What is it?
Chromium occurs naturally in the soil where it’s absorbed by plants and grains. However, intake is thought to be low with few of us getting the recommended daily dose. Deficiency signs include feeling dizzy or irritable without frequent meals, cold hands and feet, fatigue and craving sweet foods. Research found levels to be especially low in diabetics and those with cardiovascular conditions.

How can it help me?
•    Reduce insulin resistance – chromium can help enhance the body’s insulin sensitivity. According to a scientific review in The Diabetes Educator, this response can help improve blood sugar control in those people suffering from metabolic syndrome, which is found to often be a precursor to diabetes and type 2 diabetes.
•    Assist in weight loss – a long-term US study, published in the Journal of Complementary Medicine, found that for obese men and women who weren’t dieting, the higher the dose of the chromium supplement taken, the lower the weight gain over a 10-year period. Compared to those not taking a chromium supplement, the study found that weight gain was only half as much for those who were taking it. Furthermore, men taking 150mcg 
or more a day actually lost weight over the decade.
•    Lower cholesterol – chromium can help to reduce ‘bad’ LDL cholesterol and increase ‘good’ HDL cholesterol. A US study reported that total levels of cholesterol and LDL cholesterol ‘decreased significantly’ in individuals taking 200mcg of chromium daily for 42 days.

How much do I need?
There is no UK recommended daily intake for chromium, but in the US, it’s 25mcg per day for women and 35mcg for men. To help a specific condition, however, the dose can be increased to 200mcg one to three times a day*. But consult your doctor first if you are taking any medication, especially for diabetes. It’s also best to consult a nutritional therapist if you plan to take more than 200mcg for longer than a few months.

How do I use it?
Chromium levels in food vary dramatically but tend to be richest in brewer’s yeast, wholemeal and rye bread, wheatgerm, chicken, lamb, eggs and green peppers. You can also take a supplement – the most absorbable form is chromium picolinate. Some formulas combine chromium with vitamin B3 (often called Glucose Tolerance Factor), which is believed to enhance its blood sugar balancing actions.

The new happy pill?
When Professor Malcolm McLeod from the University of North Carolina observed a patient recover from years of severe depression in just a few weeks, he discovered that his patient had taken a weight-loss supplement and when he experimented with the ingredients, he discovered that chromium was responsible for the rapid improvement. More studies have backed chromium’s effect on mood so watch this space.

Expert: Susannah Lawson is a nutritional therapist and author of Optimum Nutrition Before, During and After Pregnancy (Piatkus, £9.99). She practises in Hampshire (see www.susannah-lawson.co.uk).

What is it?
This aromatic plant has been cultivated as food and traditional medicine throughout south-east Asia for centuries. Today, ginger (zingiber officinalis) is also found across the Caribbean and Latin America. Most people are aware of its use as a culinary herb, but it’s just as well known as a medicine.

How can it help me?
•    Travel sickness beater Ginger is known for relieving nausea from motion sickness. Australian studies have also noted its use in treating morning sickness.
•    Digestive helper Ginger is helpful for treating indigestion and flatulence, according to a report in the European Journal of Gastroenterology and Hepatology.
•    Fever fighter Ginger promotes perspiration and warms the body so can help with fevers and chills from colds or flu, Japanese research has found. Warm ginger tea can also be gargled to relieve sore throats.
•    Circulation easer Ginger stimulates the circulation, and has long been used for chilblains and poor circulation.
•    Blood helper Chinese research shows ginger may reduce high blood pressure and thin blood by inhibiting platelets (particles found in blood) from collecting together.
•    Pain reliever A US study indicated ginger may be as good as conventional painkillers in treating the pain of osteoarthritis.

How much do I need?
Around 1g of fresh ginger can be taken daily, or around 400mg as dried extract. As supplements differ widely, it is important to stay within the manufacturer’s guidelines. Ginger should not be used alongside anticoagulant (blood thinning) drugs such as aspirin and warfarin. As ginger 
can lower blood sugar levels, those on medicines to control diabetes should seek medical advice before taking a ginger supplement. Ginger should not be used by those with gallstones or gallbladder disease as it increases bile production and flow.

How do I use it?
Ginger is a tremendously versatile plant that can be used in both its fresh (grated or crushed) and dried forms, and is an important addition to many Asian dishes. Ginger tea is a very soothing and warming remedy for colds; why not add lemon and honey to create a delicious hot drink with increased medicinal benefits. If you don’t like the taste of ginger, but still want to enjoy its qualities, you can try a supplement in the form of tablets, capsules and tinctures. For osteoarthritis, a hot ginger compress can be used. Simply add hot water to crushed ginger to make a paste, then soak a muslin cloth in it, and apply directly to the aching joint.

Saucy spice
Ginger is reputed to have aphrodisiac powers and is mentioned in the Kama Sutra. In the South Pacific the spice is used to gain the affection of a woman. Perhaps that’s why 19th century English barkeepers put out small containers of ground ginger, for people to sprinkle into their beer – the origin of ginger ale.

Expert: Gabriella Clarke is a qualified medical herbalist and a member of the National Institute of Medical Herbalists. She teams centuries of tradition with modern science and practises from her clinic in the heart of the Chilterns in Beaconsfield, Buckinghamshire.

Travel sickness

Motion sickness or travel sickness is never fun, and you can get it travelling by car, boat, plane or train. You might feel dizzy, tired and sick and you may find yourself vomiting. For some reason women are more susceptible than men, especially if they have their period or are pregnant – and children often suffer too.
Prevent it Stay hydrated by drinking plenty of water – dehydration will just make things worse. Avoid big meals before you travel and get some fresh air to clear your head. Looking out of the window can help, so try to get on deck on a ship or sit in the front of a car. If you know you’re prone to motion sickness try taking a zinc supplement in the week leading up to your journey and on the days that you’re travelling. Zinc is often used to treat conditions such as vertigo when swaying motions cause nausea.
Treat it Ginger has long been used to ease nausea and sickness. Try grating some fresh ginger into warm water and sip it to ease that sickly feeling. You could also take ginger capsules before you travel.
When to seek medical help Most motion sickness dissipates with a bit of rest after your journey – but if you continue to feel ill, see a doctor.

Food poisoning

Trying new foods is all part of the holiday experience but they could end up upsetting your stomach. Bacteria or viruses in poorly cooked or contaminated foods could lead to nausea, vomiting, stomach cramps and diarrhoea.
Prevent it Make sure anything you eat is thoroughly cooked. Avoid buffets where food may have been sitting out for long periods of time. Steer clear of ice in drinks and only drink bottled water. Wash fruit and veg with bottled water before eating them and be suspicious of any food that smells odd. Take a supplement containing hydrochloric acid with pepsin to help to create a healthy acidic environment in your stomach which makes it harder for bugs to take hold.
Treat it Stay hydrated by drinking plenty of water. Even if you can’t keep anything down, try sipping a glass of water to prevent dehydration. Over-the-counter rehydration sachets can really help. Avoid eating solid foods until you feel better. Get plenty of rest and allow your body to rid itself of the bug. To prevent diarrhoea, try taking a probiotic supplement for a few weeks before you travel and while you’re abroad. A study in the European Journal of Clinical Nutrition found that 80 per cent of holidaymakers who took this precaution had a diarrhoea-free trip. By bolstering your good bacteria you make it harder for bad bacteria to take hold.
When to seek medical help If you get a temperature or have sickness or diarrhoea for more than two or three days, make sure you see a doctor.

Constipation

It could be the change of routine, having to go in a strange place, dehydration or a change of diet – but whatever the reason, holiday constipation is no fun. It leaves you feeling bloated and uncomfortable – the last thing you want when you’re spending most of your time in a bikini.
Prevent it Ensure you eat plenty of fibre by filling up on fruit and vegetables and wholegrain carbohydrates. Drink plenty of water too, because dehydration can make constipation worse.
Treat it Try getting some exercise to get your digestion moving – a gentle walk or some swimming might help. Snack on fibre-rich foods such as prunes or linseeds and try a herbal laxative such as senna or psyllium husk. Taking vitamin C and some extra magnesium could help to soften your stools, so look for a supplement which combines both.
When to get medical help If you experience severe stomach cramps see a doctor.

Sunburn

We know the risks of getting sunburnt but that doesn’t stop the majority of us trying to get a tan. And often we take it too far, with 66 per cent of us admitting to being sunburnt in the last 
12 months according to a survey by research company Mintel.
Prevent it Keep putting on that suncream and use a minimum of an SPF15. If you’re applying enough you should be getting through five to six bottles of suncream in a two week holiday. Stay out of the sun when it is at its strongest between 11am and 3pm. If you have to be in the sun wear a hat and cover up with a T-shirt. Take a fish oil supplement for a few weeks before you hit the beach – it helps to protect your skin from free radical UV damage and keeps it hydrated.
Treat it If you do get burnt you can’t beat aloe vera gel for soothing red hot skin and calming painful inflammation. Apply it two or three times a day and stay out of the sun completely.
When to get medical help If you’re in a lot of pain, your skin blisters or you feel nauseous, start vomiting or become dizzy, seek medical help.

Heat stroke

We’re often so sun deprived in the UK that when we arrive somewhere hot, we go a bit mad and cook ourselves in the heat. But if you overdo it you could find that you become dizzy, sick and 
very tired. Severe heat stroke can be very dangerous because your body temperature can get worryingly high.
Prevent it Seek the shade during the hottest period of the day and always wear a hat. Gradually build up your tolerance to the sun by increasing how much time you spend in the heat everyday. Avoid exercising when the sun is at its strongest.
Treat it If you become overheated, get out of the sun immediately, sit somewhere cool and drink plenty of water to avoid dehydration – avoid caffeine, alcohol and fizzy drinks, which can make dehydration worse. Take a cool bath to bring your body temperature down.
When to seek medical help If you feel faint, sick, become excessively sweaty and then very hot and dry, see a doctor.

Bites and stings

Getting bitten in the UK is often little more than a nuisance – but when you’re on holiday, getting stung or bitten by an insect could put you at risk of a serious illness such as malaria.
Prevent it Check with your GP before you travel to see if you need any inoculations or visit www.nhs.uk for advice. Stock up on citronella spray or essential oil* to put the bugs off. Keep your arms and legs covered in the evenings and close your bedroom windows at night when bugs are at their most active.
Treat it If you do get bitten, calm the inflammation by applying a cold compress gently to the bite and then dab on a drop of lavender essential oil*, tea tree oil or aloe vera gel to soothe any itching.
When to seek medical help If you develop a full-blown reaction to a bite or sting and experience difficulty breathing, swelling, vomiting or hives see a doctor straight away. And make sure you seek help if you’re in a known malarial region and you get bitten.

Expert: Dr Shamim Daya is a qualified GP who takes a holistic view of health and has trained in homeopathy, nutrition and herbal medicine. She practises at the Wholistic Medical Centre in London. Find out more at www.wholisticmedical.co.uk

*Oils should be diluted before direct use on the skin

What is it?
Onychomoycosis or nail fungus is a fungal infection that affects the toenails or the fingernails. However, it is seven times more likely to develop in toenails rather than fingernails. Approximately three million people in the UK are affected by nail fungus, and surprisingly it beats out athlete’s foot as the most common foot problem.

Why do we get it?
This kind of fungus thrives on dark, warm, moist places so wearing the same pair of shoes every day in a warm climate, or getting your feet damp for long periods will expose you to the possibility of developing nail fungus. Fungal nail infection is contagious and the risk of developing it is increased with age. Other factors that contribute include the use of communal areas such as swimming pools, public showers and sauna. People with diabetes or psoriasis also have a higher risk of developing the condition.

What are the signs?
A clear sign of nail fungus is discolouration of the nail, flakiness, thickening and distortion, loss of lustre and shine, accumulation of debris under the nail and scaliness. If left untreated, onychomycosis can cause the nail to rise completely out of the nail bed and lead to a more serious foot infection.

What’s the treatment?
If you notice any of these signs, you can begin to treat yourself easily with simple home remedies or pick up a prescribed treatment. There are several helpful brush-on treatments available in pharmacies that effectively block the fungus as well as stimulating the nail bed immune system and help prevent re-infection. As for simple remedies, tea tree oil has been found to be a powerful and natural fungicide and antiseptic. Just apply it using a cotton ball to your infected area morning and night. Another effective home-treatment is apple cider vinegar mixed with warm water. Soak your nails in the mixture for 20 minutes everyday and you’ll be well on your way to clearing up that fungus once and for all.

Words: Jessica Delaney

Mention ME or chronic fatigue syndrome (CFS) to a group of doctors and they’ll probably disagree on everything from what it is, what to call it, what causes and triggers it and how to treat it. And although most GPs now acknowledge it exists, around a fifth still dismiss it as ‘all in the mind’. This is despite the fact the World Health Organisation has viewed it as a genuine, debilitating neurological condition for 20 years.
Severe ME or CFS can totally destroy someone’s quality of life. For example, earlier this year, the court case of ex-nurse Kay Gilderdale hit the headlines. She admitted aiding and abetting the suicide of her daughter who’d suffered from ME for 17 years, enduring constant pain and needing 24-hour care. Towards the end, she couldn’t walk, talk or even drink.
Although most ME/CFS patients will improve over a period of time only a small minority fully recover and return to previous health levels. Most will go through periods of relapse and remission.
Some 240,000 people in the UK suffer from the condition which is now commonly known as ME/CFS. Patients dislike the term chronic fatigue syndrome as it fails to reflect the symptoms or the severity of the illness. Doctors prefer CFS because myalgic encephalomyelitis (ME) implies brain and spinal inflammation, which hasn’t been proven either. ME/CFS is the compromise.

Physically draining
ME/CFS describes a whole host of symptoms that follow an infection such as chicken pox, flu or gastroenteritis. Weeks after the infection has gone, sufferers are often still totally physically exhausted like they’re operating at about 60 per cent of the ‘real’ them. A simple walk to the local shops can leave them flat out: they might struggle to find the right words, be unable to concentrate and suffer memory lapses too. They also feel fluey, have sore throats and muscle pain, can have problems with balance and may become intolerant to alcohol.
This can go on for several years, or longer. Most people go through ups and downs, stabilise for a while, then relapse. But around a quarter, such as Kay Gilderdale’s daughter, are so severely affected that they become wheelchair bound, house bound and bed bound.
Most people develop ME/CFS in their 20s, 30s or 40s and have had no particular health problems before. It’s twice as common in women than men – we’re not sure why, but we know that people affected severely with the condition are more likely to have a mother with ME/CFS. Maybe the genetic link explains this. Some people who are exposed to a viral infection are more likely to develop an illness and this susceptibility may be passed on
Being under stress when you’ve got an infection may also trigger ME/CFS symptoms. Athletes have been known to get it when they’re under physical stress.
Children can develop it too – in fact, it’s one of the most common causes of long-term school absence among teenagers. However, they are more likely than adults to recover and return to a normal active life.

Could a virus be the cause?
This is still a matter of huge debate. US scientists have found a link between CFS/ME and a virus called XMRV which was discovered in 67 per cent of ME patients compared to under 4 per cent of the population. But a more recent British study couldn’t replicate these results. If further research finds that this virus is causing the disease, we may start trials on anti-viral drugs and diagnostic tests.
Despite this emerging evidence of a persisting virus, the current most popular explanation for ME/CFS is that the immune system fails to switch off after an infection. So someone gets an infection, their immune system swings into action and produces chemicals called cytokines that make anyone with normal flu feel awful. The idea is that when the infection has gone, the immune system keeps going, still making these cytokines.
About three quarters of cases are straightforward to diagnose. A typical case is someone who’s used to being well and wants to go back to work, but has been suffering post-viral symptoms for weeks or months. A doctor will carry out routine blood tests such as thyroid, kidney, and liver function tests. If the results come back okay and there are no ‘red flag’ signs of another illness, such as coughing up blood or swollen joints, then a diagnosis of ME/CFS can be made. In some cases, patients might be referred to a specialist to rule out other conditions, such as multiple sclerosis.
Early diagnosis offers the best hope of recovery – only then can sufferers start managing symptoms. Of course, this depends on how long it takes for your doctor to make an accurate diagnosis – some doctors may put symptoms down to post flu flop, encouraging you to just get on with things. This won’t help – your body is telling you to slow down.
Symptoms can get worse by not accepting there’s a problem – when people go back to work and try to exercise their way out of it.

Managing symptoms
With no known cause, there’s obviously no easy cure so it’s normally a matter of treating individual symptoms. Drugs are often prescribed to treat muscle pain, sleep disturbance or depression. If sleep is a problem, also make sure you go to bed and wake up at the same time every day and relax rather than sleep in the day.
On top of the physical symptoms, it can be incredibly stressful living with ME/CFS – dealing with doctors who don’t believe you, fighting for benefits, having a difficult employer or unsympathetic family, for instance. A counsellor can help you work through these issues – your GP can refer you to one, or visit the ME Association website, below.
The key to managing ME/CFS, however, is getting the correct balance between activity and rest. This approach, known as pacing, has been found the most helpful life change for many ME/CFS sufferers. This idea is that you split the day into periods of rest, mental activity and physical activity. Gradually over time you build up the mental and physical activity. It’s important to get the balance right – staying in bed all day or exercising hard may slow recovery or trigger relapse.
As soon as you get a diagnosis, pay particular attention to your diet – a healthy, balanced diet is important to keep up energy levels. It’s common for ME/CFS sufferers to get irritable bowel syndrome (IBS) and they can become intolerant to certain foods. But before starting exclusion diets, talk to your GP.
Natural therapies can be effective for many people.

For more information and support, log on to www.meassociation.org.uk and Action for ME’s website www.afme.org.uk. You could also try the ME Connect Helpline on 0844 576 5326.

Natural helpers
Many ME/CFS sufferers turn to alternative medicine because conventional medicine hasn’t got the answers. Alternative therapies can help relieve symptoms – but beware of practitioners promising a miracle cure. There isn’t one! For pain relief, some people find acupuncture or TENS machines helpful. There’s also evidence that supplements might be helpful:
-Carnitine may help reduce fatigue.
- St John’s Wort may help mild to moderate depression.
-Fish oil/EPO has been shown to help brain function in studies.
-Findings in the Journal of Psychosomatic Research found that homeopathy may help relieve fatigue in ME/CFS patients. Some homeopaths are medically qualified doctors too, so will know about when to use homeopathic medicine alone and when to use them with conventional medicines.

Chocolate therapy
It seems too good to be true – but a study at Hull and York Medical School found that ME sufferers were less tired after eating a small amount of dark chocolate (45g) every day. The idea is that polyphenols in chocolate boost serotonin levels in the brain, which help regulate mood and sleep.

The expert: Dr. Charles Shepherd

Dr. Charles Shepherd works in private practice and is medical adviser to the ME Association. He has lived with ME for 30 years.

Compiled: Karen Williamson

Don’t Lose The Music, the current RNID (Royal National Institute for Deaf People) campaign, is designed to encourage people to protect their hearing while enjoying music and raise awareness of the dangers of regular exposure to loud noise – for this can lead to premature hearing loss and tinnitus.
Tinnitus is a term used to describe a noise that people can hear in one or both ears – usually a humming, whistling or a ‘pulse’ sound. While there are a number of high profile tinnitus sufferers in the music industry, including Sting, Eric Clapton and Cher, the condition is certainly not restricted to musicians and pop stars. In the region of four per cent of UK adults, that’s 2.4 million people, experience tinnitus to ‘severely or moderately annoying’ levels. For 242,000 people in the UK, the condition ‘severely affects’ their ability to lead a normal life, according to Deafness Research UK.

Sound of silence
Tinnitus, which means ringing in Latin, is experienced by everyone at some time. If you sit in ‘silence’ and tune into your internal sounds, you will gradually start to hear your pulse or a ringing or whistling sound. It also manifests itself momentarily if you’ve been exposed to loud noises, such as after attending a concert or listening to loud music.
So while it’s thought that everyone has experienced momentary tinnitus, some people are tuned into this internal perception of sound, interfering with their everyday activity. Sometimes people with tinnitus also experience depression or insomnia and these conditions feed upon each other making each condition more severe. Patients with severe tinnitus describe it as being as loud as a jet engine, ruining their lives. However, when testing loudness of tinnitus in severe cases, it is often only slightly louder than the quietest sound that can be detected, leading to the conclusion that tinnitus is a disorder of perception.
Normally, the brain deals automatically with standard internal bodily sounds such as the sound of our pulse, via auditory filters that prevent unwanted internal noise coming to our attention in the same way that they filter out unwanted external sounds. For example, if you buy a new fridge you will hear it buzzing at first, but after a few days the noise no longer comes to your attention. When these filters don’t work so well, tinnitus sounds can be perceived.
Tinnitus is therefore related to internal noise that is there all the time, but which you are attending to rather than ignoring. The more you pick up on it, the more your body works to bring it to your attention. It’s a vicious circle.

Fight or flight
Anyone can suffer from tinnitus, although some people are more susceptible. For example, people who are consistently exposed to loud noise, such as musicians; older people with hearing loss; and people who suffer from stress and anxiety all tend to be more prone. Musicians are a common group of sufferers because their job is to listen to sounds – all day, every day – and this makes them susceptible to hearing their own internal tinnitus sounds.
This is because loss of detection in the sensory structures of the ear causes the brain to strain to hear, prompting the internal amplifiers to be turned up in order for people to detect speech. This amplifies internal sounds.
Stress can also be a tinnitus trigger. When the fight or flight mechanism kicks in, the body is ready to react quickly to any perceived threat. This state stops the filtering out of even small sounds in order to allow you to attend quickly to really minor danger signals, meaning you suffer from tinnitus because of heightened perception.

Getting help
While everybody experiences momentary tinnitus to a greater or lesser extent at times during their lives, the time to seek help is when it starts to have a debilitating effect. For example, if you are having difficulty sleeping, or it affects your mood or relationships. The more you understand it, the easier it is to get on with your life. In many cases it is worsened by stress or anxiety and once general wellbeing is improved, symptoms may lessen. There is no simple test for tinnitus so you will need to describe to your GP what you are experiencing. They may then refer you to an audiologist, a tinnitus clinic or an Ear Nose and Throat (ENT) doctor.

What’s the treatment?
Common ways of treating tinnitus centre around ‘retraining’ the brain to filter out internal sounds. Cognitive Behavioural Therapy (CBT) is a talking therapy that encourages sufferers to see themselves or their condition in a different way. CBT is often offered over a minimum of four or five sessions and the process trains the brain to turn down the mechanisms which affect the filters and amplifiers.
I have also been doing some new research into using a type of hearing aid called a Receiver In The Canal (RITC). It works for people who suffer from tinnitus and have hearing loss by putting back the sound they’re missing without blocking up the ear. Results so far show RITC aids reduced tinnitus annoyance in 73 per cent of hearing impaired patients, with 30 per cent reporting complete resolution of their tinnitus.
For other sufferers, sound enrichment – playing background sounds such as a babbling brook from a CD at a low level – helps stop tinnitus sufferers from perceiving their own internal sound.
Treating stress can also be very effective in reducing tinnitus. Counselling, exercise and acupuncture can all be effective as can supplements such as St John’s wort, which is a natural mood enhancer and anti-depressant; B vitamins, which help boost production of the ‘happy’ brain chemical serotonin; and potassium, which helps soothe feelings of anxiety. Chamomile tea is believed to reduce stress by relaxing the smooth muscles lining the stomach and intestine.
For years tinnitus sufferers were told nothing could be done, but as understanding grows, more people are able to manage, overcome and – crucially – understand the condition,and find much needed relief.

Cut your risk
The main action you can take to minimise your risk of tinnitus is to avoid exposing yourself to high levels of noise. The RNID campaign states that continued exposure to noise at or above 85 decibels (the measurement for sound), over time can cause hearing loss: at nightclubs and pop concerts levels can exceed 110, while iPods can reach over 100.
A helpful rule of thumb is that, if the background noise is so loud that you can’t talk to someone two metres away without shouting, the noise level could be damaging. Trying to avoid stress and anxiety and maintaining good all-round health and wellbeing is also important in minimising risk.

The expert: Andy Phillips
Andy Phillips is head of audiology services for the Royal Berkshire NHS Foundation Trust in Reading. He has been involved in audiology for over 20 years and is currently working to understand the mechanism of tinnitus perception and to try to find effective treatments.

Compiled: Nicola Smith

Dr Mark Goodfield is a consultant dermatologist at Leeds General Infirmary and President of the British Association of Dermatologists (www.bad.org.uk)
Hyperhidrosis, or excessive sweating, can have a big impact on quality of life. It affects about half a million people in the UK, men and women equally.
The normal role of sweating is to regulate body temperature, but people with hyperhidrosis sweat at inappropriate times whether they’re hot or cold. Anxiety can worsen it, as can other triggers. The main symptoms are visible sweat, wet clothes and a clammy handshake.
Localised symmetrical hyperhidrosis is the most common type and usually affects the palms, soles of the feet, skin under the arms, face and scalp or a combination – and both sides of the body equally. It tends to begin in adolescence. The cause is usually unknown, though it can run in families. Generalised hyperhidrosis affects the whole body and usually has an underlying cause, such as an infection or diabetes and an overactive thyroid gland, as well as certain medicines, such as Prozac.

If your hyperhidrosis is generalised, you may be referred to a specialist. If an underlying cause can be treated, so can your hyperhidrois. If it’s localised, your GP will offer lifestyle advice, and recommend a topical high dose aluminium chloride antiperspirant. Botulinum toxins can be injected into the skin in very small doses. This blocks the sweat glands and can last between two and six months. Or iontophoresis – passing a small electric current through skin – can be used, mainly for the palms and soles. Also try to avoid situations which trigger the sweating – such as hot places, stress and spicy food.

Dr Nicola Ridgeway is a clinical psychologist and an accredited cognitive behavioural therapist (www.westsuffolkcbt.com)
Regardless of what may be causing the hyperhidrosis, becoming anxious about sweating – a common reaction – simulates the sympathetic nervous system (our normal response to threat or danger) and actually makes people sweat more. This is where cognitive behavioural therapy (CBT) can come in.
A fundamental premise of CBT is that how we make sense of things affects the way we feel and behave. If someone with hyperhidrosis attaches meanings such as rejection, humiliation and disgust to sweating, they are more likely to become anxious when with others, and so sweat more. It is common to then avoid situations where they attach greater meaning to sweating, such as social situations, or intimate relationships. This may help them sweat less (they’ve avoided feeling anxious), but can have a very negative impact on their lifestyle. In CBT sessions for hyperhidrosis, individuals are helped to reflect specifically on the meanings they are attaching to sweating and the feelings and behaviours that follow. The result is that individuals learn their extreme ideas about how others will react to their sweating are just that – which reduces their anxiety about sweating in general. There is also a positive change in how individuals react to their own sweating and their negative feelings about it so it no longer carries the same threat. Ultimately, CBT reduces sweating related to anxiety about it. For mild to moderate cases, around 10 to 12 sessions of CBT would be usual. (Visit www.babcp.com for therapists nationwide.

Zoë Palmer-Wright is a naturopath specialising in nutrition and herbal medicine, and lectures at The College of Naturopathic Medicine (www.naturopathy-uk.com)
There are lots of helpful herbs and dietary advice for people with hyperhidrodis, but for best results, I suggest visiting a naturopath. By taking a full case history and using various diagnostic tests such as tongue diagnosis, we take into account the whole person and their spectrum of symptoms, aiming to identify and treat the causes.
Hyperhidrosis can be due to a number of reasons. If it was menopausal, a naturopath may recommend phytoestrogen-rich foods (such as chickpeas and miso) to help balance hormonal function, and may prescribe herbs such as sage, dong quai and black cohosh. The liver and adrenal glands often need support during the menopause, so various foods and herbs may also be given for this purpose. For example, Siberian ginseng to help nourish the adrenal glands, and bitter green herbs such as chicory to help support optimal liver function. If the excessive sweating was linked to blood sugar problems (in non-diabetics), the key element would be dietary changes more conducive to good blood sugar control. So that would include wholefoods such as brown rice, vegetables, lean protein and eating little and often. To help blood sugar regulation, naturopaths may also supplement with spirulina and chromium. Of course naturopaths acknowledge a person can have a genetic predisposition to develop hyperhidrosis, but we believe that certain foods, emotions and lifestyles can trigger the hyperhidrosis. So we will always look for what may be bringing on your symptoms.

Compiled: Aviva Ingram

1. Power away plaque
Like cholesterol we don’t physically see plaque. This sticky film coats the teeth full of bacteria that release toxins, which damage your teeth and gums. Some people produce more plaque than others and it can be useful to ask your dentist to carry out a saliva test, which checks your ‘buffer’ capacity. If you are one of the unlucky ones with low ‘buffering’, steps can be taken to boost it, such as using fluoride rinses and eating more alkaline foods such as cheese. But, for the vast majority shifting plaque is down to plain elbow grease – spending time cleaning your teeth before breakfast, flossing daily and creating a customised maintenance plan with your dental hygienist. For some this could mean seeing a hygienist every three months, for most every six.

2. The ‘F’ word

Floss, floss, floss. You should floss every day to reach the spaces your tooth brush cannot possibly clean – in between your teeth and deep under the gums where the bacteria lurk. Start with about two hand spans of floss and wind most of the floss around each index finger, leaving an inch or two of floss to work with. Holding the floss tautly between your thumbs and index fingers, use clean sections of floss as you move from tooth to tooth. If you are a beginner use dental tape as it does the same job as floss but is easier to use – as are floss sticks.

3. Switch to electric
Invest in an electric toothbrush. I say it’s the difference between using vacuum cleaner and a dustpan and brush because power brushing is faster and more effective than hand. The most powerful brush, recommended by the British Dental Health Foundation, is the Oral B Triumph.

4. Magic minutes
Some electric toothbrushes have timers but you should spend a minimum of two minutes every time you brush your teeth and gums twice daily. The magic two minutes has been found to be the absolute minimum time needed to effectively remove tenacious plaque by the way – so if you fancy brushing a little longer, be my guest.

5. Quit the fags!
People who smoke are more prone to gum disease because the tobacco produces toxins that damage the mouth tissue and also kill all the good cells in your mouth that help your body fight disease. Smokers really need to spend the time making sure they clean their mouth thoroughly. They should also see the hygienist every three months.

6. Sweet breath
Many things can cause bad breath from tooth decay, gum disease to the type of food you eat, as well as dehydration. Not drinking enough water means you do not produce enough saliva. Your hygienist will guide you to the best regime to beat this. Generally tea and coffee drinkers should drink an extra four glasses of water a day to cancel out their dehydrating effects.

7. Detect problems
Did you know going to the dentist could actually save your life? Screening for many cancers (including oral, breast, prostate), diabetes and heart disease will be able to be tested by swabbing saliva in as little as two years. Right now, one of the earliest ways to detect cancer growths is to check the lymph nodes around the head and neck and check for any unusual swellings.

8. Check your bite
I had a patient I had been seeing for years who, chatting after a routine hygiene visit, claimed she had suffered from migraines continually. We found the source of the problem was misaligned teeth so I fixed her bite (she had a combination of braces and veneers), which re-aligned her teeth, and the migraines disappeared. Migraines and headaches can be caused by misalignment and grinding teeth can also cause the muscles around face to go into spasm. If you are getting regular headaches, do ask your dentist to check your bite.

9. Razzle dazzle ‘em
Knock five years off your age straight away and invest in a whitening treatment. There are two ways to zap ageing discoloured teeth: at home or at the dentist. Home whitening is the least expensive because there is little clinical time involved. Your dentist will create custom-made trays to fit snugly over your teeth, protecting the gums. You then wear the trays with a special gel containing peroxide overnight, usually for a week for best results. You will see the colour of your teeth improve to match the whites of your eyes. Alternatively you can have power whitening or laser whitening at the dentist. More time is spent protecting the mouth and gums as the whitening product used is so powerful, it could burn badly. A light is used to activate the whitening gel which releases oxygen bubbles as it works. Teeth – like skin – have pores that get blocked with colour molecules from food. As the gel releases the oxygen, it dislodges the colour and teeth get whiter from the inside out. Prices for both vary from dentist to dentist but start at £250 for at home treatments and £550 for laser treatment.

10. Whitening toothpastes
There are great new advances in toothpastes but there is a limit to what they can do. Realistically they can only get rid of surface stains. Pick carefully as some can be quite abrasive. Go for a toothpaste with whitening benefits designed for sensitive teeth for the best of both worlds, and use daily.

11. Wash with fluoride
Use a fluoride toothpaste daily to attack plaque bacteria – and spit, don’t rinse as that keeps the fluoride on your teeth for longer. If you like a good slosh, use a fluoride mouthwash instead of water. Avoid mouthwashes with alcohol content (they can erode enamel) as the only ingredient necessary for a good clean is fluoride.

12. Chew gum
Chewing sugar-free gum stimulates saliva, which helps prevent cavities forming. Choose one that contains xylitol as this prevents bacteria – it acts like a disinfectant. But only chew until the gum’s flavour has run out, otherwise your jaw will be working overtime.

13. The long straw
Fizzy drinks, even diet ones, dissolve the enamel of teeth, making them open to bacterial attack – so use a straw to help protect your teeth.

14. Take your time
Wait at least 20 minutes after drinking or eating anything sweet or acidic before brushing your teeth – otherwise you can actually brush your enamel away. When you eat sweet foods, bacteria in your mouth produce toxins that soften your enamel, so brushing immediately can cause more damage.

15. Age-proof your routine
As we get older our gums shrink and our teeth shift – so you may need to invest more in your smile. The ideal schedule is hygienist every three months for cleaning, dentist every six and X-rays every 12-18 months, depending on how many fillings you have. Whitening treatments depend on lifestyle and if you grind your teeth you may have to wear a protective shield at night. If this gets bad enough, a full reconstruction may be necessary to rebuild worn enamel with veneers and crowns.

Expert: Dr Uchenna Koye
Uchenna qualified at Guys Dental School London in 1993 and now runs three London practices (www.londonsmiling.co.uk). She is also the new dentist on Channel 4’s 10 Years Younger.

Ever find yourself craving sugary treats or shouting at the children for no reason just before your period? More than 80 per cent of women do, as they experience some form of Premenstrual Syndrome (PMS) every month, and for some it can turn their lives upside down. Unfortunately, cases seem to be on the rise – I’m seeing more women with PMS than ever before. Some experts blame our high-fat, high-sugar western diet for the increase but the everyday stress of organising a career, household and family can only add to your chances of experiencing symptoms.

Monthly demon
PMS is experienced by women in the luteal phase of their menstrual cycle – the two-week period between ovulation and menstruation. Symptoms can vary wildly from person to person and are often divided into two categories; physical and behavioural – although these commonly occur together. You may experience bodily changes such as abdominal bloating and pain, excessive sweating, aching legs, tender breasts and vaginal dryness as well as a fluctuation of up to half a stone in weight. And women also report a transformation in their personality, including depression, forgetfulness, mood swings, unpredictable behaviour, clumsiness and increased levels of anger and irritation.
Happily, most of us experience just a day or two of abdominal discomfort or low mood before menstruation and, once our period arrives, life returns to normal. However, for 5-10 per cent of women, PMS is so severe that they suffer an acute level of symptoms throughout the entire two weeks of ovulation, which can have a massive impact on their overall wellbeing. Indeed, these women often find themselves feeling and acting like a completely different person for half of their reproductive life, sometimes too disturbed or unwell to go about their daily routine.

Balancing act
We’re not completely sure why PMS occurs, although most research into the condition points to a hormone imbalance within the body. At the point of ovulation, we experience two significant hormone changes – our oestrogen levels drop and levels of progesterone rise. Experts believe either the decrease in oestrogen or a sensitivity to high levels of progesterone could be the cause of PMS or, in fact, a combination of the two.
PMS does tend to run in families but there isn’t enough strong evidence to say that it’s a genetic condition. Lots of the sufferers I speak to tell me that their mothers showed similar symptoms to their own, but some experts have suggested that the behavioural traits of PMS could be subconsciously learnt from older family members.
It has been proven, however, that women with a tendency towards depression or anxiety often suffer from more severe symptoms of PMS. Those who already battle with low mood often find a decrease in oestrogen levels exacerbates their symptoms to even more extreme levels. I see women who describe the urge to commit suicide or kill in the days leading up to their period, which can have a devastating impact on their family life. In a similar way, stress can act as a trigger for PMS, too.
The foods you eat can also have an impact on your symptoms. Processed sugar is one of the biggest triggers of PMS, as it causes your blood sugar levels to rise and then plummet rapidly, which leaves you feeling confused, angry and irrational. It’s a similar principle to the hyperactivity children experience after eating sweets – an adult sugar high. Alcohol acts in a similar way, stimulating our mind and dulling the immune system.

Taking control
Unfortunately, there’s no one-size-fits-all cure for PMS but making simple changes to your lifestyle could be enough to manage your symptoms. The most important thing you can do is to discuss your condition with your partner, family and close friends. Knowing you have emotional support will not only act as a great comfort, but it will also help them to separate your premenstrual behaviour from the ‘real’ you.
Take notes I always recommend patients keep a diary of their symptoms. Once you’ve established patterns in behaviour, it’s easier to control them. It also means you can forewarn people of when you’re likely to be suffering.
Watch your diet A balanced diet with plenty of protein and vegetables is a great way to boost your immune system and help your body. Soya is a natural source of oestrogen and some women find that introducing soya milk or linseed to their diet helps to relieve symptoms. Cut out processed, sugary foods and make sure you eat complex carbohydrates at every meal to keep your blood sugar levels under control. Try to avoid alcohol during ovulation, too.
Keep hydrated A lot of people think drinking less water is the answer when they feel bloated from fluid retention, but the opposite is true. To stop your body holding excess water, increase your liquid intake to 10 glasses of water a day to flush out and hydrate your system.
Get active Lacing up your trainers for a workout is probably the last thing you feel like doing in the days before your period – our bodies go into comfort mode – but even the smallest amount of low intensity exercise can help reduce stress and aid sleep. Why not try swimming or Pilates to get your endorphins flowing? Plus, research has shown that women who exercise regularly are much less likely to suffer from PMS.
Keep calm Instead of reaching for a slice of cake or glass of wine as a way to de-stress, find a healthy way to relax your mind and body. Some people enjoy a bath with their favourite essential oil while others prefer reading a good book with a calming scented candle. Try to schedule an hour a day for me-time.

When to get help
If your symptoms suggest you’ve got PMS, your GP will make a clinical diagnosis. You may be prescribed an SSRI anti-depressant like Prozac, which acts to increase your body’s levels of the ‘happy hormone’ serotonin. Most women only take this for the two weeks of ovulation.
Oral contraception has also proved helpful for some PMS sufferers. Ask your GP for one of the newer types of contraceptive pill, which tend to be a mix of oestrogen and progesterone rather than just progesterone. But be careful – in women with a sensitivity to progesterone, the pill can make their symptoms worse.
Premenstrual oestrogen therapy (a type of HRT) is also a common treatment for PMS sufferers who are experiencing bad behavioural symptoms, as it helps increase the oestrogen levels within the body and improve your mental state. The connection between oestrogen and mood has been known for some time, and oestrogen therapy can help people with depression.
Applying oestrogen topically may also help women who complain of vaginal dryness or soreness before their period. These creams mimic the function of natural oestrogen which moisturizes and lubricates the vagina, making sex less painful and more enjoyable.
Remember that it could take up to three months for the effects of any medication to show, so continue to keep a record of your symptoms.

Natural Easers
Dr Caroline Longmore, founder of Galen Naturopathic (www.galennaturopathic.com), recommends these natural alternatives to help balance the effects of PMS:

-  Research from the University of Reading found taking vitamin B6 and magnesium decreased anxiety, irritability and mood swings after one month.
-  Black cohosh has antispasmodic properties that help soothe stomach cramps.
-  Evening primrose oil (pictured, right) contains the essential fatty acid GLA to help ease breast tenderness and bloating.
-  Acupuncture stimulates mood-boosting endorphins and has a balancing effect on the body.
-  Research from the British Medical Journal suggested taking agnus castus extract can help balance hormones and help treat PMS-related skin problems.

Expert: Pat Jones
Pat Jones is a nurse specialist in women’s health at a Warwickshire GP surgery, advising patients on PMS and the menopause. She also talks all over the UK on managing PMS symptoms naturally (www.feelwellbewell.com).

Compiled: Victoria Joy

1 Watch how you lift and carry
If I had to pick one thing which results in people getting back pain, it would be lifting. It’s surprising how many people don’t know how to lift correctly. The principle is simple – bend with your knees, not with your spine. When you’re carrying something, hold it as close to your body as you can. Holding a load far away from your body can put extra strain on the spine.

2 Don’t be a martyr
If you get sudden back pain, stop whatever it is you’re doing – mowing the lawn, changing the bed, lifting that box of files or fixing the U-bend. It sounds simple, but many people try and soldier on when they have back pain, claiming they just want to finish off the job. Don’t! You could be doing more harm than good.

3 Look after your ‘hamburgers’
Your spine is made up of vertebrae, which are a column of bones that protect the spinal cord. Between each vertebra is a disc that’s made of springy material called cartilage. Each disc resembles a tiny hamburger, and they are used as shock absorbers to cushion any impact against the spine. If too much pressure is put on them through twisting, straining and carrying heavy objects, they can bulge out to the side causing severe back pain. This is called a slipped disc.

4 It’s not always a slipped disc
However, many people assume they have a slipped disc if they get bad back pain, when slipped or prolapsed disc injuries probably only account for five per cent of backache cases. When it is a slipped disc, the pain is caused by the cartilage bulging out and pressing on the nerve root in the spine. If your back specialist suspects you of having a disc problem, they’ll carry out the Straight Leg Raising (SLR) test. This is when you lie on your back on a couch and the doctor will lift your leg upwards without bending it at the knee. If the doctor can bring your leg up to a 90-degree angle without pain, it’s unlikely to be a slipped disc. If it’s only a few degrees, it could suggest a disc is pressing on the nerve root.

5 Cold is as good as hot
Cold packs can be as effective as heat packs in alleviating back pain. If you do use heat or cold to soothe a painful back, make sure the hot water bottle or bag of frozen peas is not placed directly on you. Wrap it up in a tea towel to protect your skin.

6 Give it 24 hours before seeking help
If you get back pain, don’t rush (or rather limp) to your doctor or hospital straight away. If it’s only a small twinge, the pain might be gone by tomorrow if you take it easy, have painkillers and use hot or cold packs. If your back still hurts after a day or two, ring your GP surgery. Many now have their own physiotherapist attached to them who can advise you over the phone.

7 Diagnosis is tricky
It’s easy for doctors to recognise back pain, but often hard to identify what’s causing it as the spine is a very complicated mechanism and it’s not always easy to see the injury. People often think an X-ray will reveal the cause, but most of the time they don’t show anything helpful such as ‘soft tissues’, like muscles and ligaments – although they can pinpoint abnormality of the bones. Specialists trained in back care such as osteopaths, chiropractors or physios can help treat your back, usually through manipulating it and suggesting exercises.

8 Back pain isn’t always due to back strain
That is, the pain you feel in your back can be caused by other problems including osteoporosis, ankylosing spondylitis (a bone and joint condition that mostly occurs in young men), and, very rarely, a tumour. Period pain sometimes causes lower back pain because the nerves from the womb run up to the back, while having a kidney infection can result in a painful lower back, usually either side of the spine.

9 Keep active to ease aches
The worst thing you can do when you have a bad back is remain totally immobile, because that makes everything stiffen up. Until about 15 years ago, patients were told to remain horizontal for as long as possible, but many back specialists have realised that moving gently can actually help. Walking is generally good, as is Pilates and swimming, but avoid breaststroke as that puts quite a lot of strain on the upper part of the spine.

10 Watch your vices
Keep your lifestyle healthy and it will help keep your back well too. Smoking is bad for your back because it restricts blood vessels, so reduces the supply of blood to the spongy discs found between the vertebrae in your spine. This means they lack a healthy level of nutrients, water and blood to stay soft and can become painful. Watching your weight is important too as having a ‘spare tyre’ can put your spine under strain. Other everyday things that can potentially lead to back problems include wearing high heels – they force your bum out and stop you walking upright, and carrying heavy bags, especially on one shoulder.

11 Think about your car seat
People spend time looking at mattresses for their bed, but forget about the amount of time they spend in their car, and what that can do to their back. Car seats are a major cause of back pain so if you’re buying a new car, make sure you look at the seat positioning and spend some time sitting in the car to ensure it doesn’t cause you pain.

12 Try the two As
That’s acupuncture and the Alexander Technique. A study in the British Medical Journal in 2008 found those who practised Alexander Technique reported lessened pain and greater mobility that lasted longer than other pain relief methods. Similarly, in spring 2009, a NICE (National Institute for Health and Clinical Excellence) committee found non-specific low back pain (ie pain without disc problems) could be helped with a course of acupuncture.

13 Go alternative
Homeopaths may be able to help ease your backache. They’ll generally recommend treatments using arnica and bryonia. Make sure you visit a registered homeopath. Contact the Society of Homeopaths (www.homeopathy-soh.org) to find one near you. You can also try taking supplements. Omega-3 fish oils are anti-inflammatory, as are glucosamine and chondroitin, so may help with pain. A study in the journal Phytomedicine suggested that the herbal supplement, devil’s claw could help lower back pain, in a double-blind study. Bear in mind, these can help treat the pain and inflammation in backache, but if you have any ‘mechanical problems’ such as a slipped disc, you will probably need to see a specialist like a chiropractor or osteopath to have your spine manipulated.

14 Get in the water
Hydrotherapy is essentially doing exercises in water and is good for back pain sufferers. The water takes the weight off your back, and makes it easier for you to use your back muscles. If you’re in a warm pool, muscular spasm is relieved and pain reduced. Researchers at the University of Malaga in Spain have recently looked into how running in waist-deep water can help chronic back pain. It’s thought it helps strengthen abdominal muscles while stretching out the back, hip, hamstring and calf muscles.

15 Back pain causes sick days
The charity BackCare estimates on any day, one per cent of the working population are on sickness leave due to a back problem. Luckily, 90 per cent of people with acute back pain recover within six weeks as, if you rest and take care of yourself, the back can heal itself as inflammation gradually recedes and pain is reduced. Even a slipped disc may heal on its own, without the need for measures such as surgery. It’s thought the bulging disc may gradually wither away, or go back into its original position with adequate rest, mild exercise and a healthy diet.

Expert: Dr David Delvin
Dr David Delvin is the author of Backache: What You Need to Know (Sheldon Press, £7.99). He is the director of the Medical Information Service and has written 33 books and made over 900 TV appearances.

Compiled by Hannah Fox