Age UK survey finds hospitals are still failing on nutrition for elderly patients

See BBC News report. Michelle Mitchell, from Age UK, says, "Not enough is being done to ensure that words are transferring into action on the wards."

Nutrition training for doctors needs to be improved

Nutrition needs to be made a more important part of the doctor training system, a leading expert has said. Gastroenterologist Dr Penny Neild, who works at London's St George's Hospital, said training on how to spot and tackle malnutrition was "patchy".
Read article on the BBC News website (UK)

Is your health in a downward spiral because of constant, severe pain?

Obviously I cannot cure you. But I am sure that if you follow my advice you will feel a bit better.

You have been in pain for such a long time that the pain is now only a part of the problem. There are many other problems that have developed as a result of the pain.

Constant pain is very tiring; it takes away your energy and it disturbs your sleep. It makes you less able to take proper care of yourself. It naturally dominates your thoughts and you give less attention to your eating. The tiredness makes it harder for you to think of suitable meals and harder for you to prepare them, and the tiredness and pain sometimes make eating a chore rather than a pleasure.

Here are some of your extra problems:-

Insufficient food causes you to have even less energy and this leads to you bothering even less about proper meals and so you are on a downward spiral of less and less energy and less and less suitable food. You then get health problems caused by malnutrition. These may include anaemia, which could be helped by eating some red meat.

People in pain need more calcium than people who are not in pain. Calcium helps us to relax. As a person in constant pain, you need all the help you can get to relax! Pain makes you tense. Calcium is also helpful when you are wanting to go to sleep. I suggest you drink more milk, especially if you are feeling particularly tense, and especially in the evening to help you to get some sleep when you go to bed. Getting some sleep helps you cope with the difficulties and pain of the day ahead. If you get up from a night of no sleep you are beaten before you start.

The tiredness, the anaemia, the pain and insufficient food lead to insufficient exercise. This inactivity, and the shortage of calcium and vitamin D all lead to some demineralisation of your bones, especially, perhaps, of the wrist bones and the spine. This makes it more possible for a fall to result in a fracture. So if you drink a pint of full cream milk a day (my personal opinion is that full cream milk is better for you than skimmed milk because it tastes nicer and it is more soothing) and try to to be a little more active, this will help to protect you from further avoidable bone-weakening. A very simple exercise that is good for wrist bones is to squeeze a rubber ball several times a day. If you haven’t a rubber ball I’m sure you can find something similar and softish to squeeze in this way.

Concentrate at the moment on food. Look on eating proper meals as the most important activity of your day. Think of it as your job. Even if you do nothing else, you must do that. Your body and your brain cannot serve you well if they have insufficient nourishment. I think you would also find it helpful to get some multivitamin/multimineral tablets from Boots or Holland and Barrett or somewhere like that and to take whatever dose is recommended on the pack (do not take more than the recommended dose). They just have a bit of all the vitamins and all the minerals in them and it helps to prevent you from being short of any particular nutrient. Always take tablets with a good draught of water. Your appetite should improve as your nutrition improves.With improved nutrition you will feel a lot better, and hopefully the pain will also be reduced. Most chronic pain is also reduced by eating less salt and salty food, if you can manage that.

Are Brits really eating themselves to death or is it misinformation that is the problem?

Eating ourselves to death: Britain's fat epidemic
article in the Independent on Sunday

The comments beneath the article are interesting. There are the usual sort whose writers blame fat people themselves for their obesity and there are more thoughtful contributions by people who have given the matter much more thought and realise the problem is multi-faceted. - Here are my own thoughts:

Dieting is a snare and a delusion, and the frequent exhortation thrown at fat people to 'just eat less and exercise more' has not a jot of evidence to support its efficacy. - It absolutely does not make obese people less obese. Dieting fosters malnutrition and dietary deficiencies.

Cutting down on salt and salty food reduces weight easily and safely by reducing the fluid retention which is part of all obesity. Increasing calcium intake reduces weight by increasing fat excretion in the faeces (details on the BBC's website in the BBC2 "Truth About Food" pages from a series a few years ago) and there is growing evidence that excess weight is associated with Vitamin D deficiency as well as with calcium deficiency.

Many prescription drugs cause massive fluid retention and therefore morbid obesity, including steroids like prednisone and prednisolone, HRT, tricyclic anti-depressants like amitriptyline, anti-psychotics, etc.

Obesity is a complex illness, ill-served by the simplistic 'solutions' of the uninformed.

Lose weight, reduce your risk of most cancers, high blood pressure, type 2 diabetes, heart disease, heart attack, vascular dementia, stroke, osteopenia, osteoporosis, hypercholesterolaemia, depression, liver and kidney problems, and improve your health in many other ways without drugs, hunger or expense by eating less salt! - Try it! - You will feel so much better! See my website www.wildeaboutsteroids.co.uk
The site does not sell anything and has no banners or sponsors or adverts - just helpful information.

Read my Mensa article on Obesity and the Salt Connection

And see Sodium in foods and

http://www.wildeaboutsteroids.co.uk/story.html - my 'political' page

http://www.wildeaboutsteroids.co.uk/socio.html - social and economic considerations

amitriptyline

prescribed steroids and HRT

See advice for pregnant mothers

Children and Obesity

Associated health conditions

and FAT RETENTION

I can be contacted via my website if you need my further help. My help is free.

Britain's biggest baker, Warburtons, is selling bread with up to 20 per cent more salt than rivals.

Warburtons bread 'has highest salt content'
Article in the Telegraph

Extract 1

"An investigation revealed that some loaves made by Warburtons, – the UK's biggest food brand after Coca-Cola – contain half a gram of salt per slice, meaning that a five-year-old child would reach their safe limit from eating three sandwiches.

Salt raises heart pressure which is the biggest cause of heart attacks and strokes. Campaigners say lowering levels would save 16,500 lives a year – a third of the deaths from smoking. A further 16,500 people would be prevented from having debilitating non-fatal heart attacks and strokes, according to the pressure group Consensus Action on Salt and Health (Cash)."

Extract 2

"Overall, Warburtons had an average of 1.08g salt, 5 per cent more than Kingsmill, 12 per cent more than Tesco, and 20 per cent saltier than Sainsbury's, which has been praised for improving cardiovascular health.

Warburtons, a privately-owned brand from Bolton, Lancashire, promotes itself as a wholesome, family-run baker. Warburtons defended its record, saying it had cut salt by "over 30 per cent in recent years" and would hit targets by their deadline in 2010."

I don't think it's completely accurate for Warburton's to say that they have cut salt by "over 30 per cent in recent years" because a few years ago some of the loaves they used to sell were called, if I remember correctly, Healthy White loaves, and they definitely contained a much lower amount of salt than other loaves - about 0.3g sodium (equal to 0.75g salt) per 100g, because they used LoSalt in the making of the bread, rather than ordinary salt. - I was very sorry that they discontinued this loaf, because it was so much less harmful than other shop-bought bread. Most bread at that time contained about 0.5g (or more) sodium per 100g.

Remember, you can make your own bread easily in a breadmaker and then you could keep the salt content down. Bread manufacturers often claim that salt is necessary to the bread-making process. - I find this hard to believe because I don't put any salt at all into the bread I make and the 'process' doesn't seem to be affected...(o: - However, this is purely my own experience; I know nothing at all about salt in bread-making other than my own experience so I may well be wrong about whether salt affects bread-making.

Extract 3

"The campaign group Consensus Action on Salt and Health (Cash) urged it to immediately make steeper cuts to improve its customers' health. Three million people eat Warburtons bread every day. "Bread is the major source of salt in the diet," said Cash's chairman, Professor Graham MacGregor, an NHS doctor who treats heart patients at St George's Hospital, south London. "It is vital that bread manufacturers take a really responsible role."

Manufacturers use salt to improve taste and disguise the use of cheap ingredients. 75 per cent of sodium in the diet comes from processed food."

I do wish Professor MacGregor would tell people the most important information about salt, namely that obesity is caused by salt sensitivity/fluid retention/sodium retention and is reduced by eating less salt. It is inconceivable that he does not know it. I wrote him a long letter about obesity and the salt connection years ago. I politely pointed out that there were some serious errors in his book about salt.

The longer he delays telling the truth about obesity, the greater the harm done to millions of people. The risk of high blood pressure, heart disease and stroke, while correct to attribute (in part) to salt intake, does not have the impact that telling the truth about obesity would have. Whilever most people, including the Government's Health Ministers, the Department of Health, doctors, dieticians and the Food Standards Agency, continue to promulgate the lie that obesity is caused by eating too many calories and is reduced by eating fewer calories than the body requires, obesity and its attendant illnesses and ill-health will almost certainly continue to increase, because, as we have just read, the food companies are dragging their feet in reducing the amount of salt they ladle into their harmful products without a lot of censure from their customers, who are being misinformed by the medical profession and Government agencies and the dieting industry.

They all need to confess that they have been misleading the public. - The misinformation is causing terrible, needless suffering, because dieting/calorie restriction leads to inadequate nutrition/malnutrition and so increases the harm done by the salt sensitivity and does not reduce obesity at all. And of course they need to tell the public about the huge rôle prescription drugs play in making people sensitive to salt.

(Addendum: according to my hitcounter, it looks as though someone from Rank Hovis has been reading this blog entry today, October 31st. - Let's hope it will do some good!)

See Extract 4:

"In general, branded breads had more salt than those made by supermarkets. Hovis' white granary bread had 1.4g of salt per 100g – the highest in the survey.")

Lose weight by eating less salt! Go on! - Try it! - You will feel so much better!
See my website www.wildeaboutsteroids.co.uk
(The site does not sell anything and has no banners or sponsors or adverts - just helpful information.)

How to Lose weight!

Children and Obesity

See Sodium in foods

vulnerable groups

See amitriptyline

prescribed steroids and HRT

More than one in four adults admitted to hospitals, care homes or mental health units are suffering from malnutrition

One in four adults in hospital 'malnourished'

Extracts from the Telegraph:

"More than one in four adults admitted to hospitals, care homes or mental health units are suffering from malnutrition, the largest survey of its kind has found.

Women and the elderly were at greatest risk, says the report from the British Association for Parenteral and Enteral Nutrition (Bapen), which is published today.

More than 11,000 patients were screened for signs of being under-fed and 28 per cent were found to be malnourished."

"Patrick South, of Age Concern, said that food should be a high priority for hospital and care staff. "Not only do a significant amount of people arrive in hospital and care settings already malnourished, six out of 10 older people are at risk of becoming malnourished, or their situation getting worse in hospital.

"Malnutrition is still rife in the community, with up to 14 per cent of people aged 65 and over in the UK being malnourished."

Christine Russell, of Bapen, said that doctors, nurses and dietitians "must work to implement consistent nutritional screening policies to ensure that malnutrition is effectively addressed"."

Patients are left to starve on NHS wards...

Patients left to starve on NHS wards

Extracts from the Telegraph:

"The number released from hospital suffering from malnutrition, nutritional anaemia, or other nutritional deficiencies has risen by 84 per cent in the decade since Labour came to power, from 74,431 in 1997 to 139,127."

"The worst area in the country for malnutrition was the Pennine Acute Hospitals Trust in Greater Manchester, where 4,947 patients were discharged suffering malnourishment, followed by the University Hospitals of Leicester NHS Trust, with 2,771, and the Newcastle upon Tyne Hospitals NHS Foundation Trust.

They were among nearly 50 hospital trusts around the country that discharged more than 1,000 malnourished patients last year.

Meanwhile, it is estimated that the poor quality of hospital food is putting patients off to the extent that 13 million meals are thrown away each year, at an average cost of £2.65 each.

Last year, the health minister Ivan Lewis admitted patients were being starved on wards, with some elderly people given little more than a scoop of mashed potato for lunch.

Others were "tortured" by having meal trays placed out of reach, which they were too weak to pull towards them."

When I was in hospital (Northern General Hospital, Sheffield) for a month last summer, my main complaint about the food was the high salt content of most of the meal choices. - As a steroid victim I need to avoid eating salt and salty food, so I had to rely on friends bringing me food that I could eat.

A lovely bride has died of starvation after years of unsuccessful dieting led her to try obesity surgery - with catastrophic results.

Bride who had stomach stapled died of starvation - Daily Mail

Extract:

"A bride desperate to be slim for her wedding day died of starvation after stomach stapling surgery went wrong. Emma Favell, 32, paid a Belgian clinic £7,000 to carry out the radical procedure and within six months her weight dropped from 23 stones to 15 stones.

By the time she married in March, she weighed around eight-and-a-half stones and was able to slip into a size 8 wedding dress.

But an inquest has heard how a mistake in the operation meant she was not able to give her body the nutrition she needed to maintain a healthy lifestyle and she died a month later.

South Staffordshire Coroner's Court was told that Mrs Favell had suffered years of depression over her size.

The nurse, from Burton upon Trent, spent months researching the treatment before picking out a Sint Blasius clinic in Belgium, where the procedure is carried out for half the £14,000 price tag in the UK.

During stomach stapling, surgeons usually close off some of the patient's small intestine, leaving a smaller area where food and gastric juices can mix."

Such a sad story. Dieting does not reduce obesity, as this unfortunate young lady found out, and obesity surgery carries a high degree of risk. She has been poorly served by doctors.

The safe way to lose excess weight is to give up dieting, eat good healthy meals, low in salt, and eat plenty of fruit and fresh vegetables.

Lose weight by eating less salt! Go on! - Try it! - You will feel so much better!
How to Lose weight!

See my website http://www.wildeaboutsteroids.co.uk/.html
(The site does not sell anything and has no banners or sponsors or adverts - just helpful information.)

Read my Mensa article on Obesity and the Salt Connection

See Sodium in foods and

http://www.wildeaboutsteroids.co.uk/story.html - my 'political' page

http://www.wildeaboutsteroids.co.uk/socio.html - social and economic considerations

I can be contacted via my website if you need my further help. My help is free.

I am reading, and very much enjoying, "Cat's Eye, a novel by Margaret Atwood, the Canadian writer.

I highly recommend Margaret Atwood's writing. The novels of hers which I have most enjoyed are "The Handmaid's Tale", "Oryx and Crake" and this one, "Cat's Eye".

Here is a tiny introduction to "Cat's Eye", copied from the back cover:

"Elaine Risley, a painter, returns to Toronto to find herself overwhelmed by her past. Memories of childhood - unbearable betrayals and cruelties - surface relentlessly, forcing her to confront the spectre of Cordelia, once her best friend and tormentor, who has haunted her for forty years."

And here is a quotation from the Listener:

"Not since Graham Greene or William Golding has a novelist captured so forcefully the relationship between school bully and victim... Atwood's power games are played, exquisitely, by little girls."

The bullying certainly has the powerful ring of truth, and I find that the truth and meticulous attention to detail are compellingly attractive in this novel. I have read several of Atwood's books and greatly admire her intellect, her intelligence, her deep knowledge of and familiarity with the natural world. I also, of course, admire the layers of complexity in the thoughts and thought processes of the characters Atwood creates for us - usually as here, the thoughts of the central character who is the first person narrator of the story. And of course I relish the story itself. - Atwood is a compellingly original writer.

Having said all this, I would like to quote you a paragraph from page 269 of my copy, on the first page of chapter 48, which is where I have reached in the novel, because it is of particular interest to me and I would like to make some comments about it:

"She is sitting on a stool, her buttocks squashing out sideways; her stocky back is curved, her right leg is crossed over her left at the knee, her right elbow rests on her right knee, her left arm is placed behind her with the hand on the stool. Her eyes are bored, her head droops forward, the way it has been put. She looks cramped and uncomfortable, and also cold; I can see the goose-bumps on her upper arms. She has a thick neck. Her hair is frizzly and short, red with darker roots, and I suspect she is chewing gum: every once in a while there is a slow, furtive, sideways motion of her jaw. She is not supposed to move.

I am trying to draw this woman, with a piece of charcoal. I am trying for fluidity of line. This is how the teacher has arranged her: for fluidity of line. I would rather be using a hard pencil; the charcoal gets on my fingers and smears, and is no good for hair. Also this woman frightens me. There is a lot of flesh to her, especially below the waist; there are folds across her stomach, her breasts are saggy and have enormous dark nipples. The harsh fluorescent light, falling straight down on her, turns her eye sockets to caverns, emphasises the descending lines from nose to chin; but the massiveness of her body makes her head look like an afterthought. She is not beautiful, and I am afraid of turning into that."

As a steroid victim, I have experienced actually being morbidly obese, as opposed to being simply a careful observer of someone who is morbidly obese. This life model would certainly be 'cramped and uncomfortable'; her heart will be enlarged because of her abnormally high blood volume (the cause of her obesity), and this enlarged heart and the model's greatly enlarged/distended blood vessels mean that the space available in the thoracic cavity for the lungs to expand will be much reduced. - She will not be merely uncomfortable in the position in which she has been put; she will be having some difficulty breathing and will be breathing rather shallowly and painfully and perhaps quite rapidly. - 'She has a thick neck' because of the distended blood vessels. (The neck will also appear reddened because of the nearness of these swollen blood vessels to the surface of the sensitive, thinning skin. This has not been mentioned by Elaine, the artist in the novel.)

She is most likely to be very hungry: very overweight people obviously need larger quantities of food/calories than slimmer people because they have such a heavy body to carry around and service, and because they have a larger surface area from which to lose heat. (Eating more is a consequence of being overweight, not the cause of it.) So she is chewing and she is cold and she has goose-bumps.

Elaine says of the woman: "There is a lot of flesh to her," and here I would disagree with Elaine, though that would clearly be her perception. - Actually, the woman will have LESS flesh than if she were slimmer. This is because most of the excess weight of a morbidly obese woman is not flesh, but fluid retention - excess salt and water in her bloodstream. She is one of the unfortunate people who are sensitive to salt/sodium. Frequently fluid retention causes fat retention too, because of shortage of minerals, mainly calcium and magnesium. See http://aboutsalt.blogspot.com/search/label/malnutrition She will almost certainly have tried dieting many times and will have lost much of her firm flesh and thickness of skin because the body feeds on itself when a person eats insufficient food/calories for its requirements.

The woman's breasts are 'saggy' because of all the excess salt and water they contain: water always travels downwards. When people's bodies suddenly appear to be suffering from the effects of gravity, so-called, it is actually the effects of fluid retention, exacerbated often by dieting, which thins and weakens the skin and blood vessel walls further, so that the fluid retention increases. Similarly 'the descending lines from nose to chin' are a characteristic feature of morbidly obese people and are formed because of the downward pull of the fluid in the veins and the enclosing flesh/skin being too weak to resist its pull. The 'massivenessness of her body' when compared with her head would not be a constant. - If the woman were to be lying down, a lot of the excess blood volume would naturally migrate from her body to her head and neck, which would gradually swell/enlarge and redden, causing great discomfort. She may even feel as though she is being throttled...

She - the fictional model for the life class - would greatly benefit by eating as little salt and salty food as possible.

Lose weight by eating less salt! Go on! - Try it! - You will feel so much better!
See my website www.wildeaboutsteroids.co.uk and
http://www.wildeaboutsteroids.co.uk/vulnerable_groups.html
(The site does not sell anything and has no banners or sponsors or adverts - just helpful information.)

Alarming levels of malnutrition have been recorded in Britain.

Junk food nation - Independent on Sunday

Extract:

"3.6 million people in Britain suffer from malnutrition. Hospitals see 44% rise in cases as cost to the NHS hits £7.3bn ."

"Alarming levels of malnutrition have been recorded in Britain, The Independent on Sunday has learned, prompting further medical concern at the effects of the nation's addiction to salty, fatty, junk food.

Despite high-profile campaigns by the Government and celebrity chefs to improve eating habits, new figures reveal that there has been a 44 per cent increase in hospital cases of malnutrition over the past five years.

Amid estimates that up to 3.6 million people are suffering from malnutrition, including conditions found in sub-Saharan Africa, MPs and doctors last night called for action to tackle poor diets, and for all patients to be screened for malnutrition. They called for the Government's National Institute for Health and Clinical Excellence (Nice) guidelines to be made compulsory.

In 2002, 2,729 people in English hospitals were diagnosed with malnutrition. Last year, the number had risen to 3,931.

The British Association for Parenteral and Enteral Nutrition estimates malnutrition costs the NHS more than £7.3bn a year, double the annual obesity bill. Doctors estimate that up to 6 per cent of the population could be suffering from malnutrition and serious vitamin and mineral deficiencies caused by poor diet. Most do not have their conditions identified.

Experts said a reliance on pre-prepared food and failure to eat enough fresh fruit and vegetables is depleting levels of essential micro-nutrients. The deficiencies are found in teenagers, the elderly, adults and babies as young as 18 months. They warn the balance of nutrients is also disturbed by binge drinking, excess sugar and drug use."

Obviously a great deal of lasting harm has been done by years of junk food lunches provided as school meals for many years and only in recent years, and patchily, beginning to be improved. There is also the continuing harm done by poor hospital food provision (and that of other institutions) and failure to ensure that patients can actually eat the food provided, for example when they are too ill or frail or disabled actually to open a packet of sandwiches and no member of staff opens it for them - just removes it and throws it away uneaten...)o:

Overwhelmingly, great and lasting harm is done by dieting, yet the government's agencies and obesity 'experts' continue to advise obese people to diet/eat less, even though this is well known to be ineffective in reducing obesity. - Obese people should be told the truth: that to lose excess weight they should not eat less food, only less salt.

And the MASSIVE harm done by the over-prescribing of drugs by negligent doctors may well be the major cause of malnutrition and micronutrient deficiency in older adults.

Lose weight by eating less salt! Go on! - Try it! - You will feel so much better!
See my website www.wildeaboutsteroids.co.uk
(The site does not sell anything and has no banners or sponsors or adverts - just helpful information.)

23-stone woman, Sheila Dunn, dies of malnutrition after gastric by-pass surgery

23-stone woman dies of malnutrition after gastric by-pass - Evening Standard article

Extract:

"A 23-stone "super obese" woman died of heart failure as a result of malnutrition just months after undergoing a life-saving gastric bypass operation.

Sheila Dunn, 52, died last August, weighing just over 15 stone, just nine months after the surgery, in November 2005.

The inquest at York heard how she fell into the dangerous category of "super obese" - meaning surgery was the only way she could prevent her weight from killing her."

I can't agree that surgery was the only way forward for this very unfortunate woman. - Had she been given the correct information about what causes obesity and what is best to do to reduce it, she would still be alive.

Here is some SAFE and EFFECTIVE advice for anyone who is obese and wants to lose weight:

'Slimming' is unnecessary, ineffective and potentially harmful. It does not reduce obesity, because obesity is NOT caused by overeating. Obesity is caused by fluid retention, and is best reduced by reducing salt intake. 'Slimming' drugs, appetite suppression and calorie restriction are unnecessary, undesirable and often harmful, even if prescribed by a doctor. Surgery is always dangerous and follow-up care is often inadequate.

I believe that most morbid obesity in adults is caused by the side-effects (notably sodium retention) of many prescribed medications, especially steroids and HRT. When prescribing these dangerous drugs, doctors should warn the patient not to eat salt or salty food while taking the medication because eating salt will result in sodium retention and fluid retention. Unfortunately, doctors do not do this. The safest and most reliable way to lose the weight gained is to eat less salt.

All overweight people suffer from fluid retention. - You can reduce this and lose some of the excess fluid/weight you have in your body by eating less salt/sodium and making sure you eat plenty of fresh fruit and vegetables. - You do NOT need to restrict calories!

Lose weight by eating less salt! Go on! - Try it!
See my website www.wildeaboutsteroids.co.uk
(The site does not sell anything and has no banners or sponsors or adverts - just helpful information.)