The Weekly Wellbeing Round-Up #23

Welcome to episode 23 of the weekly wellbeing round-up!  Some of you may have noticed an item or two in the news this week about the publication of the NHS’s vision for prevention, publicised by Matt Hancock the health secretary.  Plenty to chew over there and for this reason I will be devoting this week’s post to the subject, looking at the positives, the negatives and the unanswered questions – for patients and for doctors – from a pragmatic perspective.  Let’s jump straight into it!

Prevention is better than cure

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OK, so it’s a pretty obvious title for a government paper on the subject, but one that is clearly appropriate and hard to argue with.  The paper was published this week and you can read the full forty-one page document here, as well as Matt Hancock’s blog post on its publication here.  Just in case you don’t have the time or inclination to read all of that, I have summarised some of the key points and some of the issues that arise as a result.

The importance of prevention

Whilst it’s not necessary to spend a lot of time agreeing with motherhood and apple pie, there are a few points made that are worth reflecting on.  Firstly, how might we define prevention?  Here it is described as “about staying people stay healthy, happy and independent for as long as possible”.  Not a bad definition.  It is worth remembering that we can’t prevent everything (ageing and death being two obvious examples) and sometimes it might be more accurate to use the term “delayative” rather than “preventative” medicine.  However, it’s still very important as one key area is the number of years of life that we enjoy in good health… something we will touch on later.   It is pointed out in the document that we spend over ten times more money on treating disease rather than preventing it (£97 billion vs £8 billion).  This demonstrates that, whatever the rhetoric may have been, we clearly aren’t getting the balance right and it still needs to shift significantly.  If we do what we’ve always done, we should be entirely unsurprised when we get what we have always got.

Funding for prevention

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Much play is made of the increased funding for the NHS, an apparently rising amount up to £20.5 billion a year in five years’ time.  Clearly this is welcome.  The welcome should be a cautious one, however.  First of all we need to be sure that none of this is simply rebadged money.  Secondly, money absorbed into existing NHS deficits (e.g.  overspent clinical commissioning groups and hospital trusts) is not available to be spent and therefore not a real terms increase,  so we need to be clear about where it’s going.   Thirdly,  the big issue of funding for public health was not addressed by the health secretary when he was asked this question repeatedly on the Today program this week.  Public health funding provides services such as smoking cessation, weight management and sexual health clinics.  The budget has been slashed in the last few years.  There has not been an announcement yet about the budget for next year.  If this is further reduced (or in my view, not increased) then a lot of the rhetoric about funding will ring hollow.

Who is responsible for practising prevention?

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There are a lot of references to personal responsibility in the vision document.   Generally speaking, I’m a big fan of personal responsibility.  Ultimately we all make our own decisions about what we put in our mouths, how much we drink and whether we are physically active.  I really struggle when I talk to people about the risks they face to their long-term health and wellbeing and their response is either to shrug or to suggest that it’s up to the medical profession to sort it out for them.   That said, life is not a level playing field.  There is evidence of inequalities in society increasing rather than decreasing in some areas.   Many factors influence a person’s wellbeing and the majority of them are not directly related to physical health e.g. housing, employment, education and social networks.

One area that is highlighted is the aim to halve reduce childhood obesity by 2030.  In the UK we have one of the highest childhood obesity rates in Western Europe. Serious public policy is required here, not just telling kids and their parents to eat more fruit.  People worry about the nanny state and curbs on freedom, but the biggest advances to health have often been the result of large-scale public health interventions such as safe drinking water, vaccination and smoking bans.  I’m a massive fan of the nanny state.  We need cities safe for cycling, better public transport,  advertising bans and more tax on unhealthy foods and sugary drinks, mandatory calorie counts on menus, regulation of fast food shops on the high street and near schools, and increased input into the school curriculum.  We need the government to take responsibility for this as well as expecting local authorities to do their bit.  If this does not happen, then very little else will.

Social prescribing for prevention

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Social prescribing involves helping patients to improve their health, wellbeing and social welfare by connecting them to community and other third-party services – for example those run by a council, local charity or lifestyle and wellbeing service provider.  The vision document highlights the  important part that social prescribing has to play in prevention.  It is important to “change the mindset from condition management to health creation”.

Our clinical commissioning group has a strong social prescribing model which has received national recognition .  We have a team of  community navigators serving each of our local areas.   My practice patient participation group has just launched a social prescribing group that dovetails in with this service, offering weekly clinics for primary care team members to refer into where we feel that a person’s needs might be better met by this than by a medical practitioner (e.g.  to address loneliness and debt).   However, we need to ensure that we don’t see social prescribing as an option to compensate for lack of funding and support from central government and local authorities, relying on the good will and free time of individuals and charities.  If it works as a concept and in reality, it must be properly commissioned.

I was rather tickled to read this BBC news article which reports the health secretary advocating GP’s prescribing song playlists as well as medication.  I like the idea although I’m not sure that this is necessarily something that will ever make it into the core general medical services contract.  I’m also not sure that my sharing any of my playlists with my patients would be a kindness, but just in case you are interested, here are my apple music playlists for ambient music, jazz , electronic dance music and rock.  A little something for whatever suits your mood, I hope.


Technology for prevention

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Our secretary of state for health is very keen on his technology.  I was rather suspicious at the beginning of his tenure that a lot of statements were made about using apps to transform the NHS.  Don’t get me wrong – I’m proud to consider myself a bit of a geek and have always looked to use technology to help me work smarter and more efficiently – but it did raise the suspicion that this might be a message that all we need to do to save the NHS is to use our smartphones more.  Maybe this isn’t entirely fair as there is going to be an increase in funding, which I have already covered. Two particular aspects of using technology caught my eye in this document.

Predictive technology

The first aspect is use of a predictive technology to assess risk which is not just limited to a body system or a disease.  Bearing in mind my earlier comments about the determinants of wellbeing outside of health,  I think this is a really interesting idea and would be a considerable extension above and beyond current risk tools such as Qrisk2, which allow you to put in a postcode as part of calculating a person’s risk but nothing more than that.   How such a tool would be developed and demonstrated to be valid is another issue altogether but one that I look forward to learning more about.


Oh how we love our telehealth in the NHS.  The great solution to everything.  The thing that everyone of every age demands and desires.  The thing that will radically change the NHS.  The thing that has lots of evidence behind it…oh, wait.  No, it doesn’t.  As someone who used to be responsible for telehealth developments in our clinical commissioning group, may I take this opportunity to say just how weary and cynical I am about the whole thing?  It may augment NHS services if used in just the right group of people with just the right level of engagement.  It will be convenient for some patients.  However, an appointment with a doctor remains an appointment with a doctor and takes up the same amount of time as any other kind of appointment.  Next time you are at your doctor’s surgery,  try asking about the level of excitement they feel about now having to consider telehealth as well.  See?  Told you.

Prevention…what’s the point?

This is what it all comes down to.  We need to be clear about this.  We can’t stop people ageing or dying (despite NICE’s best efforts when it approves yet another drug with marginal gains for £20,000 per quality adjusted life year).  So what is it all about?  I was pleased to see that Matt Hancock states that the aim is for an extra five years of healthy independent life.   Assuming I have understood this correctly, this is a welcome emphasis on quality rather than quantity of life – something that we can all get behind.

That’s all from me for this week.  The weekly wellbeing round up will return.  Until next week, take care of yourself!

Dr Richard Pile

The Weekly Wellbeing Round-Up #13: digital wellbeing.

Any doctor reading this who had a pound for every patient who has uttered the words “I think I need an MOT, doc” would probably be reading this from the deck of their yacht, floating on the Mediterranean.  Usually when this is said, it’s in the context of a physical and sometimes interrelated mental health concern.   No one, however, has ever come into my consulting room and said they need an MOT for their digital wellbeing.   This doesn’t mean there is not a problem…it just means that they are not aware of it.  When a health professional asks questions about a person’s health, they will usually ask about things like physical and mental symptoms, smoking, alcohol, sleep, diet, work and social issues.  But how often do we think about our digital health?  The topic of my blog this week was prompted by the news that YouTube has created tools to help users manage their digital wellbeing.  Here is the official YouTube blog on this topic.  Users can now monitor how much time they spend watching YouTube, set reminders to take a break, reduce their notifications to once a day and disable notification sounds and vibrations.   So today I will be focussing on digital wellbeing – the scale of the challenge, the signs and symptoms of digital health problems and how to increase your wellbeing so you feel better as a result.

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Is there really a problem?

Don’t get me technology, the internet, smartphones and social media can improve our lives significantly.  However,  when all of this stuff was invented, no one was sitting down thinking “we can do this, but should we?” or  “how should we use it best?”.  The genie is out of the bottle, and the times, they are a changin’.   In 1996, 16% of households owned a mobile phone.  In 2017 it was 95%.  95% of people between 16 and 34 years of age own a mobile phone, 51% up to the age of 64.   I got my first mobile in my twenties.  The average starting age of smartphone ownership is now 10.3 years.  We have other mobile devices now with software that also allows us to always be connected.  My household has five people in it and between us we own 5 mobile phones, two ipads, 5 laptops, a kindle, a desktop computer, two apple TV’s, a games console and various ipods.

“So what?”, I hear you ask.  The way we live is changing.  People have been predicting the end of the world as we know it on a regular basis since time immemorial.  Is this just another example of moral panic?  Sadly, I don’t think so.

In 2014, Ofcom reported that britons spend more time on screens than they do asleep.  When it comes to devices, the same report found that 6 year olds had the same level of knowledge about them as 45 year olds.  It’s not that hard to believe.  Over-reliance on devices has significant potential drawbacks including the effects upon our ability to maintain real life relationships, concentration levels, being present and  in touch with real world.  This article in the Independent in 2017 reports on the findings of  a study that the average briton touches their phone 10,000 times a year or 28 times a day.  That number may not seem particularly high but other studies claim that there are some groups of higher uses who touch their phone thousands of times a day.  Just think about the implications of that in terms of the time spent checking the phone for new updates and content, never mind the time spent reading some of them.

There is increasing evidence to suggest that activities done without a screen are generally associated with increased happiness and screen based activities are generally associated with decreased happiness.    More specifically, the case is being built for increased social media use being related to unhappiness, having consequences for us both personally and professionally.  A good friend of mine has worked in recruitment for various large companies over the years and has seen the consequences both in terms of its impact upon productivity and professionalism at work, and people’s inability to communicate properly when applying for jobs, struggling with simple things like eye contact and a handshake.

One of the most significant impacts on our wellbeing is how devices and being always-on, with the blurring of home and work life, affect our sleep.  This is a particular issue because the type of light (blue/white light) emitted by these screens disrupts out sleep by interfering the natural rise in levels of melatonin that normally occur as the day goes on and natural light diminishes.   The blurring of our boundaries between work and home also means that we find it harder to relax, dominated by the sympathetic nervous system (responsible for our fight-or-flight), at a time of day when our parasympathetic nervous system should be taking over and slowing things down.  A great quote from Dr Rangan Chatterjee, whose Feel Better Live More podcasts I heartily recommend, is that a sympathetic nervous system response for a short burst of adrenaline fuelled fight or flight activity was appropriate when a lion was trying to kill us but now “it’s our life that’s trying to kill us”.

Symptoms and signs of the problem



All identified disease have signs and symptoms.   Digital malaise is no different.   Like other diseases, having one or two of these might not necessarily indicate a person has a significant problem.  However, if they begin to add up, it’s a red flag.  These might include:

  1.  Checking your device last thing at night and as soon as you are awake.
  2. Cutting off a face to face conversation or any other form of social interaction with someone to check or answer your phone.
  3. Repeatedly checking your phone in any gap in the day no matter how small (on the loo, in the advert breaks, when you get into the car, when the traffic lights are red etc, whilst waiting for the kettle to boil, the microwave to ping or the download to finish) and regardless of when you last checked it.
  4. Feeling worried if you are separated from your phone.  You know where it is, but somehow it doesn’t feel right.  You list to one side when you walk because it isn’t in your pocket.  You start to wonder if your twitter following has grown in the five minutes since you last checked it, and are now concerned you cannot find this out instantly.  Note this is not the same as actually losing your phone.  My friend dropped his iphone on our bike ride the other day and we spent 15-20 mins calling it and then getting his family to Find My Iphone to locate it on the maps app and then ping it until we found it…..fair enough!
  5. Falling behind with your work and personal deadlines but being bang up to date with having checked and responded to the lastest social media updates.   No point getting a snapchat streak and getting canned at the same time.
  6. You get phantom vibrations.  We’ve all felt that sensation that makes us think we have a call or notification.  However, people who are addicted to their phones are more likely to feel this and check for it.
  7. Checking and answering work emails at weekends/evenings.  Of course we’ve all done it, from time to time.  But do you do it regularly…and particularly late at night?
  8. Meaning to go to bed/do that piece of work, but just finding yourself scrolling through social media for hours, disappearing down various side tracks and rabbit holes along the way.

Tips for improving your digital wellbeing…and the rest of your wellbeing as a result

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  1.  Do not have your phone by your bedside.  Charge it in another room or at least in the corner.  And before you protest…buy an alarm clock.  With red not blue light in the display.  Or an actual old fashioned clock.  Or get your fitbit/other quantifiable self type gadget to vibrate to wake you up.
  2. If you can’t go cold turkey with your phone out of arms’ reach, then at least use the operating system’s do-not-disturb options to stop notifications after a certain time (e.g. 10pm to 7am) and if your phone has an option to cut out blue light (e.g. Nightmode on iOS) then use that in the evenings.  Ideally get into the habit of not using your phone for 1-2 hours before you want to be asleep.  I should point out that if you are considering option 2 because you couldn’t contemplate option 1, that’s a red flag and the reason why you should choose option 1.
  3. Turn off notifications on your phone.  This means you will at least be making an active choice to check for updates, instead of having your phone ping/vibrate/display new updates constantly.   You can be selective and turn off notifications from certain apps if you wish.  I have done this and found it a huge release.   I know my wife or kids will ring or text me if it’s something really important.   The rest doesn’t matter and can wait until I’ve got some free time.  You will be less distracted and able to focus on other things like hitting that work deadline, or the conversation you are having with the person in front of you.
  4. Speaking of the person in front of you, think very carefully before you ever interrupt a real life conversation to check or respond to something on your phone. Doing that says to that person that they are less important than someone or something virtual .  Would you turn your back on someone mid sentence?  Or break off to walk away and talk to someone else?  And before you protest that sometimes the message/update might be “very important”, let’s just think about that for a second.  Ask yourself the question “Am I a super hero with a secret identity who needs to look for a phone box to change in/a highly trained special forces operative/a member of the emergency services on call?”  If the answer to those questions is no then take a breath and get a grip.  Your family,  friends and work colleagues will appreciate this.   I apply this during most of my consultations, when I don’t answer the phone unless I am the emergency doctor.  It tells the patient that what they are saying to me is more important, and whoever’s ringing can try again later.
  5. Think about whether you need to answer that work email.  There is a mistaken assumption that working long hours and answering emails even when you are on holiday or at home with your family that it makes you more productive and a better worker.  It’s not true.  You could consider turning on inbox rules.  For example, you could autoreply to all emails between 10pm and 7 am that you will deal with them the next working day.  Or more radically, auto delete all emails that arrive whilst you are on annual leave, with a response advising the sender who to contact if it is urgent and needs dealing with before you return.  If you are a boss, lead by example.  Think about the culture that you want to create within your organisation. If you need to, make a deliberate decision to get up early the next day rather than staying up late.  You will be better for a night’s sleep and it’s a conscious choice to do some focussed work, as opposed to just browsing your inbox.
  6. If you really need help with self control, you can configure the wifi network in your house for time restricted access.  This can be device specific, using what’s called the MAC or wifi address for each device in question.  If your laptop or tablet can’t connect to the internet, it seriously limits some of your options.  More details on this in a future post about looking after our children’s digital wellbeing.
  7.  Think about whether using certain social media platforms is to your benefit and makes you happy.  If you find yourself irritated by most of what you read, feel bad because people’s lives on Instagram look a lot better than yours, or end up getting into spats with people on a regular basis on your local Facebook Mum’s group, ask yourself the question whether this is really life enhancing and what purpose it actually serves.  Does it make you a better and happier person?  A better parent? A better employee?
  8. Take a digital sabbatical.  Why not try a few days or a even a week without social media or reading your (non-urgent) emails?  Or 24 hours with your notifications turned off?  If you feel that’s too much, start with a shorter period of time.   You may start with suffering from FOMO (fear of missing out), but after you’ve got over that, it can be liberating.  You may like to consider Scroll Free September , launched by the Royal Society for Public Health.  Fear not, you don’t have to abandon all forms of social media if that’s a bit too drastic.  They have lots of options that you might like to consider.   I am taking up the Sleeping Dog (no social media after 6pm) and Social Butterfly (no use of social media at social events….just enjoy the moment) options.
  9. Find other enjoyable stuff to do.  If you spend hours on a screen, just think about what else you might be able to do with that time.  Go for a walk, spend time with your kids, make that call you’ve been meaning to, read a book, listen to some music, cook a really nice meal, catch up with your friends, take up a new hobby.   I stopped reading the news every day a couple of months ago.  It’s always the same old depressing nonsense anyway and leaves me with a jaundiced view of humanity. Just listening to the today program for 5 mins in the morning  once or twice a week tells me all I need to know.  I have spent the time reading instead.  OK, and writing this blog.

If we all did some of these things we would find ourselves happier and healthier, more focussed and with better relationships.  If you have any tips for improving your digital wellbeing, they would be most welcome.  Please do share them in the comments section. If you would like to do some further thinking and listening, I recommend the TED Radio Hour Screen Time podcasts, part 1 and part 2.  Good, thought provoking stuff.

That’s it for this week.   Your comments on the blog would be really helpful.  If you like it, please share with other people…particularly anyone you know who might benefit from a digital detox!   Until next week, take care of yourself.

Dr Richard Pile.

The Weekly Wellbeing Round-Up #10

Good morning and welcome back to the weekly wellbeing round up.  I though this week I would start with…

Digital wellbeing

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Last week I posted from our family holiday in Verona.  My three younger boys are a band, Princes to Kings (shameless promotion:  click here for their instagram,  website, facebook page,  and YouTube channel). During my sunday morning run round this beautiful city,  I was also scouting out locations for their latest video.  Yesterday I was updating Facebook with pictures of me and my son’s camping weekend.   We had a lovely break in Verona and were able to share some of the highlights of this special trip with our family and friends.  It was important for the boys to be able to share some bits and pieces with their followers as well, which added extra enjoyment to the weekend.  Zac and I loved our weekend away.  My posting pictures of what we were up to enabled me to reassure my wife that we safe, having a good time, and had survived our 70 kilometre bike ride to London and back.  I don’t feel that doing this detracted from either of our trips.  The internet and social media can enhance our lives and the lives of our friends and colleagues, and enable us to do and share things that were unimaginable even ten years ago.   It’s a tool.  It isn’t intrinsically good or bad, it depends how we use it.  Just like medicine, exercise and even water, it has a correct dose.  Too much is bad for you, physically and mentally.

This article published in WebMd points out one of the pitfalls of too much screen time, namely weight gain.  Teenagers who exceeded two hours of recreational screen time were twice as likely to be overweight or obese. This will not really come as a surprise to anyone reading this, as this risk is posed by any “activity” which is essentially sedentary.  The American Heart Association recommends limiting screen time to two hours a day.  If you are struggling to persuade your children of this, you could  consider encouraging them to play games which involve physical movement as most of the latest generation consoles from microsoft, playstation and nintendo all have hardware that enables these sort of games to be played.  When my kids were younger, we loved playing games with the xbox’s kinect.   I can still remember laughing so hard it reduced me to tears when my then seven year old beat a series of my adult friends senseless in a (virtual) boxing match in an online gaming session.   We would also do a deal with our kids, such as them agreeing that they could have some screen time after walking the dog or playing football outside.  There is of course always the option of the Off Switch.  If negotiations fail, I recommend throwing the kids out of the lounge or playroom, and just remember that when they say “I’m boooooooooorrrrrrred!” you can tell them that boredom is an important part of childhood and good for their developing brains and creativity!  Of course this doesn’t address the issue of mobile devices.  I will dedicate a future blog post to this as it’s a topic worth looking at in more detail.

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Staying with the social media theme, the term “snapchat dysmorphia” has been coined by plastic surgeons who are seeing increasing numbers of people come to them requesting surgical procedures to make them look more like their snapchat photos.   The issue is described in this report of an article in JAMA.  I personally have not yet had a patient come to see me to discuss this (and they certainly wouldn’t get past our clinical commissioning group’s low priority policy if they did!) but joking aside, the article makes the point that a facial feature such as a nose that looks good in a manipulated selfie taken from a phone held just a short distance away, would look very small and weird in real life …something we can reassure ourselves and each other about!

So what might the antidote be to some of these digitally induced woes and mental health problems?  You will win no prizes at all for guessing that it’s….

Physical Activity for improving mental health

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Physical activity is good for depression, according to this summary in theBMJ.  I think this is a very encouraging study.  There are a few key points worth noting:

Firstly this was an observational study (as opposed to say a a randomised control trial) of 1.2 million adults in the US. So we can say that people who are physically active have fewer days where there mental health is “not good” compared to those who are not active. There is a consistent association but we can’t confidently claim causation in this study.  However, other variables (known as confounding factors) were taken into account in assessing the likely effects of physical activities, which is important.

The effect was noticeably greater in those with a known history of depression.  So those most in need of this intervention are also the most likely to benefit from it, which is great.

In terms of dose, the greatest effects were seen in those who were physically active for roughly about the number of minutes per week that we recommend here in the UK, which is handy as we can just remember our current guidance which is 150 mins of heart raising exercise a week (e.g. 30 mins a day, 5 days a week).  However, more than 3 hours a day was associated with worse mental health.  I wonder whether this is due to risk of injuries and their consequences, or perhaps excessive exercise being a symptom of more serious underlying mental health issues?

All types of activity (including housework, gardening and running around after children) were beneficial to a degree.  Team sports, cycling, and aerobic and gym exercise were the most beneficial.

The benefits of physical activity with regard to mental health were greater than the effect of education level, financial security or  body mass index.

Weight loss and eating breakfast

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Speaking of body mass index, this study done by the University of Alabama showed that people who were overweight were no more likely to lose weight if they skipped breakfast.   I have often been struck by how many of my patients who are overweight (and not losing any weight despite their apparent efforts) tell me in either a proud or slightly mystified way that they don’t eat breakfast.   I believe that breakfast is an important meal as it gives you nutrients and energy for the day.  A high protein lower carb breakfast (such as eggs or porridge, for example) is much healthier than sugary cereal and toast and will keep you feeling full for longer.  Many people who skip breakfast end up snacking on less healthy food during the day due to feeling hungry.  It is well known that when we then try to recall what we have eaten during the day, we are prone to underestimating (or forgetting entirely) the snacks that we may have had in between meals.

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Passive smoking in teenagers

Finally, I found this article in Paediatrics,reported in Journal Watch, quite thought provoking.  Teenagers without asthma living with a smoker were more likely to report respiratory symptoms and, as a consequence, to miss school or attend the emergency department or seek urgent care.  The suggestion is made therefore that such settings are ideal for offering health promotion to the teenagers and their smoking family members.  When I do an out of hours shift and consult with a teenager with a flare of their asthma, I haven’t necessarily thought to ask about their family smoking history or talk to their parents about this at the time, having felt this is up to their usual GP in normal hours.  However, people are more likely to change their behaviour if an intervention is timely…and surely sitting in A&E with a breathless child is the perfect time to raise the subject?  I will try to do this more in future.

That’s it for the wellbeing round up this week.   See you next week and in the meantime, take care of yourself!

Dr Richard Pile


The Weekly Wellbeing Round-Up #2

Welcome back to the Weekly Round Up.  Have you enjoyed the start of the World Cup?  Or are you already counting the days until it’s over?  In our house, we fall firmly into the former category.  My kids have already chosen world cup fantasy football teams and we are planning our family last sixteen sweepstake and what the prize might be for the lucky winner.  So let’s kick off (bad pun fully intentional) with some…

Physical activity

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Resting heart rate (RHR) has long been considered a proxy measure for physical fitness.  I first encountered this as a junior doctor when I met an olympic rower with a resting heart rate of 35 beats per minute.   Does this mean, therefore, that a higher resting heart rate is a bad thing and a possible predictor of increased risk of death?  The answer may be yes, according to the Melbourne Collaborative Cohort Study which found that a rise in resting heart rate over a decade was associated with increased risk of death from cardiovascular disease, cancer or other causes.   Of course this may be an association rather than a cause.  So what can we take from this practically in primary care?  Consider a RHR of greater than 70 in men and 80 in women to indicate a higher risk of mortality and target those individuals not with drugs to slow their heart rate down, but with more intensive lifestyle counselling.  It could be an added dimension to an NHS health check.



It can be a little awkward broaching the subject of wellbeing with an overweight patient…especially if they are a child.  Here is  a useful video on childhood obesity that has been made by Public Health England to inform and support health professionals in this area.   Take home message – we need to start with women who are pregnant or planning to become pregnant to have these conversations.  Additional materials can be found here.


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Patients and health professionals alike may be aware of the ongoing debate about food related issues such as carbs vs fats and what helps most with weight loss.  In an attempt to provide balance, and to act as an anecdote to the unedifying behaviour sometimes seen on social media in this area, the BMJ will be publishing a series of articles covering this and other contentious areas, looking at both sides of the argument.  This week’s article is on Food based dietary patterns and chronic disease prevention.  You will need to have a BMJ subscription to view the full text.  The key messages are

  • Food based prevention of chronic disease risk should prioritise fruits, vegetables, whole grains and fish and lower consumption of red and processed meats and sugar sweetened drinks

  • Higher consumption of nuts, legumes, vegetable oils, fermented dairy products, and coffee are further likely to confer benefit

Personally I recommend that you use olive oil in salads and dressings, and use other oils such as ghee or coconut oil if you are going to fry food, as they oxidise at higher temperatures than olive oil and other vegetable oils. Make of this what you will, but may I recommend you avoid behaving badly on twitter, wherever you stand?


Digital Wellbeing

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The Children’s Commissioner has recommended that social media must be made less addictive for children.  The example of “streaks” in Snapchat has been highlighted.  The protestations of social media companies that their products are not designed to be addictive sound very similar to those of Big Tobacco.  No immediate, tangible results here.  My recommendation to my patients in the meantime is that no child should have a mobile phone before secondary school age or access to social media until they are older e.g. 14+.  Parents who roll their eyes and say that they don’t understand technology and can’t figure out how their home wifi works or how to restrict applications on their kids’ phones should be asked whether they would take as relaxed an approach to allowing their kids to have access to pornography, cigarettes or under age drinking.  I will be dedicating a whole blog topic to this.  I think social media addiction is the new inactivity, which was the new obesity, which was the new smoking etc etc etc.

On a related note, Techcrunch reports that Apple has unveiled digital wellness features for children and adults alike.   These include an upgraded version of Do Not Disturb, options to reduce and restrict the intrusiveness of notifications, a regular report of how much time you have spent on your phone and which apps you use the most,  and parental controls to limit screen and game time.  Well worth a read.  Other companies such as Google are making similar moves.  In my opinion, starting with making us aware of just how much time we are spending on our screens is the first step towards us challenging ourselves and managing it better and more mindfully.


Technology is not all bad, of course.  So to end on a positive note, here are five free apps for mental health and wellbeing.  I particularly recommend Headspace (available on iOS and Android).  I started using it a few years ago when life was quite challenging because of my son’s severe uncontrolled epilepsy and all the knock on effects this had for him and for the rest of us.  It’s designed by a former buddhist monk (although it doesn’t require you to embrace any particular philosophy or belief system) and has different modules for different aspects of your life.  A subscription is roughly the price of a cup of coffee per month.  As a result of getting into the habit of using the principles regularly, I have found it hugely beneficial (disclaimer – I’m not getting paid or given a discounted membership to promote this!).

That’s all for this week.  Thanks for tuning in.  See you next week!