Category Archives: Medical

Health, Medical, Science

Menopause misery. HRT isn’t the only answer

HEALTH

DR MAX PEMBERTON, an NHS psychiatrist and medical doctor, wrote recently on the significant shift in many doctors’ attitude towards Hormone Replacement Therapy (HRT). For far too many years, peri- and post-menopausal women have to had to fight hard for their right to access this medication.

An increasing number of doctors are now open to the idea that prescribing HRT can have real benefits for their patients – and, undoubtedly, this has made a life-changing difference for many women. Even though some 13million women in the UK are going through the menopause, it is estimated that one in four have to visit their GP at least three times before getting appropriate treatment.

Last year, official draft guidelines were issued to GPs which said alternative treatments should be considered. These included talking therapies “alongside or as an alternative to” HRT to help reduce menopause symptoms such as insomnia, low mood, and hot flushes. These guidelines have now been revised with health officials backtracking after accusations of “medical misogyny” – the implication being that menopausal symptoms were “all in the mind”. The guidance issued by NICE now advises that HRT should be offered as the first line of treatment. Some may believe this a positive development, but Dr Pemberton is unsure.

The medic is known to be a keen fan of HRT and he has seen many patients’ lives transformed by it. But he goes on to say that HRT isn’t suitable for everyone and that talking therapies can help those women presenting with symptoms that have a psychological component.

Dr Pemberton says that many women talk about no longer feeling like themselves, a disconcerting sense of something having changed, a vague undercurrent of unease, despair, and discombobulation. Trying to address what causes this turmoil is far more complicated than simply a blip in hormone levels. And neither can it be explained away by a woman’s dissatisfaction with life and her sense of loss and malaise as a chemical reaction.

That’s not to say that hormones don’t play an important part. Medical professionals know that fluctuations in hormones can be responsible for low and poor mood.

Over the years, Dr Pemberton has seen far too many women struggling to cope and for whom HRT has been hugely beneficial – helping them, for instance, to manage anxiety caused by the menopause.

But the medic also believes there are other factors that contribute to a woman’s sense of losing herself. He points out that low mood and anxiety are a result of complex social and psychological factors, rather than simple biology.

Changes to the body, disrupted sleep, hot flushes, and so on, he says, can make any woman feel out of control and depressed.

Dr Pemberton documents and records other issues he’s heard women talk about – for example, erratic mood swings and out-of-character behaviour. There are stories of women having affairs, quitting their jobs, or leaving their husbands around the menopause.

While some would seek to blame this all on fluctuations in hormone levels, the evidence for this isn’t that compelling.

The clinician says it’s not at all clear that drops in oestrogen and progesterone, the female sex hormones that start to decline in menopause, are entirely responsible.

Rather, the medic believes that the menopause acts like a ticking clock. It suddenly makes women open their eyes and review their lives. Much of the trauma and emotional turmoil that besets many women as they navigate menopause isn’t the consequence of fluctuating hormones but of a re-evaluation of their life’ situation. For many, their sense of self and identity is closely bound up with their roles within their family, particularly those who are mothers, who may feel bereft at the prospect of an empty nest.

It is also a cruel aspect of the inequality between the sexes that women have to contend with a society that’s more judgmental about how woman age than men. For a lot of women in their 50s and 60s, they have given the best years of their lives to other people and their careers, and now they’re not sure why. A vast number of menopausal women now feel invisible.

Dr Pemberton has had many menopausal and post-menopausal women attending his clinics and hearing the sad story that they no longer feel like a woman.

It is here, he says, that these people would surely benefit from having the time and space to explore and discuss their feelings and situation. That’s where talking therapies can play a vital role for many who have become desperately unhappy.

In the opinion of Dr Max Pemberton, the answer to many complex problems precipitated by the menopause aren’t always going to be found in HRT pills, patches, and gels.

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Health, Medical, Research, Science

Blood test that can detect Alzheimer’s 15 years before onset

ALZHEIMER’S DISEASE

A SIMPLE blood test can detect Alzheimer’s disease up to 15 years before symptoms begin, a major trial has found. It paves the way for a national screening programme.

The trial found that the test was as accurate as the current gold standard for diagnosing the condition.

For the first time, doctors were able to say if a person had a high, medium, or low chance, of having the disease – ruling out further invasive procedures.

Experts have said it would “revolutionise” diagnosis, making Alzheimer’s as easy to test and detect as for other routine health conditions such as high cholesterol.

Patients could expect results within days of visiting their GP, rather than the years it currently takes to get a diagnosis. This could have huge implications for future treatments, removing the barriers for a diagnosis – such as long waits for spinal taps or brain scans – and speeding up trials.

It could also pave the way for screening over-50s once more effective treatments become available.

Made by diagnostics company ALZpath, it was found to be 97 per cent accurate at detecting traces of the “tau” protein, which was linked to developing Alzheimer’s disease during the eight-year trials. These proteins start to build up on the brain 10 to 15 years before symptoms start showing.

Researchers in Sweden found high levels of the “tau” protein in the blood test corresponded to high levels of Alzheimer markers seen in expensive diagnostic brain scans and painful lumbar punctures.

The more of this leaked “tau” brain protein in the blood, the more likely or advanced the Alzheimer’s disease was in the tests involving 786 people. Growing evidence suggests biomarker changes like these can be detected in the blood years before other signs of the disease appear in the brain.

It means if scientists can find a way to stop these protein levels from rising, they could effectively halt Alzheimer’s in its tracks.

With breakthrough treatments such as donanemab and lecanemab on the horizon, experts say it is vital to have quick and reliable diagnoses. Professor David Curtis of University College London Genetics Institute said this was “one half of the solution”, while we await effective treatments.

He added: “This potentially could have huge implications. Everybody over 50 could be routinely screened every few years, in much the same way as they are now screened for high cholesterol.”

Around 900,000 people in the UK live with dementia – with Alzheimer’s the most common form. The growing ageing population means numbers are expected to rise to 1.6million by 2040, making a cheap screening tool vital to get to grips with the challenge.

Alzheimer’s Research UK analysis found 74,261 people died from dementia in 2022 compared with 69,178 a year earlier, making it the country’s biggest killer. While previous blood tests have shown promise, these findings have caused particular excitement given the high accuracy levels, large study size, and because the test already exists commercially.

It is also the first time a blood test has been found to be at least as good as a painful lumbar puncture or spinal tap for detecting elevated levels of the tau protein, according to the research team at the University of Gothenburg, Sweden.

Lumbar punctures involve taking fluid from the patient’s spinal cord. The inexpensive tests – priced at around £150 – could also be used to monitor a patient’s condition, allowing more tailored trials or treatment in future.

Dr Richard Oakley, of the Alzheimer’s Society, urged that more research would be needed, but said: “This study is a huge welcome step in the right direction as it shows that blood tests can be just as accurate as more invasive and expensive tests.

“It suggests results from these tests could be clear enough to not require follow-up investigations for some people living with Alzheimer’s disease, which could speed up diagnosis.”

The tests would need regulatory approval before widespread use. But they could form part of NHS trials starting imminently and looking to roll out blood tests for Alzheimer’s within the next five years.

The scientists’ findings were first published in JAMA Neurology.

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Books, Health, Medical, Research, Science

Book Review: A Silent Fire

THE FLAMES WITHIN

Intro: A fascinating primer explores the crucial role of inflammation in our bodies and how it can go awry. What you need to know about inflammation in the body

INFLAMMATION is a crucial tool of the body’s immune system. As the first line of defence against injury or invaders, it traps bacteria and viruses, heals wounds and signals to other cells for help. It results in symptoms such as pain and swelling. Once a threat is remedied, inflammation, along with its ensuing discomfort, disappears – or at least it should.

In her debut book A Silent Fire: The story of inflammation, diet and disease, gastroenterologist Shilpa Ravella explains how inflammatory responses can turn against us. Crucially, she shows how chronic inflammation plays a role in many common conditions such as heart disease and cancer, and why Western diets are at least partially to blame.

This primer sees Ravella start with some fascinating history, travelling all the way back to the 1st century, when Aulus Cornelius Celsus first described four of the five main signs of inflammation: pain, heat, redness and swelling. The fifth, a loss of function, was identified in the mid-1800s.

Ravella spends a lot of time examining the work of Victorian scientists, such as Élie Metchnikoff, who won a Nobel Prize in 1908 for discovering immune cells called phagocytes that engulf pathogens and particles. Eventually, she moves on to modern-day researchers like Charles Serhan, who helped identify molecules known as resolvins that turn off inflammation.

This lays a proper foundation for the book’s second section, which connects these discoveries to inflammation’s possible role in disease. Low levels of inflammation have been found in people with conditions such as cancer. While inflammation is a normal response to injury and disease, persistent inflammation is now being viewed as a potential cause of illness.

Ravella further speculates that inflammation can contribute to conditions like depression and Alzheimer’s disease, though as a responsible medical professional, she provides important caveats and stresses the need for more research.

The most damning evidence links inflammation to autoimmune conditions – which occur when the body damages its own cells – such as rheumatoid arthritis. Characterised by long-lasting, low levels of inflammation, these conditions increase susceptibility to other problems like bone loss, heart disease and kidney disease.

The book wraps up by detailing how factors like diet and exercise can contribute to inflammation as well as help dampen it. For many, this won’t be new, but what may be illuminating is Ravella’s explanation of lifestyle significance.

For instance, she devotes a whole chapter to the gut microbiome, describing how processed foods and animal products, like red meat and dairy, disrupt microbial composition, setting off a chain of events that leads to increased inflammation. She then explains why fruits, vegetables and whole grains can help undo these effects.

A Silent Fire is no quick read: it is packed with information, combining medical history, innovative research and first-hand clinical experiences. At times, it feels over-ambitious, as Ravella crams in as much as possible rather than clearly connecting the various topics. It can also be difficult to keep track of all the different microbes, scientists and immune cells involved, especially if you lack a scientific or medical background.

But Ravella’s writing style keeps even the most dense page engaging. She breathes life into biological function, at one point describing types of white blood cells as “sophisticated warriors” that “voraciously gobble up” particles. Ultimately, the book is perfect for those looking to delve deeper into the history and intricate workings of immunology, diet and disease.

– A Silent Fire is published by Bodley Head

– Rheumatoid arthritis, as shown in this X-ray, is a chronic inflammatory condition
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