Phytochemicals

Phytochemicals 

These are chemicals from plants (phyto is Greek for plant)  Polyphenols, phytochemicals, flavanols, bioflavonoids etc are names which cause a lot of confusion.

Polyphenols:
The most studied class of phytochemicals are polyphenols because of their potential health benefits. There are numerous polyphenols (poly means many, phenols means benzene rings) which come from different plants and have different actions. 

• Phenolic acids – blueberries, tea, cereal grains.

• Stilbenes – the best known of these as resveratrol found in red wine, it is quite poorly absorbed.

• Lignans are found in flaxseed which may have some oestrogenic properties.

• Flavonoids (also called bioflavonoids) are named for the yellow colour and are found in flowering plants and fruit and vegetables. Flavonoids cause the colour and taste of foods, and have an antioxidant effect on fat, vitamins and enzymes.
  Flavonoids are divided into 6 subclasses many of which have confusingly similar names:
• Flavonols – found in onions, curly kale, leeks, broccoli blueberries, red wine and tea. Its production stimulated by sunlight and so its highest concentration is in the outer parts of the plants.
• Flavones - are found in parsley and celery
• Flavanones - are found in citrus fruits, tomatoes, and plants such as mint.
• Isoflavones - these have a structure similar to oestrogen, and are often called phytoestrogens. Most are made from soy and soy products.
• Flavanols - these are found in green tea, chocolate, red wine, apricots and other fruit. Also in fruits such as grapes, peaches and berries, and also cause the bitterness of chocolate.
• Anthocyanins - . These are pigments creating the blue purple red and pink colours of 4 hours fruits and vegetables.

Many variables affect the amount of polyphenols found in food, including the degree or ripeness at harvest, the rainfall, the sun exposure, how they are stored and how they are cooked.The polyphenols are designed to protect plants from oxidation, toxins and damage, and by consuming them, we can achieve some of these benefits.
The still is quite a lot of scepticism in conventional medicine on their value when taken the supplements, although there is no debate that we should all be eating plenty of fresh fruit and vegetables on a regular basis. The difficulty is to obtain polyphenols that have been growing correctly, picked at the right time, not over processed or over cooked and are available all year round. For this reason a quality supplement which is well absorbed containing these products should also be beneficial, but does not replace the need for fresh fruit and vegetables as well.

STATIN DRUGS

One of the most frequent questions I am asked as a Cardiologist and physician is – do I really need to take Statin drugs?  On one side doctors are suggesting they be incorporated in a polypill which everyone should take, to other more ‘naturally based’ experts saying they do not work and people should not take them (click here)

This article is my assessment from the current medical literature, and the advice I give to my patients.  Because the article is quite long, I will put my conclusion first as well as at the end, but I would recommend that you read the reasons for my conclusions as well.

My Conclusion – sifting through all of the data below, my recommendations are relatively simple:

1. If you have proven cardiovascular disease (heart attack, angina, stroke, angioplasty, high levels of calcium in cardiac CT scan) then you should take a statin drug preferably at a low dose. This would reduce your risk of a heart attack, stroke or death by about 20%.

2. If you get any side-effects – muscle pain, abnormal liver function tests, or you feel that your mental function has deteriorated, stop the drug for a couple of months, and then restart. Possibly consider restarting with a water-soluble statin such as pravastatin. If the symptoms recur then don't take the statins anymore.If you feel fine, then continue the statin. There is little evidence showing that any other cholesterol-lowering agent provides any benefit.

3. If you don't have cardiovascular disease (primary prevention) unless you have a very high cholesterol, diabetes or an extremely strong family history then I would not recommend that you take a statin drug. My advice would be to have a CT scan for calcium**  which will show early coronary artery disease, if this is strongly positive then maybe you should consider taking a statin drug. If it is negative or normal for age, then I would not take a statin.

4. For elderly people the benefits of statins do continue, but if there is any suggestion of impaired mental function, then stop taking the statin.

5. If you are taking a statin, you must be taking the supplement coenzyme Q 10, at least 100 mg daily.

Possible benefits of glutathione in the elderly

Glutathione is a very powerful antioxidant created within the body to prevent oxidative damage due to free radicals attacking and destroying cells. With age the amount of glutathione in the body particularly the brain decreases, and could set the stage for age-related health problems, particularly dementia, but also cardiovascular disease, diabetes and cancer.

Unfortunately glutathione cannot effectively be given as a supplement because it is poorly absorbed, but N-acetylcysteine (NAC) is converted into glutathione, and also helps the body to make more glutathione.
It is difficult in humans to trial this, but in a rather nice study (click here) the authors gave NAC to isolated liver cells in both young and old rats exposed to high levels of oxidants.  N-acetylcysteine was very protective and reduce the amount of damage greater than twofold.

Oxidative stress does appear to be a major cause of disease in today's world; antioxidants taken orally are relatively weak compared to the antioxidants created within the body (glutathione, catalase, superoxide dismutase etc.). The production of the latter tends to be less as we get older, and are frequently overwhelmed by our toxic world. It thus does seem reasonable to suggest that people should take products which could help the creation of these internal antioxidants, such as N-acetylcysteine.

Calcium supplements are safe! 

This is the conclusion from a new joint clinical guideline from the National Osteoporosis Foundation and the American Society for Preventive Cardiology (click here) . Over the years there have been many reports on the benefits and adverse effects of calcium both taken in the diet, and as supplements. Occasional studies have suggested that calcium in the diet has no effect on cardiovascular disease, but supplements might have. (The word might is in italics because in some trials there is only a suggestion but it is not clinically significant). There are also some studies which show benefit, including one which showed women taking more than 1000 mg of supplemental calcium per day had less cardiovascular disease than those who did not.  Because there are obvious benefits in bone and other health from taking calcium both in the diet and as supplements, these 2 bodies looked at all the evidence that was available, and concluded "dietary and supplemental calcium are safe for cardiovascular health when consumed in the recommended amounts. The recommendation applies to calcium consumed either alone or with vitamin D that does not exceed the National Academy of medicine is tolerable upper intake limit of 2000 to 2500 mg per day""  There will always be studies which so some benefit or lack of benefit, particularly the smaller studies, many of the studies are impure because patients report the amount of calcium they either consumer as supplements or diet during the day, and follow-up is incomplete. There is also a strong lobby against the use of supplemental calcium (in fact the use of supplements), but even if there is an indication rather than a statistically significant result, this will be reported out of proportion to its scientific evidence. When 2 major societies in the United States come to the conclusion that calcium supplementation is safe, there seems little point in individu
als debating the results of further studies.

The dangers of long-term PPI (Proton Pump Inhibitor)treatment.

Proton pump inhibitors (PPIs) like omeprazole, lantoprazole, are being used very frequently, and in many cases long-term, to treat peptic ulcers and gastro-oesophageal reflux, and "indigestion". They act by reducing the production of gastric acid. While they are incredibly effective in treating these conditions, they do have other less desirable and sometimes fatal effects:
By raising the gastric pH they can affect pepsin and other enzymes used to dissolve proteins.
The elevated pH also enables bacteria and viruses to survive where otherwise they would be killed, sometimes leading to infection in the lower GI tract.
Diseases resulting from prolonged use of PPIs include:

• Gastric and gut infections, especially traveller's diarrhoea.
• Pneumonia – the bacteria surviving in the stomach can migrate up the oesophagus and down into the lungs.
• Increasing fractures, presumably due to a direct effect of these drugs on bone architecture.
• Vitamin B12 deficiency – these drugs greatly affect the absorption of vitamin B12, particularly in the elderly. This can result in peripheral nerve problems, but also dementia.
• Heart disease and strokes, there is an increased incidence of heart disease and almost doubled increase in heart deaths according to a recent study from Stanford University. (http://www.ncbi.nlm.nih.gov/pubmed/26061035)

While there are many cases where these drugs are extremely useful, the need for long-term treatment needs to be carefully studied, and they should only be used if necessary. Like all drugs, they have significant side-effects.

Fish oils are crucial in today's diet

Fish oils – a crucial part of today's diet

The omega-3 fatty acids found in fish oils (DHA and EPA) are crucial to balance the high levels of omega 6 fatty acids we get in today's diet. The ideal ratio should be 2-to-1, omega 6 to omega 3, but the average modern diet provides a 20 to 1 ratio. This leads to inflammation and many other effects, and asthma, autoimmune disease, heart disease, diabetes, cancer, obesity, irritable bowel, macular degeneration have all been shown to be worsened by this 3/6 imbalance. The omega-3 oils are also important components of many tissues especially brain.

Below is a very impressive list of just some of the benefits of fish oil, which is why almost everybody from conception should be taking fish oils, continuing right through life. Unfortunately it is difficult to consume enough fish to achieve the major benefits, and there is always the worry of pollutants such as mercury, PCB and insecticides which could undo much of the benefit. For this reason a high quality pure fish oil supplement is by far the safest and most likely to give benefit.

The benefits of fish oil are almost to numerous to list, but some of the important ones include:

1. ADHD and IQ in babies and children – pregnant women taking fish oil supplements have babies with better mental function. After birth a study from the University of South Australia showed that children treated with fish oil had reduced symptoms of ADHD, inattention, hyperactivity, restlessness and impossible behaviour.
2. Reduced anxiety. A study in Neuroscience sure that fish oils reversed all anxiety like and depression like behaviour changes induced in rats. While this is also been seen in humans, the purity of a rat study confirms the benefit to the brain of fish oils.
3. Arthritis – the anti-inflammatory action has been shown in many studies to improve arthritis, particularly rheumatoid.
4. Alzheimer's disease – the DHA in fish oil is crucial for the brain tissue, and fish oils have been shown to help  function in patients whose minds are failing.
5. Cancer – fish oils have been found to help kill a variety of cancer cell lines, including colon, breast and prostate. While it's impossible to do a study excluding all other treatments, most cancer patients should be taking fish oils.
6. Depression – a recent fascinating study reviewed 26 papers where fish oil and depression were discussed. Over 150,000 participants were reviewed and those who had a high intake of fish oils had an almost 20% reduction in the incidence of depression.
7. Diabetes – studies in Brain Research have shown that fish oils reduce the risks of diabetic patients developing neurological problems, but the anti-inflammatory action might also reduce the development and worsening of type II diabetes.
8. Eye diseases – fish oils have been shown to reverse dry eye, cataracts and macular degeneration.
9. Cardiovascular disease – it has been known for a long time that fish oils are beneficial to patients with coronary artery disease, not just the development of the disease, but also reducing the risk of sudden death.

It is hard to understand why all doctors are not advising their patients to take fish oil supplements, probably because of the pollution (especially mercury) found in many of the supplements, or natural fish. However good quality fish oils which are pure are available, and my advice is for everybody to take them throughout life.

Why coconut oil is so good

Why coconut oil is so good

Slowly the conventional medical attitude to fats is changing. For many years we have been telling our patients not to eat saturated fats, eat a few polyunsaturated fats and mostly monounsaturated (olive oil canola oil). In reducing the fats we have encouraged people to eat sugars and this is one of the major reasons for the obesity epidemic worldwide. All of this was on very flawed data starting from the 7 country studies of Ancel Keys who claimed to show the incidence of heart disease related to the Unfortunately there were 22 countries studied by Dr Keys but only 7 were used, when all 22 were included there was still a very slight association but much less clear (see graphs). Following this the really has been virtually no information confirming that the intake of saturated fats leads to coronary artery disease. However for many years dairy fats and any other saturated fats have been excluded from the diet of people with heart disease. We are now realising we got this totally wrong!

Coconut oil is a saturated fat, and the evidence is that eating,drinking and cooking with it does nothing but good. It contains medium chain triglycerides in addition to the saturated fats. Studies have shown that consuming coconut oil has a number of beneficial effects including:

1 It has an antioxidant effect, oxidative stress is one of the major causes of many of today's health conditions.
2. It reduces inflammation and thus can be used for inflammatory conditions such as aches, pains, fevers and even stomach ulcers.
3. It seems to have an antiseptic affect, and has been used topically to treat viral bacterial and even fungal conditions.   Many people use it instead of toothpaste.
4. Probably the most exciting but sadly so far least researched is its potential effect on the brain. The brain can only use sugar or medium chain triglycerides as its source of energy (it cannot use fat). In Alzheimer's disease the brain cannot use sugar properly, and there are many anecdotal reports that coconut oil may well improve the mental function of patients with this terrible disease.
5. There have been some reports that it helps in thyroid function, and can help in weight loss and even reduction in cholesterol (click here.)

Coconut oil can be drunk as a very refreshing cool drink, it can be added to salads and other dishes, it can be used as a cooking oil, and can also be eaten straight from the spoon.

I'm quite certain that in the coming years this very safe and natural product will become part of our staple diet.

Magnesium reduces sudden cardiac death by 36%

Everybody with heart disease should be taking magnesium supplements.

It has been long suspected that low magnesium increases the incidence of sudden cardiac death, but most of the studies have been relatively small (few cases of sudden cardiac death).
In the nurses health study those with the lowest level of magnesium in their blood had a higher incidence of heart disease, the NHT FS follow-up study also suggested the same, but each only had a few sudden cardiac deaths.

A recent study of almost 10,000 normal people followed for 9 years in the Netherlands click here, showed that those with low serum magnesium level had a 36% increase in sudden cardiac death, and unexpectedly also a higher incidence of non-sudden cardiac death as well.

We often treat patients in hospital following a cardiac arrest or with severe rhythm problems with intravenous magnesium, suggesting the importance of this mineral in keeping the heart function regular.

Therefore everybody with heart disease (angina, heart attack, angioplasty, bypass surgery, palpitations and arrhythmias, hypertension, heart failure) should be taking supplemental magnesium at least 500 to 800 mg per day on a regular basis to reduce the risk of sudden death.

Because for many people, sudden death is the 1st indication of heart disease, it seems logical that all of us should be taking supplemental magnesium at least after the age of 50.

In addition to reducing the incidence of death by over 30%, magnesium also maintains a lower blood pressure, has a calming effect, relieves muscles aches spasms and cramps, and can be beneficial to prevent migraine.

A comprehensive approach to autoimmune diseases

Autoimmune diseases develop when our body's immune system attacks our own tissues. (Ankylosing spondylitis, coeliac disease, Crohn's disease, Graves' disease, thyroiditis, myasthenia gravis, multiple sclerosis, psoriasis, rheumatoid arthritis, scleroderma, Sjogren's syndrome, systemic lupus erythematosis, ulcerative colitis, vitiligo). The current medical approach is to suppress the immune system to reduce the damage to the tissues, usually with very powerful drugs (steroids, immunosuppressives, cytotoxics). In addition to the significant side-effects, these simply attempt to control the symptoms and play little part in preventing the underlying disease and damage.
By adding simple complimentary therapies designed to assist in the immune process, we can make an enormous difference to the outlook for these patients.

To understand why these treatments work, a very basic understanding of the immune response is necessary, I will try and make this a simple as possible and it is worth persisting if you can.
1. When we are exposed to any form of outside threat (virus, bacteria, toxin etc.)  the 1st reaction of the body is to create heat (fever), swelling with an increase in blood supply and white blood cells rush to the area. At the same time APCs (antigen presenting cells) detect the invader and rushed to the immune system around the body.
2. The APCs instruct the immune system to create 2 types of cells – T helper cells, and T reg cells. There are a number of types of T helper cells (cytotoxic, suppressor, killer,) and all of these attack the invader and hopefully destroy it.
The T reg cells are a bit like the brakes on a car to tell the T helper cells to slow down. Many autoimmune diseases are caused by insufficient T reg and the T helper cells start attacking the cells of our body.
3. The gut plays a crucial role in our immune response. Almost 70% of our immune system is in the gut (the gut associated lymphoid tissue GALT) and thus the majority of immune interactions occur in the gut.

By approaching all 3 of these immune responses (the T helper cells, the T reg cells and the GALT) we can fight immune diseases very much more comprehensively and with a much higher chance of success with less toxicity.
1. Suppressing the T helper cells is what modern medicine does with its powerful drugs. It would be much better for the natural brakes to be put on by the T reg cells.
2. A number of natural products are known to increase the T regs and thus should reduce the T helper cells production. These products include curcumin, botswellia, vitamin D, zinc).
3. Changes in the bacteria in the gut  affects the gut immune system (GALT), and can affect the balance between the T helper cells and the T reg cell production.  Probiotics (especially lactobacillus rhamnosus LGG) have been shown to increase the production of T reg cells and thus dampen down the excessive immune response.

Conclusion – I apologise that this may be somewhat complicated but I think it's worth sharing this information. It also makes for a much better and holistic therapy approach to patients with autoimmune disease:

• Regularly take a probiotic containing LGG.
• Regularly take tumeric (curcumin) and possibly boswellia
• Take other natural products which can reduce inflammation – omega-3 fish oil, vitamin D and zinc.
• Medical drugs as recommended by your doctor, but ask for the minimal dose necessary as the above therapies start to take an effect.

Resveretrol may reduce heart disease via the gut bacteria

Resveratrol and red wine resveratrol and red wine may prevent disease by changing the bacteria in the gut (the microbiome).

Moderate amounts of red wine, probably acting through resveratrol is known to have significant health benefits reducing the incidence of heart disease, cancer and other conditions. In a recent paper (attached but it is virtually unintelligible unless you have a PhD in biochemistry), scientists from a Chinese University have shown that resveratrol reduces the amount of TMAO (trimethyl n oxide) which is a known risk factor for artery disease.

The resveratrol increases the levels of a number of bacteria in the gut (Lactobacillus and bifidobacterium) which seems to inhibit the production of TMAO.

It does seem that the bacteria in the gut (microbiome) is incredibly important, and something we are only just beginning to understand. It also suggests that food, nutrients, drugs which are not even absorbed into the body may well have a major effect, simply by changing the bacteria in the gut.

If you would like to read the article (I would not recommend this for the faint hearted), it can be found here

Vitamin D helps treat heart failure

Vitamin D improves heart function in people with chronic heart failure.

Heart failure is an extremely serious condition, causing unpleasant symptoms of breathlessness tiredness weakness and swelling, but also has a very significant mortality. Medical treatment consists of drugs (ACE inhibitors, beta-blockers and diuretics) but these have limited effectiveness in some patients, and complimentary therapies such as coenzyme Q 10 l-carnitine and D ribose have also been suggested.

A recent study performed in Leeds hospital (the Vindicate trial) offers hope from an unexpected source, namely vitamin D.
In the study 160 patients on full medical treatment were either given vitamin D or dummy tablets for one year.  At the end of the year those taking the dummy tablets had no benefit on heart function as measured by a cardiac ultrasound scan, but in the 80 patients who took vitamin D 3 the heart function improved from 26 to 34%.

This is a very major improvement in heart function, probably greater than that achieved by any of the modern medical drugs. One wonders why this has not been trumpeted around the world, possibly because it is a supplement and not a drug. Considering there are more than 900,000 people in the United Kingdom, and over 23 million worldwide suffering from heart failure, this therapy could be an extremely cheap and efficient way of helping many people.

It was presented at the American College of cardiology, 65th annual scientific sessions in Chicago in April.

Anybody suffering from heart failure should undoubtedly be taking additional

Genetic diseases can be changed

You can change your genes

While genetic coding and therapies are being investigated by pharmaceutical firms to try and treat disease, scientists have also discovered that we can change the effects of our genes. This is a whole new science called epigenetic's and I believe gives hope to so many people.
If you have a family history of heart disease, high blood pressure, diabetes, cancer, and even some of the inherited diseases (Huntington's chorea, Down's syndrome, cystic fibrosis, muscular dystrophy etc.) – the effects of these can be changed by the way we live, the toxins we are exposed to or can avoid, and the nutrition we put in our bodies.
A quite neat and witty presentation of this can be seen here.

It seems that the genes make the major decisions, but their effect can be changed to some extent by the world we live in. For example identical twins who are brought up by different parents are often very different in their susceptibility to illness. Some genes work by affecting the metabolism, and optimal nutrition can frequently change the actions of the genes to make them less damaging, or even beneficial. Because many of these changes gradually develop over life, any treatment or approach which is likely to be effective should be a lifelong therapy.
Therefore people with inherited diseases or their children, should avoid the obvious toxins as much is possible, eat a diet which is healthy and nutritious, and make certain that the body has a surfeit of all the nutrients it requires. My recommendation would be to take an optimal dose of a good multivitamin and multi mineral, omega-3 fish oils (make certain it contains no mercury), additional calcium and magnesium, coenzyme Q 10 and probably a powerful antioxidant such as grapeseed extract. For people with neurological illnesses, there is a suspicion that may be coconut oil is beneficial for brain function, and it should probably be the cooking oil of choice.

Fish oil and baby brain development

High fish consumption during pregnancy gives brain benefits to the child.

Yet another study showing the benefits of taking supplements during pregnancy. In the Spanish study 2000 mothers were questioned, and their babies were assessed at 14 months and 5 years. Click here
On average the women consumed about 500 g (3 servings) of seafood per week while pregnant, but for every additional 10 g per week above that amount the children's test scores improved up to about 600 g.   The improvement in brain development and neuropsychological testing was most evident at 5 years, and there was also a consistent reduction in autism.

This is a population with a fairly high fish intake, they did not separate between small and large fish.   The larger fish tend to have higher mercury levels. Even despite this, the babies benefited consistently.

The omega-3 oils found in fish are obviously very important for the foetus's brain development and studies like this make it mandatory for doctors and midwives to encourage pregnant women, especially in the 1st trimester, to eat plenty of omega-3 oils. At the same time the possibility of mercury toxicity causing damage to the developing fetus is a worry, and it is recommended that the larger fish with longer life spans which concentrate the mercury more in the tissues (shark, swordfish, giant mackerel, tuna) should be avoided.
However the safest way of making certain that the baby receives the omega-3 oil and zero mercury is to take a quality supplement which is guaranteed to be mercury free.

The fact that we can create a more intelligent, better adapted child with a lower risk of autism by simply taking a quality omega-3 supplement during pregnancy and eating regular fish meals is something that should be shared with all mothers and potential mothers.

Calcium supplements are safe

Calcium supplements do not increase the risk of heart disease.

Until recently the only side-effect of calcium supplementation was a very small increase in kidney stones, but in recent years there has been a suggestion from a small number of researchers that calcium supplementation may increase the risk of heart attacks.

Because calcium and vitamin D are extremely important in bone health and many other bodily functions, people have been encouraged to stop taking supplements and rely on their diet for calcium. In most cases this is usually insufficient, particularly in the elderly.

A study recently presented at the world Congress of Osteoporosis and Musculoskeletal medicine, (April 2016) the authors reviewed the effect of both calcium and vitamin D supplements in over 500,000 people over 7 years in the United Kingdom. This showed no effect of calcium supplements or vitamin D on the incidence of heart disease in either men or women.

The UK Biobank is a large study of men and women (502,664) with a mean age of 58 years, they recorded the baseline intake of calcium and vitamin D supplements and link this to hospital admissions for any cardiovascular event and death through the 7 years of follow-up. 34,890 participants were taking calcium supplements and 20,004 vitamin D. The incidence of heart disease and death were no different from those people taking no supplements.

Hopefully, this will put to bed any suggestion that taking these supplements which are essential particularly as we age does anything other than good. Osteoporosis and falls (particularly hip fractures) are a major cause of both morbidity and death in the older population, and these people can now confidently take the supplements knowing it will do them no harm.

Medicine in 2016 - a Happy New Year?

2016 looks like becoming a very important year in the development of medicine. Over the last few years people have been looking more critically at the direction of modern medicine, at the way in which it has been driven by procedures and drugs, and questioning whether the cost of modern medicine is sustainable and is providing the benefits that are claimed.

 I can see huge changes in the two major killers in today's world – cancer and heart disease.

Cancer – in the past chemotherapy has been blunderbuss essentially damaging the most rapidly dividing cells which are assumed to be the cancer cells but at the same time knocking off any rapidly dividing normal cells in the body as well – giving the well-known side-effects. In recent years however much more selective chemotherapies have been developed which target the cancer cells specifically, giving much fewer side-effects, but more importantly a much better outlook. Unfortunately because the selective drugs are only applicable to selective cancers, the number of patients receiving them are relatively small, and thus it is difficult for the drug firms to recoup their research costs. This makes them extremely expensive, and insurance companies and Governments are going to have to decide which ones to fund, and for how long. While this is a real problem, it does give a real opportunity for quality and increased duration of life for many cancer patients. Example of these drugs include treatments for melanoma, myeloma, lung cancer, prostate cancer, pancreatic cancer and others.
Thus the diagnosis of even widespread cancer no longer needs be seen as a death sentence as it has in the past.

Heart disease – this has tended to be the pinup boy of medicine over the last couple of decades, as doctors have discovered bypass surgery, angioplasty and stenting. The same time the pharmaceutical industry has come up with a variety of drugs both to treat symptoms and to try and reduce the incidence of heart disease.  .

There has been a very strong emphasis on lowering cholesterol, and even though only one of the cholesterol-lowering drugs that have ever been shown to reduce heart disease (the statins),
The emphasis on cholesterol has continued, but more and more conventional doctors are looking critically at the evidence and the advice we have been giving to our patients in the past. By telling people not to eat fat, we have forced them into eating food containing lots of carbohydrates, which is led to an obesity epidemic. Doctors are now looking at whether we should be giving statins as frequently as we are recommending -for most doctors there is no debate - patients with definite heart disease should be on statins, their value in other situations is very debatable, in fact dubious.
People are also looking at the benefits of angioplasty which is being done every time doctors see what appears to be a significant lesion in a coronary artery. The evidence appears that only lesions that are symptomatic should be treated, and there is very little evidence that stenting any
lesion actually reduces the risk of heart attack or death. Over the forthcoming years, I suspect the number of angioplasty procedures will drop significantly.

Because of the increased cost of effective cancer treatments, I suspect that governments and insurance bodies may well be looking more closely at all other procedures, and confirm that they are value before funding them.

But perhaps the most frightening aspect of health which has the prospects of returning us to the Middle Ages is the development of drug resistant bacteria which could render most of our antibiotics impotent. Because of the speed of development of resistance, and the cost of developing new forms of antibiotics, the drug industry is unlikely to be spending a great deal of money on this problem.