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Monday, 28 May 2012

Green Tea Reduces Cancer Risk & Burns Fat

The discovery of green tea and its health benefits was made thousands of years ago. In the beginning, it was only cultivated and used in different parts of Asia like China and India but it has recently gained a lot of popularity in the western world as well because of its various health benefits proven by scientific research. Just like black tea, green tea is also prepared from the leaves of tea plant know as Camellia sinensis but green tea does not go through the same oxidation process as black tea and due to this reason, most of its beneficial properties remain intact. Coming towards the question: Does green tea burn fat? We need to find out what does green tea contain and how its ingredients help us lose fat?

Green Tea Ingredients.
Green tea contains some of the most powerful antioxidants known as polyphenols. The polyphenols contained in green tea (also known as catechins) are much stronger antioxidants even when compared with Vitamin C. Green tea contains 6 different types of catechin but the most important of them all is known as Epigallocatechin-3-gallate (EGCG).  EGCG is mainly responsible for providing various health benefits that are associated with green tea and it also helps us in fighting different diseases. Green tea also contains caffeine which gives it the refreshing effect. Other ingredients of green tea include: theanine, butyric acid, vitamins A, B1, B12, K, P, pectin, fluoride, iron, magnesium, calcium, strontium, copper, nickel, and zinc.

How Does Green Tea Burn Fat?
Scientific research has shown that green tea can help in losing excess fat from the body. That is why it is one of the main ingredients of most of the weight loss pills and supplements available in the market.
The food that we eat is converted by our liver into a gel like substance known as triglycerides. These triglycerides are used as main source of energy by our body to perform various physical activities. The more we eat, the more triglycerides are released in to our blood stream and the excess of them is converted in to body fat which can cause various health problems in the long run.  The polyphenols (especially EGCG) in green tea dissolve the excess triglycerides and prevent us from gaining extra body fat. The antioxidants and caffeine contained in green tea also signal our nervous system to release the already stored body fat in to the blood stream so that it can be used to fuel our body. Thus green tea makes us more energetic and accelerates our metabolism to burn extra calories.

Other Health Benefits.
Green tea provides us countless health benefits and only a few of them are mentioned below:

Prevents us from Cancer.
Clinical studies have shown that polyphenols in green tea can help prevent us from various types of cancer such as lung cancer, stomach cancer and colon cancer. These polyphenols can kill cancerous cells present in the body and also reduce the size of dangerous tumors.

Improves dental health.
Green tea has antibacterial effects and prevents us from the bacterium that causes tooth decay. Different compounds in green tea also help us in fighting bad breath.

Improves skin health.
Many skin care products use antioxidants such as vitamin A, C and E that help in skin care. Green tea has much stronger antioxidants and can help in preventing our skin from sun damage and wrinkles.


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Thursday, 24 May 2012

Heat Stroke (Sun Stroke)

 Heat stroke facts

  • Heat stroke is a form of hyperthermia in which the body temperature is elevated dramatically.
  • Heat stroke is a medical emergency and can be fatal if not promptly and properly treated.
  • Cooling the victim is a critical step in the treatment of heat stroke.
  • The most important measures to prevent heat strokes are to avoid becoming dehydrated and to avoid vigorous physical activities in hot and humid weather.
  • Infants, the elderly, athletes, and outdoor workers are the groups at greatest risk for heat stroke.

What is, and who is at risk for heat stroke?

Heat stroke is a form of hyperthermia, an abnormally elevated body temperature with accompanying physical symptoms including changes in the nervous system function. Unlike heat cramps and heat exhaustion, two other forms of hyperthermia that are less severe, heat stroke is a true medical emergency that is often fatal if not properly and promptly treated. Heat stroke is also sometimes referred to as heatstroke or sun stroke. Severe hyperthermia is defined as a body temperature of 104 F (40 C) or higher.
The body normally generates heat as a result of metabolism, and is usually able to dissipate the heat by radiation of heat through the skin or by evaporation of sweat. However, in extreme heat, high humidity, or vigorous physical exertion under the sun, the body may not be able to dissipate the heat and the body temperature rises, sometimes up to 106 F (41.1 C) or higher. Another cause of heat stroke is dehydration. A dehydrated person may not be able to sweat fast enough to dissipate heat, which causes the body temperature to rise.
Those most susceptible (at risk) individuals to heart strokes include:
  • infants,
  • the elderly (often with associated heart diseases, lung diseases, kidney diseases, or who are taking medications that make them vulnerable to dehydration and heat strokes),
  • athletes, and
  • individuals who work outside and physically exert themselves under the sun.

What are heat stroke symptoms and signs?

Symptoms of heat stroke can sometimes mimic those of heart attack or other conditions. Sometimes a person experiences symptoms of heat exhaustion before progressing to heat strokes.
Signs and symptoms of heat exhaustion include:
  • nausea,
  • vomiting,
  • fatigue,
  • weakness,
  • headache,
  • muscle cramps and aches, and
  • dizziness.
However, some individuals can develop symptoms of heat stroke suddenly and rapidly without warning.
Different people may have different symptoms and signs of heatstroke. Common symptoms and signs of heat stroke include:
  • high body temperature,
  • the absence of sweating, with hot red or flushed dry skin,
  • rapid pulse,
  • difficulty breathing,
  • strange behavior,
  • hallucinations,
  • confusion,
  • agitation,
  • disorientation,
  • seizure, and/or
  • coma.

What about heat stroke in children?

While the elderly are at greatest risk for heat stroke, infants and children are also at risk. In particular, infants or young children who are unattended in locked cars may suffer heat-related illness quickly, since the indoor temperature of a locked care can rise to dangerous levels even in moderate weather. Rarely, infants have died of heat stroke when overly bundled in their cribs. It is critically important that parents understand the medical dangers inherent in leaving children unattended in cars in addition to the obvious safety risks. Further, cars should always be kept locked when not in use so that children may not enter them and become trapped.
Among older children and teens, heat stroke or heat-related illness is a risk for athletes who train in hot environmental conditions. Among reported heat-related illnesses in U.S. high school athletes, the majority of cases occur in football players during the month of August.

How do you treat a heat stroke victim?

Victims of heat stroke must receive immediate treatment to avoid permanent organ damage. First and foremost, cool the victim.
  • Get the victim to a shady area, remove clothing, apply cool or tepid water to the skin (for example you may spray the victim with cool water from a garden hose), fan the victim to promote sweating and evaporation, and place ice packs under armpits and groin.
  • If the person is able to drink liquids, have them drink cool water or other cool beverages that do not contain alcohol or caffeine.
  • Monitor body temperature with a thermometer and continue cooling efforts until the body temperature drops to 101 to 102 F (38.3 to 38.8 C).
  • Always notify emergency services (911) immediately. If their arrival is delayed, they can give you further instructions for treatment of the victim.

How can heat stroke be prevented?

  • The most important measures to prevent heat strokes are to avoid becoming dehydrated and to avoid vigorous physical activities in hot and humid weather.
  • If you have to perform physical activities in hot weather, drink plenty of fluids (such as water and sports drinks), but avoid alcohol, caffeine (including soft drinks), and tea which may lead to dehydration.
  • Your body will need replenishment of electrolytes (such as sodium) as well as fluids if you sweat excessively or perform vigorous activity in the sunlight for prolonged periods.
  • Take frequent breaks to hydrate yourself. Wear hats and light-colored, lightweight, loose clothes.


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Monday, 14 May 2012

How to stretch after exercising

How to stretch and cool down after a workout to gradually relax, improve flexibility and slow your heart rate.
This cool-down routine should take about 5 minutes. Spend more time on it if you feel the need.


Buttock stretch – hold for 10 to 15 seconds

 
 To do a buttock stretch, bring knees up to chest. Cross right leg over left thigh. Grasp back of left thigh with both hands. Pull left leg toward chest. Repeat with opposite leg.



Hamstring stretch – hold for 10 to 15 seconds

 
 To do a hamstring stretch, lie on your back and lift your right leg. Keeping your left leg straight and on the floor, pull your right leg towards you. Don’t hold at the knee level. Repeat with opposite leg.



Inner thigh stretch – hold for 10 to 15 seconds

 
 For the inner thigh stretch, sit down with your back straight and bend your legs, putting the soles of your feet together. Holding on to your feet, try to lower your knees towards the floor.



Calf stretch – hold for 10 to 15 seconds

 
 For the calf stretch, step your right leg forward, keeping it bent and lean forwards slightly. Keep your left leg straight and try to lower the left heel to the ground. Repeat with opposite leg.



Thigh stretch – hold for 10 to 15 seconds

 

To do a thigh stretch, lie on right side. Grab top of left foot and gently pull heel towards left buttock to stretch the front of the thigh, keeping knees touching. Repeat on the other side.

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How to warm up before exercising


Warm up and stretch properly before exercising to prevent injury and make your workouts more effective.
This warm-up and stretching routine should take at least 6 minutes. Warm up for longer if you feel the need.


March on the spot – keep going for 2 minutes

 

Start off marching on the spot and then march forwards and backwards. Pump your arms up and down in rhythm with your steps, keeping the elbows bent and the fists soft.




Heel digs – aim for 60 heel digs in 60 seconds

 

For heel digs, place alternate heels to the front, keeping the front foot pointing up, and punch out with each heel dig. Keep a slight bend in the supporting leg.




Knee lifts – aim for 30 knee lifts in 30 seconds


To do knee lifts, stand tall, bring up alternate knees to touch the opposite hand. Keep your abs tight and back straight. Keep a slight bend in the supporting leg.




Shoulder rolls – 2 sets of 10 repetitions


For shoulder rolls, keep marching on the spot. Roll your shoulders forwards five times and backwards five times. Let your arms hang loose by your sides.




Knee bends – 10 repetitions


To do knee bends, stand with your feet shoulder-width apart and your hands stretched out. Lower yourself no more than 10cm by bending your knees. Come up and repeat.




Quad stretch – hold for 6 to 10 seconds

Quad stretch 

To do a quad stretch, grasp your ankle and gently pull your heel up and back until you feel a stretch in the front of your thigh. Stand tall, keep knees together and avoid leaning to the side. Keep a slight bend in the supporting leg. Use a wall for support. Repeat with other leg.





Hamstring stretch – hold for 6 to 10 seconds

hamstring stretch 

To do a hamstring stretch, keep hips and shoulders straight, extend one leg out, foot facing up. Bend forwards until you feel a stretch in your hamstring. Repeat with other leg.




Calf stretch – hold for 6 to 10 seconds

calf stretch

To do a calf stretch, step your right leg forward, keeping it bent and lean forwards slightly. Keep your left straight and try to lower the left heel to the ground. Repeat with other leg.




Chest stretch – hold for 6 to 10 seconds

chest stretch 

Clasp hands behind your back with palms facing up. Pull hands down and try to bring shoulder blades together. Your chest should stick out. Don't arch your back.




Upper back stretch – hold for 6 to 10 seconds

upper back stretch 

To do an upper back stretch, round the back, extend arms in front of you. Clasp hands together, palms facing in. Drop your head. Focus on increasing the gap between your hands and chest, feeling your shoulders stretching across your back.




Tricep stretch – hold for 6 to 10 seconds

Tricep stretch 

For the tricep stretch, place your hand on your upper back with the elbow bend upwards. Use other hand to pull the elbow towards your head to feel the stretch. Don't hold the elbow joint and don't arch your back. Repeat with the other arm.



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10-minute home cardio workout

Burn calories, lose weight and feel great with this 10-minute home cardio workout routine for aerobic fitness.
If you have a skipping rope, replace any of the exercises listed below with a 60-second burst of skipping.
This 10-minute cardio workout counts towards your recommended 150 minutes of aerobic activity every week.
Before you begin, warm up with this 6-minute warm-up routine.


Rocket jumps – 2 sets of 15 to 24 repetitions (reps)

 

For rocket jumps, stand with your feet hip-width apart, legs bent and hands on your thighs. Jump up, driving your hands straight above your head and extending your entire body. Land softly, reposition your feet and repeat. For more of a challenge, start in a lower squat position and hold a weight or a bottle of water in both hands at the centre of your chest.
 
  • Recovery: walk or jog on the spot for 15 to 45 seconds.

Star jumps or squats – 2 sets of 15 to 24 reps

 

To do a star jump, stand tall with your arms by your side and knees slightly bent. Jump up, extending your arms and legs out into a star shape in the air. Land softly, with your knees together and hands by your side. Keep your abs tight and back straight during the exercise.

Squats

 

As a less energetic alternative, do some squats. Stand with your feet shoulder-width apart and your hands down by your sides or stretched out in front for extra balance. Lower yourself by bending your knees until they are nearly at a right angle, with your thighs parallel to the floor. Keep your back straight and don’t let your knees extend over your toes.

  • Recovery: walk or jog on the spot for 15 to 45 seconds.

Tap backs – 2 sets of 15 to 24 reps

 

To start tap backs, step your right leg back and swing both arms forward and repeat with the opposite leg in a continuous rhythmic movement. Look forwards and keep your hips and shoulders facing forwards. Don’t let your front knee extend over your toes as you step back. For more of a challenge switch legs by jumping, also known as spotty dog, remembering to keep the knees soft as you land. Your back heel needs to be off the floor at all times.

  • Recovery: walk or jog on the spot for 15 to 45 seconds.

Burpees – 2 sets of 15 to 24 reps

 

To do a burpee (1) , from a standing position, (2) drop into a squat with your hands on the ground.(3) Kick your feet back into a push-up position. (2) Jump your feet back into a squat and (4) jump up with your arms extending overhead. For an easier burpee, don’t kick out into the push-up position and stand up instead of jumping.



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10-minute home toning workout


Resistance bands

Most resistance bands, also called resistance tubes or exercise bands, are colour-coded according to tension level. Resistance bands are available from most health and fitness shops and online retailers. If you're just starting out, use a band with a medium tension.
You will need a resistance band for some of the exercises but if you don't have one, you can use bottles of water or other weighted objects.
This toning exercise routine counts towards your recommended weekly activity target for strength. Find out more about physical activity guidelines for adults.
Before you begin, warm up with this 6-minute warm-up routine. Afterwards, cool down with a 5-minute stretch and cool down.

The 3/4 press-up or full press-up – 2 sets of 12 to 15 repetitions (reps)

The 3/4 press-up

 
Place your hands underneath your shoulders with your arms fully extended, palms flat and fingers facing forward. Rest your knees on the floor. Bend at your elbows, lowering your chest down, no lower than 2 inches from the floor. Push back up and repeat.

The full press-up

 
Place your hands underneath your shoulders with your arms fully extended, palms flat and fingers facing forward. Keep your legs straight and knees off the floor. Bend your arms at your elbows, lowering your chest until it is two inches above the floor and your elbows reach 90 degrees. Keep your back and legs straight at all times as if your body was a plank. Try not to bend or arch your upper or lower back as you push up. Push back up and repeat.




Tricep dip – 2 sets of 12 to 15 reps

 
Sit on the floor with your knees bent, feet on the floor, hands on the floor behind you with fingers pointing towards body. To begin, lift hips off floor. Now, slowly bend your elbows and lower your body close to the floor and slowly push back up but don’t lock the elbows. For more of a challenge, rest hands on a stable bench or step.




Shoulder press – 2 sets of 12 to 24 reps

 
Place resistance band under both feet, stand tall with your arms bent and by your sides, fists raised to shoulder level. Without lifting your shoulders, slowly extend your arms above your head until they come together and then widen the hand grip as you bring the arms down.




Shoulder press with lunge – 1 set of 12 to 24 reps on each side

 
Get into the lunge position, right foot forward, and place the resistance band under the right foot. Hold the resistance band in both hands, arms bent and by your sides. As you straighten your legs, extend your arms above your head until they come together. Slowly lower back into the starting position and repeat.




Bicep curl – 2 sets of 12 to 24 reps

 
Standing tall with feet hip-width apart, place the resistance band under one foot, or two for more of a challenge. Keep your stomach flat and squeeze your bum. Hold the band with arms straight and by your sides and palms facing out. Slowly bend from the elbow raising your fists to your shoulders, without moving your elbows. Slowly lower down and repeat.




Lateral raise – 2 sets of 12 to 24 reps

 
Stand tall with feet hip-width apart Place the resistance band under both feet. Keep your stomach flat and squeeze your bum. Hold the band in each hand, palms facing in, and arms straight by your sides. Slowly raise both arms, keeping them straight, up to shoulder height, taking care not to lift your shoulders. Slowly lower and repeat.


Squat – 2 sets of 15 to 24 reps

 
Stand with your feet shoulder-width apart and your hands down by your sides or stretched out in front for extra balance. Lower yourself by bending your knees until they are nearly at a right angle, with your thighs parallel to the floor. Keep your back straight and don’t let your knees extend over your toes.




Lunge – 1 set of 15 to 24 reps with each leg

 
Stand in a split stance with your right leg forward and left leg back. Slowly bend the knees, lowering into a lunge until both legs are nearly at right angles. Keeping the weight in your heels, push back up to starting position. Keep your back straight and don’t let your knees extend over your toes.




Stomach crunch – 2 sets of 15 to 24 reps

 
Lie down on your back, knees bent and hands behind your ears. Keeping your lower back pressed into the floor, raise your shoulder blades no more than 3 inches off the floor and slowly lower down. Don’t tuck your neck into your chest as you rise and don’t use your hands to pull your neck up.




Back raise – 2 sets of 15 to 24 reps

 
Lie down on your chest and place your hands by your temples or extended out in front for more of a challenge. Keeping your legs together and feet on the ground, raise your shoulders off the floor no more than 3 inches and slowly lower down. Keep a long neck and look down as your perform the exercise.

Firm up your bum, abs, legs and arms with this 10-minute home toning workout.



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Walking for health

Walking is simple, free and one of the easiest ways to get more active, lose weight and become healthier. 

It's underrated as a form of exercise but walking is ideal for people of all ages and fitness levels who want to be more active.
Regular walking has been shown to reduce the risk of chronic illnesses, such as heart disease, type 2 diabetes, asthma, stroke and some cancers.
Use this guide to increase the amount of walking you do every week and maximise the health benefits.

Before you start

A pair of shoes is all the equipment you really need. Any shoes or trainers that are comfortable, provide adequate support and don't cause blisters will do.
What a 60kg person burns in 30 minutes
  • strolling (2mph): 75 calories
  • walking (3mph): 99 calories
  • fast walking (4mph): 150 calories
Wear loose-fitting clothing that allows you to move freely. Choose thin layers rather than heavy, chunky clothing.
If you’re walking to work, you can just wear your usual work clothes with a comfy pair of shoes.
For long walks, you may want to take some water, healthy snacks, a spare top, sunscreen and a sunhat in a small backpack.
If you start taking regular, longer walks, you may want to invest in a waterproof jacket and some walking boots for more challenging routes.

Starting out

Start slowly and try to build your walking regime gradually. To get the health benefits from walking, it needs to be of moderate-intensity aerobic activity. In other words, it needs to be faster than a stroll.
Moderate-intensity aerobic activity means you're walking fast enough to raise your heart rate and break a sweat. One way to tell is that you'll be able to talk, but not sing the words to your favourite song.

Recommended physical activity levels

  • Children aged under 5 years should do 180 minutes every day
  • Young people (5-18 years) should do 60 minutes every day
  • Adults (19-64 years) should do 150 minutes every week
  • Older adults (65+ years) should do 150 minutes every week 
Try to walk 10,000 steps a day. Most of us walk between 3,000 and 4,000 steps a day anyway, so reaching 10,000 isn't as daunting as it might sound.

If, to begin with, you can only walk fast for a couple of minutes, that's fine. Don't overdo it on your first day.
You can break up your activity into 10-minute chunks, as long as you're doing your activity at a moderate intensity.
 Begin every walk slowly and gradually increase your pace. After a few minutes, if you’re ready, try walking a little faster.
 Towards the end of your walk, gradually slow down your pace to cool down. Finish off with a few gentle stretches, which will help improve your flexibility.
From walking to the shops or part of your journey to work, to walking the dog and organised group walks, every step counts.

Staying motivated

Make it a habit
The easiest way to walk more is to make walking a habit. Think of ways to include walking into your daily routine. Examples include:
  • Walk part of your journey to work.
  • Walk to the shops.
  • Use the stairs instead of the lift.
  • Leave the car behind for short journeys.
  • Walk the kids to school.
  • Do a regular walk with a friend. 
  • Go for a stroll with family or friends after dinner.
If you live in a city, Walkit has an interactive walk planner to help you find the best walking route. Each suggested route includes your journey time, calorie burn, step count and carbon saving.

Mix it up
Add variety to your walks. You don’t have to travel to the countryside to find a rewarding walk. Towns and cities offer interesting walks including parks, heritage trails, canal towpaths, riverside paths, commons, woodlands, heaths and nature reserves. For ideas for inspiring walks, see Walk England.
You can also track your walking, plan walks, set personal goals and save your favourite routes with the free My Get Walking tool. For wheelchair users and parents with buggies, visit Walks with wheelchairs.

Join a walking group
Walking in a group is a great way to start walking, make new friends and stay motivated. Walking for Health’s Walk Finder allows you to search for organised walks near you. Many of the walks are aimed at people who do little or no exercise, but who would like to become more active. The Ramblers' Get Walking Keep Walking website organises city walks for inactive people and those with health problems.

Get your boots on
Ramblers promotes walking for health, leisure and as a means for getting around to people of all ages, backgrounds and abilities, in towns and cities as well as in the countryside. Its website has details of many locally organised walking groups, for all levels of fitness.

Set yourself a goal
You can walk 1,000 steps in around 10 minutes. Try building up gradually to walking 10,000 steps on five or more days a week. Pedometers are a fun way to keep track of your walking. Use a pedometer to work out your average daily steps and then start adding those extra steps.


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Emergency contraception: coil 99.9% effective

 “The coil is a much more effective form of emergency contraception than the morning-after pill,” the Metro has reported. The coil, medically known as an intrauterine device or IUD, is often used as a form of long-term contraception, but it can also be implanted after sex to provide emergency protection against pregnancy.

IUDs are in the news as researchers have today published findings on how effectively they prevent pregnancy in women who have them implanted after unprotected sex. Drawing on data from 43 previous studies, the review found women who had an IUD fitted after having unprotected sex had a pregnancy rate of 0.09% – the equivalent of less than 1 pregnancy out of every 1,000 IUDs inserted. Another way of saying this is that 99.91% of women who used an IUD as emergency contraception did not become pregnant.

The study was mainly based on findings relating to IUDs containing copper, rather than all-plastic devices, and the data came largely from Chinese studies. As a consequence, the results may not reflect the effectiveness of other types of coil or use of the IUD in the UK. Also, the research did not directly compare the coil to the effectiveness of emergency contraceptive pills, or examine how easily women could obtain an emergency coil following unprotected sex. These will both be important factors for women deciding which option to use.

Where did the story come from?

The study was led by researchers from the University of Princeton USA in collaboration with researchers based in South Africa, China and the UK. It was funded by a grant from Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the researchers declared that they had no conflicts of interest.

The study was published in the peer-reviewed medical journal Human Reproduction.
Some news coverage of this research suggested women should “forget morning-after pills” as a form of emergency contraception, which is somewhat irresponsible as they remain an effective form of emergency contraception for some women. Also, emergency contraceptive pills may be a more practical and accessible option at times.

Women seeking emergency contraception should be informed about the full range of options available to them to help them make a decision about the most appropriate method for them.

What kind of research was this?

This research was a systematic review investigating how effective intrauterine devices are at preventing pregnancy when used for emergency contraception.

An intrauterine device (IUD) or ‘the coil’ is a form of birth control that is placed in the uterus of a woman to prevent pregnancy. An IUD is made of copper and plastic and works by physically preventing sperm from fertilising the egg. They can also prevent any fertilised eggs from implanting in the womb. Some devices, known as intrauterine systems, also release hormones that prevent fertilisation, but these were not included in this review and are not recommended for emergency contraception.

A systematic review seeks to identify and summarise all known literature published on a specific topic. It is an effective way of summarising a large body of research to answer a specific research question.

It should also be noted that the study did not directly compare the use of IUDs with the use of the morning after pill, nor did it compare how easily women could access either option after unprotected sex. This means we cannot tell which is a more viable option for women seeking emergency contraception, or say that one is intrinsically ‘better’ than the other based on the study’s results alone.

What did the research involve?

The researchers performed searches of research databases to gather all relevant published studies on women being given an IUD after seeking emergency contraception.

Studies were only included if clear information was available on whether the emergency contraception was effective and whether or not the women became pregnant. Only studies published in English or Chinese were included. The authors state that research published in Chinese was included because there is a high volume of contraceptive research taking place in China.

Those studies that met the inclusion criteria were analysed in more detail and data were extracted from them by two reviewers working independently of one another, which is intended to reduce errors and bias during data selection. The authors then described the results from the individual studies.

The researchers then used a simple method to pool the results of the different studies. During this process they combined the number of women seeking contraception and the number who became pregnant from across all the studies, which was intended to estimate the overall effectiveness of IUDs at preventing pregnancy.

What were the basic results?

The researchers included 42 studies that provided data on the effectiveness of IUDs in women seeking emergency contraception. These represented studies conducted in six countries between 1979 and 2011, and included 7,034 women using eight different types of IUD. Nearly all the IUDs were devices containing small amounts of copper, and only a small number of plastic-only IUDs were included, in the older pre-1985 studies. Most of the study data came from research based in China.

The main finding was that, out of the total 7,034 IUD insertions after unprotected sex, there were 10 recorded pregnancies. This gave a combined IUD failure rate (failure to prevent pregnancy) of 0.14% (95% CI 0.08 to 0.25%).

The authors commented that a study in Egypt gave a “surprisingly high” failure rate of 2%, which was vastly different from all the other studies. If this single atypical study was excluded the combined failure rate of using an IUD fell to 0.09% (95%CI 0.04 to 0.19%).

This rate means that less than one woman in every 1,000 would fall pregnant using the IUD as an emergency contraceptive. Another way of saying this is that 99.91% of women who used an IUD as emergency contraception did not become pregnant.

The maximum length of time from intercourse to IUD insertion ranged from two days to 10 or more days. Most of the insertions (74% of the studies) occurred within five days of intercourse. However, the studies did not include sufficient detail about the delay between intercourse and insertion of IUD for the researchers to analyse accurately how the effectiveness of the IUD was affected by any delay.

How did the researchers interpret the results?

The researchers conclude that “IUDs are a highly effective method of emergency contraception, with a failure rate of less than one per thousand”.

In discussing the different types of IUD they concluded that use of a copper IUD “is by far the most effective emergency contraception option” compared with the non-copper alternatives.

Conclusion

This systematic review of IUD use in emergency contraception provides useful estimates of pregnancy rates following insertion after unprotected sex. To assess the issue it drew upon studies in several different countries, although the studies were primarily carried out in China. The results of the study suggest that IUDs are a highly effective form of emergency contraception, with a very low failure rate of around 0.09%.
It should be noted that the research primarily estimates how likely it is that a woman would become pregnant after having unprotected sex and having an IUD fitted. It does not, however, tell us important related factors such as how available IUDs are after unprotected sex, nor does it confirm that they are necessarily a better option than emergency contraceptive pills. For example, women can obtain emergency contraceptive pills from specially trained pharmacists, whereas an IUD needs to be fitted by a trained clinician. This is not to say that either is better or more practical, rather that there are particular considerations to take into account with each form or contraception beyond overall failure rate.

The research also has some limitations, which should be considered when interpreting the results. For example, most of the results included in the review related to the copper coil and some were older devices, so the overall failure rate of 0.09% may not accurately represent the failure rate of newer IUDs or ones that contain hormones (known as intrauterine systems). More data on these devices are needed to establish whether they have a similar failure rate leading to pregnancy as the copper options included in the review. Similarly, most of the data feeding into the 0.09% figure come from studies based in China. Hence, this overall estimate best reflects copper IUD use in Chinese women. The effectiveness in other countries and for other IUDs is less certain based on this study alone.

Also, the research originally set out to assess the effectiveness of IUDs in detail so the researchers could see how many days had elapsed between unprotected sex and insertion of the IUD. However, the studies they identified did not contain sufficient detail for this to be possible. Hence, the combined IUD failure rate represents all cases together regardless of the time between intercourse and insertion of IUD. It is likely that the time between unprotected sex and insertion of the IUD directly influences the effectiveness of the contraceptive device, but this review was unable to analyse this. The recommended maximum interval after unprotected sex is 120 hours (five days) for most currently marketed devices.

As research was restricted to studies published in English or Chinese, this will exclude potentially informative research in other languages. The results of these excluded studies may have influenced the conclusions of this review had they been included.

When discussing their research the authors highlight recent studies exploring attitudes towards IUDs, which identified several potential barriers to a greater use of IUDs as emergency contraception. These included the waiting time (not being able to get a coil on the day emergency contraception is requested), low levels of awareness and understanding among patients, and a lack of understanding among healthcare providers. The results of this study, which show that IUDs are a highly effective option, may renew efforts to increase awareness of IUDs as an emergency contraceptive option. On this note, a spokeswoman for the Family Planning Association is quoted in the Metro as calling for more women to be offered the IUD routinely as a method of contraception. 

The Metro’s headline suggesting that women should “forget morning-after pills” is somewhat irresponsible, as morning after pills remain an acceptable and effective method of emergency contraception for some women. A previous systematic review carried out by the Cochrane collaboration in 2008 concluded that drugs (such as the morning after pill) and copper IUDs were both effective and safe methods of emergency contraception.

The risks of sexually transmitted diseases associated with unprotected sex are well known and the coil, whether used as a standard contraceptive or an emergency contraceptive, does not reduce these risks.


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People 'needlessly avoid sex after heart attacks'

Thousands of heart attack survivors are too worried to have sex because they fear it will trigger another attack, the Daily Mail has reported today. 

The story is based on a US study that looked at patients’ sexual activity both before their heart attack and in the year that followed. The study looked at the factors that affected whether people were still sexually active. It found that almost half of men and nearly 60% of women were less sexually active after a heart attack than previously, and that about one in ten who had been sexually active before a heart attack did not have sex in the year afterwards. 

The study also found that only a third of women and 47% of men reported receiving any counselling about resuming sexual activity on leaving hospital.
Those who had not received counselling were more likely to report reduced sexual activity in the following year. The study also found that patients who had sex in the year following a heart attack were no more likely to die than those who were sexually inactive, with mortality rates among both groups being similar.

Although it did not explore the reasons why some people were less sexually active after a heart attack, this study suggests that lack of any advice on the topic may leave patients fearing that sexual activity could put them at risk of a repeat heart attack, and that the issue needs to be addressed. 

Most people value sexual activity as an important part of life, whatever their health. In the UK, the current advice is that anyone who has had a heart attack should be able to have sex without risk to their heart once they are fit enough to walk briskly up two flights of stairs without getting chest pains or becoming out of breath. This is usually about four weeks after having a heart attack. At this point, having sex will not put you at further risk of another heart attack.

Where did the story come from?

The study was carried out by researchers from the University of Chicago, the University of Missouri and Yale University. It was funded by the US National Heart, Lung and Blood Institute, and the non-profit corporation Cardiovascular Outcomes Inc. The study was published in the peer-reviewed American Journal of Cardiology.

The research was reported accurately in the Daily Mail, which pointed out that men having heart attacks during sex is rare, despite what “dramatic movie scenes” might suggest. To aid readers in the understanding of this complex medical issue the paper featured a run down of a famous coital heart attack on film, experienced by Jack Nicholson’s character Harry Sanborn in the film Something’s Gotta Give. The Daily Telegraph combined its report of the study with comments from a doctor explaining that TV programmes often mislead people into thinking heart attacks after sex are common. The doctor gave the examples of the TV shows Downton Abbey and Mad Men, which both “feature dramatic scenes where philandering men suffer heart attacks in bed”.

What kind of research was this?

This was an observational study that looked at sexual activity among 1,879 heart attack patients both before their heart attack and in the following year. It also looked at whether these patients received any instructions on the subject when being discharged from hospital, and whether any information provided covered sexual activity. Finally, it looked at any association between sexual activity and mortality rates within a year of having a heart attack.

What did the research involve?

The study, which was part of a larger study monitoring the health of heart attack patients, began in 2007. It included 1,879 patients (1,274 men and 605 women) who were followed for a year after they had been admitted to hospital with a heart attack.

Patients included in the study were first interviewed at the bedside by trained staff within 24 to 72 hours of the event, and the details gathered were added to information from their medical records. Data collected by the interviewers included information on income and social class, depression, severity of their disease and physical functioning.

Patients who took part in the sexuality study were interviewed by telephone at one month and 12 months after being enrolled. They were asked a series of questions including whether they had been sexually active in the year before having a heart attack, and whether they had had sex since having a heart attack (asked at both one and 12 months). Those who reported being sexually active before their heart attack were also asked whether they had had sex with more, less or the same frequency afterwards. 

Patients were also asked if they had received any instructions at hospital discharge about when to resume sexual activity, and whether they had discussed sex with their doctor during the period after being in hospital.
The researchers obtained mortality data on the patients through social security records at 12 months.
They analysed the findings to assess any factors associated with “loss of sexual activity” 12 months after heart attack.

What were the basic results?

The study featured 1,274 men and 605 women, with average ages of 58.6 years and 61.1 years, respectively. Researchers found that:
  • Forty-four per cent of women and 74% of men were sexually active in the year before hospitalisation and 40% and 68% were sexually active afterwards. 
  • Of these groups, 48% of men and 59% of women reported less-frequent sexual activity in the 12 months after a heart attack. 
  • About one in 10 patients who were sexually active before their heart attack were not active in the subsequent year. 
  • One-third of women and 47% of men reported receiving hospital discharge instructions about resuming sex. 
  • Those who did not receive instructions were more likely to report loss of sexual activity (women, adjusted relative risk 1.44, 95% confidence interval 1.16 to 1.79; men, adjusted relative risk 1.27, 95% confidence interval 1.11 to 1.46). 
  • One-year mortality after heart attack was similar in those who reported sexual activity in the first month after their attack (2.1%) and those who were sexually inactive (4.1%). This suggests that whether or not people are sexually active has little bearing on their risk of death following a heart attack.
The study also found that men who had discussed sex with their doctor following their heart attack were less likely to be sexually active. The researchers say this could be because men who are anxious about having sex after a heart attack may be more likely to initiate a discussion with their doctor.

While nearly half of patients who were married and sexually active received no counselling about resuming sexual activity, two-thirds of unmarried patients who were sexually active, did not receive counselling.
Other factors such as age, marital status, depression and severity of heart disease were not associated with loss of sexual activity.

How did the researchers interpret the results?

The researchers conclude that, although many patients were sexually active before their heart attack, only a minority received counselling about resuming sexual activity at their discharge from hospital. Lack of counselling was associated with loss of sexual activity one year later. Mortality was not significantly increased in patients who were sexually active soon after their heart attack.

They say the study indicates that counselling may be an important factor in the likelihood of being sexually active after a heart attack, and that men and women can benefit equally.

They also argue that sexually inactive older adults with chronic illness value sexuality as an important part of life and that sexual inactivity before a heart attack should not exclude patients from receiving counselling in this area. “Profiling” patients for counselling based on previous sexual activity or on marital status, they argue, will exclude some patients who could benefit from this information.

Conclusion

This study had a number of limitations, including its reliance on patients recalling both their sexual activity in the year following their heart attack and also whether they received advice or counselling on the topic when discharged from hospital. This reliance on patients self-reporting past events could affect the reliability of the results, particularly as they were estimating these factors in the wake of a potentially life-changing heart attack.

Also, the researchers did not objectively measure whether it was patients or staff who initiated counselling on this topic at the time of discharge. Although counselling is likely to be initiated by hospital staff, it is possible that patients who were more interested in resuming sexual activity may also have been more likely to ask for counselling. 

Previous research has already established the extremely low risk of a heart attack from having sex, and this study raises a number of important issues including a possible lack of medical advice causing heart attack patients to be anxious about resuming sexual activity. This is unlikely to be good for people’s sex life or their peace of mind as they recover.

Most people value sexuality as an important part of life, whatever their health. In the UK, the current advice is that anyone who has had a heart attack should be able to have sex without risk to their heart once they are fit enough to walk briskly up two flights of stairs without getting chest pains or becoming out of breath. This is usually about four weeks after having a heart attack for most patients. Having sex will not put you at further risk of having another heart attack, although you can speak to your doctor or read NHS Choices’ guide to sex after a heart attack if you require further information.

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Friday, 4 May 2012

Claim flavonoids in citrus fruits 'cut stroke risk'

Grapefruit and oranges “appear to protect against having a ‘brain attack’”, the Daily Mail has reported. The Mail says that these and other citrus fruits can protect the brain from stroke due to their antioxidant content.
The research behind this story involved almost 70,000 women taking part in the Nurses’ Health Study in the US. They were asked to complete food frequency questionnaires (which asked them to recall how frequently certain foods were consumed during a specified period of time) every four years and over around 14 years of follow-up the researchers documented the numbers of strokes that occurred, overall and by type.
The researchers found that women who had the highest intake of flavanone (a crystalline compound found in citrus fruit) had a reduced risk of ischaemic stroke. However, they found no association between consuming actual citrus fruits and juices and being at risk of ischaemic stroke, and no association between consumption of flavonoids overall and risk of stroke.
This makes these findings far from conclusive. Whether citrus fruits and the chemicals they contain have any association with stroke risk needs more investigation. But on the basis of this study alone, there is no evidence that women who eat citrus fruits will reduce their risk of stroke. However, a balanced diet high in fruit and vegetables is known to be beneficial to health and can reduce the risk of several diseases, including cardiovascular disease.


Where did the story come from?

The study was carried out by researchers from the University of East Anglia and other institutions in the US and Italy, and was funded by the National Institutes of Health, Department of Health and Human Services. It was published in the peer-reviewed medical journal Stroke.
The Daily Mail does not accurately represent the findings of the study. Its headline, “How eating oranges and grapefruit can cut the risk of a stroke”, contradicts the finding that there was no significant association between intake of citrus fruits and juices and risk of stroke.

What kind of research was this?

This was an analysis of women enrolled in the ongoing Nurses’ Health Study in the US. The researchers aimed to use data from this cohort study to examine associations between subclasses of flavonoids and risk of stroke. Flavonoids are plant chemicals believed to have antioxidant properties, and are found in several food groups, including citrus fruits, berries, onions, certain pulses, tea and wine.
Cohort studies such as this aren't ideal for showing cause and effect. In this study, researchers circulated regular food frequency questionnaires at the same time as looking at clinical outcomes. It is difficult to guarantee that food intake patterns preceded the development of cardiovascular disease. Furthermore, because food frequency questionnaires are self-completed, they are also likely to contain inaccuracies and may not represent the pattern of food intake over a lifetime. Finally, it may be difficult to ensure that other things that could be associated with both diet and risk of stroke (confounding factors) have been taken into account.

What did the research involve?

The Nurses’ Health Study started in 1976 and enrolled 121,700 female nurses aged 30 to 55. Participants completed follow-up questionnaires on diseases and lifestyle factors every two years, as well as food frequency questionnaires every four years. In this study, researchers looked at food questionnaires completed from 1990 onwards (the time when the questionnaires covered sufficient fruit and vegetables to assess flavonoid intake). This study included the 69,622 women who had sufficient information on food intake and who did not report a stroke before 1990.
The researchers constructed a database to assess intake of the different flavonoid subclasses. Intake of individual subclasses was calculated as the total consumption frequency of each food, multiplied by the content of the specific flavonoid for the specified portion size. The six flavonoid subclasses were reported to be those commonly consumed in the US diet:
  • flavanones (eriodictyol, hesperetin, naringenin)
  • anthocyanins (cyanidin, delphinidin, malvidin, pelargonidin, petunidin, peonidin)
  • flavan-3-ols (catechins, epicatachins)
  • flavonols (quercetin, kaempferol, myricetin, isohamnetin)
  • flavones (luteolin, apigenin)
  • polymers (including proanthocyanidins, theaflavins, and thearubigins)
The outcome of stroke was self-reported, with reports verified by review of medical records.

What were the basic results?

Over 14 years of follow-up there were 1,803 strokes among the 69,622 participants (52% ischaemic strokes – caused by a blood clot, 14% haemorrhagic – caused by a bleed in the brain, and the rest – of unknown type).
The average intake of total flavonoids was 232mg per day. Tea was reported to be the main contributor to total flavonoid intake, followed by apples and oranges or orange juice. Women who ate more flavonoids tended to:
  • exercise more
  • have a greater intake of fibre, folate, fruits and vegetables
  • have a lower intake of caffeine and alcohol
  • be less likely to smoke
The researchers found that women who consumed the highest quantity of the flavanone subclass had reduced risk of ischaemic stroke compared with those who consumed the lowest quantity of flavanone (relative risk 0.81, 95% confidence interval 0.66 to 0.99). The relationship between flavanones and stroke overall was not reported.
As 95% of flavanones are reported to be derived from citrus (in this study, oranges and orange juice were the highest contributors), they looked for a relationship between intake of citrus fruit/juice and risk of ischaemic stroke but found no significant association (relative risk 0.90, 95% confidence interval 0.77 to 1.05).

How did the researchers interpret the results?

The researchers concluded that flavonoid intake was not associated with risk of stroke, but that increased intake of the flavanone subclass reduced the risk of ischaemic stroke. They said that because experimental data suggests that the flavanone content of citrus fruits may protect the heart, there may be an association between citrus fruit consumption and stroke risk, but this has not yet been proven.

Conclusion

Despite the news headlines, this study provides no evidence that women who eat citrus will reduce their risk of stroke.
The researchers found a link between higher intake of flavanones and reduced risk of ischaemic stroke, but:
  • no association between the actual consumption of citrus fruits and juices and risk of ischaemic stroke
  • no association between total flavonoid intake and risk of stroke
The researchers didn’t report on any association between flavanone, flavonoid or citrus consumption and risk of stroke overall. There was no association with haemorrhagic stroke and presumably there was none found for stroke overall.
Further problems with making the conclusions stated in the headlines include:
  • The design of this cohort study cannot easily imply cause and effect. The researchers excluded women who had experienced a stroke prior to 1990, but assessed both food consumption and stroke outcomes over the following 14 years. This makes it difficult to ensure that food-intake patterns preceded the development of cardiovascular disease. 
  • Food frequency questionnaires are self-completed and often contain inherent inaccuracies, and may not represent a lifelong food-intake pattern. 
  • The researchers used the most recent US Department of Agriculture databases to categorise individual foods according to their content of flavonoid chemicals. However, they did not further describe how they did this in their report. As the researchers acknowledged, there is potential for the misclassification of flavonoids using this method as there is wide variation in flavonoid content of foods. Flavonoid content of fruit depends on their geographical origin, growing season, different cultivars, agricultural methods and processing. It is also difficult to say how flavonoids are processed in the body. 
  • The researchers did adjust their analyses for multiple potential dietary, lifestyle and medical factors, but it is possible that some confounding factors that could be associated with both diet and risk of stroke have not been taken into account.

Whether or not citrus fruits and the chemicals they contain have any association with stroke risk may be a topic for further research. However, on the basis of this study alone, there is no evidence that women who eat grapefruit, oranges or any other citrus fruit will reduce their risk of stroke.

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Some pizzas 'saltier than the sea'

Some takeaway pizzas are saltier than the Atlantic Ocean, say health campaigners concerned about the amount of salt we eat. Several newspapers have reported on the high levels of salt in pizzas from both takeaway outlets and supermarkets. Some of the pizzas contained more than 10g of salt, which is more than an entire day’s salt allowance.
An analysis of 199 pizzas by the Consensus Action on Salt & Health (CASH) group found no low-salt options, with over half the takeaway pizzas containing more than 6g of salt – the recommended daily maximum for healthy adults. Shop-bought pizzas generally fared better, but many still contained more than 5g of salt – close to the daily maximum allowance.
Keeping track of how much salt we eat is important as salt can raise blood pressure, in turn raising the risk of problems such as heart attacks and strokes. Many pizzas were also found to be high in fat and saturated fat, again marking them out as an unhealthy option.


Where has the news come from?

The action group CASH is concerned about the amount of salt we eat and its impact on our health. The group comprises academics, physicians and public health experts. CASH recently conducted a survey that examined the amount of salt in pizzas available throughout London. They included 199 margherita and pepperoni pizzas from takeaways, chain restaurants and supermarkets in their study. The CASH report included information on the amount of salt per 100g of food, as well as the amount of saturated fat contained in the pizzas.

How much salt should I eat?

CASH and NHS Choices recommend that adults consume a maximum of 6g of salt a day (approximately one full teaspoon). However, UK adults currently consume an average of 8.6g a day. The recommended maximum daily levels of salt for children are:
  • under 1 year old – less than 1g
  • 1 to 3 years old – 2g 
  • 4 to 6 years old – 3g
  • 5 to 10 years old – 5g
  • 11 years and older – 6g
It is important to limit salt intake as it affects blood pressure and, in turn, the risk of serious health problems such as strokes and heart attacks. CASH estimates that if the nation reduced its intake to recommended levels, it could reduce the number of strokes by 22% and heart attacks by 16%.

Which were the saltiest takeaways?

The CASH survey found that the top five saltiest takeaway pizzas were:
  • Adam & Eve pepperoni pizza in Barnet – 2.73g of salt per 100g of food, equivalent to 10.57g of salt in their 388g pizza
  • La Vera Italia pepperoni pizza in Wandsworth 2.43g of salt per 100g of food, or 10.68g of salt per 439.6g pizza
  • Ciao Bella pepperoni pizza in Havering – 2.21g of salt per 100g of food, or 9.22g of salt per 417.4g pizza
  • Ciao Bella margherita pizza in Havering – 2.13g of salt per 100g of food, or 7.69g of salt per 361.8g pizza
  • Il Mascal Zone pepperoni pizza in Barnet – 2.08g of salt per 100g of food, or 9.21g of salt per 442g pizza
The CASH survey found that more than half of all takeaway pizzas surveyed contained over the recommended maximum of 6g of salt a day. CASH points out that makers of takeaway pizzas do not have to provide nutritional information, which can make it difficult to know how much salt you are consuming.

Which were the saltiest shop-bought pizzas?

The CASH survey found that the top five saltiest shop-bought pizzas were:
  • Tesco full-on-flavour simply pepperoni thin stonebaked pizza (fresh) – 1.8g of salt per 100g of food, equivalent to 4.77g of salt in their 265g pizza
  • Iceland stonebaked spicy double pepperoni pizza (frozen) – 1.7g of salt per 100g of food, or 6.29g of salt per 370g pizza
  • Morrisons extra thin triple pepperoni pizza (frozen) – 1.7g of salt per 100g of food, or 5.81g of salt per 342g pizza
  • Dr. Oetker ristorante pizza pepperoni salame (frozen) 1.68g of salt per 100g of food, or 5.36g of salt per 320g pizza
  • Dr. Oetker Casa di Mama pizza quattro formaggi (frozen) 1.6g of salt per 100g of food, or 6.32g per 395g pizza
Overall, the CASH survey found that 85% of shop-bought pizzas provided nutritional information on the front of the packaging, which may make it easier for customers to choose lower-salt options.

Were there any low-salt options?

Among the 199 shop-bought and takeaway pizzas, CASH did not identify any low-salt options (defined as 0.3g of salt or less per 100g of pizza).
There were, however, several medium-salt options (defined as 0.3-1.5g of salt per 100g). The takeaway with the lowest salt content pizza was Trattoria Pizzeria’s margherita pizza, with 0.778g of salt per 100g of food, equivalent to 2.15g of salt in their 275.8g pizza. However, this pizza contained a high amount of saturated fat.
The lowest salt content in a supermarket pizza was found in the ASDA Chosen by You cheese and tomato pizza, which contained 0.6g salt per 100g of food, equivalent to 0.64g of salt in the 106g pizza. This pizza also had medium levels of saturated fat.

How were the tests performed?

The survey looked at both pepperoni and margherita pizzas available in takeaways in 17 London boroughs and 8 supermarkets. They included 81 takeaway pizzas and 118 supermarket pizzas.
At present, companies selling takeaway pizzas are not required to publish nutritional information such as salt and fat content, so researchers took samples of each pizza and sent them away for lab analysis. They were analysed for the amounts of fat, saturated fat, sodium and calories per 100g. Researchers also recorded the total weight of the pizza, as well as diameter and pepperoni weight.
Supermarket pizzas are required to provide nutritional information on the packaging. For the 118 pizzas in this group, CASH photographed the packages, recording the salt, sodium, calories, fat and saturated fat content per 100g of pizza, as well as whether or not the packaging included a nutritional label on the front, the package weight and the portion weight.

How can I make a low-salt pizza?

CASH says that one way to reduce your daily salt intake and avoid the hidden salt found in many ready-made foods is to make your own pizza. CASH provides the following low-salt, low-fat recipe:
Serves: 2 (1 pizza)
Preparation time: 15-20 minutes plus 1 hour rising time
Cooking time: 30-40 minutes
For the base
300g strong white bread flour, plus extra for rolling out
½ teaspoon (half a 7g sachet) fast-action yeast
Pinch of ground black pepper
100ml warm water
1 tablespoon olive oil, plus extra for greasing
1 garlic clove, crushed
For the sauce
½ teaspoon olive oil
1 small onion, chopped
1 garlic clove, finely chopped
1 tablespoon tomato purée
1 x 227g tin chopped tomatoes
Pinch of chilli flakes, or to taste
Freshly ground black pepper, to taste
Handful of fresh basil, roughly chopped
For the topping
1 yellow pepper, sliced
1 tomato, sliced
100g cooked chicken
2 tablespoons sweetcorn
60g mozzarella, thinly sliced
A few basil leaves, torn, plus extra to garnish 
  1. To make the dough, mix the flour, yeast and black pepper together in a large bowl. In a separate container, mix the water with the oil and garlic and pour into the flour and yeast. Mix together quickly with a spoon until a sticky dough is formed. Leave to stand for 10 minutes.
  2. Dust your hands and a work surface with flour. To knead the dough, hold one side of the dough down with one hand and, with the other hand, push the other side of the dough away from you, stretching it out. Fold the stretched dough back on top of itself and push it down with your palm. Give the dough a quarter turn and repeat the process for just one minute or until the dough is smooth, elastic and bouncy.
  3. Form a ball with the dough and place it into a bowl greased with a little oil. Cover the bowl with cling film and leave to rise in a warm place for about an hour or until the dough has doubled in size.
  4. Meanwhile, make the sauce. Heat the oil in a saucepan over a medium heat and cook the onion and garlic for 5 minutes or until the onion becomes soft and transparent. Stir in the tomato purée followed by the chopped tomatoes, chilli and pepper. Simmer on a low heat for 15-20 minutes until the sauce becomes thick. Stir in the basil for the last few minutes. Use a hand blender to make a smooth sauce.
  5. Once the dough has risen, preheat the oven to 240°C/475°F/gas 9. Dust a baking sheet with a little flour and use your hands to push the dough outwards to form a round base approximately 30cm (12 inches) across.
  6. Spread the tomato sauce over the pizza base using the back of a spoon. Scatter the toppings over the pizza, top with the basil leaves and cook in the oven for 10-15 minutes or until golden brown. Scatter the remaining basil leaves on top and serve. 

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