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What you can learn from your different body shapes (Filed: 20/06/2001)

Dr Sarah Brewer on how to judge the risk of diabetes, plus advice on dairy-free supplements, healing open wounds and the treatment of fungal infections

DEAR DOCTOR - I am told that people who store fat on their waists are more likely to develop diabetes in later life. Is this true? How can I reduce this risk?

If you are overweight, where you store your excess fat is important. Those who carry excess weight around their middle (apple-shaped), rather than around their hips (pear-shaped), are more at risk of a number of conditions, including diabetes, atherosclerosis, coronary heart disease, high blood pressure and stroke. The exact reason is unknown, but is probably due to the genes that dictate how your body handles dietary fats.

To work out if you are apple-shaped, measure your waist and hip in centimetres using a non-stretchable tape measure. Divide your waist size by your hip size to get your waist/hip ratio. A waist/hip ratio greater than 0.85 is apple-shaped for women, while a ratio greater than 0.95 is apple-shaped for men.

Waist size alone may also be a good indicator, as research suggests men with a waist circumference larger than 102cm and women with a waist circumference larger than 88cm are more likely to develop diabetes and hypertension than those who are slimmer. Slight waist reductions of just 5cm-10cm have been shown to reduce the risk of a heart attack significantly, so try to lose any excess weight by following a sensible low-fat diet and increasing your level of physical activity.

Research suggests that regular brisk exercise can reduce the risk of premature death from all causes by 23 per cent and reduce the risk of developing diabetes by 40 per cent. It is best to join a gym to obtain individually tailored advice. The good news is that fat stored on the abdomen seems to be easier to shift than fat stored on the hips.

DEAR DOCTOR - I am a vegan and want to take a beneficial bacteria supplement. Are there any non milk-based varieties?

One of the most researched dairy-free probiotic supplements is ProViva, a fruit-based drink (strawberry or blackcurrant flavours) containing a strain of digestive bacteria called Lactobacillus plantarum 299v. ProViva (www.proviva.com) was originally developed in Sweden as an alternative to antibiotics for patients recovering from surgery or trauma, to reduce the risk of intestinal problems such as gastroenteritis. It is now widely used to maintain a healthy intestinal microflora in post-operative and post-trauma patients in Swedish hospitals. The Vegan Society (tel: 01424 427393; email: info@vegansociety.com) should also help.

DEAR DOCTOR - My son had a pilonoidal sinus and infected cyst at the base of his spine. Antibiotics cleared it up, but if it recurs he may need an operation in which an open wound will be left to heal naturally. Is there any complementary treatment that might speed up healing the open wound and dealing with the weeping cyst?

Supplements that help to boost immunity are worth trying, such as Echinacea (which increases the number and activity of infection-fighting white blood cells), or extracts of the mushroom Maitake.

Antioxidants help to reduce inflammation and have additional benefits: vitamin C is needed for production of collagen during wound healing, while vitamin E and selenium together increase production of antibodies to help fight infection. The Ayurvedic herb Gotu kola is used to promote healing of wounds and is believed to work by acting directly on fibre-producing cells (fibroblasts) to improve connective tissue structure.

Acupuncture is worth exploring, as is individual advice from a homoeopath. For example, the homoeopathic remedy Silica IM may be prescribed to help a pilonoidal cyst disappear or encourage drainage of purulent material.

DEAR DOCTOR - I have pityriasis versicolor on my arm and chest. I've been given medication, but understand it will recur. Is there any dietary or other advice you could give?

Pityriasis versicolor is a fungal skin infection due to the yeast, Pityrosporum orbiculare. Selenium sulphide or ketoconazole shampoo applied regularly to the affected area while bathing is usually successful in killing the infection and stopping recurrences. Tea tree oil products should also be effective. But it will take some time for the colour changes (depigmented white macules on sun-exposed skin, and pale brown patches on covered parts of the body) to clear, no matter what treatment is used. Both olive leaf and grapefruit-seed extracts are relatively new supplements shown to have powerful antifungal (as well as antibacterial, antiviral and anti-parasitic) activity, and either will help keep fungal infections at bay.

DEAR DOCTOR - The final test for entry to the National Guild of Wine and Beer Judges is passing a practical exam which includes smelling and tasting wines or beers and identifying the merits and faults. The failure rate is high, despite most candidates obtaining good results in training, trials and mock exams. Nerves cause silly mistakes, such as confusing sweetness with dryness. Is there a natural product that can build confidence and help me to be more relaxed under pressure?

The dried root of Kava Kava contains a variety of substances that are widely used to combat anxiety and panic attacks. Kava promotes feelings of relaxation and calm and, as its anxiolytic effects may be noticed after just a single dose, it may be taken when required to damp down the effects of stress. For example, a single 120mg Kava tablet can be used to produce an immediate calming effect before a stressful event such as an exam. Kava can also improve memory and does not impair driving skills, co-ordination, visual perception or judgment at therapeutic doses. As some people find it mildly sedating, however, it must be tried out in advance (for example, during a mock exam) to ensure it does not affect performance. The main drawback is that Kava should not be combined with alcohol (it may cause nausea, stomach upset or sedation) but, as candidates should be spitting rather than swallowing drinks, this may not be a problem during the exams.

Another option is Valerian, although this is more likely to cause mild sedation and should also be tested well in advance. Bach Rescue Remedy is a homoeopathic blend of five flower essences preserved in brandy - a few drops may be added to a glass of water and sipped slowly when panic rises. For those with longer to prepare, learning meditation and self-hypnosis techniques will help.

If readers have any trouble in obtaining nutritional supplements featured in this column, the Nutri Centre in London will be happy to supply them by mail order at a 15 per cent discount. Please call 020 7436 5122.

Letters should be sent to Dr Sarah Brewer, Features Department, The Daily Telegraph, Canada Square, Canary Wharf, London E14 5DT; fax 020 7513 2508. Letters cannot be answered personally. Before following any advice, please consult your GP. No responsibility can be taken for advice given in this column. Questions can also be sent by email: drsarah@bizonline.co.uk

-- Anonymous, June 20, 2001