Author: Dr J Hugh Coyne MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

  • The Mediterranean Diet for Preventing Heart Disease

    The Mediterranean Diet for Preventing Heart Disease

    “Diets, like clothes, should be tailored to you.” Joan Rivers

    According to Maimonides, a Philosopher born in Córdoba in what is now modern day Spain, “No disease that can be prevented by diet should be treated with any other means”. Although he lived almost a thousand years ago, there is more than a grain of truth in this statement. In her excellent TEDX talk, Dr Sarah Hallberg, makes a compelling argument that this is the case with Type 2 Diabetes. As the Medical Director of the Medically Supervised Weight Loss Program at IU Health Arnett, she is in a good position to know. 

    Now for the science bit…

    Unfortunately, a significant problem with any research into preventing disease is that it is inherently difficult to do. There are a number of reasons for this. Firstly, confounding factors play a big role. For example, a person who does one healthy behaviour – such as doing regular exercise – is more likely to eat a healthier diet. Researchers try to get around this by matching as closely as possible each group of participants in a study. However, it’s difficult to mitigate for everything. Secondly, it is hard to do dietary studies over a long period of time. Some people will drop out; some will get bored of the diet; some will make stuff up in their food diaries to keep the researcher happy. The latter is known as self-reporting bias. Thirdly, there is little money invested in finding out which broad diet might be the healthiest and good studies require lots of resources – and therefore lots of money. Many studies on diets are also prone to recall bias. This occurs with retrospective studies where two groups, one with a disease and one without, are asked to recall whether they ate lots of a certain food, say, cola bottle sweets. The researchers are hoping that those with the disease will say “Yeah, I ate loads of cola bottle sweets.” Then just before they publish their research paper they can hold a press conference and say “Cola bottle sweets cause disease X!”

    Recently, an article in the New England Journal of Medicine on the Mediterranean Diet gained a lot of media attention. For a number of reasons, this diet is worth close examination. The purpose of this study was primarily to test how good the Mediterranean Diet was in a head-to-head (also referred to as a randomised control trial) against a low fat diet in preventing heart disease, strokes, and deaths from all cardiovascular diseases (CVD) in otherwise healthy people. This is what is known as a primary prevention study. In contrast, a secondary prevention study would look at people who already had heart disease. The researchers also wanted to test whether two variations of the Mediterranean diet had any impact on health outcomes. One variation placed more importance on olive oil and the other placed more emphasis on nuts. So, these researchers were testing out Maimonides’ hypothesis – that a Mediterranean Diet can prevent heart disease and ultimately prevent the need for treatment by means other than diet.

    Who was in this study?

    One of the aspects that makes this study so interesting is the group of people the researches included. Although none of the participants had CVD when the study started, all of them had medical conditions or lifestyle behaviours that put them at high risk of CVD. The male participants were aged between 55-80 and the women between 60-80. This is an important point. If you are not over 55 and at high risk of CVD then the results are considerably less applicable to you. The researches likely chose patients who were at high risk of CVD for two reasons. Firstly, it is more likely that there will be a beneficial effect in people at higher risk. If they were doing this study in healthy people, they would have needed to enrol far more people to see any effect. Secondly, the people in this study – and in the population in general – really need an effective dietary intervention to prevent CVD. 

    A further important point that makes this study impressive is that as all the participants were unhealthy to begin with. Both the Mediterranean Diet and low fat diet were likely to be an improvement on what they were already eating. You might be thinking why, if the researchers want to get impressive results, did they not have one group of participants on their usual diet? This would have introduced what is known as performance bias. At the beginning and throughout the study, participants received coaching from dieticians. Participants also had assessments to check their adherence to the diet. Keeping people on their standard fare diet would have meant that they’d have received less attention than the other participants. Thus, they would have been at even more of a disadvantage. One source of performance bias that was present in the study was that the control group on the low fat diet received less coaching than the two Mediterranean Diet groups. 

    As I mentioned earlier, the goal of this study was to see the effect of a dietary intervention on an amalgamation of the number heart attacks, strokes, and deaths from all cardiovascular diseases. This is what is known as a composite end point. This study was geared from the outset to establish the effect of diet on this composite. 

    What was in the diet?

    One of the attractive aspects of the Mediterranean diet is – in my opinion – its simplicity. The dietary recommendations for the participants in the study were:

    Mediterranean Diet

    • Extra-virgin olive oil, greater than 4 tablespoons per day
    • Tree nuts and peanuts, greater than 3 servings per week
    • Fresh fruits, greater than 3 servings per day
    • Vegetables, greater than 2 servings per day
    • Fish, especially fatty fish such as tuna, salmon and mackerel, greater than 3 servings per week
    • Legumes (bean, peas and lentils), greater than 3 servings per week
    • Sofrito (diced carrots, celery, onions and garlic fried gently in extra-virgin olive oil) which forms the basis of many sauces in the Mediterranean, greater than 2 servings per week
    • White meat rather than red meat
    • Wine – yes, wine – with meals, greater than or equal to 7 glasses per week. This was optional for what the researchers called “habitual drinkers.”

    Foods that were discouraged included sweet fizzy drinks, commercial bakery goods, sweets and pastries, fat spreads and red and processed meats. 

    The low fat diet group were encouraged to eat:

    • Low fat dairy products
    • Breads, potatoes, pasta, and rice
    • Vegetables
    • Fresh fruit
    • Lean fish and seafood

    So who wins in the battle of Mediterranean vs Low Fat?

    For the composite end point I mentioned above, the Mediterranean diet resulted in a relative risk reduction of having either one of heart disease, strokes, and deaths from all cardiovascular diseases of 30%. A more useful way of looking at the data is numbers needed to treat. This tells us how many patients I would need to treat to prevent one person from getting one of the diseases in the composite end point. Crunching the numbers shows that, for the Mediterranean nut group, I would need to treat between 46-53 people to prevent one having heart disease, stroke, or death from any CVD; for the Mediterranean olive oil group, it is 56-232. 

    It is worth noting that in the subgroups that made up the composite, the two Mediterranean diets only showed a statistically significant benefit in reducing the number of strokes. However, remember the study was only powered to deliver a statistically significant result for the composite end point. 

    As mentioned early, dietary trials are difficult to do well. This trial is no different. The reason it gained press attention is that it was retracted and then republished. There were several reasons for the retraction. These included that some members of the same family were in the study but not randomised and that some people in the low-fat group ate a Mediterranean diet. After correcting for their errors, the researchers ran the analysis again and came to the same conclusion.

    Overall, the Mediterranean diet certainly shows some benefit in preventing CVD for people who are at risk. This study is certainly an important one. However, it is one of several that confirm the benefits of a Mediterranean diet. So if this diet appeals to you and is aligned with your dietary beliefs I think it is the optimal diet for health. A diet needs to align with your beliefs for you to stick with it. Hence, diets should be, to an extent, personalised. Diet is, though, only part of the picture. It is likely that the reason for longevity in so many Mediterranean communities is a composite. In addition to diet, daily exercise, fasting, sense of community and socialisation, spirituality, sunshine and clean air all contribute.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Nutrition & Lifestyle Guides
  • Compression Garments for Exercise Recovery

    Compression Garments for Exercise Recovery

    “Shall daddy put on his tights?” my daughter asked earnestly whilst holding a pair of elasticated fluorescent green hosiery. Fortuitously there was no one else around to witness my unusual taste in undergarments. I had been given these to try when I was helping out as a doctor at a triathlon. As they were free and offered the potential chance both to reduce the post-cycling pain in my muscles, as well as satisfying a previously unknown fetish for snot coloured underclothing, I gleefully accepted them. 

    I was a little dubious as to whether they were of any actual benefit. The studies I had previously looked into about compression garments had come up with conflicting results. The idea behind these absurd looking garments is to reduce exercise-induced muscle damage (EIMD). This is the soreness and reduced function of muscles that anybody who exercises will be familiar with. This discomfort can persist for days. Hence, there is an understandable desire to reduce EIMD as much as possible. 

    How do they work?

    Nobody is quite sure how compression garments might reduce EIMD.  Presently, it is thought that the external pressure from the compression garment reduces the space available for swelling within the muscle. It is also thought that they may be of benefit by enhancing the clearance of waste products from muscles after exercise. 

    Many of the previous studies had each looked at the use of compression tights in different groups of people, performing different sports and applied at different times. In these situations where there have been lots of studies all showing slightly different results. A type of scientific study called meta-analysis can be used to pool the results of all the decent trials to give an overall picture of the effect of a particular treatment. Helpfully for us, the British Journal of Sports Medicine published a meta-analysis in 2013 looking at how I should be answering my daughter’s question. The researchers examined the results of 12 studies in total. The meta-analysis found that compression garments were useful for reducing the perception of delayed onset muscle soreness (DOMS). Perhaps even more valuable it that they found compression garments also resulted in more a more rapid return of muscle function. 

    So daddy should wear tights, during or after exercise! 

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Nutrition & Lifestyle Guides
  • Preventing ACL injuries in Women and Girls

    Preventing ACL injuries in Women and Girls

    ACL injuries are common and can lead to a long time away from playing sport. Recovery can often take 9 months. Having had an ACL injury also increases the risk of having further knee problems down the line. 

    The ACL, or anterior cruciate ligament, is at the front of a pair of ligaments that form a cross. Its role is to prevent the thigh bone (Femur) from sliding too far forward over the shin bone (tibia).

    Why Women and Girls are More Likely to Suffer ACL Injuries

    Women are about 4 times more likely to rupture their ACL than men are. Most ACL tears in women are non-contact injuries that usually occur during an awkward twisting motion. Certain sports have a higher risk of ACL tear. Typically, sports that have rapid stopping or changes in direction, landing from a jump or cutting motions are the highest risk. This includes netball, basketball, football and volleyball. 

    There are several reasons that women and girls are more prone to suffering from ACL injury. Many of these factors, such as female hormones, wider hips and more lax knees cannot be altered. Thus, focusing on preventing ACL injuries has to focus on what we can change.

    Landing Differences

    Two big factors can be changed to help reduce the likelihood of ACL injuries in women and girls. The first is how females tend to land from a jump. Two landing patterns that are particularly risky are landing with stiff, straight legs or landing in a knock-kneed position. These risky landing techniques are more common in women than in men and greatly increase the force through the knees as well as the risk of ACL injury. 

    Hamstrung by Hamstrings

    The second factor that can be altered to reduce ACL injury is what is known as neuromuscular adaptation. This refers to the strength, explosivity, timing and coordination of muscular contraction. Having sufficient strength, as well as being able to engage the right muscle at the right time during movement is crucial for knee stability. The hamstrings are particularly important in knee stability, as like the ACL, they stop the shin bone from sliding too far forward. Females take longer than males to produce force in their hamstrings and contract them more slowly. 

    How To Land Well To Prevent ACL Injuries in Women and Girls

    To land well and reduce the risk of injury observe yourself jumping from a plyometric box or workout step in front of a mirror. Or, ideally, you could also have a partner observe you or film it on your phone. Start and finish the jump with the knees and hips bent. Make sure you keep your knees over and in line with your second toes as you land and that the knees don’t collapse inwards.  Try to land as softly as possible on the front half of the soles of your feet. 

    Strengthening To Prevent ACL Injuries in Women and Girls

    Strengthening hamstrings is really important for ACL prevention. A great exercise for this is Steamboats. Having strong glutes (bum muscles) is also important. They help stop the knees from knocking together. Lateral steps using a theraband and single-leg bridges can be great for this. Stabilising the trunk through core stability exercises such as plank can also help reduce the risk of leg injuries. 

    Plyometric drills such as tuck jumps and squat jumps can help with muscle explosivity and timing or muscle contraction. The core component of these exercises is the squat. it is a foundational move for athletic endeavours. Agility drills such as fast feet can also help improve power and speed while reducing injury risk. 

    If you master these tips, you’ll greatly reduce your risk of ACL injury.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Nutrition & Lifestyle Guides
  • Paediatric Multisystem Inflammatory Syndrome

    Paediatric Multisystem Inflammatory Syndrome

    PIMS is a rare condition that seems to affect children who have or who have had COVID-19. As the name suggests, it causes inflammation of many organ systems of the body. Less than 0.5% of children who contract COVID-19 will go on to have this condition. MOST children are not seriously affected, but in a small number of cases, it can be serious.

    What can happen in these serious cases?

    The inflammatory process can affect the blood vessels, particularly the ones around the heart. This process is otherwise known as vasculitis and can lead to tissue damage and poor organ function. Inflammation is usually a normal response to infection but in PIMS this process seems to go into overdrive causing damage to the body. PIMS seems to affect older children and teenagers and happens about 2-4 weeks after infection with COVID-19.

    How can I tell if my child might be developing PIMS?

    Typically, children with PIMS have a high fever over several days and can also have symptoms of:

    • Tummy pain
    • Diarrhoea
    • Vomiting
    • Rash
    • Cold hands and feet
    • Red eyes

    If your child has these symptoms or has a fever >38C, cold hands and feet and is sleepy – do discuss this with a GP so further action can be taken.

    What can be done if doctors think that my child has PIMS?

    There is no single test to diagnose PIMS. Further tests will be carried out and along with the medical history, it can be determined whether your child might have PIMS. If this is the case, then treatments can be started to suppress the inflammatory process. 

    Despite the increased numbers of children having contracted COVID-19 during the Autumn of 2020, it is rare for children to become unwell with COVID. It is even less likely for them to be admitted to hospital (1-5 children per 100, 000). Most children would be expected to make a full recovery following PIMS with the right treatment and will be followed up to ensure they remain well.

    It is difficult to confirm whether there has been any death related to PIMS. There have been 2 suspected cases of PIMS where children have sadly died. But, doctors cannot be certain if there were other reasons for this. It is important to remember that there are more deaths in children related to illnesses like influenza or even chickenpox.

    In short, it is worth being aware that PIMS exists and to be aware of how it might present. As it is so rare, it is not something that you should be overly concerned about. But, if you do have concerns you should get in touch with your GP to discuss things further. 

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Child Health Guides
  • How To Improve Recovery From Exercise

    How To Improve Recovery From Exercise

    Many of our patients want to get the very best from their bodies. To be able to maximise your training you need to maximise your recovery from exercise. Active recovery optimises training gains. So what are the best ways to recover from exercise?

    Stretching

    Stretching has several benefits after exercise. It can help increase both muscle length and range of motion. It may align collagen fibres which results in pain-relieving benefits. It also can help improve our posture. Of course, it also reduces muscle tension and alleviates stress.

    All stretching modalities can improve range of motion. PNF (Proprioceptive Neuromuscular Facilitation) is the best form of stretching to increase range of motion. This type of stretching works by stretching and contracting the muscles. A few examples of this type of stretching includes:

    · The Hold-relax technique – Stretch the muscle without moving, hold and then relax.

    · The Contract-relax technique – Stretching the muscle whilst movement or resistance is added

    · Hold-relax-contract technique – Stretch the muscle without moving, hold and then pushing deeper into the stretch.

    Light Exercise

    Gentle exercise works (yes, more exercise!) best when combined with stretching. This might include walking or very gentle spinning the legs on the bike. Gentle exercise helps your body cool down and calms the nervous system. It has been found to improve sleep after exercise and reduce soreness. But remember, don’t overdo it. You do not want to deplete energy levels or to increase muscle damage. Simple games can be helpful to boost psychological recovery. For this, playing with your kids provides great recovery.

    Myofascial release

    Myofascial release is a soft tissue therapy. It is done using a foam roller. It works by something called autogenic inhibition. This reduces the excited state of the stretched muscle and activates the opposing muscle. It can help increase the range of motion of joints and reduce muscle pain. To perform myofascial release roll your muscles on your foam roller. When you hit a tender spot, maintain pressure on that area for 30-60 seconds. 

    Hot or Cold

    Cold and hot therapies work by decreasing the “thermal load” of the muscle and hence improve performance. The combination of hot and cold is often used at a ratio of 3 or 4:1. Both hot and cold and heat can be effective for reduces muscle damage after exercise. Cold is superior to heat in reducing muscle pain after exercise. Whole-body cryotherapy has been found to reduce muscle pain after exercise and improve recovery from exercise.

    Compression

    Compression tights may have some limited benefits on performance and physiology of muscles. They also seem to help with reducing muscle swelling and soreness. The main effect of compression tights appears to be psychological but this beneficial effect should not be underestimated.

    Nutrition

    Nutrition can have a profound impact on our recovery from exercise. In endurance exercise, optimal ingestion of macronutrients following a workout to boost recovery is 30-60 minutes post-exercise, 7-10g/kg of carbohydrate and 1.2-1.8g/kg of protein. The carbohydrate helps restore glycogen levels in the muscles. The protein helps with protein production in the fatigued muscles. Don’t forget re-hydration as part of your nutritional strategy after exercise. Checking your weight pre- and post-exercise can be helpful for calculating how much you need to drink to re-hydrate. 

    Psychology

    Relaxing the mind is as important as relaxing the body. Music, meditation and breathing exercises have all been found to benefit recovery. These techniques also have great benefit in reducing stress.

    There are multiple avenues by which we can optimise muscle recovery post-exercise. A strong balance between training and recovery will accelerate your athletic progression. All of these techniques also provide great stress relief which makes them a double win.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Nutrition & Lifestyle Guides
  • The qFIT test – the new detection test tackling Bowel Cancer

    The qFIT test – the new detection test tackling Bowel Cancer

    The qFIT test checks for bleeding from the gastrointestinal tract. Bowel cancer is the 4th most common cancer and the 2nd most common cause of death in the UK. This makes it a strong target for new and innovative detection technologies. Early detection is vital for potential intervention and cure with any disease. However, we still see the majority of cases not being diagnosed early due to a lack of knowledge or understanding of symptoms.

    Bowel cancer is an all-inclusive term for cancer in the large bowel or colon and the back passage or the rectum. Abnormal cells start to divide and grow in an uncontrollable way which can lead to the possibility of unwanted cells spreading to other parts of the body.

    To help minimise this progression, a simple test to help diagnose possible symptoms leading to potential intervention is the most successful tool we have in reducing these statistics. Most, but by no means all bowel cancers start off as polyps. The majority of polyps remain small and harmless. Some, however, develop into malignant cancers that can invade into the wall of the colon. The progression from harmless polyp to cancer can occur over 10 or so years. So, screening can provide an excellent tool in our armoury against cancer in this 10-year window of opportunity.

    The new qFIT (Quantitative Faecal Immunochemical Test) testing package is a tool used for primary screening for patients without symptoms such as bleeding or change in bowel habit. It is also sometimes as a management guide for patients with symptoms. The simple stool sample test does not look for cancerous cells specifically. However, it detects certain antibodies and blood in the stool that could develop into cancerous symptoms. This is used as the first line of detection to allow for further testing if needed to identify the cause. The next line of testing is usually direct visualisation of the colon with a colonoscopy.

    This new test, is now offered here at Coyne Medical. We use it as part of our health screenings and opportunistically in GP appointments for patients who are suitable. FIT Testing has been shown to detect twice as many cancers and four times as many advanced polyps as the previous test, making it the most effective point of call for early detection.

    How The Test Is Carried Out

    Fit testing is carried out on a small amount of stool. We give you a special container for the sample and detailed instructions on how to do the test. You obtain the stool sample from stool passed into the disposable container we provide you with. The stool should not come into contact with the toilet water. The qFIT test requires only one stool sample and does not need any medications to be stopped. In addition, no alterations to diet are needed. When you have done the sample it can be mailed back to the laboratory. The process the results as soon as they receive the sample. It’s important to send it back to the lab as soon as possible. This is because delayed processing of the sample has been associated with lower detection of adenomas.

    Be Symptom Aware

    Whether or not you are planning to have a qFIT test done. It is very important to be aware of the symptoms of bowel cancer. These include:

    • Tummy pain
    • Change in bowel habit
    • Unintentional weight loss
    • Bleeding from the back passage
    • Bloating of the tummy
    • Nausea or vomiting
    • Fatigue, lack of energy and shortness of breath on exertion

    For people between the ages of 40-74 years, we recommend having a screening annually. In the UK and some other countries, the testing is less frequent and one study in the Netherlands did show that screening every three years resulted in the same population positivity rate. However, if you have any relevant family history, a simple concern or would like to find out more information about symptoms or the test itself, please contact us on 020 7731 3077.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Cancer Health Guides
  • Using Your DNA To Personalise Your Medication

    Using Your DNA To Personalise Your Medication

    Treat. Better.

    What is pharmacogenomics? It is the idea that a person’s genes influence their response to medicinal drugs. This means that by knowing and understanding your genes we can discover the right medication for you at the optimum dose.

    Personalised Medicine

    Many patients do not benefit from the first medication they are prescribed. Some will have side effects. Pharmacogenomics has the ability to make the medicines you are prescribed personalised to you.

    The Benefits of Pharmacogenomics

    The idea of pharmacogenetics is not a new one. As early as 1953 University of Washington geneticist Arno Motulski had established that gene variants affect the metabolism of certain drugs. Our Pharmacogenomics testing examines 50 well-established genes with over 200 gene-varients to establish:

    • What medication is right for you.
    • What is the best medication dose for you.
    • Whether you may experience side effects.

    Getting the Most out of Pharmacogenomics

    The people who benefit most from pharmacogenomic testing are those who require a long-term medication. This is particularly the case when there is more than one potential medication to choose from when the medication carries with it a high risk or side effects, when the starting dosage is undecided, or when patients are on more than one medication.

    Accurate Results

    Once your saliva sample is taken it is sent to the laboratory to undergo cutting edge, next-generation sequencing. The testing has demonstrated 100% sensitivity (true positive detection rate) and 100% specificity (true negative detection rate).

    Contact us to arrange your pharmacogenetics test or find out more here.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Lab Tests & Results Guides
  • Breastfeeding newborns – the simple yet essential questions

    Breastfeeding newborns – the simple yet essential questions

    Breastfeeding is supposed be a very natural thing. You would think that some sort of instinct would kick in, and that it really would be something everyone would be able to do. For whatever reason, this is not always the case and it definitely was not something that I found particularly easy. Perhaps because our lives have changed so much, it is not something we are exposed to or really have much knowledge about until you are expected to feed a crying infant. Despite the fact that there has been such a big push to promote breastfeeding, babies are hidden away under muslins and feeding bibs because that is just what is socially acceptable. So, how can we ask the questions we need to? That’s why this blog is intended as a tool for newcomers that have the simply yet important questions.

    Q: How do I prepare?

    It is definitely a good idea to try to talk about breastfeeding and look at pictures or videos, before baby arrives. This can be at an antenatal class, at an NCT meeting or simply with friends or family. Don’t be afraid to ask, most people are happy to share their tips and distastes stories. Despite being prepared, don’t worry if it takes a little time to get the hang of it. The midwives are great at explaining and showing you what to do and if you can get access to a specific breastfeeding consultant, this goes a long way to helping you get things going. If things are going a little slowly or you need to express, this does not mean that you will not be able to breastfeed. Simply go with what baby needs at the time and don’t give up.

    The first fluid that you will produce following the birth is colostrum, which does not look like milk at all, but is usually a yellow coloured fluid. Colostrum has more protein and less fat and carbohydrates than mature breast milk. It is rich in secretory immunoglobulin A, which helps to protect baby from infections and also helps to establish a normal gut microbiome. As it is low volume and highly nutritious, it helps your newborn as they learn to regulate the suck, swallow, and breathe cycle during feeds. I remember having to hand express tiny quantities of colostrum and painstakingly collect tiny drops in a syringe, which did seem a bit ridiculous but given the benefits, felt worth all the effort. The main thing to remember is that you just do the best that you can and try to get some of the benefits of this precious fluid.

    Q: How long will I have to do this?

    Initially baby may want to feed very often, so it is not unusual to have to feed every hour. Then once your breasts produce more milk and baby gets better at feeding you will notice baby feeding for longer. The more you feed the more this will stimulate your milk production. The other thing that you will notice is that the sucking will release your milk – otherwise know as the let-down reflex. Some women will feel this as a tingling or burning sensation, which can be quite strange. Baby will initially do quick sucks at the start of the feed, then sometimes pause waiting for the release of milk and change to a deep rhythmic suck when the flow begins. It can be quite fast and may cause your baby to cough or splutter when the milk does start to flow. This is not usually a persistent problem as baby will adapt to this, but you may need to change your position.

    Q: How do I know how long baby needs to feed for?

    The general rule about how much to breastfeed a baby is – on demand, which means as often as they want and for as long as they want. This will change over the days and weeks to settle into a more reasonable pattern. A rough guide is at least 8 times in 24 hours in the first few weeks. It is not possible to overfeed a breastfed baby – you will hear this many times. It is worth trying to look out for the hunger cues and start feeding then, because once they are really crying it is difficult to calm them down and just makes everything more stressful for you. If you notice baby sucking their fist, getting restless or rooting (turning their head an opening their mouth), try to get yourself in a place and position to be feeding.

    I felt that the most important thing, was being taught about how to get baby to latch. It is a bit counter intuitive and there are a couple of tips that may help, although it really is something that is easier to demonstrate and get somebody to help you with. The first thing is to ensure you are comfortable and relaxed, make sure your arms are relaxed and not straining, you may be there a while! Your baby’s head and body should be in a straight line and baby’s face should be close to your breast. Support their neck, shoulders and back, but don’t hold the back of their head. They will tilt their head back a bit which allows them to swallow more easily. Bring your baby towards your breast, with their nose at the level of your nipple. Wait for them to open their mouth wide and allow them to get a big mouthful of breast, with their chin coming into contact with your breast first.

    Q: Should I express?

    This is a personal choice and everyone will find their own happy balance. It is very useful to have some milk stored and to be able to get baby to take a bottle, to give you some rest. I would recommend that everyone has a pump though. Even if you are not planning to express for feeds, you may need to use the pump to help prevent or ease the symptoms of mastitis. This is something that breastfeeding mothers fear as it makes you feel so awful. Usually you will be feverish, and there will be an area on the breast that will be red, hot, firm and very tender. If this is the case seek medical attention immediately as you may need a course of antibiotics. This can come on when there is a mismatch in your supply and how much baby is feeding. If you feel that after a feed instead of being soft and pain free, they are still firm and sore it can be useful to express until the pain eases and are less firm. Don’t be tempted to express too much as this can increase your supply. Baby will usually then catch up or your body will regulate your milk supply.

    Q: How can I tell if I have thrush?

    You may notice burning or stinging around the nipple or areola. The nipple may look different – going white during feeds and bright red after feeds or cracks that don’t seem to heal. You may also notice severe pain on latching, which worsens with re-latching or a deep pain in the breast. Baby can also get thrush, which can be white patches or a coating on the tongue or appearing uncomfortable during feeds. If you notice any of these symptoms please seek medical attention for you and baby to be checked over and to get appropriate treatment.

    Q: How long should I breastfeed for?

    This is also a very personal thing, every mother and baby is different. Do not feel bad if you have to or want to top up with formula. You may be advised to do this if baby is not gaining weight, and the main thing is having a healthy, happy baby (and Mummy). The World Health Organisation (WHO) recommend breastfeeding for at least 6 months, at which point most babies start weaning. There are so many factors that determine how long women breastfeed for and it is different with each child. Ironically, after having struggled through and becoming successful breastfeeders, some mothers find the next battle is how to stop. The WHO also recommend that breastfeeding should continue for up to 2 years or beyond. It really it something that you will decide for yourself and when the time is right, you will find the strength to overcome this hurdle. I wish you all the very best of luck!

    Some additional great resources for further information on these topics can be found online at Mom Loves Best, a fantastic place for all your questions.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Child Health Guides
  • Caring for your Skin in Winter

    Caring for your Skin in Winter

    It is that time of year, when the weather is less kind and it starts to affect your skin. With the cold wind, wet outdoors and heating indoors, skin tends to get very dry and irritated. Here are a few simple things we need to remember to keep our skin happy throughout these colder months.

    1.Try to switch to soap substitutes during these months, for both your face and body. For your face this means avoiding gel cleansers and opting for cream based cleansers. Your local pharmacist can assist you in choosing an array of soap substitutes to use either in the bath or shower.

    2. Although it is tempting to have a very hot bath or shower when it is cold outside, it is better for your skin to have less contact with water and instead have a shorter warm shower. Try not to rub yourself dry vigorously, but pat yourself dry and apply a fragrance free moisturiser or emollient immediately after. This will help lock in the moisture.

    Similarly, if you are washing your hands frequently, try to apply an emollient after each wash if convenient. Choosing an emollient is based on how dry your skin is and what you feel comfortable using. Cream or gel based emollients go on without leaving a greasy feeling, and although they are less moisturising they are fine for regular use. If your skin is very dry it is probably best to opt for an ointment which is greasier, but will work more effectively and quickly to sooth irritation. You could consider using a greasier emollient at night and a less greasy one in the day.

    3.Exposed skin is vulnerable and more likely to dry out and become irritated, so if you can – cover it up! This means wearing gloves, hats and scarves in addition to your other warm winter gear. For some people direct contact with wool can cause irritation, so it is sensible to layer up and wear comfortable breathable materials under these.

    4.Although it may not feel like you see the sun much at this time of the year, it is also advisable to use sunscreen in winter if you are going to be outside – even if you are not skiing on a sunny mountain slope.

    5.It is also important to stay hydrated and maintain a healthy balanced diet. Our eating habits tend to get worse during the colder months and we reach for things that we find comforting. Additionally, it is worth considering taking supplements during this time of the year, especially vitamin D (see our blog about this for further details).

    If you are still struggling with dry irritated skin despite these measures, it may be worth coming in for a review to see if your skin condition is more serious and may need topical steroids. We at Coyne Medical are always looking to help with any questions you may have, therefore please get in contact with us to book an appointment today.

  • Optimising Recovery From Exercise – Capitalise on your rest days

    Optimising Recovery From Exercise – Capitalise on your rest days

    From when we are small children, we are told about the importance of exercise. Whether it be that we need to go outside and play during break time or that as we age, we need to do cardiovascular exercise to maintain heart health and that resistance training will help muscle tone.

    While this is all shown to us as influencing a healthy lifestyle, information about the importance of recovery is not as readily talked about. With recovery possibly being almost as important as physical exercise (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5916096/ , Dr Hugh has provided us with some ways to capitalise on our rest days, and that yes, most of these can be done sitting on the couch in front of the TV!

    Stretching

    PNF (Proprioceptive Neuromuscular Facilitation) has been found to be best for increasing range of motion. This type of stretching activates both muscle structure and reflex by stretching and contracting the muscles. A mix of both static stretching (a classic static stretch would be bending forwards to touch your toes and holding that position for 20 seconds) and dynamic stretches, including PNF, and partner assisted stretching can benefit. A few examples of this type of stretching includes:

    The Hold-Relax Technique – Stretching the muscle without moving, holding and then relaxing

    The Contract-Relax Technique – Stretching the muscle while moving or resistance is added

    Hold-Relax-Contract Technique – Stretching the muscle without moving, holding and then pushing into the stretch.

    Light Exercise

    Gentle exercise works (yes, more exercise!) best when combined with stretching. This might include walking or very gently spinning the legs on the bike. But be cautioned to not deplete energy levels or to increase muscle damage. Simple games can be helpful to boost psychological recovery and for this playing with your kids provides great recovery.

    Myofascial release

    Myofascial release works by something called autogenic inhibition which reduces the excited state of stretched muscle and activated opposing muscle. It can help increase range of motion of joints and reduce muscle pain. Therefore, even though that foam roller is horrendously painful, give it a shot and see the benefits!

    Hot or Cold

    Cold and hot therapies work by decreasing the “thermal load” of the muscle and hence improving performance. The combination of hot and cold is often used at a ratio of 3 or 4:1. More information on the benefits of both and whether one is better than the other can be found here, https://pubmed.ncbi.nlm.nih.gov/26502272/

    Compression

    Compression tights have some limited benefits on performance and physiology of muscles. However, the main effect to be seen is psychological from a strong placebo effect which can be extremely effective according to this study. (https://pubmed.ncbi.nlm.nih.gov/30310979/)

    Nutrition

    In endurance exercise, optimal ingestion of macronutrients following a workout to boost recovery is 30-60 minutes post-exercise, 7-10g/kg of carbohydrate and 1.2-1.8g/kg of protein. https://www.ncbi.nlm.nih.gov/pubmed/9127682/

    Psychology

    Relaxing the mind is just as important as relaxing the body. Music, biofeedback, meditation, and breathing exercises have all been found to benefit the mental aspect of recovery.

    With there being multiple avenues in which we can optimise muscle recovery post exercise, it is important to remember that a strong balance between the two will ultimately further progression. This is a great point to keep in mind rather than relying on constant exercise or alternatively constant TV watching ‘recovery’ to optimise our amazing bodies!

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Nutrition & Lifestyle Guides