There has been numerous questions asked about the safety of mobile phone and so far no one has given conclusive proof that it is dangerous. What I do know, is that if there are dangers, it should not be used by the young simply because the skull is thinner than in adults and microwaves can reach the developing brain.

Below is an email sent to me. I am sure it is controversial and it is certainly food for thought.

Interesting article in today’s Daily Telegraph – page 30 of the main section. The most important part is “Evidence is increasing that radiation from handsets presents a cancer hazard, particularly to children and to those who use their phones for more than a decade. On Monday, some of the data will be presented at a US Senate hearing. Later this month, a long-awaited 13-nation study should be published.  The official European environment Agency (EEA) is sounding a discreet alarm. And the French government is so concerned that it is developing measures to ban the devices from primary schools, stop their promotion to children under 12, and prevent them being sold without a headset to heavily reduce radiation exposure.”

It goes on to say that earlier studies were flawed, because at that time people had not been using mobile phones for long enough for problems to reveal themselves, but that more recent studies in Sweden have shown that long-term users are twice as likely to get incurable brain cancer on the side of the head where the phone is held, and people who started to use mobile phones before the age of 20 were much more likely to contract the cancers.

Apparently there are nearly two mobile phones per person in the UK! One possible outcome is that phones may have to prominently display the radiation level of each phone – apparently they vary wildly.

Hope this post will not cause you chest pain stress.

These problems can make driving safely more difficult. In addition getting in and out of your vehicle becomes a problem if you have arthritis of the ankles, knees or hips.

You can still drive safely but get help, advise and reassurance from your family doctor. Check also that the medication you take for your arthritis does not affect your alertness and ability to drive effectively. Make sure your arthritis treatment does not make you drowsy.
If you are not sure what to do contact the Arthritis Foundation at 1-800-283-7800.

If you have been driving for some time before you develop arthritis, then you need to make note of two things. Is your arthritis affecting your ability to drive? Has it lasted more than three months? You need to notify the licensing authority. You also need to notify your insurance company. It is true that since the Disability Discrimination Act in UK, your insurance premium will not go up, but your Insurance Company will need to know of any changes in your health.

If you are thinking of learning to drive, and you are applying for a provisional license, make sure you include information about your arthritis on the form. Your driving test will be just as stringent as for anyone else. The driving inspector is more interested in your ability to drive correctly and how safe you are on the road.

Sometimes seat belts can be real bother for someone with arthritis. You may be tempted to request an exemption from wearing seat belts. If you are inclined to do this, please remember that should you have an accident, not wearing a seat belt leaves you open to further injury to your joints.

Dr. Phil Hariram.

Arthritis Guide.

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My son, in his teens, did not have acne but I noticed that when he went  off on Ice Hockey weekends, he always returned very spotty. At home his diet was controlled but when away he had lots of junk foods.

I always suspected that that there is a strong relationship between diet and acne. A recent study suggested just that.
Acne is a common skin lesion affecting people of all ages: 79 to 95% adolescents have acne, 40 to 54% aged 25 and older, 12% women and 3% men in middle age.

The cause of acne is still not clearly known but on the basis of global figures, showing higher level of acne in the West, it is likely that high carbohydrate consumption may be a factor. High carbohydrate intake results in high levels of Insulin (Hyperinsulinemia). Exports feel that hyperinsulinemia plays a part in acne because of the association with available androgen and growth factor.

In a  12 week study,  Dr.Robyn. N. Smith and colleagues, from RMIT University in Melbourne, Australia, gave 43 male adult acne patients, aged between 15 and 25, a randomised  low glycemic load diet (25% energy from protein and 45% from low glycemic index carbohydrates) and a control diet rich in carbohydrate dense foods without consideration of the glycemic index.
The results published in the July issue of the American Journal of Clinical Nutrition showed the low glycemic diet was associated with a significant reduction in total acne compared with the normal diet.
This is the first randomised controlled trial to examine the influence the effects of glycemic load has on acne.

“Although we could not isolate the effect of the low glycemic load diet from that of weight loss, the findings support the hypothesis of a relationship between acne and high insulin levels and acne.” Dr. Smith’s team said.

Low glycemic load foods are rich in complex carbohydrates and releases sugar into the blood stream slowly. This reduces the peak level of insulin. This hormone regulates blood sugar levels but it also affects sex and growth hormones.

Glycemic Index is a value obtained by monitoring blood sugar after eating the food.

Low Glycemic Index: 55 and lower.

Medium Glycemic Index: 56 to 69.

High Glycemic Index: 70 +

Low GI Foods.

All-bran (UK) 30
Oat bran 50
Rolled Oats 51
Whole Wheat 49
Special K (UK) 54
Natural Muesli 40
Porridge 58
Soya and Linseed 36
Wholegrain Pumpernickel 46
Heavy Mixed Grain 45
Frozen Green Peas 39
Frozen Sweet Corn 47
Tomatoes 15
Raw Carrots 16
Broccoli 10
Boiled Carrots 41
Cauliflower 15
Cabbage 10
Mushrooms 10
Lettuce 10
Green Beans 15
Red Peppers 10
Onions 10
Chillies 10

High Glycemic Index Foods.

Watermelon 80
Dates 103
Instant White Rice 87
Glutinous Rice 86
Short Grain White Rice 83
Tapioca 70
Scones 92
Pretzels 83 Rice Cakes 87
Fresh Mashed Potatoes 73
French Fries 75
Donuts 76
Instant Mashed Potatoes 80

So if you want to knock spots off your teenage child or yourself, reject white bread, burgers, potatoes and french fries and embrace cereals and beans.

Dr. Phil Hariram.

Acne Treatment.

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Patients with Rheumatoid Arthritis should benefit from the new range of drugs called Tumour Necrotic Factor Inhibitors (Anti-TNF).

Tests on three of these new drugs slowed progression and reduced symptoms by up to 50%.

Research at the Medical University of Vienna, Austria, has shown that these three drugs are most effective in combination with the standard treatment, methotrexate.

In their published article, the team said, “The emerging agents show that a new era has started in the treatment of Rheumatoid Arthritis.”  UK expert, Paul Emery said, “They are strikingly effective and they work  on different targets from the existing drugs. That’s the joy of it.”

The three drugs in the trial are MabThera (rituximab), Orenca (abatacept), and tocilizumab.

These drugs are, however, not cheap. It is estimated that it will add around £250 million to the NHS drug bill.

Rheumatoid Arthritis is a debilitating joint disease and develops when the immune system attacks the joints causing destruction, stiffness and pain. It is estimated that there are about 400,000 rheumatoid arthritis patients in the UK.

Orenca was the first drug to target T cell in blood and tissue. Other Anti-TNF drugs are Enbrel (etanercept) and Remicade (inifliximab).

As these drugs affect the immune system, there is a higher risk of infections. They can cause headaches, fevers and increase blood cholesterol.

Ailsa BOSWORTH of the National Rheumatoid Arthritis Society said, “It means that we have some choice, and that’s very important if you are 22 and facing a lifetime of the Disease.”

Dr. Phil Hariram.

Arthritis Treatment.

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Age is risk factor for acid reflux. This does not mean that as you grow old you are expected to develop GERD. Acid reflux is most common in the 60-70 age group.

According to statistics complied by NHBA, more than 30% of women over 65 have regular acid reflux symptoms and more than half of reflux sufferers are aged between 45 and 65.

Acid reflux in the elderly is more likely to cause damage to teeth. Older sufferers tend to accept acid reflux as part of the ageing process and delay getting adequate treatment. There is a higher incident of Barrett’s esophagus, a potential precursor to adenocarcinoma, in the elderly. It is suggested that Barrett’s Esophagus is present in one in seven GERD sufferers in the over 60s group.

As we age, our muscles weaken. This includes the gut muscles. The peristaltic waves of contraction weaken leading to constipation and reduced ability to clear food from the esophagus into the stomach.

Saliva is an alkaline liquid that helps in the process of preventing reflux symptoms. As we age we produce less saliva. Saliva mixes with the chewed up food and permits smooth transit down the esophagus. Reduced level of saliva makes the process a bit difficult and food can stick.

Saliva is alkaline and neutralises acid refluxed from the stomach. With reduced saliva production, the refluxate will stay in the esophagus longer creating a greater opportunity for injury.

The elderly are more likely to be on medication. Arthritis is common in the elderly and they could be on prescribed NSAIDs or they buy them over the counter. NSAIDs inhibit prostaglandins and in the stomach prostaglandin helps protect the stomach from the harsh gastric acid.

Dr. Phil Hariram.

Omeprazole was the first proton pump inhibitor to be introduced for acid suppression. It inhibits the function of the proton pump which is the final pathway in acid secretion.

It is inactive in neutral pH but acts specifically in areas of low pH such as at the parietal cells that produce acid. Other proton pump inhibitors are lansoprazole and pantoprazole. Esomeprazole is a mirror image molecule of omeprazole.

Omeprazole is given orally in capsules containing coated granules. This drug has a short half life of just one hour yet it remains effective for a long time. One dose of omeprazole can continue to affect acid secretion for 2-3 days.

When taken daily, the benefits gradually increase until the fifth day when the effect reach optimal limit.

Side effects in this group are rare. On the rare occasion proton pump inhibitors can cause headache and diarrhoea. When this occur, it is usually severe but resolve when the drug is discontinued. Rashes can develop.

Also reported as potential side effects are dizziness, mental confusion, impotence, muscle and joint pain, and gynaecomastia.

Omeprazole and other proton pump inhibitors represent the best medical acid reflux treatment. These drugs and H2-receptor antagonists have significantly reduced the serious complications of acid reflux.

Dr. Phil Hariram.

Antacids are often the first line in acid reflux treatment when lifestyle changes have not produced satisfactory relief of symptoms.

Antacids, when used as an acid reflux treatment, simply neutralise gastric acid in the stomach and by doing this, raise the pH level towards neutral. Pepsin activity stops when pH is 5 or higher. If given in sufficient quantities and maintained, antacids will reduce acid reflux symptoms. There is evidence, however, that antacids will not heal esophagitis. Usually when esophigitis is diagnosed, acid suppressant drugs will be prescribed..

Antacids are useful acid reflux treatment in mild reflux and can be continued if there is no evidence of esophagitis. If symptoms persists then you may need further investigations. Do not ignore your symptoms. If they are not going away check them out.

The antacids more commonly used are salts of magnesium and aluminium. Both groups are effective. Magnesium salts, however, can cause diarrhoea and aluminium can produce constipation. A mixture of the two can counteract each other.

These substances can have high concentration of sodium. If you are on a sodium restricted diet i.e. in heart disease, do not take these antacids. If in doubt ask your doctor.

Dr. Phil Hariram

Once esophageal reflux has been clinically diagnosed you should put in place a plan of action.

First you should look at lifestyle changes. This includes stopping smoking, avoiding heavy meals, weight reduction, raising the head of the bed by about 10cm, avoiding hot drinks and alcohol before going to bed, avoiding certain drugs, and not eating at least 3 hours before going to bed.

If these general measures are ineffective then add an antacid or alginate. There is no evidence that one antacid is more effective than another. The choice is yours. Remember if there is esophagitis, these drugs although they will help neutralise stomach acid and reduce acid reflux, there is no evidence that they will heal esophagitis. So if you have adequate relief then it is likely you did not have esophagitis.

If there is no relief after four weeks of lifestyle changes and antacids or alginates then a trip to your doctor is necessary. You will have an endoscopy and biopsy. If there is no esophagitis, then the doctor will look for other possible causes and when excluded may suggest that you continue taking antacids or add an H2- antagonist such as ranitidine. This is available over the counter. Trials have suggested that long term use of these drugs are safe.

Esophagitis will require specific treatment. Omeprazole or other proton pump inhibitors, or ranitidine at a dose that should heal esophagitis will be prescribed. Omeprazole still remains the best medical treatment of acid reflux. With severe or recurrent symptoms maintenance treatment may be needed.

If these is no relief after six weeks then a repeat endoscopy and biopsy will be taken. It is very rare that esophagitis does not respond to proton pump inhibitors. There are, however, a rare few cases when omeprazole is not an effective acid reflux treatment. These patients are likely to have surgery and this is usually done before the age of 60.
Statistics have shown that if your first endoscopy was negative and you do not have esophagitis, subsequent endoscopies is likely to remain negative.

Dr. Phil Hariram,

Antacids neutralise acid in the stomach. They do not prevent acid secretions or acid reflux into the esophagus. Antacids react with stomach acid, hydrochloric acid, and help to raise the pH from a low acidic level.

Antacids are base compounds and the mode of action is same as I learnt at school.

Acid + Base= Salt + Water.

Following this reaction the acid level is reduced and the refluxate is less likely to cause problem to the lining of the esophagus.

The most common antacids are compounds of aluminium, magnesium, calcium, sodium and bismuth.

Aluminium is in the form of aluminium hydroxide and carbonate. Magnesium is present as magnesium hydroxide and trisilicate. Calcium as calcium carbonate and sodium as sodium bicarbonate.

These compounds are safe if used as recommended. If symptoms persists while taking antacids, rather than increase the dose and frequency of the drugs, it is wise to see your family doctor for diagnosis, investigation and additional acid reflux treatment.

Although antacids are a safe form of acid reflux treatment, they can produce side effects. Magnesium compounds can produce diarrhoea. Calcium containing antacids can cause constipation, urinary problems, headache and nausea. Aluminium compounds can cause bone pains, constipation and loss of appetite. Sodium compounds increase sodium intake into the body and not recommended for anyone with high blood pressure or heart disease.

Antacids should not be given to children under six years old. In addition antacids can affect absorption of certain prescribed drugs. If you are taking a drug that can be affected by antacids, then do not take the two together but wait at least three hours ( The average time for gastric clearance) before taking the antacid.

Dr.Phil Hariram,

GERD is common and increasing in the West. At least 20% of the population have symptoms weekly. A Gallup poll in USA showed that 44% reported symptoms on a monthly basis. 20% have frequent symptoms ie weekly.

From a study in Sweden, from all endoscopies, 10 % had esophagitis. In Norway 8% of asymptomatic controls had esophagitis. In patients with dyspepsia 12% had esophagitis.

GERD is higher in whites and obese. There is a higher incidence in people aged 60-70 years old. It is more common in men than women and it is rare in blacks. GERD is much lower in the East and studies have suggested that recurrent acid reflux is higher in Indians (7.5%) than Malays (3%) and Chinese (0.8%). It is suggested that as these areas gradually introduce western diets, higher in fats, the incidence will increase.

In the early 1990s, proton pump inhibitors such as omeprazole became the backbone of treatment for gerd with higher success at a faster rate compared to H2 receptor agonists. However, numerous studies show that with erosive esophagitis, after a healing course of proton pump inhibitor, 85% relapsed within 6 months and the relapse rate is higher the more severe the esophagitis.

Studies show that the impact on the quality of life due to gerd is similar to and at times greater than that of conditions such as myocardial infarction, arthritis, heart failure and hypertension.

The main aim of treatment of GERD is to provide immediate and long lasting relief of symptoms. Trials have shown that omeprazole decreased symptom severity and frequency and had significantly improved quality of life.

There is an association between acid reflux and pregnancy, obesity and smoking.

Many sufferers do not seek medical help and only a few see the gut specialist. This led Castell to develop the “GERD iceberg”.

Dr. Phil Hariram,