Last year was an eventful one for health news and new health research. In this post, we'll look at some of the questions these stories and studies posed, and discuss what the outcomes of some of these may be.

Is there a link between irregular sleep patterns and heart disease?

September 2018 - Getting sufficient sleep is an important part of our health, both mentally and physically. The body needs to recover for us to function effectively during the day, and lessen the chance of catching an illness.

A new study published in the Scientific Reports journal has highlighted the impact that a disturbed sleep schedule can have on cardiometabolic health risks such as heart disease, diabetes and stroke.

It had already been established that not getting sufficient sleep, and having a circadian misalignment (sleeping at inappropriate times such as during the day) was associated with an increased cardiometabolic risk. However, this latest research suggests that the connection between sleep problems and cardiometabolic conditions runs deeper.

What did the study involve?

The study involved 2156 people aged 45-84, who were located in six regions across the USA and were from four different ethnic groups (Caucasian, African-American, Chinese-American, and Hispanic). The baseline assessment for the study took place between 2000 and 2002, during which the participants were followed up to find about potential future cardiovascular diseases.

The measures for the study were a combination of actigraphy and self-reports. Actigraphy is the monitoring of rest cycles, in this case measuring physical activity and light exposure from a device worn on the wrist. The participants were required to wear the devices for seven days, and keep a sleep diary.

What were the findings?

The main finding was that sleep irregularity had the most significant relationship with obesity, high levels of blood glucose and haemoglobin AIC. The study also showed that irregular sleep patterns were closely related to reduced physical activity, as well as an increased propensity to sleep during the day, and overall reduced light exposure.

Furthermore, there was a higher projected risk for the decade following the start of the study for developing cardiovascular disease. It was also surmised that stress and depression had a close correlation with irregular sleep, and those participants who suffered from high blood pressure had more irregular sleep than those who did not.

What could this mean for the future?

The paper accompanying the study also outlined the possible benefits and limitations from the outcomes. The researchers hypothesised that consistent sleep irregularity could be used as an indicator and precursor for identifying individuals who were susceptible to developing cardiometabolic diseases and the possible prevention opportunities that this opens up. They also suggested that future studies should contain information relating to employment, as this study was not able to exclude shift workers who, in general, are more likely to develop cardiometabolic conditions.

If you are struggling to get regular sleep, then establishing a time at which you wind down and go to bed will help. It can also be useful to create a relaxing atmosphere in the bedroom, by having on soft lights before bedtime, and avoiding looking at an electronic screen and reading a book instead.

Will the Sale of Energy Drinks to Under 16s Be Banned?

In November 2018, a cross-party committee advising the Government concluded an examination of whether the sale of energy drinks to young persons (under 16) should be made illegal. The committee found that, while they heard concerns that could make a ban feasible, there was insufficient scientific evidence for them to recommend a ban.

They advised the Government to commission further research to determine how unhealthy energy drinks are compared to other soft drinks.

Why was a ban being discussed?

The consultation was launched in August 2018, and was undertaken by the Science and Technology Committee. It came after spokespersons for several health bodies voiced concerns around the issue.

Steve Brine MP, a minister for the Department of Health and Social Care, stated that UK teenagers ‘consume 50% more of these drinks’ than teenagers in Europe. Research shows that there was a 185% increase in energy drinks sales in the UK between 2006 and 2015.  

A study undertaken by academics from FUSE and published in PLOS ONE found that around one third of young people said they regularly consume energy drinks. The study cited research suggesting a link between energy drink consumption in young people and unhealthy behaviours, as well as physical symptoms such as headaches, stomach aches, sleeping problems and palpitations.

Giving evidence to the consultation, the General Secretary of teachers union NASUWT, Chris Keates, commented that energy drinks were contributing towards poor pupil concentration in lessons and behavioural problems.

The committee was also told that the cheapness of energy drinks made them too easily accessible to young people.

What did the committee find?

The committee did not think there was currently enough evidence for them to recommend a blanket ban on the sale of energy drinks to under-16s. They said that it was unclear whether there was any notable difference in younger persons’ consumption habits between energy drinks and other soft drinks containing caffeine (such as coffee).

However, Norman Lamb MP, Chairman and spokesperson for the committee, stated that they had discovered significant concerns around the issue. In view of these, he said the Government could go ‘beyond the evidence’ currently available, and would be justified in implementing a ban. But if it did, it should explain why it had done so.

The committee recommended that the Government commission more research to be independently carried out, and investigate how bad for health energy drinks are in comparison to soft drink alternatives.

Responding to the outcome of the consultation, President of the Royal College of Pediatrics and Child Health (RCPCH) Professor Russell Viner expressed disappointment that a ban was not recommended. He went on to say that a minimum price for energy drinks should be considered as their pricing was certainly a factor in young people’s consumption.

What makes energy drinks unhealthy?

Energy drinks tend to contain more caffeine than other carbonated soft drinks, such as Coke, and can also be just as high in sugar.

For example, a 330ml can of Coke contains 32mg of caffeine and 35g of sugar.

A regular can of Red Bull (250ml) contains 80mg of caffeine and 27.5g of sugar. A 500ml can of Monster (regular) contains 160mg of caffeine and 55g of sugar.

To provide a coffee comparison, a McDonald’s small Americano contains 71mg of caffeine, and a medium 142mg.

Studies on the overall health benefits of caffeine consumption have produced conflicting results. But the short-term effects of too much caffeine are well-known. And as well as causing the jitters, a headache and inability to sleep, over the long-term, excessive caffeine consumption is thought to increase the risk of osteoporosis; so it’s important to stay within sensible limits.

There is no recommended set guideline or reference intake on caffeine in the UK, apart from in pregnant women, who are advised to have no more than 200mg per day. We’ve written previously on the subject of recommended daily coffee consumption that for most adults, it’s generally better to stay under 400mg a day.

However younger people, particularly those under 16, should generally be consuming less than this. Mayo Clinic advises no more than 100mg a day for adolescents. The European Food Standards Agency states that 3mg per kilogram of body weight is a safe level (so for a child weighing 40kg, 120mg would be the limit).

In his response to the consultation, Professor Viner argued that energy drinks present no benefit to children, and are only detrimental to health.

There’s also the sugar-dense aspect of some energy drinks to consider.

The daily reference intake of sugar for an adult is 90g; however, food and drink containing added sugars should make up no more than 5% percent of an adult’s daily calorie intake. This brings the added sugar reference intake for adults and children over the age of 11 down to around 30g; whereas children aged between 7 and 10 are advised to consume no more than 24g in added sugars a day.

So a 250ml serving of a regular (non-diet) energy drink would bring someone close to this. A 500ml serving would see them comfortably exceed it. (And, for the sake of balance, a 330ml can of Coke would tip them over the threshold too.)

Regularly exceeding recommended sugar intake can contribute towards diet-related diseases such as type 2 diabetes and obesity, as well as other health issues such as gum disease and tooth decay.

Could the sale of energy drinks to under 16s be made illegal?

It likely won’t be soon, but it could still happen.

While the consultation hasn’t resulted in a ban, it’s still possible that the subject could be returned to the House of Commons if further research is carried out (as per the recommendation of the committee), and this suggests that a ban would help to protect younger people’s health.

Several large supermarket chains, including Asda, Tesco and Morrisons, have already taken action and introduced their own no-selling policies on energy drinks to under 16s; so the sale of these products to younger people is already restricted to an extent. However, a straight ban imposed by the government would take this further, and prevent smaller shops and off-licences from selling to under-16s as well.

In any case, it’s advisable to stay under the threshold when it comes to consuming sugar and caffeine. Maintaining good sleep hygiene and eating a healthy, balanced diet can help to reduce feelings of tiredness and help you focus; so you don’t need to rely on quick caffeine and sugar hits quite as much.

Can Writing Down Positive Emotions Improve Mental Wellbeing?

July 2018 - Stress and anxiety can impact on both our mental and physical health. They can cause symptoms such as stomach upsets, headaches, sleep problems, irritability and chest pain.

Previous research has suggested that writing down negative emotions has the potential to improve mental and physical symptoms. It has also been suggested that writing about positive experiences can result in an improvement in mood.

A new study published in the British Journal of Health Psychology wanted to explore this theory this further and has looked at how writing about positive experiences might impact feelings of stress and anxiety.

What were the participants asked to write?

Let’s take a look at a breakdown of the study’s components:

  • 71 healthy participants were divided into two groups.
  • One group (with 37 participants) was asked to write about the most wonderful experiences of their lives.

The instructions provided to participants in this group were as follows: ‘Think of the most wonderful experience or experiences in your life, happiest moments, ecstatic moments, moments of rapture, perhaps from being in love, or from listening to music, or suddenly ‘being hit’ by a book or painting or from some great creative moment. Choose one such experience or moment. Try to imagine yourself at that moment, including all the feelings and emotions associated with the experience. Now write about the experience in as much detail as possible trying to include the feelings, thoughts, and emotions that were present at the time. Please try your best to re‐experience the emotions involved.’

  • The other group (with 34 participants) was asked to write about a neutral topic, such as aspects of daily life and their plans for the next day.
  • Both had to complete the task for 20 minutes each day, for three consecutive days.  
  • Self-reported anxiety levels were gathered before and after the writing task.

Did writing these thoughts down make a difference?

The participants in the positive-experience group were found to have a ‘significantly greater decrease in anxiety’ when compared to the neutral topic group.

Four weeks after the writing task the participants reported on their stress and anxiety levels, as well as any physical health complaints.

Stress and anxiety levels were reported to have decreased by a significantly greater amount for those who had written about positive experiences, when compared to their levels recorded before the writing task.

The writing experience did not lead to any reported improvements in physical health problems.

What do the results mean for stress and anxiety?

Mental health services in England are said to be under increasing pressure as more people are turning to them for help.

Arts and creative therapies are already used to help some patients talk about and understand their feelings but they are usually carried out under the guidance of a therapist. Complementary and alternative therapies such as yoga and meditation can be used to help some people manage stress.

A simple task such as writing about positive experiences can be completed for free and at the patient’s convenience. Perhaps this type of writing therapy will form a part of alternative or creative therapy strategies in the future.

Alternative therapies do not suit all patients and those using more traditional therapy methods such as cognitive behavioural therapy (CBT) and medication should consult with their doctor before trying alternative methods.

It is also important to remember that this is a small study that was not conducted in a clinical setting. The single-blind approach that was applied means that it could have been possible for participants to display unconscious bias during the process.

Could positive writing improve physical illnesses?

Our mental and physical health are intrinsically linked. However, the results of this particular study did not provide evidence to suggest that writing about positive experiences can benefit physical health.

Further research would be required in order for more concrete conclusions to be drawn about the impact of positive emotional writing on physical health.

Can weekend lie-ins make up for lost sleep in the week?

May 2018 - Good sleep hygiene is, as we’ve written previously, integral to good physical and mental health. Not getting enough can inhibit how well we function during the day, and increase the risk of illness.

In the past, studies have suggested a link between too much or too little sleep and an increased risk of early mortality. But none have looked at the impact of weekend sleep specifically.

A new study has done exactly this, by analysing weekday and weekend sleep patterns, and examining whether these can have an impact on mortality risk. The study was published in The Journal of Sleep Research, and prompted several media headlines that seemed to suggest that weekend lie-ins can stave off an early death.

In this post, we’ll take a look at the study in more detail.

How was the study carried out?

The observational study used record-linkages to follow the 43,880 subjects for 13 years. Record linkage is a type of data acquisition which involves using multiple sources to retrieve information on the same person.

Participants also provided self-reported data, through questionnaires, on their sleep habits from 1997 until 2010.

The research received financial backing from the Italian Institute Stockholm and AFA Insurance. It was undertaken by the Karolinska Institute and Stockholm University in Sweden, and Texas A&M University in the US.

The results

Compared to the reference group that regularly slept for 6-7 hours per night on both evenings and weekends:

  • adults under 65 who regularly slept for five hours or less throughout the seven day week were found to have an increased risk of death during the 13-year follow up period. This group were 65 percent more likely to have died
  • adults under 65 who during weekends slept for five hours or less had an increased risk of death (52 percent more likely to have died)
  • and people under 65 who slept upwards of eight hours during the week and nine hours on the weekend were 25 percent more likely to have died.

Other sleep patterns, including shorter sleep on weekdays combined with longer sleep at the weekend, did not produce a change in the mortality rate, when compared with the 6-7 hour reference group.

In adults over the age of 65, no link between weekday/weekend sleep and mortality risk was observed.

What do the findings suggest?

The findings serve as confirmation that not getting enough sleep over the long-term can negatively impact on health.

The researchers suggested, because no increased risk was observed in the group having shorter weekday sleep/longer weekend sleep, that [...] long weekend sleep may compensate for short weekday sleep.’

However, the researchers also recognised that their study is only ‘speculative’ and that further research is required to confirm any of the findings.

The fact that the over 65 age group did not produce a difference between weekend and weekday sleep could be because Swedish people tend to retire at the age of 65.

Are we getting enough sleep?

The NHS says that most adults require between six and nine hours of sleep each night. A regular bedtime can help to let your bodyclock know that it needs to wind down and prepare for sleep.

A lack of sufficient sleep can contribute to several health issues such as stress, obesity and diabetes, and exacerbate conditions such as asthma.

If you’re experiencing problems with sleep or are concerned that it may be impacting on your health, speak to your doctor for advice.

What is ‘The Planetary Diet’ and is it good for us?

January 2019 - A new study published by the Lancet commission has suggested implementing “the planetary diet” to help sustainably feed a growing population that will soon reach 10 billion. It recommends a huge shift towards drastically reducing meat and dairy from our diets and increasing our consumption of vegetables and legumes instead.

The study was produced through a collaboration of 37 leading scientists from 16 countries. These scientists represented several different disciplines such as agriculture, environmental sustainability and human health.

What does the planetary diet consist of?

The diet that the commission came up with is rich in plant-based foods with less reliance on animals for food sources. This has the benefit of improving both health and the environment. The study defines planetary health as ‘the health of human civilisation and the state of the natural systems on which it depends’.

The diet consists of the following daily nutritional recommendations (in grams):

  • Whole grains (such as rice, wheat, corn) - 232
  • Starchy vegetables such as potatoes - 50
  • Vegetables - 300
  • Fruits - 200
  • Dairy foods - 250
  • Protein sources
    • Beef, lamp and pork - 14
    • Chicken and poultry - 29
    • Eggs - 13
    • Fish - 28
    • Legumes - 75
    • Nuts - 50
  • Added fats
    • Unsaturated oils - 40
    • Saturated oils - 11.8
  • Added sugars
    • All sugars - 31

The meat numbers will likely be the most striking for the majority of meat-eaters. 14 grams of beef equates to roughly five to ten percent of a pre-packed supermarket steak. 29 grams of chicken is around one third of a chicken breast.

Why has it been developed, and why is what we eat a concern?

The aim of the research was to develop a strategy to satisfy the demands of a growing population whilst limiting the expansion of farmland, the waste of water, and the amount of greenhouse emissions.

Livestock is thought to account for as much as 18% of greenhouse gas emissions caused by humans. Rearing livestock is also a key cause of methane and nitrous oxide emissions. Currently, The Lancet has estimated that around 820 million people in the world do not have sufficient food, and many others either have poor quality diets with a nutritional imbalance or eat too much. This provides a greater global risk for morbidity and mortality than unsafe sex, tobacco use, alcohol and drug abuse combined.

If the current level of global food production continues, the study argues, then the stability of the climate and ecosystems will be threatened, and future generations will increasingly suffer from malnutrition and disease. However, the study also argues that this can be prevented with an overhaul of current dietary trends.

Is the planetary diet good for us?

The planetary diet would be a healthy diet to convert to, given the significant increase in consumption of vegetables and legumes which provide essential nutrition and vitamins for a healthy diet. Eating too much red or processed meat, saturated fat, and added sugar have been associated with metabolic disorders and heart disease. Therefore, if you eat a lot, cutting down on them is very likely to be  beneficial.

Does it contain enough calories?

The planetary diet which is detailed above, is based around the idea of the recommended calorie intake of 2,500. The authors of the Lancet report have suggested that the recommended diet does not mean that everyone around the world should eat exactly the same thing, but rather that intakes within the specified food group frameworks would optimise human health. There is still room for variation which is consistent with the culture of a particular group of people.

Why is eating varied food groups important?

It is important to eat a variety of food groups to ensure that you receive the right amount of nutrients. For example, you need calcium and protein from dairy products, whereas you need vitamins and fibre from fruit and vegetables. Different nutrients from food contribute towards different organs and functions in the body.

Where can I go for information on eating a healthy balanced diet?

There are lots of websites available to visit for guidance on healthy eating. The NHS change for life program provides options on how to substitute unhealthy foods for healthy alternatives. There is also the NHS ‘eat well’ page which offers guidance on how to eat a balanced diet.