Welcome back to the Weekly Wellbeing Round Up. We’ve taken a couple of weeks off to focus on the low down on low carb diets, and digital wellbeing. I’m pleased to say that this week normal service is resumed. Topics for today include calorie counts in menus,veganism, probiotics, the cost of eating health food, heart age and heart disease. Let’s tuck in….
Counting the cost of counting calories
The department of health and social care is to launch a consultation on its plans to require calorie counts on menus as part of its childhood obesity strategy. The BBC reported this week that concerns had been raised by the treasury about the cost to small businesses, and the risk of distressing people with eating disorders. recommended this week that. Whilst I have sympathy for both potentially affected groups, I think we should ask ourselves what our priorities should be for the health of our nation and particularly our nation’s children. I seriously doubt that my local greasy spoon cafe will go out of business because they have to work out the calories in their full english breakfast.
Is being vegan good for your health?
The BBC reported this week on the experience of Dr Giles Yeo going vegan for a month, in an episode of Trust Me I’m A Doctor. During his trial, Giles lost weight, reduced his body fat and his cholesterol. He required dietary advice to avoid becoming deficient in certain nutrients such as iron, vitamins B &D, omega 3 fatty acids, calcium, iodine and protein. Some of this can be sourced from plants, but some probably requires supplementation.
This meta-analysis found that people on a vegetarian (including vegan) diet had an overall descreased risk of dying from heart disease and cancer but that there was no overall decrease in cardiovascular deaths or all cause mortality compared to non-vegetarians.
Take home message? You might be slightly less likely to die of heart disease and cancer but overall vegetarians don’t live longer. It is sensible to consider going meat free for some of your meals each week…maybe replacing them with oily fish. Whilst my quality of life might be improved in some respects, I could no longer have a sausage, egg & bacon bap with my buddy Al on a sunday morning after our bike ride. That would be a No then.
Children in food poverty
On a more serious note, the Food Foundation issued a report stating that “a healthy diet is beyond the reach of 3.7 million children in the UK“. It’s a shocking statistic. There isn’t an easy answer to this one. It’s easy to glibly state that an apple costs less than a mars bar (which is generally true, in fairness), but it is a fact that crap food is cheap, and good food either costs more or (and I think this is part of the problem) takes more time and knowledge to prepare.
The answer for me has to be pragmatic. Whilst influencing national policy and financial instruments is beyond the ability of most of us, we can take simple steps to improve the situation even if we can’t achieve perfection. There are plenty of books and websites out there about cooking on a budget. Some examples include:
Some providers of lifestyle services including cooking lessons, not just lectures about healthy eating. If you really want to be challenged and inspired in this area, I heartily recommend Dr Rangan Chatterjee’s interview with Jamie Oliver in Episode 16 of his Feel Better Live More podcast. Jamie’s passion for this subject shines through. I particularly like his ideas about using his recipes like a jukebox for types of meal and associated costs, to come out with some realistic options for families struggling in this area. If you are a health professional talking to a family about this, just remember that even if they eat one or two healthier family meals per week, and their kids have maybe one or two healthier lunches at school, that is making a difference and it’s a start.
Probiotics…the sage continues.
Finally for our food section this week, the BBC reported on this study in the journal Cell which reported on the use of probiotics and whether they have a meaningful impact on our gut flora. It’s a very long paper and to summarise very simply…they don’t have much effect if taken in a one-size fits all approach. If you think about it logically, introducing a tiny amount of unsuspecting friendly bacteria into a person’s entire gut flora or “microbiome” is going to have very little impact in terms of relative numbers.
Take home message? Our understanding of the gut microbiome is still at a very basic stage and there is very little available to us so far in terms of evidence that has immediate practical applications. In the future we will look back and realise how little we knew. Probiotics might work better if it is possible to take a personalised, individual approach to treatment. For now, if a patient asks me whether they should take some “friendly bacteria”, I advise them that they won’t do any harm but in the average person they won’t do much good either.
The World Health Organisation has recently produced a report on global levels of activity. It was a self reported study based in 168 countries with 1.9 million participants from 2001 to 2016. The BMJ reported on the findings this week. Sufficient activity was defined as 150 mins of moderate intensity activity per week. 36% of UK adults were insufficiently active, with Kuwait winning the wooden spoon at a whopping 67%. Women were generally less active than men. Inactivity was a worse problem in high income activities. Over the study period, levels of physical activity did not rise. The solutions are large scale and up to governments when it comes to decisions about transport and infrastructure etc. Personally, I think 36% of UK adults being insufficiently active is a massive under-estimate and a reflection of a lot of people kidding themselves when they filled int the report. My take home message is that health professionals should bear this in mind and drill down a bit more into a person’s history when asking about how active they are. Physical activity is a miracle cure, a wonder drug. If you haven’t seen it, I recommend you take five minutes to view Twenty Three and a Half Hours on YouTube. It ends with an excellent challenge that puts all our excuses about physical activity into perspective.
My dog Prince has offered to be share, with anyone who wants to know, how he feels about exercise. All you need to do is to come round to our house, look him in the eyes and ask him if he would like a walk. You may wish to consider wearing body armour with an anti-slobber coating for this exercise. Don’t say I didn’t warn you. Here is the presentation he has put together.
Heart health and disease
In a collaboration between Public Health England have released a Heart Age online tool that allows you to calculate what your heart age is compared to your actual age. When it comes to risk, people often struggle to get their heads around risk scores as percentages over a number of years and scoring tools are increasingly calculating the age of the relevant organs in your body (heart, brain, lungs) as it is felt that this is a more powerful motivator for people to make changes. You can take the test online. If your heart appears to be significantly older (according to Public Health England!) then you actually are, it may be worth booking a phone call with your GP to talk things through. If you haven’t already done so and are between the ages of 40 and 74, I recommend you take up the offer of a free NHS health check.
As a new user of EMIS (a GP computer system), I attended the national user group conference in Birmingham this year. It was a great event and both I and the rest of my surgery team learnt a lot and came away with loads of ideas for how we can provide better and more efficient care for our patients. One of the highlights of the conference was the Lifestyle Medicine presentation by Dr Rangan Chatterjee and Dr Ayan Panja. Excellent, inspiring stuff. The real time roleplay between Rangan and Ayan of a GP consulting with a stressed, sleep deprived patient was particularly good and could have taken place in any GP surgery in the land. I was able to catch up with both of them afterwards and we talked about the difference that this approach can make to our lives as patients and healthcare professionals. I have already seen a positive impact on the lives of some of my patients. I am definitely going to sign up for their highly rated, RCGP-approved Prescribing Lifestyle Medicine course in January 2019. If you can’t wait that long, I recommend you get a copy of Rangan’s Four Pillar Plan in the meantime. I recommend it to all my patients who need to make changes in their life, as it has helped me to make changes in my mine.
That’s it for this week. I hope you have enjoyed the blog. Your comments and feedback would be really helpful. If there are particular topics you would like me to cover, please let me know and I will do my best to keep it real. Until next week, take care of yourself!
Dr Richard Pile