Saturday, 31 August 2013

Complacency sets in

So… Back from holidays, and, despite 14 consecutive days of eating, drinking and paying no heed whatsoever to the 5:2 regime, I seem to have remained exactly the same weight. But for how long?
Last Monday (August bank holiday) it was back to the miso broth for supper and – to the chagrin of our neighbours – we boldly said no to a glass of wine and cake in the afternoon, and they, too, had to drink plain old tea…
But Thursday was an early birthday celebration for our daughter Coco, who turned 25 yesterday – so we swapped our “starving” days around and went to her choice of restaurant, Byron; there ploughing through cheese melted nachos, potato skins, and deep fried calamares. We majored on cheese burgers, fries, courgette fritters and - oh yes -  let’s not forget the onion rings, followed by desserts to share (Eton mess and rocky road…). I am someone who would normally pick the skinny burger – the one without the bun and chips that comes with a healthy side salad. What has come over me? I say it’s complacency. Utter complacency that, after a holiday where I ate steak and chips with creamy pepper sauce, even creamier frogs legs gratin, and a sumptuous quail stuffed with cepes and foie gras, I had remained the same weight.
The Byron meal is not something I would normally choose – and, having chomped my way through it, I am now more convinced than ever that there is something addictive about burgers, fries and all the other trimmings. For I now find myself thinking about going back – and I have already worked out that next time the courgette fries will be better with a healthy squirt of mayo on them…
Bella and I passed the Charing Cross Road Byron today, and the smell had a Pavlovian effect on me. I almost heard myself say: “well we could go there” – planning that I’d try the salmon this time, with frites.
We ended up in Pret – despite Bella just having told me that to the best of her knowledge it’s owned by McDonalds, and me responding that this would not surprise me at all. Bella already knew exactly what she wanted – the tuna baguette “which has chives in the mayo”.
I wasn’t even hungry – although I knew I soon would be. I eyed the Sushi, but could hear Steve’s voice in my head saying, “I’d never eat Sushi that wasn’t 100% fresh and made in the last few minutes”. I looked at the salads – Bella, telling me the chicken one was great.
I despaired of the sandwich selection – the choice seems to have shrunk over recent years. Didn’t they used to do a prawn marie rose, and a mozza with tomato?? Or am I imagining things? The most appetising was a child’s ham sandwich – but – complacent after yesterday’s fast – my hand reached out for the Classic Super Club. All 505 calories of it. Though I am appeased to discover it’s just 505, not 750 as I had imagined as I plunged into all that mayo, and the rather nasty mystery flavour that I take to be the unique "Pret seasoning" as I swear it was the same reason I went off their crayfish sandwich.
I now learn that there is a slimline version of the Super Club – I didn’t see it today, but, on my way home, I decided this was the last time I have a Pret sandwich. And, next time in Byron, it has to be the skinny or the salmon… The 5.2 is no excuse to go mad five days a week.

Friday, 2 August 2013

How not to feel hungry

Three months in to the 5:2, and how are we doing?
Not too badly, I’d like to think. We haven’t strayed from the regime, or (knowingly) cheated – tempting though it may be, I don’t see the point in sneaking a secret bar of chocolate on a fast day. I would only be cheating myself out of the chance of a trimmer body.
It has to be said, though, that the slimmer body I think I have already gained may be nothing more than emperor’s new clothes… I didn’t weigh myself at the start of this diet, and, when I did get on the scales a couple of weeks ago, I was exactly the same weight I’d been when I’d last weighed myself (2-3 years ago?) and had decided never to do it again until I was truly happy with the way I felt and looked. Well, that time had come, so, in theory I should just accept that weight and be contented with it.
And I am conscious I may be sabotaging my efforts on the non fast days. Last week I ate out at Gilbert Scott’s – three courses plus canapés, champagne and wine… Very nice crab salad, dover sole, and trifle – but a bit bland compared to the sensational skate my husband pan fried this week and served with sauté potatoes, tomato concasse, capers and samphire – the huge rustic portion awash with delicious foaming butter…. You see where I’m coming from? If nothing else the two fast days are essential respite from my usual greedy appetite.
But what everyone wants to know is how to survive a fast day without getting too hungry.
Here are some tips I’ve scrounged from a great Dr Oz posting:
. Glucomannan – it’s a actually our friend Konjac (he of the skinny pasta) again. But Dr Oz recommends it in supplement form, three times a day before meals, to bulk out the stomach and keep hunger at bay. I plan to try it!
. Grapeseed oil – now maybe this is what we should all be drizzling on our salads instead of olive oil. Grapeseed is high in linoleic acid, which slows gastric emptying so you feel full for longer. Dr Oz recommends 2 tsps 2 hours before lunch. However I have a feeling its calorie content eat into the 500 allowance… Dilemma!
. 5-HTP – this is a serotonin boosting amino acid, used to treat mood disorders and depression, but according to Dr Oz serotonin also curbs hunger. He recommends 200mg three times a day.
. Pine nuts – I like the sound of this! – Steve makes a mean mini pine nut tart which he serves as a petit four at dinner parties. But who knew that these sweet tiny nuts contain a fat that stimulates hormones to tell the stomach it’s full. Dr Oz recommends a handful everyday to keep hunger under control. Now that's something I am very ready to try.

* Picture from

Thursday, 1 August 2013

Is this why your blood pressure drugs aren’t working?

Most days a parcel will arrive at my house containing products a PR company would like me to try, love and write about. The selection can be quite random: I receive supplements for toddlers, pregnant women, and the elderly – none of which I can use. But with yesterday’s post came a very pleasant surprise – a blood pressure monitor and a new supplement, ProKardia, said to help circulation and lower blood pressure… I must try it. I do not meet the official guidelines for high blood pressure (140/90) – but I am not far off (at 140/84 last time I was tested), and experts now say the systolic (top) figure is the one to worry about most.
Will I take drugs if I ever have to? Almost certainly – blood pressure is a major risk for stroke.
But, for some people, the drugs don’t work – and this week in the Daily Mail    I wrote about one of the lesser known reasons for this: a condition called Conn’s Disease…
High blood pressure is usually symptomless and, like most people, Susan Thornton only discovered by chance that hers was above the desirable level of 120/80 during a routine check up with her GP.
‘The doctor didn’t tell me what the reading was, just that it was above average and, though I didn’t need to take a drug, he suggested I tried losing a bit of weight and taking more exercise to bring it down.’
This was three years ago, and Susan, then 45, took her GP’s advice on board. ‘I had a pool erected in the garden, and started swimming,’ she says. ‘I felt great - until, one afternoon, halfway through a fifteen minute drive from home to collect my then partner from work, I suddenly felt extremely ill and had to pull over.
‘I had mild chest pains and feared something was happening to my heart, but the overriding sensation was that I was passing out and was going to die.’
Susan ended up being blue-lighted by ambulance to Peterborough District Hospital where staff were waiting to treat her. Her blood pressure, which had read 200/104 en route to A&E had gone off the digital scale by the time she arrived. And, although blood tests and an ECG found nothing wrong and indeed Susan’s blood pressure had returned to a more normal level by the next day when she was discharged, this turned out to be no one-off event.
‘I was put on the ACE inhibitor Ramipril to keep my blood pressure more stable after the incident, but had a total of eight similar ambulance admissions to hospital over the next eighteen months – each time with my blood pressure measuring 170/90, way higher than it should be for someone taking drugs to control it.’
10 million adults in the UK have high blood pressure (hypertension), with one in five finding, like Susan, that the usual drugs are of little help. This “resistant hypertension” is frustrating for them – and also for their GPs, struggling to cope with the problem.
High blood pressure is the leading cause of stroke, with the risk doubling with every 20 point (or mm) rise in systolic blood pressure (the top measurement) over 115.
But, for at least 10 per cent of these resistant cases (around 200,000 in the UK), there is likely to be a treatable cause that is too often overlooked: a condition called hyperaldosteronism – meaning that the adrenal glands are producing too much of the hormone aldosterone.
High levels of this hormone cause the body to retain salt, notoriously linked to high blood pressure, explains Professor Morris Brown of Addenbrookes Hospital, Cambridge. ‘Instead of getting rid of salt, the body hangs onto it in exchange for potassium – the very mineral needed to balance and normalise blood pressure – which is pushed out of the body, so exacerbating the problem.
‘The condition can be caused by benign tumours or nodules, known as Conn’s adenomas, on one or both adrenal glands – these are the glands responsible for producing our fight or flight stress hormones (eg cortisol and adrenalin as well as aldosterone) and sit just above our kidneys,’ says Professor Brown.
‘Most doctors have been trained up to believe that hyperaldosteronism affects just one per cent of people with hypertension, and, because it is considered extremely rare, it is often not looked for and only discovered by chance during a scan looking for something completely different.’
This is exactly what happened to Susan - after she was referred for an angiogram by a consultant who suspected the regular collapses were due to a problem with her heart. ‘It turned out that my heart was fine – but the angiogram caused some bleeding under my skin, and what looked suspiciously like an aneurysm, which had to be checked out with a CT scan,’ Susan says.
‘And it was this scan that showed up the 17mm lump on my left adrenal gland, and the diagnosis of Conn’s syndrome by my physician Dr Mark Gurnell at Addenbrookes Hospital.’
Susan had the adrenal gland removed by keyhole surgery in February 2012, and has had textbook blood pressure of 120/80, or lower, ever since.
‘I haven’t taken a single Ramipril, or any other blood pressure drug, since the operation and I am so relieved to be free of their side effects: they made me generally lethargic and unwell, and so low that I could barely function.
‘Once I’d come off the drugs, I felt like I’d come back from a very long journey and found myself again.’
At least ten per cent of cases of resistant hypertension are caused by Conn’s tumours like Susan’s, according to Professor Brown, but often the tumour is much smaller than hers, and easily missed on a routine CT scan. ‘A further 10-15% may still have Conn’s disease, but with microscopic nodules in both adrenals that currently make surgery inappropriate.’
Because the special scans to locate Conn’s nodules are expensive, and would rarely turn up trumps if used in all hypertensive patients, Professor Brown recommends the scans only in patients who have been diagnosed with Conn’s and are likely to benefit from surgery. Young patients (aged under 45) with consistently high blood pressure after 24 hour monitoring (a systolic of 140-160, or a diastolic over 100) should have a £15 blood test to check levels of the kidney hormone renin which are almost always suppressed in this condition, and are a good indicator of it.
‘If renin is low, then a further blood test costing about £25 can check aldosterone levels, and then scans can look for tumours.’
For those who have high aldosterone without tumours (and also those with tumours who don’t want surgery, or those with tumours on both glands, who therefore cannot benefit from surgery) there is another option: a drug – spironolactone, which is cheap but has side effects (such as breast tissue) in men, or eplerenone, costing £40-80 a month - to block the aldosterone.
Charles Payne, 63, had been taking high doses of six different blood pressure drugs daily for nearly ten years – yet even on this regime his blood pressured remained exceptionally high, hovering around 180/120.
‘My father and grandfather had both died young from heart attacks – at 62 and 71 respectively – and I was worried that would be my fate too. When I realised a stroke was even more likely that terrified me far more,’ Charles says.
‘My GP had been trying everything she could to lower my blood pressure but eventually offered a referral to a cardiologist. By luck, the one with the first appointment was at Addenbrookes, where I was invited to join a British Heart Foundation funded trial for patients with resistant hypertension, under Professor Brown who early on told me he suspected my hypertension was hormonal.’
With no detectable tumours, Charles did not qualify for surgery, but a combination of the drugs eplerenone and amiloride (a potassium sparing diuretic) now keeps his blood pressure at a steady 135/90.
Professor Brown says: ‘Stroke causes 42,000 deaths in the UK every year, but, with systolic blood pressure over 170-180, the risk overtakes that of heart attack – which kills 103,000 people annually.
‘We owe it to patients to make sure that their unexplained hypertension is investigated. This is why I am so keen for a blood test for renin to become routine in all younger patients, who might be prevented by surgery from developing resistant hypertension like Charles, or from needing any drug treatment at all.
‘Once resistant hypertension has developed, the chances of this being due to hyperaldosteronism are so high that, once again, renin should be measured, if only to make sure the patient receives the correct drugs which are not usually used in hypertension. Even in resistant hypertensives in whom hyperaldocteronism or Conn’s disease is not diagnosed, the rennin measurement will enable doctors to prescribe the most appropriate drug to successfully lower their blood pressure.
‘Not only is high blood pressure a major health risk, but the low levels of potassium hyperaldosteronism causes can be very fatiguing – our muscles need this mineral to perform at their peak. As soon as we redress this balance – with surgery or aldosterone blocking drugs – potassium levels return to normal, and patients often feel so much more energetic.
‘One patient even said her husband found her so energetic after surgery that he wished she could go back to how she had been before her Conn’s tumour was found and removed!’