SEASONAL AFFECTIVE DISORDER (SAD)
Seasonal affective disorder (SAD) is a type of depression that comes and goes in a seasonal pattern. SAD is sometimes known as "winter depression" because the symptoms are usually more apparent and more severe during the winter.
Symptoms of SAD can include:
- a persistent low mood
- a loss of pleasure or interest in normal everyday activities
- irritability
- feelings of despair, guilt and worthlessness
- feeling lethargic (lacking in energy) and sleepy during the day
- sleeping for longer than normal and finding it hard to get up in the morning
- craving carbohydrates and gaining weight
- difficulty concentrating
- decreased sex drive
For some people, these symptoms can be severe and have a significant impact on their day-to-day activities.
You should consider seeing the GP if you think you might have SAD and you're struggling to cope. The GP can carry out an assessment to check your mental health. They may ask you about your mood, lifestyle, eating habits and sleeping patterns, plus any seasonal changes in your thoughts and behaviour.
What causes SAD?
The exact cause of SAD is not fully understood, but it's often linked to reduced exposure to sunlight during the shorter autumn and winter days. The main theory is that a lack of sunlight might stop a part of the brain called the hypothalamus working properly, which may affect the:
- production of melatonin – melatonin is a hormone that makes you feel sleepy; in people with SAD, the body may produce it in higher than normal levels. Serotonin is a hormone that affects your mood, appetite and sleep; a lack of sunlight may lead to lower serotonin levels, which is linked to feelings of depression
- body's internal clock (circadian rhythm) – your body uses sunlight to time various important functions, such as when you wake up, so lower light levels during the winter may disrupt your body clock and lead to symptoms of SAD
It's also possible that some people are more vulnerable to SAD as a result of their genes, as some cases appear to run in families. A range of treatments are available for SAD. The GP will recommend the most suitable treatment programme for you.
The main treatments are:
- lifestyle measures – including getting as much natural sunlight as possible, exercising regularly and managing your stress levels
- light therapy – where a special lamp called a light box is used to simulate exposure to sunlight
- talking therapies – such as cognitive behavioural therapy (CBT) or counselling
- antidepressant medicine – such as selective serotonin reuptake inhibitors (SSRIs)
IRRITABLE BOWEL SYNDROME
Irritable bowel syndrome (IBS) is a common condition that causes a variety of unpleasant abdominal symptoms.
Who's affected?
IBS is the most common gut condition and affects up to one in five people at some time, often between the ages of 25 to 45 years old. Women are more often affected than men.
Although the exact cause is unknown, the condition is thought to be caused by a combination of factors including abnormal movements of the intestines and altered sensation of the gut. Some people develop IBS following gut infections and food poisoning. It isn't possible to prevent IBS from developing. However, certain things can trigger attacks for those with IBS and should be avoided. These include stress, eating irregular meals and, in some cases, a lack of dietary fibre.
Symptoms
Abdominal cramps that may be eased by passing wind or passing a motion; bloating and abdominal distension; diarrhoea, constipation, or alternating diarrhoea and constipation; or a feeling of incomplete emptying of the rectum are all common.
Other possible symptoms that aren't related to the gut include backache, tiredness, headaches, and urinary or gynaecological symptoms.
IBS doesn't develop into bowel cancer.
Treatment
Peppermint oil and antispasmodic medication relieve abdominal pain. Anti-diarrhoea medication will stop diarrhoea. If constipation is a problem then increasing fluid, fibre, activity, as well as taking a gentle laxative may be recommended.
Some people with IBS find that increasing the amount of dietary fibre and reducing caffeine helps. Reducing stress and taking time to relax is important. Complementary therapies, such as acupuncture and homeopathy, are often used.
OSTEOPOROSIS
Osteoporosis is a condition where the bones - particularly those of the spine, wrist and the hips - become thin and weak and break easily. Often there are no symptoms.
Osteoporosis mainly affects women after the age of the menopause, although men can have it too. It can occur in younger people if they have other predisposing factors.
What causes it?
The condition occurs because from around the age of 35 more bone cells are lost than replaced. This causes the bone density to decrease.
The first sign is commonly when a minor bump or fall causes a bone fracture. These may result in pain, disability, loss of independence, and death. Osteoporosis may cause people to 'shrink' as they get older. It causes the characteristic 'dowager's hump'.
Who is affected?
About 3 million people in the UK have the condition, which is more common in women than men. Every year in the UK over 230,000 fractures occur because of osteoporosis. In the UK one in two women and one in five men over the age of 50 will suffer a fracture.
After the menopause bone loss speeds up making osteoporosis more likely. In women the risk is increased if they have an early menopause, have their ovaries removed before the menopause, or miss periods for six months or more as a result of over-exercising or over-dieting. For men low levels of testosterone increase the risk. For men and women long-term use of corticosteroid medication, maternal osteoporosis, smoking, heavy drinking, sedentary lifestyle, and low body weight all increase the risk.
How do I know if I've got it?
First, you need to consider if you're at higher than average risk for osteoporosis.
Ask yourself the following questions:
If female, have you had the menopause? Was it premature - earlier than 45?
Did you have an eating disorder severe enough to stop your periods?
Have you had low trauma or spontaneous fractures in the past?
Have you been told that previous x-rays suggest thinning of the bones?
Have you lost height in the past ten years?
Have you been on steroids for more than six months?
Is there a family history of osteoporosis, easy fractures or 'dowager's hump'?
Do you have chronic illness such as thyroid disease, arthritis or bone disease, renal disease or hormonal problems?
Have you been immobile for any reason?
Do you have a high cigarette or alcohol use?
What happens then?
If you answer yes to two or more of these questions, you may have osteoporosis or be at risk of it. Go to see your GP who'll send you for specialist assessment.
As well as an examination and blood checks, there are a variety of tests which can give you a more definite density assessment. The commonest one is called a DEXA scan. This painless test involves a low dose of x-rays (less than a normal x-ray) usually across your wrist or hip, which gives a specific picture of how dense your bones are. The specialist will then tell you whether you have osteoporosis, or are at risk, and will suggest treatments.
Oestrogen, either naturally before the menopause or as HRT, is known to protect against bone loss. There a number of treatment options if you're diagnosed with osteoporosis.
Ways to prevent osteoporosis
You can help yourself by taking general measures such as the following:
Increasing the calcium in your diet.
Increasing weight-bearing exercise as this helps maintain bone density.
Reducing both alcohol intake and cigarette smoking.
Medication may include:
Calcium and vitamin D supplements.
A variety of hormone-type treatments including HRT, tibolone and SERMS.
Bisphosphonates are a group of drugs, which prevent bone breakdown and can be very effective in osteoporosis.
It's better to prevent any condition than simply to manage it when it happens. Osteoporosis assessment and management is an important factor in maintaining the health of your bone structure as you enter middle age.
Further help
The National Osteoporosis Society
Camerton Bath BA2 0PJ
Helpline: 0845 450 0230
Tel: 01761 471771
Website: www.nos.org.uk
FOOD INTOLERANCE
Not to be confused with food allergies, a food intolerance can cause various symptoms including bloating, abdominal pain and diarrhoea. We look at the most common causes and how to get a diagnosis.
What is it?
Food intolerance is an adverse reaction to some sort of food or ingredient that occurs every time the food is eaten, but particularly if larger quantities are consumed.
This isn't the same as a food allergy, because the immune system isn't activated. Neither is it the same as food poisoning, which is caused by toxic substances that would cause symptoms in anyone who ate the food. Food intolerance doesn't include psychological reactions to food either.
Causes
Food intolerance occurs when the body is unable to deal with a certain type of foodstuff. This is usually because the body doesn't produce enough of the particular chemical or enzyme that's needed for digestion of that food. For example, one of the most common types is intolerance of cow's milk, which contains a type of sugar called lactose. Many people have a shortage of the enzyme lactase, which is normally made by cells lining the small intestine. Without this enzyme they can't break down milk sugar into simpler forms that can be absorbed into the bloodstream. Lactose intolerance can cause symptoms very similar to irritable bowel syndrome. Another common example is a deficiency of an enzyme called aldehyde dehydrogenase, which is needed to break down alcohol. Drinking even small amounts can make affected people feel unwell. Some people have adverse reactions to chemical preservatives and additives in food such as seen with sulphites, benzoates, salicylates, monosodium glutamate, caffeine, aspartame and tartrazine.
The lack of a specific enzyme in the body may lead to the build up of toxic byproducts and histamine, which then mimic the symptoms of an allergy. This is called a 'pseudo-allergic' reaction.
Who’s Affected?
There's a strong genetic pattern to food intolerances. Lactose intolerance is less common among northern and western Europeans (10 to 15 per cent are affected) than in Asian, African, native American and Mediterranean populations (70 to 90 per cent are affected).
Babies are usually born with higher levels of lactase, so lactose intolerance usually only begins after the age of about two, as the body begins to produce less of the enzyme. However, many people don't experience symptoms until they're much older. A temporary lactase deficiency may follow gastroenteritis, especially in children.
Alcohol intolerance is common among Asian people - 50 per cent are affected.
Symptoms
Food intolerances are rarely harmful but may cause unpleasant symptoms, including nausea, bloating, abdominal pain and diarrhoea, which begin about half an hour after eating or drinking the food in question. The severity of symptoms varies depending on the amount of enzyme the person makes and how much of the food has been consumed. In alcohol intolerance, there may be intense flushing of the skin, nausea, palpitations, headache and feeling faint.
Diagnosis and Treatment
The easiest test for a food intolerance is to remove the food from your diet, see if symptoms improve and then try reintroducing the food. If symptoms return, an intolerance is likely. Lactose intolerance can be tested for more thoroughly using a lactose tolerance test, a hydrogen breath test and a stool acidity test. Your doctor can arrange these and other food intolerance tests if necessary. Food intolerance can be managed simply by cutting the food out of your diet. Babies or younger children with a lactose intolerance can be given soya milk or hypoallergenic milk formula instead of cow's milk. Adults may be able to tolerate small amounts of troublesome foods, so may need to experiment to work out what they can eat.