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| HEALTH & FITNESS |
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Fruit & veg: How much is enough?
Sleep your way to health
Bipolar illness
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Fruit & veg: How much is enough? That’s a big percentage: more than a fifth increase in your chances from eating just a few extra portions each day. The lead author, Dr Francesca Crowe, of Oxford University agrees: “This study shows a 4 per cent reduced risk of dying from IHD for each additional portion of fruit and vegetables consumed.” It might be news to us, but the fact that five a day doesn’t cut it is old news for most health bodies. The World Cancer Research Fund has long recommended 5-10 portions. A recent survey for the UK’s Institute of Optimum Nutrition showed that the healthiest people ate eight portions. What’s more, outside of unhealthy Britain the government bar is set way higher. In Denmark it’s six a day, in Australia seven, in Spain eight, in Greece nine, in Canada “up to 10” and in Japan, a dizzying 17. Tim Lang, professor of food policy at City University, London, is unsurprised by these latest findings. “I’ve been giving speeches saying nine a day for a long time. The drift of scientific evidence is ever upwards.” If you’re disgruntled by the shifting goalposts, that’s nothing compared to the reaction of maverick nutritionist and obesity writer Zöe Harcombe. “If the idiot powers-that-be try to get people to eat eight a day instead of the already fattening and unjustifiable five a day it will make the obesity epidemic worse,” Harcombe seethes. But fattening? Five a day’s supposed to be healthy, surely? “People are majoring on fruit because it’s sweeter and the fructose [fruit sugar] is simply converted into fat.” A simple internet search confirms substantial support for this contention. Harcombe goes on: “We shouldn’t make the usual bad science leap from association to causation and say: ‘more portions of fruit and veg means less risk of dying from heart disease.’ Does being in the bath cause singing?” Going even further by referring to that original Californian scheme, Harcombe claims the whole five-a-day campaign is a con. “There just isn’t any benefit from eating fruit and vegetables,” she claims, though by now she may have lost most people. So Harcombe sees this latest survey as casting around for benefit after last year’s report on the same EPIC study suggested a weaker connection between fruit and veg and cancer than previously claimed. Despite a lot of negative headlines, the World Cancer Research Fund defends five a day. Dr Rachel Thompson said: “In men 2.6 per cent and in women 2.3 per cent of cancers could be prevented if people ate another two portions of fruit and vegetables a day.” In the UK alone that could still save 7,000 lives a year. All the nutritionists and experts you talk to are, inevitably, convincing, making it almost impossible not to change your view with each new bit of advice. It leaves you wanting to leave them to fight it out and let the victor present us with a single, coherent message. Last year’s Health Food Manufacturer’s survey revealed that 50 per cent of people were confused about the Government’s nutrition advice. So what does the Government have to say? “We are providing clear advice on why and how people can change their lifestyles, so people can make informed, healthier choices,” says a UK Department of Health spokesman. “However, ultimately individuals have to take responsibility for their own diet.” Victoria Taylor, senior dietician at the British Heart Foundation (who part-funded the EPIC research) is more sympathetic. “We get criticised a lot for changing our advice. Five a day is a really positive message – one that’s consistent and that people understand. Let’s keep working towards that before moving the goalposts further.”
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Sleep your way to health The World Sleep Day is held every year on March 18 to raise awareness about the merits of sleeping well for a healthy life. The theme for this year (2011) is promoting healthy sleep for all ages. Sleep is a basic human need—a crucial component of healthy living, much like breathing, eating and remaining physically fit. Unfortunately, in today’s world it is often compromised by the habits of a whirlwind lifestyle. Very often our waking hours tread with impunity upon the territory of our dreams. Sleep disorders constitute a global epidemic, affecting up to 45% of the world’s population. Insomnia, obstructive sleep apnea (OSA), restless legs syndrome (RLS), and sleep deprivation significantly impact physical, mental and emotional health, in addition to affecting work performance and personal relationships. Sleep problems are not limited to adults. Poor sleep also affects about 25 per cent of the world’s children. Lack of quality sleep can lead to accidental injuries, hyper/hypo-activity, obesity, emotional problems (irritability, aggressiveness), impaired memory and/or decreased attention span. Sleep disorders also make it more difficult to control diabetes, hypertension and coronary heart disease. Insomnia, the most common sleep disorder is highly co-morbid with psychiatric disorders, and may lead to anxiety, depression and even suicide. It has been demonstrated in various studies that it is associated with a high risk of hypertension and Type 2 Diabetes. Short sleep duration also impacts mortality. A study published in the journal Sleep found an elevated risk of death in men with a complaint of chronic insomnia and objectively measured short sleep duration. Compared to men without insomnia who slept for six hours or more, men with chronic insomnia who slept for less than six hours were four times more likely to die during the 14-year follow-up period. The results suggest that public health policy should emphasise the diagnosis and appropriate treatment of chronic insomnia. Obstructive sleep apnea is another sleep malaise which refers to snoring and choking in sleep. This happens due to the collapse of air passages during sleep, resulting in reduced oxygen and various cardiac rhythm abnormalities. Recent studies have demonstrated increased risk of sudden death in patients with untreated OSA — especially from midnight to 6 am. During this period sudden death from cardiac causes occurred in 46 per cent of people with obstructive sleep apnoea, as compared with 21 percent of people without it. OSA is also associated with increased risk of hypertension, diabetes, coronary artery disease, stroke, metabolic syndrome etc. Children with sleep disordered breathing (SDB), if not diagnosed and treated early, may develop complications which will impact their future. SDB may result in behavioural changes such as irritability and aggression, changes in intelligence, memory, attention/ concentration, with a decrease in scholastic performance. Early treatment may reverse the deficits. Thus it is imperative that children with SDB should be diagnosed and treated early to avoid permanent damage. In a recent interview Dr Manvir Bhatia, Senior Consultant, Neurologist and Sleep Specialist at Medanta, Medicity Hospital, cautioned against students burning the proverbial midnight oil, depriving themselves of sleep, especially during examinations. The writer is the Director
of CNS Diabetes Media Initiative.
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Bipolar illness Meeting him on his narrowboat, moored on London’s Regents Canal, it is easy to understand their surprise. Cousins is a sprightly 55-year-old who lives between Cambridgeshire and San Diego. He chose to do business on America’s west coast simply, he says, because he imagined it would be a nice place to spend time. He’s carrying coffees for everyone and in his bag are a brand new iPad and a copy of a The New York Times magazine, which featured him in an article about how geeky internet pioneers are using the web to record the minutiae of their daily lives. In Cousins’ case, he has harnessed a piece of cyberspace to record and manage his mental illness. During the many years he had been hiding his illness from friends and family, Cousins became a successful businessman and entrepreneur. He started his career as an advertising creative and went on to open his own agency in his late twenties. At 40 he sold the business, which was turning over Ł12m, to travel the world, and returned to the UK to work on a series of internet start-ups. Unexpectedly, his full time job is now with Moodscope, the online tool he’s created to help other people with mental illness. The site is showing remarkable results. Behind his outward success, Cousins had always experienced severe bouts of depression interspersed with spurts of creative highs, when he would work through the night and act on new ideas – the “manic” part of living life as a manic depressive, as bipolar disorder was formerly, and still is commonly, known. In February, 2008, he met a psychiatrist who said she suspected he suffered from cyclothymia, a mild form of bipolar disorder, considered to be on the “bipolar spectrum”. Stephen Fry is a famous sufferer, and two of Cousins’ friends, independently, had said to him they thought he might have it too, after they had seen Fry’s BBC programme, The Secret Life of the Manic Depressive. The psychiatrist asked him to go away and record his moods before his next appointment. Not sure of how best to do this, Cousins turned to Google and came across a test called Panas – the Positive and Negative Affect Schedule. “There were all sorts of tests online for depression, but I wanted something that would tell me not just if I was feeling depressed, but also if I was happy, and how happy.” Ever the ad creative, he adapted the test into a set of playing cards. Each one of 20 represents a different mood and is graded from one to four, so Cousins could give himself a four one day for “alert”, but a zero for the cards marked “proud” and “excited”. He plotted his progression on a graph. In May he met another psychiatrist, who confirmed the cyclothymia diagnosis from the mood charts. This was a blow, even though it meant Cousins was no longer in limbo. But the psychiatrist was baffled and amazed by the way Cousins had recorded his moods. “That was when I first started thinking of Moodscope,” says Cousins. Moodscope began to develop when it was put online. Cousins asked his friends to monitor his own progress and join in if they wished. Four years later, it works as an online community for people suffering from mental health problems and has more than 16,700 devotees. Every day, users can take the same test Cousins did (and still does) himself. Their mood is given a percentage for the day where a zero means someone is at rock bottom. Each result is then plotted on a graph that, with time, allows users to look back over their high periods and low ones – or however their depression manifests itself – with much greater accuracy than a few notes in a diary would permit. What is bipolar illness? Bipolar disorder, also known as manic-depressive illness, causes unusual shifts in mood. It involves periods of elevated mood, alternating abruptly with periods of depression. Bipolar disorder affects men and women equally. It usually first appears between the ages of 15 and 25. The exact cause is unknown, but genetic factors appear to be involved.
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In last January’s European Heart Journal a study from the massive and still continuing European Prospective Investigation into Cancer and Nutrition (EPIC) found that people consuming eight portions of fruit and vegetables a day had a 22 per cent lower risk of dying from ischaemic heart disease (IHD) than those consuming three portions or fewer. 
When Jon Cousins confessed to his two closest childhood friends that he suffered from bipolar disorder, they were stunned. They had known him for four decades or so, but he had hidden his illness so diligently that no one close to him suspected he was anything but contented.