‘Wake-up call’ over liver disease risks due to weight

One in eight middle-aged adults in the UK could have a potentially serious form of liver disease – because they are overweight.

Scans of nearly 3,000 individuals from the UK Biobank research project showed that 12% had inflamed, fatty livers.

The British Liver Trust said the “very alarming” findings were a ‘wake-up call’ because the condition can lead to cirrhosis, liver failure and death.

Hepatologists said there was a silent epidemic of fatty liver disease.

This is especially worrying because symptoms often do not emerge until permanent damage is done – but the condition is reversible if caught in time.

Back to normal

Frances Carroll, aged 52, from Oxford, was told she had fatty liver disease seven years ago.

At the time she weighed over 18 stone (116 kilos).

She lost 7 stone, and went down from a size 22 to a 12.

Frances said: “I was shocked when I was told my liver was diseased, but determined to do something about it. I started by eating more healthily and then combined that with physical activity – I’m delighted my liver is back to normal.”

Frances now teaches fitness classes and does nutrition coaching.

She said: “Back in 2011 I would not have believed that I would end up as a personal trainer. I used to get out of breath when I walked any distance – now I run up hills!”

And she has had a new type of MRI scan which has showed her liver is healthy again.

The results of the MRI scanning study, led by scientists in Oxford, were announced at the International Liver Congress in Paris.

They were made possible by an innovative software analysis tool called LiverMultiScan, developed by Perspectum Diagnositics, a spin-out company from the University of Oxford.

Dr Rajarshi Banerjee, CEO of Perspectum Diagnostics said: “LiverMultiScan is a great example of a smart health technology discovered and developed by UK clinicians and scientists with clear benefits for patients, the NHS, and taxpayers.

“Whilst liver biopsy remains an important part of hepatology practice, clearly we need better non-invasive tools at our disposal to evaluate the nature and severity of liver disease.”

Needle biopsies are the gold standard for assessing liver disease, but they are costly, invasive, painful and carry some health risks.

The software tool can be used in any MRI scanner but is not yet in routine clinical practice.

Southampton General is the first NHS hospital to use the new system outside of research.

David Breen, associate professor of radiology at University Hospital Southampton believes it could reduce the need for biopsies.

He said: “The scan gives a map of the entire liver as opposed to a needle-core biopsy which samples just one area and can be unpleasant.

“It also allows us to re-scan patients over time and see if they improve.”

Previous studies had suggested that around one in 20 adults might have the potentially serious form of fatty liver disease known as NASH (non-alcoholic steatophepatitis).

This is where there is inflammation in and around the liver cells liver which, over time, can can lead to the build up of scar tissue known as fibrosis – eventually this can lead to cirrhosis.

But the scanning study suggests the proportion could be much higher.

Steve Ryder, consultant liver specialist in Nottingham said: “This study accords with what we are seeing on the ground – a lot of people are coming to hospital with significant liver disease because they are overweight.”

Ninety per cent of liver disease is reversible if caught in time.

Judi Rhys, chief executive of the British Liver Trust said: “Reducing alcohol is important which most people already know, but for fatty liver disease the key things are having a healthy weight and doing exercise.”

The charity has an online screening tool to assess your risk of liver disease.

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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, 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

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.

Teenagers urged to take part in meningitis B vaccine trial

Teenagers in Great Britain are being asked to take part in a study to learn if immunising them against meningitis B could protect them and other people.

The NHS wants 24,000 to take part in the Oxford Vaccine Group’s Be On The Team trial, which is helped by National Institute for Health Research funding.

Bacteria at the back of the throat can cause meningitis and the study will see if vaccination can stop this happening.

The trial will take place in four waves of recruitment over the next two years.

Control group

Each of the teenagers who chooses to participate, in Year 12 in England or the equivalent in Scotland and Wales, will be put into one of three groups of 8,000 participants and will receive two doses of one of two vaccines.

Two of these groups will be in the programme for a year, with the third, which will act as a control group, taking part for 18 months.

The recruitment started this week and is planned to work around school holidays and exams, taking place in March-April and September-October this year and in 2019.

Meningitis B facts

  • Meningitis B is a bacterial infection that most often affects children below the age of one
  • It is the most common form of the condition in the UK
  • Since 2015, children under 12 months have been offered the vaccination
  • There are about 1,200 meningitis B cases each year in the UK
  • With early diagnosis and antibiotic treatment, most people will make a full recovery
  • It is fatal in one in 10 cases
  • About one in four of those who survive is left with long-term problems, such as amputation, deafness, epilepsy and learning difficulties

    Dr Matthew Snape, a consultant paediatrician at the Oxford Vaccine Group, told the BBC: “We’ve had great enthusiasm from the schools we have approached, with the majority of Year 12 students interested in taking part.

    “The peak of carriage for the bacteria is from the teenage years through to young adulthood – there is a lot of carriage with university students.

    “We are doing the study to help us understand whether an immunisation campaign in teenagers would help us to protect the whole community.”

    Dr Snape said the study’s findings would be passed on to policymakers “to inform any future decisions about adolescent meningococcal immunisation”. And there have already been calls for a wider meningitis B immunisation programme.

    Following the death of two-year-old Faye Burdett in 2016, a petition set up to ask for all children to be routinely vaccinated attracted 820,000 signatures.

    As a result, the government published a report last month explaining how it made decisions about which vaccines to fund.

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      One of the report’s recommendations was to lower the cost-effectiveness threshold for immunisation – widescale vaccination against meningitis B had been rejected as being “not cost effective”.

      A consultation on the report is running until 21 May.

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      Georgie Hall, whose six-year-old son died from the condition last October, told the BBC: “The government, I know, are saying that it’s not cost effective to vaccinate more children against this disease. We really need the government to listen to the families.”

      And Health Secretary Jeremy Hunt apologised for “system failures” that led to the deaths of two teenagers from the disease in Bristol in 2016.

      Claire Donovan, head of research and information at Meningitis Now, told the BBC: “We support the trial, and it’s something we’ve been waiting to happen for a number of years – we are very keen that it goes ahead.”

      Ms Donovan added that if the trial was successful, “then potentially vaccinating that age group will help protect the rest of the nation”.

      Dr Tom Nutt, the charity’s chief executive, said: “This important study is a chance for young people to make a real difference to not only their own health but that of their wider community.”

NHS: Over 3,000 more midwifery training places offered

More than 3,000 places on midwifery training courses are to be created over the next four years in England as part of plans to meet NHS staffing demands.

The government has announced a 25% boost in training places, which it said amounted to the “largest ever” increase in NHS midwives and maternity staff.

It follows a similar plan for nurses which was announced last year.

The Royal College of Midwives welcomed the move but said training more midwives was only half of the problem.

The plan needs investment and time to make it work, the RCM added.

Shorter treatment ‘will help tackle’ drug-resistant TB

New international guidelines aim to halve the cost and time for treating multi-drug resistant tuberculosis (MDR-TB).

The advice from the World Health Organization (WHO) should reduce treatment to around nine months.

Currently, it can take as long as two years – and many patients fail to complete what can be a burdensome course.

Doctors urged countries to implement the guidelines quickly.

Conventional treatment can involve thousands of pills and daily injections. Deafness is one of the main side-effects.

Cure rates are as low as 50% because patients abandon treatment, leading to further problems with resistance.

The WHO is also recommending a faster test for MDR-TB, which gives results within two days – compared with the current three months.

It hailed the guidelines as a “critical step forward”. Around 5% of TB cases are thought to have resistance to the two most effective drugs.

This translates into 480,000 cases worldwide – and 190,000 deaths from this form of TB every year. Many patients are not being identified.

The shorter treatment plan costs less than $1,000 per patient – compared with conventional treatment which costs $2,400 for the medicines alone.

The International Union against TB and Lung Disease and Medecins Sans Frontieres have been involved in trials of the new treatment method in Bangladesh and nine African countries, which have influenced the WHO’s decision.

The Union hailed today’s advice as “an historic moment”.

Cases ‘driven underground’

Its senior vice president, Dr I D Rusen, told me: “When we first saw evidence about the shorter regimen, back in 2007, it was almost too good to be true.

“Then further results which were consistent were presented at our conference late last year. Next year we’ll have more evidence from a head-to-head trial comparing the two treatment methods.

“The shorter treatment plan uses different doses of existing drugs which were previously used for leprosy.

“So we hope there will be time for production to scale up, while countries get systems in place for the new guidelines, although it’s possible there could be some supply issues.”

David Lister, an MSF TB Doctor working in Uzbekistan, co-ordinated one of the studies and described the huge difference it made.

He said: “The prospect of two years of TB treatment drives parents to hide their children from treatment, teenagers to abandon their ambitions and adults to decide between providing for their family or getting healthy.

“The fear of relentless suffering due to side-effects manages to outweigh any hopes of cure and returning to a normal life.

“But when I say, ‘it’s only nine months’ they say, ‘I can do that’.”

We learn nothing about nutrition, claim medical students

Medical students say they currently learn almost nothing about the way diet and lifestyle affect health – and they should be taught more.

They say what they are taught is not practical or relevant to most of the medical problems they see in GP surgeries, clinics and hospitals.

A leading GP estimated that up to 80% of his patients had conditions linked to lifestyle and diet.

These included obesity, type 2 diabetes and depression.

Why does this lack of training matter?

This year the NHS will spend more than £11bn on diabetes alone – social care costs, time off work etc, will almost double that bill.

Type 2 diabetes – the most common kind – is linked to obesity. And right now Britain is the fat man of Europe.

Training too traditional

But doctors are not being trained to deal with what medics call non-communicable diseases – and it’s those kind of illnesses that are threatening to bankrupt our health system, so a new kind of training is crucial.

Speaking to BBC Radio 4’s The Food Programme, Dr Rangan Chatterjee, author and podcast host, told me: “The health landscape of the UK has dramatically changed over the last 30 or 40 years and I think the bulk of what I see as a GP now – almost 80% – is in some way driven by our collective lifestyles.”

Dr Michael Mosley, presenter of BBC One’s Trust Me I’m A Doctor, said, “Unfortunately it’s not part of the traditional training. At medical school I learnt almost nothing about nutrition. And I have a son at medical school and it’s again not part of his key curriculum.

“So I don’t get the sense that there are lots of doctors out there who feel empowered to tell patients much about nutrition.”

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    A hotbed of the new revolution is Bristol University where, in 2017, third year medical students Ally Jaffee and Iain Broadley founded Nutritank.

    It’s an online organisation created for and by medical students to share nutrition science research and organises events and lectures on campus.

    This summer, it will welcome GP, author and podcast host Dr Rupy Aujla to Bristol to lead the first UK course in culinary medicine for medical students.

    From one society in Bristol, Nutritank has now spread to 15 other student-led groups at universities across the country.

    ‘It’s time’

    Ally Jaffee said: “There’s just about a society at medical school in everything from sexual health to orthopaedics to dermatology. But there just wasn’t a nutrition and lifestyle or a preventative medicine society.

    “We’re taught about 10 to 24 hours over five to six years in medical school on nutrition.”

    This month, the British Medical Journal announced it will launch a journal on the science and politics of nutrition in June 2018.

    Dr Fiona Godlee, editor-in-chief of the BMJ, told me, “It’s time we recognised that food and nutrition are core to health. There is a growing body of research out there that needs to be published – and we want to contribute to that effort.”

    She said the same levels of quality and scrutiny should be applied to food science that are applied to other areas of health research.

    The BMJ’s announcement follows an opinion piece it published in October 2017 written by two University of Cambridge graduate medical students, Kate Womersley and Katherine Ripullone.

    Kate said: “I was in an obesity clinic as part of my medical shadowing.

    “A patient came in and said very frankly to the doctor, the consultant in charge, ‘Why am I so fat?’.

    “The patient was asking a very straightforward question and I think was expecting a straightforward answer. But often that’s a question where doctors seem to clam up a bit.

    “We were interested to write this piece for the BMJ, because we didn’t feel prepared to be receiving that question.”

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      Medical schools in the UK are responsible for setting their own curriculum with guidance and standards published by the General Medical Council.

      The GMC is now reviewing that guidance but so far it’s been very general. It told us that it recognises the significance of the impact of diet and nutrition on health and wellbeing and has sought to express this more explicitly in its revised “outcomes” that will be released this summer.

      Things are also beginning to change at medical schools. University of Cambridge told us it plans to double the amount of core course content on nutrition and has asked Kate and Katherine to help.

      Similarly, Bristol medical school has sought input from students to redesign its curriculum.

      Meanwhile, Prof Sumantra Ray of NNedPro Global Centre for Nutrition and Health told us his organisation is involved in rolling out training in diet and nutrition for student doctors by 2020.

      Kate said: “Students need to see nutrition as something at the cutting edge of scientific discovery.

      “I think there needs to be an image change of how doctors perceive nutrition, but also how it’s presented to students.”

      You can hear more about this story on The Food Programme on Radio 4 at 12:32 BST on Sunday or on iPlayer afterwards.

Tuberculosis rates in England fall by third in six years

New figures show rates of tuberculosis (TB) in England have declined by a third in six years, and are currently at their lowest level in 35 years.

The data from Public Health England shows a 38% fall since 2012, with a 9.3% decline in cases in 2017 alone.

Improved diagnosis, treatment and awareness are being credited for the fall.

But England still has one of the highest rates of TB in Western Europe with just under 5,200 affected in 2017.

And TB is still one of the leading causes of death worldwide.

The data has been released to coincide with World TB Day on 24 March.

The World Health Organization’s campaign Light up the World for TB will see buildings and landmarks across the world lit up in red across the weekend 23-25 March.

It’s hoped it will highlight the continued focus that is required to meet the ultimate ambition of making England TB-free.

Dr Sarah Anderson, head of the National TB Office at Public Health England, said: “People often think that TB is a Victorian disease that is no longer a problem in England, but in fact it still affects over 5,000 people a year and there is still a lot to do until the target to eliminate TB is met.

“We urge everyone to join the fight to confine TB to history. World TB Day is an opportunity for people everywhere to be informed about TB, educate others and urge governments to take action. This global movement will make a powerful statement and show solidarity for people who have been affected by TB.”

Tuberculosis facts

  • TB is a bacterial infection spread through inhaling tiny droplets from the coughs or sneezes of an infected person
  • It mainly affects the lungs, but it can affect any part of the body, including the tummy (abdomen) glands, bones and nervous system
  • The most common symptoms of TB are a persistent cough for more than three weeks, unexplained weight loss, fever and night sweats.
  • TB is difficult to catch and you need to spend many hours in close contact with a person with infectious TB to be at risk of infection
  • TB can be fatal if left untreated – but can be cured if it’s treated with the right antibiotics over a course of six months
  • The BCG vaccine offers protection against TB, and is recommended for babies, children and adults under the age of 35 who are at risk of catching TB
  • At-risk groups include: children living in areas with high rates of TB and people with close family members from countries with high TB rates

    The most recent data on infection rates show parts of London still have higher rates of TB than some developing countries, such as Iraq, Libya and even Yemen.

    London is known as the TB capital of Western Europe and has seen initiatives such as a mobile clinic taking to the capital’s streets to test vulnerable people, such as the homeless.

    Free testing and treatment of latent TB is available in England for people from areas where TB is common.

    TB breakthrough

    Last year researchers in Oxford and Birmingham reported they had made a world-first breakthrough in the diagnosis of tuberculosis.

    They managed to isolate different strains of the disease using a process called genome sequencing.

    It means patients who may have waited months to get the right drugs can now be diagnosed in only a few days – so they have a greater chance of recovery.

    While figures have gone down over the last six years in England, another issue in the battle to eradicate TB is drug resistance.

    A recent study found one in five global cases of the disease is now resistant to at least one major treatment drug.

Woman dies after having bee-sting therapy

A woman has died after undergoing bee-sting therapy, a form of treatment backed by Gwyneth Paltrow.

The 55-year-old Spanish woman had been having live bee acupuncture for two years when she developed a severe reaction.

She died weeks later of multiple organ failure.

Researchers who studied the case say live bee acupuncture therapy is “unsafe and unadvisable”.

It is thought to be the first death due to the treatment of someone who was previously tolerant of the stings.

The woman’s case has been reported in the Journal of Investigational Allergology and Clinical Immunology, by doctors from the allergy division of University Hospital, Madrid.

She had been having the treatment once a month for two years at a private clinic to improve muscular contractures and stress.

During a session, she developed wheezing, shortness of breath, and sudden loss of consciousness immediately after a live bee sting.

She was given steroid medication but no adrenaline was available, and it took 30 minutes for an ambulance to arrive.

The woman had no history of any other diseases like asthma or heart disease, or other risk factors, or any previous allergic reactions.

What is apitherapy?

  • Apitherapy is the use of substances from honeybees, such as honey, propolis, royal jelly, or even venom (extracted or from live bees), to relieve various medical conditions. One type of apitherapy is live bee acupuncture.
  • Although some benefits of apitherapy have been reported, they have mainly been anecdotal.
  • Bee-venom therapy has been used for treating conditions including arthritis and MS.
  • The theory behind the treatment is that bee stings cause inflammation leading to an anti-inflammatory response by the immune system.
  • But the Multiple Sclerosis Trust says “there is no research to show it is an effective treatment for people with MS”. They said a 2008 review of non-conventional approaches to treating MS found that there was only marginal evidence for bee-venom therapy.
    • In an interview with the New York Times in 2016 Gwyneth Paltrow said she had tried apitherapy.
    • “I’ve been stung by bees. It’s a thousands-of years-old treatment called apitherapy. People use it to get rid of inflammation and scarring. It’s actually pretty incredible if you research it. But, man, it’s painful.”
    • And on her wellbeing website Goop she says she was “given ‘bee-venom therapy’ for an old injury and it disappeared”.
    • Last year, Gerard Butler revealed he had been injected with bee sting venom to try to help reduce inflammation from stunt work. He ended up in hospital after he was injected with the venom of 23 bees. He said he felt like his heart might explode and as if he had ants under his skin.

      The doctors found severe anaphylaxis had caused a massive stroke and permanent coma with multiple organ failure.

      The report’s authors called for:

      • Patients to be fully informed of the dangers of apitherapy before undergoing treatment
      • Measures to identify sensitised patients at risk should be implemented before each apitherapy sting
      • Apitherapy practitioners should be trained in managing severe reactions
      • Apitherapy practitioners should be able to ensure they perform their techniques in a safe environment
      • They should have adequate facilities for management of anaphylaxis and rapid access to an intensive care unit

        But they acknowledged that because the treatment often takes place in private clinics, these measures may not be possible.

        One of the report’s authors Ricardo Madrigal-Burgaleta concluded: “The risks of undergoing apitherapy may exceed the presumed benefits, leading us to conclude that this practice is both unsafe and unadvisable.”

        Amena Warner, Head of Clinical Services for Allergy UK, said:

        “The public need to be very aware of the unorthodox use of allergens such as bee venom. This will come with risk and, in susceptible individuals, can lead to serious life threatening reactions.”