Ask DR KAYE: Why do foods such as lentils make me feel much calmer? 

I suffer of anxiety and depression and have found that I feel much calmer when I eat certain foods – legumes and lentils and some fermented drinks like kefir. What’s going on and what will still improve my mood?

The gut is in constant communication with the brain through the nervous system and through the release of hormones and chemicals known as neurotransmitters. A good example is when you are nervous before an exam or an interview. In addition to anxious thoughts, there is often a loss of appetite, nausea and even diarrhea.

An important part of this gut-brain axis is the microbiome — the billions of bacteria, viruses, fungi, and other microorganisms that happily live in our digestive tract. The microbiome also helps regulate the immune system, and there is early evidence that the health of our gut has an impact on many neurological and psychological disorders, and vice versa.

We know that stress is linked to changes in the diversity of microbes in the gut – although why this is not clear.

It is important to note that no food or diet alone can treat depression or anxiety. However, some smaller studies suggest that eating a healthy, balanced diet and limiting refined and processed foods such as sweets are associated with improvements in mood in depressed patients. And there’s also some limited evidence that drinking a lot of caffeine might make anxious thoughts worse.

Of course, this doesn’t have to be due to the food itself – we know that taking better care of yourself and sleeping better can be an important step in tackling mental health issues.

Foods like kefir — a fermented yogurt — legumes and lentils are all known to support a healthy and diverse microbiome. If a patient tells me that eating such foods also helps their mood, I would encourage them.

A word of warning: Fermented and high-fiber foods like lentils can be harder to digest and cause gas and other digestive problems, so it’s important not to overeat too soon. Start slow. When someone is struggling with mental health it is important to tell a doctor – we can offer a lot of support.

I’m getting a knee prosthesis and the thought scares me. I had a blood clot in my lung a few years ago and have been on blood thinners for life. Would an operation be very risky?

Almost all medical procedures involve some risk. In any case, this must be weighed against the benefit of this treatment in order to determine the best and safest course of action.

In the case of a knee replacement, surgery can have a life-changing effect, ending knee pain and restoring mobility.

The risks of surgery include bleeding, infection, and deep vein thrombosis (DVT), when a blood clot forms in a deep vein, usually in the leg, which can then travel to the lungs.

Blood clots can develop if people stay in bed often or move less for long periods of time during their recovery. The lack of exercise means blood flows more slowly in the veins, increasing the risk of a clot forming. It’s important that anyone with a history of blood clots informs their medical team before having surgery, as this will help them better manage this risk.

There are also things patients can do: Smoking increases the risk of DVT, so quit if you can and maintain a healthy weight.

Patients are given compression stockings after surgery, which reduce the risk of DVT. It also helps to get mobile as quickly as possible and to move your feet and ankles even when lying down.

I have to pee 5 times a night which disturbs my sleep. I’ve tried to avoid caffeine and not eat or drink anything after 6pm. I had a hysterectomy about 30 years ago.

Nocturia is the medical term for waking up several times during the night to urinate — and it can be a symptom of many things. In men, it can be related to an enlarged prostate. Urgency and recurrent UTIs are common postmenopausal women, which can be treated with topical vaginal estrogens. This is safe for most and doesn’t have the risks of HRT – in fact it’s now an over-the-counter treatment.

Oxybutynin is given for overactive bladder but can cause side effects such as dry mouth. Avoiding caffeine, which is a diuretic, should help, and I would advise avoiding alcohol as well. However, drinking less may not be a good idea. When you have an overactive bladder, it contracts even when it’s not full. The less you drink, the more concentrated the urine becomes, so even a small amount irritates the bladder and makes contractions worse.

If your GP thinks you have an overactive bladder, they may recommend bladder training aimed at stretching the bladder so it can hold more urine. This means you can hold out for a few minutes when you need to go and gradually build up over time.

Sexism in medicine must end

Thousands of women have missed heart attack treatment due to “sexism in medicine,” a study finds.

Women often suffer from different heart attack symptoms than men: In addition to chest pain, they can experience dizziness, fatigue, nausea, indigestion or shortness of breath.

Researchers at Imperial College London looked at data from 420,000 cases between 2005 and 2017 and found that one in 20 women with a heart attack were incorrectly classified as not at high risk of death. Some are simply told they had “a weird twist,” the researchers found — with tragic results.

Historically, women have been excluded from medical research – scientists have been reluctant to test drugs on women because their monthly hormone fluctuations could otherwise conceive.

It is clear that extrapolating data from studies involving only men is not enough. Just because we’re different from men doesn’t make it okay to ignore our health.

Still having trouble getting your HRT medication?

The government’s HRT czar resigns after just four months in office. Madelaine McTernan has been assigned to address the widespread shortage of some hormone replacement therapy medications, but from my position as a GP I can’t see that the situation has improved.

Women still struggle to get the hormonal drugs they desperately need, and if anything, the shortage now affects a much wider range of products than before.

Patients are given HRT prescriptions only to find pharmacies have run out, meaning they have to make another doctor’s appointment for an alternative to be prescribed, which can take weeks. New rules introduced under McTernan’s oversight mean pharmacists can prescribe an equivalent product if that’s not available on the prescription, but many seem unaware of this. There is certainly still a lot to do. Have you had trouble getting HRT? Let us know.