Sarah’s surgery
Dr Sarah Brewer, GP and expert in complementary medicine, has the answers to your questions
Dr Sarah answers your most pressing questions
Doctor or dentist?
Q I get recurring mouth ulcers. Should I visit my GP or dentist?
A In general, recurrent mouth ulcers are usually best assessed by your doctor in the first instance. While GPS can’t often offer much in the way of treatment, we can rule out conditions such as anaemia, coeliac disease (dietary sensitivity to gluten), inflammatory bowel disease and other autoimmune problems that can be associated with recurrent mouth ulcers. Your dentist is the best port of call for general mouth check-ups, and can screen you for gum and soft tissue changes that can lead to mouth cancer if not detected and treated. These include a persistent white patch or red velvety lesion – these pre-cancerous changes are mostly painless.
Pain relief safety
Q As I went to buy ibuprofen, I was asked if I had high blood pressure, and was told I couldn’t take it if I did. Do these painkillers affect readings? A Non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen can raise blood pressure and block the effects of some anti-hypertensive medicines, too. These drugs reduce pain by regulating the production of substances called prostaglandins, which also play a role in blood vessel dilation and kidney function. In some people whose blood pressure was previously controlled by medication, taking ibuprofen can cause the upper blood pressure reading to increase by 2-10 mmhg, with the largest rises seen in those taking an ACE inhibitor – a calcium channel blocker or a betablocker that controls blood pressure. In one study, involving people without hypertension, as many as one in four people taking ibuprofen were newly diagnosed with hypertension within four weeks of starting ibuprofen. Pain itself can raise blood pressure, so it’s important to find a way to control your symptoms. Talk to your doctor – rub-on creams and gels may suit you better.
Supplements to ease anxiety
Q I’ve recently been suffering from anxiety. My GP referred me to a psychologist, but I wondered if there were any supplements I could try? A Anxiety, in which you worry excessively about everyday problems and are always anticipating disaster, usually responds well to cognitive behavioural therapy, and herbal medicines can provide additional support. St John’s wort is a traditional herbal medicine licensed for the relief of low moods and mild anxiety. Valerian is another calming herb that can help to relieve anxiety, muscle tension and promote
sleep, so it’s useful if anxiety is causing insomnia. If you feel anxious and lacking in energy, rhodiola helps to combat mild anxiety, fatigue and exhaustion. I usually recommend pharmaceuticalgrade lavender oil capsules (for example, Kalms Lavender One-a-day capsules, £6.49, Boots). Clinical trials show they’re effective for treating anxiety and, unlike when inhaling the oil, there are no unwanted sedative effects. Typically, there was at least a 50% reduction in the severity of anxiety symptoms at the end of each study, with improvements in anxious moods, tension, fears and physical symptoms such as muscle aches, racing heart, breathing changes and gastrointestinal symptoms. If taking any prescribed medicines, check with a pharmacist or your doctor before taking any supplements.
For treatments for serious stress and anxiety, read our feature on page 82.
Reversing diabetes
Q I’ve just been diagnosed with type 2 diabetes and my GP says I may need to take metformin. Is this a treatment I need for life? Or could lifestyle changes help?
A Diet and lifestyle are key for improving blood glucose levels in type 2 diabetes. Your doctor will monitor your blood glucose levels and a substance called Hba1c, which is a measure of how well your glucose levels have been controlled over the previous three months. If you’re overweight and lose some of those extra pounds, you may find your condition can be controlled without medication. In some cases, diet and lifestyle changes, plus weight loss, reverse the disease so the patient is no longer classed as having type 2 diabetes. You can find information at diabetes.co.uk.
Best probiotic
Q My IBS has flared up and my doctor suggested trying a probiotic. Can you tell me the best products to take?
A Studies show that twice as many people with IBS who took probiotics experienced a significant improvement in symptoms compared with those taking a placebo. Improvements were seen after less than eight weeks’ treatment. If your doctor has confirmed your symptoms are due to IBS, the most beneficial products are VSL#3 (£14.95 for 10 sachets, vsl3.co.uk) and Symprove (£79 for a four-week supply, symprove.com). If you have diarrhoea-predominant IBS, then a gel that absorbs toxins can help (Enterosgel, £12.80, Boots).