http://www.bbc.

com/future/story/20130304-skip-breakfast-pile-on-weight/all
Does skipping breakfast make you put on weight?
Were often told that breakfast is an essential part of a healthy diet, especially
if you are watching your weight. Some schools run breakfast to ensure that as m
any pupils as possible eat this all-important first meal of the day. But not eve
ryone can stomach an early morning meal. In Europe and US between 10% and 30% of
people skip breakfast, with teenage girls most likely to give it a miss, saying
theyve not got time, dont feel hungry or that theyre on a diet.
Missing breakfast for dietary reasons runs counter to a great deal of advice. Th
e logic goes that missing an early morning meal will leave you hungry for the re
st of the day, tempting you to snack on high-calorie foods, and resulting in wei
ght gain.
Its a plausible theory, until you look for evidence that people who skip breakfas
t consume any more calories than anyone else. The impact skipping breakfast has
on weight is harder to study systematically than you might expect. The first pro
blem is how to define that first meal of the day. How much food counts as a real
breakfast? Do you have to eat it seven days a week to be defined as a breakfast
-eater? And how early in the day does it need to be eaten? For example, when the
US Department of Agriculture conducted a systematic review on the topic they fo
und that most studies defined breakfast as food eaten before ten in the morning.
Anyone who ate at 10.05 was considered to have skipped breakfast, which could s
kew the results.
Another difficulty is that what is eaten for breakfast varies from country to co
untry. In Scandinavia it might include smoked fish, in Germany cold meats, and i
n the UK boxed cereals, which can often contain more sugar and salt than people
realise (the Consensus Action on Salt and Health group says some cereals are sal
tier than seawater). This makes the impact of eating breakfast more difficult to
study on a global level because the nutritional benefits will depend on what yo
u include in the meal.
But if we stick to looking at calories consumed, there have been many attempts t
o study the impact of eating breakfast on a persons weight. A review of studies
conducted before 2004 found that on the whole breakfast-skippers do not consume
more calories during the rest of the day to compensate. People who ate breakfast
tended to have a diet that was more nutritionally balanced, but it wasnt more ca
lorific. The findings on weight are a little more complex. Four studies found th
at children who didnt eat breakfast had on average a higher body mass index, but
another three studies found it made no difference. The advantage of those first
four studies was that they had taken more trouble to control for factors which m
ight skew the results. So the evidence begins to tip slightly towards a link bet
ween missing breakfast and increased weight.
To muddy the waters, a US review in 2011 cited five studies that found an associ
ation between breakfast-skipping and weight gain: three that found it made no di
fference, and one which found the opposite that amongst overweight children, the
breakfast-eaters weighed even more. And to confuse the issue even more, a meta-
analysis which pooled the results of nineteen studies conducted in Asian and Pac
ific regions found a relationship between increased weight and missing breakfast
. A European systematic review had similar findings, but one study found the rel
ationship between breakfast-skipping and weight only existed for boys.
Does size matter?
What happens when you turn the question round? Seven studies found that overweig
ht children are more likely to skip breakfast. But this highlights the problem w
ith these studies they are cross-sectional. They take a snapshot in time. They d
ont prove causation. We cant know which came first the excess weight or the breakf
ast-skipping. Perhaps these children are missing breakfast because they are alre
ady overweight and are trying to eat less.
The alternative is to study people for a long period of time, and the first long
itudinal study on this topic was done in 2003. When the study researchers took a
snapshot in time they found that children who skipped breakfast weighed more on
average. But when they followed the same children for three years the heavier c
hildren who missed breakfast actually lost weight over time.
So were left with a situation where many studies, but by no means all, find that
children who miss breakfast are more likely to be overweight. However, we cant be
sure whether their diet or missing breakfast is making them overweight. If miss
ing breakfast is contributing to their weight gain then its not clear why, becaus
e they dont consume more calories overall.
If its not about total calories consumed, could the timing of meals have an effec
t? Are three smaller meals better than two larger ones? Very few randomised cont
rolled trials have been done on this topic, but there was one carried out in 199
2 on adults. Obese women were given diet plans in which everyone ate the same to
tal number of calories in a day half had three smaller meals a day, while the ot
her half missed breakfast, but had lunch, followed by a larger supper later on.
These results really are fascinating. Those who were accustomed to skipping brea
kfast lost more weight if they were put in the group who ate breakfast, while th
e people used to regularly eating an early morning meal lost more weight if they
skipped breakfast. In other words, a change in their normal routine helped the
m to lose weight. So maybe the lesson of that study is that you should simply d
o something different. At the University of Hertfordshire in the UK psychologist
s have developed and researched a weight loss programme based on just this premi
se.
It is a confusing picture, which is why a new paper just published on dieting my
ths includes skipping breakfast as one of the diet presumptions that have not be
en proven. If you choose a single study you can prove your argument either way.
So when it comes to weight the jury is out,
But there could be other benefits of eating breakfast. Randomised controlled tri
als in rural Jamaica and Peru showed improved grades in children who ate breakfa
st at school. These might not generalise to everywhere because they might well h
ave been nutritionally-deprived beforehand, so breakfast might have made more di
fference there than in well-nourished children.
So, to the acid question: should you eat breakfast or not if you want to lose we
ight? People who eat breakfast do tend to have a more balanced diet overall, but
if you are only interested in the weight aspect, then until more randomised con
trolled trials have been done, it comes down to personal preference. Some of us
simply cant face the idea of an early breakfast. If thats you, you can blame your
chronotype new research has found that evening types just dont feel hungry early
in the mornings. In that case, until some really good randomised controlled tria
ls prove otherwise, perhaps the answer is to follow your stomach, not fight it.
http://www.bbc.com/future/story/20130513-can-you-use-phones-in-hospitals/all
Are mobile phones dangerous in hospitals?
When I was a volunteer working in hospital radio in my teens, patients who wante
d to call their relatives had to wait until a heavy payphone on wheels was trund
led up to their bedside. When it wasnt being used by another patient, that is. Th
en came mobile phones and for a short time people were able to keep in touch wit
h their families as much as they desired, until many hospitals around the world
banned the use of mobile phones on hospital wards, fearing they might cause esse
ntial medical equipment to malfunction.
Lots of patients flouted the rules and so did some staff. In a survey in 2004, 6
4% of doctors confessed to leaving their phones switched on in high-risk areas,
such as operating theatres or high dependency units.
Many hospitals are now relaxing the rules when it comes to wards and corridors,
but its taking some time. In the Canadian province of Quebec the first hospital l
ifted restrictions only six months ago.
Is there any evidence that mobile phone signals do, or ever did, disrupt equipme
nt? In a paper published in 2006 the eminent epidemiologist Martin McKee pointed
out that although the use of evidence-based treatment was on the increase, evid
ence was sometimes lacking when it came to other hospital activities. Mobile pho
nes were a prime example. He examined practices in eight European countries and
found that all had a ban of some kind, with France even bringing in legislation
against mobile phone use in hospitals.
In some early studies, there was minimal interference in 1-4% of equipment teste
d, but only if they were within a metre of a phone. This might sound like a smal
l number, but if its a vital piece of equipment keeping someone alive then it cou
ld be critical. Yet the authors of a 2007 paper on the topic could not track dow
n a single death caused by the use of a mobile phone.
Interference from a phone depends on three things the intensity of the signal, t
he frequency of the signal and the degree to which equipment is shielded. Whene
ver a phone is switched on it transmits a signal hoping to make contact with a b
ase station in order to send and receive calls or texts and with smartphones, em
ails and other data. Once these electromagnetic waves are being transmitted, any
length of wire in a piece of medical equipment can act as an antenna. In princi
ple, even the wire linking a patient to a monitor could do it. Its the resulting
electric current which could disrupt the equipment. In the newest kinds of devic
es the internal wires have been shortened in order to avoid this.
A few studies have recorded flickering screens and in one case an old infusion p
ump stopped working. In another study interference was observed in 20% of the te
sts, but only 1.2% was considered clinically important.
A Dutch study of second and third generation phones tested 61 medical devices us
ed in critical care, and found that 43% were affected by phones. These ranged fr
om ventilators turning off, to syringe pumps stopping and external pacemakers lo
sing the correct pace. But the phones were very, very close the median distance
was just 3cm. Also instead of using real phones, they used a generator which si
mulated a worst-case scenario, where a phone transmits with increased power in t
he hope of getting a signal. (To save on battery power phones transmit at weaker
power whenever they can.) In real life, provided the signal in a hospital is go
od then phones wont be transmitting at this rate.
Current phones cause even less interference and modern medical equipment is bett
er-shielded, but the most recent guidance from the National Health Service in Br
itain, for example, still warns against their use in critical or intensive card
wards, stating that they could interfere with dialysis machines, defibrillators,
ventilators and monitors. For the moment, this could be a wise precaution, beca
use if a phone were held very close to a piece of equipment then it might affect
it. For this reason, some have suggested that medical equipment should come rea
dy-protected from such signals, or that hospitals install phone base stations to
prevent the phones from having to transmit at stronger power in order to get a
signal. This would, of course, cost hospitals money.
Far from causing incidents, mobile phones might even prevent them by allowing do
ctors to respond faster. A survey of more than four thousand anaesthesiologists
in the US found they were six times more likely to have witnessed an injury or e
rror as a result of delays in communication than to have observed interference o
f any kind (even non-risky interference) caused by a mobile phone.
So with the exception of holding phones next to critical care equipment, there i
s no convincing evidence supporting blanket bans on the grounds of electromagnet
ic interference. But there might be other reasons why phones are not so desirabl
e in hospitals. Phones are hard to clean, and how many of us ever do so? A study
of healthcare workers in Southern India found that 95% of their phones were con
taminated with bacteria. Meanwhile studies of staff phones in Barbados and patie
nts phones in a hospital in Turkey both showed contamination rates of 40%, someti
mes with bacteria known to show resistance to many types of antibiotics.
On top of the hygiene problems, there are issues of privacy. Most phones now com
e complete with cameras and sometimes people just cant resist taking pictures. Th
e LA Times reported that staff at one hospital even took photos of a 60-year-old
man dying from multiple stab wounds and put them up on Facebook. In that case,
perhaps phones in hospitals arent such a good idea after all.
http://www.bbc.com/future/story/20130917-truth-about-drink-and-antibiotics/all
Can you mix antibiotics and alcohol?
Women who are in the early stages of pregnancy, and who are not ready to share t
he happy news, know that turning down an alcoholic drink at a social occasion ca
n be a dead giveaway. Telling friends and colleagues they are on antibiotics is
the perfect excuse because they are so commonly used. Even the nosiest of acquai
ntances is unlikely to ask what they are being taken for.
But is it really true that you need to abstain from alcohol when on a course of
antibiotics?
Some people assume that alcohol will stop antibiotics from working properly, whi
le others believe that it will cause side-effects. When staff in a London genito
urinary clinic surveyed more than 300 patients they found that 81% believed the
former assumption, with 71% believing the latter.
For most antibiotics neither of these assumptions is true. The fear for doctors
is that these erroneous beliefs might make patients skip their medication over a
glass of wine. Anything that encourages people to miss doses of antibiotics add
s to the serious problem of antibiotic resistance.
In fact, the majority of the most commonly prescribed antibiotics are not affect
ed by alcohol. There are some exceptions. The antibiotics cephalosporin cefoteta
n and cephalosporin ceftriaxone slow alcohol breakdown, leading to a rise in lev
els of a substance called acetaldehyde. This can cause a host of unpleasant symp
toms including nausea, vomiting, facial flushing, headache, breathlessness and c
hest pain. Similar symptoms are caused by a drug called disulfiram, sometimes us
ed in the treatment for alcohol dependency. The idea is that the moment a patien
t has a drink, they experience these unpleasant symptoms, and this dissuades the
m from drinking more. The symptoms are unpleasant, so it is important that peopl
e abstain from alcohol while theyre taking these particular antibiotics, and for
a few days afterwards.
Another type of antibiotic that comes with a specific warning not to take alongs
ide alcohol is metronidazole. Used to treat dental infections, infected leg ulce
rs and pressure sores, its thought to cause the same list of symptoms as the prev
iously mentioned cephalosporins. This link has been disputed since a 2003 review
of studies found a lack of evidence to support it, and a very small controlled
study in which Finnish men given metronidazole for five days suffered no side ef
fects when they consumed alcohol. The authors concede that this doesnt rule out t
he possibility that a few individuals are affected, and the current advice is st
ill to avoid alcohol when taking it.
There are a few other antibiotics for which there are good reasons to avoid drin
king alcohol while taking them, including tinidazole, linezolid and erythromycin
, but these interactions are so well-known that doctors give patients specific w
arnings.
Recycled tale
This leaves a long list of other antibiotics that can be mixed with alcohol. Of
course getting drunk is not going to help your recovery when youre ill. It can ma
ke you tired and dehydrated, but its not because of any interaction with your med
ication.
Its possible that the isolated cases led to the myth that all antibiotics dont mix
with alcoholic drinks, but there are two more intriguing theories. One is that
because antibiotics are used to treat some of the most common sexually transmitt
ed diseases, doctors in the past were somehow punishing the patients for becomin
g infected by depriving them of their favourite tipple.
Or theres the explanation given to one of the authors of the London genitourinary
clinic survey. James Bingham met the late Brigadier Sir Ian Fraser, who introdu
ced the use of penicillin for injured soldiers in North Africa during World War
II. At the time penicillin was in such short supply that after a patient had tak
en it, the drug was retrieved from his urine and recycled. Recuperating soldiers
were allowed to drink beer, but unfortunately this increased the volume of thei
r urine, making it harder obtain the penicillin and, according to the Brigadier,
led commanding officers to ban beer.
It's a good story, irrespective of whether or not it is the true source of the p
opular misconception. Dispelling the myth is something of a double-edged sword.
Encouraging those on the antibiotics who cannot resist a glass or two to complet
e their courses of treatment could help counter the spread of antibiotic resista
nce. However greater public understanding of the true picture may mean that wome
n wanting to keep their early pregnancies to themselves in social situations may
have to be a little more inventive in future.
http://www.bbc.com/future/story/20130904-does-milk-calm-an-upset-stomach/all
Does milk settle an upset stomach?
When youre feeling too ill to eat, or have indigestion, what could be better than
a gentle, thick glass of milk to settle your stomach? Its soothing to drink, and
at least you are getting something nutritious inside you. This remedy has been
around for years in countries where milk is popular. Until the 1980s, doctors wo
uld sometimes recommend milk to patients with duodenal ulcers (in the intestine
just beyond the stomach) to help ease their discomfort.
Milk is in fact slightly acidic, but far less so than the gastric acid naturally
produced by the stomach. So it was long thought that milk could neutralise this
stronger acid and relieve the pain. Milk does help provide a temporary buffer t
o gastric acid, but studies have shown that milk stimulates acid production, whi
ch can make you feel sick again after a short period of relief.
In 1976, ten hardy research participants put themselves forward to test this out
. They had their stomachs emptied and were then fed milk through a tube up their
nose. An hour later the contents of their stomachs were sucked out again and th
en gastric acid secretion was measured every five minutes. The researchers found
that milk caused an increase in the secretion of gastric acid for the next thre
e hours, which could explain why people with ulcers typically experience pain a
few hours after a meal.
Its not just milk, though. Studies comparing coffee, tea, beer and milk found the
y all stimulated the secretion of acid. Beer and milk have the greatest effect,
which suggests, somewhat surprisingly, that the pH of a drink is irrelevant when
it comes to acid production.
So what is the ingredient in milk that causes the stomach to produce acid? Resea
rchers in the 1976 study looked at fat by comparing whole, low-fat and fat-free
milk. All increased acid secretion. How about calcium? When they tried the exper
iment using low-calcium milk, less acid was produced, but there was an exception
. The patients who had evidence of duodenal ulcers, but were not currently exper
iencing symptoms, produced more acid.
The other ingredient which might stop milk from settling your stomach is the mil
k protein casein. It is thought it either stimulates the release of the hormone
gastrin, which in turn controls the production of gastric acid, or it stimulates
directly the cells in the stomach lining, known as parietal cells, to release a
cid.
Either way, milk is no longer recommended for people with ulcers because it migh
t do the opposite of soothing them. It could make them worse. In 1986 patients w
ith duodenal ulcers spent four weeks in hospital on medication as part of a cont
rolled trial. One unlucky group was assigned to drink only milk two litres a day
in total, with added sugar if they preferred. The other group ate the usual hos
pital diet and both groups were also offered additional fruit, so there was a si
milar total intake of calories between the two groups. At the end of the four we
eks each patient underwent an endoscopy to examine their ulcers. Significantly m
ore people on the standard diet had ulcers that had healed, while fewer than exp
ected got better in the milk-drinking group. Milk appeared to hinder the healing
process.
If you are well, drinking milk is still encouraged, as it is a good source of pr
otein and calcium. But could very large quantities of milk present a problem? In
1980, 21,000 adults in the city of Tromso in Norway were invited to join a heal
th study where they would be followed for seven years, during which time 328 dev
eloped peptic ulcers (an umbrella term covering duodenal and stomach ulcers). Th
ey found that heavy milk drinkers (defined as four or more glasses a day) were m
ore likely to develop an ulcer, especially amongst the men. Again, it made no di
fference whether the milk was full fat or skimmed. So was the milk causing the u
lcers? The difficulty here is that some people with pain drink milk to ease the
symptoms temporarily, so perhaps they were consuming milk as a result of the ulc
er. But the risk was also high in those drinking large quantities of milk, despi
te not having symptoms, so its hard to disentangle the causality.
So although milk temporarily coats the lining of the stomach, buffering the acid
in your stomach and making you feel a bit better, the relief might last for onl
y twenty minutes or so. In other words milk may have many benefits, but settling
an upset stomach isnt one of them.