, and a decrease in ketogenic dieters might actual be a sign of their lifespan increasing. Those who are very long-lived tend to have low T3 levels and it's not just because they are old. Genetic research into longevity confirms that low T3 is a good indicator of increased lifespan.

So yes, ketogenic diets affect your thyroid, but no, I wouldn't say that it was a bad thing. 

Now, I'm off to get more blood drawn to find out if my thyroid is actually under functioning, or whether I'm just adapting to an increased life span, but either way, the search for my mystery illness continues!

What's new?

Spring is in the air and this weekend we had approximately one hour where the sun showed it's face and I was happy to be outside gardening. My garden, it seems, hasn't been missing the sun at all and I now have a ridiculous amount of bluebells EVERYWHERE and comfrey as high as my chest.

I'm relocating the bluebells out of my vegetable patch and cutting the comfrey down for some very grateful chickens, and Matt and I managed to get lots of romanesco, chard and peas in the ground, whilst carefully rescuing our strawberries, raspberries and rhubarb from the bluebell invasion. 

All these beautiful flowers made me decide it was time for a new look on my blog though, particularly once the weather clouded over and got cold again (too cold to play out, so coding a website seemed like the way forward!) and here you are on my beautiful new blog! Sorry if you tried to access it earlier today and it was all messy. I probably should have put up one of those 'site under construction pages' but I was too lazy, and anyway, it's done now. 
I hope you like it as much as I do :-)

In other news, inspired by our time in Thailand Matt has really taken to juicing, so much so that we bought ourselves a new fancy slow juicer and blender, and we've been enjoying growing our own wheatgrass on the kitchen side to press. The kids love wheatgrass juice and Will swears it helps him think more clearly when he is concentrating(!)

I also invested in a brand new journal which I absolutely LOVE. It's called the daily greatness journal and it's going to inspire me to greatness. Daily. Obviously. 

My favourite part about it is that it doesn't have any dates, so I don't have to wait for a new academic year to use it. I can just start tomorrow. I'll just leave you with some beautiful pictures here for other stationary addicts to drool over. 

Yoga - it's not just for girls

The yoga class here every morning is brutal. Today we had to do a bar workout using the wall of the salaa as a bar.

That's fine if you are pretty tall, but as the shortest person in the class getting my leg up to nearly chest height before we even start the stretches was seriously challenging. 

To begin with I said it was to tall and the yogi scoffed and said "Thai people are shorter than you", but after about five minutes of struggling he decided to give me a lower bar. 

He is seriously the bendiest person I've ever met. He even puts this guy to shame:

Yesterday he started the class with "today it's hot. It's good to do cardio when hot. You get better results" then proceeded to do some kind of body combat class. Who on earth decides the best day to do cardio is the hottest day??

At the end he apologised. "Oh I forgot it's Sunday. I'm supposed to make class easy on Sunday. Give you rest. Oh well."

He frequently stops the class to tell us we are all doing it wrong before he starts again and by the end of the class even Matt is sweating and shaking. 

In fact, Matt quite likes yoga, he even admitted to thinking it was a bit "girly" before, but now recognises it's a serious core workout. 

I hate it. 
It hurts. 
And if he says "no pain, no gain little missy" to me one more time someone is definitely going to get hurt. 

Probably me.


We did our first day of snorkelling today and this beach is seriously teaming with life - including plenty of sea urchins and anemones, so best not to put your feet down until you've got clear googles and you can check! 

There's also lots of hermit crabs, some of the tiniest I've ever seen all over the place, but once you get into the seaweedy areas, that's where all the fish are hiding. 

This morning I saw several blue tang:

A handful of yellow tang 
And two of the cutest little angel fish I've ever seen:

I don't have an underwater camera unfortunately, so I stole these images from google. 

There was also tonnes of little brown and white fish, but I don't know what they're called. 

I seriously love snorkelling and I think it's the one of the best holiday activities you can do. Firstly - swimming is good exercise, which we all know is good for you health. Secondly - you are bathing in salt water, literally copious amounts of transdermal magnesium and other trace minerals seeping in through your skin. Thirdly - when you put your face under water, you automagically lower your blood pressure and slow your heart rate right down. Fourthly - it's relaxing and de-stressing. 

Just make sure you aren't doing it at mid day. The water feels cool, but you will still burn!!!

Thai Massage

Today I had my first ever Thai massage. Our chiropractor had warned us "no funny stuff, don't let anybody walk on your back" but that ultimately having a daily massage is going to do our backs a lot of good. 

This isn't the kind of massage I was taught at school. It's very pokey, and pressing more than stroking. 

I wore a swimsuit, as the massages are performed outside on a deck by the beach, with a dress that I could easily remove - expecting that the masseuse would ask me to "undress to my level of comfort" as I have always done with my clients. Actually though, this massage is performed through clothes, and whilst the masseuse did everything he could to preserve my dignity (the massage was performed through an opaque silk scarf) it would have been a lot easier for both of us if i had just worn shorts or leggings. 

It started out kind of like the end of a chiropractic adjustment, just pressing on acupressure points etc... But turned into some kind of assisted yoga with the masseuse pushing and pulling me into all kinds of positions. 

It's oddly relaxing, although painful at times, but I highly recommend it. 
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