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Health News from NHS Choices

Constantly updated health news across a range of subjects.

NHS Choices News

  • Short bursts of intense exercise 'as good' as endurance training

    "Researchers have found that short bursts of intense exercise produce similar results to traditional longer-duration workouts," the Mail Online reports.

    Researchers compared two types of exercise programme over a 12-week period with a control. The two programmes were:

    • a 10-minute "intense" workout, three times a week (referred to as Sprint Interval Training)
    • a 50-minute moderate intensity workout, once a week

    At the end of the study, they found similar improvements in reliable fitness markers in both groups, such as the body's response to insulin, peak uptake of oxygen and the functioning of muscle cells. However, it is uncertain that the changes seen would have an effect on cardiovascular disease risk and outcomes in the long term.

    The study was also quite small (just 25 young men), and the results ideally need verifying in a larger trial, including a study of wider population groups, such as women and different age groups. The study showed no effect on the men's weight or body mass index (BMI), and did not include information about any adverse effects or risks.

    The message that your health may benefit from a 10-minute workout is welcome for anyone who struggles to find time to exercise. However, the researchers warn that very high-intensity exercise is not suitable for everyone.

    There are also questions over its safety. Famously, in 2013, the broadcaster and journalist Andrew Marr blamed high-intensity training for triggering his stroke.

    If you think you are very unfit, it is probably best to build up your fitness gradually, rather than trying to go all-out straight away.

     

    Where did the story come from?

    The study was carried out by researchers from McMaster University in Canada and was funded by the Natural Sciences and Engineering Research Council and McMaster University.

    The study was published in the peer-reviewed journal Public Library of Science (PLOS) One on an open access basis, so it is free to read online.

    The Mail Online's headline that you only need a "minute of exercise" is a bit disingenuous, as the intervals of high-intensity exercise were within a 10-minute session, which included a warm-up and warm-down, and was done three times a week. However, the full text of the story quickly makes that clear, and reports the study reasonably accurately.

     

    What kind of research was this?

    This was a randomised controlled trial (RCT), which is a good way of finding out if a treatment works. Researchers wanted to know whether very short, high-intensity exercise could improve health measures as much as moderate-intensity exercise, when compared to a group who did a "no exercise" programme.

     

    What did the research involve?

    Researchers recruited 27 men (two later dropped out) who did little exercise and whose average age was 27. They matched them for similar age, BMI and peak oxygen uptake. They were then randomly assigned to either high-intensity sprint interval training (SIT), traditional moderate-intensity continuous training (MICT), or to a control group which was not given an exercise programme.

    They carried out a number of tests on their cardiovascular and metabolic health at the start, during, then again after they finished the 12-week programme. They then compared results of the two exercise groups to the control group.

    The tests included:

    • peak oxygen uptake (VO2 peak), measured through a mask worn while cycling on an exercise bike – high oxygen uptake shows the heart and lungs are working efficiently
    • insulin sensitivity index (CS1) measured by monitoring how quickly the body clears glucose from the blood, after it's been infused into a blood vessel – poor insulin sensitivity can lead to type 2 diabetes
    • muscle mitochondrial content, measured by taking a muscle biopsy – mitchondiral content gives an indication of how efficient the muscle is at using energy

    Both exercise programmes were carried out using exercise bikes and included a two-minute warm-up and three-minute cool-down, cycling at low intensity. For the SIT programme, men cycled three 20-second bursts of "all out" effort, separated by periods of two minutes of low-intensity cycling, adding up to 10 minutes in total. For the MICT programme, they cycled for 45 minutes at approximately 70% of maximal heart rate, adding up to 50 minutes total.

     

    What were the basic results?

    Both exercise groups improved on the three tests, while the control group did not show much difference on any test.

    Maximum oxygen uptake improved by about 19% for both exercise groups. Insulin sensitivity improved by 53% for men in the SIT programme and 34% for men in the MICT programme, while the measure of mitochondrial content in muscle cells rose 48% after the SIT programme and 27% after MICT.

    None of the men showed much change in their weight or BMI, although body fat percentage decreased for men on either exercise programme.

     

    How did the researchers interpret the results?

    The researchers said their study showed that a weekly exercise programme of 30 minutes, including three minutes of intense intermittent exercise, was as effective as 150 minutes a week of moderate-intensity, continuous training on three measures of cardiovascular and metabolic health.

    "Considering that a large number of individuals do not meet the current physical activity recommendations, there is value in exploring the potential benefits of exercise strategies that involve reduced time commitment," they say. However, they warn that, "this type of exercise requires a very high level of motivation and is clearly not suited for everyone."

     

    Conclusion

    The idea that a 10-minute workout could have the same benefits as spending 45 minutes in the gym is tempting. The researchers found it may improve specific markers of health, in one group of young men.

    However, this is a small study in a specific population, and we don't know whether it would have comparable effects in older people or women. Also, we don't know the long-term effects of this type of training programme on people's health.

    Studies that look at the effects of an intervention, whether it's exercise, diet or medicine, on health measures such as insulin resistance and oxygen uptake, can only give us a short-term, partial picture. What we really want to know is whether an intervention will reduce your chances of having a heart attack or stroke, or of getting diabetes, or dying earlier. Unfortunately, that information can only come from very long-term studies, which are expensive.

    One gap in the study is assessment of safety or negative effects of this type of exercise. High-intensity exercise has been linked in the media to the risk of stroke, especially after broadcaster Andrew Marr suffered a stroke shortly after completing an intense session of exercise.

    This study doesn't report any adverse effects, nor does it address safety issues. It is probably too small and of too short a duration to be able to detect any. Ideally, some comparison of the risks of strokes or heart attacks with different types of exercise would be needed. However, this would require a large trial and with long enough duration to identify differences. 

    There's no doubt that most of us need to do more exercise than we do, and that exercise has many health benefits. If you're concerned about the safety of a new exercise programme, it's best to talk to your doctor. You might need to start slowly and build up the amount and intensity of exercise you do, especially if you already have a medical condition. 

    Government guidelines recommend that adults in the UK should do at least 150 minutes a week of moderate-intensity exercise, or 75 minutes of vigorous exercise, as well as exercise to strengthen muscles. Read more about health and fitness.

    Links To The Headlines

    Is a MINUTE of exercise all you need? Researchers find 60 seconds of hard work in the gym can be as beneficial as a 45 minute endurance session. Mail Online, April 28 2016

    Links To Science

    Gillen JA, Martin BJ, MacInnis MJ, et al. Twelve Weeks of Sprint Interval Training Improves Indices of Cardiometabolic Health Similar to Traditional Endurance Training despite a Five-Fold Lower Exercise Volume and Time Commitment. PLOS One. Published online April 26 2016



  • Yoga 'probably good for asthma symptoms and quality of life'

    "Yoga could help asthma sufferers, research finds," reports The Independent.

    A major review of existing data found there is "moderate-quality evidence" that yoga improves both symptoms and reported quality of life in people with asthma.

    Yoga is an ancient form of exercise that focuses on strength, flexibility and breathing to boost physical and mental wellbeing.

    Hong Kong-based researchers reviewed previously published data to see if yoga could improve symptoms and quality of life for people with asthma, compared with usual care or a dummy therapy.

    Data from 1,048 people who took part in 15 randomised controlled trials (RCTs) was analysed. The researchers found small improvements for quality of life and symptoms, and a reduction in asthma medication use. However, the only meaningful clinical difference was for quality of life.

    The review was well designed, but reviews are only as good as the studies they include – there was a high risk of bias in many studies.

    There is also no comparison with other forms of exercise that could be equally effective in improving quality of life for people with asthma.

    Still, one of the positives of yoga is that, provided you train with a properly qualified instructor, it is relatively risk-free and does not usually have any side effects or complications.

    Read more advice about getting started with yoga

    Where did the story come from?

    The study was carried out by researchers from the Cochrane Collaboration and was funded by the National Institute for Health Research. 

    It was published online via the Cochrane Library in the peer-reviewed Cochrane Databases of Systematic Reviews. The Cochrane Library is a non-profit organisation, so, like all their research, the review is open access and can be read for free online.

    This story has been reported relatively accurately in the UK media, with a clear message that the findings are not entirely reliable because of the inclusion of flawed studies. We also don't know whether yoga has any negative effects, if any.

    However, the Daily Mail's headline that yoga could help people with asthma "get their breath back" and reduce the risk of asthma attacks is rather misleading – this is not what this review concluded.

    There was also some inaccuracy with The Independent's story, which incorrectly stated that participants were aged between six months and 23 years old – this was actually how long people had asthma for. We're not sure how you could get a six-month-old baby to start learning yoga.  

    What kind of research was this?

    This systematic review aimed to assess the effect of yoga in people with asthma.

    A review like this combines data from individual studies to form conclusions about the current state of the evidence on the effectiveness and safety of an intervention.

    Caution should always be taken with the results, however, as a systematic review is only as reliable as the studies included in the analysis. 

    What did the research involve?

    A comprehensive search of medical databases, trial registries, and hand-searching of relevant journals and meeting abstracts was carried out to identify studies for inclusion in the review.

    The researchers decided to only include RCTs that compared yoga with usual care, no intervention, or a dummy intervention – a "sham" treatment.

    They measured the following outcomes:

    • quality of life
    • asthma symptom score
    • asthma control
    • lung function measures
    • asthma medication usage
    • adverse events

    After relevant studies were chosen, data was extracted on the characteristics of participants, interventions, methodology, and outcomes. Outcome data was combined where appropriate and analysed using statistical methods.  

    What were the basic results?

    Fifteen trials were included in the study, with a total of 1,048 participants. Participants mostly had mild to moderate asthma for a range of 6 months to more than 23 years.

    The quality of the studies included was assessed as ranging from very low to moderate.

    Analysis found some evidence that yoga may improve outcomes in people with asthma compared with usual care or a dummy intervention:

    • quality of life – mean score difference on the seven-point scale of the Asthma Quality of Life Questionnaire (AQLQ) 0.57 units (95% confidence interval [CI] 0.37 to 0.77); 0.5 units is considered clinically meaningful
    • improve symptoms – standardised mean difference 0.37, 95% CI 0.09 to 0.65; this is equivalent to a small effect
    • reduce medication usage – relative risk 5.35, 95% CI 1.29 to 22.11; the wide range of this confidence interval casts the reliability of the result into doubt

    To put these findings into context, the change in quality of life had a minimal clinically important difference, while yoga had no clinical benefit for symptoms.

    Yoga did not improve lung function during the course of the study and there were no serious side effects associated with the practice, but there was limited data on this outcome.  

    How did the researchers interpret the results?

    The researchers concluded that, "We found moderate-quality evidence that yoga probably leads to small improvements in quality of life and symptoms in people with asthma.

    "There is more uncertainty about potential adverse effects of yoga and its impact on lung function and medication usage.

    "RCTs with a large sample size and high methodological and reporting quality are needed to confirm the effects of yoga for asthma."

    Conclusion

    This well-conducted systematic review aimed to assess whether yoga could improve outcomes for people with asthma when compared with usual care or dummy therapy.

    Using statistical methods, small improvements were found for quality of life, symptoms, and a reduction in medication use.

    However, the only effect that could make a meaningful difference for someone is the small benefit seen for quality of life.

    The review itself was well designed. Efforts were made by the researchers to avoid combining studies that differed significantly in their design and methods.

    However, this study did have some limitations:

    • The studies included were of very low to moderate quality, and many were small in sample size, which has an impact on the reliability of the findings.
    • The studies varied widely in their described yoga interventions and additional drug therapy.
    • Some of the analyses included small numbers of participants and the confidence intervals were therefore wide, which reduces the reliability of the estimate.
    • Data on some outcomes, such as unwanted side effects, was limited.
    • Most of the studies included those with mild to moderate asthma, so yoga may not relieve symptoms in those that need it the most.

    This review does not produce conclusive evidence that yoga would be beneficial to people with asthma, and any negative effects were not investigated.

    The main thing it found was that yoga may improve quality of life – however, this could be the case if you take part in many types of physical activity, not just yoga. There was no comparison with other forms of exercise.

    If you have asthma, there is usually no reason why you should have a restricted life. There are several things you can do to keep asthma under control:

    • make sure to take all medicine as prescribed
    • attend regular reviews
    • understand your symptoms – know when to take your inhaler or call for emergency help
    • keep away from known triggers, such as animal fur and cigarette smoke

    Read more lifestyle advice about how to live better with asthma.

    Links To The Headlines

    Yoga could help asthma sufferers, research finds. The Independent, April 27 2016

    Can yoga really help to fight asthma? Daily Mirror, April 27 2016

    Yoga could help asthma sufferers get their breath back: Exercises found to decrease chance of attacks by relaxing muscles in the airways and anxiety that can cause them. Daily Mail, April 27 2016

    Links To Science

    Yang Z, Zhong H, Mao C, et al. Yoga for asthma. Cochrane Database of Systematic Reviews. Published online April 27 2016



  • Vitamin D, fish oil and folates may enhance antidepressants

    "Do antidepressants work better when taken with supplements?," the Mail Online asks.

    A new review of existing evidence suggests that, "Omega-3 fish oils, certain amino acids, folate and vitamin D" may boost the beneficial effect of antidepressants, the Mail says.

    There was also tentative evidence that S-Adenosyl methionine (SAMe) – a type of amino acid supplement popular in some countries – may boost the effects of antidepressants.

    Researchers from Melbourne, Australia, reviewed the evidence about combining antidepressant treatment for depression with "nutraceuticals" – nutrient-based supplements produced to pharmaceutical standards. This means that consumers can be confident about information relating to important issues such as dosage and ingredients. 

    The researchers looked at 40 studies, of varying quality, to pool the results where possible and draw conclusions. They found that omega-3 supplements (usually derived from fish oil) had a significant effect, but there were varying results for other nutraceuticals studied.

    In some cases, only one or two small studies had been published, making it hard to rely on the results. The researchers also found evidence that more positive studies than expected had been published, suggesting that some negative studies had not been published (publication bias).

    The researchers say they have shown that EPA-rich omega-3 oil "may be recommended" as an additional treatment for depression, alongside antidepressants. But they caution that people taking antidepressants should talk to their doctors before starting any supplements.  

     

    Where did the story come from?

    The study was carried out by researchers from the University of Melbourne, Swinburne University of Technology, Deakin University, the National Centre of Excellence in Youth Mental Health, and the Florey Institute for Neuroscience and Mental Health, all in Australia, and Harvard Medical School in the US. Information on funding was not provided in the study. 

    The study was published in the peer-reviewed journal The American Journal of Psychiatry. Six of the seven authors reported financial interests in the field, mainly research funding and payments for speaking and writing about pharmaceuticals and nutraceuticals.

    The Mail Online reported the results of the study uncritically, without considering the strength of the evidence for the different nutrients studied. Of the three nutrients named in its headline, the study only found strong evidence for omega-3.

     

    What kind of research was this?

    This study was a systematic review, with meta-analyses performed where there was sufficient evidence to do so. The researchers found enough studies to perform meta-analyses for just two nutrients: omega-3 and folic acid.

    Meta-analyses are a good way of pooling results of studies, giving an overall view of whether a treatment works. However, systematic reviews and meta-analyses are only as good as the individual trials that go into them.

     

    What did the research involve?

    Researchers searched for any studies in English that looked at the effects of adding one of 14 nutrients known to be involved in nerve cell function to antidepressant treatments. They divided them into groups and summarised the results. For nutrients where they had at least two randomised controlled trials (RCTs), they carried out a meta-analysis.

    They included open-label studies (where people knew which treatment they were taking) and uncontrolled studies, where they looked at the effect of adding a nutraceutical treatment to an antidepressant for people who had not responded to an antidepressant, without using a placebo for comparison. People in the studies had to have been diagnosed with a major depressive disorder or have ongoing depression.

    For most of the nutrients, they summarised the results from the different studies, stating how many showed a positive effect and how many did not. For folic acid and omega-3 oils, they carried out meta-analyses of the mean difference between treatment and placebo, in the change from start to end of the study.

     

    What were the basic results?

    The most reliable evidence came from the meta-analyses:

    Omega-3

    Eight studies, all RCTs containing 20 to 122 people, looked at the effect of omega-3. Six of the eight studies showed a statistically significant reduction in depression scores for the treatment group, compared to the placebo group. The meta-analysis showed a statistically significant effect size of 0.61 for the difference between the treatment and placebo group (p=0.0009). It is not possible to interpret how clinically important this effect size is, as there was no information about the actual depression scores in the studies.

    Folic acid

    Four RCTs looked at the effects of folic acid. Two of them showed a reduction in depression scores for people taking folic acid, but one big study showed no significant effect. The meta-analysis showed no statistically significant effect size.

    Other nutrients

    Other nutrients which the researchers said showed positive effects included:

    • an amino acid based nutrient called S-adenosylmethionine (SAMe) – three small open-label studies found a positive effect; however, the only RCT found no significant effect
    • methylfolate, a type of folate – three small trials (one open-label) found a positive effect; one larger RCT found no significant effect
    • vitamin D – one RCT and one open-label study, both fairly small, found a positive effect

    The other nutrients studied either had only one study looking at them, or mixed results. Evaluation of the meta-analyses showed big differences between the study results, and potential publication bias (where studies are published if they are positive, but not if they are negative).

     

    How did the researchers interpret the results?

    The researchers were upbeat about the results, especially for omega-3 oils, which they said could now be recommended for use as an add-on treatment alongside antidepressants, on the basis of their results.

    They conclude: "several nutraceuticals may hold a potential clinical application to enhance the antidepressant effect of medications" and that groups issuing guidelines for doctors should consider including nutraceuticals.

    However, they admit that good-quality, large RCTs are now needed.

     

    Conclusion

    Many people with depression benefit from taking antidepressants, but some either don't find them helpful, or don't completely recover while taking them. A safe and effective way to boost the effects of antidepressants would therefore be useful.

    This study is a useful summary of which nutrients have been tested as an add-on to antidepressants, and an overall indication of what the studies found. It shows that, for most of these nutrients, the evidence comes from small studies of varying quality and length, and that we need bigger, better studies to get a true picture of their effects.

    For the nutrients where there was sufficient evidence to carry out a meta-analysis, the difficulty is that the way the results are presented makes it hard to tell how much of an effect the nutrients actually had on people's depression.

    We don't know whether the difference in the effect of treatment seen with omega-3 supplements amounted to more people getting completely better from depression, or whether some people's depression scores on questionnaires improved a few points, but not enough to make much difference to their quality of life. The researchers describe the effect as "moderate to strong".

    If you are taking antidepressants and feel they are not making much difference, talk to your doctor. Antidepressants take a while to start working properly, so you may need to wait a little longer. If you've been taking them for a while and they don't help, talk to your GP about trying another type of antidepressant, or a different dose. If you are interested in taking a supplement alongside your antidepressant, talk to your doctor first.

    Finally, it's important to remember that the study was looking at "nutraceuticals" – nutrient-based supplements produced to pharmaceutical standards. If you do decide to try a supplement, make sure it is from a trusted source with a reputation for safety and high quality.

    Links To The Headlines

    Do antidepressants work better when taken with supplements? Fish oils, folate and vitamin D found to 'significantly improve mood'. Mail Online, April 26 2016

    Links To Science

    Sarris J, Murphy J, Mischoulon D, et al. Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses. The American Journal of Psychiatry. Published online April 26 2016



  • Bedbugs 'prefer certain colours'

    "Bed bugs appear to have a strong preference for particular colours," BBC News reports. A new study suggests the pests prefer red and black and "hate yellow and green".

    It's unclear whether changing the colour of your bed sheets would prevent an infestation of bedbugs, though certain colours could prove useful for traps.

    Bedbugs can be upsetting and cause a rash or itchy bumps on your skin. They don't pass on infectious diseases, but can cause an allergic reaction in some people, such as severe itching.

    They can be present in even the cleanest of homes, but are more common in crowded lodgings and places with a high turnover of occupants.

    Some tell-tale signs to look out for are blood spots on your sheets. Checking in the crevices of your mattress is a good way to spot them.

    In this study, researchers used coloured tents in a petri dish and gave the bedbugs 10 minutes to choose their dwelling. Overall, bedbugs strongly preferred red and black, but tended to avoid colours such as green and yellow.

    When they were split into sub-groups, the bedbugs' preferences varied by gender, whether they had recently been fed, and life stage.

    However, this research can't tell us that yellow or green sheets would prevent an infestation of bedbugs.

    If you do suspect bedbugs, it's recommended that you contact your local pest control firm, making sure they are a member of the British Pest Control Association, or your local council. 

     

    Where did the story come from?

    The study was carried out by researchers from Union College in Lincoln and the University of Florida.

    Funding was provided by the Florida Pest Management Association and a University of Florida Endowed Professor Fund. Florida Pest Management Association is the trade group for the state's pest control companies.

    The study was published in the peer-reviewed Journal of Medical Entomology on an open access basis, so you can read it for free online.

    While the reporting of the study by the UK media is generally accurate, some of the coverage is not representative of the facts.

    Neither the BBC's claim that bedbugs "hate yellow and green" nor the Mail Online's advice that you should "buy yellow sheets and avoid red carpets" is supported by the evidence.

    The Daily Telegraph wins the shameless clickbait award of the day for managing to shoehorn in four Fifty Shades of Grey references in its first two paragraphs.

    Some of the media sources carry some interesting speculation from a number of the study's authors.

    One of the co-authors, Dr Corraine McNeill, explained: "We originally thought the bedbugs might prefer red because blood is red and that's what they feed on."

    Dr McNeill went on to suggest that, "The main reason we think they preferred red colours is because bedbug themselves appear red, so they go to these harbourages because they want to be with other bedbugs.

    "The bugs appeared to dislike yellow and green shelters, possibly because these bright colours remind them of brightly lit areas that are less safe to hide in." 

    What kind of research was this?

    This experimental laboratory study aimed to find out if bedbugs have a preference for living in specific-coloured dwellings.

    This study is able to identify themes by observing the bedbugs' movements and examining differences by gender, life stage and nutritional status.

    However, it cannot prove why they made their choices or if they would do so outside of the laboratory environment.  

    What did the research involve?

    The researchers set up an experiment that used small tents made from different coloured card in a petri dish to test where bedbugs would prefer to dwell.

    Tests were performed to see if there were differences resulting from gender or nutritional status – starved (not fed within a week) or fed (blood one to two days before).

    In a two-colour test, the bedbugs were to choose between the following eight colour dwellings against the standard white tent:

    • lilac
    • violet
    • blue
    • green
    • yellow
    • orange
    • red
    • black

    A single bedbug was placed in the middle of the petri dish arena and was given 10 minutes, after which time the colour of the dwelling the bedbug was found under was recorded.

    The next experiment used seven coloured tents – as above, excluding yellow – in a semi-circular arrangement and the same test was performed.

    Bedbugs were tested either individually or aggregated in groups of 10 at a time. Groups were either all males, all females, or a 1:1 ratio of males and females.

    Researchers also used these seven colours to test whether female bedbugs prefer to lay their eggs in dwellings of specific colours. 

    What were the basic results?

    Researchers found the two-choice and seven-choice colour tests indicate that red (28.5%) and black (23.4%) dwellings were the prime choices for bedbugs, while yellow and green were not popular at all. The colours chosen changed according to gender, nutritional status, aggregation and life stage.

    Female bedbugs preferred lilac and violet, compared with males, who preferred red and black. When the bedbugs were fed, they appeared to be drawn to the orange and violet dwellings.

    Significantly more eggs were laid in red, blue, orange and black dwellings compared with green. Bedbugs at different stages of life also appear to show different colour preferences, which may be down to the development of their eyes.  

    How did the researchers interpret the results?

    The researchers concluded that, "This study has given further support for bedbug preferences that may indicate that a mechanism exists for colour discrimination in bedbugs.

    "Our findings should be useful in bedbug trap design as an attempt to enhance trap captures." 

    Conclusion

    This experimental laboratory study of bedbugs aimed to see whether the pests showed a colour preference for their dwellings.

    The study found, overall, bedbugs strongly preferred red and black, but tended to avoid colours such as green and yellow.

    When split into sub-groups, preferences varied by gender, whether they had recently been fed, and their life stage.

    It is not clear why the researchers did not test yellow in their seven-colour test, as it would have been interesting to see whether the two-colour findings were replicated.

    While these findings are of some interest and have been widely covered in the media, even the researchers say we shouldn't rush out to buy yellow sheets.

    The research was only conducted over a timescale of 10 minutes, so we do not know what would have happened over time – for example, whether bedbugs would be less likely to mate and produce viable eggs if they were only given a yellow environment, or conversely whether their numbers would greatly increase in a red or black environment.

    What we do know is that they need human blood to survive, prefer places that are warm, and can be carried on clothing and linen, hence why they are more common in hostels and places with a high turnover of people.

    Bedbugs are very difficult to spot and can squeeze into the smallest of spaces. They are not attracted to dirt, so are not an indication of an unclean home.

    Signs to look out for include:

    • an unexplained rash on the skin, or itchy bumps
    • black spots of their dried faeces on your mattress
    • mottled shells, which they may have shed
    • blood spots on your sheets where they may have been squashed
    • looking in the crevices of your mattress to see if you can spot them
    • in some cases of a large infestation, there could be a unpleasant, musty scent in rooms

    If you do suspect bed bugs, it's recommended that you contact your local pest control firm, making sure they are a member of the British Pest Control Association, or your local council.

    To prevent a bedbug infestation, inspect your mattress regularly for common signs and take immediate action if necessary. Avoid buying second-hand mattresses and be wary of old beds you might be using in rented accommodation.

    Keeping your bedroom tidy and removing clutter, especially from the floor and under your bed, reduces the amount of hiding places for bedbugs.

    Links To The Headlines

    Bed bugs repulsed by certain colours. BBC News, April 25 2016

    Bedbugs won't suck your blood - but you'll have to buy very specific sheets. Daily Mirror, April 26 2016

    How to get rid of bed bugs? Buy yellow sheets and avoid red carpets: Pests have favourite colours when searching for shelter. Mail Online, April 25 2016

    Why Christian Grey’s ‘red room’ is more likely to have bed bugs. The Daily Telegraph, April 25 2016

    Links To Science

    McNeill CA, Pereira RM, Koehler PG, et al. Behavioral Responses of Nymph and Adult Cimex lectularius (Hemiptera: Cimicidae) to Colored Harborages. Journal of Medical Entomology. Published online April 25 2016



  • Med diet best for heart disease (but some junk food won’t hurt)

    "People with heart disease have a lower risk of heart attack and strokes if they eat a Mediterranean-style diet," The Guardian reports.

    The study it reports on also suggests that the occasional Western-style treat probably doesn't pose much of a risk for people with heart disease.

    After recruiting more than 15,000 people with heart disease from 39 countries, researchers scored their diets for Mediterranean elements such as eating plenty of whole grains, fruits, vegetables, legumes, fish, some alcohol, and some meat. They also scored diets for Western diet elements, such as consumption of refined grains, sweets and desserts, sugared drinks, and deep-fried foods.

    After an average of 3.7 years, death, non-fatal heart attack or stroke occurred in 7.3% of people with a Mediterranean score of 15 or more – about 3% less than those scoring 14 or below (around 10%).

    Surprisingly for some, higher Western diet scores did not increase the risk of these same problems.

    The findings related to a very specific group: adults with stable coronary heart disease (CHD) who were at high risk of having a major cardiovascular event. This means the 3% reduction is not generalisable to the wider population, or even to all people with heart disease.

    Although heart disease cannot be cured, treatment and lifestyle changes can help manage the symptoms and reduce the risk of further complications.

    Some of the reporting promotes the line that "eating good food is more important than avoiding bad food".  

    Where did the story come from?

    The study was carried out by researchers from universities in the US, New Zealand, Sweden, France, Denmark and Canada, and was funded by pharmaceutical manufacturer GlaxoSmithKline.

    The authors involved in the study have financial links with various large pharmaceutical companies or are employed by them.

    The study was published in the peer-reviewed European Heart Journal on an open-access basis, so you can read the study online for free.

    The media reporting was generally accurate, with many focusing on the finding that the Western diet did not increase major risk of cardiovascular events. Only the Guardian acknowledged that the study also pointed to the benefits of the Mediterranean-style diet.

     

    What kind of research was this?

    This was a longitudinal study looking at the effect of diet on serious cardiovascular outcomes in adults with CHD.

    CHD is the leading cause of death both in the UK and worldwide. It's responsible for more than 73,000 deaths in the UK each year. About 1 in 6 men and 1 in 10 women die from CHD.

     

    What did the research involve?

    The study analysed data from adults with stable CHD and a high risk of a major cardiovascular event already recruited to a study, called the STABILITY trial. This was designed to test whether a new drug called Darapladib (not currently licensed in the UK) would prevent major cardiovascular events in this high-risk group. Some of the group were taking Darapladib, while others were taking a placebo.

    From the STABILITY trial, the researchers used self-reported lifestyle data from 15,482 people from 39 countries to score each for "Mediterranean diet" elements, like eating plenty of whole grains, fruits, vegetables, legumes, fish, alcohol and some meat. They then scored them for "Western diet" elements, such as consumption of refined grains, sweets and desserts, sugared drinks, and deep-fried foods. People were asked to recall both the type and frequency of food during "a typical week".

    They then compared the numbers of major cardiovascular events – defined as death, non-fatal heart attack or non-fatal stroke – over the next three years (median 3.7 years) in those with greater Mediterranean or Western diet scores, to see if they were protective or harmful.

    The analysis took account of many confounding factors known to affect risk of major cardiovascular events, including:

    • age
    • sex
    • treatment with Darapladib or placebo
    • smoking history
    • CHD severity
    • cardiovascular disease risk factors (diabetes, HDL-cholesterol, history of high blood pressure)
    • LDL – "bad" – cholesterol
    • body mass index (BMI)
    • self-reported physical activity
    • geographic region
    • level of education

    The Mediterranean and Western diet scores were totalled and categories defined. For example, most people (56%) scored 12 or less for Mediterranean score, a quarter scored 13 to 14 (26%) and a minority scored 15 or over (18%). Despite the differences in Mediterranean score, Western diet scores were around 12 across all three groups.

     

    What were the basic results?

    Those scoring highest for a Mediterranean-style had fewer deaths, non-fatal heart attack or non-fatal stroke over an average of 3.7 years. These events occurred in 7.3% of people with a Mediterranean score of 15 or more – about 3% less than those scoring 13 to 14 (10.5%), or less than 12 (10.8%).

    For Mediterranean diet scores less than 12, there was no link between increase in score and fewer major cardiovascular events.

    But for every point increase on the Mediterranean style diet score over 12, the risk of death, non-fatal heart attack or stroke lowered by 5% (hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.92 to 0.99).

    There was no corresponding link between higher Western diet scores and deaths, non-fatal heart attack or strokes over the same period, which was not what the researchers had expected.

     

    How did the researchers interpret the results?

    The researchers' conclusion was refreshingly simple: "Greater consumption of healthy foods may be more important for secondary prevention of coronary artery disease than avoidance of less healthy foods typical of Western diets."

    They also point out the diet is not specific to Mediterranean countries, and is similar to the diet already recommended to people to stop high blood pressure, and is recommended in broader national dietary guidelines.

     

    Conclusion

    This study showed 3% fewer people with CHD, at high risk of major cardiovascular events, who reported eating the healthiest Mediterranean-style diets, had either died, or had a non-fatal heart attack or stroke over a three-year period than those with less healthy diets. Western diet scores were not related to major cardiovascular events.

    The study was large, worldwide and its methods quite robust, all boosting the believability of the findings.

    It is possible that unmeasured factors explain all or part of the findings, but the study made a concerted attempt to minimise the chance of this through adjusting for important confounders in their analysis.

    Only around 18% of the 15,000 or so studied fell into the Mediterranean-style diet group that showed health benefits; the same link wasn't found in lower-scoring groups. This suggests that most of those studied could potentially benefit from a healthier diet.

    It is important to realise that the findings relate to a very specific group: adults with stable CHD who were at high risk of having a major cardiovascular event. The group was even more uncommon than this, as some were also taking an experimental drug called Darapladib as part of a separate study; this reportedly had little impact on the diet-related findings. Therefore, the 3% reduction figure does not apply to the general population, or even to all people with CHD.

    That is not to say that a healthy diet won't benefit the wider population – it probably will, but this study didn't look at this or provide a figure of the magnitude of benefit.

    What is more applicable to the masses is the clear implication of the study. That a diet high in whole grains, fruits, vegetables, legumes, fish, some alcohol, and lower in meat, has health benefits. This is nothing new and is already incorporated into most healthy lifestyle recommendations and diet advice for people looking to lower their risk of high blood pressure. What the study does add is a quantification of the benefit of a good diet in a specific high-risk group.

    Interestingly, higher scores for a Mediterranean diet were more common in the Asia/Pacific and Northern Europe regions than Mediterranean countries themselves. It seems people living in, for example, Japan or Norway are more likely to follow a traditional Mediterranean diet than people living in the Mediterranean.

    The finding that a higher Western diet score – usually associated with worse heart health – was not linked to major cardiovascular events was more surprising. These new data suggest, as the study authors put it: "Greater consumption of healthy foods may be more important for secondary prevention of coronary artery disease than avoidance of less healthy foods typical of Western diets."

    That shouldn't be taken as a green light to start chugging down the cheeseburgers, especially if you have a history of heart disease. The saying, "the absence of evidence is not the same as evidence of absence" may be clichéd, but like most clichés, it contains an element of truth.

    It could be the case that a larger study with a more generalised population could find a link between Western-style diet and increased risk of serious cardiovascular events.

    Links To The Headlines

    Mediterranean-style diet reduces stroke risk in heart patients – study. The Guardian, April 25 2016

    Heart disease patients 'no more likely to suffer a heart attack or stroke if they eat a fatty Western diet after being diagnosed'. Mail Online, April 25 2016

    Junk food not harmful to heart when eaten with Mediterranean diet, study finds. The Daily Telegraph, April 25 2016

    Links To Science

    Stewart RHA, Wallentin L, Benatar J, et al. Dietary patterns and the risk of major adverse cardiovascular events in a global study of high-risk patients with stable coronary heart disease. European Heart Disease. Published online April 24 2016