ANOREXIA DAMAGES BODY

Lizzie Porter lived with anorexia throughout her teens. Now in late 20s, she’s been discovering that those years of starvation have left a lasting imprint on her body. “You have osteoporosis in your spine and osteopenia in your hip. I’m going to put you on calcium and vitamin D and I think you should take them forever. We need to prevent breaks and fractures.” It is May 2018, and my doctor’s words jolt me out of a long-standing state of denial. They come with a set of complicated graphs, which apparently show my low bone density. I don’t understand them. But I can read the words printed next to a fuzzy X-ray-like picture of my spine: “World Health Organization classification: osteoporosis. Fracture risk: high.” For years, I have muddled along, pretending to myself that I had pretty much made a full recovery from anorexia. Yes, I was told back in 2010 that I had osteoporosis. But over the next eight years I persuaded myself that things must have improved, that the holes in my spine must have healed.

Sadly, they haven’t.


Osteoporosis and osteopenia

  • Osteoporosis is a condition in which bones lose their strength and are more likely to break
  • If your bone density is between the lower end of the normal range and the osteoporosis range, you have osteopenia.

Source: National Osteoporosis Society


I was first diagnosed with anorexia at the age of 12, and soon experienced its unglamorous consequences. As summers grew hotter, I shivered: I was like a reptile, unable to generate my own body heat. In winter, my skin cracked and bled, but would not heal, for want of nutrition. I had constipation, bloating and my hair fell out in great clumps. My life revolved around avoiding food.  Over the past 15 years, I have had two in-patient stints in hospital and taken thousands of antidepressants – anorexia is often accompanied by a low mood, sometimes even a suicidal mood is one reason it has the highest mortality rate of all psychiatric disorders. I have seen more doctors than I can be bothered to remember. I have done my best to keep what my mother calls the “anorexic minx” in my mind in check, preventing it from doing a Jack-in-the-Box-style bounce back into my life. The desire to get on with things has spurred me to give up many of my anorexic behaviour patterns. Time was, I would spend hours weighing out salad components in the kitchen, using a different knife to chop each tomato, cucumber and lettuce leaf. I no longer want to waste time on my old routines. And, mostly, I do not.

Lizzie Porter and Muhammad EidoLizzie Porter with a friend – her teeth may look healthy but have required expensive treatment

Anorexia caused my body to age rapidly and I am struggling with the disorder’s longer-term consequences. Osteoporosis involves loss of bone density, and in later life may lead to painful breakages, curvature of the spine, and loss of height. Although it has many causes and often affects post-menopausal women, anorexics are also at risk, especially girls who develop the illness at puberty when the body is trying to build a strong skeleton. For a day or so, the bone scans shake me awake. I walk around the Lebanese capital Beirut, where I live, feeling a bit sick. What am I doing to myself? The thought rolls over in my mind. I remember one elderly woman in my home village in Hertfordshire, who used to walk bent double. Osteoporosis is an old ladies’ problem, I tell myself angrily. I am only 27. Yet all too soon I return to my state of calm apathy. I pretend that my bones aren’t really thin and weak. I’m strong and perfectly healthy, I tell myself, even though I am on calcium and Vitamin D supplements for life, I get dizzy when I stand up, and blood tests show I have been suffering badly from anaemia – a lack of red blood cells or haemoglobin in the blood. To improve my bone density I should eat more and gain a little weight. But my life is “too busy” to deal with the stress of challenging the last remnants of my anorexic behaviour. I still add up my daily calorie count on a calculator, and I am prone to lash out at anyone who forces to me to eat things I am scared of, such as cake, pastry and cream. This year I have at least allowed a friend to coax me into ordering salad with oil – this fills me with pride, though at the same time I feel ashamed of years I spent worrying over salad dressing. But I need to go further. Osteoporosis is not the only long-term effect of my anorexia. The loss of bone density has also affected my teeth, which ache and easily rot. Since the beginning of the year I have spent £4,200 ($5,500) on dental treatment, including eight fillings, root canal treatment, two crowns and an implant.

X-ray of Lizzie Porter's teeth
 X-ray of Lizzie Porter’s teeth

“The lack of calcium and vitamin D is definitely contributing to this,” says my doctor – a GP who happens to be a specialist in eating disorders. One upshot of my weak teeth and gums is that after years of being subject to psychological barriers that restricted my diet, I now have physical ones. Anything chewy, crunchy or cold is almost impossible to eat. Can you recover from anorexia?

  • A 2002 study found that 46% of patients made a full recovery, a third improved (but retained some eating disorder symptoms), and 20% remained chronically ill over the long term
  • The eating disorder charity, Beat, says recovery is always possible with the right help and support – but what recovery looks like is individual to the person
  • It adds that most medical complications arising from anorexia are reversible, but not all – for example, osteoporosis

It is difficult to predict how badly anorexia will affect each sufferer’s long-term health: bodies react in different ways. Other possible long-term effects can include infertility and difficulty conceiving, heart problems, and kidney and liver complications, according to the UK-based eating disorders charity, Beat. “I don’t think people realise the dangers of the illness and its physical and mental consequences, including the suicide risk. I know it frightens people, but we need to know the facts,” says Jane Smith, chief executive of the UK-registered charity Anorexia and Bulimia Care. The National Institute for Health and Care Excellence guidelines for treating anorexia instruct doctors to explain to sufferers that the main way of preventing and treating low bone density is “reaching and maintaining a healthy body weight or BMI for their age.”If I am entirely honest with myself, I know I have to try a little bit harder if I am to minimise the long-term consequences of anorexia. I certainly cannot go backwards. I have enough purpose in my life to want to live it. I have a job as a journalist that I love, friends I trust, and parents who support my every move. One morning this May, one of my closest friends, Leila, sent me a WhatsApp message in response to one of my many rants. I was tired and fed-up with life. “I’m not going to tell you a few kilos won’t make you fat, because that’s what’s in your head,” she wrote. “I’m going to tell you that you get to choose between being ‘fat’ and functioning, or thin and bed-bound. You get to be thin but your life is over. That’s all there is to it.”

What can I say? Most of me knows she is right.

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IRON DEFICIENCY ANAEMIA

Iron-rich foodsDo you get enough iron from your diet? If not, liver red meat, green vegetables, nuts and seeds are good dietary sources of iron. And if you often feel tired, short of breath or you feel you heart beating faster inside your chest go for check up from your doctor. If friends commented you look unusually pale iron deficiency anaemia, is the world’s most common nutritional disorder in UK, common among young women. Analysis by the government’s Scientific Advisory Committee Nutrition (SACN) on iron and health in 2011 indicated 21% of women aged between 19 and 34 had below recommended level ferritin of iron is stored in the body. I recently suggested to a friend with the symptoms to get herself checked out by her GP. A blood test revealed she was so anaemic it was surprising she could still walk upstairs. A few iron tablets sorted her out. It’s worth adding that you should talk to your GP if you’re considering taking them – you might not need them and your symptoms could be caused by something else. The body can’t produce iron, so you have to get it in your diet whether through foods that naturally contain it or those fortified with iron, such as white bread and breakfast cereal. The problem is not all of iron is in a form you can actually absorb.Trust Me teamTo get iron from food eat leafy green vegetables raw, steamed, but do lightly boil your spinach. Eat or the fruit juice containing vitamin C with meals And a fermented bread is best for ealth. The Trust Me I’m a Doctor asked nutrition scientist Prof Paul Sharp, from King’s College London, to find the foods you should be eating to boost iron levels naturally. Red meat is rich in the sort of iron bodies find easy to absorb but these days many people are either cutting back on red-meat consumption or cutting it out altogether. And there are good sources of iron in dark-green leafy vegetables, such as kale and spinach, and pulses, such as peas and lentils. The problem is you don’t absorb as much iron from plant sources as you do from red meat. Then, there is the iron you can get from fortified bread and breakfast cereals, though again it is not always in a very absorbable form. To demonstrate this, a neat party trick is to grind up the cereal, add some warm water and you can actually use a magnet to draw the iron filings out of the mush. Wait for your coffee. How you prepare your food and what you drink with it can change how much iron you absorb. To demonstrate this, Prof Sharp carried out experiments to mimic human digestion. The tests mimicked the effect of the enzymes involved in digesting food and the chemical reaction that occurs in human gut cells to show how much iron would be absorbed. Prof Sharp showed that if you drink orange juice with your fortified breakfast cereal you absorb much more iron than when eating the cereal on its own – because orange juice contains vitamin C, makes it easier to absorb iron from food. Disappointingly, if you drink coffee with your morning bowl of cereal, then that will mean you absorb significantly less iron.CabbageRaw cabbage anyone? According to Prof Sharp, it’s because coffee is full of chemicals called polyphenols that are very efficient at binding to the iron and making that iron less soluble. So, if a fortified cereal is your breakfast of choice, then having a small glass of orange juice or an orange will help increase your iron uptake. You might also want to consider postponing your morning coffee until at least 30 minutes after you’ve eaten.But what if you prefer getting your iron from more natural sources? Raw cabbage is a good source of available iron but we found that steaming it lessened the amount of available iron while boiling reduced it even further. That’s because, like oranges, cabbage is rich in vitamin C – and when you boil it, the vitamin C is released into cooking water. If you want to get the maximum nutrients from your cabbage, eat it raw (an acquired taste) or steam it. The same is true of other veggies that contain both iron and vitamin C, such as kale, broccoli, cauliflower and watercress. But, strangely enough, spinach is completely different. We found that when we boiled the spinach, it actually released 55% more “bioavailable” iron than when eaten raw. Prof Sharp says: “Spinach has compounds, called oxalates, and they basically trap the iron. “When we cook spinach, the oxalate is released into the cooking water, and therefore the iron that remains will be more available for absorption.” Finally, what about the bread? We found the best bread for delivering iron was sourdough bread. That’s because wheat contains a chemical called phytic acid that slows down iron absorption by body. When sourdough bread is made, the fermentation process breaks down the phytic acid so the iron that remains is more available for absorption. There are more diet tips on the Trust Me website.

Trust Me I’m a Doctor continues on BBC Two on Wednesday, September 12, at 20:00

VEGAN FOOD BEYOND MEAT

The Vegan BEYOND MEAT founder Ethan Brown wants people to eat less meat for healthy eating to save environment. BBC’s weekly The Boss series profiles a different business leaders in the world. This week Ethan Brown, the boss and founder of vegan food company Beyond Meat is featured. Ethan Brown’s 12 year old son eats a burger almost every day. It may not sound like a diet a parent would want for their child, but Mr Brown has no concerns, because the burger patties come from his own company, Beyond Meat. And they are made entirely from plants. “My son gets clean protein and no cholesterol,” he says. “He’s growing like crazy right now so I want him to have that protein.” Mr Brown says he is on mission to redefine the word “meat.” The 40-something’s Los Angeles-based business makes vegan burger patties, chicken strips and sausages from plant proteins. They are formulated to mimic the taste, texture and look of beef, chicken and pork.A Beyond Burger pack being picked off a shelfBeyond Meat asks supermarkets to stock Beyond Meat Burgers next to their packs of meat. Stocks of the company’s flagship Beyond Burger product quickly sold out after launch in the US in 2016, helped by a positive article in the New York Times. And more than 25 million Beyond Burgers have been sold and this summer the company launched product in UK and also mainland Europe. Their High-profile investors are Microsoft’s Bill Gates, Twitter founders Biz Stone and Evan Williams, and actor Leonardo DiCaprio. “There’s no mystery to meat,” says Mr Brown. “It’s amino acids, lipids, trace minerals and water. “And if you can deliver those four things in same blueprint or architecture as muscle – why can’t that be called meat?”Cattle on a ranch in KansasMr Brown is concerned about effects of environmental impact farming animals has causing ozone methane gas and the amount of resources used per cattle. So before launching Beyond Meat in 2009, Mr Brown worked in alternative energy sector as a hydrogen fuel cell developer. While he liked that work because of its potential for lowering vehicle emissions he decided to make bigger contribution to society focusing on trying to reduce the environmental impact livestock has on the planet. He also wants people to eat less meat for animal welfare and the health issues. Mr Brown set up Beyond Meat, and began researching how you can use plant materials to replicate the composition of the proteins and fats in meat. Getting in touch with scientists at the University of Missouri who were doing research on plant-based meat substitutes, he began working with them on creating a viable product.A Beyond Meat patty in a burgerBeyond Burger uses beetroot extract to give it a blood-like colour. Put together by the best scientists on this [challenge], Mr Brown says. He understands meat more than anyone else in the world, so and build it bit by bit using plants.” Mr Brown spent all his savings on venture, raised money from family and friends. “I truly begged family members,” he says. “It’s amazing what do to make it work.” The first product Mr Brown and the team of scientists came up with was Beyond Chicken Strips. After repeatedly phoning grocery Whole Foods, “almost to the point of indecent behaviour”, he says he managed to get a meeting that resulted in the store stocking product from 2013. However, Mr Brown wasn’t happy with the early recipes. “We got the vegetarians by the droves, but we didn’t get the mainstream consumer,” he says. “We had to go back to the drawing board.” Team of biochemists, biophysicists and biomedical scientists got to work on making products even closer to real meat. With improving the formulations Mr Brown says the biggest challenge is people to stop thinking of it “fake meat.” I would never call it that,” he says. A mobile phone is not a fake phone it’s better phone than landline so people need to think about it this way. The best-selling Beyond Burger patties “bleed” like beef burgers, thanks to the addition of beetroot juice. They include pea protein, coconut oil, potato starch, and the company asks supermarkets to stock them beside the raw beef products by chilled counters. The product is now stocked by 8,000 supermarkets across US, and in thousands of the country’s restaurants. In the UK it is served at burger chain Honest Burger. It was also due to be on sale at supermarket chain Tesco from last month, but that has now been delayed until later in the year. Beyond Meat says it’s because it was struggling to keep up with existing demand, both in the US and overseas.UK chain Honest Burger's Beyond BurgerUK chain Honest Burger sells the burger made Beyond Meat’s patty. Consumers are coming round to the notion of plant-based meat substitutes that aim to look and taste like the real thing. More than a quarter of Britons (26%) say they find idea of products appealing, according to research group Mintel.“So this company Beyond Meat is in a strong position to capitalise on current interest in limiting meat intake,” says Mintel’s UK food and drink research director Kiti Soininen. So just how good does company’s products taste? A trawl of online food blogs show reviews are mostly positive. While some reviewers say burgers taste unnervingly like real beef, others say they definitely don’t. While Beyond Meat has many rivals, including US start-up Impossible Meat and the UK’s Moving Mountains, Mr Brown says that Beyond Meat is struggling to keep up with demand. “We are trying as hard as we can to catch up,” he says. The company, started with 10 people operating from a kitchen in a former hospital, now employs 200.An Impossible BurgerA number of other companies make vegan burger patties that replicate beef as closely as possible, as this offering is from Impossible Burger. And it has just opened its second production facility in Columbia, Missouri, which it says will create a further 250 jobs. In addition, it has launched a new research lab in Los Angeles. This expansion is been funded by external investment in the business that now totals $72m (£56m). Mr Brown won’t reveal the stake he retains in the company, but calls it “decent share.” Mr Brown, who spent his childhood outside Washington DC, says he approaches his every working day like an athletic event eating well, exercising and meditating. At work, he admits, his focus is intense, and there’s “not much chitchat time.” “I tell my son this all the time,” You ‘re not going to get extraordinary outcome if you don’t put an extraordinary amount of work in.”

UGLY FOODS THROWN AWAY

fruit and vegetablesQuality foods grown with precious time and resources are thrown away because these foods do not look PERFECT to the buyer. A third of farmed fruits and good vegetables never reaches supermarket shelves because its misshaped or wrong size according to new research. Though billions of people starve everyday, these foods are not donated to people as Olio App does helping save good foods. It is a sad thing that a mere aesthetic shape of a nutritious food is thrown while people including children die from starvation. It is necessary to stop using these foods, provided by Almighty God to feed all the people as weapon of power to deny feeding people or those who can it turn into cooked food for the homeless. This is gone on for far too long as tonnes of perfect food is buried everyday but the human beings die from starvation. This is an issue can help save farmers from bankruptcy as their crops are wasted. No matter how perfect a food crop is, it is cut to shape or mashed depending on the recipe. Often finished food product served looks beautiful regardless of the shape before cooking. Food waste must stop because even hard-working people cannot afford expensive ingredients in the supermarkets anymore. Setting up a department for lower incomes to buy is frowned upon because of fear it might undercut profit margins if cheaper food is sold alongside “perfect glamourised” shapes selected in name of customers. It is argued customers “prefer” the perfect fruits and vegetables shapes only. But a lot of ordinary people struggling to feed their families do not mind the shape of an ingredient. Cooking foods or eating a misshaped fruit does not affect people in any way. It is unacceptable excuse so volunteers can organise the distribution to people listed to buy vegetable boxes regularly or receive it as the donations to homeless Charities to cook. There is more than enough food to feed all the people living on earth but this sort of actions deprives billions of food globally each day. It does not make any sense to throw good away because of its shape. .onions in fieldA University of Edinburgh study found more than 50 million tonnes of fruit and vegetables grown across Europe were discarded each year. This was in part because they did not “meet consumers’ expectations” of how they should look. The study was published in the Journal of Cleaner Production. It examined food loss and waste in European Economic Area and examined how much food was discarded each year before it reached the point of being sold. The researchers attributed losses to strict government regulations, supermarket high standard as well as customer expectations of how produce should look. They found that the farmers contracted to supermarkets typically grew more food than obliged to supply, to allow for a proportion that would not be deemed fit to sell. The researchers suggested that greater awareness among consumer movement towards shopping encourage the sale of more ugly vegetables. Stephen Porter, of the University of Edinburgh’s School of GeoSciences, said: “Encouraging people to be less picky about how their fruit and vegetables look could go a long way to cutting waste, reducing the impact of food production on the climate, and easing the food supply chain.” In recent times, UK supermarkets are making more space for increasing amounts of less-than-perfect produceLast year, Sainsbury’s campaign encourages use of blemished bananas, while Morrisons introduced a new “wonky” range that included avocados. Others, including Waitrose, Tesco and Asda, branched out into selling misshapen fresh items. A lot of unemployed people can organise sale of cheaper food produce schemes to help solve food waste. Billions of people starve everyday even in these advanced countries in Europe but food is thrown away everyday. The golden rule is to be each other’s keeper so feel good helping others and saving food from wastage. 

More on this story

  • Supermarkets step up wonky fruit and veg push

COCONUT OIL SUPER FOOD?

CoconutsCoconut oil classified is considered a superfood according toCoconut oil is high in saturated fatSales of coconut oil are rocketing, propelled by celebrity endorsements and claims that drinking the stuff will cure everything from halitosis to digestive disorders. Actress Angelina Jolie-Pitt is said to have a tablespoon or so with breakfast most mornings, while model Miranda Kerr says she not only adds it to salads and smoothies, but she cooks with it and splashes it on her skin as well. The health claims that swirl around coconut oil are treated with a great deal of scepticism by scientists. Coconut oil is seen, in the scientific community, as an unhealthy fat. It is very high in saturated fat (86%), even more so than butter (51%) or lard (39%). The reason that foods rich in saturated fats are frowned on is because eating them causes a rise in blood levels of LDL (low density lipoprotein). LDL is known as “bad cholesterol” because high levels are linked with increased risk of heart disease. On the other hand, saturated fats – which are particularly bad for you – also tend to raise HDL, “good” cholesterol, which has the opposite effect. It is possible that a particular food can raise overall cholesterol levels, yet still be heart-friendly.

Cholesterol check

So is coconut oil a cholesterol-busting wonder food, as some claim, or is this all dangerous hype? Despite all the sound and fury that surrounds coconut oil there have been surprisingly few human studies carried out to test specific health claims. So for the current BBC2 series of Trust Me I’m a Doctor, we thought we should help organise a trial. The Trust Me team started by contacting Prof Kay-Tee Khaw and Prof Nita Forouhi, both eminent Cambridge academics. With their help we recruited 94 volunteers, aged 50-75 and with no history of diabetes or heart disease, and designed a study to assess what effect eating different types of fat would have on their cholesterol levels. We began by randomly allocating our volunteers to one of three groups. Every day for four weeks, the first was asked to eat 50g of extra virgin coconut oil – that’s about three tablespoons full.

Type of oil or fat Polyunsaturated (%) Monounsaturated (%) Saturated (%)
Coconut oil 2 6 86
Butter 3 21 51
Lard 11 45 39
Goose fat 11 56 27
Olive oil 10 76 14
Rapeseed oil 28 63 7
Sesame oil 41 40 14
Corn oil 54 27 12
Sunflower oil 65 20 10

The second group was asked to consume the same amount of extra virgin olive oil. Olive oil is a key element of the Mediterranean diet, which is widely seen as being extremely healthy. And the third was asked to eat 50g of unsalted butter a day. Again, that adds up to just over three tablespoons. The volunteers were told that they could consume these fats in whatever way they pleased, as long as they did so every day for the whole four weeks. On the other hand others think that Coconut oil ‘as unhealthy as beef fat and butter’ so the Diet debate: Is butter back and is sat fat good? They were also warned that, because they were consuming an extra 450 calories a day, they might well put on some weight. Before our volunteers started on their new high-fat regime we took blood samples to get baseline measurements, focusing mainly on their levels of LDL (the “bad” cholesterol) and HDL (the “good” cholesterol) The importance of these two measures is that your heart attack risk is best calculated, not by looking at your total cholesterol score, but your total cholesterol divided by your HDL score. NHS Choices suggests that this figure should be below four. So what happened? As expected the butter eaters saw an average rise in their LDL levels of about 10%, which was almost matched by a 5% rise in their HDL levels Those consuming olive oil saw a small reduction, albeit a non-significant drop, in LDL cholesterol, and a 5% rise in HDL. So olive oil lived up to its heart-friendly reputation.Olive oil

Early Stages of Studies

But the big surprise was the coconut oil. Not only was there no rise in LDL levels, which was what we were expecting, but there was a particularly large rise in HDL, the “good” cholesterol, up by 15. On the face of it that would suggest that the people consuming the coconut oil had actually reduced their risk of developing heart disease or stroke. Olive oil is a key element of the Mediterranean diet, which is seen as particularly healthy. I asked Prof Khaw, who was clearly surprised by these results, why she thought it had happened. “I have no real idea,” she candidly replied. “Perhaps it is because the main saturated fat in coconut oil is lauric acid and lauric acid may have different biological impacts on blood lipids to other fatty acids. The evidence for that comes mainly from animals, so it was fascinating to see this effect in free-living humans.” So should we be hailing coconut oil as a health food? “I think decisions to eat particular oils depend on more than just the health effects” she said. “This is just one study and it would be irresponsible to suggest changing dietary advice based on one study, however well conducted.” This was a very short-term study and compared to olive oil, research on coconut oil is at an early stage. So the claims about coconut oil being a superfood are premature. But if, like me, you enjoy putting coconut in your curries, there seems no very good reason to stop.

The new series of Trust Me I’m a Doctorcontinues on BBC2 at 20:30 GMT on Wednesday 10 January and will be available on iPlayer afterwards.

AN AMAZING WEIGHT LOSS

Among many people’s priority resolution for the new year is the desire to lose weight. An amazing weight loss plan used by this man transformed his life to shed the extra pounds of weight in a short time. So there is hope for many more people to follow his example to lose weight too. The father-of-two lost 12 stones in under a year in remarkable weight loss effort attributed to low calorie diet. Lorry driver Adam Moffat, 44, sheds half his body mass after adjusting eating habits. The Independent Online shared this story of Adam Moffat with his wife Margaret and daughters Hannah, 13, and Holly, nine Katielee pictured here by Arrowsmith /SWNS. The father-of-two is now half the size of the man he used to be after shedding more than 12 stone in less than a year. Prior to shedding half his body weight Adam Moffat, 44, gorged on pies, cakes and daily double rolls crammed with sausages. He would scoff cakes with breakfast and lunch and would even sneak in a kingsize Mars bar before dinner.

A FAMILY FEELS NO PAIN?

Letizia MarsiliA family does not feel pain according to the story recently reported in the news. Letizia Marsili and five other members rarely feel pain  Letizia Marsili, 52, first realised she was different when she was very young. She has high threshold for pain meaning she did not feel burns or notice broken bones. Five other family members are also affected by condition which means they are insensitive to pain. Letizia told the BBC: “From day to day we live a very normal life, perhaps better than the rest of the population, because we very rarely get unwell and we hardly feel any pain. “However, in truth we do feel pain perception of pain, but this only lasts for a few seconds.” Scientists believe the condition could be down to some nerves not reacting properly. Researchers who studied the family hope their discovery of a gene mutation in family members could help chronic-pain sufferers in future. “We have opened up a whole new route to drug discovery for pain relief,” said Prof Anna Maria Aloisi from the University of Siena in Italy.

How is family affected?

Letizia’s mother, two sons, sister and niece all show signs of being affected by syndrome that is named after the family Marsili pain syndrome. She said pain was an important alarm signal because they feel it fleetingly, the family often have fractures go undetected and this leads to inflammation in their bones. They also experience burns and other injuries without knowing. Letizia said her 24-year-old son Ludovico, who plays football, has encountered problems. “He rarely stays on the ground, even when he is knocked down. However, he has fragility at the ankles and he suffers distortions, which are micro fractures. “In fact, recently X-rays have shown that he has lots of micro fractures in both ankles.” She said her younger son Bernardo, 21, had a calcification of the elbow without realising he had broken it after falling off his bike. He continued cycling another nine miles. Fractures, broken bones and burns are often not noticed and don’t heal properly.Fractures are often missed because the family doesn't feel the pain

Letizia says when she fractured right shoulder skiing she continued to ski all afternoon, only going to the hospital the next morning because her fingers were tingling. So same thing happened when she broke a bone in her elbow playing tennis. “Because of a lack of pain, it got so stressed that it ended up breaking,” she says. But the worst thing, she says, was problems in her mouth because of a tooth implant went wrong. Letizia’s mother, Maria Domenica, 78, has had a number of fractures which have never healed properly and have hardened naturally. She suffers burns because she doesn’t feel any pain. Her sister Maria Elena often damages the top of her mouth because she burns herself with hot drinks, and her daughter Virginia once left her hand in ice for about 20 minutes without feeling pain. Despite all this, Letizia says she has never seen  condition “as a negative for our lives.”

Do they feel little pain?

Lead study author Dr James Cox, from University College London said Marsili family members had all their nerves present, but “they’re just not working how they should be.” He said: “We’re working to gain a better understanding of exactly why they don’t feel much pain, to see if could help us find new pain relief treatments.” The research team, whose findings are published in the journal Brain, worked with family to find out nature of their phenotype the observable characteristics caused by their genetics. The Marsili syndrome, named after them, means the affected individuals are less than normally sensitive (or hyposensitive) to extreme heat, capsaicin in chilli peppers, have experienced pain-free bone fractures.

Scientists discover genes

The researchers mapped out protein-coding genes in each family member’s genome and found a mutation in the ZFHX2 gene. They then conducted two studies in mice which had been bred without this gene and found their pain thresholds had been altered. When they bred a new line of mice with relevant mutation they found they were notably insensitive to high temperatures. Prof Aloisi said: “With more research to understand exactly how the mutation impacts pain sensitivity, and to see what other genes might be involved, we could identify novel targets for drug development.” The family is believed to be the one in the world to be affected by this faulty gene.

Additional reporting by Mauro Galluzzo