Nurse

Changes in bowel habit and stools can arise as a result of disease, be a side effect of treatment (even some months after treatment has finished) or arise as a result of an infection.

If you are constipated try to:

• Eat regular meals
• Eat foods rich in fibre such as whole wheat breakfast cereals, oat based breakfast cereals with
  added nuts, seeds and dried fruit, wholemeal bread, wholewheat pasta, brown rice, fresh fruit and
  vegetables
• Keep hydrated by drinking plenty of fluids. (Note: If you increase your
  fibre intake you need to ensure you are drinking lots of fluid, or your
  constipation may get worse. All fluids count: soups, tea, coffee, milk,
  juice, squash, water.)
• Try taking a small glass of prune juice or fig syrup, or up to 5 ‘ready-to-eat’
  dried prunes or apricots
• Consider adding some linseed (ground or seeds) to soups, salads, mix into cereal or yogurt. Start with
  one dessertspoonful a day and build up to two dessert spoonfuls a day after 3 days
• Gentle exercise and pelvic floor exercises can also help bowel function

If you have diarrhoea:

• Drink plenty of fluid each day to replace what you are losing but avoid or minimise alcohol and
  caffeinated drinks
• Eat small, frequent light meals made with easy to digest foods such as white fish, poultry, low fat dairy
  produce, well cooked eggs, white bread, pasta, rice
• Some people find reducing the fibre in their diet, for example, switching from wholegrain bread to white bread
  and from wholegrain cereals to lower fibre cereals such as cornflakes or rice krispies can help. Others find taking softer forms of fibre, for example, porridge rather than Weetabix or stewed fruit rather than fresh, is
  helpful. Seek further advice from a dietitian
• Be aware that fatty foods and spicy foods may make diarrhoea worse
• Eat your meals slowly

If the symptoms are severe or do not settle within a few days consider speaking to a dietitian or your healthcare team

The risk of developing a range of illnesses, including certain cancers, increases with any amount of alcohol you drink on a regular basis. However if people keep within the recommended limits, you can reduce this risk.

The Department for Health (DOH) recommends that you should not regularly drink more than 14 units per week. However it is best to spread this evenly over three days or more. If you have one or two heavy drinking sessions, there are increased health risks.

One unit of pure alcohol is 10ml (1cl) or 8g.
For example, one unit of alcohol is about equal to:

• half a pint of ordinary strength beer, lager or cider (3 to 4% alcohol by volume)
• a small pub measure (25ml) of spirits (40% alcohol by volume)
• a standard pub measure (50ml) of fortified wine such as sherry or port (20% alcohol by volume).

There are one and a half units of alcohol in:

• a small glass (125ml) of ordinary strength wine (12% alcohol by volume)
• a standard pub measure (35ml) of spirits (40% alcohol by volume).

Remember, many wines and beers are stronger than the more traditional ‘ordinary’ strengths and many measures, particularly home measures, are larger than standard sizes.

A more accurate way of calculating units is as follows. The percentage alcohol by volume (% abv) of a drink equals the number of units in one litre of that drink.
For example:

• strong beer at 6% abv has six units in one litre, if you drink half a litre (500ml), which is just under a pint, then you have had three units
• wine at 14% abv has 14 units in one litre, if you drink a quarter of a litre (250ml), two small glasses, then you have had three and a half units.

There has been recent concern that people who see themselves as ‘social drinkers’, or who drink at home, are actually drinking too much and are at risk of developing long-term health conditions. Most of these people are unaware that regularly drinking more than is recommended can increase the risk of serious health problems, for example, they

• are greater than three times more likely to have mouth cancer
• could be three times more likely to have a stroke.

Women who regularly drink two large glasses of 13% wine (6.5 units) or more a day:

• are twice as likely to have high blood pressure
• are 50% more likely to have breast cancer.

Binge drinking (more than four units at any one time) and drinking to get drunk, common among young adults, is bad for your health and should always be avoided. In other words you should not save up all your units for the week and drink them all in one go.

Studies show that young female British women have amongst the highest intakes of alcohol in the world. Binge drinking can cause a range of social and health issues for example violent and unsafe behaviour. Heavy and prolonged drinking can lead to a wide range of health problems, including certain cancers, liver disease, stroke, high blood pressure and can affect mental health.

Binge drinking can often result in vomiting, collapse and seizures which can be potentially life threatening. Alcohol tolerance is different in everyone, however those who feel they can drink large amounts without feeling unwell are still causing the same damage to their bodies and put themselves at the same risk of social and health problems.

The NHS states that ‘Most people who have alcohol-related health problems aren’t alcoholics. They’re simply people who have regularly drunk more than the recommended levels for some years.’ If you have drunk too much, you should avoid alcohol for at least 48 hours to give your body a chance to recover.

Alcohol and calories

Be aware that alcohol is high in calories and so can contribute to weight gain. One gram of alcohol provides seven calories (7kcal), compared with 9kcal per gram for fat, and 4kcal per gram for carbohydrate and protein. One unit of alcohol contains eight grams or 10ml of alcohol which provides 56kcal. However other ingredients in alcoholic drinks, such as sugar, cream and fruit juice, can add more calories.

Many people forget to include drinks including alcohol when they are watching or recalling what they eat. It’s easy for these calories to add up quickly and unnoticed as they are being consumed as a liquid.
Alcohol is also an appetite stimulant and can lead to overeating at mealtimes, late at night and even the next day.

To provide all the nutrients needed to maintain health and reduce risk of disease, a healthy balanced diet containing a variety of foods is needed. Alcoholic drinks lack most essential nutrients and vitamins so if alcohol is providing most of the calories in the diet then there is a risk of nutritional deficiencies. Therefore, the practice of ‘saving’ calories from food for alcohol, for example, drinking alcohol rather than eating to prevent putting on weight, should be discouraged.
Alcohol is also a diuretic, which means it makes the body lose more water than usual. When you drink alcohol, it’s a good idea to drink water or other diet soft drinks in between and afterwards to avoid dehydration.

Practical tips on cutting down

If you want to try to cut down on the amount of alcohol you are drinking, here are some practical tips:

• Set yourself a limit on how much you are going to drink on a night out or set yourself a budget of how much money you will spend on alcohol.
• Let your friends and family know you are trying to cut down so they can support you.
• Always try to eat before you start drinking, eat before you go out for the evening or have a meal while you are out. Even a snack at work will help, for example vegetable and bean soup, oat cakes or a smoothie.
• Don’t drink alcohol if you are thirsty.
• Avoid salty snacks such as crisps and salted nuts because these make you thirstier (as well as being high in fat and salt).
• Have some non-alcoholic or low-alcoholic drinks through the evening instead.
• Always have a glass or bottle of water with you or a jug of water on the table as well as your alcoholic drink.
• Think about the strength of your drink, choose beers or lagers that contain less alcohol (they will have a lower ‘abv’, or ‘alcohol by volume’).
• Sip a drink slowly so it lasts longer.
• Don’t top up the glass before it’s finished so the volume consumed can be monitored more accurately.
• Replace high calorie mixer for a lower calorie one, for example, low calorie tonic or diet cola and alternate drinks with water, diet or low calorie drinks.
• Try white wine as a spritzer mixed with sparkling water.
• Choose half pint, small can, small glass, single measure.
• Use a smaller wine glass.

If you’re pregnant, or are planning a pregnancy, you are advised to stop drinking alcohol altogether. Alcohol can reduce the ability to conceive, damage the unborn baby and may even lead to early miscarriage.

If you are breastfeeding, occasional drinking, such as one or two units once or twice a week, is not harmful to your baby but drinking any more than this can cause problems. It’s best to avoid drinking alcohol just before a feed. This is because the alcohol can pass to the baby in small amounts through breast milk.

You should also take care or seek medical advice if you are ill or suffer from conditions such as diabetes, gastric ulcers, high blood pressure or depression or taking certain medication. If you are unsure, then check with your GP or pharmacist.

Water

Water is essential for life. As a major constituent of the body, it has many functions including transporting nutrients and compounds in blood, removing waste products that are passed in the urine and acting as a lubricant and shock absorber in joints.

Water regulates the body’s temperature; sweating is a very effective way of reducing the body’s temperature. The water content of the body varies with age and gender; males have more water than females because women have a higher proportion of body fat.
At birth the human body is approximately 70% water and this decreases with age; in the elderly it is about 55%. Drinking enough is vital to maintain good health in the short and long term, for example, for the prevention of constipation, kidney stones and urinary tract infections. Good hydration also can prevent other conditions, for example, chronic renal disease.

What happens if I don’t drink enough?

If you don’t consume enough water you will become dehydrated. The first thing you will notice is increased thirst and a dry sticky mouth. Other effects include tiredness, poor concentration, headache and dizziness or light headedness.

How much do I need to drink?

In the UK, drinks provide 70 to 80% of our water needs, the remaining 20 to 30% comes from food, for example, soup, stews, some fruits such as melon and vegetables such as celery. The table below shows the recommended amount of water that should be taken as drinks per day.

These are average values and an individual’s requirement will depend on many factors including temperature and humidity and exercise. Warm and dry environments such as air conditioned offices or centrally heated homes increase the need for water as they speed up the evaporation of sweat on the skin.

How do I know I am drinking enough?

Thirst is only part of the way we regulate hydration in the body. When you drink you stop you feeling thirsty before your body is completely rehydrated. The colour of urine is the best indicator, if you are drinking enough your urine should be a straw or pale yellow colour.

What type of drinks should I have?

To an extent this is a matter of personal taste and preference. In the UK drinking plain tap water is a good way to get enough to drink. Chilling or filtering tap water are cheap ways of making it taste more pleasant. Bottled water has the same hydrating abilities as tap water. Tea and coffee provide water and can be a good way of keeping older adults well hydrated.

However if you drink a lot of tea and coffee you need to be aware of the amount of caffeine you are consuming. This is particularly important for pregnant women.
Regular fizzy and still drinks contain a lot of sugar and should only be drunk in small amounts. Fruit juices provide water and other nutrients but contain sugar so only have one small serving per day; this counts towards your 5 a day.

Alcohol may make the body pass more urine than usual and make you dehydrated. It’s a good idea to also drink low-sugar soft drinks or water when drinking alcohol.

Children

While adults are very good at regulating water in the body these mechanisms are not yet fully developed in children. In addition younger children can’t ask for a drink or say they are thirsty so children are particularly vulnerable to dehydration.

Access to water and avoiding lots of toilet breaks in schools can also be a problem. It is important that children drink frequently throughout the day. There is some evidence that children who drink extra water perform better in attention and memory tests.

Elderly people

Elderly people are vulnerable to dehydration and they may have difficulties accessing drinks. Fear of incontinence may also mean that some elderly people restrict their fluid intake.

Regular drinks should be encouraged, tea and coffee are a good way of getting elderly to drink. Elderly dehydrated people are at particular risk of urine infections and falls and should monitor how much they drink in hot weather.

Sport

It is important that water lost through sweat when exercising is replaced to maintain performance and health. Some athletes may find isotonic drinks useful.

Summary

Having regular drinks throughout the day will help you stay well hydrated especially when it is hot or you are exercising. Keep an eye on the colour of your urine, if it dark you need to drink more.

Children and the elderly are particularly vulnerable to dehydration and may need to be encouraged to drink more.