Cholesterol- The Good and the Bad!

Cholesterol is a fatty substance in our blood. You’ve probably heard of its association with the risk of heart attack and stroke. But actually, not all cholesterol is bad- we all have it, and produce it in the liver, and we all actually need some of it for maintenance and repair. So here’s the good and the bad of cholesterol!

It’s about quality, not just quantity!
There are different types of cholesterol which mean different things regarding your health.

Low density lipoprotein/LDL cholesterol is the ‘baddie’ here, as it deposits itself in to cells around your body, to the point where it can clog your arteries, increasing the risk of heart attack and stroke. 

By contrast, High-density lipoproteins/HDL cholesterol is the ‘good’ cholesterol which is broken down in the liver, and actually helps to dispose of bad cholesterol from your blood vessels.

Doctors will consider both the total amount of cholesterol in your blood, and also the ratio of of bad (LDL) to good (HDL) cholesterol when assessing your cholesterol levels.

There is much that can be done to influence your cholesterol levels.
Some factors influencing cholesterol levels are beyond our control- such as family history, ethnic background and growing older. However, several lifestyle factors also come in to play, which we can work to improve. 

Diet
The types of fat we eat can directly influence our good and bad cholesterol levels.

Foods containing high levels of saturated fat (linked to LDL cholesterol) should be limited in favour of those containing unsaturated fat (linked to HDL cholesterol).

 As a general rule of thumb, saturated fats tend to be animal/dairy in origin- such as meat and dairy. However coconut and palm oil are also saturated fats.

Meanwhile unsaturated fats tend to originate from fish or plants in origin- think nuts, seeds, avocados, vegetable oils.

Lifestyle
Reducing your alcohol intake, and increasing exercise also help to restore a healthy balance of cholesterol.

What might your doctor do?
Lifestyle changes are always the first port of call when managing cholesterol. But should these not prove effective on their own, there are many medical options, which are proven to be highly beneficial and should be taken consistently and regularly. 

Know your levels
As many people with high cholesterol do not have symptoms, it’s well worth checking your cholesterol levels regularly. See your friendly GP to discuss the various NHS and private screening options available.

Good to know
Naturally, there is heaps more information to be found online. The NHS is a great and reputable source of information on how to lower your cholesterol.  

https://www.nhs.uk/live-well/healthy-body/lower-your-cholesterol/

Happy Blood Pressure Week 10th-17th September

Who doesn't like an 'easy win'??
Why is it useful to know your blood pressure? In medical speak, blood pressure is "one of the four modifiable cardiovascular risk factors". More simply put, managing your blood pressure is a relatively 'easy win’, if you would like to minimise your chances of having a stroke or heart attack! Do we have your attention now? 

Many people have no symptoms of high blood pressure, so getting a test, even if you feel 'fit as a fiddle', is the only way to know for sure. 

What do the numbers mean? 
Blood pressure readings come in the form of 2 numbers. The first, higher number is the systolic pressure, when your heart pushes blood around your body. The second lower number is the diastolic pressure, when your heart relaxes. A text book normal blood pressure would be 120/80 which means 120 systolic over 80 diastolic, and a systolic number over 140 or a diastolic number over 90 (on single readings) would be considered high blood pressure. The diastolic and the systolic numbers are equally important, so even if you are just high in one of the other, it’s worth investigating.

Testing your blood pressure at home or in clinic
Monitoring your blood pressure need not be expensive, and can be free via one of the many testing centres, including your NHS GP, where there might even be a monitor in the waiting room. However, testing from home has many advantages including convenience, and removing the possible impact of ‘white coat syndrome’. Omron make excellent home BP monitors which can be bought online or from your local chemist for under £40. 

How to test
When monitoring yourself, we suggest taking 2 readings in the morning, 2 in the afternoon, over 5 days. You should be seated at rest. Take the average of all the systolic readings and the average of all the diastolic readings over that period, to give you an average overall reading. Happily, Winchester GP has put together a spreadsheet template, which you can download here- if you just pop your numbers in to the relevant columns it will do the maths-ing for you! If the average systolic number is higher than 135, and/or if the average diastolic number is above 85, this would be considered an elevated reading and worth managing. (Remember, diastolic and systolic are equally important) Don’t panic- there’s lots that can be done, both through lifestyle changes and/or medication. Just book an appointment with a friendly empathetic GP, and let them explain the options to you. Happy measuring!! 

Help! I think I've got 'flu!

With the recent surge in ‘flu cases, we thought it would be worth giving a quick recap of what to do and when to seek medical intervention. 

If this is you... it could be 'flu... 

Flu is a viral infection which will make you feel absolutely rotten - it’s not simply a ‘bad cold', as it affects your whole body rather than mainly just your nose and throat. If you are a normally healthy adult, the biggest favour you can do yourself (and to limit the chances of spreading this highly infectious virus) is to consign yourself  to your bed or sofa. If you have full-blown flu, you will not need any persuading!

Symptomatic relief for fever and aches and pains will come from paracetamol and ibuprofen (take care to keep track of how much you are taking, so as not  to exceed safe doses). And make sure that you are taking on plenty of fluids (your pee should be light golden). 

While you rest and medicate, your immune system will set to work fighting off the virus and you should expect to be feeling better in around a week. However, there are some circumstances in which you should seek further medical advice: 

• your symptoms don't improve after 7 days
• you're worried about your child's symptoms
• you're 65 or over
• you're pregnant
• you have a long-term medical condition – for example, diabetes or a heart, lung, kidney or neurological disease
• you have a weakened immune system – for example, because of chemotherapy or HIV
• ‘Red flag’ symptoms that suggest urgent medical intervention (999 or A&E) would be sudden chest pain, difficulty breathing or if you start coughing up blood

What can your GP do? 

• As flu is a virus, antibiotics are no help
• Anti-viral medications are available and your doctor will advise whether they might be appropriate to help your body fight the infection. The sooner they are started after the onset of symptoms, the better.  
• It is possible to test for flu and which strain you have, by taking swabs from your nose and throat. In many cases, putting a name to the infection you have might not greatly change the treatment you are under. Nevertheless it can still be useful to know if, for example, you have been in contact with others at greater risk of complications from the illness, who might therefore benefit from taking anti-viral’s pre-emptively. 

Limit the spread of flu

• If you haven’t already had your flu vaccine, do book in for one ASAP
• Wash your hands often with warm water and soap
• Use tissues to trap germs when you cough or sneeze, and bin them straight away

Does your baby have undiagnosed cows' milk allergy?

This week is food allergy awareness week and we have enlisted the help of Joan Gavin, State Registered Paediatric Dietitian within the NHS and holder of a Masters degree in Applied Paediatric Nutrition to advise on the topic of cows' milk allergy in babies. Food fad, or fact? Read on to learn more. 

• Reflux (frequent regurgitation of feeds)
• Constipation or loose and frequent stools
• Eczema
• Abdominal pain
• Severe colic
• Difficulty putting on weight?

If your baby suffers from any combination of the above symptoms it may be because they have an undiagnosed cows’ milk allergy. 

Surprisingly, cows milk allergy can be evident even in exclusively breastfed babies who have never consumed any cows’ milk! Cows milk allergy is one of the most common food allergies in childhood affecting more than 1 in 50 children under the age of 3 years, presenting initially in the first year of life. Babies with a mother, father or sibling with asthma, eczema or hay fever are more likely to develop cows milk allergy than those with no family history of these medical conditions.

The difference between cow’s milk allergy and lactose intolerance
Cows’ milk allergy is an immune reaction to one or more of the proteins found in milk, and is triggered either through cows milk protein present in breast milk, a formula feed or a dairy weaning food. The symptoms are easily confused with lactose intolerance, an enzyme deficiency that creates an inability to digest the milk sugar (lactose) causing similar gut symptoms, but these are not related to the immune system unlike an allergy, and require a different dietary treatment. Lactose intolerance is rarely seen in babies under 1 year except following a bout of gastroenteritis which may cause a temporary lactose intolerance.

Cows’ milk allergy can present in two ways:
a)   “immediate onset” reaction, where symptoms such as hives (nettle rash), vomiting, lip swelling, worsening of the eczema, red flushing of the face and body and breathing difficulties rapidly appear after taking a small quantity of cows’ milk

b)    “delayed onset” reaction where symptoms such as diarrhoea, constipation, reflux, blood in stools, progressive worsening of eczema appear several hours or even days after ingestion of a larger quantity of cow’s milk

“Immediate onset” reactions can be confirmed by IgE mediated allergy skin prick testing or a specific IgE antibody blood tests undertaken at an NHS hospital through GP referral to a consultant paediatrician.

“Delayed onset” reactions are the most common presentation of cows’ milk allergy and the only way of diagnosing this type of reaction is to exclude cows milk from the formula and diet, or from the maternal diet, if breastfeeding, and reintroduce it after a prescribed period of time.

Elimination of milk and dairy from the diet should always be done under the guidance of a paediatric dietitian who will take a detailed clinical history to assess, diagnose and treat the cow’s milk allergy ensuring both mother and baby are being provided with all the nutrition they need in the absence of this major food group from the diet. This is especially important in the first year of life when a baby’s nutritional requirements are high and growth is rapid.  To access a paediatric dietitian, ask your GP to refer your baby to the dietetic department at your local NHS hospital. Alternatively, for direct access to a private consultation with a paediatric dietitian email joangavin@dietitian4kids.co.uk

About Joan Gavin
Joan Gavin has 20 years of clinical experience as a State Registered Paediatric Dietitian within the NHS and holds a Masters degree in Applied Paediatric Nutrition. Her specialities include food allergies and gastroenterology and she has published articles in medical journals and books. Joan can assess, diagnose and treat nutrition related conditions providing up to date practical advice suited to your child’s needs. She is a member of the British Dietetic Association and registered with the Health Professions Council.