Where is the worlds noisiest city?

The ignored pollutant can cause depression, stress, diabetes and heart attacks. What are cities doing to curb excess noise?

The constant roar of traffic, incessant construction noise, piercing sirens, honking horns, shrieking loudspeakers noise in cities is clearly a nuisance.

But its also a danger. The World Health Organisation (WHO) has described noise pollution as an underestimated threat that can cause hearing loss, cardiovascular problems, cognitive impairment, stress and depression. Some experts go further: they believe exposure to environmental noise could be slowly killing us.

Noise pollution causes hypertension, diabetes, obesity, heart attacks, strokes and death, says Dr Daniel Fink, chairman of the Quiet Coalition, a community of health and legal professionals concerned with the adverse impacts of environmental noise.

Noise pollution is often cited as one of the main factors in the reduced quality of life in large, 24-hour cities like New York (where more than 200,000 noise complaints were recorded in 2016). It causes stress, which has its own adverse effects on health.

While the impact of noise on mental health has not been studied extensively, research has shown that strong noise annoyance is associated with a twofold higher prevalence of depression and anxiety in the general population.

A recent study by experts at the American College of Cardiology linked noise pollution to increased cardiovascular problems (high blood pressure, heart attacks, stroke, coronary heart disease) through the bodys stress mediated response resulting in the release of the stress hormone cortisol, which in turn damages blood vessels.

At a conference on noise organised by the European commission in April 2017, noise was regarded as the silent killer, with potentially severe consequences for our physical and mental health. And yet its impacts remain unreported and underestimated.

Worst offenders

Dr Eoin King, assistant professor of acoustics and author of the book Environmental Noise Pollution, calls noise the ignored pollutant. Environmental noise still continues to be poorly understood by practitioners, policymakers and the general public, he says.

Most worrying, says King, is the impact on children. Studies considering the effect that noise may have on children have found that tasks such as reading, attention span, problem-solving and memory appear to be most affected by exposure to noise.

The issue is compounded by debate over how much noise it is safe to be exposed to. In its Make Listening Safe guide, WHO states that 85 decibels is considered the highest safe exposure level, up to a maximum of eight hours. However, others Fink among them argue this is still too loud.

A car measures 70 decibels, a jackhammer 100, and a plane taking off 120, according to the WHO. Though there is no set threshold to establish risk, we do know that anything above 60 decibels can increase risk for heart disease, Dr Thomas Mnzel, from the Mainz University Medical Centre, has said.

A recent report by the BBC found that parts of the London Underground were loud enough to damage peoples hearing, with noise levels greater than 105 decibels on many lines. The report stated that some were so loud they would require hearing protection if they were workplaces.

Guangzhou
Guangzhou has been ranked as having the worse levels of noise pollution in the world Photograph: ChinaFotoPress via Getty Images

Concerned about increased risk of hearing loss in cities, last year Mimi Hearing Technologies created a World Hearing Index to draw attention to the issue. With the results of hearing tests of 200,000 of their users worldwide and data on noise pollution from WHO and Sintef, a Norwegian research organisation, the index plotted levels of noise pollution and hearing loss in 50 cities.

The study found that, on average, a person living in the loudest cities has hearing loss equivalent to that of someone 10-20 years older. Overall the results showed a 64% correlation between hearing loss and noise pollution.

Guangzhou, China, ranked as having the worse levels of noise pollution in the world, followed by Cairo, Paris, Beijing and Delhi. Of the 50 cities, Zurich was found to have the least noise pollution.

Participants in Delhi recorded the highest average hearing loss equivalent to someone 19.34 years older than them. Vienna had the lowest hearing loss but still, on average, that of someone 10.59 years older.

We were able to collect quite a unique hearing data warehouse on hearing abilities across countries and continents, says Henrik Matthies, managing director of Mimi Hearing Technologies. There is an obvious known correlation between being exposed to noise and decreased hearing ability.

However, mapping this correlation to cities helped us to get the message out, sparking a debate about noise pollution and hearing in megacities like Hong Kong and Delhi.

But what can be done about it?

Political will

The EU are probably the world leaders at setting out a process to tackle noise pollution, says King. In 2002, it issued an environmental noise directive that requires member states to map noise exposure in urban areas holding upwards of 100,000 people, to develop noise abatement action plans in these areas and to preserve quiet areas.

Action plans usually incorporate a variety of measures such as traffic management strategies, promoting light rail systems and electric buses, reduced speed limits, introducing noise barriers and improved planning processes.

But good intentions only go so far. The problem is that there is no real enforcement associated with these action plans, says King. Until there is more of a political will to drive planning decision related to noise, I dont think much will change.

With road traffic by far the largest source of noise pollution in Europe, affecting an estimated 100 million Europeans, concepts like Pariss car-free day could have an impact. For one day every month in the French capital, 30% of the city becomes off limits to vehicles. The project has seen sound levels in the city centre drop by half.

The most effective way to control noise is at the source. If we could make planes, trains and cars quieter we would solve a lot of our problems, says King. If all vehicles in a city street were electric, noise would be significantly reduced.

Increasingly citizens can also do their bit to monitor noise pollution in cities by transforming their smartphones into sound level meters.

The NoiseTube app, developed by researchers at the Free University of Brussels in Belgium, enables users to record where and at what times decibel levels are highest to produce a detailed noise map of the city. Councils can use the data to target noise pollution more effectively, using sound absorbent materials such as foam and fibreglass precisely where they are needed most.

King says there are many such projects looking to harness the potential of big data in the fight against noise for example, noise complaint data, or social media chatter related to noise, to better assess public sentiments towards soundscapes. There is a lot going on which I suppose gives us some hope.

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Read more: https://www.theguardian.com/cities/2018/mar/08/where-world-noisiest-city

Going TV cold turkey what is it like to give up the box for a month?

In this golden age of television, the pressure to binge-watch is immense even as evidence mounts about the health risks. So how did one heavy user cope with the big switch-off?

There are almost no pleasures left in life that someone hasnt suggested we give up to better ourselves. Booze, sugar, smoking, meat, clutter, coffee, even our smartphone. Soon well be told that all this teeth-brushing is getting rid of our bodies important natural tooth bacteria and Joe Wicks will launch his new book: How to Live with Decay … Everyday!

Yet there is one indulgence that engulfs our life like nothing else. We spend a dizzying amount of time doing it, yet it goes almost completely unchallenged by self-help books and wellbeing advice: watching television. We spend, on average, over four hours a day looking at our TV sets. In the UK, 74% of viewers say they sometimes watch more TV than they intended to, with a third of adults admitting that binge-watching has cost them sleep and left them feeling tired.

Weve found that self-proclaimed binge-watchers exhibit higher levels of stress, anxiety and depression, says Jessica S Kruger, an assistant professor at the University at Buffalo who has studied the public health impacts of binge-watching. There are also studies out of Harvard showing that among people who spend two hours watching TV the risk of diabetes goes up by 20%, the risk of heart disease by 15% and early death by 13%.

Given that people in Britain watch twice that amount, you would think the government might have declared a national crisis and appointed a bingeing tsar by now. But the only message we ever hear about TV is that we are living in its golden age and have a responsibility to watch it all: every week there is another must-see show we have to finish, just to engage with our fellow humans.

Im starting to think I could be spending this time better. A lot of my other life goals making my flat nice, reading more serious books, shedding a roll or two of stomach have been sidelined by TV. After a particularly square-eyed Christmas, I decide its time to try life without television and promise not to watch any for a month.

It wont be easy. Im what you would call a heavy user. I have a 43in TV in the front room, with Freeview Play, an Amazon Fire TV stick and Apple TV. Ive got Netflix and Amazon Prime.

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More time for jigsaw puzzles … Wolfson discovers one of the great things about switching off the TV. Photograph: Sarah Lee for the Guardian

I have always been like this. When I was young, I would go to friends houses where TV was presented as a reward that should be rationed out: You can watch cartoons when youve done your homework. But in our house, TV was part of the family. We would eat dinner in the living room, watch EastEnders and then get into heated family discussions about the precariousness of Steve and Mel Owens relationship. Even as I got older, I would spend an inordinate number of Saturday nights in with the family, voting for Will Young on Pop Idol or doing those weird national IQ tests they used to have on BBC One. I learned as much about the world from Harry from Spooks and Toby from The West Wing as I did from my teachers.

Now I go out quite often, but when I stay in, TV can sap the life out of my evenings. Ill come home with plans to better myself. Then, almost as if by magic, five-and-a-half hours disappear and Im splayed on the sofa, surrounded by the crumbs of some stale crackers Ive managed to forage from the kitchen, the remote having never left my hand.

Giving up TV is complicated because the boundaries between what is and isnt TV are foggy in the age of Netflix and Amazon. Kruger tells me that its these on-demand services, available on every device and making it easy to watch an entire series in one go, that make us most susceptible to bingeing. So I opt for a total ban. No TV shows, sport or films on any device. Im still allowed to go the cinema because thats, you know, living life.

The first week or so feels fantastic. Almost immediately I become a grown-up version of myself. I read the first few chapters of Ta-Nehisi Coates collected essays on the Obama years, while starting Michael Wolffs Fire and Fury on audiobook. I go to a talk about the early Jewish settlers in London, and see the Ai Weiwei documentary about the refugee crisis. My girlfriend, who doesnt watch much telly and is thrilled about this new development, takes me to an exhibition by the painter Roy Colmer at the Lisson Gallery exactly the sort of thing I would normally try to get out of. Unexpectly, I love it: spray-gun patterns that echo TV distortion on canvas, it all feels very fitting for my journey.

My initial pang of withdrawal comes on the first Friday night I come back from the pub, feeling drunk and very ready to sink into the sofa and put away a couple of old 30 Rock episodes. When I realise I cant, Im suddenly at a loss: Im too drunk to read, too awake to go to sleep. Then, after a few minutes, it just happens: I tidy my room not just shoving things under the bed, but folding, ironing, get-to-the-bottom-of-the-wash-basket tidying. I wake up on Saturday morning in what feels like a hotel room, but one of my own making. I feel like I have a secret butler.

Lots
Lots of reading time, too. Photograph: Sarah Lee for the Guardian

While I think Im doing quite well, my friends and family seem almost angry with me. When I tell people what Im doing theres a look of exasperation on their faces, as though I have insulted a relative. People cant understand what point Im trying to prove. What, youre not even going to watch McMafia, says my mum, sounding hurt that we wont be able to discuss it.

The hardest thing is missing the snooker. Its the Masters, and for me this would normally mean a lovely week of horizontal evenings, gently dozing between frames. But with my new go-getter attitude, I organise a trip to see a match live instead, a thrilling showdown between Ryan Day and Ding Jun-Hui. I feel like Ive cracked the code for life: dont just watch, do.

Its all going well until week three, when my girlfriend leaves to go on a week-long retreat, and it really hits me. This would be perfect boxset time; instead I am slightly bereft. I try everything to stop myself from watching: laser quest; bowling; bingo, twice. On Saturday night my friend Anna comes for dinner, and we begin a 1,500-piece jigsaw puzzle of a shelf of soft drinks. I bought it at a charity shop years ago and never opened it. At 4am we are still going, in silence, fitting pieces together with mindful clarity.

Not all the ways I distract myself are so wholesome. Ive always been a light gambler, but now its rampant: betting on football matches and then listening to them on BBC 5 Live, like a wideboy in the 1950s. On a particularly dark night I download the app of the ITV gameshow The Chase, which allows you to play the Bradley Walsh quiz on your phone with a virtual Bradley cracking gags between the questions. It even has the same music. I beat the chaser twice. My cravings are sated.

But I only properly break my abstinence once during the month. I have to watch a bit of the Trump and Piers Morgan interview on my laptop for work. Its as if, in my absence from television, we have switched over to some state-controlled, despotic network, the interviewer fawning over a politician telling him he is so fabulous he could even manage our football team. Im happy to switch it off.

By the end of the month I havent, as I had hoped, finished a library of books and become trim and fit. But I am enjoying life in a more rounded way: getting up early, reading the paper, cooking for myself every night.

Then, finally, I am allowed to watch again. I wait till midnight on the final day and then feel the soft remote in my hand again, endorphins rushing through me before I have even reached the familiar Amazon Fire homepage. I decide to start with the Grammys, having felt like I had missed out on all the bitching about Lorde being snubbed and Gagas new face earlier in the week.

But something isnt quite right. Its almost like watching through someone elses window. Maybe its because Ive already missed the zeitgeist, or it was just a really bad Grammys, but it isnt giving me the same buzz. I switch off about a third of the way through.

Three days later, Ive watched a bit of a film, but I just cant quite bring myself to get back into a series.

Im sure it wont last. One friend has sent an unsolicited list of everything Ive missed, and the weight of unwatched box sets feels heavy on my shoulders once again. But Kruger gives me a few tips on how to fight the urges: we shouldnt fast-forward adverts, which make the bingeing process less enjoyable and less addictive, and I should consider getting an app that locks you out of your Netflix account after a certain amount of time.

Its advice worth heeding. New studies about the dangers of extended TV watching emerge all the time. One, published in the Journal of Clinical Sleep Medicine, found that a higher frequency of binge-viewing was related to poorer sleep quality, more fatigue and insomnia. There was also evidence that bingeing drama boxsets, with complex storylines and cliffhangers, had a greater impact on normal sleep patterns than traditional TV watching.

Im going to start putting in my calendar when I plan to watch something, like a treat, and switching off after that. Im grateful for everything TV has taught me, and Im certain my formative years would have been much worse without it. But after decades of devotion, Im ready to start being my own strict parent: only watching cartoons when Ive done my homework.

Read more: https://www.theguardian.com/tv-and-radio/2018/feb/25/television-binge-watcher-eastenders-give-up-a-month

Blood-thinning drugs ‘can reduce risk of dementia by up to 48%’

Research strongly suggests that patients taking anticoagulants for irregular heartbeat could be protected against dementia and stroke

Blood-thinning drugs could protect against dementia and stroke in people with an irregular heartbeat, research suggests.

A study found that patients being treated for atrial fibrillation (AF) were less likely to develop dementia if they were taking anticoagulants. Their risk was reduced by up to 48% compared with others with the same condition who were not prescribed the drugs.

Scientists analysed health record data from more than 444,000 Swedish AF patients.

While the findings could not prove cause and effect, they strongly suggested blood-thinning pills protect against dementia in patients with the condition, the team said.

Atrial fibrillation increases the risk of stroke and blood clots, which some experts think may appear in the brain and help trigger dementia.

Dr Leif Friberg from the Karolinska Institute in Stockholm, Sweden, who co-led the study, said: As a clinician I know there are AF patients who have a fatalistic view on stroke. Either it happens or it does not. Few patients are fatalistic about dementia, which gradually makes you lose your mind.

No brain can withstand a constant bombardment of microscopic clots in the long run. Patients probably want to hang on to as many of their little grey cells for as long as they can.

In order to preserve what youve got, you should take care to use anticoagulants if you are diagnosed with AF, as they have been proved to protect against stroke and, which this study indicates, also appear to protect against dementia.

The researchers identified everyone in Sweden who had been given a diagnosis of AF between 2006 and 2014. Monitoring each persons progress provided 1.5m years of follow-up during which 26,210 patients were diagnosed with dementia.

Prescribed blood thinners include the drugs warfarin, apixaban, dabigatran, edoxaban and rivaroxaban. Their protective effect was greater the earlier treatment started after a diagnosis of AF, the scientists found.

Friberg said patients should begin taking the drugs as soon as possible and continue using them.

He added: Doctors should not tell their patients to stop using oral anticoagulants without a really good reason. To patients, I would say dont stop unless your doctor says so.

The study, published in the European Heart Journal, found no difference in dementia prevention between the older blood-thinning drug warfarin and newer anticoagulants.

Prof Jeremy Pearson, associate medical director at the British Heart Foundation, said: Strokes caused by a clot blocking the blood vessels in the brain are a major cause of dementia, and atrial fibrillation is an important risk factor as it increases the chances of these clots forming.

By treating AF patients with blood-thinning drugs, you reduce the risk of both stroke and dementia.

Dr Carol Routledge, head of science at Alzheimers Research UK, said: The findings highlight a need to investigate this link further, but the nature of the study prevents us from firmly concluding that anticoagulants reduce the risk of dementia.

It will be important to see the results of other ongoing studies in this area, as well as teasing apart the exact relationship between anticoagulants and the risk of different types of dementia.

Read more: https://www.theguardian.com/science/2017/oct/25/blood-thinning-pills-irregular-heartbeat-patients-dementia-stroke

Poor diet is a factor in one in five deaths, global disease study reveals

Study compiling data from every country finds people are living longer but millions are eating wrong foods for their health

Poor diet is a factor in one in five deaths around the world, according to the most comprehensive study ever carried out on the subject.

Millions of people are eating the wrong sorts of food for good health. Eating a diet that is low in whole grains, fruit, nuts and seeds and fish oils and high in salt raises the risk of an early death, according to the huge and ongoing study Global Burden of Disease.

The study, based at the Institute of Health Metrics and Evaluation at the University of Washington, compiles data from every country in the world and makes informed estimates where there are gaps. Five papers on life expectancy and the causes and risk factors of death and ill health have been published by the Lancet medical journal.

It finds that people are living longer. Life expectancy in 2016 worldwide was 75.3 years for women and 69.8 for men. Japan has the highest life expectancy at 84 years and the Central African Republic has the lowest at just over 50. In the UK, life expectancy for a man born in 2016 is 79, and for a woman 82.9.

Diet is the second highest risk factor for early death after smoking. Other high risks are high blood glucose which can lead to diabetes, high blood pressure, high body mass index (BMI) which is a measure of obesity, and high total cholesterol. All of these can be related to eating the wrong foods, although there are also other causes.

causes of death graphic

This is really large, Dr Christopher Murray, IHMEs director, told the Guardian. It is amongst the really big problems in the world. It is a cluster that is getting worse. While obesity gets attention, he was not sure policymakers were as focused on the area of diet and health as they needed to be. That constellation is a really, really big challenge for health and health systems, he said.

The problem is often seen as the spread of western diets, taking over from traditional foods in the developing world. But it is not that simple, says Murray. Take fruit. It has lots of health benefits but only very wealthy people eat a lot of fruit, with some exceptions.

Sugary drinks are harmful to health but eating a lot of red meat, the study finds, is not as big a risk to health as failing to eat whole grains. We need to look really carefully at what are the healthy compounds in diets that provide protection, he said.

undernourishment graphic

Prof John Newton, director of health improvement at Public Health England, said the studies show how quickly diet and obesity-related disease is spreading around the world. I dont think people realise how quickly the focus is shifting towards non-communicable disease [such as cancer, heart disease and stroke] and diseases that come with development, in particular related to poor diet. The numbers are quite shocking in my view, he said.

The UK tracks childhood obesity through the school measurement programme and has brought in measures to try to tackle it. But no country in the world has been able to solve the problem and it is a concern that we really need to think about tackling globally, he said.

Today, 72% of deaths are from non-communicable diseases for which obesity and diet are among the risk factors, with ischaemic heart disease as the leading cause worldwide of early deaths, including in the UK. Lung cancer, stroke, lung disease (chronic obstructive pulmonary disorder) and Alzheimers are the other main causes in the UK.

The success story is children under five. In 2016, for the first time in modern history, fewer than 5 million children under five died in one year a significant fall compared with 1990, when 11 million died. Increased education for women, less poverty, having fewer children, vaccinations, anti-malaria bed-nets, improved water and sanitation are among the changes in low-income countries that have brought the death rate down, thanks to development aid.

People are living longer but spending more years in ill health. Obesity is one of the major reasons. More than a billion people worldwide are living with mental health and substance misuse disorders. Depression features in the top 10 causes of ill health in all but four countries.

Our findings indicate people are living longer and, over the past decade, we identified substantial progress in driving down death rates from some of the worlds most pernicious diseases and conditions, such as under age-five mortality and malaria, said Murray Yet, despite this progress, we are facing a triad of trouble holding back many nations and communities obesity, conflict, and mental illness, including substance use disorders.

In the UK, the concern is particularly about the increase in ill-health that prevents people from working or having a fulfilling life, said Newton. A man in the UK born in 2016 can expect only 69 years in good health and a woman 71 years.

This is yet another reminder that while were living longer, much of that extra time is spent in ill-health. It underlines the importance of preventing the conditions that keep people out of work and put their long term health in jeopardy, like musculoskeletal problems, poor hearing and mental ill health. Our priority is to help people, including during the crucial early years of life and in middle age, to give them the best chance of a long and healthy later life, he said.

Read more: https://www.theguardian.com/society/2017/sep/14/poor-diet-is-a-factor-in-one-in-five-deaths-global-disease-study-reveals

Neoliberalism is creating loneliness. Thats whats wrenching society apart | George Monbiot

Epidemics of mental illness are crushing the minds and bodies of millions. Its time to ask where we are heading and why

What greater indictment of a system could there be than an epidemic of mental illness? Yet plagues of anxiety, stress, depression, social phobia, eating disorders, self-harm and loneliness now strike people down all over the world. The latest, catastrophic figures for childrens mental health in England reflect a global crisis.

There are plenty of secondary reasons for this distress, but it seems to me that the underlying cause is everywhere the same: human beings, the ultrasocial mammals, whose brains are wired to respond to other people, are being peeled apart. Economic and technological change play a major role, but so does ideology. Though our wellbeing is inextricably linked to the lives of others, everywhere we are told that we will prosper through competitive self-interest and extreme individualism.

In Britain, men who have spent their entire lives in quadrangles at school, at college, at the bar, in parliament instruct us to stand on our own two feet. The education system becomes more brutally competitive by the year. Employment is a fight to the near-death with a multitude of other desperate people chasing ever fewer jobs. The modern overseers of the poor ascribe individual blame to economic circumstance. Endless competitions on television feed impossible aspirations as real opportunities contract.

Consumerism fills the social void. But far from curing the disease of isolation, it intensifies social comparison to the point at which, having consumed all else, we start to prey upon ourselves. Social media brings us together and drives us apart, allowing us precisely to quantify our social standing, and to see that other people have more friends and followers than we do.

As Rhiannon Lucy Cosslett has brilliantly documented, girls and young women routinely alter the photos they post to make themselves look smoother and slimmer. Some phones, using their beauty settings, do it for you without asking; now you can become your own thinspiration. Welcome to the post-Hobbesian dystopia: a war of everyone against themselves.

Is it any wonder, in these lonely inner worlds, in which touching has been replaced by retouching, that young women are drowning in mental distress? A recent survey in England suggests that one in four women between 16 and 24 have harmed themselves, and one in eight now suffer from post-traumatic stress disorder. Anxiety, depression, phobias or obsessive compulsive disorder affect 26% of women in this age group. This is what a public health crisis looks like.

If social rupture is not treated as seriously as broken limbs, it is because we cannot see it. But neuroscientists can. A series of fascinating papers suggest that social pain and physical pain are processed by the same neural circuits. This might explain why, in many languages, it is hard to describe the impact of breaking social bonds without the words we use to denote physical pain and injury. In both humans and other social mammals, social contact reduces physical pain. This is why we hug our children when they hurt themselves: affection is a powerful analgesic. Opioids relieve both physical agony and the distress of separation. Perhaps this explains the link between social isolation and drug addiction.

Experiments summarised in the journal Physiology & Behaviour last month suggest that, given a choice of physical pain or isolation, social mammals will choose the former. Capuchin monkeys starved of both food and contact for 22 hours will rejoin their companions before eating. Children who experience emotional neglect, according to some findings, suffer worse mental health consequences than children suffering both emotional neglect and physical abuse: hideous as it is, violence involves attention and contact. Self-harm is often used as an attempt to alleviate distress: another indication that physical pain is not as bad as emotional pain. As the prison system knows only too well, one of the most effective forms of torture is solitary confinement.

It is not hard to see what the evolutionary reasons for social pain might be. Survival among social mammals is greatly enhanced when they are strongly bonded with the rest of the pack. It is the isolated and marginalised animals that are most likely to be picked off by predators, or to starve. Just as physical pain protects us from physical injury, emotional pain protects us from social injury. It drives us to reconnect. But many people find this almost impossible.

Its unsurprising that social isolation is strongly associated with depression, suicide, anxiety, insomnia, fear and theperception of threat. Its more surprising to discover the range of physical illnesses it causes or exacerbates. Dementia, high blood pressure, heart disease, strokes, loweredresistance to viruses, even accidents are more common among chronically lonely people. Loneliness has a comparable impact on physical health to smoking 15 cigarettes a day: it appears to raise the risk of early death by 26%. This is partly because it enhances production of the stress hormone cortisol, which suppresses the immune system.

Studies in both animals and humans suggest a reason for comfort eating: isolation reduces impulse control, leading to obesity. As those at the bottom of the socioeconomic ladder are the most likely to suffer from loneliness, might this provide one of the explanations for the strong link between low economic status and obesity?

Anyone can see that something far more important than most of the issues we fret about has gone wrong. So why are we engaging in this world-eating, self-consuming frenzy of environmental destruction and social dislocation, if all it produces is unbearable pain? Should this question not burn the lips of everyone in public life?

There are some wonderful charities doing what they can to fight this tide, some of which I am going to be working with as part of my loneliness project. But for every person they reach, several others are swept past.

This does not require a policy response. It requires something much bigger: the reappraisal of an entire worldview. Of all the fantasies human beings entertain, the idea that we can go it alone is the most absurd and perhaps the most dangerous. We stand together or we fall apart.

Read more: https://www.theguardian.com/commentisfree/2016/oct/12/neoliberalism-creating-loneliness-wrenching-society-apart

In Pursuit of Memory: The Fight Against Alzheimers review

Joseph Jebellis personal study of a disease that has reached epidemic proportions offers the latest research but not much hope

The human animal derives its humanity from language and memory. What are we, without memory ? The short answer is: wild beasts.

Memory gives us personality, emotional intelligence, family relations, and community. Memory anchors us in space and time. It defines the parameters of existence. Paradoxically, it might even confirm the futility of existence.

Dementia, in the broadest sense, lays an axe at the root of memory, creating that bare, forked animal, unaccommodated man. Keep me in temper, exclaims King Lear before his final breakdown, I would not be mad.

Madness comes in many guises, but the cruellest manifestation thats hitting the headlines today is the affliction named after the German doctor who first identified its most virulent strain in 1906, Professor Alois Alzheimer.

The biology of the ageing brain remains among the greatest enigmas of neuroscience. For several decades, the German psychoanalytic establishment seized on the mysterious nature of the disease to subordinate insignificant biological explanations of dementia to broader, Freudian interpretations. Until the 1960s, Alzheimers was at once neglected and controversial. If no one could agree about its fundamental symptoms, many others disputed its causes. Slowly, as a result of improved brain-mapping, and the identification of plaques and tangles in the geriatric brain as a source of dementia, Alzheimers emerged as the global epidemic we now recognise.

Alzheimers has become a new plague, threatening the worlds population with a global strike rate of one every four seconds. In the UK, there are now more people with the disease than live in the city of Liverpool. Six million inhabitants of the EU and 4 million Americans have it, figures that are projected to double by 2030. So bad is the outlook that the WHO has declared dementia a global health priority.

It has become the salient fact of 21st-century life that, with an ageing world population, Alzheimers will overtake cancer as the second leading cause of death after heart disease. Were at a point, writes Joseph Jebelli, at which almost everyone knows someone a family member or friend who has been affected.

Jebelli, a young British neuroscientist, has greater cause than many to make this claim. As a boy, he watched his grandfather acting strangely, before descending into the abyss of dementia in which he could no longer recognise his family. Jebellis testament, In Pursuit of Memory, is a moving, sober and forensic study of the past, present and future of Alzheimers from the point of view of a neurologist who has lived with the disease, at home and in the lab, from a very young age.

Jebellis timely analysis is a reminder that, in recent years, Alzheimers or other forms of dementia have not merely devastated the lives of millions, they have destroyed the retirements of Harold Wilson, Ronald Reagan, Charlton Heston, and Margaret Thatcher, killed Terry Pratchett, and claimed Glen Campbell and Iris Murdoch among its victims. The lineaments of this fate were recently dramatised in the Oscar-winning film Still Alice, starring Julianne Moore.

WH Auden once compared death to the rumble of distant thunder at a picnic. The stages of Alzheimers occur as storm clouds on the horizon of a perfect summers day. The initial symptoms flashes of anger; occasional forgetfulness are often so slight that even doctors can misdiagnose them. As the disease takes hold, it becomes clear that something terrible is happening to the patients brain (repetitive questions; the inability to recognise friends and family).

Finally, as Alzheimers ignites in the hippocampus and the entorhinal cortex, episodic memory gets burned away, past and present become forever dissociated, and the patient is at the mercy of cerebral Furies. In this merciless process of dehumanisation, the only means of human communication at the end will be the comforts of touch and possibly some snatches of music.

Julianne
Julianne Moore as a dementia sufferer in the film Still Alice. Photograph: Artificial Eye

The story that Jebelli tells of his grandfathers decline illustrates the tantalising mystery of Alzheimers: its both highly visible yet agonisingly elusive. Like McCavity, this disease defies all known laws, slipping through the net of neurological inquiry.

The incidence of Alzheimers is a lottery. You can live a decidedly salubrious life, reports Jebelli, and still get struck down in your 70s, sometimes even sooner, with no obvious cause. In the department of prevention, he takes us through a familiar catalogue of potential risk-factors: stress, diet, exercise, etc. Hes forced to conclude, as every visitor to the catacombs of dementia will eventually acknowledge, that Alzheimers remains an enigma, a tangle of amyloid plaques, sticky buildups of protein in the brain that continue to resist the investigations of the neurological police.

Here, Jebellis own pursuit of answers to his grandfathers death turns into a fascinating quest at the frontiers of neuro-degeneration. He identifies several key areas of recent research, from cerebral renewal (the implantation of iPS cells) and parabiosis (reversing the pathological changes in an old animal by bathing its tissue in the blood of a young one), to the pioneering study of Kuru (a shaking disease found in Papua New Guinea) and the latest research into PCA (posterior cortical atrophy), the variant of Alzheimers that afflicted the late Terry Pratchett. In Jebellis optimistic summary, the web of treatment is widening. At the end of his pursuit, he declares: We are closer than ever to the abolition ofAlzheimers.

Not everyone agrees with him, and the dividends of intense neuro-scientific research are painfully modest. From 2000 to 2012, indeed, its estimated that about 99% of all newly developed dementia drugs failed to pass their clinical trials. For all the tabloid headlines about a cure for Alzheimers, this goal remains fugitive.

Frustrated by the limitations of neuroscience, some Alzheimers experts have begun to argue for an alternative approach. In his Penguin Special on Alzheimers, Andrew Lees, an acknowledged expert, focused on a fascinating new genre of Alzheimers writing, books by patients at the beginning of their slow fade who can illuminate the experience of losingmemory.

Yet even this avenue is contentious. As the Observer reported recently, a new Edinburgh University study, the Prevent Project, suggests that Alzheimers may not be the disease of memory that Jebelli describes.

In truth, there has been no shortage of neuroscientific investigations, but its hard to resist the conclusion that these have been blind alleys. By contrast, the phenomenology of losing personal cognition (the territory explored by the late Oliver Sacks) offers, from some points of view, a more fruitful cerebral exploration. It might at least give comfort, if not hope.

In Pursuit of Memory by Joseph Jebelli is published by John Murray (20). To order a copy for 17 go tobookshop.theguardian.comor call 0330 333 6846. Free UK p&p over 10, online orders only. Phone orders min p&p of 1.99

Read more: https://www.theguardian.com/books/2017/may/29/in-pursuit-of-memory-the-fight-against-alzheimers-joseph-jebelli-review

Should link between dementia and artificial sweeteners be taken with a pinch of salt?

How peoples capacity for forgetfulness and lies may have impacted on research tying stroke and dementia to diet drinks

They were supposed to be the healthy alternative to their sugar-rich siblings. But now lovers of diet colas and other low-calorie drinks have been hit by news that will radically undermine those credentials: a counterintuitive study suggesting a link to stroke and dementia.

The study in the journal Stroke may cause a rethink among those worried about obesity, diabetes or a possible early heart attack from sugar-rich drinks who have been considering making a change. It comes to the alarming conclusion that people polishing off one can a day of artificially sweetened drink are nearly three times as likely to have a stroke or develop dementia.

Its a shocking conclusion. But the first reason to pause is that the study found no such risk in people who drank standard sugary lemonades and colas.

There is little previous evidence with regard to dementia, which is why the researchers were looking at it, but the link between sugar and stroke is very well known. Too much sugar raises the risk of obesity, diabetes, heart attacks and stroke. Its altogether a bad thing, which is why the World Health Organisation is telling us all to cut down. So what was going on in this study?

The evidence it analyses is pulled from the well-respected Framingham Heart Study a cohort of more than 5,000 people in Massachusetts, US, whose diets and lifestyles have been monitored for nearly 50 years, with the main objective of finding out more about heart disease. Along the way, researchers have looked at other health outcomes.

What they are up against is peoples capacity for forgetfulness and lies. This is the case with every study into the food we eat except for those rare ones, almost impossible to do today, which have in effect imprisoned their subjects and controlled every sip and mouthful they took.Researchers understand this and try to take account of it, but it is difficult.

There are several possible other reasons why an increased stroke risk was associated with diet drinks and not sugary drinks. One is what is called reverse causality. People who come to realise that they are ill and have a high risk of a stroke then switch their behaviour by choosing diet drinks long after sugary drinks have helped cause the problem.

When it came to dementia, the link with diet drinks that researchers saw disappeared once they took some elements of the health of the people in the study into account. When the researchers accounted for other risk factors for Alzheimers, such as risk genes, diabetes, heart disease, cholesterol levels and weight, this significant association was lost, suggesting that these drinks are not the whole story, said Dr Rosa Sancho, head of research at Alzheimers Research UK.

The researchers point to it themselves: We are unable to determine whether artificially sweetened soft drink intake increased the risk of incident dementia through diabetes mellitus or whether people with diabetes mellitus were simply more likely to consume diet beverages, they write. But they call for more research and others will support them in that.

Artificial sweeteners have been viewed with suspicion by a lot of consumers for many years and not entirely deservedly. They are not natural, in the way that sugar is natural, being grown from beet or cane. Some of the hostility comes from those who worry about ingesting man-made chemicals. But while some artificial flavourings have been shown to carry health risks, studies have failed to find similar problems with artificial sweeteners.

Aspartame has been extremely controversial since its approval for use by several European countries in the 1980s, says NHS Choices. In 1996, a study linked it to a rise in brain tumours. However, the study had very little scientific basis and later studies showed that aspartame was in fact safe to consume, says the NHS.

Large studies have also been carried out to look at whether the sweetener increased cancer risks, and gave it a clean bill of health. The European Food Safety Authority said in 2013 it was safe even for pregnant women and children, except for anyone with a rare genetic condition called phenylketonuria.

Dumping aspartame from its low calorie bestseller did not give PepsiCo the halo effect it hoped. In 2015, it announced it was taking the sweetener some people love to hate out of Diet Pepsi and replacing it with sucralose. A year later, when it became clear Coca Cola would not follow suit and that fans preferred their drink the way it used to be, it did a U-turn and put aspartame back in.

There have been huge efforts to develop artificial sweeteners that will taste as good as sugar and be acceptable to the doubters. Stevia, a plant extract, is marketed as a natural sweetener to the increasingly sceptical health-conscious.

Now it is not just drinks. Public Health England is putting pressure on food companies to cut 20% of sugar from their products by 2020. That will probably mean smaller chocolate bars, where artificial sweeteners just wont deliver the same taste. But they will be part of the answer in other foods.

Sweeteners such as sucralose, which is 650 times sweeter than sugar, have long been in breakfast cereals and salad dressings, while saccharin is in store-bought cakes, despite a scare over bladder cancer which caused the Canadian government to ban it as an additive in 1977. It lifted the ban in 2014. The safety debate will go on, but artificial sweeteners are likely to play a bigger part in our diet as the squeeze on sugar ramps up.

There are those, however, who think artificial sweeteners will never be the answer to obesity and the diseases that follow in its wake. The problem, in their view, is our sweet tooth and the answer is to reduce our liking for sweetness. So they want to see the gradual reduction of the amount of sugar in our drinks and our food and snacks without it.

It worked with salt, says Cash, the campaign for action on salt and health, which did much to bring down the salt levels in our food without our noticing it. The same should be possible for sugar. But not if artificial substitutes are used to keep our food and drinks tasting just as sweet as they did before.

Read more: https://www.theguardian.com/society/2017/apr/21/link-dementia-stroke-diet-drinks-artificial-sweeteners-study