Thursday, 24 May 2012

Quacks, alternative medicine and open minds!!

I’ve just been reading the comments on the article by Edward Ernest in the Guardian ‘Alternative medicines can't escape the long arm of the law’ and I am once again dismayed (though not surprised) at the vitriol displayed by the promoters of alternative medicine and the sceptics who are quick to dismiss complementary theories as ‘quackary’

The term alternative or complementary medicine covers a wide range of practices and products claiming to support/heal/treat illnesses and symptoms and which are not considered part of conventional medicine.  Osteopathy, chiropractise, massage, yoga, hypnotherapy, chinese medicine and vitamin supplements all come under the mantal of complementary therapies.

Sceptics are quick to dismiss these therapies on the grounds that:
  1. There is no scientific ‘evidence base’ behind these practices - ie it is difficult/impossible to demonstrate scientifically how these therapies work and that their efficacy is therefore questionable.

  2. Many of the therapies are unregulated (oesteopathy and chiropractic are self-regulated) and the titles are not protected.  For example anyone can call themselves a naturopath or a nutritional therapist.  Therapists do not necessarily have to follow the strict codes of professional conduct and standards which conventional medical practitioners have to follow.
  3. Lack of regulation puts the public at risk of  a)  inexperienced/unqualified practitioners giving ineffective/possibly dangerous treatments/advice b) being 'conned' into paying for these ineffective/possibly dangerous treatments/products c) seeking an alternative practitioner when they should really be seeing a doctor for an urgent medical issue.
The 'quacks' are quick to argue back that:
  1. Just because we can’t scientifically explain how something works, does not necessary mean that it does not work. 

  2. Big Pharma (the pharmaceutical companies) are out to make a fortune from selling medications to us that we either don’t really need/could actually harm us and making us all into pill popping dependent, unhealthy zombies!
    (The Mediator case is often cited.  It is currently ongoing here in France. Mediator was a diabetes drug which was banned last year due to links to heart valve damage.)
  3. That based on 'clinical practice' many of the alternative therapies can be effective and that these therapies provide support and comfort to many patients. 
Many alternative practitioners are keen to push for regulation.  In the UK there is the ‘Complementary and Natural Healthcare Council’ which was established to regulate a range of alternative therapies.  Practitioners have to demonstrate professional standards and qualifications and the key aim is to  protect the public from ‘quacks’.  The sceptics though argue that regulating ‘alternative rubbish’ just makes it ‘regulated alternative rubbish’ and so the heated debate continues.........

The people who are drawn to alternative therapies are often the ones who have found that conventional medicine does not necessarily have all the answers, such as chronic fatigue, back problems, autoimmune diseases, depression and infertility.  Alternative therapies usually take a holistic approach and often involve long consultations focused on getting to know the patient and their medical history (in contrast to time pressed medical GPs).  It could be argued that an hour of talking about oneself to a nice smiley therapist in a calm, relaxed environment over a herbal tea would would be beneficial for almost everyone!   More importantly, many therapies possibly play a role in helping people to have a sense of control over difficult and sometimes heart breaking situations as well as providing an additional source of support.

Conventional medicine is fantastic at addressing so many causes and symptoms.  If I have a broken arm, I need to get to a surgeon rather than have my auras read.  If I’ve got a raging bacterial infection, I need a doctor to prescribe antibiotics rather than relying on mega doses of vitamin C.  Feeling blue, tired, weak or in pain, then possibly (and ideally after having been checked out by your doctor) you might be drawn to alternative therapies to see if they can help you feel better.

Sceptics argue that the placebo effect is the only possible explanation of why alternative theories work - ie, because you believe it’s going to make you better it does!  Is this anything wrong with this?  Well yes and no.  If you think it’s going to work and it means that you don’t need to resort to drugs or pills then this might be a good thing.  But, if it also means that you pay a small fortune for your alternative treatment and that it stops you seeking appropriate conventional medical advice when you need it, this is not ideal. 

As an aside, it’s interesting that in France there are many General Practitioners who also practise homeopathy which I do feel is an absolute contradiction in terms.  There is absolutely no evidence base to support homeopathy and of the small trials that have been performed, the results indicate that it is absolutely no more effective than placebo.  So why oh why are some medical doctors promoting it and why are so many pharmacies selling expensive homeopathic products?!  

My personal opinion is that some alternative therapies can be both helpful and useful alongside conventional medicine.  To complement it, rather than replace it. Conventional medicine for the body and complementary therapies for the mind, or something like that! Some therapies however are an absolute load of rubbish (sorry!) and no, I’m not going to list them because I’ve probably already upset enough homeopaths!  I would caution anyone to be careful when selecting alternative practitioners.  Do ask them about their training, qualification, possible side effects (just because it’s ‘natural’ does not mean that it is always ‘safe’) and be highly sceptical of anyone who promises to cure or treat you or tries to sell you expensive products.

The two quotes which are always used by both sides of this debate are:
‘To work, your mind needs to be open like a parachute’ in contrast to ‘Your mind should not be so open that your brains fall out’.  The answer as always lies somewhere in the middle.  In a world which can be cruel, unpredictable and changeable, complementary theories or indeed anything which you feel might comfort, support or make you feel better is always worth exploring alongside of conventional medicine care.

Guardian article link: 

On a lighter note, a nifty recipe which I’ve taken straight from the BBC Good Food Magazine.  It’s a kind of vegetarian goulash - healthy, low in fat and bursting with goodness.  It was perfect at the start of this week when it was rainy and cold.  I served it with cooked spinach and a cucumber and radish raita (chopped red onion, lime juice, chopped radish, chopped cucumber, fresh coriander and black onion seeds).

Squash, Lentil and Bean Goulash
500g peeled and chopped butternut squash
1 sliced onion
1 Tbs olive oil
2 tsp ground cumin
1/2 tsp chilli flakes ( I used 1 tsp as I like my food spicy)
400g can of chopped tomatoes
2 tsp brown sugar
2 tsp vinegar
400g can rinsed and drained kidney beans
fresh parsley
Fry squash and onion in oil for 5-10 minutes until softened.  Stir in cumin and chilli and cook for a further minute.  Add tomatoes plus 400 ml of water, lentils, sugar and vinegar.  (I also added a vegetable stock cube!).  Bring to simmer and cook for 20 minutes.  Add kidney beans and cook for a further 10 minutes.  Season and add fresh chopped parsley. Enjoy! 

Tuesday, 15 May 2012

Are the french too obsessed with weight? !

The results of a large study by L'Inserm (Institute national de la santé et de la recherche medicale) looking into the relationship between nutrition, health and diet found that nearly 7 out of 10 women and 1 in 2 men (!) in France wanted to lose weight, even if their BMI was in the normal reference range (19-25).

The study found that some women begin dieting from 10 years of age and that 30% of woman have already tried 5 different diets. A further 9% will have tried at least 10 diets.

On closer analysis of the different diets which were tried, such as high protein and calorie restriction, the research found (and no surprises here!) that the best long term results were achieved by following a varied and balanced diet, watching the portion sizes and avoiding snacks.

The study highlighted that the risk of excessive dieting includes nutrition deficiencies, distorted body image and eating disorders.

France has one of the lowest obesity rates in Europe, along with the Italians and the Swiss.  It is also the first European country to notice its childhood obesity rates levelling off, which is linked to a fantastic initiative dating from 2004 where, amongst other changes, soft drinks and snack machines were removed from over 50% of colleges and lycees.

These initiatives are good ones and it is so important from a public health perspective to provide an environment that encourages people to make healthy food choices and be as physically active as possible.

Yet, as always there is a balance and as an expat living in the ile de france region, I do feel that the French (in general) are overly obsessed with weight.  People here can be very judgemental, direct and quick to pass critical comments on other people’s weight and I have spent some time wondering why!  Is it because being overweight is seen as a loss of control (mon dieu!) or because it is seen as a sign that France is becoming ‘anglicised’ and closer to the relaxed, corrupt English/American style of living (double mon dieu!).

My lovely elderly neighbour was very quick to tell an acquaintance of mine that her teenage daughter was being a bit ‘grosse’.  My equally lovely mother-in-law weighs herself every day without fail and monitors very gram gained or lost with eagle like precision.

Here’s an example:

You go out for a girly night with anglo saxon friends and mention over dinner that you are worried you might have gained a few kilos recently.  These friends will usually rush to tell you that you look lovely/don’t appear to have gained any weight/encourage you to have another glass or wine or dessert.

The same scenario with your french girl friends?  As soon as you mention you might have gained some weight, they will look you up and down checking for wobbly thighs and jelly bellies.  They will then either tell you that you don’t need to worry or that yes, you’ve gained some weight, are getting a bit fat and should stop drinking so much wine and skip the dessert.

The social pressure is on!  It’s also incredibly difficult to find sizes above a 42 (size 14) in most of the clothes shops and asking one of the immaculately dressed, super slender assistants for a larger size is terrifying experience......

With this additional social pressure, does France possibly have a higher percentage of eating disorders?? Statistics show that France has an estimated 1-3% of young women estimated to be anorexic, 5% bulimic and 11% with compulsive eating disorders.  This is not necessarily higher than other countries, but does support the theory that French women may not necessarily have the balanced attitude to food that we might think they have.

There are at least 5 ‘lollipop’ ladies in my village - emaciated, way too skinny and a huge head sitting on a stick like frame, who make me shudder whenever I pass them.  I wonder a) if they really understand just how much damage they are doing to themselves and b) the potential damage they might be doing to their children.  The statistics show that children are more at risk of developing eating disorders if their parents themselves are over preoccupied with their own weight and appearance.

Ultimately (and unfortunately) we are all judged to some extent on our appearance and in France there is a lot of social pressure to be ‘slim’. However, what is more important is developing a healthy attitude to food and nutrition.  Yes, it is unhealthy to  be too overweight, but it is equally unhealthy to be whippet thin and weight obsessed.  Harsh criticism and unkind words are more likely to make the sobbing recipient reach for a comforting slice of ‘tarte aux pommes’! Honesty tempered with gentleness and sensitivity might be more effective. Research demonstrates time and time again that education, support and motivation are the best tools in the battle against obesity.

As always a nifty little recipe and this tuna recipe is taken from the fantastic Ottolenghi cookbook.  I served it with:

Spicy tomato salsa (4-5 large chopped tomatoes, 1 finely chopped red onion, 1/2 fresh chopped and deseeded chili, grated zest and juice of 1 lime, chopped coriander and sea salt)

Green bean, chick pea and feta salad (steam beans till just tender.   Dress with olive oil and raspberry vinegar.  Mix in drained tin of chickpeas and some chopped feta.  Scatter over chopped fresh mint and parsley)

Seared Tuna with pistachio crust

Serves 4

4 tuna steaks
2 tbsp olive oil
4 tbsp dijon mustard
120g shelled pistachio nuts
grated zest of 1 lemon

Heat oven as high as possible.  Brush tuna steaks with olive oil and quickly sear for 30 seconds each side in a frying or griddle pan.  Allow to cool slightly then brush all over generously with mustard.

Put pistachio nuts in a blender and blend until you have a fine breadcrumb like texture.  Add lemon zest and seasoning.

Cover tuna steaks with the nut mixture.

Roast in the oven for 4-5 minutes.  (Timing is variable depending on how you like your tuna, so feel free to reduce/increase cooking time as necessary).