Angina pectoris is favoured by cardiovascular risk factors. It is caused by an imbalance between the heart's oxygen supply and demand. Angina can be treated with medication or surgery.

1. Definition of angina

Angina is a pain in the chest behind the breastbone. It causes constrictive pain, making the patient feel as if the chest is in a vice. The pain can sometimes reach the stomach. The pain caused by angina usually occurs during exertion, or in a stressful situation. Five minutes are enough to make the attack disappear, after a period of rest or taking nitroxide. Angina is a symptom of heart disease or cardiovascular disease. The right and left coronary arteries and the anterior interventricular artery are the main vessels supplying the heart. They carry oxygen-rich blood, allowing the heart muscle to contract. If the oxygen supply is less than the heart needs, the symptoms of angina occur.

2. Symptoms of angina

The symptoms of angina are pain behind the breastbone in the middle of the chest. The pain may radiate to the arms, back, stomach, neck, jaw, and teeth. The patient experiences a feeling of tightness. The pain may be accentuated by stress, eating, or exposure to cold or wind. When the effort stops, it only takes a few minutes for the pain to subside. If the pain lasts only a few seconds, it is probably not angina.

Angina can lead to serious complications, the first of which is myocardial infarction. This is usually preceded by angina pectoris. The pain during an infarction lasts longer than during angina. Chest pain is usually the first symptom of a heart attack, but according to Vidal, 20% of people have a painless heart attack (including people with diabetes). A heart attack may be associated with other symptoms, such as anxiety, visual disturbances, shortness of breath, dizziness, fainting or nausea.

3. Causes of angina

According to the French National Health Insurance, 90% of angina pectoris cases are caused by atherosclerosis which reduces the calibre of the coronary arteries. The oxygen supply is reduced: this is known as coronary artery disease or ischaemic heart disease. The symptoms of angina appear when the arterial diameter is reduced by at least 50%. Atherosclerosis leads to the formation of atherosclerotic plaques consisting of cholesterol, which are deposited on the inner walls of the arteries. This deposition of cholesterol is accompanied by inflammatory reactions and a thickening of the inner wall of the arteries. Plaques take time to develop, but can lead to complete blockage of the vessel.

As of 31 December 2017, 1,210,620 people (72% men and 29% women) in the French health insurance scheme for salaried workers had coronary heart disease, according to the French health insurance scheme. This is the fourth most common cause of long-term sick leave, after diabetes, cancer, and psychiatric diseases. There are other rarer causes of angina pectoris:

• heart valve abnormality;
• cardiomyopathy;
• severe hypertension;
• arterial spasm.

4. Angina: when to consult a doctor?

Angina can be an emergency to consult a doctor if the pain does not stop after five minutes despite rest and taking nitroxide. Similarly, if the pain is unusual or if it is accompanied by other signs, such as malaise or nausea, it is imperative to call the emergency room. On the other hand, if the pain stops quickly, there is no need for an emergency room, but a consultation with a doctor is recommended afterwards to set up an appropriate treatment. You should have regular medical follow-up in case of angina pectoris:

• consult your GP regularly and follow his or her advice, as well as a cardiologist, at least once a year;
• carry out check-ups, such as blood tests;
• Follow your treatment without changing it and without stopping it;
• Follow healthy lifestyle rules and eliminate risk factors;
• get an annual flu vaccination;
• Inform any health professional of your treatment;
• alert your doctor to any unusual signs or new symptoms.

Monitoring your angina does not usually require you to take time off work. However, if your work is physical, time off may be considered. The length of time off work depends on your occupation, the severity of your illness, your overall health, and any complications of your condition.

5. Examinations and diagnosis of angina

The doctor interviews the patient to assess the severity of the symptoms. The doctor looks for triggers, such as exertion, stress or eating. The doctor performs a stress electrocardiogram to diagnose angina. An ultrasound scan of the heart may also be performed to examine the coronary arteries and visualise any narrowing of the arteries. A coronary angiogram may also be recommended to visualise the condition of the coronary arteries.

6. Treatments for angina

Angina can be treated with certain drugs. Trinitrine and its derivatives dilate the veins of the heart and the arteries. These medicines are prescribed as sprays or tablets. They can be used for prevention as well as during an attack. There are also basic treatments to reduce the symptoms and possible complications of angina. These include beta-blockers, which reduce the blood pressure during exercise and the risk of recurrence of angina and heart attack.

Surgery may be considered to increase the diameter of the arteries and crush the cholesterol deposits. A small spring can then be placed to hold the artery apart. If the artery is damaged, a piece of the vein can be used to perform a bypass. Non-surgical treatment can also be offered: angioplasty. A very thin probe with an inflatable balloon is inserted into an artery and moved to the coronary. The pressure of the balloon crushes the atherosclerotic plaques and restores the artery to a sufficient diameter. Preventive treatments are also essential to avoid angina and heart attacks. The aim is to reduce excess cholesterol by adopting hygienic and dietary measures. Drug treatments can target high blood pressure, cholesterol levels, or diabetes.

7. How to prevent angina

Angina can be prevented by a program of physical exercise suggested by a doctor, by stopping smoking, and by choosing a balanced diet, according to the Montreal Heart Institute. Stopping smoking is essential if a person suffers from angina. Cigarettes reduce breathing capacity and the body's ability to oxygenate itself. After a year without smoking, the risk of a heart attack is halved, as is the risk of a stroke. Diet also plays an essential role in preventing angina. The intake of saturated fats of animal origin (butter, cheese, meat, etc.) should be reduced. On the contrary, it is advisable to increase the intake of fruit and vegetables and whole grains. All this helps to reduce cholesterol. Avoid eating industrial dishes that are high in sugar, fat, and salt. Cook your own food as much as possible. Steam rather than cook in butter. Moderate your alcohol consumption by not drinking more than two glasses a day.

Certain food supplements are recommended to prevent heart disease. The omega-3 fatty acids found in fish and vegetable oils are thought to help prevent cardiovascular disease. Similarly, omega-6 and omega-9 are recommended for prevention. Other food supplements can be considered, such as pectins, potassium, red yeast rice, soya proteins, or vitamin B3. Weight monitoring is also advisable if a patient has angina: the waist circumference should be monitored (less than 88 cm for women and less than 102 cm for men). The BMI can also be monitored. The help of a dietician is recommended.

Physical activity is essential in the prevention of angina, as it promotes the formation of new blood vessels. Moderate physical activity is particularly recommended for people who have suffered a heart attack, in order to strengthen the heart and compensate for the loss of efficiency caused by the heart attack. 30 to 60 minutes of moderate physical activity is recommended, five times a week. Endurance sports, such as walking, swimming, or hiking in the lowlands, should be preferred. You can also naturally increase your physical activity by taking the stairs instead of the escalator, walking instead of taking public transport, keeping your home clean by vacuuming or gardening, and going for walks. People with angina should get a flu shot. Severe flu can cause severe respiratory problems, putting a strain on the heart.

The body needs water to carry out its main functions. It is one of our body's essential fuels. In fact, the average human body contains about 60% water, according to Hydration for Health. Dehydration occurs when water losses are not sufficiently compensated.

1. Definition of dehydration

Water is the main constituent of the human body. However, the amount of water in the body depends on several factors. It can vary according to

The person's build: the leaner the individual, the greater the proportion of water in the body.

The age of the individual: the amount of water in the body decreases over the years, as the tissues age. Water is gradually replaced by fat. For example, in a newborn baby, the amount of water represents 75 to 80% of the weight. It then drops to about 60% for an adult and is further reduced for a senior citizens according to Eufic (Food Information Council of Europe).

However, the human body is not capable of storing the water it absorbs in the long term. It eliminates it constantly, whether through breathing, perspiration, or urine. This is why water losses must be systematically compensated for by external inputs. It is customary to say that you need to drink an average of 1.5 litres of water per day to stay healthy. In reality, this figure should be adapted to the situation. In fact, the quantity of water to be absorbed is not at all the same according to the physical activity that we practice or the outside temperature. Dehydration refers to the lack of water and mineral salts in the body. It occurs when their levels are no longer sufficient to ensure the proper functioning of the body.

2. Symptoms of dehydration

The first signs of dehydration are

• thirst ;
• Dry lips;
• feeling abnormally tired;
• loss of strength;
• rapid weight loss.

The colour of the urine is also a very good indicator of dehydration. When the urine is very dark, it means that you are not drinking enough. This is one of the simplest signs to recognise this condition. When dehydration becomes more severe, it leads to other symptoms:

• a decrease in weight of more than 5%;
• intense thirst
• dryness of the tongue;
• accentuation of skin folds, and the difficulty of the skin to recover its initial aspect after being pinched;
• Pale skin tone;
• headaches;
• disorientation and/or dizziness;
• decreased urine output;
• fever;
• a change in behaviour, resulting in both agitation and a feeling of great weakness.

According to Dr. Bernard Durand-Gasselin, geriatrician, and Dr Jean-Michel Borys, endocrinologist-nutritionist, other signs can also appear when it is a question of atypical dehydration in an elderly person. In this case, it is not uncommon to see a loss of appetite, as well as unusual sleepiness or even depression.

Similarly, infants under two years of age are a special case where dehydration can quickly become a very serious problem. In younger children, water loss can be very rapid, resulting in a 10-15% weight loss in a very short time. Alarming symptoms include:

• a listless state and a constant desire to sleep ;
• a child who is difficult to wake up and then lets out some moans;
• Pale skin and dark circles around the eyes;
• rapid breathing;
• a weight loss of more than 5%;
• Depression of the fontanelles on the upper part of the skull.

4. Dehydration: when to consult?

Depending on the profile of the individual and the level of dehydration, the situation can be more or less worrying. It is therefore essential to know how to assess the seriousness of the symptoms. This will help to identify urgent situations where it is necessary to contact a health professional as soon as possible. Regardless of the age of the dehydrated person, when the person is facing severe dehydration, it is an emergency. Similarly, when dehydration affects an infant, an elderly person or someone with a chronic illness, it is best to seek medical attention quickly. If in doubt, call a medical emergency number, such as 15 or 112, without delay. On the phone, the regulating doctor will be able to ask you the right questions to help you assess the person's medical condition and the seriousness of the dehydration.

When dehydration is moderate, certain measures may be sufficient to rebalance the body's water intake, while continuing to monitor the person suffering. In this case, it is necessary to:

• lie down ;
• undress the person;
• cool them down with a damp cloth
• ventilate;

compensate for water and mineral losses by encouraging her to drink more frequently than normal, and by administering oral re-hydration solutions if necessary.

5. Tests and diagnoses of dehydration

In most cases, dehydration is diagnosed by observation of symptoms. However, sometimes blood tests are necessary. Usually, this additional examination is prescribed for people who are seriously ill, suffering from certain specific disorders, and/or taking certain medications. Dehydration is a phenomenon that usually involves an increase in the level of sodium in the blood. This is known as hypernatremia. In addition, the most common causes of dehydration, such as vomiting and diarrhoea, also tend to result in a simultaneous loss of electrolytes from the body. These are therefore important elements in confirming or refuting the initial diagnosis. When dehydration is considered severe, the person is hospitalised and water losses are then compensated by infusion.

6. Treatments for dehydration

When dehydration is mild, drinking large amounts of water is sufficient to treat it. However, when dehydration is more severe, the electrolytes lost in the body, i.e. sodium and potassium must also be replenished. For this purpose, it is recommended to take rehydration solutions. These contain large quantities of electrolytes and are available without a prescription. They are very useful for children, especially during an episode of vomiting or diarrhoea.

Oral rehydration solutions come in sachets of powder and are available in pharmacies. They are medicines covered by the Health Insurance for all children under 5 years of age suffering from acute diarrhoea. They can be given to a breastfeeding infant between feeds or directly into a bottle to replace powdered milk. This medicine can be offered to the child several times an hour, in very small quantities at first, to avoid any regurgitation, and then as much as the child wants, depending on his thirst, as long as the risk of dehydration persists.

In the most serious cases of dehydration, it is necessary to administer an intravenous solution. These contain sodium chloride and not only help to rehydrate the body, but also slow down the causes of dehydration, such as nausea.

7. How can dehydration be prevented?

Because prevention is better than cure, it is strongly recommended to adopt certain actions to avoid dehydration. These concern all individuals, but even more specific populations at risk, such as infants, patients with chronic pathologies or the elderly. Similarly, preventing dehydration is even more important in a heatwave situation. In general, adults are advised to drink at least six glasses of water a day and to eat fluid-rich foods such as fruit and vegetables. The amount of water taken in by the body should be increased in hot weather or after prolonged exercise. The amount of water taken in by the body should also be increased after vomiting and/or diarrhoea.

When exercising, the body temperature naturally increases. This increases the body's need for water. This is why there are specific sports drinks containing electrolytes to compensate for the losses suffered by the body during intense physical exercise. These drinks are an excellent way to prevent dehydration.

Finally, because people with kidney problems are more prone to dehydration, and because dehydration can have much more serious consequences for them, they are advised to consult a doctor before any physical activity, so that they know exactly how to rehydrate properly.

 Kidney cancer is a rare disease, accounting for only 3% of cancers diagnosed each year (according to the long-term condition guide on the management of kidney cancer published by the High Authority for Health in 2010). These malignant tumors can easily metastasize in the absence of adequate treatment.

According to the Kidney cancer key points file published by the National Cancer Institute in 2022, approximately 11,090 cases were diagnosed in France in 2011. Those affected are mainly men, with an average age of 65 years (National Cancer Institute). In the majority of cases, kidney cancer sets in and develops in patients without symptoms for several years. The disease is detected incidentally during examinations carried out for other reasons, or at a very advanced stage. The treatment of this cancer is mainly based on surgery, i.e. The removal of the affected kidney.

1. Definition of kidney cancer

The kidney is essential to the functioning of the body and its function is to filter the blood and remove toxins. In patients with kidney cancer, a cell in the kidney multiplies uncontrollably, and malignant tumours begin to form. In about 85% of cases, cancer originates in the kidney parenchyma. In this case, it is called renal cell carcinoma (according to the dossier on kidney cancer published by the Léon Bérard Cancer Centre in 2021). The latter can be of three distinct types (National Cancer Institute):

• clear cell carcinoma also called adenocarcinoma, which accounts for 80% of cases;
• papillary or tubulo-papillary carcinoma, which accounts for 10 to 15% of cases, and which can be type 1 or 2;
• chromophobe carcinoma, which accounts for 5% of cases.

Other kidney cancers are particularly rare and occur in the excretory tract. Another form can be observed in young children: Wilms' tumour, also called nephroblastoma. Note that like all cancers, kidney cancer can be classified according to its progression (stage 1, 2, 3 or 4), and its degree of aggressiveness (grade I, II or III). In France, kidney cancer represents about 3% of cancers and was identified in about 11,090 adults in 2011 (National Cancer Institute). Male patients are twice as numerous as females and are on average 65 years old at the time of diagnosis (National Cancer Institute). Kidney cancer has the particularity of remaining silent for a long time (sometimes several years). In 60% of cases, it is diagnosed at a localised stage and incidentally (according to the long-term disease guide on adult kidney cancer, published by the French National Authority for Health in 2010). If it is not discovered early, it can easily metastasise and reach other organs, such as the lungs (in 75% of cases of migration), bones, liver or brain (Haute Autorité de Santé). On average, patients have a 63% chance of survival at 5 years, and 90% when the cancer is still localised (Haute Autorité de Santé).

2. Symptoms of kidney cancer

Unlike other cancers, kidney cancer usually progresses very slowly. Symptoms come late, and the disease can remain silent for many years. Clinical signs can vary greatly and are not always specific. Common symptoms include (National Cancer Institute)

• fatigue ;
• blood in the urine (macroscopic haematuria): painless, complete, recurrent and spontaneous;
• back pain;
• a palpable mass in the abdomen
• unjustified weight loss;
• unexplained fever;
• enlargement of a testicular vein in men;
• phlebitis or swelling of the legs (less common).

In some patients, metastases may be identified in other organs: lungs, bones, liver or brain. This can lead to other symptoms, such as coughing, shortness of breath or polycythemia (abnormal increase in the number of red blood cells in the blood).

3. Causes of kidney cancer

Kidney cancer affects twice as many men as women. It is also strongly linked to age: on average, patients are 65 years old at the time of discovery. But beyond gender and age, certain risk factors have been clearly identified by medical research. Three of them are particularly likely to promote kidney cancer (National Cancer Institute, Vidal):

• dialysis treatment for more than 3 years: this long-term treatment to compensate for kidney failure is conducive to the appearance of cysts in the kidneys and the development of tubulo-papillary type kidney cancer. However, only 2-3% of people on dialysis will develop kidney cancer in their lifetime;
• Overweight and obesity: at a BMI (body mass index) of more than 25 kg/m², individuals are much more likely to develop kidney cancer. It is estimated that for an increase of 5 kg/m², the risk is increased by 24-34%;
• Smoking: Smoking significantly increases the risk of developing cancer, particularly kidney cancer. Smokers are 1.5 times more likely to develop this disease.

But other risk factors are suspected. These include high blood pressure and repeated exposure to asbestos, arsenic or cadmium. Finally, in a very limited number of patients, kidney cancer can be explained by a familial predisposition. Some rare genetic diseases, such as von Hippel-Lindau disease (VHL) or tuberous sclerosis of Bourneville, are often the cause of kidney cancer.

4. Kidney cancer: when to seek help?

Most patients with kidney cancer discover their disease by chance during examinations for other reasons. This is because the disease develops particularly slowly, and the first clinical signs do not appear until later. Sometimes the first symptoms are not specific and do not alarm patients. However, after a while, kidney cancer can easily metastasise and spread to other organs. It is therefore important to detect it early. According to the file on the symptoms and diagnosis of kidney cancer published by the Cancer Research Foundation in 2018, certain symptoms require medical consultation and additional tests (National Cancer Institute):

• the presence of blood in the urine;
• pain in the flanks;
• an alteration in general health and/or a general loss of weight;
• unexplained fatigue and/or fever;
• A palpable mass in the abdomen.

Patients who notice these symptoms should be examined by their doctor. Only he or she can determine their origin and possibly suspect a diagnosis of kidney cancer. Finally, it should be noted that in cases of familial forms, kidney cancer may be discovered during routine screening.

5. Kidney cancer investigations and diagnoses

As with the vast majority of cancers, the cure rate for kidney cancer is highly dependent on early diagnosis. In about 60% of cases, it is discovered incidentally, during an ultrasound or abdominal CT scan (Haute Autorité de Santé), carried out in the context of a completely different health problem. First of all, the doctor will question the patient (study personal history and lifestyle), note his or her symptoms, and assess any risk factors. If kidney cancer is suspected, a CT scan of the abdomen is the first step. The aim of this examination is to detect a possible mass. If a mass is found, its size and extension are analysed, but it cannot always be concluded that the tumour is cancerous. It may also be a benign cyst-like tumour. In order to confirm this, the doctor may carry out several additional tests. These may include (Cancer Research Foundation):

• an MRI (magnetic resonance imaging) ;
• a biopsy: removal of the tumour, microscopic analysis and anatomopathological examination of the tumour or a metastasis;
• a thoracic CT scan;
• Brain and/or bone imaging: in case of symptoms that may indicate generalization of cancer.

6. Treatments for kidney cancer

 Yoga is an ancient technique that is good for us. What kind of yoga is right for me? What are its benefits? Postures, exercises... You will know everything about this wellness practice.

Yoga, which originated in India several thousand years ago, is practised by more than 2.8 million people in France. This philosophy of life, which is gaining in popularity, consists of a series of postures and breathing exercises to achieve physical and mental well-being.  There are no contraindications. You just need to adapt the exercises to your state of health. Open your chakras wide to discover the different types of yoga. 

What are the benefits of yoga?

Practising yoga is great for the body and mind. As well as improving breath and breathing, it helps reduce stress and gives you a more peaceful outlook on life. It helps to be more connected to the present moment and to work on concentration. If practised regularly, it develops flexibility and elasticity of muscles. Of course, certain sequences and postures offer a real muscular reinforcement for a progressive but long term weight loss.

Which yoga postures to start with?

• The lotus pose: sit with your legs folded in a lotus or cross-legged position. Stand up straight and join your hands in front of your chest before placing them on your knees.
• Tree pose: stand and stare at a point in front of you. Anchor one leg in the ground. The other leg bends while the sole of the foot is placed on the inner side of the opposite thigh. 
• Child's pose: on all fours, lower your hips to your heels and ankles and then release your arms to the ground, palms up.
• Warrior poses: stand with your right leg out to the side and turn your foot to 45 degrees. The other foot does not move. Stretch your arms to shoulder level, then bend your right knee as if you were going to do a lunge. Look away.
• The Sun Salutation is one of the best-known exercises. It combines 12 asanas (postures) and should be practiced 8-12 times a day.

What type of yoga to choose?

Yoga is a trend. Whether you are a beginner or an advanced practitioner, whether you are looking for a gentle, dynamic or spiritual practice, your choice of yoga will not be the same. Between Hatha yoga, Ashtanga yoga, Bikram yoga and all the others, you will be spoilt for choice. Here is an overview of the different types of yoga.  

• Hatha yoga: the moon and the sun, yin and yang... This method consists of bringing together the most antipodal energies. In fact, other yogas have their origins in it. The principle: to seek balance and physiological and anatomical well-being at the same time. How does it work? By adopting postures, designed to make the joints more supple, to learn how to position one's breathing and to gain concentration, while paying close attention to one's gestures. This practice also aims to be attentive to oneself, and therefore to others. And with so many virtues, isn't Hatha yoga the royal road to well-being?
• Ashtanga Vinyasa yoga: an ultra-dynamic and energetic variant of Hatha yoga, Madonna and Gwyneth Paltrow are fans of it! Its success can be explained by its multiple therapeutic benefits. Based on synchronised breathing and movements, Ashtanga Vinyasa yoga considerably improves the cardio-respiratory faculties. The session is divided into three stages: alignment of the body, cleansing of the nervous system and work on flexibility. A very complete programme which, in addition, sculpts the silhouette!
• Vishranta yoga: need for relaxation and softness? Vishranta yoga is very relaxing and is the right method for you. While the body surrenders to the floor exercises, the mind remains alert. The student becomes fully aware of the breath and sensations. He eliminates the small evils related to the stress and finds an absolute plenitude.
• Yin Yoga: very cocooning, Yin yoga is one of the yogas that relaxes. It is a gentle activity that combines stretching, breathing and postures that must be held for several minutes. It allows you to regain calm, to relax while working the tissues in depth.
• Iyengar yoga: don't be a beginner! Based on "asanas", postures, and "pranayama", the breath, this sports method requires a lot of rigour and a healthy lifestyle. It focuses on the alignment of the body. Foam blocks, chairs and belts help to maintain different postures. The result is natural breathing and purification of the body, freed from the toxins accumulated in daily life.
• Vidyaa yoga: is good for strengthening the mind, this practice allows you to refocus on yourself and stimulates concentration. The programme? Postures that follow one another to a soundtrack with fast but regular rhythms. An excellent way to learn how to gather your energies so as not to lose any of them.
• Yoga Nidra: in Sanskrit, the language of Indian culture, yoga Nidra means the yoga of sleep. However, it requires a few years of practice... The principle? Infiltrate the unconscious state of rest to stir up energy and display greater vitality. How does it work? With meditation sessions where letting go is a must, to help you fall asleep.
• Bikram yoga: a room heated to 40°C and no less than twenty-six postures to be linked together. The principle of Bikram yoga is simple: combine breath, movement and heat to stimulate the evacuation of toxins. Originally, this method was dedicated to the simple stretching of muscles. The practice in a heated room has made it very caliente! Get ready to sweat!
• Prenatal yoga: ideal for preparing for childbirth, this method has drawn from Hatha yoga the postures that are beneficial to the arrival of the baby. The movements evolve according to the time of the pregnancy. Based on the control of the breath, prenatal yoga provides the keys to giving birth as serenely as possible.
• Facial yoga: the face is a particularly solicited area that deserves to be studied. It is made up of a multitude of muscles that can be worked to relax and tone them. Thanks to exercises that can be done at home, volumes are redefined and cheekbones are enhanced for an assured lifting effect.

Why does yoga make you lose weight?

Yoga is a discipline that is thousands of years old and aims to achieve a form of harmony between the body and the mind. By integrating it into your lifestyle, you learn to better control your emotions and manage your anxiety. As a result, you sleep better and feel less like throwing yourself on food! There are many yoga classes that will help you sculpt your figure! For a tonic and dynamic practice, you can initiate yourself with Ashtanga, which solicits the muscles and the endurance. The postures practised in yoga help to tighten and slim the body.

If you want to get rid of a small belly, adopt the boat position without delay. To do it, nothing could be simpler: sit with your legs tight and bent, lean back gently and hold the position to work your abdominal muscles.

To challenge your whole body, try the warrior pose. With your left foot forward, place your right foot back and bend your legs. Keep your back straight and extend your arms to either side of your body, keeping them in line with your shoulders.

Osteosarcoma is the most common bone malignancy or bone cancer (tumours that start in the bone) in adolescents and young adults. Osteosarcoma affects about 100 to 150 new patients per year in France. The majority of these osteosarcomas (70%) occur in young people aged 10 to 25 years. There is a male predominance (1 girl affected for 1.4 boys). 

Localized osteosarcomas are limited to the bone, the site of the original tumor development. Half of these tumors occur on the femur and 80% around the knee, either on the upper end of the tibia or the lower end of the femur. Other sites are possible.

In 10-20% of cases, metastases are present upon diagnosis. These metastases are located 85 to 90% of them in the lungs. Then come the metastases on another bone.

1. Definition of osteosarcoma

Osteosarcoma is a cancer of bone tissue. The Gustave-Roussy Institute provides the following epidemiological data: osteosarcoma affects young people aged between 10 and 25 years in 70% of cases and affects more boys than girls (it affects 1.4 boys for every girl). This cancer of bone tissue can be localised to the bone (stage 1 to 3 cancer) and in this case, it mainly affects the femur (lower extremity) and the knee (upper extremity of the tibia). However, it can also be located in other bones: shoulder, pelvis, jaw, skull, hip, and vertebrae. According to the Gustave-Roussy Institute, in 10 to 20% of cases, metastases are already present at the time of diagnosis, which increases the risk of recurrence. In the most frequent cases (80 to 90% of cases), these metastases have spread to the lungs. If not, they are found on a bone other than the original tumour site. Finally, the last observation is that this type of cancer affects more men of African-American origin. The management of osteosarcoma is usually a combination of surgery and chemotherapy.

2. Symptoms of osteosarcoma

The main symptoms of osteosarcoma are:

• Pain at the site of the bone tumour: the pain can be moderate or intense, very localised or diffuse, constant or transient. It can be felt during the day or at night. It is often the first noticeable sign of osteosarcoma.
• A swelling: a swelling or a ball can be felt in the bone tissue. This can sometimes be seen early if the tumour has swollen rapidly. However, if the tumour is located in deep bones, such as the pelvis or a vertebra, the swelling may not be visible until later.
• Pathological fracture: osteosarcoma can lead to bone fragility, therefore, to spontaneous fracture or fracture after a very slight impact.
• Difficulty in moving the affected joint, resulting in lameness or difficulty in walking.

3. Causes of osteosarcoma

The Canadian Cancer Society reports that the risk of developing osteosarcoma increases during the adolescent growth phase. Factors identified as being at risk include:

• Genetic factors: several inherited genetic diseases can promote the development of osteosarcoma. These include familial retinoblastoma (eye cancer), Rothmund-Thomson syndrome (bone and skin problems), Werner syndrome (accelerated ageing of the body) and Bloom syndrome. But also Li-Fraumeni syndrome, neurofibromatosis type 1 (a disorder of the nervous system) or Diamond-Blackfan anaemia (a disorder of the bone marrow).
• Previous radiotherapy or chemotherapy: Children who have undergone radiotherapy or chemotherapy at a very young age are more likely to develop osteosarcoma in the next 5 to 20 years.
• A history of bone diseases such as Paget's disease: Paget's disease is a chronic skeletal disease in which the bones become brittle and grow enlarged. Scientists have found that Paget's disease favours the subsequent development of osteosarcoma.

4. Osteosarcoma: when to consult?

In the event of unexplained and persistent bone pain or swelling, it is essential to consult your doctor urgently. Indeed, the chances of recovery for a patient suffering from osteosarcoma are greater the earlier it is diagnosed. If the cancer is diagnosed before stage 4, which corresponds to the presence of metastases, it will be localised. And treatment is more likely to achieve remission, limit recurrence, and lead to a cure or reduced sequelae.

On the other hand, late management of bone cancer can lead to complications such as metastatic osteosarcoma, with a high risk of amputation or death. Metastases may have developed to organs (frequently the lungs) or to another bone. Treatment in the latter case will require higher doses of radiotherapy, a dose level not always feasible if the metastases are located close to organs. Furthermore, while recurrence of osteosarcoma at the original tumour site is rare, this is not the case for metastatic osteosarcoma. In this case, the patient must undergo re-operation and, if the metastases can be removed, further radiotherapy or even amputation of the affected limb. It is therefore easy to understand why it is absolutely necessary not to delay consulting a doctor in case of doubt, as the consequences of an extensive osteosarcoma are serious, even lethal.

5. Examinations and diagnosis of osteosarcoma

The diagnosis of osteosarcoma is based on various elements:

• A clinical examination: by examining the patient, he or she looks for any swelling and locates the pain. The doctor also checks the mobility of the joint, feels the lymph nodes, listens to the lungs, etc.
• Questioning of the patient: the doctor asks questions about any previous pathologies (bone pathology, radiotherapy or chemotherapy, hereditary genetic diseases mentioned above), the context of the appearance of the symptoms, and the factors that aggravate or relieve the symptoms...
• Medical imaging tests such as X-rays to detect possible bone cancer. Then a CT scan, an MRI or scintigraphy to orientate toward the diagnosis of bone cancer and to check whether it has spread to other parts of the body.
• A biopsy is the only test that confirms the diagnosis: removal of bone tissue for analysis.
• A full blood test.

6. Treatments for osteosarcoma

The treatment plan will depend on several factors: the stage of development of the osteosarcoma (stage 1, 2, 3 or 4), the patient's general health and the location of the tumour. There are several stages of care.

• Chemotherapy: Whether the osteosarcoma is localised or metastatic, the first step is neo-adjuvant chemotherapy. The products used are generally cisplatin and doxorubicin, methotrexate or ifosfamide. The aim is to reduce the size of the tumour and treat any metastatic sites, stop the progression of the disease and reduce pain. This stage prepares the patient for surgery.
• Surgery: After chemotherapy, surgery is performed. The type of surgery considered depends on both the size of the tumour, its location and its response to pre-operative chemotherapy. It may be a wide excision, i.e. Removal of the tumour and a large part of the surrounding bone and soft tissue. On the other hand, it can be a conservative surgery, i.e. The removal of the diseased part of the bone and its reconstruction (bone graft, Endoprosthesis...) during the same operation. In 10% of cases, according to the Gustave-Roussy Institute, amputation is necessary (because the tumour is infected, too large, the osteosarcoma has affected the nerves and blood vessels, there is too little healthy tissue, etc.).
• Post-operative adjuvant chemotherapy: this chemotherapy is considered in specific cases of risk of recurrence. In other words, if metastases have been observed, if cancer has not responded well to pre-operative chemotherapy treatment if the tumour could not be removed at all or not entirely.

Scientists are continuing to explore ways of treating and preventing this type of cancer. One of the avenues being pursued is that of immunotherapy, developed in particular at Inserm over the last ten years. The principle of immunotherapy is to strengthen the immune system, so that it recognises cancer cells more easily and fights them better, rather than seeking a treatment that will attack the cancer cells themselves. This involves research into vaccines, monoclonal antibodies and immunomodulatory drugs (drugs that stimulate the immune system).

7. How can osteosarcoma be prevented?

As the causes of osteosarcoma can be multiple and are not all understood at this time, it is difficult to prevent this disease. However, it is advisable to adopt a healthy lifestyle, with a balanced and varied diet, regular physical activity, limiting alcohol consumption and stopping smoking. In this way, the risk of cancer and, more generally, health problems are limited to a minimum. Finally, as previously mentioned, it is essential to consult one's doctor quickly at the slightest doubt, especially if the patient is at risk: between 10 and 25 years of age, in the middle of a growth spurt, with a history of radiotherapy or bone disease, etc. The faster osteosarcoma is treated, the greater the chance of recovery and the lower the risk of sequelae.

 Peripheral neuropathy can have many causes. These include traumatic injury, infection, metabolic, neurotoxic, genetic, and often poorly regulated diabetes. The variety of causes and symptoms sometimes leads to a delay in the diagnosis and therefore in the effective management of the condition.

1. Definition of peripheral neuropathy

In the nervous system, a distinction is made between the central nervous system and the peripheral nervous system. The central nervous system includes the spinal cord and the brain, while the peripheral nervous system refers to the nerves located outside the spinal cord and the brain. In other words, the peripheral nervous system includes the cranial nerves, the spinal nerves and the billions of nerve cells in the body. The damage to or dysfunction of one or more peripheral nerves is called peripheral neuropathy. When only one nerve is affected, it is called mononeuritis. When several nerves are affected, it is called polyneuropathy or polyneuritis. The causes are very varied, as are the symptoms, which sometimes make the diagnosis difficult. However, this condition is far from rare. According to the journal Pain, in its article entitled "Neuropathic pain in the general population: A systematic review of epidemiological studies", neuropathy affects 7-10% of the population. 

2. Symptoms of peripheral neuropathy

The symptoms of peripheral neuropathy form a varied picture depending on the location of the nerve damage, but also on its severity. According to the High Authority for Health, the main symptoms are:

• Sensory symptoms: paresthesias (tingling, pins and needles, numbness...), dysesthesias (painful sensations) as well as hypoesthesias (loss of sensitivity) can be observed in the lower limbs, most often, but also moderate or intense pain (burning, a sensation of being held in a vice...), especially at night, and sometimes, balance disorders.
• Motor symptoms: motor disorders mainly affect the legs and result in muscle weakness in these limbs, or even paralysis. They are often accompanied by a loss of reflexes.
• Neurovegetative symptoms: malaise due to falls in orthostatic tension, erectile and ejaculation disorders, difficulty in urinating, abnormal sweating, diarrhoea or constipation, etc.

3. Causes of peripheral neuropathy

The causes of peripheral neuropathy can be many. There are several hundred of them, the most frequent of which are :

• Hereditary causes: indeed, a family history of neuropathy is a frequent cause in France. They are essentially a manifestation of the genetic disease of Charcot-Marie-Tooth.
• Neurotoxic causes: certain drugs (particularly those used in chemotherapy for the treatment of cancers, such as vincristine or cisplatin), but also exposure to neurotoxic elements in the diet and in the environment (lead, mercury, industrial chemicals, etc.) can cause peripheral neuropathy. Excessive and regular consumption of alcohol can also be a cause.
• Metabolic causes: kidney or liver dysfunction (chronic renal failure, hepatitis), hypothyroidism, poorly controlled diabetes, cancer, AIDS, autoimmune diseases such as rheumatoid arthritis or lupus can lead to the development of peripheral neuropathy.

4. Peripheral neuropathy: when to consult?

In the event of persistent pain that is not relieved by traditional analgesics, or lasting sensory, motor or neurovegetative symptoms, it is important to consult your doctor, who will refer you to a specialist (neurologist, rheumatologist, etc.) if necessary. Indeed, if peripheral neuropathy is not treated, complications may arise. This can be observed in the following cases:

• Falls: in the event of muscular weakness or orthostatic discomfort, the person may fall and injure themselves (fracture, head trauma, etc.).
• Infections: if the person has hypoesthesia, they may not perceive their wounds, especially on the foot, and allow them to become infected. This can lead to a major gangrene-like infection. This is why, especially for people with diabetes, it is recommended to regularly inspect the feet and areas of the body at risk and to scrupulously disinfect the smallest wounds.
• Burns: in the case of paresthesia or hypoesthesia, the patient may not be aware of the excessive heat of the water or the affected surface and may get burned.

5. Investigations and diagnoses of peripheral neuropathy

According to the Canadian Cancer Society, to establish the diagnosis of peripheral neuropathy, the physician, neurologist or rheumatologist relies on several elements:

• A discussion with the patient: this involves determining the chronology and evolution of the symptoms, the context of their appearance, the location of the symptoms and the factors that aggravate or alleviate them. But it is also a question of finding out about the existence of similar cases in the family, possible exposure to neurotoxic agents, etc.
• A clinical and neurological examination: this aims to analyse muscle strength, reflexes, the functioning of the cranial nerves, sensations, posture and coordination.
• An electromyogram (an examination that measures the electrical activity of the muscles) and a nerve conduction examination may be useful. These can determine whether the problem is located in the nerves, the nerve-muscle junction or the muscle.
• A biological check-up: analysis of fasting blood sugar to detect possible diabetes, search for hypothyroidism, blood count...
• A genetic test: if there is a suspicion of a hereditary disease such as Charcot-Marie-Tooth disease.
• A nerve or skin biopsy: a small part of a nerve or skin is removed to detect any abnormality.
• A medical imaging test such as an MRI or CT scan, to detect tumours, hernias or other problems.

6. Treatments for peripheral neuropathy

Treatments for peripheral neuropathy have two aims: firstly, to treat the condition that caused the neuropathy and, secondly, to relieve the symptoms. To do this, the doctor has various means at his disposal:

• Medicinal treatments: the specialist may prescribe analgesics (such as gabapentin or pregabalin for example), and non-steroidal anti-inflammatory drugs. Anti-epileptic drugs can also help relieve nerve pain, as can certain tricyclic antidepressants (venlafaxine, amitriptyline, etc.). Finally, topical treatments, such as capsaicin cream or lidocaine patches, can help reduce pain.
• Non-medicinal treatments: various options are available, depending on the nature of the neuropathy. If there is pressure on one or more nerves, surgery may help to release the compressed nerve(s). Another possibility is transcutaneous electrical nerve stimulation (TENS). This is carried out in a daily session of 30 minutes over a period of one month and consists of diffusing a gentle electric current at variable frequencies on the skin.
• A healthy lifestyle: eating a balanced diet rich in fibre, vitamins, antioxidants and lean protein helps to maintain the nervous system. A healthy lifestyle also includes regular physical activity compatible with the state of health: it is recommended to exercise for 30 minutes every day.
• Psychological support: as peripheral neuropathy sometimes greatly affects the quality of life of patients, psychological support may be necessary to live as well as possible with this pathology.

Alternative medicine can be a complement in the case of peripheral neuropathy.

7. How to prevent peripheral neuropathy

The best way to prevent peripheral neuropathic disease is to try to limit the risks upstream, i.e. to properly manage the conditions that play a role in its development. This can be achieved through various measures, such as:

• Limiting alcohol and tobacco consumption. If necessary, seek the help of an alcohol or drug specialist.
• Monitoring blood sugar levels to detect possible diabetes and, if this is the case, having it monitored in order to balance it.
• Adopting a healthy diet: eating 5 fresh fruits and vegetables a day, limiting the intake of animal proteins and saturated fats, and getting enough vitamin B12 to keep the nervous system in good condition.
• Regular physical exercise, of the order of 30 minutes a day, 5 days a week.
• Use good posture to limit pressure on the nerves.
• Avoiding exposure to nerve agents in your professional or personal environment.

Malaria is a potentially fatal disease caused by parasites. To find out more, see our full detailed fact sheet below:

 What is malaria?

Malaria is a potentially fatal disease caused by parasites. Parasites of the genus Plasmodium are transmitted by infected Anopheles mosquitoes, which usually bite at night.

The disease occurs mainly in tropical regions of Africa and South-East Asia. However, it can also be found in many countries, such as Mexico, Central and South America, the Middle East, Turkey, Pakistan, India and several Asian countries such as China.

There are four types of human malaria. The two most common are Plasmodium falciparum (the most deadly) and Plasmodium vivax. There is also Plasmodium malariae and Plasnmodium ovale.

Malaria can be cured. With proper treatment, the parasites can be completely eliminated from the body of the person affected. The parasite types, P. vivax and P. ovale have stages of the parasite that can remain in the liver without causing symptoms.

If not treated with the right treatment, and the right dosage, these stages can be reactivated and cause a relapse of the disease, even after several months or years. The P. malariae type can also remain in the blood for decades if left untreated.

In recent years, monkey malaria (Plasmodium Knowles), has been recorded in humans in some forests in South-East Asia.

Malaria transmission

Anopheles mosquitoes become infected when they bite a person with malaria. The small amount of blood they take contains parasites. These mix with their saliva and are in turn injected into the next person they bite.

In the human body, the parasites reach the liver and can remain there dormant for several days to several months (depending on the parasite involved).

When the parasites mature, they attack the blood cells. This is when people experience the symptoms of malaria.

Because the parasite is present in blood cells, malaria can also be transmitted through blood transfusions, organ transplants or sharing contaminated needles.

Malaria can also be transmitted from a pregnant mother to her child, either before or during birth.

 Malaria: how is it diagnosed?

In order to ascertain the presence of malaria, a diagnostic test can be carried out. A drop of blood analysed under a microscope can identify the presence of the parasite.

Rapid diagnostic tests, in the form of test strips, detect specific antigens produced by malaria parasites and present in the blood.

These tests are usually used in the field by travellers or small organisations to quickly and efficiently assess populations affected by the disease.

 Malaria: who is affected?

According to a World Health Organization (WHO) report1, there were nearly 216 million episodes of malaria in 2010, 81% of which occurred in Africa and 13% in South-East Asia.

In 2010, deaths associated with malaria are estimated at 655,000, 91% of which were in various parts of Africa and most of which were children under 5 years of age.

According to the WHO, since 2000, malaria mortality rates are estimated to have declined by more than 25% worldwide and by 30% in Africa.

This progress has been made possible by measures to combat and prevent malaria in malaria-affected areas: the widespread use of mosquito nets, improved diagnostic tools and better availability of antimalarial drugs.

Since 2008, 25 April has been declared World Malaria Day to raise awareness of the global effort needed to effectively combat this disease.

 Malaria: possible complications

Most malaria-related deaths are due to the consequences of complications of the disease; it is estimated that 90% of malaria deaths occur in Africa, especially in children under 5 years of age.

Brain damage (neuromalaria)

When blood cells infected with the parasite reach the brain, resulting in delirium, loss of consciousness, coma or death.

Pulmonary oedema

A build-up of fluid in the lungs that can lead to severe breathing problems.

Organ failure

Such as kidney or liver failure or rupture of the spleen which can cause death.

Severe anaemia

Caused by the destruction of infected red blood cells.

Drop-in blood sugar

Due to some severe forms of the disease, it can cause coma or death.

Recurrent episodes

Some strains of the malaria parasite, which usually cause milder forms of the disease, can persist in the body for years and cause relapses.

Malaria: symptoms

Symptoms appear between 10 and 15 days after the bite of the infected insect. Some types of malaria parasite (Plasmodium vivax and Plasmodium ovale) can remain inactive in the liver for weeks or even months before the first signs appear.

Malaria is characterised by recurrent attacks with three phases:

• chills ;
• headache; and
• fatigue and muscle pain;
• nausea and vomiting;
• diarrhoea (occasionally).

An hour or two later :

• high fever;
• skin becomes hot and dry.

Then the body temperature drops:

• profuse sweating;
• fatigue and weakness;
• the affected person falls asleep.

Malaria infections with P. vivax and P. ovale can relapse weeks or even months after the first infection, even if the patient has left the area of infection. These new episodes are due to "dormant" hepatic forms.

Some people are more likely to develop malaria. Also, there are risk factors for developing the disease.

Find out about them here.

 Malaria: people at risk

• Travellers

Children or adults who come from countries where malaria is not present and who have therefore not developed immunity.

• Residents of areas where malaria is present

They may be frequently exposed to the disease, so they develop partial immunity, which may reduce the severity of symptoms. However, this immunity may be lost by moving to a country where the parasite is absent.

• Other

Pregnant women and their unborn children;

• People with HIV/AIDS;
• people who receive blood transfusions (rarely).
•  Malaria: risk factors

Living in or visiting tropical areas where malaria is common and where the strains present to cause the most deaths, for example:

• African countries south of the Sahara Desert;
• countries on the Indian subcontinent;
• Solomon Islands, Papua New Guinea and Haiti.

There are certain preventive measures that can be taken to prevent the contraction of malaria.

Find out about them in this fact sheet.

 Malaria: preventive measures

• Why prevent malaria?

If not treated within 24 hours, Plasmodium falciparum malaria can lead to severe and often fatal complications.

Malaria is a preventable and curable disease.

Non-immune travellers from malaria-free areas are very vulnerable to the disease when they become infected.

• Basic preventive measures

Preventive medication

If you are planning to travel to an area where malaria is present, medicines can be taken a few days or weeks before, during and after your trip. They protect against malaria parasites.

Reducing exposure to mosquitoes

Using insect repellents (those containing DEET 20% to 35% or Picaridin 20%) are the most effective) to spray the walls of houses, clothes or skin.

Other measures:

• sleep under a mosquito net impregnated or not with insecticide (permethrin);
• cover the skin by wearing trousers and long sleeves after dark;
• avoid going out from sunset to dawn.

Measures to prevent aggravation

If symptoms of the disease are experienced after travelling to a malaria-affected country, it is best to have a diagnostic test carried out without delay, as the consequences of the disease can be fatal.

Malaria: treatments

Chloroquine is the cheapest and most widely used treatment for malaria. However, in many areas, especially in Africa, the parasites have become resistant to the most common drugs. This means that the drugs used are no longer effective in curing the disease.

Some drugs, based on artemisinin, are used intravenously and exceptionally in very severe cases.

A promising natural antimalarial

Artemisinin, a substance isolated from natural mugwort (Artemisia annua), has been used for various infections in Chinese medicine for 2000 years. Chinese researchers first became interested in it during the Vietnam War, when many Vietnamese soldiers were dying of malaria after spending time in mosquito-ridden swamps.

However, the plant was known in certain Chinese regions and was administered in the form of tea at the first signs of malaria. The Chinese physician and naturalist Li Shizhen discovered its effectiveness in killing Plasmodium falsiparum in the 16th century. In 1972, Professor Youyou Tu isolated artemisinin, the plant's active substance.

In the 1990s, when parasites were becoming more resistant to conventional drugs such as chloroquine, artemisinin offered new hope in the fight against the disease. Artemisinin weakens the parasite, but does not systematically kill it. It was first used alone, then in combination with other antimalarial drugs. Unfortunately, resistance is gaining ground and since 20094, there has been an increase in the resistance of P. falciparum to artemisinin in certain regions of Asia. A constant battle to be renewed.

Resistance to antimalarial drugs

The emergence of drug resistance in malaria parasites is a worrying phenomenon. Not only does malaria cause a significant number of deaths, but ineffective treatment can have significant consequences for the long-term elimination of the disease. Poorly chosen or interrupted treatment prevents the parasite from being completely eliminated from the infected person's body. The surviving parasites, less sensitive to the drug, reproduce. Through very rapid genetic mechanisms, subsequent generations of strains become resistant to the drug. The same phenomenon occurs in mass drug administration programmes in highly endemic areas. The doses administered are often too low to kill the parasite, which then develops resistance.

Malaria, when will there be a vaccine?

No vaccine against malaria is currently approved for human use. The malaria parasite is an organism with a complex life cycle and its antigens are constantly changing. Many research projects are currently underway internationally. Of these, the most advanced is in clinical trials (phase 3) for the development of a vaccine against P. falciparum (the RTS, S/AS01 vaccine) aimed at babies aged 6-14 weeks2.

 Malaria: the opinion of Dr Jacques Allard

"Malaria is a disease that is usually very treatable, but it is always very trying and can sometimes be fatal. It is, therefore, best to prevent it. If you are planning to travel to a country where malaria is endemic, first consult your doctor or a Clinique du Voyageur (in Quebec) to obtain a prescription for an anti-malarial drug for prevention. Furthermore, if you develop a high fever and chills during your stay abroad or even several months after your return, consult a doctor quickly because the complications can be very serious.

Dr. Jacques Allard M.D. FCMFC

In the case of malaria, there are complementary approaches to treat it in a more natural way.

See the list here.

 Malaria: complementary approaches

Eucalyptus

For travellers and residents of countries affected by malaria, it is recommended to protect the skin with insect repellents. Lemon eucalyptus (E. citriodora) essential oil is a traditional remedy for repelling biting insects5 that may have similar efficacy to insect repellents containing DEET.

Vitamin A

Vitamin A is thought to reduce fever, blood parasite levels and mortality in people infected with Plasmodium falciparum. Vitamin A is thought to be an effective and inexpensive way to control the parasite3.  However, there is still insufficient research to prove that vitamin A is equivalent or superior in efficacy to drugs used in the prevention or treatment of malaria.

Here you can find additional information and contact communities or support groups to learn more about the disease.

 Malaria: Sites of interest

International UNICEF Malaria dossier. www.unicef.org

World Health Organization (WHO) Numerous articles on malaria control strategies. www.who.int

Canada Public Health Agency of Canada Frequently asked questions about malaria, fact sheets on travel

 health. www.santepublique.gc.ca

Canadian International Development Agency Canada's contribution to malaria control and prevention.

 www.acdi-cida.gc.ca

France National Malaria Reference Centre for metropolitan France

Annual reports, publications and practical information. www.cnrpalu-france.org

PLAN France Child-centred development non-governmental organisation.

 www.luttercontrelepaludisme.fr

 What are the benefits of vitamin E? How to get it and what dosage is recommended? Here's everything you need to know about this vitamin.

Origin

It was in 1922, at the University of California at Berkeley, that the embryologist Herbert McLean Evans found following an experiment on rats, that females following a diet depleted in lipids could not produce viable fetuses. They conclude that a fat-related compound is essential for the development of the fetus.

Then, in 1924, further studies conducted by Benett Sure at the University of Arkansas showed that a compound removed from the diet of male rats caused their sterility. Benett Sure calls it vitamin E.

In 1936, it was again Herbert McLean Evans who succeeded in isolating vitamin E from wheat germ oil.

It will then take 30 years for vitamin E to be recognized by the National Research Council of the United States as an essential nutrient for human health.

What is vitamin E used for?

Vitamin E is a substance that is found in 8 forms in nature: 4 tocopherols and 4 tocotrienols. The most common form is alpha-tocopherol. Vitamin E acts as an antioxidant. It neutralises the free radicals that destabilise the lipid molecules present in the cell membranes. These antioxidant properties are also used in the food industry: vitamin E is added to food to prevent the oxidation of fatty acids, a reaction is commonly known as "rancidity".

According to a 2012 study, gamma-tocopherol and tocotrienols help fight Alzheimer's disease. According to a 2010 study, they also prevent cirrhosis (caused by non-alcoholic fatty liver disease). Vitamin E has also been shown to be effective in the treatment of menstrual pain (2001 and 2005 studies in Tehran).

Thanks to its antioxidant effect, vitamin E helps to combat cataracts, arthritis and coronary diseases.

In addition, vitamin E has benefits for the skin: it delays ageing, makes the skin more supple and facilitates healing. For example, there are vitamin E face masks. Vitamin E is also beneficial for the health of the hair. In addition, vitamin E, together with other vitamins A, C and D, helps to maintain good hearing.

How much vitamin E do we need?

Here is the satisfactory intake (AI) of vitamin E published by the Anses (National Agency for Food, Environmental and Occupational Health Safety), according to sex and age, in milligrams per day:

• children under 6 months: 4 mg/d ;
• children aged 6 months and over: 5 mg/d ;
• children aged 1 to 3 years: 7 mg/d;
• children aged 4-6 years: 7 mg/d;
• children 7 to 10 years: 9 mg/d ;
• adolescents 11-14 years: 10 mg/d;
• adolescents 15-17 years: 10 mg/d;
• adolescent girls 15-17 years: 8 mg/d;
• men 18 years and older: 10 mg/d;
• women 18 years and older: 9 mg/d;
• pregnant women: 9 mg/d;
• breastfeeding women: 9 mg/d.

What are the signs of vitamin E deficiency?

Vitamin E deficiency is very rare and only occurs after several years without intake. It occurs mainly in people with diseases characterised by poor fat absorption, such as Crohn's disease, celiac disease and cystic fibrosis. Symptoms of vitamin E deficiency are burning in the feet and hands and neurological problems (impaired reflexes and muscle weakness).

In infants, vitamin E deficiency can lead to a form of haemolytic anaemia and muscle weakness. Premature babies can suffer from haemorrhages in the brain and abnormal growth of blood vessels in the eyes (retinopathy of prematurity).

What foods are rich in vitamin E?

Natural vitamin E is present in certain oils: wheat germ oil, argan oil, sunflower oil, avocado oil, rapeseed oil, almond oil, safflower oil, cottonseed oil, etc. Other sources of vitamin E include dried soya, peanuts, almonds, sunflower seeds, spinach, paprika and tuna.

Where to find vitamin E?

What are the dangers of overdosing?