Dementia risk linked to some medicines

A study links the long-term use of some drugs with a higher risk of dementia.

In England, 1.5 to two million people are likely to be taking anticholinergics for depression, Parkinson’s and bladder problems.

University of East Anglia researchers found more cases of dementia in patients prescribed larger quantities of particular anticholinergics.

But experts said patients should not stop taking them, as their benefits may outweigh any risk.

The study found no risk with other anticholinergic medicines used to treat common conditions such as hay fever, travel sickness and stomach cramps.

What did the study look at?

The research, funded by Alzheimer’s Society and published in the British Medical Journal, looked at the medical records of 40,770 patients aged from 65 to 99 with a diagnosis of dementia between April 2006 and July 2015 and compared them with those of 283,933 people without dementia.

It also analysed more than 27 million prescriptions – making it the biggest study of its kind into the long-term impact of anticholinergic drugs in relation to dementia.

What are anticholinergic drugs?

They block acetylcholine, a chemical messenger that carries signals across the nervous system.

Some are available on prescription only.

What should patients do if they take any of these drugs?

The most important thing is “not to panic”, according to Dr Ian Maidment, from Aston University.

“Don’t do anything suddenly. Don’t stop taking your medication,” he told the BBC.

“As a patient, if you are concerned about it, go and speak to your doctor or your pharmacist. You don’t have to see them urgently.”

Not taking prescribed drugs could have serious consequences, Dr Maidment said.

“Having untreated depression is also a risk as people can die from that, so it is a question of balancing risks,” he added.

How have experts reacted?

Alzheimer’s Society head of research Dr James Pickett told the BBC that compared with the risk of dementia being caused by an unhealthy lifestyle, the potential risk of an anticholinergic drug contributing to the onset of the disease was “quite small”.

“We don’t exactly know within those that are taking these drugs, who is at the increased risk and who isn’t,” he said.

Dementia Research national director Prof Martin Rossor said: “It is important to be cautious about associations as they do not prove causation.”

Alzheimer’s Research UK research director Dr Carol Routledge said: “The study didn’t investigate what might cause this link between anticholinergics and dementia risk, and researchers will need to build on these findings in future studies.”

Rob Howard, professor of old age psychiatry at University College London, said: “It is possible that use of some of these drugs may have actually been to treat the very earliest symptoms of Alzheimer’s disease, which can be associated with low mood and lower urinary tract infections, many years before the development of dementia.”

Dr Parastou Donyai, associate professor of social and cognitive pharmacy at the University of Reading, said: “This type of study imagines that patients actually take their drugs as they were prescribed for them.

“But we know from other research that people with long-term health conditions really only take their medication as prescribed around half of the time – the other half, people either take more or less of their medication or not at all.”

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Buying Viagra: What you should know

Men can now buy the impotence pill Viagra Connect without a prescription at some UK pharmacies.

Health experts hope it will mean more men get help for erectile dysfunction – a condition thought to affect up to one in five adult men, 4.3 million in the UK.

Like any medication though, the drug can cause side-effects and should not be misused or abused.

What should men consider before buying and trying the little blue pills?

Who can have it?

Viagra Connect is only for men who have impotence.

No-one under the age of 18 can buy it, although women might be able to buy it on behalf of their partner if the pharmacist is satisfied it is appropriate to dispense it.

And it will not be sold to men who are not medically fit enough to have sex. This includes men with severe heart or blood vessel problems.

As a rule of thumb, men who become very breathless or experience chest pain when doing light exercise, such as climbing two flights of stairs, should not take these pills.

Can it be bought off the shelf?

No. You will need to ask the pharmacist for it, who will then check it is safe for you to take.

A packet of four pills will cost £19.99.

Do men wanting to buy have to talk to someone and be examined?

You can ask at the pharmacy counter for a quiet word or to have a conversation in a private room if they prefer – most pharmacies now have private consultation facilities.

The pharmacist will ask about symptoms, general health, and any other medications you might be taking. They should not ask personal questions about your sex life or sexual preferences.

You should not need a physical examination.

Will it work?

In many cases yes, but it is not effective for everyone.

The drug relaxes the blood vessels in the penis to help blood flow and will help achieve an erection in response to sexual stimulation.

It can be taken with or without food, although it may take a little longer to start working if you have just had a big meal.

You should take it about an hour before you plan to have sex.

Do not take it with grapefruit or grapefruit juice, because this can affect how the medicine works.

And do not take more than one 50mg tablet per day.

If it has been some time since you were able to get or keep an erection, it may take a couple of attempts before you are able to achieve one.

Drinking lots of alcohol can also make it more difficult to get an erection.

What if it is too strong?

Talk to your pharmacist or doctor if you think it is too strong – the drug’s effects last too long or are too powerful.

Prolonged and sometimes painful erections lasting longer than four hours have been occasionally reported by men taking the drug.

Although unlikely, if this does happen, seek immediate medical assistance.

What other side-effects might there be?

Very common (may affect more than one in 10 people):

  • headache

    Common (may affect up to one in 10):

    • dizziness
    • colour tinge to vision or blurred vision – some people start seeing a blue hue
    • hot flushes
    • blocked nose
    • nausea

      Stop taking the pills and seek immediate medical attention if you have a serious side-effect such as:

      • chest pain
      • sudden decrease or loss of vision
      • an allergic reaction (eg difficulty breathing, wheeze and swelling of the lips, eyelids or face)
      • a seizure or fit

        Drug clashes

        People on nitrate pills for angina should not take Viagra Connect. That also goes for people taking recreational poppers (amyl nitrite).

        There is also a clash with a medicine called riociguat and an HIV medication called ritonavir.

        Make sure you tell the pharmacists about any treatments you are taking so they can check it will be safe for you to also have Viagra Connect.

        Pharmacists should advise men to book a follow-up appointment with their doctor within six months of starting on Viagra Connect because erectile dysfunction can sometimes be a sign of other underlying conditions, including heart disease, high cholesterol and diabetes.

        Can I get it anywhere else?

        GPs can prescribe it. And some pharmacies will be selling it online, after a virtual consultation.

        Always check that the seller is reputable. Drugs from unregulated sellers may be fake, ineffective and unsafe.

How Amsterdam is reducing child obesity

Childhood obesity rates are rising in many parts of the world – but in Amsterdam they are falling. The city’s healthy-weight programme has seen a 12% drop in overweight and obese children.

“Go!” shouts the instructor. Tyrell van der Wees throws himself forward to do sit-ups, then jumps up and runs to the end of the gym and back again. He is breathing fast, his heart pumping.

The nine-year-old is smiling, working hard and having fun. He is also part of Amsterdam’s efforts to improve the health of its children.

At the back of the gym Tyrell’s mother, Janice, is sitting with other parents watching the fitness class.

“He’s really happy. He is doing something to improve his health. He knows the consequences and he is trying to do something about it,” she says.

Child and teen obesity spreading across the globe

UK: ‘Stark’ increase in overweight youngsters

A year ago Tyrell’s school told Janice he was overweight. Children in Amsterdam are now regularly weighed and tested for agility and balance.

Tyrell was referred to a child health nurse, Kristel de Lijster.

She offered them a package of help including dietary advice, joining a gym class and a volunteer to make home visits – all for free.

In a health centre in south-east Amsterdam, Kristel de Lijster explains how she helps families such as Tyrell’s.

“The most important thing is not to communicate in a standard way, because everybody already knows eating sugar and eating fast food is unhealthy,” she says.

“You really want to communicate the message on the level the parent and the child understands.

“So, when the child is overweight it is more important for them to tell you what they think is going wrong.”

In Tyrell’s case, Janice thinks he was snacking on unhealthy food and playing computer games after school before she returned home from work.

At Tyrell’s flat, Daniphra Millerson has come to pay a visit. She is Tyrell’s “buddy”, part of a volunteer network helping families towards healthier lifestyles.

She makes weekly visits. She has also taken Tyrell to the supermarket to look at healthier food choices and introduced him to some after-school activities.

He now plays tennis, goes to gym class and is much more active.

“It’s working. It’s really working,” says Janice. She is delighted with the range of help available for her son.

“I am really happy that all that support is there from the city so we can make use of it. I wish I had known this before,” she says.

Immigrant communities

Amsterdam’s childhood obesity problem is concentrated in the poorer parts of the city, among immigrant communities from Surinam, North Africa and Turkey.

It is here the city’s healthy-weight programme targets its resources. And it is here the fall in obesity has been greatest.

Between 2012 and 2015 the percentage of children who were overweight fell from 21% to 18.5%, resulting in a 12% drop in the total number of overweight children.

The city authorities are cautious about the findings, but the trend is encouraging.

At a community centre in north Amsterdam, women are chopping vegetables and cooking chicken soup. Most are from Morocco, Syria or West Africa. A dietician is with them giving advice on healthier cooking.

“Obesity is a problem in Amsterdam so it is urgent to work on this,” says Fatima Ouahou, a community organiser.

“The women are the ones who buy and cook the food, so we want them to be the example and spread the message on healthy eating.”

Amsterdam’s healthy-weight programme’s budget is less than €6m (£5.3m) a year.

Rather than hiring new staff, it works with existing professionals including teachers, nurses, social workers and community leaders to get across a consistent healthy lifestyle message.

“We have managed to build a whole systems approach in Amsterdam,” says Karen den Hertog, deputy programme manager.

“In the everyday life of children and their parents, we manage to get the healthy message across and help people have a healthier lifestyle.

“Once we decided what the message was, we were surprised by the enthusiasm from all our partners – youth workers, schools, teachers, doctors and nurses.

“All are using the same message. We hear back from children that it’s good they get the same message.”

Much of the budget goes into supporting Jump-In primary schools, which allow only fruit, water and healthy food in school and encourage exercise.

It was here they faced some early obstacles from parental opposition. However, complaints soon faded, says Pascal Reit, head teacher of Pro Rege School.

“There has been some protest from some parents who think we should not be telling them how to raise their children. Now everyone accepts it. There is no problem any more,” she says.

To keep its healthy message consistent, the city has banned junk food companies from advertising on the subway or sponsoring sporting events. It is also working with shops and supermarkets to promote fresh food.

All political parties back the programme, and this consensus helps the programme take a long-term approach towards healthier lifestyles.

Sugar tax: Will paying more for fizzy drinks and alcohol make us healthier?

An anti-obesity drive is about to see a tax introduced on sugary drinks across the UK, while Scotland is set to impose a minimum price on alcohol to target problem drinking.

But does making unhealthy products more expensive persuade people to make “better” choices? And what are the trade-offs associated with doing so?

Everybody will pay more

The price increases being introduced could lead to significant health improvements, but they will be felt by everybody, not just those with the unhealthiest lifestyles.

From 6 April, the UK’s tax on sugary drinks will see shoppers asked to pay 18p or 24p more a litre, depending on just how much has been added to their drinks. The price of a 1.75-litre bottle of cola bought from a supermarket could increase by about 25%.

In Scotland, from May, alcohol will not be allowed to be sold for less than 50p per unit, which could see a four-pack of cider cost 10% more, while a pack of 20 cans could double in price. Wales is looking at similar measures.

This is happening because sugar and alcohol are associated with problems that impose a substantial cost on society.

For example, problem drinking can lead to anti-social behaviour, crime, pressure on A&Es and increased liver disease. Excessive sugar consumption is linked to rising obesity rates, some cancers, type 2 diabetes and heart disease.

But alcohol consumption is concentrated among a relatively small number of people: 5% of households buy more than 30% of all alcohol.

And the government is particularly concerned about obesity among children and young people: teenagers consume more than three times the recommended amount of free sugars – those which are not naturally present in food.

The government has to consider the trade-off between potentially large improvements to public health and making everybody pay more.

Will shoppers make healthier choices?

Price increases will be most effective if the people who consume too much sugar and alcohol significantly reduce their intake.

But people respond differently to higher prices, depending on how much they like the product. And, in the case of alcohol, addiction can also be a factor.

Research by the Institute for Fiscal Studies suggests that heavy drinkers respond less strongly to price increases.

For example, if the price of alcohol increases by 1%, the percentage fall in consumption among households which buy more than 40 units per adult each week is only half as large as among those which buy fewer than eight units.

What people choose to buy instead also matters.

In the case of sugary drinks, increasing the price of a bottle of cola might work if people choose water instead.

But only some drinks, and no foods are being taxed. So, if people choose to buy a milkshake, a chocolate bar, a cake, or ice cream instead of the cola, then the impact of the tax on sugar consumption will be reduced.

It can also be difficult to know how great the impact of a price rise has been, compared with other measures.

The proportion of adults smoking halved between 1974 and 2013 – at the same time as the real rate of excise duties on tobacco more than doubled.

But higher taxes are not the only thing that affected behaviour, as awareness about the dangers of smoking also increased significantly.

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    What will shops and manufacturers do?

    The food and drink industry will react to the taxes – but not necessarily in the intended way.

    The simplest response is for firms to pass on price changes to their customers. But they could choose to change prices by more or less than the tax, which will affect how much consumption falls.

    They may also change their products – a move which could make the policy more effective.

    There are examples of this happening – several soft drinks companies have already reduced the sugar content of their products to avoid the tax. The sugar content of Fanta has been reduced by 30%, for example.

    If people are happy to buy the reduced sugar varieties, this could be a relatively effective way of reducing the nation’s sugar intake.

    And new recipes can work – voluntary targets led to a 5% reduction in the salt content of groceries between 2005 and 2011.

    Money from the sugar tax will go to the government, which could use some of the tax revenue it receives to improve public health, for example by increasing funding for school sports.

    However, minimum pricing per unit of alcohol is likely to create windfall profits for the manufacturers and retailers.

    If the alcohol industry uses the money to increase promotions, or advertising, this could undo some of the potential benefits of the policy.

    The sugar tax and minimum pricing

    • The UK-wide sugar tax takes effect 6 April
    • 18p per litre if the drink has 5g of sugar or more per 100ml
    • 24p per litre if the drink has 8g of sugar or more per 100ml
    • A sugary drink is exempt if it contains at least 75% milk
    • The Scottish Alcohol Minimum Pricing Bill takes effect 1 May
    • Minimum pricing for alcohol to be fixed at 50p a unit

      Other ways of suggesting healthier choices

      Introducing taxes is only one of many options available to the government.

      A lot of attention has been paid to differences in the quality of diet between different people. But there are also big differences in the same person over time.

      Research by the IFS suggests that the share of calories people get from healthy food increases sharply in January and falls by 15% by the end of the year. Similarly, searches for “diet” on Google spike at the start of the year.

      This suggests that if the government could persuade people to behave as they do in January for the whole year, then there could be substantial improvements in nutrition.

      And “nudge” policies that encourage people to make better decisions – such as not allowing sweets and chocolates to be sold next to tills – could be used more widely.

      Such policies could be effective at reducing impulse buys that people later regret.

      A related idea would be adding information about the dangers of excess sugar and alcohol to food labelling, just as health warnings are placed on cigarette packets.

      • Sugar tax is already producing results
      • What happens to sugar tax money?
      • Minimum price ‘will affect 70% of alcohol’

        No easy solution

        The challenges posed by obesity, poor nutrition and alcohol consumption are substantial.

        All the options involve trade-offs.

        The government needs to balance the potential improvements to public health against the costs to consumers.

        It is likely that a whole range of policies will be needed to tackle these major public health challenges.

        Unfortunately, there is no silver bullet.

        About this piece

        This analysis piece was commissioned by the BBC from an expert working for an outside organisation.

        Kate Smith is a senior research economist at the Institute for Fiscal Studies, which describes itself as an independent research institute which aims to inform public debate on economics.

        More details about its work and its funding can be found here.

        Charts produced by Daniel Dunford

        Edited by Duncan Walker

Record number of organ donors in 2017

A record number of people donated organs in the UK last year, with the highest increase in 28 years.

There were 1,575 donors, an 11% increase on the previous year.

Ben Glean from Grimsby, who died aged 18, was one of those donors. He suffered a cardiac arrest from undiagnosed type 1 diabetes.

His mum Karen said: “I knew what Ben wanted because we’d had the conversation, which made it easier for me.

“In my darkest time there was a light to be shone for someone else.”

He’d told his mum he was in support of donation but had not yet got around to joining the NHS Organ Donor Register.

His kidneys were transplanted into two men in their 30s and his liver into a man in his 50s. His corneas were also used for two sight-saving transplants.

“The intensive care unit was absolutely incredible,” said Karen.

“They were completely honest with me and answered countless questions. There aren’t words enough to thank those amazing nurses for the respect shown to my son, even after we knew there was no hope of him recovering.

“The tears of the nurses and doctors showed me how much they cared, and our goodbye to Ben was special because of them.”

Describing his last moments Karen said: “I’d crawl through the machinery and wires to play with his curly hair, to stroke his beautiful eyebrows and to whisper in his ear.

“I must have told him hundreds of times I loved him and I begged him to come back even though I knew he could not.

“Ben was kept comfortable and warm, his face cleaned, his hair brushed and he looked so peaceful and cared for. This is my last memory of my baby boy.”

Proactive approach

The record figures are being attributed to a proactive approach and the introduction of specialist nurses across the NHS, who are there to support donor families and ensure the donation is properly co-ordinated.

This has helped ensure fewer missed opportunities because families block donations, or the necessary equipment is not available.

Sally Johnson, NHS Blood and Transplant director of organ donation and transplantation, said the improvement had been magnificent.

She said the figures “would make any country in the world proud,” but added that a “deadly shortage of organ donors remains”.

“Around three people who could benefit from a donated organ still die each day.”

Fewer than 5,000 people a year die in circumstances where organ donation is possible.

Man in hospital after eating world’s hottest chilli

A man who ate the world’s hottest chilli pepper in a chilli-eating contest ended up in hospital after experiencing “thunderclap” headaches.

The 34-year-old man had eaten one Carolina Reaper chilli in the contest in New York State.

The “crushingly painful” headaches came on in the next few days.

His experience has been published in the BMJ Case Reports as it is the first case to be associated with eating chilli peppers.

The doctor who reviewed his case has warned anyone eating hot chilli peppers to seek medical attention immediately if they experience sudden onset headaches.

“Thunderclap” headaches are caused by the sudden tightening of the vessels that supply blood to the brain, a condition known as reversible cerebral vasoconstriction syndrome (RCSV).

  • Why hot chillies might be good for us
  • Is the chilli pepper friend or foe?

    Immediately after eating at the contest, the man experienced dry heaves.

    Severe neck pain developed over the next few days along with debilitating severe headaches, lasting just a few seconds at a time.

    The pain was so bad he went to the emergency room and was tested for various neurological conditions, but the results were negative.

    A CT scan showed that several arteries in his brain had constricted, leading doctors to diagnose him with RCVS.

    World’s hottest chilli

    • The Carolina Reaper delivers an average of 1,569,300 Scoville Heat Units (SHU)
    • As a comparison jalapeno peppers score between 2,500 to 8,000 SHU
    • It was named the world’s hottest chilli pepper by the Guinness World Records in 2013
    • It was created by Ed Currie from the Pucker Butt Pepper Company in South Carolina over ten years
    • He started growing chillies after learning that capsaicin found in chillies had potential as a cancer-fighting drug and he donates half of his harvest to cancer research

      RCVS does not always have an obvious cause, but can occur as a reaction to some prescription medication, or after taking illegal drugs.

      This is the first case to be associated with eating chilli peppers. Previously eating cayenne pepper has been linked to sudden constriction of the coronary artery and heart attacks.

      The man’s symptoms cleared up by themselves. And a CT scan five weeks later showed that his arteries had returned to their normal size.

      Generally RCVS resolves within days to weeks and often has a favourable long-term prognosis, but in some cases severe vasoconstriction resulting in a stroke have been reported – but they are very rare.

      Dr Kulothungan Gunasekaran, at the Henry Ford Hospital in Detroit, who wrote the report, said people need to be aware of these risks, if eating the chilli.

      “We would not advise against eating Carolina Reaper at this time, but we would recommend the general public be cautious about these adverse effects and we advise that they should seek medical attention immediately if they develop sudden onset headache after eating hot peppers.”

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Brain injuries increase dementia risk, study finds

People who suffer brain injuries are at increased risk of dementia later in life, a large study suggests.

An analysis of 2.8 million people found those who had one or more traumatic brain injuries were 24% more likely to get dementia than those who had not.

The risk was greatest in people who had the injuries in their 20s, who were 63% more likely to get the condition at some point in their life.

But independent experts said other lifestyle factors were more important.

  • Alzheimer’s researchers win brain prize

    Dementia, a category of brain diseases that includes Alzheimer’s, affects some 47 million people worldwide – a number expected to double in the next 20 years.

    Previous research has suggested a link between brain injuries – leading causes of which include falls, motor vehicle accidents, and assaults – and subsequent dementia, but evidence has been mixed.

    This new study, which followed people in Denmark over a 36-year period, found those who had experienced even one mild TBI (concussion) were 17% more likely to get dementia, with the risk increasing with the number of TBIs and the severity of injury.

    Sustaining the injury at a younger age appeared to further increase the risk of getting the condition, the research found.

    Those who suffered a TBI in their 30s were 37% more likely to develop dementia later in life, while those who had the injury in their 50s were only 2% more likely to get the condition.

    Jesse Fann, professor of psychiatry and behavioural sciences at the University of Washington School of Medicine in Seattle, said: “Our analysis raises some very important issues, in particular that efforts to prevent traumatic brain injury, especially in younger people, may be inadequate considering the huge and growing burden of dementia and the prevalence of TBI worldwide.”

    But Prof Fann explained that the actual risk of getting dementia after a brain injury was small, as less than 5% of the people in the study ended up getting the condition and of those, about 5% had suffered a TBI.

    The study, published in the Lancet Psychiatry, focused on brain injuries that were treated in hospital but the data did not break down what the causes were.

    Prof Fann added: “Our findings do not suggest that everyone who suffers a traumatic brain injury will go on to develop dementia in later life.”

    While the paper did not specifically look at brain injuries caused through sport, Dr Mahmoud Maina, research fellow at the University of Sussex, said the study “reinforces the fact that sports in which head injury occurs are dangerous and may make us susceptible to dementia”.

    Professor Tara Spires-Jones, from the University of Edinburgh, said the study “strongly supports the conclusion that TBI is associated with increased risk of dementia”.

    But Dr Doug Brown, chief policy and research officer at Alzheimer’s Society, said brain injuries were a “much smaller” contributory factor than smoking or a sedentary lifestyle – “risk factors that are much easier for all of us to do something about”.

    Dr Carol Routledge, director of research at Alzheimer’s Research UK, added that a healthy diet, drinking in moderation and not smoking were all things that can help maintain a healthy brain as we age.

    Prof Fann said the study was limited by the fact it was taken from one country with a largely similar ethnic population, so the findings cannot be generalised to all ethnic groups in other countries.

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More than half your body is not human

More than half of your body is not human, say scientists.

Human cells make up only 43% of the body’s total cell count. The rest are microscopic colonists.

Understanding this hidden half of ourselves – our microbiome – is rapidly transforming understanding of diseases from allergy to Parkinson’s.

The field is even asking questions of what it means to be “human” and is leading to new innovative treatments as a result.

“They are essential to your health,” says Prof Ruth Ley, the director of the department of microbiome science at the Max Planck Institute, “your body isn’t just you”.

No matter how well you wash, nearly every nook and cranny of your body is covered in microscopic creatures.

This includes bacteria, viruses, fungi and archaea (organisms originally misclassified as bacteria). The greatest concentration of this microscopic life is in the dark murky depths of our oxygen-deprived bowels.

Prof Rob Knight, from University of California San Diego, told the BBC: “You’re more microbe than you are human.”

Originally it was thought our cells were outnumbered 10 to one.

“That’s been refined much closer to one-to-one, so the current estimate is you’re about 43% human if you’re counting up all the cells,” he says.

But genetically we’re even more outgunned.

The human genome – the full set of genetic instructions for a human being – is made up of 20,000 instructions called genes.

But add all the genes in our microbiome together and the figure comes out between two and 20 million microbial genes.

Prof Sarkis Mazmanian, a microbiologist from Caltech, argues: “We don’t have just one genome, the genes of our microbiome present essentially a second genome which augment the activity of our own.

“What makes us human is, in my opinion, the combination of our own DNA, plus the DNA of our gut microbes.”

Listen to The Second Genome on BBC Radio 4.

Airs 11:00 BST Tuesday April 10, repeated 21:00 BST Monday April 16 and on the BBC iPlayer

It would be naive to think we carry around so much microbial material without it interacting or having any effect on our bodies at all.

Science is rapidly uncovering the role the microbiome plays in digestion, regulating the immune system, protecting against disease and manufacturing vital vitamins.

Prof Knight said: “We’re finding ways that these tiny creatures totally transform our health in ways we never imagined until recently.”

It is a new way of thinking about the microbial world. To date, our relationship with microbes has largely been one of warfare.

Microbial battleground

Antibiotics and vaccines have been the weapons unleashed against the likes of smallpox, Mycobacterium tuberculosis or MRSA.

That’s been a good thing and has saved large numbers of lives.

But some researchers are concerned that our assault on the bad guys has done untold damage to our “good bacteria”.

Prof Ley told me: “We have over the past 50 years done a terrific job of eliminating infectious disease.

“But we have seen an enormous and terrifying increase in autoimmune disease and in allergy.

“Where work on the microbiome comes in is seeing how changes in the microbiome, that happened as a result of the success we’ve had fighting pathogens, have now contributed to a whole new set of diseases that we have to deal with.”

The microbiome is also being linked to diseases including inflammatory bowel disease, Parkinson’s, whether cancer drugs work and even depression and autism.

Obesity is another example. Family history and lifestyle choices clearly play a role, but what about your gut microbes?

This is where it might get confusing.

A diet of burgers and chocolate will affect both your risk of obesity and the type of microbes that grow in your digestive tract.

So how do you know if it is a bad mix of bacteria metabolising your food in such a way, that contributes to obesity?

Prof Knight has performed experiments on mice that were born in the most sanitised world imaginable.

Their entire existence is completely free of microbes.

He says: “We were able to show that if you take lean and obese humans and take their faeces and transplant the bacteria into mice you can make the mouse thinner or fatter depending on whose microbiome it got.”

Topping up obese with lean bacteria also helped the mice lose weight.

“This is pretty amazing right, but the question now is will this be translatable to humans”

This is the big hope for the field, that microbes could be a new form of medicine. It is known as using “bugs as drugs”.

Goldmine of information

I met Dr Trevor Lawley at the Wellcome Trust Sanger Institute, where he is trying to grow the whole microbiome from healthy patients and those who are ill.

“In a diseased state there could be bugs missing, for example, the concept is to reintroduce those.”

Dr Lawley says there’s growing evidence that repairing someone’s microbiome “can actually lead to remission” in diseases such as ulcerative colitis, a type of inflammatory bowel disease.

And he added: “I think for a lot of diseases we study it’s going to be defined mixtures of bugs, maybe 10 or 15 that are going into a patient.”

Microbial medicine is in its early stages, but some researchers think that monitoring our microbiome will soon become a daily event that provides a brown goldmine of information about our health.

Prof Knight said: “It’s incredible to think each teaspoon of your stool contains more data in the DNA of those microbes than it would take literally a tonne of DVDs to store.

“At the moment every time you’re taking one of those data dumps as it were, you’re just flushing that information away.

“Part of our vision is, in the not too distant future, where as soon as you flush it’ll do some kind of instant read-out and tells you are you going in a good direction or a bad direction.

“That I think is going to be really transformative.”

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Illustrations: Katie Horwich

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Exercise benefits to the brain ‘may be passed on’

Physical and mental exercise has been found to be beneficial for our brains, but scientists have now found it could also improve the learning ability of our children.

In a mouse study, researchers found the benefits gained from these activities were passed on to their offspring, despite not altering their DNA.

Further research is needed to see if this replicates in humans.

The German study is being published in the journal Cell Reports.

Exercise is recommended to keep the mind sharp in the over-50s and doing puzzles and brain training exercises has been found to delay the onset of dementia and reduce the risk of diseases such as Alzheimer’s.

Researchers from the German Centre for Neurodegenerative Diseases (DZNE) found that when they exposed mice to a stimulating environment in which they also had plenty of exercise, their offspring which they had later also benefitted.

The younger mice achieved better results in tests that evaluated their learning ability than the control group.

They also had improved synaptic plasticity – which is a measure of how well nerve cells communicate with each other and the cellular basis for learning.

They found this in the hippocampus, the area of the brain that is important for learning.

This phenomenon is known as epigenetic inheritance.

What is epigenetics?

  • Epigenetics is a growing field trying to understand how the environment interacts with genes.
  • Previously it was believed that acquired skills don’t modify the DNA sequence so therefore can’t be passed on to children.
  • But in recent years scientists have found that in some circumstances lifestyle factors such as stress and trauma in parents can affect the next generation.
  • For example, a poor diet increases the risk of disease in ourselves but also raises the risk in our children.
  • This phenomenon is known as “epigenetic” inheritance, as it is not associated with changes in DNA sequence.

    They found the benefits were conveyed through the RNA molecules that are contained in sperm, along with paternal DNA.

    “Presumably, they modify brain development in a very subtle manner improving the connection of neurons. This results in a cognitive advantage for the offspring,” said Prof André Fischer from DZNE.

    The researchers say that whether their findings are translatable to people needs to be determined.

    Prof Marcus Pembrey, from Great Ormond Street Institute of Child Health, said the research was an “important step” in unravelling “what, if anything, contributes to an individual’s intelligence beyond genetic inheritance and learning after birth”.

    He added: “If this system of the offspring inheriting a ‘head start’ applies to humans, it might help to explain the so-called Flynn effect, where the population IQ in industrial societies has risen every decade for the last century.”

    Prof Simon Fishel, of the private Care Fertility group, said it was a “fascinating study” providing “further increasing evidence of how we conduct our lives before we conceive our children may have consequences for our offspring”.

    He said it “opens up further the enthralling study of a ‘transgenerational inheritance’ and added: “However, there is much work to do to understand if this study can not only be replicated in mice, but other mammalian species too, and ultimately in humans.”

Why some cancers are ‘born to be bad’

A groundbreaking study has uncovered why some patients’ cancers are more deadly than others, despite appearing identical.

Francis Crick Institute scientists developed a way of analysing a cancer’s history to predict its future.

The study on kidney cancer patients showed some tumours were “born to be bad” while others never became aggressive and may not need treating.

Cancer Research UK says the study could help patients get the best care.

“We don’t really have tools to differentiate between those that need treatment and those that can be observed,” said researcher and cancer doctor Samra Turajlic.

One cancer could kill quickly while a patient with a seemingly identical cancer could live for decades after treatment.

It means uncertainty for both the patient and the doctor.

Kidney cancer

It is most common in people in their 60s and 70s. Symptoms include:

  • Blood in your pee
  • Persistent pain in the lower back or side
  • Sometimes a lump or swelling in your side

    The work, published in three papers in the journal Cell, analysed kidney cancers in 100 patients.

    The team at the Crick performed a sophisticated feat of genetics to work out the cancer’s history.

    It works like a paternity or ancestry test on steroids.

    As cancers grow and evolve, they become more mutated and, eventually, different parts of the tumour start to mutate in different ways.

    Researchers take dozens of samples from different parts of the same tumour and then work out how closely related they are.

    It allows scientists to piece together the evolutionary history of the whole tumour.

    “That also tells us where the tumour might be heading as well,” said Dr Turajlic.

    Chance to change care

    The researchers were able to classify kidney cancer into one of three broad categories:

    • Born to be bad
    • Benign
    • Intermediate

      The “born to be bad” tumours had rapid and extensive mutations and would grow so quickly they are likely to have spread round the body before they are even detected.

      Surgery to remove the original tumour may delay the use of drugs that can slow the disease.

      The benign tumours are at the complete opposite and are likely to grow so slowly they may never be a problem to patients and could just be monitored.

      The intermediate tumours were likely to initially spread to just one other location in the body and could be treated with surgery.

      Michael Malley, 72, from London, took part in the trial at the Royal Marsden Hospital after being diagnosed with kidney cancer.

      He said: “Clearly studies like these are really important for understanding how kidney cancer evolves over time, and I hope this one day leads to better treatments for patients like me.”

      There is still the challenge of figuring out how best to tailor treatments to each tumour type, and even how to perform such tests in a hospital rather than a research lab.

      The tools used in this study are being investigated in other cancers, including lung cancer.

      Dr Turajlic says: “We’ve no doubt they will be applicable to other types of cancer.”

      The studies also revealed that the earliest mutations that lead to kidney cancer were happening up to half a century before the cancer was detected.

      Sir Harpal Kumar, the chief executive of Cancer Research UK, said the study was “groundbreaking”.

      He added: “For years we’ve grappled with the fact that patients with seemingly very similar diagnoses nevertheless have very different outcomes.

      “We’re learning from the history of these tumours to better predict the future.

      “This is profoundly important because hopefully we can predict the path a cancer will take for each individual patient and that will drive us towards more personalised treatment.”

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