Tuesday, November 04, 2008

Women told to limit caffeine during pregnancy

Now that a few glasses of wine are off the hook, they have to have something else that they can bear down on. But once again all they have is epidemiological evidence. Big coffee drinkers have smaller babies but why? A direct causal link is only an assumption. Maybe (for instance) anxious mothers drink more coffee and it is the anxiety that affects the baby, not the coffee. You wonder how these guys got past Statistics 101 -- if they did

Pregnant women will be warned this week to limit their caffeine consumption to two cups of coffee a day or risk giving birth to underweight babies. The government's food standards watchdog will issue guidance to coincide with a study linking caffeine to low birth weight. Scientists have previously linked it to miscarriages. The advice from the Food Standards Agency (FSA) comes a week after scientists found that a weekly glass of wine during pregnancy could help boost a baby's behaviour and vocabulary.

The FSA is lowering the current recommended caffeine limit of 300mg a day to 200mg, the equivalent of two average-sized mugs of instant or two cups of brewed coffee a day. It has also identified other products containing caffeine that count towards the 200mg total. The limit is equivalent to four cups of tea, five cans of cola, three energy drinks or five bars of chocolate. Andrew Wadge, chief scientist at the FSA, said: "This is new advice but these are not new risks. I want to reassure women that if you're pregnant and have been following the previous advice, the risk is likely to be tiny."

Coffee shops have higher levels of caffeine in their drinks than assumed in the FSA guide-lines, which state that an average mug of coffee contains 100mg. A small cafe latte in Starbucks contains 240mg of caffeine, meaning a pregnant woman would exceed the recommended daily caffeine intake in one drink. A new generation of energy drinks, including Spike Shooter, contain up to 300mg of caffeine in a single can. The mass market drink, Red Bull, typically contains 80mg.

The FSA is changing its guide-lines following advice from the independent committee on toxicity, which after assessing the new research and previous studies decided that caffeine could be harmful to the unborn child at lower levels.

Researchers from Leicester and Leeds universities monitored the daily caffeine intake of 2,500 pregnant women using questionnaires. They compared this with the birth weight of the baby, taking into account the weight and ethnic background of the mother. The research, to be published in the British Medical Journal on Wednesday, found that women with a caffeine intake of more than 200mg a day were more likely to give birth to smaller babies.

One committee member said: "The [body of] research shows we get an adverse effect at a slightly lower caffeine intake than we previously thought, in terms of both reduced birth weight and increased instance of spontaneous abortion. "The final decision mainly went on the birth weight with babies born at a weight appropriate for a baby a few weeks younger. If you're small for gestational age, you're more likely to have intellectual impairment and hyperactivity in later life."

Research in the US published this year in the American Journal of Obstetrics & Gynaecology found that drinking more than 200mg of coffee a day doubled the risk of miscarriage.

Pat O'Brien, consultant obstetrician and spokesman for the Royal College of Obstetricians and Gynaecologists, said he recommended women should abstain from caffeine in the first 12 weeks of pregnancy. He said: "This is a very vulnerable time for the baby, and it's when most miscarriages occur."


Fight dementia with a keen social life

New research suggests that there is hope for people with dementia, the key is to keep up their social life. Amusing that demented people are mostly happy. That rather confirms my take on the happiness literature

For many of us, there's little more bleak than the prospect of Alzheimer's disease - it's that idea of the loss of self that is so frightening. Yet a new study turns on its head the assumption that a good quality of life ends once Alzheimer's and other forms of dementia take hold. Not only does it indicate that those affected can lead fulfilling lives, but that there's something that will make happiness almost guaranteed: keep up the social life.

The study, from University College London published in the Journal of Neurology, Neurosurgery & Psychiatry, is one of the first to ask people with dementia directly about their feelings over time, to try and gauge their quality of life.

Dementia is the accelerated loss of brain cells, usually due to a disease such as Alzheimer's. It affects 750,000 people in the UK. This new study comes at a time when news stories about the need for treatments, and the decline of high-profile figures such as Iris Murdoch have consistently painted a picture of loss. Baroness Warnock, an expert in medical ethics, has controversially proposed euthanasia for dementia sufferers because of the strain they put on their families and public services.

But Cornelius Katona, a leading expert in old-age psychiatry from University College London's medical school, believes we should pay more attention to the factors that can make a difference to the lives of people affected by this potentially terrifying condition. And his research suggests that if we make sure the right activities and environments are available, we can give people with dementia a good quality of life without searching for elusive, expensive drugs.

"If you work clinically with people with dementia, you aren't usually struck by how distressed and miserable they are," Professor Katona says. "People with dementia generally rate their quality of life highly. That was a starting point for our research. We also suspected that the traditional ideas of what it meant to age `successfully' - avoiding ill-health, poverty and other adversity - were flawed. Actually, avoiding adversity isn't necessarily the key to being satisfied with life as you get older."

The new study focused around interviews with 224 people with mild, moderate and severe Alzheimer's, but its results apply to all forms of dementia. The interviewees were assessed to ensure that they could give meaningful answers and asked questions using standard health status, cognitive impairment and quality of life questionnaires. These indicated how happy they were with their life, and also how well they were mentally and physically functioning.

The researchers went back after 18 months, and asked the same questions. The resulting analysis looked at who had declined most physically and mentally, and who had stayed happiest. It came up with some fascinating results. Generally, those affected by dementia - whether it be severe or mild - didn't experience any decline in their sense of wellbeing over the 18 months, even though an objective assessment might have noted one.

And those with the highest sense of wellbeing were also those who scored highest on "social relationships" measures - how many people they regarded as close, how often they saw them, and what the relationships were like. People who had the best relationships were the most happy, and stayed happy longer. The results also showed that the happiest people were those who hadn't any indication of mental health problems such as anxiety and depression at the onset of Alzheimer's. This, says Katona, indicated that they were ageing "successfully" - despite their decline in cognitive function. It means we should be careful not to judge a decline by our own standards, rather than their own. "When you compare how a carer rates the quality of life of someone with dementia with how the person with dementia themselves rates it, then you find the carer always rates it lower. This is all probably related to the carer's own susceptibility to anxiety and depression, because their lives are so stressed."

A study published in the Journal of International Psychogeriatrics last month found that one in four spouses of people with dementia was suffering from clinical depression.

Since conducting the study into Alzheimer's, with UCL's Professor of Mental Health Sciences, Gill Livingstone, Katona has conducted a larger study into what predicts good quality of life as we age generally. Again the factors are your previous state of mental health, and how socially engaged you are. "The real point of this is that there's something you can do," Katona says. "If we're going to prepare for an ageing population, with a higher proportion of people with dementia, we need to tackle anxiety and depression better whatever age it strikes. And we need to facilitate social networks in middle and late life, before people start becoming more dependent."

For those of us worried about ageing, the lesson is to make sure you don't become socially isolated in mid to late life. And address any problems you have with anxiety or depression - talking to your doctor is a good start.

For those caring for people with dementia, the message is more complex: you can't change someone's history of mental health, and dementia is, by its very nature, an isolating condition. When people no longer behave in a socially acceptable manner, getting out and meeting people - or even having visitors - can be problematic. But local groups, such as those run by the Alzheimer's Society, can provide a continuing opportunity for a social life and for people to talk about their illness by phone or in person.

Professor June Andrews, Director of the esteemed Dementia Services Development Centre at the University of Stirling, says the new research is a welcome recognition that dementia is not the sentence to distress and misery that it's made out to be - and that much can be done now to improve the experience of people affected, without wonder drugs. "What people need, if they're to cope, is not a pill but to get out," she says.

James McKillop, aged 68, from Glasgow, agrees. In fact, a diagnosis of dementia in November 1999 changed his life for the better. For years before that, he'd been depressed. Things kept on going wrong in his personal and work life, and he didn't understand why. In 1995, he'd had to give up his Civil Service job because he was forgetting how to do routine procedures - things that he'd done week-in, week-out for the past 25 years.

"In the end, I couldn't cope. I became a hermit, staring at a blank TV screen all day. I'd become more and more frustrated, unable to make head or tail of what was happening, and I gave my wife and family a really miserable time. But receiving a diagnosis of dementia changed everything because I realised I was at fault and they realised I was ill." McKillop believes that he has a better quality of life now than before the diagnosis. "I have met so many wonderful people who have enriched my life. I wish I had developed dementia many years ago."

And so what is the advice for people with dementia, and their families? It's essential to identify the first signs of the disease early, so family members can discuss how to keep social activities and ties going. Another area to consider is starting a life story book (see box left) - a detailed record of a person's past life which they keep with them, so that even when they're in an environment (like a home) where they're not well known, there are prompts to start conversations and possibly a relationship.

And does Katona have any specific suggestions for activities that might stand people in good stead if they develop dementia? Something, even, that the Government might prescribe in the absence of wonder drugs? "It's all about keeping active socially as well as physically. Something like ballroom dancing seems to be especially beneficial, because as well as giving people a good cardiovascular workout, it provides a social network. So, if you're in your fifties or sixties, I'd recommend people should start that."


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