Saturday, 15 December 2012

Alcohol dependency



Alcohol-related health issues among baby boomers are on the rise. Daily drinking can start off as a social event but turn into dependency, addiction experts say. So when does social drinking become alcoholism?
In the festive season, with office parties, Christmas, and new year, there is opportunity aplenty for yet another tipple.
Since the 1950s, alcohol consumption in the UK has gradually increased. The NHS now spends more on alcohol-related illness among baby boomers than any other age group, with £825m spent on 55 to 74-year-olds in 2010-11 compared to £64m on under-24s.
Estimates also suggest about nine per cent of men and three per cent of women in the UK show signs of alcohol dependence.
But it is the functioning alcoholic that can slip under the radar - before their health issues are severe enough to need treatment.
Straight vodka
Dr John Marsden, an alcohol and drug dependency expert from King's College London, says a typical functioning alcoholic can manage to hold down a job despite having a "very severe drinking problem that they have been incubating over a very long period".
"Alcohol problems are difficult to understand because they do not occur overnight. They are hidden from view which makes functioning alcoholics a group we cannot easily help."
Rob C, who is 61, was one of them. At his worst he was drinking 1.5 litres of straight vodka per day.
"Then I began to suffer blackouts, losing whole days and not remembering anything."
He would be first to arrive at work, which made him able to set out his "drinks for the day with what looked like a bottle of mineral water".
"I would hide bottles around the office. You think nobody else knows, that it doesn't smell, that you're getting away with it. But of course they did notice."
Life saver
For several years, maintaining a full-time finance job, he drank increasingly more during the day.

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There was work, there was money and increasingly the motivation to alter ones mood quickly. Alcohol has been the drug of choice to do that”
Dr John MarsdenAddiction expert
What started as a social pastime nearly cost him his relationship. Now sober for eight years, looking back he says that even if a colleague had said something at the time, he would not have listened.
"I resented the changes at work and told myself I deserved a drink. I would buy wine at lunchtime and drink it from a polystyrene cup."
Wine turned to vodka for a "bigger kick" and lunchtime turned to morning through to night.
Early retirement on medical grounds made his addiction worse. It was only when his partner threatened to kick him out that he sought help with Alcoholics Anonymous, who he says saved his life.
Rob is not alone. In the last decade there has been a 63% increase in prescriptions for the treatment of alcohol dependency in England, as well as a 20% rise in deaths from liver disease.
Prof Sir Ian Gilmore, a liver specialist and chair of the Alcohol Health Alliance, believes the number of people dying from liver disease will keep rising.
The majority of people who have alcohol-related health problems are middle-aged, which Sir Ian says is a consequence of chronic alcohol misuse - many years of frequent heavy drinking, rather than binge drinking - a session of drinking large amounts of alcohol in a small space of time.
But he says that though there is a big overlap, it is important to remember not all heavy social drinkers are dependent on alcohol.
"Some people can control their drinking after work, others can't. If people are frequently drinking harmful levels of alcohol - over 50 units a week for men, 35 for women - most will end up suffering some form of physical, mental or social harm."
A lifetime's worth of drinking is catching up with baby boomers, says Emily Robinson from the Alcohol Concern.
The charity hopes that their campaign, Dry January, will help get people thinking about how much they drink, especially at home when units are harder to measure, and crucially, before they reach a stage where drinking is affecting their health.
"The issue of people drinking every day is worrying as it's a way of slipping into dependency, as you need to drink a little more each time to feel the same effects," she says.
Dr Marsden suggests the line between social drinking and dependency are clear. He says the first question that needs to be asked by clinicians or family members is: "Has anyone expressed concern to you about your drinking?"
This question assesses whether a person's behaviour has negatively impacted on someone close to them, he adds.
"If your alcohol consumption has caused a problem for someone else - I'm not rushing to label you an alcoholic but suggesting you need to take a closer look at your behaviour."
There is a clear reason the baby boomer generation is now most at risk from alcohol-related problems, argues Dr Marsden.
A hard-working generation led to an appetite for entertainment and relaxation.
"There was work, there was money and increasingly the motivation to alter one's mood quickly. Alcohol has been the drug of choice to do that."
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'Action needed on vitamin D levels'




There is growing awareness about the importance of the "sunshine vitamin" - vitamin D - for health.
But Professor Mitch Blair, from the Royal College of Paediatrics and Child Health, says more action is needed - potentially including fortifying more foods and even cutting the cost of the vitamin to make it more easily available,
Vitamin D is an essential nutrient that contributes to healthy, strong bones and helps to control the amount of calcium in the blood.
Unlike many other vitamins, getting your recommended daily amount of vitamin D is not that easy.
The main source is sunlight; but with short days, long nights and limited sunlight even during the summer, it's not easy to get your fix that way.
Vitamin D can be found in some foods such as oily fish, eggs and mushrooms - but only 10% of a person's recommended daily amount is found naturally in food.
Put bluntly, eating more fish and getting out in the sun a bit more won't make much of a difference to your vitamin D levels.
Unfortunately, there is limited national research on the true extent of vitamin D deficiency in the UK population.
But we do know that there has been a four-fold increase in admissions to hospital with rickets in the last 15 years and that some groups are more 'at risk' than others - namely children, pregnant women and certain ethnic minority groups.
Broken bones
Pilot studies and regional monitoring suggests that vitamin D deficiency is likely to affect at least half the UK's white population, up to 90% of the multi-ethnic population and a quarter of all children living in Britain.

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In some countries, supplements are free for all”
A recent study in Australia revealed that a third of under-25% are vitamin D deficient - perhaps surprising in a country blessed with plenty of sunshine.
Vitamin D deficiency has been linked to a range of debilitating diseases in children and adults - including diabetes, tuberculosis, multiple sclerosis and rickets, a bone disease associated with poor children in Victorian England.
Lack of vitamin D is often cited as a contributory factor in broken bones and fractures, with obvious implications for some child protection cases.
The National Institute of Clinical Excellence (NICE) recommends supplements for pregnant or breastfeeding women and their children from six months to four years.
The Chief Medical Officer recommends supplements for children up to the age of five and the government's Healthy Start programme provides vitamins free for people on income support.
'Out of the shadows'
But we believe more needs to be done.
Firstly, Vitamin D supplementation should be widely available at low-cost.
In some countries, supplements are free for all.
Whilst the Healthy Start programme of free supplements for low income families is a positive step, evidence suggest the vitamins are in short supply and uptake is low - with many eligible people unaware that they are available or of the need to take them.
Secondly, we need to look at fortifying more foods with vitamin D.
Currently, many brands of cereal and orange juice contain added vitamin D which helps boost daily intake.
In the USA most milk is supplemented with vitamin D, which has helped reduce deficiency, particularly in children. The Scientific Advisory Committee on Nutrition is currently looking into this.
We also need to make sure healthcare professionals - including GPs, paediatricians, doctors and nurses - know the signs and symptoms of vitamin D deficiency, but more importantly give appropriate advice to patients who are 'at risk' to prevent problems developing.
And it's important that the public are aware of the implications of vitamin D deficiency, where they can get supplements and how they can boost their intake.
In addition, we need more research into the links between vitamin D deficiency and bone disease - and there must be better surveillance to monitor the prevalence and incidence of vitamin D deficiency across the population.
Only by knowing the true extent of the problem can we develop the most appropriate preventions - and ensure that vitamin D is brought out of the shadows and into the sun.
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cocaine breast implants



When the 20-year-old was stopped for a search at Barcelona's Prat international airport, police noticed that she had gauze under her breasts.
She said she had had plastic surgery two months before, but the wounds were open and she was still bleeding.
She was taken to hospital, where the cocaine bags were removed.
Spanish police say thousands of people try to take illegal drugs into the country every year, but this is the first time they have come across fake breast implants containing cocaine.
Flights coming from South America, where most of the world's cocaine is produced, are subject to thorough checks.
The young Panamanian woman had flown in from Colombia and initially denied having any illegal drugs on her, police said.
But on closer examination, they were able to see a "white object" through her wounds.
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Friday, 14 December 2012

The Chinese delicacy of hairy crabs


Hairy crabs are the great autumn delicacy of eastern China, and an obsession for those who can afford to eat them. The female crabs ripen in the ninth lunar month, the males in the tenth, and from then until the end of the year they are almost inescapable.
A pair of crabs crouched on my plate, eyeballing each other like adversaries, their legs spiky with yellow hair.
The male was big and beefy, the colour of a mandarin, with claws bedded in dark mossy fur. The female was smaller, its shell a less flamboyant shade of orange.
Steam drifted up from both of them. I took a deep breath and prepared for the attack.
Eating hairy crabs is a wild and messy business. You must pull off the legs and claws, prise open the shells and scrape, pick, suck and crunch until you have extracted every last, delicious morsel.
The pale, silken flesh of the crab legs is delectable enough, but their shells contain the real treasures: the golden, voluptuous semen of the males and the bright orange roe of the females, sprawled lazily atop a custardy mess of meat.
Of course, for those who find eating whole crabs a hassle, restaurants offer seasonal menus of dishes made with meat that has been painstakingly excavated from the shells.
You might try the legs stir-fried with asparagus, the luscious shell-meat and roe on a dishful of quivering tofu, or a hairy crab version of Shanghai's most famous steamed dumpling, the xiao long bao.
The crabs have long inspired passion in their devotees. The 17th Century playwright Li Yu wrote that his heart lusted after them, and there was not a day in his life when he had not thought of them.
I had not intended to eat hairy crab every day during my recent stay in Shanghai, but they seemed to greet me everywhere I went.

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And although I had always considered myself to be a competent crab-picker, I found myself taking what seemed to be an advanced course in the art of crab-eating, because everyone I met offered me a new piece of advice.
My friend Jason's mother told me to leave two legs attached to each half of the body like a handle, so I could raise it to my lips and chomp out the strandy white flesh at the sides.
The uncle of another friend, Rose, taught me how to stick parts of both claws together so they looked like a butterfly.
And most intriguingly, he showed me how to turn the stomach inside out to reveal a tiny knobbly appendage that resembled the head of an ancient monk, complete with wizened face and long, straggly beard.
There was plenty of medical advice too, because eating hairy crabs is a dangerous game, as any Shanghainese can tell you.
According to Chinese medicine, their flesh is perilously cold, and must be balanced with warming foods, which is why they are always served with vinegar and ginger, and sometimes a flask of Shaoxing rice wine.
And crabs should never be eaten with "cold" persimmon, because it is thought to be a toxic combination.
Then there are the parts of the crab that must be avoided. The pillowy, finger-like lungs and plasticky pyramid of the stomach should be discarded, said another friend, Haichen.
After a couple of weeks of excessive crab-eating, despite my delight, I was becoming paranoid.And do not, whatever you do, eat the heart, she added - it is a sinister grey flap of rubbery flesh tucked away inside the body, which is even colder than the meat and should never be eaten. Smaller than a SIM card, it is easily overlooked.
Haichen had warned me that for women especially, crabs should be eaten in extreme moderation, but I could not seem to escape them.

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I was ambushed by crabs at what was supposed to be simple lunches at the homes of friends, surprised by crab dishes on every dinner table.
Even after a wine-and-food pairing event when I had been tasting crab all day long, the
piece de resistance at the judges' banquet was... crabmeat on a bed of eggwhite custard.
Despite my diligent consumption of ginger and wine, would I succumb to the symptoms of cold - stomach-ache and vomiting?
And just how soon after eating a crab was it safe to consume persimmons, which were also perfectly in season and quite irresistible?
I recalled, with a shudder, that I must have eaten a few of the flabby grey hearts before I had learned to pick them out.
For a few days I walked around in a state of unease, waiting for the crabs' revenge. But I am pleased to report that I survived the experience in robust good health.
And I cannot wait to go to Shanghai next autumn for more.
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