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England Rugby Captain discusses his Ulcerative Colitis

The former England rugby captain Lewis Moody was used to some tough battles on the pitch but none were to prove harder than coping with a bowel disease.

Ulcerative Colitis is a long-term inflammatory disorder that causes ulceration of the rectum and the colon.

When symptoms of the condition – which can mean bloody diarrhoea, abdominal pain, a frequent need to go to the toilet and weight loss – first appeared, the rugby star put off going to the doctor for four weeks.

“It was very debilitating and humiliating as a young man because you expect it to be an old person’s disease”
Lewis Moody

Then once he was diagnosed he feared it would wreck his rugby career.

So he hid it from his teammates – but the frequent need to visit the toilet was not always an easy thing to conceal.

“That was really tough to be fair. I don’t know anyone that openly talks about their toilet habits.

“So for a young man – I was 25 at the time – all of a sudden you are going to the loo 20 or 30 times a day.

“You are losing a relentless amount of blood and being a classic bloke I left it a month before I went to see the doctor even though this was a daily routine,” he told the BBC’s HARDtalk programme.

Charity support
Moody, known affectionately by teammates and fans as “Mad Dog” retired from rugby in March following a shoulder injury.


1996: Makes his senior debut at Leicester Tigers at 18 while still at school
2001: Makes his debut for England against Canada
2003: Part of England’s Grand Slam-winning Six Nations squad
2005: Wins three caps for the British & Irish Lions on their tour of New Zealand
2010: Captains England for the first time in a Six Nations clash with France. Leaves Leicester after 14 seasons to join Bath
2012: Announces retirement from rugby after a shoulder injury
He is now supporting the work of the charity Crohn’s and Colitis UK and urging other sufferers to get treatment quickly and to try to lift the taboo surrounding the subject.
He said: “It was very debilitating and humiliating as a young man because you expect it to be an old person’s disease but it is the complete opposite I have learnt since – most people are diagnosed under the age of 30.”
Doctors say the most vulnerable age groups for the disease are those aged between 15 and 30.
“For me not having any information was the hardest thing and trying to hide it from my teammates.
“I had such an array of injuries I didn’t want there to be another reason for the guys to say ‘well we are not going to be able to pick Lewis because he will never make it to the start of the game because he might have to run off the loo’.”

Special diet
Covering the short distance from his home to training ground could be a battle in itself.
He recalled: “I was struggling to leave the house sometimes. I only lived four minutes away from the training ground and sometimes I would have to plan my route so that I could stop three or four times en route just to go to the loo.

“Some of the poor people in the establishments on the way probably wondered what on earth was going on as I pulled in every morning.”

Moody wrote in his autobiography that he believed his rugby career could have played a part in him developing the condition.

He was plagued by injuries throughout his 15 years at the top and this led to an over-exposure to anti-inflammatories, antibiotics and painkillers.

To keep the disease under control he now takes tablets daily and has to stick to a special diet.

Being more open about his condition eventually made it easier to cope with.
“I have to admit it was probably a couple of years until I told my good mates and they probably knew anyway because it was obvious. I had lost weight. I was gaunt.
“But it became much easier when I did tell the guys…

“That was one of the learning curves for me with the disease. The more I spoke about it, the easier it became.”

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Timebomb of ‘impossible to treat’ diseases in UK as experts see a rise in antibiotic-resistant infections

A rise in antibiotic-resistant blood poisoning – caused by the E.coli bacteria – is posing such a huge risk that experts fear the country could be facing a timebomb of diseases that are impossible to treat.

The growth of antibiotic-resistance has become so serious that experts now say it is as much of a threat to global health as the emergence of new diseases such as Aids and pandemic flu.

It is now such a cause for concern that health professionals believe the issue has become the medicine world’s equivalent to climate change, it has been reported.

According to the Independent, Professor Peter Hawkey said common infections are threatening to turn into untreatable diseases by the ‘slow but insidious growth’ of resistant organisms.

The clinical microbiologist, and chair of the Government’s antibiotic-resistance working group, told the Independent: ‘It is a worldwide issue – there are no boundaries.

‘We have very good policies on the use of antibiotics in man and in animals in the UK. But we are not alone. We have to think globally.’

It is estimated that 25,000 people die every year in Europe from bacterial infections resistant to antibiotics.

Those resistant to antibiotics have risen from 1 per cent at the beginning of the century to 10 per cent, according to the Independent.

The incidence of E.coli ‘bacteraemias’ – which is the presence of bacteria in the blood – rose by 30 per cent, from 18,000 to over 25,000 cases, between 2005 and 2009.
Professor Hawkey’s group has produced a report commissioned by the Department of Health and the Department for Environment, Food and Rural Affairs into the issue.

‘Drug companies are not as interested in developing new and more effective types of antiobiotics as they are, for instance, heart medication, because the former is a short-term course while the latter is a lifelong medication – and more commercially viable.

In it, says: ‘Only one in 20 of infections with [resistant] E.coli is a bacteraemia, so the above data are only the tip of an iceberg of infected individuals.’

The Government’s chief medical officer, Dame Sally Davies, has now pledged £500,000 to fund research into the threat.

The steep increase in E.coli blood poisoning is thought to be linked with the ageing of the population.

The bacteria is also a common cause of urinary-tract infections but may also cause wound infections following surgery or injury.

Last year it emerged how a ‘super’ resistant strain of E.coli was behind many cases of cystitis, which doctors were having trouble treating with antibiotics.

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‘Doctors were certain I was Anorexic – in fact I had Crohn’s’

Looking back at teenage photos, Fiona Argo can barely recognise herself as the young woman with jutting collarbones and stick-thin legs. But she can see why concerned friends and family thought she was in the grip of an eating disorder.

Between the ages of 16 and 19, Fiona’s weight plummeted from 9½ stone to just 5st, extremely underweight for her 5ft 5in frame. Her periods stopped and her weight was so dangerously low she was told she was at risk of heart failure and even death.
She was diagnosed with anorexia and hospitalised. But while the diagnosis seemed obvious to doctors, friends and family, Fiona remained adamant she was not anorexic.

‘I always knew I was experiencing a physical reaction to eating, not a mental one,’ she says. ‘Every time I ate I’d suffer crippling stomach cramps and end up being sick after most meals. I’d never suffered from negative body image and didn’t want to lose weight, so I knew I didn’t have an eating disorder.’

But despite Fiona’s protestations, her doctor did not run tests to establish whether she had an undiagnosed medical condition, instead interpreting her constant denials as secrecy, a trait often exhibited by anorexia sufferers.

It was only when Fiona collapsed in agony in January 2004, aged 19, and was rushed to hospital that doctors discovered she was suffering from Crohn’s disease, a chronic bowel disorder that affects the gastrointestinal tract.

‘Every day is an uphill struggle, and I’ll never forgive the doctors for getting it so terribly wrong,’ says Fiona, now 27, who lives with her partner Simon, 30, in St Peter Port on Guernsey.

‘Sadly, Crohn’s is an illness with no cure, but I probably wouldn’t be this ill today if it had been detected earlier. Though I’m a normal weight, I’m often in pain and still struggle to keep food down. These are symptoms I’d suffer anyway, but are worse because the Crohn’s was allowed to progress.

‘I have to eat several small meals a day because large amounts of food leave me in agony, and I also need to take daily medication.

‘It makes me angry that doctors could have given me a simple stool test or blood test, yet they chose to ignore my symptoms and told me I had a psychiatric illness.’
Fiona’s nightmare started in 2001 when she suddenly started losing weight, dropping from 9½ stone to just 7st in a less than a year.

‘My mum and dad realised something was wrong when I started eating smaller portions at dinner, and they thought I was making excuses. But I couldn’t eat a full meal without pain and vomiting afterwards,’ she says.

In March 2002, when she weighed just under 8st, Fiona’s worried mother Jacqui took her to a local GP, who immediately diagnosed anorexia.

‘I told the doctors that I found eating extremely painful, and that I didn’t want to be this way, but they clearly didn’t believe me,’ says Fiona.

Other GPs at the practice and a bone specialist confirmed this diagnosis.
‘One doctor told my mum I was in denial, and that it was a classic symptom of anorexia. They even told my mum the tricks to watch out for, such as hiding food under the table or slipping off to the bathroom to make myself sick after meals. I wasn’t anorexic, but I don’t blame my parents for thinking I was. I looked really ill.’

Over the next two years, Fiona’s weight dropped further, and by the age of 18 she weighed just 6st. That was when the GP referred her to a bone specialist, thinking the pain may be due to a bad back, but again she hit a brick wall.

‘The specialist wrote a letter to my parents insisting there was “nothing physically wrong” with me and it was all in my head. I felt trapped in a nightmare in which no one was listening to me.

‘My relationship with my parents became strained, too. In the end we went to family therapy, but as the cause wasn’t emotional it wasn’t that helpful.’

By January 2004, Fiona’s weight had dropped to just 5st, dangerously low for her height, and she was admitted to a psychiatric hospital, where doctors force-fed her small meals, but her stay was cut short on the third day when she collapsed in agony.
It was only then that hospital doctors discovered Fiona had suffered a perforated ulcer on her small intestine. Further blood tests revealed she was suffering from advanced Crohn’s disease.

Septicaemia had started to set in and Fiona underwent emergency surgery that same day.
‘For a while it was touch and go, and my dad still can’t speak about my time in hospital without getting upset.’ Thankfully, Fiona made a good recovery and was discharged from hospital two weeks later.

‘My intestines had been blocked because a symptom of Crohn’s is a narrowing of the intestinal tract, but the doctors removed the damaged section of my bowel.
‘Suddenly I could eat properly again — it was a revelation. My parents kept apologising for not believing me. In less than a month, I gained more than a stone.’
There is a simple, non-invasive test that can help diagnose Crohn’s disease even in the early stages of the illness, which could have prevented Fiona’s ordeal.
‘If a doctor suspects Crohn’s, they can carry out a faecal calprotectin test early on, which will show any inflammation in the bowel,’ says Dr Shaw.

‘Crohn’s is a long-term chronic disease that needs to be controlled and half of patients will need an operation at some point. But there is evidence that early diagnosis can avoid complications and the risk of surgery is likely to be reduced.’
Earlier this month, Fiona underwent a fourth operation to remove part of her bowel, and is now in recovery.

‘I don’t know how many more operations I’ll need or if I’ll end up with a colostomy bag, but I try not to think about it,’ she says. ‘I’m moving on with my life, but I hope no one else has to experience what I went through.’

For more information, visit the National Association for Colitis and Crohn’s Disease (NACC),

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Patrick Strudwick talks about SIBO

Those of you who have had telephone consultations with the Helpline Team here at Immunecare may have heard us talking about SIBO – Small Intestinal Bacterial Overgrowth as an alternative diagnosis for some cases of IBS. We have recognised this for years, and it is now becoming more to the forefront. This is the story of a SIBO sufferer:

“For ten years I looked pregnant. Between 1997 and 2007 my bloated belly peered over my waistband as I tried to hold it in. I wasn’t overweight or malnourished. Instead, doctor after doctor gave me the same diagnosis: irritable bowel syndrome.
About one in ten people have – or think they have – this horrible condition. Its chief symptoms, apart from bloating, are constipation and diarrhoea, with pain, fatigue and sometimes depression joining in.

It is hardly taboo – several celebrities have revealed they suffer from IBS: actress Kirsten Dunst and model Tyra Banks to name a few. But are we being told the truth? Do we all really have IBS?

Four years ago, I began to suspect not. All my symptoms had intensified, in particular, the pain. I tried cutting out some of the known triggers: wheat, alcohol and cheese. I tried yoga and meditation – stress is thought to worsen the condition. But still I looked pregnant, and I grew suspicious something else was wrong. Desperate and fed up, I went to my GP and begged to be referred to a gastroenterologist.
He prodded at my protruding belly in search of cysts or tumours. He asked about my symptoms and how long I had suffered from them. He ran blood and urine tests to check for diabetes or signs of various cancers. Crucially, he took me seriously.

Having eliminated the most serious possible causes, he referred me for two tests at London’s St. Thomas’ Hospital: one for lactose intolerance and one for something called Small Intestinal Bacterial Overgrowth (SIBO).
The first test involved drinking a sugar solution and every 15 minutes for three hours breathing into a tube to measure the hydrogen levels in my breath. The second was the same except I drank a lactulose solution – a type of glucose also used as a laxative.
The first test – which was looking for a lactose (milk sugar) intolerance – came back negative, but the other, for SIBO, was positive. I had never heard of it. So back at home, I plundered Google in search of answers. The same symptoms kept coming up as for IBS: constipation, diarrhoea, bloating, pain and fatigue. Why had none of the doctors I had seen ever mentioned this condition?

‘Most GPs have never heard of it,’ explains Dr Ian Penman, a consultant gastroenterologist at Edinburgh’s Western General Hospital.

So what is it? And how many other IBS sufferers could in fact have SIBO? ‘SIBO is a condition whereby the small intestine, which normally has very few bacteria in it, becomes colonised with too many bacteria. In healthy people, stomach acid and the waves of muscular contraction in the small intestine flush most bacteria into the bowel. But with SIBO that doesn’t happen.’
Why? Mostly, Dr Penman says, it is because of four different types of underlying conditions. The first is when stomach acid is not produced because of gastric surgery, such as a bypass, or old age.
Another vulnerable group is people who’ve had multiple operations on their intestines with parts cut out or joined together, such as those with Crohn’s disease. Thirdly there are people who have other gut disorders. And, finally, people who have had multiple courses of antibiotics.

‘People with recurrent chest or urinary infections may have had lots of antibiotics,’ says Dr Penman. ‘This can upset the delicate ecosystem in the bowel – the balance of different types of bacteria – which then allows certain bacteria groups to proliferate.’

In my early 20s I had a succession of antibiotics for tonsillitis – eventually they were removed – which may explain my diagnosis. But, says Dr Penman, there are also those who do not fall into any of these categories who think they have IBS but test positive for SIBO, with none of the underlying factors.
‘We get into the area of could SIBO be the cause of IBS?’ he says. ‘The answer is that it is unclear. It’s difficult to tease out – the causes of IBS are multi-factorial: stress, food intolerances, and in some cases, bacterial overgrowth.’

A 2005 study published in the journal of Alimentary Pharmacology and Therapeutics found a staggering link between the condition: 98 IBS sufferers were given the hydrogen breath test for SIBO and 64 tested positive. This suggests a huge proportion of those who think they have IBS actually suffer from SIBO.
However, Dr Penman points out: ‘A more recent study found that some people with IBS give false positive results for the SIBO breath test. The reason is that what they really have wrong with them is the time it takes for stuff to go from the stomach to the bowel is too fast. So when we give them lactulose for the breath test, it reaches the bowel too quickly, which causes them to excrete hydrogen in their breath, so we get a positive result. My estimate would be that in fact no more than 10 per cent of IBS sufferers actually have SIBO.’

But if ten percent of Britons have IBS and even five percent of those in fact have SIBO, that would mean 300,000 people with a chronic undiagnosed intestinal disorder.
There is no cure. Instead, the condition is managed. If it is not it can lead to vitamins such as B12 and folic acid not being absorbed by the body. This can cause infertility, depression, and chronic fatigue. What then is the treatment?

‘Firstly, we look for any underlying case – are they making no acid, do they have Crohn’s or have they had surgery?’ Says Dr Penman. ‘If we can treat those factors we will. But otherwise the treatment is cyclical courses of antibiotics to reduce the number of bacteria in the small intestine.
‘We rotate several different antibiotics one after the other to try and prevent resistance or side effects. Another strategy would be four weeks on antibiotics and then four weeks off.’
A change in diet is also essential. ‘I recommend small, frequent meals, making sure you get a good intake of vitamins, and a reduction in intake of carbohydrates.’
Dr Penman advises SIBO patients to take a multi-vitamin supplement and peppermint capsules to help with bloating. ‘I’m also a fan of pro-biotics,’ he says. ‘Not so much the yoghurt-y drinks from the supermarket but a dried formulation of acidophilus from a pharmacy.’

The treatment works. After a few courses of antibiotics my symptoms all but vanished. Concerned about taking them long-term, however, I started taking probiotics instead every day, and only taking antibiotics every year or so.

Sticking to the dietary guidelines are not easy when – as I do – you have a problematic cupcake obsession. But, annoyingly, limiting carbohydrates has proved to be the most effective way of managing the condition. Although I give in now and again, cutting out cake, I can report with some sadness, is the only way to avoid looking like I’m in my second trimester.

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Health warnings written on your face

Everyone knows a lucky so-and-so who hates the gym, eats junk food and drinks wine every night, yet somehow maintains an enviably tiny and firm figure.

But some experts are warning that, in fact, there really is no such thing as a free lunch — because regardless of what your body looks like, your face will tell the truth about your bad habits.

‘You can tell a lot about someone’s lifestyle from their face, including what their diet is like and how much they smoke or drink,’ says Dr  Tabi Leslie, dermatologist and spokesperson for the British Skin Foundation.

Alcohol seems to be one of the worst offenders for the face. Dr Michael Prager, a Harley Street cosmetic surgeon, says he is treating increasing numbers of women whose faces have become podgy, pallid and wrinkly because of their nightly wine habit.

‘They often say to me: “My mother looked so well at my age, I don’t understand why I look so much older.” I tell them it’s probably because their mother didn’t drink so much,’ he says. But that’s not the only lifestyle habit that could be damaging your looks — stress, over-exercising, and even becoming vegetarian have an impact, as we reveal here…


Culprits: Over-exercising, yo-yo dieting.
Although exercise is crucial for healthy body and skin, too much can leave us with hollow, saggy cheeks, says Dr Aamer Khan, medical director of the Harley Street Skin Clinic.
‘It’s known as the runner’s face but any excessive cardiovascular exercise that raises the heart rate will do it — cyclists have the same look.
‘Initially when you start running, the face goes red as the blood vessels widen to get oxygen flowing round the body.

‘But after 15 minutes, as the muscles start to require more oxygen, the blood starts to be diverted away from the face, meaning the fat pads in the cheeks are deprived of oxygen and start to die off slowly.
‘If you run excessively, you’ll have a great heart and lungs, but you’ll lose the plumpness in the cheeks, and look emaciated.’
Varying your workouts with different types of exercise, such as weight-training or yoga, will help prevent this. Ditching cigarettes will also have an effect, he adds, as toxins in cigarettes also attack the blood supply to the fat pads in the cheeks, exacerbating the narrowed face.
And avoid faddy crash diets, as these can take their toll on your looks, warns dermatologist Dr Nick Lowe of the Cranley Clinic. ‘Yo-yo dieters regularly lose weight on the face then quickly put it back on. This rapid fluctuation in weight causes the skin to stretch and lose elasticity — so you start to have excess skin and jowls.’

Culprits: Alcohol, lack of exercise.
Cosmetic surgeon Dr Prager says alcohol ‘stresses the body, causing you to produce the hormone cortisol’. This hormone causes more fat to collect around the face, as well as triggering water retention around the cheeks, leaving a ‘bloated-looking face’.

Furthermore, alcohol is also known to overstimulate the parotid — or salivary — glands, which sit on either side where the neck meets the jaw, adds Dr Khan. ‘Excessive drinking causes these glands to become bigger which gives that chubby, jowly look. If you stop drinking or cut down, you’ll soon notice an improvement.’
Alcohol is 50 per cent sugar, and there’s growing evidence that a diet high in sugar can age the skin by a process called glycolisation. Here, molecules produced when sugar is broken down slow the production of collagen and elastin fibres, the building blocks of skin.
‘The face becomes saggy and loses elasticity, facial muscle and shape in general so it looks podgy,’ says Dr Prager. ‘Between 20 and 30 you can get away with murder, but if you carry on drinking like that, by your 40th birthday the damage will be done.’
Regular exercise is also essential for keeping the skin on the face healthy and youthful.
In 2010, researchers at the University of St Andrews released images of three people showing what they would look like in 20 years’ time if they did no exercise — inactive people were more at risk of sagging, loose skin on the neck and fattening in the forehead and eye area. Exercise keeps blood circulating to the skin, maintaining collagen production.


Culprit: Not wearing sun block.
You can tell what’s caused a wrinkle just by looking at it, says Chris Griffiths, professor of dermatology at Manchester University and an expert on ageing. ‘Fine, crepey wrinkles occur with age, but coarse, deeper wrinkles tend to be from the sun.’
Dr Aamer Khan adds that lines and ridges under the eyes tend to be a sign of too much time spent in the sun. ‘The whole face will be hit, but the hair will protect the forehead, so generally it’s the areas under the eyes that are most affected.
‘The skin is thinner here, too, and so more vulnerable to wrinkling.’

Culprits: Not eating your greens, being overweight.
In March last year, researchers at the University of St Andrews published research showing that eating just three portions of fruit and vegetables a day can give skin a natural glow akin to a suntan within weeks. Ross Whitehead, research fellow at the university, who led the study, explains: ‘Fruit and vegetables contain pigments called carotenoids, which give carrots their orange colour, for example, and tomatoes their red colour. When we eat them, these pigments get deposited on the skin, creating a glow.’
He adds that an overweight person may have to consume more fruit and vegetables in order to get the glow. Carotenoid pigments are fat-soluble, meaning they are absorbed by fat in the body.
‘The more fat a person has under the skin, the more the visibility of these pigments might be obscured.’
Meanwhile, a natural flush to the cheeks can also indicate cardiovascular fitness, adds Whitehead.
‘Oxygenated blood has a redder tinge to it than deoxygenated blood, so someone who exercises and has a strong heart will have a permanent redness to their cheeks. So a pale complexion might indicate someone who doesn’t do a lot of exercise.’

Culprits: Sugary food.
Discoloured, brownish-grey patches on the neck can be a warning sign for type 2 diabetes, a condition linked to a diet high in sugars and carbohydrates.

Known as acanthosis nigricans, the patches suggest high levels of the hormone insulin, involved in breaking down sugar in the body. They can start small, but if the underlying cause is not treated, may spread to take over the whole neck. ‘It’s very much a feature of obesity and diabetes, and tends to appear on the armpits and sometimes the neck,’ says Dr David Price, a diabetes expert at the Morriston Hospital in Swansea.
‘It suggests the insulin is not working very well, so the body is having to produce a lot more of it. Losing weight is the best treatment for this.’

Culprits: Caffeine, lack of sunlight.
Dr Aamer Khan says drinking too much coffee can dehydrate the skin, giving it a red and parched appearance. ‘If you drink more than three cups a day, for each one you need to drink an extra glass of water to counter the effects,’ he advises.
Low levels of vitamin D, formed in the body when sunlight hits the skin, can also cause redness in the face, adds Dr Khan. This is because the vitamin is vital for the creation of new skin cells, so a deficiency can lead to flaky, red skin.
Around one in ten of the population is thought to suffer with some degree of rosacea, a chronic skin condition that starts with flushing in the face and can progress to permanent redness, spots and blood vessels in the skin becoming visible.
Rosacea can run in families, but the condition is triggered or made worse by alcohol, coffee and spicy food, says dermatologist Dr Tabi Leslie. ‘Alcohol and caffeine seem to dilate the blood vessels, which can aggravate the rash on the face.’

Culprits: Dairy foods and Atkins-style diets.
It’s now widely recognised that acne is genetic rather than lifestyle related.
‘However, there is increasing evidence that in some cases excess dairy intake or high-calorie diets may be a contributory factor to the severity of the condition,’ says Dr Leslie.
The reasons are unclear, but some experts suggest that the compound insulin growth factor-1, which is found in milk (and is also naturally occuring in humans), might be to blame.
Dr Khan adds that Atkins-style diets that promote high protein and low carbohydrate intake may trigger acne, too.
‘Protein contains certain amino acids which encourage production of hormones such as testosterone which can cause acne,’ he says. A diet high in omega-3 (found in oily fish such as salmon or mackerel), fresh fruit and vegetables is thought to be the best way to prevent or reduce acne.
Omega-3s have been shown to control the production of sebum — the oil produced naturally by the skin that can cause acne.


Culprit: Not eating your greens.
Cracks in the corner of the mouth — angular stomatitis — can be a sign of vitamin B deficiency, says dermatologist Dr Leslie.
Vitamin B has anti-inflammatory properties and too little is linked to redness and cracking. ‘You may also have a thickened tongue. Meanwhile, a vitamin C deficiency can result in sore, cracked lips.’
Dr Leslie adds that both these vitamins are found in many fruit and vegetables, with vitamin B particularly high in peas and wholegrains and vitamin C high in oranges and peppers.

Culprits: Stress, fatty and spicy foods.
‘A person’s dental age can be quite distinct from their chronological age,’ says Dr Ben Atkins, principal dentist at Revive Dental Care in Manchester.
Stress can cause people to grind their teeth at night or clench in the day, which can reduce the length of the teeth, he explains. ‘Often people don’t realise they’re doing it. I see people who’ve lost 50 to 80 per cent of their teeth because of this, causing the actual face height to shrink in size, too.’
Mouth guards can be worn at night, but Dr Atkins says clearly it’s also vital to work out the cause of your anxiety.
Excess stomach acid from a fatty diet or drinking too much alcohol can also wear away the teeth, he adds.

‘Eating lots of high-fat and spicy foods like curry means you’ll produce more acid, and if you suffer reflux, where there is a weakness in the valve between the gullet and the stomach, the acid can splash up the gullet into the mouth and damage the teeth.
‘You’ll see your teeth shrinking in size and may notice the back surfaces of your teeth feel very smooth.’

Culprits: Cigarettes.
Tooth decay is usually linked to sugary snacks, but gum disease is more strongly linked to smoking, says Dr Atkins.
‘The damage to the blood supply in the gums from smoking may cause them to recede, and they can also start to look pale and leathery — in the same way a fish does when you smoke it. That’s essentially what you’re doing to your mouth when you smoke a cigarette.’


Culprits: Too much screen time, lack of sleep.
Watery eyes are usually, surprisingly, a tell-tale sign that you actually have dry eyes — this is because the tear glands react by overproducing tears, says Shamina Asif, from the College of Optometrists.
Often this is caused by spending too much time at a computer. ‘When you’re concentrating on a screen you’re less likely to blink, and it’s blinking that generates tears and lubricates the eyes,’ she says.
‘This is why a lack of sleep also contributes to dryness — during sleep your eyes repair themselves and produce tears.’ Constant blinking and watery eyes are the most common symptoms, she says.
‘If you suffer from dry eyes, make sure you take regular screen breaks, and consciously remember to blink regularly,’ she says. ‘And drink plenty of water to keep hydrated.’

Culprits: Vegetarian diet, lack of sleep.
A lack of iron — anaemia — may be to blame for dark circles under your eyes, suggests Dr Aamer Khan. This problem can be common in vegetarians, as meat is a major source of the nutrient.
‘Iron is needed for the turnover of tissue, so a deficiency slows down the creation of new skin and can cause the face to look pale and dark under the eyes.’ Furthermore, Dr Khan adds that tiredness can cause blood vessels in the skin to dilate.
The skin under the eyes is particularly thin, meaning that the blueish tinge of these blood vessels will be seen more acutely (the skin makes blood in vessels appear blue, although it is actually red), adding to the dark circles.

Culprits: Fatty diet.
White rings in the iris, known as arcus senilis, and yellow plaques or lumps around the eyelids, known as xanthelasma, can both be signs of high cholesterol, often linked to a diet rich in high-fat foods.
The excess cholesterol is deposited around the eye because it has a rich blood supply.
‘Studies have shown that people with arcus senilis and xanthelasma have a higher risk of developing heart disease,’ says Ms Asif.
She recommends seeing your GP for a check if you are worried about your cholesterol levels.

Culprits: Not wearing sunglasses, surfing.
Not shielding your eyes in bright sunlight can leave you at raised risk of a condition called pinguecula. This causes a whitish-yellow ‘pearly’ lesion or blister on the eyeball, that’s usually just next to the iris on the side closest to the nose.
It may remain small or grow large enough to interfere with vision. If it starts to extend over the iris, and becomes triangular-shaped, this is known as a pterygium.
These growths, also known as Surfer’s eye — due to the fact they are more common in people who spend a lot of time in the sun — can sometimes interfere with vision.
‘Both pinguecula and pterygiums are pretty common — I see around two patients a day with this,’ says Shamina Asif. ‘UV light is one of the main risk factors, so it’s important to wear sunglasses to stop it from getting worse or preventing it from occurring in the first place.’
The condition tends to be slow-growing, and does not usually require treatment, but if it starts to cause irritation, lubricating eyedrops or a short course of steroid eyedrops can help.