The Weekly Wellbeing Round-Up #15: making a plan to improve your wellbeing.

When I first became a GP, I decided that many of my patients who needed to make lifestyle changes also had undiagnosed conditions that resulted in problems with their understanding,  memory and planning processes.  There must be something wrong with them, so my reasoning went, because they left my consulting room chastened by me about their lifestyle choices,  concerned about their impending doom, and clearly intent on turning their lives around….but when I saw them again they hadn’t done anything.   In fact, some of them were even more unhealthy than before.   Some cases stood out, like the man who was still popping out for fag breaks in between ward rounds on the coronary care unit after he’d had his heart attack.  Or the elderly lady with furred up arteries in her legs who looked me straight in the eye and told me that she was more scared by the thought of life without cigarettes than she was by the below knee amputation that she was heading relentlessly towards.   Surely the only explanation was stupidity or a death wish?  Or so I thought.

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Years have gone by and I have learnt a lot about people, which is an inevitable and highly desirable side effect of working in primary care.  I have spent time talking these things through with patients.  I have read round the subject of behavioural psychology (I highly recommend Nudge, Inside the Nudge Unit, and Think Small for a good grounding in this area), met with people from the Nudge Unit (or Behavioural Insights team, to give them their proper name)  and spent time discussing these issues with psychologists and other colleagues.   At Thrive Tribe, we are working with the Centre for Behavioural Change to ensure that all our practitioners are appropriately skilled in this area to help their clients, offering a service that is more than just education about giving up smoking or losing weight.

For the purpose of today’s blog post, I am going to share with you a small but important part of what I have learnt over the years.  It’s not very clever or surprising.   Neither is it difficult.  Everyone can do it.  It’s about having a plan.

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Why do we need a plan?

Humans are not rational creatures.  We assume that because we have been well in the past we will be so in the future.  We cleverly avoid joining the dots with all that we know about what is likely to happen as we get older.  We know that there are theoretical risks of things happening, like heart attacks and cancer and road accidents, but we assume that somehow we as individuals are exempt from this risk,  unlike everybody else in the world around us.   I’m sure you can see the potential flaws in this reasoning.  When things unravel, they can unravel quickly.  Even when things are not yet seriously unravelling health-wise, people are often still aware of their wellbeing issues.  When people fail to make changes that are needed, it isn’t because they don’t know what to do.  It’s beause they either don’t know how to do it, or they do know how to but have no plan in place to make it happen.   I know that I would like to catch up with my brother for breakfast over the next few weeks.  I also know based on the endless games of message-tag we play that via text, facebook messenger, what’s app and email unless we actually make a plan, it will  never happen.   It’s better to have a plan.  It could be written on paper, or stored electronically – just as long as you can refer to it and review it whenever you need.

Do wellbeing plans work?

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Plans are not foolproof.  Otherwise we wouldn’t refer to the best-laid ones or talk what the road to hell is paved with.  They do, however, increase our chances of making and sustaining the changes that we want to.   There are various reasons for this.

Accepting the need to make changes

Firstly, making a plan to change means that we have generally (perhaps grudgingly!) accepted that there is a change that needs to be made.  Maybe you’ve been along to see your GP, practice nurse or health care assistant and a few issues have been raised that you concede might be worth a look at – that weight you’ve been meaning to lose for years, your need to quit smoking or reduce your drinking because of the effect it’s having on your health,  or perhaps your worries about getting a bit fitter as you move into middle age.

Being specific about the changes

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Vague plans are not much good.  “I will lose weight/eat fewer biscuits/do more exercise” might work for a small minority, but for more people it will never translate into anything.  Why? Because they have leapt straight to the desired outcome and are too vague.  We need to be clear about what we are going differently that will result in those outcomes.   Each step in the process needs to be considered, broken down into even smaller steps if required, to see how realistic it is and what needs to be done in what order.  A plan makes it easier to achieve than a one-off mental note to self or vague intention.

A plan makes us accountable for the changes

If we have a plan, it means that we are accountable.  Not just to ourselves, which helps a bit, but potentially to others, which significantly increases our chances of success. Letting other people know what you are doing and even asking one or more of them to be a referee and hold you accountable means you are more likely to follow through.

A plan helps us to measure success as well as failure

If we have been specific in terms of what we want to achieve, how we will achieve it and how we will measure our success, then this will help us by encouraging us when we achieve what we have planned (which increases the chances of making further changes and sustaining what we have already done) as well as maybe challenging us with the areas where it hasn’t quite worked out yet.   The plan can always be changed when we learn as we go.   Putting rewards into the plan for when we achieve each stage of success can be quite motivating as well.

My top tips for making your wellbeing plan

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  1. Make it for yourself and only if you really mean it.  Not to make your GP happy.  If you’re not ready to make changes, let them down gently as early as possible and perhaps keep an open mind for the next time you have a wellbeing conversation.
  2. Make it simple.  The more complicated it gets, the more likely you are not to achieve bits of it, which can be disheartening.  Better to have simple success and build on it.
  3. Make it specific.  Losing weight might be the overall desired outcome, but break it down into smaller chunks e.g. cycling or walking to work, cutting out snacks, shopping for and preparing more of your own meals, not eating after a certain time of day.
  4. Make it achievable.  If you are inactive at present and break into a sweat at the thought of breaking into a sweat,  don’t aim for 150 mins of exercise a week from the outset.  Start with 5-10 mins a day every other day.  If you want to learn about mindfulness, start with 5 minutes a day on your smartphone app or just spend the time reading a book or listening to music.  I know a lot of people who say “I tried that” by which they mean they gave it a go a couple of times and gave up because it was too difficult or not immediately rewarding.  Changes are more likely to be made if they are easy, accessible, social and timely.
  5. Make it rational.  Think about what changes you can implement that are compatible with every day life and easy to sustain.  It needn’t involve hours of your time every day or expensive kit, diet plans or gym memberships.  It could be walking more briskly to the shops or whilst out with your dog, taking the stairs at work or working in the garden.
  6. Make it measurable.  It might be weight lost, minutes of activity completed, amount of sleep you have obtained or personal goals achieved (e.g. taking part in a social activity with your friends or playing football with your children or grandchildren)
  7. Make yourself accountable.  Tell people what you are doing e.g. work colleagues, friends and family, social media groups.  Consider asking someone to be a referee who will check in with you regularly.  Some people might ask their spouse.  Some might prefer a friend or colleague depending on how much they enjoy being nagged!
  8.  Make it a work in progress.  Your objectives are likely to change over time.  You will succeed in some areas and maybe not others.  That might simply mean not giving up and then trying again, or it might mean learning from what has worked well and not so well, and coming up with a better plan for the future.

Wellbeing planning in the real world.

I thought I would finished with some real life examples.

  1. Last year, all the GP practices in my area took part in a local Cardiac Prehab scheme which I had designed with some of my colleagues for our CCG.  Part of the service included identifying patients at higher risk of having a heart attack, stroke or developing diabetes and inviting them to an educational event at their GP practice.  The evening included a presentation on wellbeing and finished with each patient signing up to their own personal wellbeing plan.   These plans were collected and scanned into each patient’s records.  When they were reviewed a few months later, the doctor or nurse they saw reviewed their plans with them and discussed what had worked well or not so well.  The majority of the patients I reviewed had achieved at least one of their intended outcomes and were really pleased to see how well they had done, which encouraged them further.  This year the scheme has been rolled out across our entire clinical commissioning group, with a patient population of over 600,000 people.
  2. Those of you that are kind/enlightened/fortunate enough (delete as applicable) to read my blog posts regularly will know that I talk a lot about Rangan Chatterjee’s Four Pillar Plan.  Inspired by this, I have started to develop a welbeing plan template for EMIS (our computer system) which is based on this.  I have shared it with my practice colleagues and am now using it to enter data into the patient’s record and give them a printed copy after our consultation, so they have something to remind them of what we have agreed and to document their progress. Rangan Chatterjee and Ayan Panja did an excellent presentation on Prescribing Lifestyle Medicine at last week’s Emis National User Group conference at which they showcased an early version of their own lifestyle medicine template which is currently in development and  which will no doubt be snazzier than mine when it’s finished!

And finally, my own personal wellbeing plan

It is only right, of course, that I practice what I preach.  For years I have meant to lose a bit of weight.  For years I have surveyed my profile in the mirror in the morning, disappointed in myself for not having achieved anything and disappointed in the Six-Pack Fairy for not having visited overnight as I had hoped.  So in the end, I made a plan.  This included eating a lower carb diet (specifically changes to what I make for breakfast, making salads for lunch and cutting back on biscuits), exercising more regularly (getting up early to walk before work, doing HIIT workouts when I didn’t have time to ride or run), and doing press-ups as strengthening exercises each morning).   I am also much better at getting enough sleep, although there is always room for improvement.  I told my wife about this as I knew full well she would remind me if/when I lost track.   The results?  I have lost just over half a stone without feeling that I am depriving myself.   I feel fitter and have more energy.  I still don’t have a six pack and have decided that I was probably born without one, so maybe I will leave that out of the next version of the plan.

That’s all for this week from me.  Weekly Wellbeing Round Up #10 will be out next week.

Please do make a comment on the blog if you have enjoyed it, if you feel it could be improved, or to suggest future topics for me to work on.  I want to make it as useful as possible for all of you.  Please feel free to share the blog with your friends/colleagues/pateints/family members and sign up to it to receive updates automatically if you haven’t already.

Until next week, take care of yourself!

Dr Richard Pile

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The Weekly Wellbeing Round-Up #11

Good morning and welcome to the latest edition of my weekly wellbeing round up.  Plenty to cover today, so let’s get started…

Smoking

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This BBC news article reminds us that passive smoking has effects way beyond childhood, including a significantly increased risk ischaemic heart disease and chronic lung disease in adulthood.  Participants were questioned about their exposure to smoking throughout their lives, and then their health was tracked over the next 22 years. As I reported last week, children were also more likely to end up with respiratory illnesses and spending time in urgent care or the local emergency department.   Now when I talk to people about quitting smoking, if they are parents I explore this as well.  We might feel comfortable making a decision that affects only our own health…hopefully most of us would feel less comfortable if we were reminded it affects others too and there is no safe level of smoking.

If people are thinking about quitting smoking, they might well consider using increasing popular e-cigarettes.  Whilst there has been some debate about potential safety issues (as reported in this article about changes to immune cells exposed to vaping chemicals in a laboratory setting), the House of Commons Science and Technology committee has published its report on vaping, and strongly recommends that more be done to encourage it.   The report states:

“These recommendations are based on a fair and accurate assessment of existing evidence from the UK that suggests vaping is significantly less harmful than smoking, few young people who have never smoked regularly vape, smoking in young people continues to decline, and e-cigarettes are helping smokers to quit.”

In one line?  E-cigarettes are much less bad for you than real ones.  Duh.

More good news for ex-smokers and those trying to quit came in this article in the New England Journal of Medicine.  The headline is that smokers are better off (in terms of health gains) after they quit, even if they gain weight.  To quote the Journal Watch commentary, “even quitters who gained over 10 kg had a 67% reduction in cardiovascular mortality and a 50% reduction in overall mortality, relative to current smokers”.  The next time I am talking to someone about quitting smoking and they say that weight gain is one of their reasons not to, I will explore this a little bit more with them to check whether it’s just gaining a few pounds they are worried about, or the consequence of weight gain on their health…in which case I will encourage them to quit first and work on the weight later.

Hypertension

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A few weeks ago I posted about the revised american guidance on hypertension and the explosion in the numbers of people labelled with the disease that would occur should this frankly bonkers approach be adopted around the world.   One thing to consider is how much more time and capacity will be needed by the NHS to help all these people control their blood pressure, should such an approach be taken.  This study published in the Journal of the American Medical Association reports on the effectiveness of a low dose 3-drug pill in controlling hypertension.  We already know that multiple drugs at a low dose are more likely to achieve blood pressure control than slowly titrating up one drug at a time to a higher dose. This result is not surprising. It is worth noting that adverse events were reported to be no higher taking this approach.

Take home message for me? Whilst I will always try to encourage lifestyle measures where relevant to lower or control BP, when considering starting therapy it may be worth adopting a different mindset, considering multiple drugs not to necessarily be a bad thing.  Particularly if GP’s have patients with hypertension coming out of their ears, so to speak.

Diabetes

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On the back of this report on the worrying rise of children with Type 2 Diabetes in the UK, there was some encouraging news for people with diabetes who are trying to control their risks factors in this study published in the New England Journal of Medicine.  Patients with type 2 diabetes who had five risk-factor variables within the target ranges appeared to have little or no excess risk of death, myocardial infarction, or stroke, as compared with the general population.   So whilst I would much rather focus my efforts on helping people not to become diabetic to start with, we can encourage our patients who have diabetes that with good control of their blood pressure, blood sugar, cholesterol etc, their risk of developing these complications is not significantly different from those without diabetes.

Carb Wars…the saga continues.

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You may well be aware of this prospective cohort study and meta analysis published recently in the Lancet Public Health.  The headline is “Moderate Carb Intake Seems Best for Longevity”.  As you can imagine, the publication of such an article made Twitter explode as troops on either side of the Low Fat vs Low Carb war lined up to either crow jubilantly or defend their positions respectively.  I will summarise in a moment but if you would like to do some further reading around the responses to and limitations of the study, here are some links:

Consultant Cardiologist Dr Aseem Malhotra’s response on the BBC news (YouTube clip, pro-low carb)

Science Media Centre briefing (anti-low carb)

As most readers of my blog will know, I am broadly in favour of a lower carb approach.  I no longer eat cereal, have cut back on bread, love my eggs for breakfast, enjoy some nuts each day and tend to have salads for lunch with either chicken or oily fish.  However, I still have the odd sandwich for lunch and am known to enjoy a bag of pork scratchings and a pint with my work colleagues during our friday evening debrief in our local.   It is rumoured that fish and chips made an appearance last week when neither my wife nor I could be bothered to cook after a long day.  The study cannot fully bear the weight of the headlines because it is observational and there are some concerns about the statistics and claims arising as a result (check out Dr Zoe Harcombe’s comments here and Luis Correia’s comments here ).

So what will I tell my friends, colleagues and patients when we end up talking about this over the next few days?  I will say that moderation is the key.   All extreme diets pose health risk.  The one thing that we do NOT consume “in moderation” at present in most western diets is carbohydrates.  In fact, you could argue that the western world is in the grip of an extreme high carb diet experiment.  We consume far too much, driven by decades of messages about low fat and the evil genius of the food companies who produce cheap, highly processed foods (with “low fat” labels on them) which are almost impossible to avoid.   So don’t worry about no or very low carb diets, just think a bit lower than most of us are eating now.   Less in the way of beige carbohydrates (most of which have zero nutritional value), lots of vegetables, more protein (fish, meat, eggs).  Eating a lower carb diet does not mean eating bacon every day and dying early of bowel cancer or heart disease.    Polarising the debate is unhelpful and will leave most people bewildered.  Let’s be pragmatic –  eating a lower carb diet will result in weight loss partly because of it being lower carb and partly because it will inevitably result in reduced calorie intake for most people.  Having debated evidence based medicine, I will give you a bit of anecdote based medicine:  I have lost over half a stone on a lower carb diet and no longer need to use medication for my inflammatory bowel disease.

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Cardiac rehabilitation

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Finally, we will finish on a more positive and entirely uncontroversial note.

Over the years I have had the privilege of working with our local cardiac rehabilitation team.  They are a great team of people, providing an important service to all of our patients with heart disease.  They work with patients with angina, heart attacks, stents, coronary artery bypass grafts, valve replacements and heart failure.   I have taken part in some of their sessions.  Many patients speak very highly of the service.  One of the trickier aspects of the job is proving what a difference the service makes.  This can be either because it is hard to prove that something was prevented from happening or sometimes because the service hasn’t been set up to properly collect the necessary outcome data.   So this systematic review and meta analysis published in Heart is most welcome.  It concludes that there is evidence of physical activity in patients who have had cardiac rehab, whilst also recommending that further high quality studies need to be conducted to give us more detail and measure other outcomes.  Shockingly, only about 50% of patients who have been offered cardiac rehab actually take it up.  Take home message?  All health professionals should strongly encourage patients to take up this offer, and encourage them to stick with the programme.

In Herts Valleys Clinical Commissioning group we have taken the principles of cardiac rehab and commissioned a cardiac prehab service for our patients at high risk of cardiovascular disease.  Working with my colleagues in cardiac rehab, public health and the CCG I designed the specification for this service.  For the first time this year, practices will be identifying such patients and offering education and support in the hope of improving outcomes and preventing disease occurring.  I will report back at a later date.

That’s it for this week’s wellbeing round up.  Stay tuned for next week’s edition and in the meantime, 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 # 7

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.

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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.

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Social Prescribing

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.

 

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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.

white bed linen

Photo by Kristin Vogt on Pexels.com

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