Fact or fiction?

When it comes to health reporting, the popular press seems to swing between must-dos and scare stories but the experts can set the record straight 

Newspapers and magazines love a health story. Whether it is “the latest superfood that everyone must eat” or “the remedy in everyone’s medicine cabinet that could kill you”, the way the media goes from one extreme to the other seems designed to confuse rather than offer the sound health advice that the public is looking for. This feature looks at some familiar headlines, and judges which are grounded in fact, and which have got bogged down in their own hype.

Avoid alcohol while on antibiotics

“I won’t have a drink, I’m on antibiotics.” There can be few people who haven’t heard this uttered on an evening out. But is it true that alcohol needs to be avoided altogether? Certainly this is the case if on metronidazole, an antibacterial drug commonly used for dental infections. Combining metronidazole and alcohol can cause a nasty reaction, with symptoms likely to include nausea, vomiting, dizziness, palpitations, flushing, headaches, breathlessness and chest pain. In fact, this reaction is so acute that all forms of alcohol – including products such as mouthwashes – should be given a wide berth not only while on metronidazole but for 48 hours afterwards.

There is a small chance of a similar reaction with the related antibiotic tinidazole, but the British National Formulary – the pharmacist’s bible – denotes it as a “caution” rather than “contraindication”. Other antibacterial agents for which the NHS website recommends care when combined with alcohol are erythromycin and doxycycline, both of which may have slightly reduced effectiveness, and co-trimoxazole and linezolid, though these two are not in widespread use.

But generally, the odd glass of wine or nightcap while on antibiotics is unlikely to cause problems, though many people develop a natural aversion to alcohol when unwell, subconsciously wanting to swerve after-effects such as headache, nausea and an upset tummy. And sparing the body from the effects of alcohol means its systems can concentrate on the healing process, which is surely worth the short-term sacrifice.

Untrue, unless the antibiotic is metronidazole, but keeping it to a minimum is a good idea.

More information is available via NHS Choices.

Hormonal contraceptives cause weight gain 

It’s not uncommon for a woman to blame her method of contraception for any weight she has put on, but is this fair? The best place to look for an answer is the Cochrane Database of Systematic Reviews, which holds evaluations of existing evidence conducted by teams of researchers in order to obtain a robust answer to a question.

In 2014, a Cochrane review was published that looked into the effect of combined contraceptives on weight. The scientists considered 49 clinical trials and stated that while there wasn’t strong enough evidence to be certain that pills or patches containing both an oestrogen and progestogen don’t cause any changes in weight, they were certain that any effects that such products have on body mass index are minor. 

In 2016, the same treatment was given to single component contraceptives, with the research team considering 22 studies involving over 11,000 women on progestogen-only injections, implants, pills and intrauterine systems. The authors stated that there was little evidence of weight gain, with – again – any increases in BMI being relatively minor and not markedly different to that experienced by women on other birth control methods.

Yet, with so many women claiming they have put on weight since going on the pill, something has to be going on, so what is it? Chances are it is changes in lifestyle – perhaps triggered by changing hormone levels, which can cause short-term fluid retention and increase appetite, or by settling down into a relationship that may mean more indulgent meals and sedentary snuggling up together – so pharmacy staff have a valuable role to play in promoting exercise and healthy eating. 

Not really, and it is possible to offset any minimal gains by adopting healthier habits in terms of diet and activity levels.

Find out more via the Cochrane Review on combined contraceptives and progestogen-only methods.

You are more likely to die if you go into hospital at the weekend

Doom and gloom for anyone who ends up being admitted to hospital on a Saturday and Sunday has been a big news story over the last few years, mainly because health secretary Jeremy Hunt has repeatedly used it to try and push both junior and consultant doctors into foregoing extra payments for working
at the weekend as part of NHS contract negotiations.

Behind the facts are some figures: an analysis published in the highly regarded British Medical Journal (BMJ) stated that around 11,000 more people die each year within 30 days of hospital admission on Friday, Saturday, Sunday or Monday compared to other days of the week. This was dubbed “the weekend effect”, with the reduced support services that are in place in secondary care over the weekend cited as one of the reasons.

But given that people already admitted to hospital before the weekend are not at increased risk of death, the issue is far from straightforward. While the authors of the study looked at some possible contributing factors, such as patient age, diagnosis and previous admissions – and said that such individuals were often sicker – they didn’t look at whether the way in which the NHS is run at the weekends was to blame. And while a “seven day NHS” might seem like a logical way to solve the problem, there are concerns that shifting services around could leave gaps during the week that only greater overall staffing levels – and therefore higher costs – will fill.

Furthermore, subsequent research contradicted the BMJ paper’s findings, stating that while the death rate was higher among those who were admitted at the weekend, fewer were admitted in the first place, and they tended to be among the most unwell: the actual number of deaths was lower. 

Yes, but only because you are more likely to be more unwell and be admitted as an emergency.

The original study is explained by UCL and the second study can be found via Sage Journals.

Everyone should drink at least two litres of fluid a day 

Everyone knows the importance of an adequate fluid intake to stay healthy, and the body isn’t slow to say when more is needed; headaches, tiredness and poor concentration are all signs that a top-up is in order. But what about the advice, commonly proffered by lifestyle magazines, to drink at least two litres a day?

The reality is that someone’s fluid requirements are, well, fluid. The amount of exercise done, what the weather is like, and age are among the factors that influence hydration levels. Put simply, a child who is very active on a hot day has higher fluid requirements than an adult who is working in an air-conditioned office. But it is possible to take on too much – over-hydration can lead to the body’s sodium levels becoming too dilute, which can be fatal.

Apart from strong alcoholic drinks, all forms of drink count towards someone’s fluid intake. Water is usually recommended over other drinks because it is sugar-free and therefore has no effect on dental health and the fact that it is calorie-free means it doesn’t cause weight gain. Food also contributes to fluid intake, with fruit, vegetables and soups being particularly good in this regard. So the UK guidance is to drink six to eight glasses of liquid on top of this each day, and adjust according to thirst and urine colour and output.

Nope, this one is an urban myth, but it is important to make sure that fluid intake matches an individual’s requirements.

The British Nutrition Foundation has a helpful healthy hydration guide.

Reading in the dark ruins your eyes

Book-worming children the world over know all too well the illicit pleasure gained from reading by torchlight under the bed covers… and the subsequent telling off when discovered by their parents. The reason? Reading in poor light will destroy eyesight forever more, of course. Or will it?

It is unquestionable that the eyes have to work harder to focus when lighting is poor. This means that blinking rate drops, which in turn means eyes feel dryer. This can lead to discomfort, but what is important is that there is no evidence that this sensation persists. Putting down the reading material and blinking hard a few times to stimulate tear production and distribution across the surface of the eyes is usually all that is needed to get back to normal.

So far, so debunked. But the picture is a little less clear (pardon the pun) when it comes to short-sightedness, with some experts saying that increased close work such as reading – including in dimly-lit conditions – is likely to be contributing to rising rates of myopia. However, others have scoffed at this theory, highlighting the fact that in years gone by, when short-sightedness was not as common, people had no choice but to read by candlelight or other poor sources of illumination. So perhaps, on balance, it is more accurate to say that reading in poor light is a risk factor for myopia rather than a cause in itself. Therefore someone who likes reading to the point that they will do it regardless of how much light there is may be at higher risk of needing their vision corrected in the future, which means that regular sight tests are a good idea.

Not true, but regular sight tests, at least every two years, should be recommended anyway.

The topic has been looked at in more detail by the BBC.

Generally, the odd glass of wine or nightcap while on antibiotics is unlikely to cause problems

Originally Published by Training Matters

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