Ask the doctor - gap year health

My 18-year-old son is planning to take a gap year abroad. Any tips on how I can ensure he stays healthy while he’s away?
Some simple precautions are vital – according to a survey, half of British holidaymakers have had an illness or injury on holiday that requires some kind of medical attention. For all trips outside Western Europe and the USA, check with your GP or travel health clinic six to eight weeks before you travel in case you need immunisations. The EHIC (European Health Insurance Card) entitles you to the same state-provided medical treatment as an insured local resident if you get ill in the European Economic Area or Switzerland. Ring 0845 606 2030 or visit www.ehic.org.uk and have your NHS or National Insurance number to hand. When it comes to food while your son is away, tell him to boil it, peel it, cook it or forget it! In developing countries, fruits and salads, as well as ice, should be avoided. He should also take DEET-based insect repellant if he travels anywhere with a risk of malaria, and a traveller’s first aid kit. Visit www.nhs.uk/livewell/travelhealth to find out more.
Dr Sarah Jarvis, Good Housekeeping (May 12)

I’ve had stomach problems for years and have been diagnosed with a food intolerance. Cutting out rapeseed oil seems to have worked for me, but why didn’t my doctor tell me it could cause problems?

Food intolerance is a broad term covering any symptoms related to food. It’s very different from a food allergy, which is much rarer but can cause a life-threatening collapse. Technically, the many people who get indigestion after they eat onions, tomatoes or spicy food are intolerant to these, but we don’t ‘warn’ everyone to avoid them. I have advocated rapeseed oil for years as it’s the most heart healthy oil that exists – even better than olive oil – because it retains its beneficial properties at high cooking temperatures. It has a high proportion of heart-healthy omega 3s (second only to flax oil, which is not suitable for cooking) and is very low in saturated fats. It’s a cheap and healthy version of vegetable oil for cooking, and substituting tastier ‘cold pressed’ versions (those in dark bottles retain their vitamin E better) for butter or extra virgin olive oil to use for dipping is an easy tip for the cholesterol conscious. Having said that, no food suits everyone, so of course you should avoid it if you’re intolerant.
Dr Sarah Jarvis, Good Housekeeping (Apr 12)

I’d like to start using coconut oil in cooking but wonder if it’s classed as a healthy option?
I’m very fond of coconut oil. Although it contains saturated fat, it’s in the form of medium-chain triglycerides, which the liver transforms directly into energy rather than fat. As a result, it does not have a significant effect on cholesterol levels and may even help with weight loss, especially if you tend to store excess fat around your waist. A study of 40 women found that those whose low-calorie diet was supplemented with 30ml coconut oil per day for 12 weeks experienced a significantly greater reduction in waist size than those given soy bean oil, for example. Many celebrities endorse coconut oil, for use internally and externally. Miranda Kerr, model and wife of Orlando Bloom, attributes her smooth skin and glossy hair to the oil. Try Barlean’s Extra-Virgin Coconut Oil from the Philippines (£11.99 for 473ml from www.healthyandessential.com).
Dr Sarah Brewer, Prima (Jan 12)

What are living foods and are they necessary in my diet? I’m not keen on raw vegetables.
In practice, raw and living foods are very similar. The main di erence is that raw foods are uncooked and unprocessed, while living foods (mainly sprouts) are still growing, therefore have a higher enzyme content and are better for you, according to naturopaths. Those following a raw food diet are usually vegetarian and eat organic produce, such as fresh vegetables, fruits, grains, nuts, and seeds. Nuts, legumes and seeds may be sprouted to increase their enzyme content, while fruit and vegetables may be freshly juiced. Wheatgrass juice, purified water, and bluegreen algae (spirulina) may also be included, but regimes vary, and some are very strict (eg including only sprouts or living foods) by individuals with strong beliefs that dictate what they will and will not eat. For more information, visit www.gorawforaday.com.
Dr Sarah Brewer, Prima (Jan 12)

My GP recently told me I have irritable bowel syndrome, I’ve had bloating and tummy pain on and off for months. Do I need any tests to confirm the diagnosis, and what lifestyle changes can I make to avoid the symptoms?

When it comes to irritable bowel syndrome, or IBS, there isn’t a test to prove you have it. Instead, other causes need to be excluded – for example, you may have blood tests to rule out conditions such as coeliac disease and anaemia. Importantly, though, IBS very rarely starts for the first time over the age of 40 and, in women over this age, cancer of the ovary needs to be considered as a possible cause of IBS-like symptoms. Somewhat bizarrely, IBS can cause diarrhoea, constipation, or a combination of the two in turn. Other symptoms often include: abdominal pain that is eased by opening your bowels or passing wind; a feeling of not completely opening your bowels; passing mucus with a motion; bloating and feeling full after eating only a small amount. Advice for the treatment of IBS has changed over the years, and doctors now recognise that while dietary fi bre may relieve constipation, it can worsen IBS-associated diarrhoea. It also seems that the kind of fi bre you eat makes a major di erence. Foods we traditionally think of as high fibre, such as wholemeal foods and bran, contain insoluble fi bre or ‘roughage’ that can make symptoms of IBS worse. By contrast, foods high in soluble fibre – oats, okra, aubergines, prunes, strawberries, beans, peas and nuts – may help. Lifestyle changes, including trying to avoid stress, eating regular meals and cutting down on fizzy drinks, are all worth trying. Probiotics are products rich in bacteria that help our guts to function properly. While some foods such as yogurts and sauerkraut are naturally high in probiotics, it’s not clear if enough of the ‘good’ bacteria survive their journey through the rest of the digestive system to help, so it may be worth trying a fortified product such as Danone’s Activia. The National Institute of Clinical Excellence suggests at least a four-week trial before deciding whether they are helping you.
Dr Sarah Jarvis, Good Housekeeping (Nov 11)

I have high cholesterol and would like to bring it down without taking any drugs. My doctor suggests eating oatmeal. How effective is this?
Oats contain soluble fibre which acts like a sponge to mop up dietary cholesterol and slow the rate at which it is absorbed. They also contain substances known as betaglucans, which act on the liver to reduce your own natural cholesterol production. These combined effects can lower ‘bad’ low-density lipoprotein (LDL) cholesterol levels by up to 23 per cent. As well as eating oatmeal porridge, you can sprinkle oat bran over your cereal, yoghurt, fruit, soups and casseroles or add it to bread, muffins and biscuits when baking. Or, try an oat bran cereal, as one 40g serving provides 2.5g of beta-glucans – most of the 3g suggested daily intake for lowering cholesterol. Alternatively, you can take barley beta-glucan supplements, such as Help:Cholesterol (£11.99 at Boots).
Dr Sarah Brewer, Prima (Oct 11)

I’ve noticed that sandwich shops now sell packets of popcorn. Is it a healthier option than crisps?
Popcorn is made from maize kernels, similar to sweetcorn, which are naturally high in fibre and low in calories, fat, sugar and sodium. But if you add salt, oil, butter, toffee or artificial flavourings, it becomes less good for you. Like everything, moderation is the key. Air-popped popcorn is very low in fat and provides fewer than 100 calories per bag. Try Diva Popcorn, 85p per bag from health-food shops or www.divaallstars.com.
Dr Sarah Brewer, Prima (Sept 11)

I’m using rapeseed oil, as my healthfood shop says it’s good for my heart. But some friends say it’s harmful. Who’s right?
Rapeseed oil is nutritious and healthy. It provides a high concentration of the same monounsaturated fat found in olive oil (oleic acid) and omega-3 fatty acids. Its high concentration of plant sterols can also help lower cholesterol levels. Studies in Finland found that between 1972 and 1992, deaths from coronary heart disease more than halved. This was attributed to a switch towards growing and using rapeseed oil in three-quarters of cases. Cold-pressed oils, such as Oleifera (£9.95 for 500ml from www.oleifera.co.uk) retain the most health benefits.
Dr Sarah Brewer, Prima (Jul 11)

I’m allergic to fish so can’t take omega-3 fish oil supplements. Is there a vegetarian option?
Many vegetarian products are rich in omega-3 oils, but these often only contain the short-chain omega-3s, such as ALA, which is found in flaxseed oil. In fact, it’s the long-chain omega-3s, such as EPA and DHA, which are most important for heart, brain and joint health. Unfortunately, very little dietary ALA is converted into EPA and DHA in the body. So, check labels for vegetarian products that contain these longer-chain fatty acids. DHA is found in certain algae, and supplements – try Mind & More pure DHA (£9.99 for 30 from Holland & Barrett, 0870 606 6606) or Cerebrum (£13.95 for 120 capsules from healthspan.co.uk). Products containing echium oil also produce five times more EPA in the body than flaxseed oil (try Echiomega, £11.95 for 60 capsules from http://shop.igennus.com).
Dr Sarah Brewer, Prima (Feb 11)

I eat more pastry than usual at Christmas and often get indigestion. Is there anything that can help?
Pastry can trigger indigestion, as it contains a high amount of fat and is often combined with alcohol, eating too much, and eating late, at this time of year. It may help to eat little and often, rather than having large amounts at a time. A probiotic drink or yoghurt can aid digestion and reduce intestinal discomfort, while globe artichoke supplements boost bile production to improve fat digestion. Try Healthspan Artichoke Extract (£5.95 for 120 tablets from healthspan.co.uk). A supplement containing lipase to digest fats, amylase to tackle carbohydrates and protease to break down protein is another option. Try Solgar Digestive Enzymes (£9.90 for 100 tablets, from health-food shops).
Dr Sarah Brewer, Prima (Dec 10)

Why do I tolerate alcohol less well as I get older? I used to drink lots when I was younger, but these days my limit is two glasses of wine. Christmas parties are no fun any more!
As we get older, the total amount of water in our body reduces, so alcohol is ‘less diluted’ and produces higher blood concentrations. We may produce lower amounts of the stomach enzyme, gastric alcohol dehydrogenase, so less alcohol is deactivated before it’s absorbed into the circulatory system. Also, the liver may metabolise alcohol less efficiently, and the brain doesn’t respond as well. Bear in mind, too, that wine tends to be stronger now (13-14 per cent alcohol is common), and wine glasses are much larger than the small ‘hock’ glasses you may have used just 15 years ago. Women are more vulnerable to developing alcoholic liver disease than men as our hormones make the liver more likely to become fatty. Supplements containing milk thistle help to improve liver function – try Good N Natural Milk Thistle Seed Capsules (£19.49 for 100 from hollandandbarrett.com).
Dr Sarah Brewer, Prima (Dec 10)

My ten-year-old keeps asking if she can try a cup of tea – is it alright to let her have some?
One of my earliest memories is of my granny pouring her tea into a saucer for me to slurp when I was an infant. Although some people worry about its caffeine content, research confirms that tea is just as hydrating as water. Tea is a refreshing drink which is full of antioxidants known as flavonoids. Research shows these help to reduce the future risk of both heart disease and stroke. Recent studies confirm the health benefits for young adults and the benefits are likely to build up through life.
Dr Sarah Brewer, Prima (Nov 10)  

Are any foods or supplements helpful for asthma? Someone suggested that I try fish oils.
I suggest eating a Mediterranean-style diet, providing plenty of fruit, vegetables, garlic, olive oil and fish. Coffee, dark chocolate and unsweetened cocoa are also beneficial as they contain theobromine, which can open the airways. Regular coffee intake reduces current asthma symptoms by 30 per cent compared with those of non-coffee drinkers, and ground coffee provides more benefit than instant coffee. People who eat oily fi sh at least twice a week are half as likely to experience asthma, wheezing or chest tightness on waking compared to those who eat little oily fish – even when other factors, such as smoking, are taken into account. Fish oils can also reduce the severity of exercise-induced asthma. Aim to eat 150g oily fish (salmon, herrings, fresh tuna, mackerel, sardines, pilchards, kippers, sprats) twice a week, or take an omega-3 fish-oil supplement supplying a total of 1g to 3g omega-3 essential fatty acids (EPA and DHA). Some evidence supports the use of vitamin C, vitamin E, magnesium, probiotics and Pycnogenol (French maritime pine bark extract), too.
Dr Sarah Brewer, Prima (Nov 10) 

I keep seeing acai berry extract on sale. Is it just the latest gimmick?
Acai berries, the fruit of a Brazilian palm tree, are a good source of fibre, omega-3 fatty acids and monounsaturated fats, and have excellent nutritional value. They also appear to have an anti-inflammatory, pain-reducing action. They are mainly taken in supplement form for their high antioxidant content as the freeze-dried acai pulp and skin powder in supplements is among the highest for any food tested. Try Acai Berry 2000mg (£10.95 for 120 tabs from healthspan.co.uk) or Acai Capsules 1500mg (£24.99 for 120 caps from hollandandbarrett.com).
Dr Sarah Brewer, Prima (Oct 10) 

My doctor thinks I’ve developed a lactose intolerance in my forties. What could have caused this?
Lactose intolerance occurs when you stop making an enzyme, lactase, that’s needed to break down milk sugar (lactose). The enzyme is important for infants but, as we get older, many people stop producing it in large amounts. In the UK, up to 15 per cent of the population is lactose intolerant as a result. When milk sugar is not broken down and absorbed in the upper intestines, it passes through to the large bowel. Here, fermentation causes gas, bloating, pain and diarrhoea. In fact, many people who think they have irritable bowel syndrome actually have lactose intolerance. The only effective treatment is to avoid products containing lactose. Try the Lactofree range of milk, cheese and yogurts from lactofree.co.uk.
Dr Sarah Brewer, Prima (Oct 10) 

My husband often has business lunches and dinners where he’ll drink wine. He has two or three glasses at home, too, often finishing the bottle. Is he drinking too much?
Drinking is hazardous if it exceeds 21 units per week for men (14 for women). Binge drinking (consuming at least eight units in one session for men, six units for women) is also considered dangerous. Excess alcohol increases blood pressure, can cause abnormal heart rhythms and, if prolonged, leads to liver disease. Your husband can track his units at drinkaware.co.uk. Try suggesting that he visits his GP for a check-up, including a blood test to check his liver function. He will also benefit from taking milk thistle tablets, to help protect the liver from some of the toxic effects of alcohol. Try Healthspan Milk Thistle (£5.95 for 120 tablets from healthspan.co.uk).
Dr Sarah Brewer, Prima (Sept 10) 

I’ve been advised to drink more water. Is mineral or spring bottled water safer than the water from my kitchen tap?
Strict European directives control the quality of both tap water and bottled water, all of which must be perfectly safe to drink. Tap water comes from a variety of sources, including reservoirs, lakes and rivers, and is treated to remove contaminants, then disinfected with chlorine. If you dislike the slight chemical taste, try placing a covered jug of water in the fridge for around an hour (but use within 24 hours). You can also use a water filter to remove chlorine and improve flavour. Bottled mineral water comes from a single, identified and protected source, has a guaranteed consistent mineral composition and has not undergone any treatments. Bottled spring water must originate from an underground source and, although it must be microbiologically pure, may be treated to remove certain minerals. For more information, visit dwi.gov.uk.
Dr Sarah Brewer, Prima (Sept 10) 

Is it a good idea to give my children lunchboxes for picnics in this heat? I'm worried about the risk of food poisoning.
You're right to be concerned - when the temperature of food rises to room temperature, bacterial growth multiplies, which increases the risk of food poisoning. Unfortunately, lunchboxes left in the sun or in warm cars may cause problems if they contain food (such as meats and pâtés) that should usually be chilled. One way to minimise the risk is to add small ice packs to the lunchbox, which can keep food fridge-fresh for up to six hours. It's also helpful to use a lunchbox with separate compartments so that food that doesn't need to be chilled can be stored separately, with less risk of crushing. Try Easy Lunchboxes, which are priced from £15.98 atjomoval.com.
Dr Sarah Brewer, Prima (Aug 10) 

My favourite cookbook contains a tempting recipe for chocolate mousse using raw eggs. But don't they carry a risk of salmonella?
The risk of salmonella is much lower than it used to be. A survey of more than 28,500 eggs in UK stores found that only one in every 290 boxes had salmonella contamination, and none had salmonella in the eggs themselves. Use eggs that carry the British Lion Mark, as these are from hens vaccinated against salmonella. Store eggs in the fridge, check use-by dates, and wash hands thoroughly before and after handling. If making chocolate mousse, keep it chilled and eat as soon as possible after preparation. Raw egg products should be avoided by the elderly, babies and toddlers, pregnant women and people who are unwell and vulnerable to infection.
Dr Sarah Brewer, Prima (Jul 10) 

I recently saw a dietician but she said she wasn't allowed to recommend supplements. I apparently need a nutritionist for this - how do I find one?
A registered dietician can assess, diagnose and treat diet and nutrition problems, but they're only allowed to offer advice on supplements if the effectiveness is medically proven. Similarly, a nutritionist works mainly with food, and will only recommend supplements where there is good evidence for benefit. For supplement advice, you will need a nutritional therapist, who can recommend specific nutrients to improve or support body functions. Unfortunately, anyone can call themselves a nutritional therapist - it's not a legally protected title. I'd therefore recommend that you select one who is a member of the British Association for Applied Nutrition and Nutritional Therapy (they will have the initials MBANT after their name). Visit bant.org.uk to find a practitioner.
Dr Sarah Brewer, Prima (Jun 10) 

I stopped drinking coffee a few years ago because I believed it was bad for me. Is the new type of coffee, which contains unroasted green coffee beans, healthier?
Like most things in life, a moderate intake of coffee is unlikely to cause harm, and may do some good. People who drink three or more cups of coffee a day, for example, appear to have better lung function as it contains substances similar to some anti-asthma medication. Coffee contains antioxidants called flavonoids, which have beneficial effects on the heart and circulation. In fact, the new Green Blend from Nestle contains polyphenol antioxidants similar to those that give green tea and dark chocolate their healthy properties. Most of the coffee ‘health scares' were linked with over-boiled and percolated coffee, which we tend not to drink nowadays - not the more modern instant and filter coffees.
Dr Sarah Brewer, Prima (Feb 10)

My mother suffers from Parkinson's disease and has been in and out of hospital recently after falls. She has lost a lot of weight and tires easily, and although she gets meals on wheels I've noticed that she often doesn't eat them. Would vitamin supplements be a good idea?
Like three million other people in the UK, it sounds as if your mother is suffering from malnutrition, or is at least at risk of it. Malnutrition doesn't just affect people in developing countries - older people, especially if they also have medical conditions like cancer, dementia, Parkinson's or chronic lung or heart disease, are particularly likely to be affected. Being malnourished almost doubles your mother's chance of being admitted to hospital, or getting complications while she's an inpatient. That's why the National Institute for Clinical Excellence (NICE) recommends that patients with, or at risk of malnutrition should be prescribed oral nutrition supplements. These come in the form of drinks densely packed with vitamins and minerals, which can help build up her strength and increase the chance that she will stay independent and out of hospital. Talk to her GP about whether these drinks would help.
Dr Sarah Jarvis, Good Housekeeping (Feb 10)

I believe manuka honey has antibiotic properties, but I'm not sure how I should take it. Do you have any advice?
Some manuka honey contains a natural substance known as unique manuka factor or UMF. Select a honey which has a UMF rating of at least UMF10, which can kill more than 250 types of bacteria - these include antibiotic-resistant strains such as MRSA. The honey may also help to protect against winter infections such as bronchitis. Take one to four teaspoons per day (seek medical advice if you have diabetes). It is also used for wound infections, but it's important that you don't apply honey from a jar directly to a wound. This is because some types of honey contain spores from Clostridium bacteria, which can cause skin infections, including gangrene. Only medicinal honey designed for topical use (such as Medihoney Antibacterial Wound Gel, £5.87 for 25g), which is available from pharmacies or at medihoney.com, should be used.
Dr Sarah Brewer, Prima (Jan 10) 

The answers to specific problems may not apply to everyone and are not substitutes for professional medical advice. If you're worried, see your GP. For more information, visit netdoctor.co.uk