PROTECTING your peace of mind is an underrated way to safeguard your physical health.
Last week, a study of nearly 20,000 adults found loneliness, poor sleep and mental health struggles can each increase the risk of developing type 2 diabetes by 35 per cent.
When all three factors are present, the risk is 78 per cent greater.
Chronic stress keeps your body in a “fight or flight” state, and exposes your system to unregulated levels of the hormone cortisol.
This can contribute to chronic inflammation, linked to a host of diseases, and may make blood sugar regulation more difficult.
When we feel down and tired, we are also wired to reach for unhealthy foods.
If you struggle with your mood or sleep, have a ten-minute walk in the morning, which can lower cortisol later in the day, and a wind-down routine before sleep.
Reach out to a friend for connection. If insomnia persists, see your GP.
Here’s a selection of what readers have asked me this week.
WILL THIS HELP MY UTIs?
Q: I AM a 79-year-old woman and have suffered many urinary tract infections for several years following surgery for endometrial cancer.
I now have stage 3 chronic kidney disease and am awaiting surgery for an anterior and posterior repair.
I have excessive global pelvic collapse and a rectocele.
The UTIs plague me constantly and make me feel really poorly.
Now, I am also resistant to many antibiotics.
I would like to take some natural form of D-mannose to prevent the UTIs, but I’m not sure if it’s safe with the kidney disease.
A: Recurrent UTIs can be incredibly draining, particularly when they are frequent and antibiotics are becoming less effective.
D-mannose is a type of natural sugar that works by preventing certain bacteria, especially E. coli, from sticking to the lining of the bladder, making it easier for them to be flushed out in urine.
There is some evidence that it may help reduce recurrent UTIs in some women, and it is generally considered safe for many people when used short term.
However, in your situation, you’re correct to check and be more cautious.
Your kidneys are not filtering as efficiently, and there is limited research on the safety of D-mannose in people with reduced kidney function, particularly with long-term use.
D-mannose may be worth considering as an additional measure, but in your case it’s important not to start it without first discussing it with your GP or renal team and following any required monitoring.
Your underlying pelvic organ prolapse and rectocele – conditions where pelvic organs and the rectum bulge into the vagina – are also very relevant, as these can interfere with complete bladder emptying, which is a common reason for recurrent UTIs.
The planned surgery may therefore make a significant difference by improving bladder function.
Other evidence-based strategies that may help reduce UTIs include topical vaginal oestrogen in postmenopausal women and low-dose preventative antibiotics, or methenamine hippurate.
Antibiotic resistance can make things more complicated, which is why prevention becomes even more important.
With the right combination of approaches, it is often possible to reduce the frequency and impact of these infections.
I’M COUGHING UP BLOOD IN MORNINGS
Q: OVER the last year, l have been coughing up blood in the mornings.
I’ve reduced it from daily to weekly by stopping eating or drinking for three hours before bed and getting a bed that raises my upper body.
Five years ago l was diagnosed with a small hiatus hernia and given lansoprazole. I also take apixaban to avoid blood clots in my leg.
After tests, one doctor told me it could be caused by spondylosis.
Another dismissed that theory, but could not offer a permanent solution.
A: Coughing up blood, even small amounts, is something we always take seriously.
Your hiatus hernia and reflux are relevant, as acid coming up into the oesophagus and throat can cause irritation and inflammation, sometimes leading to bleeding, particularly overnight.
The fact your symptoms have improved by raising the head of the bed and avoiding food before lying down supports reflux as a contributing factor.
However, you’re also taking apixaban, which is a blood thinner.
This doesn’t cause bleeding on its own, but it can make any minor irritation bleed more easily and visibly.
It’s also important to be clear about where the blood is coming from.
Sometimes, what feels like coughing up blood can actually be coming from the upper airways, sinuses or back of the nose.
Less commonly, it can come from the lungs or lower respiratory tract.
Your investigations are reassuring (assuming a chest X-ray and gastroscopy).
However, ongoing symptoms over 12 months do warrant review and you could perhaps ask whether an ENT (ear, nose and throat) assessment is worthwhile, as well as whether your reflux treatment could be optimised by adjusting the dose.
While a single “permanent fix” isn’t always possible, the aim is to identify the source and reduce irritation, rather than accept it as normal.
TIP OF THE WEEK
MANY of us are used to calling the GP at 8am.
But in most cases, filling out an e-consult online helps triage you to the right member of the team, depending on your symptoms, and is quicker.
You’ll find this on your practice’s website. If you require urgent medical care, phone reception.
Q: EVERY three months I have to have a blood test, so at my last one I asked for a prostate check.
I take finasteride tablets for my prostate.
The nurse said I would need to make an appointment with the doctor and get the OK from them.
Why couldn’t she ask for me? It would have saved time.
A: I can understand your frustration. The blood test you are referring to is the prostate-specific antigen test.
It isn’t offered routinely without a discussion first because it’s not a straightforward screening test.
PSA can be raised for a number of reasons other than prostate cancer, including an enlarged prostate, inflammation, infection, recent ejaculation or even exercise such as cycling.
Equally, some men with prostate cancer can have a normal PSA.
This means the test can lead to false positives and false reassurance, which is why guidance in the UK recommends that men have all the information explained to them so they can weigh it up and make an informed decision.
Some men choose to go ahead with PSA testing.
They may have risk factors, including a family history of the disease, being over the age of 50 or being black.
Some men decide not to go ahead with PSA testing – often because of the risk of over-diagnosis and picking up slow-growing cancers that may never cause harm, but the discovery can lead to further tests or treatments with side-effects.
Your situation is more complex as you’re taking finasteride, which can reduce PSA levels by around half, meaning results need to be interpreted carefully by a doctor.
For that reason, a GP or appropriate clinician usually needs to ensure your decision is informed (as inappropriate testing can cause harm), authorise it, and interpret the results in context.
It’s better to get ordering and test-taking right first time to avoid multiple blood tests and make sure results are interpreted safely and meaningfully.
Men can check their risk of prostate cancer in 30 seconds at prostatecanceruk.org/risk-checker.
The charity is campaigning for all men to be screened for the disease, but this was decided against by the screening committee in 2025, except for men with BRCA gene variations.
Men can ask their GP about PSA testing if they have any risk factors or are worried about the disease.
And don’t forget symptoms, too – trouble peeing, needing to pee urgently/often, stop-start flow or weak flow are among them.
