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The world’s deadliest infectious disease is on the rise in the UK

A blood test could identify millions of people who unknowingly spread tuberculosis, scientists have said.

More than a million people a year die from tuberculosis (TB), making it the world’s deadliest infectious disease, according to the World Health Organisation.

Researchers at the University of Southampton discovered a group of biological markers that are high among infectious patients – and the test could be a significant step in reducing the spread of the disease.

Thankfully, in the UK figures remain low. However, TB cases in the UK increased to around 5,000 in 2023, according to the UK Health Security Agency, and are expecting to continue to rise this year.

So, how do you catch TB, and what else do you need to know about the infectious disease?

What is TB?

Emma Rubach, head of health advice at the charity Asthma + Lung UK, says tuberculosis or TB is a bacterial infection that usually affects the lungs.

“Anyone can get tuberculosis, however, the people most at risk are those who have lived outside of the UK where TB rates are high. Countries where tuberculosis is more common include Bangladesh, China, India, Pakistan, and Indonesia.

“Only 5-10% of people who breathe in TB bacteria develop symptoms and they can become ill in weeks, months, or even years after exposure,” Rubach adds.

“There are two types of tuberculosis. Latent tuberculosis, which is when you have TB bacteria in your body, but because the body’s immune system controls the bacteria and stops it from growing, you don’t experience any symptoms and can’t pass the infection on to others. Then there is active tuberculosis, when the body’s immune system can’t control the TB bacteria and you develop an infection.”

 

Tuberculosis remains a major killer in low and middle income countries (Janice Carr/Centers for Disease) (PA Media)© Provided by The Independent

How do you catch TB?

“Most tuberculosis infections are airborne. You can contract it from bacteria coughed up by another person with the infection,” says Dr Colin Michie, associate dean for research and knowledge exchange at the University of Central Lancashire.

“There is a less common type of TB, Mycobacterium bovis, which is found in unpasteurised milk. Consuming this product can therefore put you at risk of contracting the infection, particularly if the cattle involved are not carefully screened.” 

What are the symptoms of TB and is it serious?

Tuberculosis is a serious infection, which can be fatal if not treated properly.

“The poet Keats, composer Chopin, and authors Bronte and Orwell are just some of the people throughout history who have died from tuberculosis,” notes Michie.

Rubach says some people may be more at risk of suffering serious symptoms, such as those with weak immune systems, malnourishment, diabetes, people who regularly smoke, drink or take drugs, as well as children under five.

“Active tuberculosis usually affects the lungs but can also affect other parts of the body,” says Rubach. “Symptoms include a cough that lasts more than three weeks, chest pain, weight loss, extreme tiredness, loss of appetite, a high temperature, swollen glands, headaches and body aches and pains.”

Asthma + Lung UK also advises people to call 999 or go to A&E if they have a stiff neck and severe headache, it hurts to look at bright lights, you’ve had a fit (seizure), or your behaviour changes – for example, you become confused – and if you can’t move certain parts of your body. 

How do you treat TB?

Rubach says both latent and active TB need to be treated with antibiotics, to help kill off the bacteria. “For latent TB, treatment usually lasts between three to six months, and in active TB, for at least six months,” she adds. “If the TB is affecting the brain or spinal cord, the treatment may last for 12 months.” 

The Best Substitutes for Allspice

As its name suggests, allspice has uses in all sorts of recipes. This chameleon of a spice lends its aromatic warmth to both sweet and savory dishes—everything from meats to beverages to pumpkin pie. If you use allspice with regularity—which, given its versatility, you certainly might—you may run out of it quickly. 

Whether you have used the last of your allspice or your local grocery store simply does not stock it, there are several alternatives you can use in a pinch. Here is everything you need to know about allspice, plus three handy substitutes that offer something close to its signature flavor. 

What Is Allspice?

Because allspice’s flavor mimics that of a blend of other spices, it is easy to assume it is made up of various components. But check the side of your allspice tin and you will see just one ingredient—allspice! 

When first picked, the berries are green but then dry to the darker brown color you are likely familiar with. Ground into a powder, the flavor of allspice is somewhat sweet and earthy reminiscent of cinnamon, nutmeg, or cloves with a hint of bite like black pepper. 

Allspice Uses

Not surprisingly, allspice is used frequently in the cuisines closest to its origins. Latin American and Caribbean—especially Jamaican—dishes often call for a sizable dose. Allspice is an invaluable component in Jamaican jerk seasoning used on chicken, fish, and more. 

The flavoring power of allspice is not limited to the Western hemisphere, though. Plenty of Middle Eastern recipes make use of allspice to add complexity to lentils, vegetables, and meat. 

Indian chai tea often includes allspice in its sweet-and-savory, multi-spice blend, and English Christmas pudding simply would not be the same without its fragrant warmth. Meanwhile, other desserts like gingerbread, cookies, pumpkin mousse, or sweet potato pie are all enhanced by allspice. 

Whole Allspice vs. Ground Allspice

As mentioned, allspice begins as peppercorn-sized pellets. Leaving these berries whole has advantages in certain recipes. According to spice manufacturer McCormick, whole allspice berries have a milder, less intense flavor than the ground version.1 

This fact makes them ideal for flavoring—but not overpowering—slow-cooked stews and meats with lengthy braising times. If you would like to mull your own holiday cider or wine, allspice berries can join whole cloves and cinnamon sticks in a bouquet of autumnal flavor. Just remember to remove them before drinking. Pickles and sauerkraut also get a subtle flavor boost from whole allspice berries. 

In baked goods, ground allspice can blend seamlessly with wet and dry ingredients. And, in velvety soups and sauces, the last thing you want is an unpleasant crunch—so ground allspice is best. As part of a spice rub, ground allspice is superior to the whole version for smoothly coating meats or vegetables. 

Allspice Nutrition Facts

Allspice is not a source of many nutrients. In fact, it flavors foods with nearly zero calories, carbs, and sodium. The following nutrition information, for 1 teaspoon (1.9 grams) of ground allspice, has been provided by the USDA.2 

Best Substitutes for Allspice

Fortunately, allspice’s signature flavor, though unique, is not impossible to imitate. To select the right alternative, look for spices with a balance of warmth, sweetness, and hint of bite. 

Also, do not forget about color. In recipes where appearance matters, stick to substitutes with a deep brown hue. Use any of the following spices—or a blend of all three—as a suitable substitute for allspice. 

Cloves

Of all the options for allspice alternatives, ground cloves may be the best. Their dark color is nearly a match for allspice’s deep brown, so they will not change the appearance of foods. 

As for flavor, their combination of sweetness and pungency is a close cousin to allspice. Still, you may find cloves leave a stronger impression than allspice—so try adding them gradually, if possible. Cloves also are not known for being as peppery as allspice. 

Ground cloves can be substituted for ground allspice with a one-to-one ratio. Because they are low in almost all nutrients, using them will not dramatically change the nutrition in a finished food. 

Nutmeg

There is a reason you will often see allspice paired with nutmeg—the two have a strikingly similar flavor. Like allspice, nutmeg is also harvested in whole pods from an evergreen tree—though it originates in Indonesia, not Central America. 

When possible, start with a one-to-two ratio of nutmeg to allspice and work your way up, tasting as you go. If the recipe calls for 1/2 teaspoon of allspice, for example, start with 1/4 teaspoon of nutmeg. 

To recreate the signature kick of allspice in savory dishes, again, try a dash of pepper alongside the nutmeg. Swapping nutmeg for allspice will not make any significant nutrition changes and is not likely to change the appearance of foods either. 

Are you still perusing the spice cabinet? Here is one last common option you are likely to have on hand when the allspice jar is empty—cinnamon. 

But in a pinch, its pleasant earthiness will do just fine. And do not forget about that extra sprinkle-of-pepper option. 

Because cinnamon’s taste is not overpowering, you can add it to recipes with a one-to-one ratio to allspice. Like nutmeg and cloves, cinnamon’s color and nutrient profile are close enough to allspice for a nearly indistinguishable switch. 

 The Health Benefits of Cinnamon 

A Word from Verywell

Several com on pantry spices can easily come to the rescue when your allspice is all gone. Alone or in combination, warming options like cloves, nutmeg, or cinnamon bring much-needed flavor to stews, muffins, pies, and casseroles.

You also could try similar spice blends like pumpkin pie spice or Chinese five-spice powder. A bit of tinkering with your own perfect blend may yield the best results. 

Reference:  Sarah Garone, NDTR ; Published on November 10, 2021;  Medically reviewed by Ayana Habtemariam, MSW, RDN, LDN

What is gender dysphoria and how can you support your trans friends?

People can question their gender for a lot of reasons, but many people do so because they feel uncomfortable in their body or in living as the gender they were assigned at birth. This discomfort is known as ‘gender dysphoria’.

Gender dysphoria is a broad-ranging term that’s used in the medical field, but also more generally by some trans people to discuss their experiences with their gender identity. While people experiencing gender dysphoria may be referred to a gender dysphoria clinic (GDC) for further advice on how to manage or alleviate their dysphoria, gender dysphoria itself is not a mental illness.

“There is a phenomenon called gender incongruence which describes any feeling where your internal sense of identity – your sense of who you are in terms of gender – is different to the sex that you’re born into,” explains Cleo. “This incongruence can come with feelings of discomfort and anxiety, physical discomfort, or even pain. In some cases, these can be quite severe, permanent feelings of discomfort about one’s body or the relationship between yourself and your body.”

Cleo points out that while all trans people feel a sense of gender incongruence, not everyone who feels gender incongruence is necessarily trans. People might feel unaligned with the gender they were assigned at birth due to gender stereotypes, for example.  

There are lots of ways to manage gender dysphoria, Cleo adds, including medical interventions such as hormone replacement therapy (HRT) or surgery (also known as ‘medical transition’), parental support, peer support, and educational support.

Cleo explains that one of the first things that can help someone who is experiencing gender dysphoria is “being able to have conversations about how they’re feeling in a supportive environment.”

“Being able to talk to their friends and family about how they’re feeling, and being supported if they want to change their name, try out different pronouns, dress in a different way, these can all be really effective in helping someone feel well,” she continues.

After this, some people may go on to medically transition, although Cleo points out that this is becoming increasingly difficult in the UK, due to increasing hostility towards trans people and lengthening waiting times to access gender-affirming healthcare. But, she continues, for people who do need those services, it can be life-changing. “It can completely remove or significantly reduce that discomfort and give people a new lease on life.”

How to support someone who is experiencing gender dysphoria

Experiencing gender dysphoria can be distressing, so it’s important to continue to support your loved one as they navigate their feelings. “The first thing to do is to just be the friend, loved one, or partner that you are to them already,” advises Cleo.

“One thing we see a lot [at Gendered Intelligence] is someone coming out as trans or asking questions around gender identity, and the people around them pulling away because they’re not sure how to act or what to say,” explains Cleo, adding that this isn’t necessarily because the person is transphobic or unsupportive, but because they may be surprised or confused. 

But, she points out, what people who are experiencing gender dysphoria or questioning their gender need most at that time is stability. Someone confiding in you about their gender dysphoria is, as Cleo says, a “display of trust”.

“The best way to help them is reassurance and to help them walk through their thoughts,” she adds.

Where to find support

If you’re looking for support to help you better understand gender dysphoria or to better support a loved one who may be experiencing it, Cleo recommends reaching out to local Pride groups who may be able to direct you to resources in your area.

You can also find support from Switchboard, a national LGBTQIA+ support line, or Gendered Intelligence (where Cleo works), a trans-lead charity that offers support services for trans people and their loved ones. 

“No one’s expected to become an expert overnight on trans issues,” concludes Cleo. “But what can be really meaningful is listening, offering the support that you can provide, and helping that person to get the support that they need – whatever that is – that you can’t [help them with].” 

Pioneering cooling boots and mittens to help stop chemo side-effect

Brian Conroy is used to the cold nipping at his fingers and toes after a lifetime in construction work and fishing in all weathers at weekends. But his hands and feet are now being deliberately cooled in a clinical trial - the first of its kind in the NHS - looking at reducing one of the most debilitating side-effects of chemotherapy: peripheral neuropathy.

This type of nerve damage can cause constant pain, as well as a tingling sensation, weakness or numbness, in the fingers and toes.

While for some the side-effect is short term, in many others it lasts for months, years or becomes permanent.

If fingers are affected, it can make everyday tasks difficult, particularly fiddly ones such as doing up buttons. And with toes, it can cause balance problems, meaning patients have to rely on walking aids.

Some research suggests more than two-thirds of patients suffer chemotherapy-induced peripheral neuropathy - and a 2019 study in the journal Pain reported about 30 per cent of patients will still be living with it a year or more after finishing chemotherapy.

Brian Conroy's hands and feet are being deliberately cooled in a clinical trial looking at reducing one of the most debilitating side-effects of chemotherapy: peripheral neuropathy© Provided by Daily Mail

Dr Rick Walshaw, a consultant clinical oncologist at the Clatterbridge Cancer Centre in Liverpool, who is leading the new trial, explains: 'Several chemotherapy drugs can cause peripheral neuropathy, because they damage the tiny nerve endings that supply the skin in the fingers and toes.' 

Indeed, it is a side-effect of some of the most common chemotherapy drugs, used for multiple cancer types. These include the taxanes, such as paclitaxel, often used to treat breast, ovarian, prostate and lung cancers; as well as alkylating agents, including oxaliplatin, used to treat colorectal, stomach or pancreatic cancers.

Peripheral neuropathy can seriously affect patients' quality of life, explains Dr Walshaw. 'A significant proportion can suffer with it years after finishing chemotherapy - even if their cancer is in remission. It can be very stubborn to treat once it has occurred.'

He adds: 'It also has a cumulative effect - so it may not be obvious after the first one or two cycles, but the longer patients take the drug, the more damage it can cause.

'Currently, if a patient gets peripheral neuropathy during treatment, then the dose of oxaliplatin, for instance, has to be reduced or even stopped. Potentially, this means we are not going to control the cancer as well.' 

Dr Walshaw adds: 'Antidepressants and anticonvulsants can lessen the pain of peripheral neuropathy, as these drugs increase brain chemicals which can affect pain signals - but there are no drugs to prevent or cure it.'

Brian, 64, is being treated with oxaliplatin following a bowel cancer diagnosis earlier this year, and has already had two of his four chemotherapy treatment cycles (these are given every three weeks: his treatment will end in January), when he also had the hand-cooling therapy.

Before he was diagnosed, Brian had been suffering from diarrhoea for two months and had been taking daily loperamide, an over-the-counter tablet, to control it. When he spoke to his GP surgery about having this on a regular prescription, it was suggested he make an appointment to see his doctor. 

'They said my symptoms needed investigating,' recalls Brian, who lives with his wife in Birchwood, near Warrington, Cheshire.

After examining Brian, his GP referred him for an endoscopy, where a tiny camera is used to examine the bowel. 'It found a tumour and they said this was highly likely to be cancerous,' says Brian. 'I was shocked as up to then I had been pretty blasé.

'The first thing I said was, 'Where do we go from here?' '

In September, Brian had a CT scan, which showed the cancer had not spread. He underwent surgery within two weeks and 'just felt glad to be alive', he says. Then, before starting three months of chemotherapy, Brian was asked if he wanted to join the trial.

He says: 'I was keen to be involved because I'm self-employed in the building trade and want to continue to use my hands and my feet as normal once I'm recovered so I can get back to work as soon as possible.'

Peripheral neuropathy can seriously affect patients' quality of life, explains Dr Walshaw (Stock photo)© Provided by Daily Mail

Half an hour before each chemo session begins, he puts on specially adapted boots (similar to ski boot liners) and mitten-style gloves, keeping them on while the oxaliplatin is delivered via a drip in his arm (in his case for two hours), while he sits in a chair.

Cold water is pumped into the gloves and boots via tubes running through them; the temperature is maintained at around 15c.It is thought that when hands and toes are cooled, the blood vessels constrict, meaning less chemotherapy drug reaches them.

This week: Dr Nighat Arif, a GP and menopause specialist, recommends magnesium. She says:
Good dietary sources include nuts, dark chocolate and wholegrains. Magnesium intake generally has dropped - and deficiencies can lead to high blood pressure, hardened arteries and osteoporosis.

A 2018 review warned that many people in the UK were suffering from magnesium deficiency, potentially a principal driver of cardiovascular disease, reported the journal Open Heart. This is of particular concern for middle-aged women - the review stated 84 per cent of postmenopausal women with osteoporosis were magnesium deficient.

Studies also show supplements can increase sleep duration and quality so I recommend magnesium if menopause is affecting sleep. Research to explain this is limited, but we do know it helps raise levels of melatonin [the hormone which regulates sleep/wake patterns]. 

Suggested dose: 300-600mg of magnesium citrate a day.

The approach is not dissimilar to the use of cold caps to reduce hair loss during certain types of chemotherapy - this cooling process cuts blood flow to the scalp, reducing the amount of drug reaching this area, preventing hair loss.

Research published earlier this year in the Annals of Oncology showed promising results for the hand and foot cooling system.

The study in Belgium, which used the same kit supplied at the Clatterbridge, compared side-effects in 77 patients receiving oxaliplatin with and without cooling. After 12 weeks, the patients in the control group (who didn't have the cooling therapy) had 20 per cent more peripheral neuropathy in their hands or feet compared with those who wore the cooling gloves and boots.

Similar results were found after 24 weeks, with the study concluding the treatment was generally well tolerated by patients. 

The UK trial came about after medical student Emily Kelly, who was on placement at the Clatterbridge, spoke to Dr Walshaw about her mother Barbara's experience of bowel cancer treatment. Barbara had done her own research and read about how cooling her hands and feet - which in parts of Europe is also used for breast cancer patients - could help her lessen these common side-effects.

Dr Walshaw's team looked into the practicalities of keeping a patient's hands and feet cool while having chemotherapy and borrowed two cooling systems from the equipment's manufacturer, Hilotherm.

As the loan was for only five months, it was decided to use the machines on bowel cancer patients having oxali- platin, as the treatment fits into that timeframe.

'This ongoing study is about the feasibility of delivering this treatment without causing significant disruption,' says Dr Walshaw. 'We want to ensure it is not too cumbersome for the patients and that the staff can easily apply it.

'A few years ago, the cold cap technology started out like this,' says Dr Walshaw. 'That also was tried on only a few patients in clinical trials - but today it's standard care for many.'

If the new study, which will involve 25 patients with bowel cancer being treated at the Clatterbridge's Wirral and Halton clinics, proves successful, then the approach will be trialled in different cancers and with different chemotherapy drugs. The current study is due to end in March.

Dr Duncan Gilbert, a consultant oncologist in lower gastrointestinal cancers at University Hospitals Sussex NHS Foundation Trust, welcomes the new trial.

'Peripheral neuropathy can be a major problem for patients. Its effects can be lifelong and given that many of these patients will be cured of their cancer, this can represent a life-changing side-effect.

'So looking at cooling aids like this to improve long-term healthcare is very welcome.' 

Brian's experience of the new kit so far has been promising.

'I didn't have any tingling in my hands and toes after my first two sessions of chemotherapy which was good. And the temperature is not unpleasant, only a bit cold - like going out on a winter's day without gloves on,' he says.

'If this can stop the pins and needles being a lasting side-effect, it's certainly worth doing.'