Welcome back to the weekly wellbeing round-up! After a few weeks of posts focusing on more specific topics like the miracle cure of physical activity and mental wellbeing, we are back to a good old-fashioned trawl through the week’s wellbeing news, digging out the most interesting, relevant and useful bits. Let’s get stuck in…
Omega 3 and Oily Fish
A study in the BMJ this week found that there was an association between the intake of omega 3 polyunsaturated fatty acids (n3-PUFA’s) from sea food and healthier ageing. Healthier ageing was defined as the absence of disease and physical dysfunction. Risk was reduced of unhealthy ageing by up to 25%. Recommendations are made for further research into the possible causal mechanisms. This reinforces the existing dietary recommendations already made by most doctors which is to eat oily fish at least twice a week. I suspect that the benefits of n3-PUFA’s will apply to all age groups but it is easiest to demonstrate reduced risk in older patients who are, by definition, a higher risk group.
Oily fish include herring, salmon, sardines, trout, mackerel and pilchards. Shellfish (mussels, oysters, squid, crab) and white fish (cod, haddock, plaice) are considered healthy but don’t contain the same amount of the n3-PUFA’s as the oily fish.
Organic Food and Cancer
Research published in JAMA Internal Medicine appears to suggest that eating organic food may be associated with a lower risk of lymphoma, a particular type of cancer. However, there may be confounding factors such as lifestyle differences in people who choose organic food. So in summary: whilst it makes sense to try to minimise chemicals used in growing food that may cause inflammatory responses in our bodies, there is not yet a compelling case for switching to organic food on a large scale, at least in terms of reduced risk of cancer anyway.
One of the questions my patients commonly ask me is – should I take food supplements? This was debated again in the press this week after the case of a man who ended up with liver failure after taking green tea supplements. Here is a simple, fairly balanced BBC news article on the subject. My advice on the subject is:
- Most people don’t need food supplements if they have a balanced diet (although I am in favour of children under five having safe doses of multivitamins and I recommend all pregnant women take folic acid)
- Getting nutrition from eating whole foods is more desirable than taking supplements
- Don’t make the mistake of assuming that if a little extra of something is good for you then a lot must be even better. Check the recommended daily amount.
- Buy from reputable manufacturers
Wellbeing for Doctors
There is a good article in the BMJ this week by Greta McLachlan about the importance of doctor’s wellbeing. You can read it here. She describes the challenge of burnout (faced by up to 50% of doctors) and the importance of doctors putting themselves first at times. After all, passengers on a plane are given the advice that they should put their own oxygen masks on first before attempting to help others. The article contains some links for doctors to use if they are either struggling themselves or are aware of a colleague that is. These are the Practitioner Help Programme, the Sick Doctors’ Trust and the Doctors’ Support Network.
I recently read an article on the same subject, looking at what we can learn from the history of doctors’ working conditions. I know I often find myself reminiscing with colleagues about the good old days. On the one hand, there were undesirable aspects of a macho culture and the “it never did me any harm” mindset. On the other hand, job satisfaction may have been higher because doctors had a sense of belonging as part of their “firm” and continuity of care and patient relationships were better. We worked an on call rota as a team and were not fragmented by shift work. To me, this is a reminder of the importance of purpose and meaningful work – not just the pay or the hours associated with it. In this age of talk about lifestyle medicine and wellbeing, we must avoid putting the responsibility for doctors’ wellbeing entirely on their heads and consider carefully the system that they are being asked to work within. Practising a bit of yoga and mindfulness at lunchtime may well be helpful but it shouldn’t be used to paint over the cracks of underlying system failure.
Lifestyle Medicine: it’s a thing.
In fresh and not entirely shocking news, this article in the BMJ reports the findings of a UK biobank cohort study into the risks of stroke and the role of both genetics and a healthy lifestyle. It comes to the conclusion that just as genetics can significantly affect your risk of having a stroke, so adopting a healthy lifestyle may significantly reduce it. A healthy lifestyle was defined for the study as being physically active, not smoking, having a healthy diet and a BMI of < 30. People are prescribing and taking their own lifestyle medicine and benefitting from it.
When I was training as a doctor, the only kind of medicine that we learnt about was the kind that was prescribed and came in bottles or packets. Nowadays we hear more and more about lifestyle medicine. There are two parts to lifestyle medicine of course – the information and advice that’s given to us , and our actual practice of it. There is debate within the medical profession as to its value and place. Whether you view lifestyle medicine as a relatively recent and increasingly important speciality, an integral part of whatever speciality you practice, or just stating the bleedin’ obvious, it seems to be gaining more and more traction. As a GP I find it bizarre that having been a doctor for over twenty years it is only in the last few years that I have really begun to understand it and do it properly…both for my sake and the sake of my patients.
This article on lifestyle medicine in this week’s BMJ is well worth a few minutes of your time. It asks the question as to whether lifestyle medicine is a speciality or should be part of all medical practice, whether it is something to be practised by a few or should be done by everyone. There is further information about the British Society of Lifestyle Medicine and the diploma that they offer.
From my own perspective, what I can say is that both preaching and practising lifestyle medicine (and in my opinion you have to do both to be credible) has improved my life both personally and professionally. I was in danger of low-grade chronic burnout as I found myself increasingly frustrated and disillusioned by my experience of general practice and the relatively minor difference that I was able to make for most of my patients. The medicine I was practising was often just a sticking plaster, an exercise in damage limitation and closing the stable door after yet another horse had bolted. It was based on a pathological model of health. Please don’t misunderstand: this still has value. Our patients with long-term conditions, cancer and life limiting illnesses still need our compassion and care, technology and drugs. However, lifestyle medicine is based on a salutogenic (positive and health-based) model. It is optimistic, energising and life changing. In this context, the relationship between a patient and their doctor as a powerful catalyst for change. The challenge that we face in primary care should not be whether we “do” lifestyle medicine (many if not most GP’s already are, to varying degrees), but how we do it within the constraints of our current consultation model and contract framework. The answer probably lies partially within and partially outside our current ways of working…but that’s a topic for discussion another week.
I thought would finish with a mention of some of the podcasts that I have particularly enjoyed and found helpful this week and are related to some of the topics in this week’s post. For your aural delectation, I heartily recommend:
Feel Better Live More Episode 32: The science of happiness with Dr Rangan Chatterjee and Meik Wiking
That’s it for this week’s wellbeing round-up. I hope you have enjoyed it – if so, do share with your friends, colleagues and patients. Your comments and feedback are really welcome. They will help me make it as useful as possible in future. Until next week, take care of yourself!
Dr Richard Pile