Saturday, 3 November 2018

Bath oils for childhood eczema provide 'no clinical benefit'

Image result for bath oils in childhood eczemaA recent clinical trial has found that bath oils used to help treat eczema in children offer no meaningful benefit as part of their care.

Childhood eczema, also known as atopic eczema, is a common condition that causes redness and soreness of the skin. Treatments include using moisturisers (emollients), which have been shown to work, and using emollients as soap substitutes in the bath or shower. However, until now, there has been little evidence for a third type of treatment: adding emollient additives to baths. In the first big study of its kind, researchers found commonly prescribed emollient bath additives – designed to be added to bathwater and leave a thin layer over the skin – made little difference to children's eczema symptoms.

The study, carried out in England and Wales, involved 483 children aged 1 to 11 years. Half were randomly assigned to use bath additives regularly for a year – in addition to their usual treatments, including standard leave-on emollients – while the other half did not use them. The results showed that bath additives made too small a difference to symptoms to be considered clinically important.

Where did the story come from?
The study was commissioned by the UK National Institute for Health Research as part of a programme to investigate which treatments are effective and provide value for money, and carried out by researchers from Cardiff University, the University of Bristol, the University of Southampton and the University of Nottingham. It was published in the peer-reviewed British Medical Journal ( and is free to read online ( The UK media reports were generally accurate and balanced.

What kind of research was this?
This was a randomised controlled trial, which is often the best way to investigate whether a treatment works. To make results more accurate, many trials like this use a dummy treatment (placebo) so that patients don't know if they are receiving the real treatment. However, in this case, the researchers decided they could not make a convincing placebo for emollient bath additives so did not include one in the study.

What did the research involve?
Researchers used records from 96 general practices in Wales, south England and west England to identify children diagnosed with eczema. The children's parents or carers were then contacted and invited to take part. After screening, half the children were prescribed bath emollient additives for a year and the other half were asked not to use them. Most of the experimental group were prescribed Oilatum, Balneum or Aveeno bath products.

Image result for bath oils in childhood eczemaAll children continued their usual eczema treatments, which included using emollients as creams and soap substitutes, and using steroid creams where needed. Parents or carers recorded children's eczema symptoms – weekly for the first 16 weeks and then monthly for a year – using the standard patient oriented eczema measure (POEM).

In children, this is usually assessed on how severe parents or guardians think a child's eczema is. POEM gives a score of 0 to 28, with 0 to 7 being no or mild eczema, 8 to 16 moderate eczema and 17 to 28 severe eczema. A drop of 3 points on the scale is considered enough to represent a clinically meaningful improvement in symptoms.

The parents or carers also recorded how often the children bathed and how often they used the bath emollient additives. The researchers compared symptom scores for the 2 groups, adjusting for eczema severity at the start of the study, use of steroid creams and soap substitutes, and ethnic group.

What were the basic results?
The average symptom score at the start of the study was 9.5 in the bath-additives group and 10.1 in the no-bath-additives group, meaning most children had moderate eczema. Over 16 weeks, the average symptom score was:

7.5 in the bath-additives group
8.4 in the no-bath-additives group

After controlling for confounding factors such as use of other eczema medication, the average symptom score was 0.41 points lower in the bath additives group (95% confidence interval [CI] (-2.7 to +1.10). This was not a statistically significant difference and was well below the 3-point difference considered to be clinically important.

The researchers also looked at subgroups to see if any particular group of children were more likely to benefit from the bath additives. While they did find some effect for children under 5 years old, it still did not reach the 3-point threshold.

They did find a possibly clinically meaningful benefit for children who bathed 5 times or more a week (2.27-point improvement, 95% CI 0.63 to 3.91), but this analysis was based on fewer children, making it less reliable.

How did the researchers interpret the results?
The researchers said the trial "provides strong evidence that emollient bath additives provide minimal or no additional benefit beyond standard eczema care in the management of eczema in children".

The study shows that bath emollient additives may not be a useful part of eczema care for children. But it's important to be clear this does not apply to the use of leave-on emollient creams and lotions, or to the use of emollients instead of soap. There's evidence that leave-on emollient creams work, and doctors agree using emollients instead of soap is helpful.

This study's results only apply to emollient products added to the bathwater. If you're not sure of the difference, speak to a pharmacist or your GP. If your child has been prescribed bath emollient additives and is happy with them, there's no reason to stop using them. The study found no increased risk of side effects – such as slipping in the bath, soreness or redness – among children who used them.

However, they may not make much difference to your child's eczema, and it's possible the NHS may decide to recommend that doctors stop prescribing these products in future. The study was well conducted but had a few limitations, the main one being that, unusually for research of this type, there was no placebo. Placebos are normally included to control for the placebo effect – where people tend to feel better if they are taking a treatment because they expect it to work.

Image result for bath oils poured into a baby bathtubHowever, in this case, people that did receive the bath additives did not report symptoms significantly different from those not using the additives, which suggests the placebo effect did not have much influence in this study.

The study also looked at lots of subgroups among the 483 children to see if any showed different results. However, this increases the likelihood that some of the results are due to chance.

We therefore cannot put too much stock in the finding that children bathing 5 times or more a week may get some benefit from emollient bath additives, as this analysis included just 143 children.

If your child isn't responding well to a particular treatment for eczema, there are other treatments that may be more effective.

Find out more about treating childhood eczema:


Saturday, 13 October 2018

Antidepressant Withdrawal Symptoms - should you worry?

Image result for depressionThis month, there were calls for guidelines to be revised over antidepressant withdrawal symptoms over alarming and dangerous symptoms, particularly the risk of suicide. In response to this, the NHS reported on the findings of a systematic review which was published in a paper by academics James Davies and John  Reid this year (2018) entitled: "A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based?" in the Journal Addictive Behaviours. The following is the response from the NHS:

A review of the evidence about antidepressant withdrawal symptoms found more people may experience them for longer than previously thought, and many people describe these symptoms as severe. Symptoms recorded in the study included sleeplessness, anxiety, dizziness, "brain zaps" (a feeling of an electrical shock in the brain), and nausea.

But the review included evidence from online surveys, which can overestimate a problem because people who respond to surveys tend to be those most affected by it. Current UK guidance for doctors says withdrawal symptoms "are usually mild and self-limiting over about 1 week, but can be
severe, particularly if the drug is stopped abruptly".

This research calls for the guidelines, based on evidence from 2004, to be "urgently updated" to take account of the study's findings. Anyone concerned about problems stopping antidepressant drugs should talk to their GP. People are usually advised to gradually reduce the dose they take over time, rather than stopping taking them suddenly, to minimise the risk of withdrawal symptoms. It isn't recommended anyone stops taking any type of prescribed medication without first talking to a GP or pharmacist.

It's reported that the organisation responsible for producing the guidelines (the National Institute for Health and Care Excellence) is in the process of updating them as a result of recent evidence.

Where did the story come from?
The study was carried out by researchers from the University of Roehampton and the University of East London for the UK's All Party Parliamentary Group for Prescribed Drug Dependence. This was a systematic review ( glossary#systematic-review) of research into antidepressant withdrawal.

A systematic review is a good way to get an overview of the state of research on any given topic. But these types of reviews are only as good as the studies that can be included.

What did the research involve?
Researchers searched for studies published in peer-reviewed journals that recorded the number of people experiencing withdrawal from antidepressants, the severity of their symptoms, or the duration of withdrawal symptoms. They found 23 relevant studies, which used a variety of methods and were of widely differing sizes - ranging from 14 to 1,367 people - and durations. This can make it difficult to summarise the evidence to come up with an overall result.

Where the types of studies and the way their results were presented allowed, the researchers calculated the average percentage of people experiencing symptoms and the average percentage rating symptoms as severe.

Image result for antidepressantsThey excluded 2 studies where symptoms were reported after doctors reviewed patients' records, rather than asking patients directly about withdrawal symptoms or side effects.

They also excluded an additional study about severity that had a short treatment period (8 weeks) and asked doctors to rate severity, rather than patients.

The 3 biggest studies used to calculate the percentage of people experiencing withdrawal symptoms were online surveys of antidepressant users (1 from the UK that's been withdrawn from the Royal College of Psychiatrists website, 1 from New Zealand, and 1 international study).

What were the basic results?
The researchers found:
  • an average of 56.4% of people in 14 studies said they'd had withdrawal symptoms, ranging from 27% to 86% of people
  • an average of 45.7% of people in 4 studies who experienced withdrawal symptoms rated them as severe (or ticked the box with the highest severity rating in the study)
  • a very wide range in how long the withdrawal symptoms reportedly lasted, from a few days to several months, in 10 "very diverse" studies. 
The studies that looked at duration were so varied that the researchers couldn't come up with an average duration of symptoms, or say how many people on average had symptoms lasting longer than a week. But they said "a significant proportion" of the people who experience withdrawal symptoms "do so for more than 2 weeks".

How did the researchers interpret the results?
The researchers said their findings showed that "antidepressant withdrawal symptoms are widespread" and "current clinical guidelines in the UK and US are in urgent need of correction, in
order to be evidence-based, as withdrawal effects are neither 'mild' nor 'self-limiting'".

They speculated that misunderstanding of withdrawal symptoms among doctors may have driven the rise in antidepressant prescriptions and the length of time people take antidepressants.

They said people experiencing withdrawal reactions may be misdiagnosed as having a relapse of depression or anxiety, and so be put back on medication, have their medication switched or be given a higher dose.

Antidepressants are a helpful treatment for many people, but some people do have problems when they stop taking them. The headlines that accompany this study are alarming, but not everyone who takes antidepressants has withdrawal symptoms, and not everyone gets severe symptoms.

Image result for withdrawal symptoms of antidepressantsThe study suggests about half of people get symptoms, and about half of those people get severe symptoms. But the study's limitations mean we can't be sure these figures are accurate.

The results were weighted by study size, and the biggest studies were online surveys of people who have taken antidepressants.

Online surveys are prone to selection bias as people are more likely to respond to a survey if they have experienced a problem than if they haven't. This means the results may overestimate the proportion of people who experience antidepressant withdrawal. Withdrawal symptoms also may vary by antidepressant type. And some of the studies followed unusually short trials of antidepressants (for example, 8 weeks or 12 weeks), whereas most people are prescribed the drugs for at least 6 months.

Short treatment trials might underestimate difficulties seen withdrawing from longer-term treatment.
Withdrawal symptoms are more likely to be severe if you stop taking an antidepressant suddenly. If you want to talk about stopping taking an antidepressant, talk to your doctor about the safest way to do so. People are usually helped to reduce the dose gradually.

Find out more about antidepressants


Sunday, 30 September 2018

Negative Press on Coconut Oil Attacked

Coconut oil attacked by Harvard professor: The truth behind the propaganda
Image result for coconut oilIn the mid-1990’s, coconut oil was (unjustly) vilified for its high content of saturated fat – and for allegedly contributing to heart disease. However, nearly two decades later, this tropical oil had become the darling of nutritionists, holistic physicians and health enthusiast alike.

But, now in a whiplash-inducing shift, coconut oil is under attack yet again – this time by a Harvard professor who condemns it as “pure poison” and “one of  the worst foods you can eat.” (you just can’t make this stuff up.)

In response to this shocking attack, natural health experts, nutritionists and physicians have leaped to the defence of coconut oil. So, let’s take a closer look at  what the research on coconut oil actually shows – and the true impact of saturated fat on heart health.

Professor’s rant against coconut oil has gone viral
In a video posted to YouTube on July 10, Professor Karin Michels, of the Harvard TH Chan School of Public Health, delivered a lecture in which she insisted that saturated fats – coconut oil in particular – are artery-clogging threats to health. (Of course, we know there are greater threats to the heart.)

The lecture, which was originally delivered in Germany, has since attracted almost 1.4 million views – and raised a storm of protest from coconut oil's supporters.

The controversy over the effects of coconut oil was actually re-ignited in June of 2017, when the American Heart Association published a “Presidential Advisory” advising people to avoid coconut oil due to its content of saturated fat. (It’s like the 1990s all over again!)

The American Heart Association (AHA) maintains that coconut oil raises LDL cholesterol – and the risk of heart disease. The organisation also claimed that coconut oil has “no known offsetting favorable effects” – a statement that many natural health experts find ludicrous, in light of the oil’s many real benefits.

In addition to attacking coconut oil, the AHA’s advisory recommended lowering intake of all saturated fats – and replacing them with unsaturated fats (such as polyunsaturated fats) in order to lower the incidence of heart disease.

Renowned cardiologist condemns Prof. Michel’s remarks as “unscientific nonsense”
Leading proponents of saturated fats and a foe of refined sugar, condemned Professor Michel’s comments as “unscientific nonsense” – and warned that she is bringing Harvard University “into disrepute.”

They have argued that saturated fat does not necessarily increase the risk of heart attack. In addition, they stated that reducing saturated fats in the diet only leads to the use of more carbohydrates (sugar). (Note: many integrative healthcare providers see sugar as a fuel for type 2 diabetes and obesity.) No studies to date have shown a link between coconut oil and heart disease?

Earlier, negative coconut oil studies have been discredited
In the 1950s and 1960s, a series of studies linked saturated fats to increased risk of dementia and cancer – as well as with high levels of LDL cholesterol, traditionally considered harmful. (Coconut oil is composed of 82% saturated fat.) However, later analysis has caused many scientists to dismiss these studies as suspect –
and their findings as flawed.

Related imageCoconut oil supporters point out that the original studies were conducted using partially hydrogenated coconut oil, which is not as healthy as the chemically-untreated virgin coconut oil used today. And, when meat, butter and eggs (pro-inflammatory) were replaced with vegetable oils, margarine and processed whole grains, the incidence of obesity, heart disease and diabetes actually skyrocketed, which went quickly from a national statistic in the US then the UK but subsequently a global health issue. 

More recent studies have helped to redeem saturated fat – and show that it can boost levels of beneficial HDL cholesterol – which helps to prevent heart disease plus many forms of dementia. And, in a study published in July in The American Journal of Clinical Nutrition, scientists found that long-term exposure to the saturated fats found in butter, milk and cheese was not significantly associated with total mortality or incidence of heart disease in older adults.

What foods are really behind heart disease?
Well-educated experts maintain that heart disease can be triggered by a variety of factors – including blood vessel inflammation brought on by consumption of artificially hydrogenated oils (trans fats) and pro-inflammatory vegetable oils such as corn, soy and canola oils. Refined sugar, high fructose corn syrup and starchy carbohydrates are also culprits.

In addition, non-dietary factors – such as obesity, smoking, stress and lack of exercise – can play a role. The point is clear: Inactivity, too many toxins in the body and a poor diet (deficient in necessary nutrients) will increase the risk of chronic inflammation and disease. Fake news about how ‘bad’ healthy foods can be for us – just can’t compare to the truth about good nutrition.

Experts note that African tribes who have traditionally eaten a tropical diet high in coconut fat were virtually free of heart disease – until they began eating a more “modern” Western diet laden with wheat, sugar and vegetable oils. Then, they become diabetic, obese and prone to heart disease.

And, if you’re wondering why the AHA is committed to preaching the “dangers” of saturated fats and high cholesterol, remember that the organisation receives millions of dollars in donations from pharmaceutical companies, including AstraZeneca, Pfizer and GlaxoSmithKline – which just so happen to produce cholesterol-lowering statin drugs.

Disgracefully, many Californian companies selling coconut oil are currently being sued for daring to make the claim that coconut oil is “healthy.” (The AHA is listed as a “beneficiary of unallocated funds” in one of the lawsuits – no surprise there!)

What the media isn’t telling you: How coconut oil protects the heart
Coconut oil, an antioxidant-rich, low-glycemic food that has been used for many centuries in tropical diets, contains lauric and palmitic acids that can increase desirable HDL cholesterol, boost the immune system, spark up metabolism and help to regulate blood sugar.

In addition, coconut oil’s medium-chain triglycerides are easy for the body to break down and use as fuel. Proponents have credited coconut oil with natural ketogenic, or “fat-burning, properties that help to fight obesity, a factor in heart disease. Even if coconut oil does increase LDL, there is evidence that the type of large LDL particles that are produced as a result of eating more saturated fats are not (repeat, not) associated with cardiovascular disease. Many experts believe that it is only Very Small Particle LDL, or VSPLDL, that is harmful.

And, guess what has been shown to raise levels of VSPLDL? Eating excessive amounts of sugar and carbohydrates (surprise!) Fortunately, natural health advocates are speaking out against the latest assault on coconut oil from Prof. Michels. Meanwhile, the AHA – which is ‘in the pocket’ of the pharmaceutical industry – continues to demonize saturated fats while pushing its own proinflammatory agenda – while heart disease persists as the number one killer in the United