Disturbed sleep patterns may be key to ADHD, study finds

Research links disruption of body clock to number of chronic conditions

Struggling to concentrate, having too much energy and being unable to control behaviour the main manifestations of attention deficit hyperactivity disorder (ADHD) have been linked to disruptions in sleep, researchers will reveal on Sunday.

The findings underline a growing awareness among doctors that disturbed sleep is associated with many major health hazards. Other ailments linked to the problem include obesity, diabetes and heart disease. The work opens up the possibility of developing treatments for ADHD without drugs, the researchers say.

Speaking at a pharmacology conference in Paris, Professor Sandra Kooij, of VU University Medical Centre in Amsterdam, will outline research which shows poor sleep is a sign that the timings of many physiological processes are not properly synchronised.

The onset of ADHD is one of the clear signs that this is taking place. Our research is making clear that sleep disruption and ADHD are intertwined. Essentially, they are two sides of the same physiological and mental coin, said Kooij, speaking before her presentation.

Symptoms of ADHD, which also include mood swings and impulsiveness, are generally noticed at a fairly early age, often when a child is being sent to school for the first time, although cases are sometimes not recognised until adulthood. It is estimated that between 2% and 5% of people are affected by ADHD at some time. According to Kooij, the condition is very often inherited and usually has a pronounced neurological background.

In addition, about 80% of cases are associated with profound sleep disturbances. This is most frequently manifested as delays in the onset of sleep, Kooij will tell delegates at the annual congress of the European College of Neuropsychopharmacology in Paris.

People simply cannot go to bed and fall sleep at the end of the day like others, she said. And that has consequences. Affected individuals sometimes cannot get to sleep until around 3am but they still have to get up to go to work or school. The result is a drastic loss of sleep.

This problem is linked, in turn, to disturbances in levels of the neurological transmitters dopamine and melatonin in the brain, she said. These chemicals control when we fall asleep and when we wake up by directing the brains circadian system, the internal biological clock which keeps us in sync with the 24-hour day.

Other conditions linked to disturbed dopamine and melatonin levels include restless leg syndrome an irresistible urge to move your legs and sleep apnoea, in which breathing is disturbed during sleep. These disorders are also linked to ADHD, said Kooij.

This claim is backed by Professor Andreas Reif, of University Hospital, Frankfurt. A disturbance of the circadian system may indeed be a core mechanism in ADHD but beyond these considerations, sleep abnormalities are a huge problem for many patients, heavily impacting on their social life. More research is very relevant to improve patients lives. The crucial point is that a cascade of health disorders, including ADHD, appear to be triggered by disruptions to circadian rhythms, offering some routes to counter these conditions by attempting to restore a patients body clock. Kooij said her team was now looking for biomarkers, such as vitaminD levels, blood glucose, cortisol levels, 24-hour blood pressure, and heart-rate variability that are associated with sleeplessness.

Once we can do that, we may be able to treat some ADHD by non-pharmacological methods, such as changing light or sleep patterns. We may also be able to prevent the negative impact of chronic sleep loss on health in general.

Read more: https://www.theguardian.com/society/2017/sep/02/disturbed-sleep-patterns-may-be-key-to-adhd

I live a healthier life now Im free of the trappings of modernity | Mark Boyle

Being healthy is not about doctors, ambulances and technology. I use natural methods to keep my body in balance, writes Mark Boyle, the Guardians Life Without Technology columnist

When people learn of my decision to reject modern complex technology in favour of older, slower, forgotten ways, their first line of inquiry usually involves healthcare. Considering its importance to our lives, this is hardly surprising. Yet because of its emotive nature which of us, after all, doesnt have friends or family needing glasses, hearing aids, stents or prescription drugs? it seems difficult to have a calm, objective discussion on the subject.

The more concerned and curious inquirers often ask me what I would do if I got seriously ill. While the long answer is complicated and nuanced, honestly, I dont know. Its easy to live by your values when times are good, much harder when youre having a stroke or dying of cancer.

One thing I can say with more confidence is this: if we continue pursuing this political ideology of mass industrialism which has given us ambulances, dialysis machines, wheelchairs and antidepressants not only will we continue to harm our physical, emotional and mental health (leading to even more people needing such things) well also wipe out much of life on Earth.

Industrial civilisation, itself only 200 years old, is already causing the sixth mass extinction of species of the last half billion years. Whats that got to do with an ambulance? Well, both nothing and everything. The ambulance itself undoubtedly saves lives (including my dads). Yet deconstruct a single ambulance with its plastics, oils, fluids, copper, acids, glass, rubber, PVC, minerals and steel and Ill show you how to lay waste to the very thing all our lives depend upon: the planet.

Big picture aside, most of what afflicts us today cancer, obesity, mental illness, diabetes, stress, auto-immune disorders, heart disease, along with those slow killers: meaninglessness, clock-watching and loneliness are industrial ailments. We create stressful, toxic, unhealthy lifestyles fuelled by sugar, caffeine, tobacco, antidepressants, adrenaline, discontent, energy drinks and fast food, and then defend the political ideology that got us hooked on these things in the first place. Our sedentary jobs further deplete our physical, emotional and mental wellbeing, but instead of honestly addressing the root cause of the illness we exert ever more effort, energy, genius and money trying to treat the symptoms and contain the epidemics.

Weve developed Stockholm syndrome, sympathising with the very system that has economically held us hostage since the 18th century. Industrialism, along with its partner in crime, capitalism, has even persuaded us that, in order to save ourselves and loved ones from the horrors of disease we should spray every surface with chemicals, keep childrens hands out of the dirt and muck, and try to sterilise our entire world. With our immune systems compromised as a result, multi-billion-dollar pharmaceutical companies then sell us products to fend off what our bodies should be able to fight off naturally.

In their cleverness they have even persuaded us to pop painkillers for things that hardier generations would balk at. My own approach to healthcare wont satisfy the critics, the advocates of this strange thing called progress that seems to have us all more stressed and less content. And thats OK; Im not trying to tell people what to do, and Ive got no product to sell. I share it only because my editor tells me its the most common online inquiry.

In doing so Im very aware that Ive been blessed to be born without any serious long-term health issues, and that at 38 Im relatively young. That said, Im not convinced that its necessary to fall into such poor physical shape, as civilised peoples tend to do. My dad is almost 73 and he can still cycle 150km before dinner, simply because he has never stopped looking after his health.

The philosophy underlying my approach is that of any herbalist: keep the vitality in your body strong, and be mindful to do it every day. When it goes out of ease and into disease, use the appropriate plants the original source of many industrial medicines to bring your body and mind back into balance, and to restore optimal functioning. Your body is always aiming for balance and health, and listening to it is one of the best things you can do. Illness is feedback the sooner you heed it and restore your vitality, the less likely it is youll develop more serious problems.

I find it impossible to describe my approach to health without describing my approach to life. I wouldnt dream of suggesting that this is a prescriptive solution for anyone else; but with the exception of a voluntary vasectomy, I havent seen a doctor or nurse for 20 years.

I pick my own fruit and vegetables from the garden and hedgerows, and eat them as fresh, raw and unwashed as is optimal. I cycle 120km each week to lakes and rivers, where I then spend three evenings of that week relaxing and catching the following days dinner. I work outdoors, getting sweaty and dirty doing things I enjoy. I made the tough decision to live in the natural world so that I could breathe clean air, drink pure water and create life that allows others the same. I wash with water, and water only. I use no chemicals inside or outside the house. I wear as few clothes as I need, I use nothing electrical no fridge, no screens, no phone. I avoid sugar, caffeine and stress like the plague.

Sleep comes and goes with the light I find six hours of peaceful rest sufficient. If and when I do feel ill or out of balance, my girlfriend Kirsty (who illustrates these articles and is teaching herself herbalism) recommends a plant from our herb patch and I slowly feel vital again. Shes currently drying yarrow, horsetail, silverweed, self-heal, calendula and chamomile for the winter months.

Ive suffered from hay fever something becoming more common as CO2 levels in the atmosphere increase since I was a child. These days I eat a handful of plantain leaves a natural antihistamine three or four times a day, and that sorts it. Plantain comes out just before hay fever season and goes to seed shortly afterwards, and is a common in the cracks of city pavements and lawns as it is in the countryside.

I appreciate that this may sound unrealistic to many. When I was working 60 hours a week in a low-paid job in the City, 10 years ago, it did to me too. I only managed to do it by stripping away modernitys bullshit, learning to live with the land, and reducing my bills down to zero. Simplicity in these times is hard won, but Ive found that its worth it.

I can only speak for myself, and I support everyones decision to care for their own health as they see fit. Ultimately, were all going to die and I wish to go out like the American writer and conservationist Edward Abbey: by taking off to the wilderness, where wildlife can feed on my dead body just as I have done on theirs. It seems only fair.

Two things, in this respect, I find important. One is that like Henry David Thoreau once remarked, I do not safely reach death and discover that I had not lived. Second, that I dont cling to my own fading light so desperately that I extinguish it for all else. Like all good guests, its wise not to overstay your welcome.

This article was written by hand and posted to an editor at the Guardian, who typed it up to go online. Get in touch with Mark Boyle, the Guardians Living Without Technology columnist, here or in the comments below, a selection of which will be posted to him

Read more: https://www.theguardian.com/commentisfree/2017/sep/21/healthier-life-free-modernity-doctors-technology-exercise-herbs

6 million middle-aged people take no exercise

Public Health Englands research suggests large numbers of adults do not walk for 10 minutes at a time once a month

About 6 million middle-aged people in England are endangering their health by not taking so much as a brisk walk once a month, government advisers have said.

Clinicians said such a lack of exercise increases an individuals risk of prematurely developing serious health conditions including type 2 diabetes, heart disease, dementia and cancer.

Public Health England (PHE) said 41% of the 15.3 million English adults aged 40 to 60 walk less than 10 minutes continuously each month at a brisk pace of at least 3mph.

PHE has launched a health campaign targeting the sedentary middle-aged by encouraging them to walk to the shop instead of using a car and to take up walking on lunch breaks to add many healthy years to their lives.

Health leaders believe that 10 minutes walking a day is likely to be seen as achievable by people who are chronically inactive and that the health benefits include increased fitness, improved mood, a healthier body weight and a 15% reduction in the risk of dying prematurely.

PHE said walking required no skill, facilities or equipment and was more accessible and acceptable than other forms of physical activity for most people. Guidance issued by the UKs four chief medical officers in 2011 instructed the British population on how much exercise they should be participating in each week.

They said that adults should do at least two and a half hours of moderately intensive activity a week.

The PHE report said a quarter of the English population are inactive, doing less than 30 minutes of exercise a week. For some of these individuals 150 minutes may seem an unrealistic aim, according to the PHE report.

PHEs One You campaign is urging those people to take up the challenge of walking briskly for 10 minutes a day. As part of the drive it has released the Active 10 app which will help users achieve the goal and GPs will be recommending it to their patients to help build up their activity levels.

Dr Jenny Harries, the deputy medical director of PHE, said: I know first hand that juggling the priorities of everyday life often means exercise takes a back seat.
Walking to the shops instead of driving or going for a brisk 10-minute walk on your lunch break each day can add many healthy years to your life. The Active 10 app is a free and easy way to help anyone build more brisk walking into their daily routine.

Prof Sir Muir Gray, a clinical adviser for the Active 10 app and the One You campaign, added: We all know physical activity is good for your health but for the first time were seeing the effects that easily achievable changes can make. By walking just 10 continuous minutes at a brisk pace every day, an individual can reduce their risk of early death by 15%.

They can also prevent or delay the onset of disability and further reduce their risk of serious health conditions, such as type 2 diabetes, heart disease, dementia and some cancers.

Read more: https://www.theguardian.com/lifeandstyle/2017/aug/24/around-6-million-middle-aged-english-people-take-no-exercise

Forget five a day, eat 10 portions of fruit and veg to cut risk of early death

Scientists say even just 2.5 portions daily can lower chance of heart disease, stroke, cancer and premature death

Five portions of fruit and veg a day is good for you, but 10 is much better and could prevent up to 7.8 million premature deaths worldwide every year, say scientists.

The findings of the study led by Imperial College London may dismay the two in three adults who struggle to manage three or four portions perhaps some tomatoes in a sandwich at lunchtime, an apple and a few spoonfuls of peas at dinner.

All of that is good because a daily intake of even 200g, or two and a half standard 80g portions, is associated with a 16% reduced risk of heart disease, an 18% reduced risk of stroke, a 13% reduced risk of cardiovascular disease, 4% reduced risk of cancer and a 15% reduction in the risk of premature death.

But the study suggests we should be piling up platefuls of vegetables and raiding the fruit bowl every day if we want the best chance of avoiding chronic diseases or an early death.

We wanted to investigate how much fruit and vegetables you need to eat to gain the maximum protection against disease, and premature death. Our results suggest that although five portions of fruit and vegetables is good, 10 a day is even better, said Dr Dagfinn Aune, lead author of the research from the School of Public Health at Imperial.

Eating up to 800g of fruit and vegetables equivalent to 10 portions and double the recommended amount in the UK was associated with a 24% reduced risk of heart disease, a 33% reduced risk of stroke, a 28% reduced risk of cardiovascular disease, a 13% reduced risk of total cancer, and a 31% reduction in premature deaths.

What does 800g look like?

And not all fruit and veg are created equal. Apples and pears, citrus fruits, salads and green leafy vegetables such as spinach, lettuce and chicory, and cruciferous vegetables such as broccoli, cabbage and cauliflower were found to be best at preventing heart disease and stroke.

To reduce the risk of cancer, however, the menu should include green vegetables, such as green beans; yellow and orange vegetables such as peppers and carrots; and cruciferous vegetables.

The researchers did not find any difference between the protective effects of cooked and raw fruit and vegetables.

Fruit and vegetables have been shown to reduce cholesterol levels, blood pressure, and to boost the health of our blood vessels and immune system, said Aune. This may be due to the complex network of nutrients they hold. For instance they contain many antioxidants, which may reduce DNA damage, and lead to a reduction in cancer risk.

Compounds called glucosinolates in cruciferous vegetables, such as broccoli, activate enzymes that may help prevent cancer. Fruit and vegetables may also have a beneficial effect on the naturally occurring bacteria in our gut, he said.

Toddler
Most people struggle to eat three or four portions a day, the study shows. Photograph: Simon Masters/Getty Images/Vetta

And it will not be possible to bottle the effects of fruit and vegetables or put them in a pill, he said. Forget the supplements. Most likely it is the whole package of beneficial nutrients you obtain by eating fruits and vegetables that is crucial to health, he said. This is why it is important to eat whole plant foods to get the benefit, instead of taking antioxidant or vitamin supplements (which have not been shown to reduce disease risk).

The analysis in the International Journal of Epidemiology pooled the results from 95 different studies involving a total of approximately 2 million people. They assessed up to 43,000 cases of heart disease, 47,000 cases of stroke, 81,000 cases of cardiovascular disease, 112,000 cancer cases and 94,000 deaths.

Aune said more research was needed, but it is clear from this work that a high intake of fruit and vegetables hold tremendous health benefits, and we should try to increase their intake in our diet.

Sarah Toule, from the World Cancer Research Fund, said: This interesting research shows just how incredibly important vegetables and fruit are as part of a healthy diet. In fact, theyre essential for maintaining a healthy weight, which our own evidence has shown reduces the risk of 11 common cancers.

People should aim to eat at least five portions of vegetables and fruit a day but the more the better. If people find this hard, why not start by adding an extra portion of fruit or veg a day to your lunch or try swapping one of your naughty snacks for a piece of fruit?

Read more: https://www.theguardian.com/society/2017/feb/23/five-day-10-portions-fruit-veg-cut-early-death

Eating cheese does not raise risk of heart attack or stroke, study finds

Consumption of even full-fat dairy products does not increase risk, international team of experts says

Consuming cheese, milk and yoghurt even full-fat versions does not increase the risk of a heart attack or stroke, according to research that challenges the widely held belief that dairy products can damage health.

The findings, from an international team of experts, contradict the view that dairy products can be harmful because of their high saturated fat content. The experts dismiss that fear as a misconception [and] mistaken belief.

The results come from a new meta-analysis of 29 previous studies of whether dairy products increase the risk of death from any cause and from either serious heart problems or cardiovascular disease. The study concluded that such foodstuffs did not raise the risk of any of those events and had a neutral impact on human health.

This meta-analysis showed there were no associations between total dairy, high- and low-fat dairy, milk and the health outcomes including all-cause mortality, coronary heart disease or cardiovascular disease, says the report, published in the European Journal of Epidemiology.

Ian Givens, a professor of food chain nutrition at Reading University, who was one of the researchers, said: Theres quite a widespread but mistaken belief among the public that dairy products in general can be bad for you, but thats a misconception. While it is a widely held belief, our research shows that thats wrong.

Theres been a lot of publicity over the last five to 10 years about how saturated fats increase the risk of cardiovascular disease and a belief has grown up that they must increase the risk, but they dont.

However, the governments health advisers urged consumers to continue to exercise caution about eating too many products high in saturated fat and to stick to low-fat versions instead.

Dairy products form an important part of a healthy balanced diet; however, many are high in saturated fat and salt. Were all consuming too much of both, increasing our risk of heart disease, said a spokesman for Public Health England. We recommend choosing lower-fat varieties of milk and dairy products or eating smaller amounts to reduce saturated fat and salt in the diet.

Givens and colleagues from Reading, Copenhagen University in Denmark and Wageningen University in the Netherlands analysed 29 studies involving 938,465 participants from around the world undertaken over the last 35 years, including five done in the UK.

No associations were found for total (high-fat/low-fat) dairy and milk with the health outcomes of mortality, CHD or CVD, they said. In fact, they added, fermented dairy products may potentially slightly lower the risk of having a heart attack or stroke.

Doctors, public health experts and official healthy eating guidelines have for many years identified saturated fats as potentially harmful for heart and cardiovascular health and advised consumers to minimise their intake.

That has led to consumers increasingly buying lower-fat versions of dairy products. For example, 85% of all milk sold in the UK is now semi-skimmed or skimmed.

Givens said consumers were shunning full-fat versions of cheese, milk or yoghurt in the mistaken view that they could harm their health. Young people, especially young women, were now often drinking too little milk as a result of that concern, which could damage the development of their bones and lead to conditions in later life including osteoporosis, or brittle bones, he said. Consuming too little milk can deprive young people of calcium.

Pregnant women who drank too little milk could be increasing the risk of their child having neuro-developmental difficulties, which could affect their cognitive abilities and stunt their growth, Givens added.

The most recent National Diet and Nutrition Survey, the governments occasional snapshot of eating habits, found that dairy products, including butter, accounted for the highest proportion of saturated fat consumption in British diets 27%, compared with meats 24%. But if butter was not counted then dairy products together were the second largest source of saturated fat, at 22%.

Saturated fat is a vital part of diet. The NDNS found that adults typically got 34.6% of their total energy from fats as a whole, just below the 35% the government recommends. However, while total fat consumption was just within target, saturated fats still made up an unhealthily large proportion of total food energy 12.6%, against the recommended maximum of 11%.

Givens said: Our meta-analysis included an unusually large number of participants. We are confident that our results are robust and accurate.

The research was part-funded by the three pro-dairy groups Global Dairy Platform, Dairy Research Institute and Dairy Australia but they had no influence over it, the paper said. Givens is an adviser to the Food Standards Agency.

Read more: https://www.theguardian.com/society/2017/may/08/consuming-dairy-does-not-raise-risk-of-heart-attack-or-stroke-study

Sugar is poison. My heart attack has finally opened my eyes to the truth | Giles Fraser: Loose canon

Loose canon: Globally, diabetes has almost quadrupled in 35 years and yet the multibillion-dollar sugar industry is happy to keep us in the dark about why

I am now a member of the zipper club. I know, I thought it sounded rude too. But apparently its the club name for those of us who have a scar right down the middleof our chest. I have one down my leg too, from groin to ankle. And as I spend time recovering from a heart bypass operation mostly doing very little, watching the cricket, reading the paper I have started to reflect on my condition. How did it come to this? How did the arteries of my heart become so clogged with gunk that I may have been just weeks from meeting my maker?

Diabetic, they said. Pah, I thought. I dont feel any different. Ijust get up to pee a bit more at night. Some biochemical medical problem just seemed a bit too elusive, abstract, distant. I mean, when Diane Abbott blamed a bad interview on diabetes, who really took that seriously? Earlier this year, I was sent on a diabetes awareness day and spent the time looking out of the window, bored. They tried to explain it to me but I wasnt concentrating.

Well, now that someone has sliced through my breastbone as they might a Christmas turkey, the whole thing doesnt seem quite so distant. And suddenly and unsurprisingly I am concentrating. All ears to, and pretty evangelical about, the evils of sugar. Sorry to have doubted you, Diane.

Back in September 2016, the Journal of the American Medical Association published papers, discovered deep in the Harvard University archives, that demonstrated how the sugar industry has been manipulating research into heart disease for years. These papers revealed that the purveyors of this white poison in behaviour straight out of the tobacco industry playbook had been paying Harvard scientists throughout the 1960sto emphasise the link between fatand heart disease and ignore the connection with sugar. Since then, Coca-Cola has funded research into the link between sugar and obesity. And the confectionery industry has paid for research which demonstrated that children who eat sweets are thinner than those who dont.

As I write, my son returns from the shops, perfectly on cue, laden with a chocolate bar, a full-fat Coke and a packet of lollipops. I want to tell him that Willy Wonka is a death-dealing drug dealer. But I bite my lip for now. He will think me a crank. Everything he likes has sugar in it. Thats my fault he got hooked on sugary breakfast cereals as a child. As Gary Taubes explained in his remarkable book The Case Against Sugar, published last year, it has assimilated itself into all aspects of our eating experience. Advertisements have normalised the omnipresence of sugar as a part of a balanced diet. And my sons brain has become accustomed to the dopamine it releases. He has become an addict. Most of us are addicts.

In 1996, 1.4 million people in the UK had diabetes. Since then the figure has trebled to over 4 million. Diabetes now gobbles up more than 10% of the NHS budget, with that percentage set to rise steeply in the coming years. The World Health Authority published a major report on global diabetes last year. Its figures show that the number of people with diabetes has gone up from 108 million in 1980 to 422 million in 2014. This is not just a matter of bad individual choices. You cant dismiss this as the aggregate of many millions of singular decisions, each one nothing more than a matter of weakness of will and responsible for itself alone. This has become a global epidemic.

For the last 30 years I have built a pretty effective protective shell against fat-shaming. I would probably have taken losing half a stone if offered, but I wasnt especially unhappy with my body shape. But now I see things differently. Now I see a multibillion-dollar industry that makes its profits by keeping us obese and in the dark about why. After my operation, I cut out sugar and carbohydrates as best I could. I have lost 10 kilograms in the five weeks since. And I plan to lose a lot more. Itsnot a diet I hate diets. Its a form ofprotest. The scales have fallen from my eyes. Beware the candy man.

Read more: https://www.theguardian.com/commentisfree/belief/2017/jul/13/sugar-is-poison-my-heart-attack-has-finally-opened-my-eyes-to-the-truth

Threats, bullying, lawsuits: tobacco industry’s dirty war for the African market

Revealed: In pursuit of growth in Africa, British American Tobacco and others use intimidatory tactics to attempt to suppress health warnings and regulation

British American Tobacco (BAT) and other multinational tobacco firms have threatened governments in at least eight countries in Africa demanding they axe or dilute the kind of protections that have saved millions of lives in the west, a Guardian investigation has found.

BAT, one of the worlds leading cigarette manufacturers, is fighting through the courts to try to block the Kenyan and Ugandan governments attempts to bring in regulations to limit the harm caused by smoking. The giant tobacco firms hope to boost their markets in Africa, which has a fast-growing young and increasingly prosperous population.

In one undisclosed court document in Kenya, seen by the Guardian, BATs lawyers demand the countrys high court quash in its entirety a package of anti-smoking regulations and rails against what it calls a capricious tax plan. The case is now before the supreme court after BAT Kenya lost in the high court and the appeal court. A ruling is expected as early as next month.

Tobacco: a deadly business

BAT in Uganda asserts in another document that the governments Tobacco Control Act is inconsistent with and in contravention of the constitution.

The Guardian has also seen letters, including three by BAT, sent to the governments of Uganda, Namibia, Togo, Gabon, Democratic Republic of Congo, Ethiopia and Burkina Faso revealing the intimidatory tactics that tobacco companies are using, accusing governments of breaching their own laws and international trade agreements and warning of damage to the economy.

BAT denies it is opposed to all tobacco regulation, but says it reserves the right to ask the courts to intervene where it believes regulations may not comply with the law.

Later this month, BAT is expected to become the worlds biggest listed tobacco firm as it completes its acquisition of the large US tobacco company Reynolds in a $49bn deal, and there are fears over the extent to which big tobacco can financially outmuscle health ministries in poorer nations. A vote on the deal by shareholders of both firms is due to take place next Wednesday, simultaneously in London at BAT and North Carolina at Reynolds.

Professor Peter Odhiambo, a former heart surgeon who is head of the governments Tobacco Control Board in Kenya, told the Guardian: BAT has done as much as they can to block us.

Experts say Africa and southern Asia are urgent new battlegrounds in the global fight against smoking because of demographics and rising prosperity. Despite declining smoking and more controls in some richer countries, it still kills more than seven million people globally every year, according to the WHO, and there are fears the tactics of big tobacco will effectively succeed in exporting the death and harm to poorer nations.

There are an estimated 77 million smokers in Africa and those numbers are predicted to rise by nearly 40% from 2010 levels by 2030, which is the largest projected such increase in the world.

In Kenya, BAT has succeeded in delaying regulations to restrict the promotion and sale of cigarettes for 15 years, fighting through every level of the legal system. In February it launched a case in the supreme court that has already halted the imposition of tobacco controls until probably after the countrys general election in August, which are being contested by parliamentarians who have been linked to payments by the multinational company.

In Uganda, BAT launched legal action against the government in November, arguing that the Tobacco Control Act, which became law in 2015, contravenes the constitution. It is fighting restrictions that are now commonplace in richer countries, including the expansion of health warnings on packets and point-of-sale displays, arguing that they unfairly restrict its trade.

The court actions are brought by BATs local affiliates, BAT Kenya and BAT Uganda, but approved at Globe House, the London headquarters of the multinational, which receives most of the profits from the African trade. In its 2016 annual report, BAT outlined the risk that unreasonable litigation would be brought in to control tobacco around the world. Its response was an engagement and litigation strategy coordinated and aligned across the Group.

Focus on emerging markets

British
British packets of cigarettes, with stark warnings, beside packs from Africa. Photograph: Linda Nylind for the Guardian

At its annual meeting in March, chairman Richard Burrows toasted a vintage year for BAT, as profits rose 4% to 5.2bn after investors took their cut their dividend had increased by 10%. When asked about the legal actions in Africa, he said tobacco was an industry that should be regulated … but we want to see that regulation is serving the correct interests of the health mission and human mission which should lie behind it.

So, from time to time its necessary for us to take legal action to challenge new regulation which he said was led by the local board.

BAT says it is simply not true that we oppose all tobacco regulation, particularly in developing countries. Tobacco should be appropriately regulated as a product that has risks to health, it said, but where there are different interpretations of whether regulations comply with the law, we think it is entirely reasonable to ask the courts to assist in resolving it. It was opposed to only a handful of the issues in Kenyas regulations, not the entirety, it said in a statement.

Although most countries in Africa have signed the World Health Organisation (WHO) treaty on tobacco control, none has yet fully implemented the smoking restrictions it endorses.

The WHO predicts that by 2025, smoking rates will go up in 17 of the 30 Africa-region countries from their 2010 level. In some countries a massive hike is expected in Congo-Brazzaville, from 13.9% to nearly half the population (47.1%) and in Cameroon from 13.7% to 42.7%. In Sierra Leone it will be 41.2% (74% among men) and in Lesotho 36.9%.

The tobacco industrys march on Africa

In contrast, research showed last year that just 16.9% of adults smoke in the UK; and last month new figures showed UK heart disease deaths had fallen 20% since that countrys indoor smoking ban.

The tobacco industry is now turning its focus toward emerging markets in sub-Saharan Africa, seeking to exploit the continents patchwork tobacco control regulations and limited resources to combat industry marketing advances, said Dr Emmanuela Gakidou and colleagues at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, publishing an analysis of smoking prevalence around the world in the Lancet in April.

Africas growing numbers of children and young people, and its increasing wealth, represent a huge future market for the tobacco industry. The companies deny targeting children and cannot sell packs smaller than 10, but a new study carried out in Nairobi by the Johns Hopkins school of public health in the US and the Kenya-based Consumer Information Network found vendors selling cigarettes along the routes children take to walk to primary schools.

Graphic

Stalls sell single Dunhill, Embassy, Safari and other BAT cigarette sticks, costing around 4p (5 cents) each, alongside sweets, biscuits and fizzy drinks. The vendors split the packets of 20 manufactured by BAT. They are targeting children, said Samuel Ochieng, chief executive of the Consumer Information Network. They mix cigarettes with candies and sell along the school paths.

BAT said that its products were for adult smokers only and that it would much prefer that stalls sold whole packets rather than single sticks, given our investment in the brands and the fact there are clear health warnings on the packs.

Across the world, we have very strict rules regarding not selling our products to retailers located near schools. BAT Kenya provides support to many of these independent vendors, including providing stalls painted in non-corporate colours, and providing youth smoking prevention and health warnings messages. We also educate vendors to ensure they do not sell tobacco products near schools.

Links with politicians

Cigarettes
Cigarettes on sale (alongside sweets) in Nairobi, Kenya. Photograph: David Levene for the Guardian

The Kenya case, expected to be heard after the elections on 8 August, is seen as critical for the continent. If the government loses, other countries will have less appetite for the long and expensive fight against the wealthy tobacco industry.

BAT has around 70% of the Kenyan market; its Kenyan competitor, Mastermind, has joined in the legal action against the government.

Concerns have been raised about links between politicians and the tobacco companies. There are allegations of some of them having been bribed in the past, said Joel Gitali, chief executive of the Kenya Tobacco Control Alliance.

BAT whistleblower Paul Hopkins, who worked in Africa for BAT for 13 years, told a British newspaper he paid bribes on the companys behalf to the Kenya Revenue Authority for access to information BAT could use against its Kenyan competitor, Mastermind. Hopkins has also alleged links between certain prominent opposition Kenyan politicians and two tobacco companies, BAT Kenya and Mastermind. Hopkins, who says he alerted BAT to the documents before the company made him redundant, claimed BAT Kenya paid bribes to government officials in Burundi, Rwanda and the Comoros Islands to undermine tobacco control regulations. Gitali is concerned about the outcome of the election: If the opposition takes over government we shall be deeply in the hands of the tobacco companies.

BAT denies any wrongdoing. A spokesperson said: We will not tolerate improper conduct in our business anywhere in the world and take any allegations of misconduct extremely seriously. We are investigating, through external legal advisors, allegations of misconduct and are liaising with the Serious Fraud Office and other relevant authorities.

We grow up dreaming we can be one of them

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The headquarters and factory of British American Tobacco in Nairobi, Kenya. Photograph: David Levene for the Guardian

Tih Ntiabang, regional coordinator for Africa of the Framework Convention Alliance NGOs that support the WHO treaty said the tobacco companies had become bolder. In the past it used to be invisible interference, but today it is so shameful that it is so visible and they are openly opposing public health treaties like the case in Kenya at the moment Today they boldly go to court to oppose public health policy. Every single government is highly interested in economic growth. They [the tobacco companies] know they have this economic power. The budget of tobacco companies like BAT could be as much as the whole budget of the Africa region.

Our health systems are not really well organised. Our policy makers cant see clearly what are the health costs of inaction on tobacco control because our health system is not very good. It puts the tobacco industry at an advantage on public health.

The sale across the whole of Africa of single cigarette sticks was a serious problem because it enabled children to buy them. They are extremely affordable. Young teenagers are able to purchase a cigarette. You dont need 1 for a pack of 20, he said.

There are fears the number of deaths and illnesses in Africa from tobacco could rise dramatically

BAT has a reputation in Africa as an employer offering steady and well-paid jobs, said Ntiabang, based in Cameroon. When I was about 10, I was always dreaming I could work for BAT. They have always painted themselves as a responsible company a dream company to work for. All the staff are well-off. The young people think I want to work for BAT. They promote a lot of events and make their name appear to young people. We grow up dreaming we can be one of them.

In Uganda in 2014, BAT managing director, Jonathan DSouza, sent a 13-page detailed attack on the tobacco control bill, then going through parliament, to the chair of the governments health committee.

BAT was contracting with 18,000 farmers and paid them 61bn Ugandan shillings for 16.8m kg of tobacco in 2013, said the letter. The economy has benefited significantly from BAT Ugandas investments, it said. This has helped to alleviate poverty and improve welfare in urban and rural areas, it says.

BAT Uganda (BATU) agreed tobacco should be regulated while respecting the informed choices and rights of adults who choose to smoke and the legal rights of a legal industry. But it cited 11 areas of concern, claiming there is no evidence to support a ban on tobacco displays in shops, that large graphic health warnings on packs are ineffective, that proposals on bans on smoking in public places were too broad and that prohibiting smoking under the age of 21 was unreasonable, since at 18 young people are adults and can make up their own mind.

Documents made public by the University of Bath show that BATU had another concern: the ban on the sale of cheap single cigarettes. Adults should be free to purchase what they can afford, says an internal leaked paper. BATU also took action against the MP who sponsored the bill. A letter informed him that the company would no longer be contracting with the 709 tobacco farmers in his region. There is evidence that the company also lobbied other MPs with tobacco farmers in their constituencies.

The Tobacco Control Act became law in 2015, and in November last year, BAT sued. Many people choose to smoke, said an affidavit to the court from managing director Dadson Mwaura and it was important to ensure regulation did not lead to unintended consequences that risk an untaxed and unrestrained illegitimate trade in tobacco products. BATUs legal product contributed to the Ugandan economy in many dimensions.

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A vendor in Nairobis Uhuru Park sells single stick cigarettes. Photograph: David Levene for the Guardian

The Guardian has seen letters showing that at least six other African governments have faced challenges from the multinational tobacco companies over their attempts to control smoking.

  • Democratic Republic of Congo: Letter to the president sent in April 2017 by the Fdration des Entreprises du Congo (chamber of commerce) on behalf of the tobacco industry, listing 29 concerns with the proposed tobacco control regulations, which they claim violate the constitution, international agreements and domestic law.
  • Burkina Faso: Letter sent in January 2016 to the minister of health from Imperial Tobacco, warning that restrictions on labeling and packaging cigarettes risks economic and social damage to the country. Previous letter sent to the prime minister from the US Chambers of Commerce in December 2013 warning that large health warnings and plain packaging could put Burkina Faso in breach of its obligations to the World Trade Organisation.
  • Ethiopia: Letter sent in February 2015 to the ministers of health and science and technology by Philip Morris International, claiming that the governments tobacco directive banning trademarks, brands and added ingredients to tobacco breached existing laws and would penalise all consumer retailers.
  • Togo: Letter to the minister of commerce in June 2012 from Philip Morris International opposing plain packaging, which risks having damaging consequences on Togos economy and business environment.
  • Gabon: Letter from BAT arguing that there is no evidence that plain packaging reduces smoking, citing the Deloitte report of 2011, alleging its introduction would put Gabon in breach of trade agreements and promote smuggling.
  • Namibia: Letter to the minister of health from BAT, warning that planned tobacco controls will have a massive impact on the Namibian economy at large.

Bintou Camara, director of Africa programs at Campaign for Tobacco-Free Kids, said: British American Tobacco, Philip Morris International and other multinational tobacco companies have set their sights on Africa as a growth market for their deadly products. Throughout Africa, tobacco companies have tried to intimidate countries from taking effective action to reduce tobacco use, the worlds leading cause of preventable death, he added.

Governments in Africa should know that they can and should move forward with measures aimed at preventing and reducing tobacco use and that they do so with the support of the many governments and leaders around the world that have taken strong action to protect public health.

Cloe Franko, senior international organizer at Corporate Accountability International, said: In Kenya, as in other parts of the world, the industry has resorted to frivolous litigation, aggressive interference … to thwart, block, and delay lifesaving policies. BATs actions are emblematic of a desperate industry grasping to maintain its hold over countries and continue to peddle its deadly product.

Philip Morris said it is regularly engaged in discussions with governments. We are approached by or approach public authorities to discuss a range of issues that are important for them and for us, such as taxation, international trade, and tobacco control policies. Participating in discussions and sharing points of view is a basic principle of public policy making and does not stop governments from taking decisions and enacting the laws they deem best. It said that it supports effective regulation, including laws banning sales to minors, mandatory health warnings, and advertising restrictions.

Imperial Tobacco said it sold its brands where theres a legitimate and existing demand for tobacco and take the same responsible approach in Africa as we do in any Western territory. A spokesman said it supported reasonable, proportionate and evidence-based regulation of tobacco, including health warnings that are consistent with global public health messages. But, it said, Imperial would continue to make our views known on excessive, unnecessary and often counter-productive regulatory proposals.

Read more: https://www.theguardian.com/world/2017/jul/12/big-tobacco-dirty-war-africa-market

Coffee cuts risk of dying from stroke and heart disease, study suggests

Coffee a day keeps the doctor away? Perhaps, but benefits may be down to lifestyles rather than the brew itself, researchers say

People who drink coffee have a lower risk of dying from a host of causes, including heart disease, stroke and liver disease, research suggests but experts say its unclear whether the health boost is down to the brew itself.

The connection, revealed in two large studies, was found to hold regardless of whether the coffee was caffeinated or not, with the effect higher among those who drank more cups of coffee a day.

But scientists say that the link might just be down to coffee-drinkers having healthier behaviours.

It is plausible that there is something else behind this that is causing this relationship, said Marc Gunter, a co-author of one of the studies, from the International Agency for Research on Cancer.

But, he added, based on the consistency of the results he would be surprised if coffee itself didnt play a role in reducing the risk of death.

About 2.25bn cups of coffee are consumed worldwide every day. While previous studies have suggested coffee might have health benefits, the latest research involves large and diverse cohorts of participants.

The first study looked at coffee consumption among more than 185,000 white and non-white participants, recruited in the early 1990s and followed up for an average of over 16 years. The results revealed that drinking one cup of coffee a day was linked to a 12% lower risk of death at any age, from any cause while those drinking two or three cups a day had an 18% lower risk, with the association not linked to ethnicity.

We found that coffee drinkers had a reduced risk of death from heart disease, from cancer, from stroke, respiratory disease, diabetes and kidney disease, said Veronica Setiawan, associate professor of preventive medicine at the University of Southern California and a co-author of the research.

The second study the largest of its kind involved more than 450,000 participants, recruited between 1992 and 2000 across ten European countries, who were again followed for just over 16 years on average. We felt this analysis would capture some of [the] variation in coffee preparation methods and drinking habits, said Gunter.

After a range of factors including age, smoking status, physical activity and education were taken into account, those who drank three or more cups a day were found to have a 18% lower risk of death for men, and a 8% lower risk of death for women at any age, compared with those who didnt drink the brew. The benefits were found to hold regardless of the country, although coffee drinking was not linked to a lower risk of death for all types of cancer.

The study also looked at a subset of 14,800 participants, finding that coffee-drinkers had better results on many biological markers including liver enzymes and glucose control. We know many of these biological factors are related to different health outcomes, so it is another piece of the puzzle, said Gunter.

But experts warn that the two studies, both published in the Annals of Internal Medicine, do not show that drinking coffee was behind the overall lower risk, pointing out that it could be that coffee drinkers are healthier in various ways or that those who are unwell drink less coffee.

In addition, levels of coffee-drinking were self-reported, some participants consumed both caffeinated and decaffeinated coffee, and the European study only looked at coffee consumption levels at one point in time all factors which could have affected the results.

It is not necessarily the coffee drinking per se, it is that fact that there are other things about your lifestyle or the lack of ill-health that might be causing the association, said Naveed Sattar, professor of metabolic medicine at the University of Glasgow, pointing out that while coffee might have beneficial effects, it would take randomised trials to be sure.

Authors of both studies also agreed more work is needed, and said that it was unclear which of the many biologically active components within the coffee might potentially be driving the health benefits. This is an observational study, said Setiawan. We cannot say, OK, [if] you drink coffee it is going to prolong your life.

Gunter agreed. I wouldnt recommend people start rushing out drinking lots of coffee, but I think what it does suggests is drinking coffee certainly does you no harm, he said. It can be part of a healthy diet.

Sattar also urged caution. If people enjoy their coffee they can relax and enjoy their coffee, he said, adding that people should not imagine that drinking extra coffee would militate against other bad health behaviours.

Read more: https://www.theguardian.com/science/2017/jul/10/coffee-cuts-risk-of-dying-from-stroke-and-heart-disease-study-suggests

Air pollution kills more people in the UK than in Sweden, US and Mexico

WHO figures show people in Britain are more likely to die from dirty air than those living in some other comparable countries

People in the UK are 64 times as likely to die of air pollution as those in Sweden and twice as likely as those in the US, figures from the World Health Organisation reveal.

Britain, which has a mortality rate for air pollution of 25.7 for every 100,000 people, was also beaten by Brazil and Mexico and it trailed far behind Sweden, the cleanest nation in the EU, with a rate of 0.4.

The US rate was 12.1 for every 100,000, Brazils was 15.8 and Mexicos was 23.5, while Argentina was at 24.6.

The figures are revealed in the WHO World Health Statistics 2017 report, published on Wednesday, which says substantially reducing the number of deaths globally from air pollution is a key target.

The report reveals outdoor air pollution caused an estimated 3 million deaths worldwide, most of these in low- and middle-income countries.

Wealthy European nations had high levels of air pollution from fine particulate matter. The UK had an average of 12.4 micrograms of fine particulate pollutants (PM 2.5) for each cubic metre of air, which includes pollution from traffic, industry, oil and wood burning and power plants in urban areas. This is higher than the pollutant levels of 5.9 in Sweden, 9.9 in Spain and 12.6 in France. Germany had higher levels of particulate pollution than the UK at 14.4 and Polands was 25.4.

Dr Penny Woods, chief executive of the British Lung Foundation, said the report confirmed that deaths from air pollution were higher in the UK than many other comparable countries.

She said: It is deeply tragic that around 3 million lives are cut short worldwide because the air we breathe is dirty and polluted. In the UK, air pollution is a public health crisis hitting our most vulnerable the hardest our children, people with a lung condition and the elderly.

Yet, we are in the fortunate position of having the technology and resources to fix this problem. Its time to use what we have to sort this problem out as a matter of urgency and clean up our filthy, poisonous air. The next government needs to bring in a new Clean Air Act to protect the nations lung health.

The worst countries for toxic air included India, where 133.7 deaths for every 100,000 people are attributed to air pollution, and Myanmar, where the rate was 230.6 deaths.

WHO said: Outdoor air pollution is a major environmental health problem affecting everyone in developed and developing countries alike.

Some 72% of outdoor air pollution-related premature deaths were due to ischaemic heart disease and strokes, while 14% of deaths were due to chronic obstructive pulmonary disease or acute lower respiratory infections, and 14% of deaths were due to lung cancer.

The World Health Organisation said it was up to national and international policymakers to tackle the toxic air crisis

Most sources of outdoor air pollution are well beyond the control of individuals and demand action by cities, as well as national and international policymakers in sectors like transport, energy, waste management, buildings and agriculture, the WHO said recently.

Read more: https://www.theguardian.com/environment/2017/may/17/air-pollution-kills-more-people-in-the-uk-than-in-sweden-us-and-mexico

No such thing as ‘fat but fit’, major study finds

Metabolically healthy obese are 50% more likely to suffer heart disease than those of normal weight, finds University of Birmingham study

People who are obese run an increased risk of heart failure and stroke even if they appear healthy, without the obvious warning signs such as high blood pressure or diabetes, according to a major new study.

The findings, presented at the European Congress on Obesity in Porto, Portugal, may be the final death knell for the claim that it is possible to be obese but still metabolically healthy or fat but fit say scientists.

Several studies in the past have suggested that the idea of metabolically healthy obese individuals is an illusion, but they have been smaller than this one. The new study, from the University of Birmingham, involved 3.5 million people, approximately 61,000 of whom developed coronary heart disease.

The issue has been controversial. Obesity is usually measured by body mass index (BMI) a ratio of weight against height. It is generally agreed to be imperfect because athletes and very fit people with dense muscle can have the same BMI as somebody who is obese.

The scientists examined electronic health records from 1995 to 2015 in the Health Improvement Network a large UK general practice database. They found records for 3.5 million people who were free of coronary heart disease at the starting point of the study and divided them into groups according to their BMI and whether they had diabetes, high blood pressure [hypertension], and abnormal blood fats [hyperlipidemia], which are all classed as metabolic abnormalities. Anyone who had none of those was classed as metabolically healthy obese.

The study found that those obese individuals who appeared healthy in fact had a 50% higher risk of coronary heart disease than people who were of normal weight. They had a 7% increased risk of cerebrovascular disease problems affecting the blood supply to the brain which can cause a stroke, and double the risk of heart failure.

Dr Rishi Caleyachetty, who led the study, said it was true that weightlifters could be healthy and yet have a BMI that suggested they were obese. I understand that argument. BMI is crude but it is the only measure we have in the clinic to get a proxy for body fat. It is not realistic [to use anything else] in a GP setting or in the normal hospital clinic. We have to rely on BMI measurements, however crude they may be, he said.

While BMI results for particular individuals could be misleading, the study showed that on a population level, the idea that large numbers of people can be obese and yet metabolically healthy and at no risk of heart disease was wrong.

Caleyachetty said: The priority of health professionals should be to promote and facilitate weight loss among obese persons, regardless of the presence or absence of metabolic abnormalities.

At the population level, so-called metabolically healthy obesity is not a harmless condition and perhaps it is better not to use this term to describe an obese person, regardless of how many metabolic complications they have.

Last August a study from Sweden, which followed 1.3 million men over 30 years, found that those who were the fittest when they were 18 years old were 51% less likely to die prematurely than those who were the least fit. But if the men were obese, that cancelled out the advantage they had from their fitness in their youth.

Professor Peter Nordstrom, who led the study published in the International Journal of Epidemiology, said at the time: These results suggest low BMI early in life is more important than high physical fitness with regard to reducing the risk of early death.

Professor Timothy Gill from the Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders at the University of Sydney, Australia, said that there would always be some people who remain healthy in spite of obesity, just as there are some lifetime smokers who do not get lung cancer.

I think you can argue that there are still likely to be some people who are not going to suffer the ill-health consequences as much as other people just because of the distribution of risk, he said.

The World Obesity Federation has this month officially recognised obesity as a disease because of the wide variety of health problems associated with it.

Susannah Brown, senior scientist at World Cancer Research Fund, said the studys finding, emphasise the urgent need to take the obesity epidemic seriously.

As well as increasing your risk of cardiovascular disease, being overweight or obese can increase your risk of 11 common cancers, including prostate and liver. If everyone were a healthy weight, around 25,000 cases of cancer could be prevented in the UK each year.

Read more: https://www.theguardian.com/society/2017/may/17/obesity-health-no-such-thing-as-fat-but-fit-major-study