Protocols vary but cold plunging (ice bath) commonly involves immersing the body in water as cold as -1 to 4 degrees celsius for 2-3 minutes. Cold therapy (CT) can also include cold showers, cryotherapy, open water swimming and even short walks in cold weather. The goal of cold therapy is to boost energy expenditure and improve metabolic health. Energy is required to produce heat. Mammals are known to produce heat through either skeletal muscle shivering or “non-shivering thermogenesis”. The latter relies on a special type of fat called brown fat, or brown adipose tissue (BAT).

Why take the plunge?

The vast majority of fat in the human body is known as white adipose tissue (WAT). Unlike WAT, brown fat contains a high concentration of iron-rich mitochondria, which, in addition to giving the tissue a brown colour, make BAT far more metabolically active than WAT.

Cold exposure activates brown adipose tissue. The literature explores whether this increase in BAT increases energy expenditure and therefore could help with obesity and insulin sensitivity/metabolic health. Increasing BAT mass and activity may represent a promising new therapeutic target for the treatment of both obesity and insulin resistance.

There is also evidence that ice baths could help reduce Delayed Onset Muscle Soreness (DOMS) after exercise. The greatest benefits appear to occur when treated with CT 24 to 72 hours post exercise. Some studies have shown that cryotherapy decreases inflammation however not all results agree and more data is needed.

Is cold therapy safe?

Whilst generally considered safe to cold plunge in a controlled environment, it is important to warm the body immediately after cold water plunging to avoid a phenomenon known as afterdrop.

Under cold conditions, your body tries to keep the core temperature as warm as possible, at the expense of the peripheral temperature. At some point the colder blood in the periphery is dumped into the warmer core blood. Afterdrop occurs when the core temperature drops from something safe like 35-36 degrees celsius to something unsafe like 33 degrees celsius, which could technically result in a ventricular arrhythmia or abnormal heart rhythm.

Dr Nikki’s anecdotal experience: I do regular cold plunges at home and feel amazing afterwards (but I admit it could be the placebo effect)… Are you keen to take the plunge?

Written by Dr Nikki Fisicaro

References:

• Effect of Acute Cold Exposure on Energy Metabolism and Activity of Brown Adipose Tissue in Humans: A Systematic Review and Meta-Analysis (Huo et al., 2022)
• Role of human brown fat in obesity, metabolism and cardiovascular disease: Strategies to turn up the heat (Ruiz et al., 2018)
• Human Brown Adipose Tissue: What we have learned so far (Betz & Enerbäck, 2015)
• Temperature-Acclimated Brown Adipose Tissue Modulates Insulin Sensitivity in Humans (Lee et al., 2014)
• Brown Adipose Tissue Improves Whole-Body Glucose Homeostasis and Insulin Sensitivity in Humans (Chondronikola et al., 2014)
• Effects of recovery method after exercise on performance, immune changes, and psychological outcomes (Stacey et al., 2010)
• The effect of recovery strategies on physical performance and cumulative fatigue in competitive basketball (Montgomery et al., 2008)
• Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise (Bleakley et al., 2012)
• Cold water immersion and recovery from strenuous exercise: a meta-analysis (Leeder et al., 2011)
• The efficacy of cryotherapy on recovery following exercise-induced muscle damage (Burgess and Lambert, 2010)
• Time-course of changes in inflammatory response after whole-body cryotherapy multi exposures following severe exercise (Pournot et al, 2011)
• Cold exposure and immune function (Shephard & Shek, 1998)
• The effects of cold water immersion and recovery on molecular factors that regulate growth and remodeling of skeletal muscle after resistance exercise (Peake et al, 2020)
• https://en.wikipedia.org/wiki/Afterdrop

With record heat temperatures breaking across the world and summer fast approaching, many of us are increasingly concerned on how to best protect ourselves and loved ones this season. Summer in Australia is often associated with the beach, holidays, celebrations and fun. However, we too often forget the dangers that come with such long and intense summers, in particular UV radiation exposure.

Australia has the highest rate of skin cancer in the world; with two thirds of Australians being diagnosed with a skin cancer over their lifetime. For this reason, it is extremely important of us to take care of our skin during summer.

General precautions include:

– wearing SPF30 or higher sunscreen (water resistant is best, especially at the beach or pool), ensuring to apply 20 minutes prior to going outside and reapplying every 2 hours

– wearing a broad brim hat and breathable clothing that protects your skin as much as your skin as possible

– sunglasses that meet Australian Standards for UV protection

– stay in shade/under umbrella as much as possible when outdoors

– avoid sun exposure in the middle of the day as this is generally when UV levels are most dangerous

As particular note, babies under 12 months should not be exposed to direct sun when UV levels reach 3 or higher (and use of sunscreen on babies under six months old should be avoided).

Monitoring UV levels is particularly useful to assess your daily risk. A good resource can be found on: cancer.org.au/SunSmartApp.

Children are particularly vulnerable to sunburn (as little as 10 minutes of sun exposure) and heatstroke, and so extra precautions should be taken.

If your child does get sunburnt, ensure they are adequately hydrated by encouraging them to drink water. You can also use cool compresses on the skin and simple pain relief such as paracetamol can assist. Any signs of severe sunburn such as blisters, swollen skin or severe pain should be reviewed by a GP as soon as possible.

Extended duration in the sun can also cause heatstroke in child or vulnerable people in the community. Signs and symptoms include fever, headaches or nausea and vomiting. If any of these symptoms occur after time in the sun, present to your GP immediately (or your local emergency department if outside practice hours).

Having regular skin checks is also an extremely important screening tool to help detect and treat any irregular skin lesions early that may be cancerous. Talk to your local GP for more information to assess your individual risk of skin cancer and form a personalised plan to protect yourself and your family this summer.

References:

Kids Health Information : Safety: Sun protection (rch.org.au)

National Skin Cancer Action Week | Combatting Australia’s ‘national cancer’ | Cancer Council

With La Niña’s reign over the last 3 years coming to end, Australia will once again face the fierce nature of bushfires. Not only can the fires themselves put lives at risk, but many people in the community can be vulnerable to the dangers of smoke inhalation. This includes people with lung conditions such as asthma and chronic obstructive pulmonary disease (COPD), those with hay fever, people with heart conditions such as angina and ischaemic heart disease (IHD), people over 65 years of age, children 14 years and younger, pregnant women, people with diabetes and people with active respiratory infections including COVID-19.

Some general measures to take during bushfire season include:

– keeping your home window and doors closed, especially with active fires nearby

– utilize air conditioners with recycled air setting activated

– air purifiers inside the home

– monitor air quality everyday to assess your risks of outdoor activities/pollutant exposure; a good resource for this is Air Pollution in Australia: Real-time Air Quality Index Visual Map (aqicn.org)

– constantly check in and monitor on health of children, elderly people and others at risk

It is highly recommended that you see your GP for an individualised management plan to optimise your protection this bush fire season, especially if you are at risk. This can facilitate many important interventions such as an updated Asthma/Wheeze Management Plan, medication optimization, ensuring adequate supply of relievers/preventors on hand, discussing preventative strategies, and consolidating an escalation plan for emergency situations.

References: Fact-sheet-Bushfire smoke – vulnerable people (health.gov.au)

IUD FAQs.

The information below is based on my experience and recommendations as a GP practicing in women’s health for nearly a decade. I am not endorsed by any particular device or brand. Please consider all of the advice below and select the device which is best suited for your needs.

What is the best contraceptive option?

I consider the Hormonal IUD (Mirena or the Kyleena) as the most reliable and convenient contraceptive option for women both before and after having children. The IUD is a long active reversible contraceptive (LARC) which are the contraceptive type recommended by many peak health bodies including the RACGP as first line contraception for women as they are safe, effective and reversible. (https://www.racgp.org.au/afp/2017/october/larcs-as-first-line-contraception)

Compared with the oral contraceptive pill, the IUD is set and forget method that lasts up to 5 years. And because they are inserted directly where they are needed to work (in the uterus), they have the least side effects in terms of mood, weight and skin changes compared with the other hormonal contraceptive options.

One particular benefit of hormonal IUDs in addition to contraception are that they also often make periods lighter and less crampy. The Mirena IUD is considered first line management for women with troublesome heavy or painful periods due to conditions such as endometriosis.

What do you think of the Copper IUD?

The copper IUD is also a very reliable form of contraception, but as it increases menstrual blood loss and period cramping in most women. I usually recommend the hormonal IUDs first.

Do IUD’s have a negative impact on your fertility?

IUDs have been used for over 30 years and have not shown to have a negative impact on fertility. (reference link: https://contraceptionmedicine.biomedcentral.com/articles/10.1186/s40834-018-0064-y )

Why haven’t I heard of the IUD before?

Traditionally IUDs have only been inserted by specialists and thus less commonly known about. Thankfully access has improved now that specialist GPs are upskilling in insertion. We are still trying to improve public education around this contraceptive option. The fact that there is a small procedure involved in getting the device also serves as a bit of a barrier. Thankfully due to the increasing number of women looking for alternative contraception to the oral contraceptive pill, it has become a lot more popular in the last decade.

I haven’t had children, is the IUD still suitable for me?

Yes yes yes! There is a frequent misconception that IUDs are more suitable for women post birth, but that is simply not true. https://societyfp.org/wp-content/uploads/2021/06/PIIS0010782416303857.pdf

What is the procedure like?

For most women, insertion is a short 10-15 minute procedure, but insertion appointments are made for 30-45 minutes to allow for discussion, set up and recovery time. It can be crampy during the procedure and also for 1-2 days after. We advise women to take oral analgesia such as Panadol and Nurofen 1 hour prior to the procedure, and we can discuss further analgesic options that we offer at the clinic at your booking appointment. 

What is the best time to do the IUD insertion?

If possible, IUD insertions should be timed for during your period.

How do I arrange getting an IUD device?

While IUDs are suitable for most women, it is still crucial to have a consultation to discuss your personal medical history and your individual benefits and risks of choosing the IUD as contraception. We often also arrange tests prior to doing the insertion, such as an STI screen and cervical screening test (if due). We usually advise a 15-30 minute planning consultation to answer any questions about the insertion and after care as well as arrange any investigations that may be required beforehand. 

How do I obtain more information about IUD insertion?

You can request general information about the procedure and costs involved before booking in for your initial consultation by discussing with our reception.

Turning 50 is one of life’s major milestones. You’ve reached the half-century mark and are closer to retirement, while still in the prime of your life. But with age being a risk factor for many diseases, it’s also beneficial to celebrate this birthday as a guidepost to preserving your health.

Have you ever scrolled through your newsfeed and felt instantly uplifted by that sunlit image of a popular tourist destination or even swooned over that latest wellness product pictured with the sun shining brightly? Sunshine makes everything more appealing and inviting.

We instinctively associate sunshine with vitality. There is good reason for it – invisible UVB rays in sunlight trigger skin activation of Vitamin D, an essential fat-soluble vitamin, which has numerous functions in the body. Best known for accumulating calcium in bones, it improves sleep and mood. It’s an immune booster, optimises cognition and improves muscle function. Deficiencies are common but can be treated easily to confer positive health benefits.

Role in wellness

Vitamin D strengthens bones via increased calcium absorption in the gut and then incorporating this calcium into the bone matrix, giving us strong, healthy bones. Low vitamin D is a risk factor for brittle, weak bones easily prone to fractures (Osteoporosis). Vitamin D also helps absorb magnesium, phosphate and iron, promoting healthy muscle functioning, bones and tooth enamel.

It’s now known that there are vitamin D receptors in parts of the brain implicated in depression as well as sleep-wake cycles. Studies show that correcting vitamin D deficiency leads to improvement in sleep quality, as well as sleep duration in people with insomnia. Vitamin D directs circadian (sleep) rhythm through secretion of Melatonin, the glorious sleep hormone and aiding the synthesis of Serotonin, an important mood hormone. If you notice a dip in your mood during the winter months, consult your GP and find ways to improve your sunshine exposure. You may be suffering from Seasonal Affective Disorder and require a professional opinion. Severe cases do require medication along with lifestyle measures.

Interestingly, Vitamin D is also involved in boosting the immune system in multiple ways, including better absorption of minerals, better communication of immune cells, enhanced recognition of infections by the body’s immune defence cells, as well as reducing auto-immunity (a condition where the immune system mistakenly attacks the body’s own tissue and organs).

Creating the St Tropez effect

In reality, few of us have that self-care balance perfected amidst a pandemic juggling a busy life with the winter months rolling in or balancing the risk of pre-mature ageing, and preventing skin cancer. Therefore, it is hardly a surprise that up to one in four Australians are deficient in vitamin D. Vitamin D levels of over 50nmol/L are essential. Still, athletes, expecting mothers, those with certain medical conditions and the elderly require higher levels.

To meet minimum requirements, sunbathe for a few minutes (10 minutes in winter, less in summer) under the mid-morning (before 10am) or mid-afternoon sun (after 3pm) daily. Expose arms and hands (equivalent to 10% body surface area) and avoid the intense midday sun. Sitting in a sunny window with your favourite BB cream won’t count as glass, clothing, darker skin tones and sunscreen filter out UVB rays. Sun protection is always advised for any more prolonged sun exposure due to the risk of skin damage.

When sun exposure is sparse, supplementation can help. Supplements are available in the form of capsules, sprays or injections. Your GP can advise a suitable preparation. Vitamin D in the D3 compound combined with Vitamin K2 (food sources include fermented foods) allow superior, selective absorption and keep steadier blood levels of vitamin D.

Food sources are a great adjunct to natural sunlight. They include sun-soaked shiitake mushrooms, egg yolks, liver, fortified foods (including plant milk) and oily fish (think salmon, sardines and mackerel).

Therefore, bring some sunshine to your everyday! Head to your nearest outdoor park if you don’t have access to a yard or a balcony. Grab a mushroom omelette and maybe add something that helps you feel centred, such as incorporating your favourite meditation or concentrating on your breathing. Be consistent. A few sustainable minutes every day is all you need!

In my clinical experience, a comprehensive health assessment can screen, identify and assist in many dietary and lifestyle-related nutrient deficiencies, including Vitamin D. Routine blood testing is not recommended for most people. If you have a chronic medical condition, it is worth investing in a multi-disciplinary care plan. Your GP can provide an EPC qualified dietician referral.

Dr Maria Kahloon is an integrative GP, recently joining the multi-disciplinary team at Bourke Street Clinic. She has a focus on wellness and holistic disease prevention. Her books were closed to new patients before relocating to Sydney. Now, she is available to take on new patients and would be glad to be a part of your wellness journey.

As if COVID-19 wasn’t a challenge enough for so many of us with job losses, financial strain, home-schooling kids and keeping little ones entertained, then as time went on an interesting bonus challenge emerged, popularly referred to as ‘COVID kilos.’ These are the pesky kilos associated with being in lockdown most often due to cancelled gym membership, endless trips to the fridge and cupboards whilst stuck at home and every day is a potential alcohol day.

I’ve seen this phenomenon really get many people down and impact their mood, which often only makes it harder to shift back to healthy habits. In more severe cases, I’ve also seen patients’ cholesterol and blood pressure rise to the point where they need to begin medication, as well as a spike in blood sugar levels, leading to a diagnosis of type 2 diabetes.

It seems that many people were expecting the life changes that came with COVID-19 to last only a short time but now six months later, our lives are different and this may be the case for some time to come. With this needs to be a change in the way we function and the way we care for ourselves, so here are a few tips that can really help to manage our health and our weight during COVID-19:

1. Eating habits

• Grazing all day – this is common if you’re used to being in the office and now working from or being home more often as there is no schedule or routine, so I’d encourage creating one. Set up meal times and snack breaks throughout the day and don’t eat outside of those times.
• More junk food – if this is because you have greater access to it because it’s at home and so are you, I’d encourage you to simply keep it out of the house and get some more nutritious alternatives to take its place. Think bliss balls, fruit, wholegrain crackers and yoghurt. Then if you really feel like that choccy bar or packet of chips, get just the one and enjoy it!
• Emotional eating – There are many ways to manage emotions and using food is a really common one. It’s ok to do this – but it can become problematic if it’s the only coping mechanism and it’s used often. Identifying exactly what it is that you’re feeling and matching it with the right response can help, for example, if you’re bored, have a list of things you want to do or get done around the house and tick one of those off before heading to the fridge.
• Difficulty accessing healthy food – this is a really tricky one but there are few things that are for sure, buying food and preparing it from home is always going to be more cost-effective and more likely a healthier option than take away as you have more control over the ingredients you use

2. Less activity

Trial other activities – If you were once a gym-goer and cancelled your membership, perhaps you’re a bit nervous to get back into the gym, which is completely understandable, it might be worth trialling some other activities.

• Get outside – Nothing could be better for the soul than being out in the fresh air getting a little safe sun exposure (hello vitamin D) so heading out for a walk or run, doing your own or a small group exercise session is a great way to stick to your workout routine. Many people are feeling lonely and isolated through this time too so meet a friend and get outside for a walk or a workout, with some safe social distancing of course.
• Take it indoors – there are now a plethora of home workouts available which have had a surge of popularity since the start of COVID-19. A search on Youtube will provide with you a huge variety of workouts to follow – from yoga to pilates, HIIT sessions to resistance training. There are also fitness apps available for download and most gyms, fitness centres and personal trainers have all taken it online now as well. It’s a new way of exercising for many people so it’s worth doing a little research and looking around at what’s now available and what might suit you. The beauty is there are workouts available that can be done on the spot with no equipment if you don’t have any, to workouts that use more space and some equipment if you do.

To help you get started, here is a receipt from my book Everyday Food As Medicine:

EDAMAME, AVOCADO & SPINACH SOBA NOODLES

PREP + COOK TIME 30 MINUTES  SERVES 4

4 green tea bags
250g (8oz) 100% buckwheat
soba noodles
2 cups (300g) frozen shelled edamame (soybeans), thawed
1 tablespoon sesame oil
2 green onions (scallions), sliced thinly
3 cloves garlic, sliced thinly
1 long green chilli, chopped finely
120g (4oz) baby spinach leaves
1 cup coriander (cilantro) leaves, chopped coarsely
¼ cup (60ml) lime juice
2 medium avocados (500g), chopped coarsely
½ cup (80g) almond kernels, roasted, chopped coarsel

1. Bring 3 litres (12 cups) water to the boil in a large saucepan. Turn off the heat. Add tea bags; steep for 10 minutes. Discard tea bags.
2. Fill a large bowl with cold water. Return tea water to the boil; add soba noodles, then cook for 5 minutes or until tender. Drain, reserving ½ cup (125ml) cooking liquid. Working quickly, refresh noodles in the cold water; drain. Cover until ready to serve.
3. Pat thawed edamame dry with paper towel. Heat oil in a wok or large frying pan over high heat. Add green onion, garlic and chilli; cook, stirring frequently, for 1 minute or until fragrant. Add edamame; cook, stirring occasionally, for 2 minutes or until edamame are blistered slightly.
4. Add noodles to wok with spinach, half the coriander, the lime juice and reserved cooking liquid; cook, tossing continuously, for 2 minutes or until well combined and spinach has wilted.
5. Serve topped with avocado, remaining coriander and the almonds. tips  Make sure you buy unsalted edamame as they are better for heart health. Seed the chilli if you prefer less heat. swap  You can use peas instead of the edamame, if you like.

THE Doctor SAYS

Buckwheat soba noodles are often more nutritious than noodles made with other refined flours. Buckwheat is also better for heart health and blood sugar control.

THE dietitian says

Edamame (soybeans) have heart-health benefits because they are a great plant-based replacement for a meat meal, which is high in saturated fats.

Roasting the almond kernels brings out their flavour

Acupuncture is a safe and gentle way to assist women in fertility and pregnancy planning. Just like preparing the soil to plant a tree you want to prepare your internal environment to grow a life.

Acupuncture and Traditional Chinese Medicine (TCM) suggests that you start fertility preparation three months prior to conception. I recommend starting the woman’s treatments three months prior to conception; once a fortnight which includes Acupuncture, Chinese Herbs, dietary and lifestyle guidance as needed.

Research has shown that TCM (Acupuncture and Traditional Chinese Medicine) can significantly improve the woman’s eggs quality and improve the thickness of the uterine lining by increasing the blood flow to the reproductive organs.

Acupuncture can also improve digestion, strengthen the immune system and calm anxiety, which are all important factors for improving a woman’s Fertility and maintain a healthy pregnancy.

What Acupuncture and TCM can help with?

• Irregular Menses, unexplained infertility, sub fertility, PCOS and fibroids.
• In early pregnancy-nausea, fatigue and miscarriage prevention.
• Second stages of pregnancy- hemorrhoids, constipation, reflux, heartburn, insomnia, fatigue and exhaustion, anxiety, depression and small for dates.
• Third stage- back and neck pain, sciatica, pubic symphysis pain, rib pain, irritability, carpal tunnel syndrome and oedema.
• Breach babies -optimal at weeks 34-36.
• Pre Labor assistance at home – Partner instruction for acupressure.
• Labor preparation – weekly from week 36.
• Labor induction – Week 40 and 41 (Acupuncture can reduce the need for medical induction and the use of epidurals or caesarean sections).
• Post Labor- Recovery, absence of lactation and mastitis due to blocked mild ducts.

Despite the male reproductive systems being less complex than a women’s, the World Health Organisation recognises infertility as 50% male and 50% female factors. Acupuncture has been shown to have a positive effect on sperm morphology (shape of the sperm), motility (ability to swim) and sperm count. TCM will also improve the overall health and vitality of a man.

Breakfast is indeed the most important meal of the day, but simply making sure you eat isn’t enough. What you eat and how much is just as important. Here are few brekkie mistakes many people make that might cause weight gain or derail a healthy lifestyle:

1. Skipping the carbs – with grand intentions, many healthy eaters start their day with a protein-based breakfast of eggs, veges and avocado. Fantastic! But it’s missing a super important component: carbohydrates. Skipping the wholegrain toast means there’s no rise in blood sugar levels after a night of ‘fasting’ and no kick-start the metabolism, which means you’re in danger of being extra hungry later in the day and making up for it then.
2. Overdoing the superfoods – smoothies and blended juices are a great vehicle for a super nutrient-dense meal but overdo it with some ingredients and you’ll end up getting your day’s worth of calories in that one meal. Think coconut oil, coconut milk, chia seeds, flaxseeds, banana, protein powders, cacao, apple, oats, nuts, seeds, almond butter etc etc…
3. Right food, wrong portion – oats are a gold standard breakfast food but they are also incredibly energy dense and overdoing it is really easy. Free-pouring a bowl of muesli or cooking up some porridge can easily lead to two to six times the recommended portion size and a huge hit of carbohydrates to start your day. This is often the reason we feel SO satisfied from this breakfast we can sail right through to a late lunch without feeling hungry.
4. Too light on the fibre – Fibre swells in our tummy and fills us up. Starting your day with a breakfast that is light on fibre means that we’re at risk of being hungry not long afterwards. It may also mean breakfast choices are processed grains such as white breads and sugary cereals that are low in fibre.
5. Coffee calories – for most people, there’s no harm in having a good coffee with breakfast but it’s not the caffeine that’s the problem, it’s the calories, fat and sugar that come along with the type of coffee you order. Large size, full fat milk, soy milk, coconut milk and added syrups, flavourings and sugar all add up. For example a large soy vanilla latte will give you the equivalent of 9 teaspoons of sugar and 330 calories, the number of calories you should have for breakfast alone.
6. Eating because you think you have to – many busy people scoff a quick brekkie racing out the door to work when they’re not actually hungry yet. This super early meal lengthens your eating day and means you need to eat again sooner. By just waiting an hour or so until you’re settled in at work give you a little more time to put together a healthy meal, eating slowly and thoughtfully is better for digestion and when you’re actually hungry so it’s often far more satisfying.
7.  Breakfast’ products – think breakfast biscuits, breakfast bars and breakfast drinks. These highly processed, minimally nutritious products often have a very long list of ingredients that include refined sugar and white flour causing a dramatic spike in blood sugar levels followed by the crash shortly after, making us feel tired – and it’s not even lunchtime yet.
8. Snack for breakfast – sometimes all we have the chance to get down is a banana or yoghurt for breakfast as we run into a meeting or drop the kids to school. Although this is not unhealthy, it’s simply not enough. Having a snack for breakfast is likely to throw out your eating routine for the day and by 10-11am you’re starving.
9. Drinking your breakfast – Smoothies, protein shakes and juices are very popular as an on-the-run breakfast option. They range in nutritional quality but the biggest issue with a liquid breakfast is that it’s often not terribly satisfying. The act of chewing is important for many people to feel satisfaction from a meal. Without that satisfaction from breakfast, we’re left with a void that needs to be filled. This may make you more vulnerable to more ‘satisfying’ foods later in the day.
10. Skipping breakfast altogether – skipping breakfast is often due to a lack of time, lack of appetite or based on recent media reports that fasting until lunchtime may be beneficial for weight loss. There is no cookie-cutter way of eating for anyone but in my experience, a lack of appetite in the morning is usually because too much has been eaten the night before. Fasting until lunchtime isn’t for everyone and the downside is that if you’re starving by lunchtime this can make us susceptible to overeating and making less healthy food choices.

Like many things we take for granted in life you don’t miss it until it is gone. And like many things we take for granted, once it is gone it is all you think about. All too soon you dread going to sleep. The nights have never seemed so long and the days seem endless both for you and those close to you who have to listen to you talking about your insomnia. While you could fall asleep at work in a heartbeat, it becomes the last thing your brain will let you do at night.

The reasons why people lose the ability to sleep are many and varied. The statement we hear most commonly is that nothing has changed. In reality insomnia usually results from an accumulation of reasons although a crisis can certainly precipitate insomnia.

The solutions are equally many and varied. A short course of sleeping pills does help some people but if continued for too long they wear off and become addictive.  There are a variety of natural supplements, some available only on prescription and some not, that may help in the short to medium turn.

Sleep hygiene is a detailed analysis of all the things you do before bed that affect your sleep. Blue light suppresses Melatonin production. Too much adrenaline before bed such as exercise, or the latest 11pm instalment of your favourite series can make it hard to switch off. There are professionals who can help.

Sleep medicine is a specialty whereby a GP refers you to a doctor experienced in sleep medicine who takes a detailed history and works out a sleep diagnosis. Sometimes the sleep specialist needs to admit you to hospital for a sleep test whereby you are wired up and analysed while you are sleep. There is also a home version of this test which can be referred by a GP.