Good morning and welcome to the latest edition of the Weekly Wellbeing Round Up! Today I thought I would kick things off with news about things that don’t work.
The Health Supplements Don’t Work
As you may be aware, it is recommended in the UK that we take a daily over the counter dose of Vitamin D in the winter months. This is to compensate for our rubbish weather at that time of year with insufficient sunlight. Whilst it’s all very sensible to top up levels of things we might be deficient in, this does not necessarily mean therefore that more and more of something is better and better.
This New Zealand study published in JAMA found that there was no difference in cancer rates between those given vitamin D and those given placebo. Previous studies have suggested there may be an inverse relationship between Vitamin D dose and incidence of cancers, although the data is inconsistent. In fairness, this was a post hoc analysis on a study into cardiovascular health and high monthly doses of Vitamin D were taken. So you could speculate whether taking the vitamin D in a different way (i.e. lower dose, more regularly) might work differently. But that would just be speculation.
Speaking of things that don’t appear to work, this article giving commentary on the Cochrane review into Omega 3 supplementation makes interesting reading. Omega 3 fat acids have been generally considered to be a good thing, being anti inflammatory with some observational studies suggesting improved outcomes and reduced mortality in cardiovascular disease. This cochrane review states that for primary and secondary prevention of cardiovascular disease, there is no evidence that supplementation with omega 3 has any effect. But before you throw your oily fish in the bin, it’s worth considering a few things. Firstly, it is probably a mistake just to take one specific nutrient and focus on giving people more of it. The benefits that have been observed historically from eating oily fish may well not just be due to omega 3 in isolation. So just as I recommend you eat the fruit, not the juice, I also recommend you eat the fish, not the tablets. Supplements are not a replacement for a health diet. Secondly, there is much more omega 3 in our foods generally now than there was a few years ago, so this may be a confounding factor which potentially disguises any benefits from introducing a supplement in a study population. Previous studies have demonstrated a threshold for certain levels of fatty acid below which the increase of heart disease increases. It doesn’t necessarily follow that mega doses of these same fatty acids have any increased benefit once an adequate level in the body is reached.
To summarise…too much of a good thing can be completely ineffectual. In fact, anything can be toxic in the right dose, including sunshine and water! There is a large and growing industry out there in nutritional supplementation. I tell my patients that by and large if they are eating a healthy varied diet and do not suffer from any known malabsorption problems, there is no need solid evidence to support taking nutritional supplements and therefore no need to waste their money on it. I suspect this makes me a persona non grata in my local health food shop. Unless I’m buying goji berries and nuts.
Continuing on the theme of things that either don’t work or are potentially bad for you, I found this article in the BMJ on the risks of sulfonylureas (a second line drug for type 2 diabetes) rather concerning. An increased risk of cardiovascular events and hypoglycaemia (low blood sugar) was noted. The recommendation was made that metformin (the drug that most people with type 2 diabetes are first started on) be continued along with the sulfonylurea (rather than swapped out). It is accepted that metformin has cardiovascular benefits, or, to put it in every day language, “gives your heart a hug”. What really concerns me here is that this recommendation is basically saying we should use one drug to counteract the side effects of another. In my view is that doctors and patients should be discussing lifestyle medicine as the main first line treatment to control or cure diabetes, way before we end up introducing first/second/third line drugs for this condition, which are not without their risks.
Having spent the first part of this blog bashing drugs and supplements, let’s take a look at a different kind of prescribing…social prescribing. This is something that we have been focussing on in Hertfordshire and there is some great work being done in this area. We have people called Community Navigators who are there to help when the issues are not directly medical but more about the other, possibly more important, determinants of health such as housing, employment and social networks. This survey discussed in GP Online shows that social prescribing continues to gain traction amongst GP’s with almost one in four GP’s now using it. The Royal College of GP’s has recommended that there should be a social prescribing service in every GP surgery. I agree. For me, the GP practice of the future is not just a surgery but a wellbeing hub with all these services accessible as simply as possible, ideally under one roof.
Public Health and Prevention
Our new secretary of state for health Matt Hancock (yep, I’d never heard of him either until the cabinet reshuffle) has gone on record as saying he would like to see an end to the “over-prescription of unsophisticated drugs”, focusing instead on approaches that address a person’s physical and mental well-being. This is very welcome. However, fine words butter no parsnips. There have been huge cuts to to public health budgets which is going to pose a challenge when it comes to his apparent commitment to spending money on prevention. It was handed over to local authorities in 2013, which I believe was a mistake. The cuts are having a real impact. Smoking cessation services in some part of the country have already been affected, as detailed in this article in GP online. CCG’s and Public Health teams are going to have to talk to each other about this as a matter of urgency. I would go a step further. For me, Public Health needs to become part of the NHS again with more decision making by front line clinicians. That’s not to say my colleagues in public health are not doing their level best with what resources they have, but I believe to best serve our patient population we need more clinical leadership. Dr Michael Dixon offers the same opinion in this other article on GP online about public health. As before, I believe that this is likely to work better if delivery of these services is more GP practice or wellbeing hub-based, perhaps making better use of volunteers where appropriate.
The best health intervention, freely available to all of us.
Finally, my favourite podcast this week is Episode 27 of Feel Better, Live More. Dr Rangan Chatterjee interviews Professor Matthew Walker in part 2 of their conversation about sleep. I cannot recommend this enough. Having previously disclosed my struggles with giving myself enough of a “sleep opportunity”, since I listened to these two podcasts and reading Matthew Walker’s excellent book “Why We Sleep”, it has really changed my behaviour. I’m prioritising sleep more and waking up every morning feeling refreshed, before my alarm goes off…which is my body’s way of telling me that I am now getting enough sleep. It has helped me with weight loss and I feel that I have a lot more energy. The added bonus of waking up early is that I now have extra time in my day to do things like exercise, meditate, catch up with work…and write this blog! Episode 27 was the last in this excellent series which has had over a million listens since it went live in January. No need for those of us who have enjoyed this to worry, however, as a new series will be coming in September. So if you haven’t listened to any of the episodes so far, you can enjoy bingeing on them over the summer holidays!
That’s it for this week’s Wellbeing Round Up. It’s going to be a scorcher this week with temperatures hitting thirty degrees most days and a lot of humidity, so keep your fluids up, stay out of the sun between 11 and 3 (particularly if you are very young or very old), wear a hat and use suncream. Until next week… take care of yourself.
Dr Richard Pile