The Weekly Wellbeing Round-Up #21

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…

Food

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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.

Food supplements

 

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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:

  1. 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)
  2. Getting nutrition from eating whole foods is more desirable than taking supplements
  3. 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.
  4. Buy from reputable manufacturers

Wellbeing for Doctors

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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.

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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.

Podcast recommendations

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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

TED Radio Hour:  The meaning of work.

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

 

 

 

 

 

The Weekly Wellbeing Round-Up #6

Welcome back to the Weekly Wellbeing Round Up!   I hope you have had a good weekend, enjoying the weather and the world cup final.  Having overcome the disappointment of England not getting to the final,  I made the decision not to watch the entirely meaningless 3rd/4th place playoff , and so missed watching England lose to Belgium (again)…which was probably much better for my overall wellbeing!  Let’s start off today with…

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Cardiovascular disease 

Today instead of watching the final, I spent the afternoon with my wife.  This is partly because I am a very caring and considerate husband (hopefully she won’t read this or at least will have the good grace not to contradict me in the comments) but also because I am an evidence based husband as well and had read this systematic review and meta-analysis in Heart concerning marital status and the risk of cardiovascular disease (subscription required for full article).  Being married was associated with a decreased rate of death from heart disease and stroke.  Being divorced was associated with increased CHD mortality, being widowed with increased risk of stroke, and never being married with an increase in mortality in the event of a heart attack.  The article points out the obvious that association does not mean causation, but does raise the idea that marital status could be considered as part of CVD risk calculation in future.  I have shared this with my wife.  She says she needs more evidence before she is convinced.

Whilst I would like to spend all my time helping patients not to get premature cardiovascular disease (such as heart attacks and strokes), clearly a part of a GP’s workload is helping people who have developed it look after themselves as well as possible.  Again, I like to focus on lifestyle measures such as food, physical activity and sleep but inevitably most if not all people in this situation will also be taking a number of medications to reduce the risk of their conditions worsening.  The world health organisation stats for adherence or compliance (i.e. people taking their tablets as prescribed) are truly shocking.  Take for example hypertension or raised blood pressure:  it is estimated that only half of people diagnosed with hypertension are taking their meds regularly (80% or more of the time) within a year of being diagnosed.  Clearly I must have the best patients in the world, because they all look me in the eye and reassure me that they take their drugs every day.  But for doctors out there whose patients are not as well behaved, this systematic review, also published in Heart, may make useful reading.  Three interventions were found to improve adherence and clinical outcomes:  SMS (text) reminders to take medication, a fixed dose combination pill (interesting to consider as these drugs may be more expensive and less flexible in dosing but if the outcomes are better maybe doctors should be prescribing more of them) and a community health worker-based intervention.  It is worth noting that these demonstrated relatively short term improvements so we need longer term outcome data to confirm this.

Instead of talking about cardiovascular risk, the focus of this article is about calculating Cardiovascular Health.  CVH is a concept developed by the American Heart Association.  It takes into account 4 ideal health behaviours: non-smoking, body mass index < 25, regular physical activity and adopting a healthy diet.  It also factors in cholesterol, blood pressure and blood sugar level.   It has been suggested that CVH could be a proxy for wellbeing.  Of course that leaves the question as to what comes first..wellbeing or health.?   What are the practical implications of this for me?  The next time that a patient comes into my consulting room and says that they would just like a bit of an MOT, this is perhaps where I could start, rather than asking them a lot of questions about their bodily functions and sending them off for a load of blood tests.

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Hypertension

Speaking rather less positively about the American Heart Association, I was deeply troubled by their suggestions about changing the threshold for diagnosing and treating hypertension.  The guidelines suggest that a blood pressure of greater than 120 (systolic) and/or 80 (diastolic) should be considered “elevated”.   This would result in a huge increase in numbers of patients diagnosed with a disease and then potentially medicalised by offering them drugs…with the associated risks of this.  The author of this article in the BMJ estimates that this would result in half of the adult population over 45 being diagnosed with hypertension.  My view?  Utterly bonkers.  We should be sticking to identifying people who already have undiagnosed hypertension (>140/90, as defined by the European Society of Cardiology), giving appropriate lifestyle advice as first line management where appropriate, and offering a personalised approach to risk reduction based on an individual person’s risk factors.  I would be very interested to learn more about the individuals and organisations who had input into the AHA guidelines, and where they might have potential conflicts of interest…big pharma, anyone?

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Food 

The low carb debate continues and I for one am more than a bit fed up of the unedifying content and behaviours on social media, particularly twitter.  Yes, it may well be that it’s hard to prove that there is something intrinsically good about eating a diet low in carbohydrates because it is almost inevitably associated with also reducing calories, but then again this is a food group that, plant based carbohydrates aside, we have largely manufactured for ourselves (often with a lot of processing involved) has very little if any nutritional value, and the increased consumption of which (particularly in the US) has been associated with sky rocketing obesity levels.   So its nice to see this article in the BMJ on the role of carbohydrates , quality and quantity, in chronic disease.  It takes a  fairly measured approach to the subject.  It’s well worth a read as it’s too detailed to really summarise, but the key messages are:

  • Human populations have thrived on diets with widely varying carbohydrate content
  • Carbohydrate quality has a major influence on risk for numerous chronic diseases
  • Replacing processed carbohydrates with unprocessed carbohydrates or healthy fats would greatly benefit public health
  • The benefit of replacing fructose containing sugars with other processed carbohydrates is unclear
  • People with severe insulin resistance or diabetes may benefit from reduction of total carbohydrate intake

My view on this is that there might be a number of reasons why a lower carbohydrate diet is of potential benefit for some patients, but really…who cares if the end result is better health outcomes and wellbeing?  It’s particularly worth considering in people who are diabetic, pre-diabetic, or need to lose a significant amount of weight…especially if they have struggled with weight loss in the past.

Staying with diabetes and pre-diabetes, this Cochrane review found that  in order to delay or to prevent the onset of Type 2 Diabetes, there wasn’t sufficient evidence in the meta analysis it carried out for diet or physical activity alone…but both combined together produced results.   Patients who have been told by their doctors that they are pre-diabetic should have be advised accordingly.  I used to talk mainly to patients about their diet and weight loss and say that physical activity didn’t contribute particularly to the latter…but we now know that physical activity is protective in itself and has favourable effects on the way that your body deals with both sugar and cholesterol.  The greatest benefits in reducing the risk of disease and death are seen in patients who go from being inactive to moderately active.   It doesn’t require a gym membership, donning lycra, or dragging a tyre round your local park whilst someone in combat fatigues with anger management issues barks instructions at you.   Just ten minutes a day of heart raising exercise, such as brisk walking, is enough to get you going in the right direction.

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Sleep

Last week I confessed that sleep is one of the areas of my life that I have struggled with.  Not because I can’t get to sleep but because I choose not to get what I really need.  I have done better this last week, inspired by having started to read Why We Sleep by Matthew Walker.  My favourite podcast this week has therefore been Episode 26 (Part 1) of Feel Better Live More podcast by Dr Rangan Chatterjee, who interviews Professor Walker, on this subject.     There’s a quote early on in the book which makes the point (and I’m paraphrasing) that if sleep does not serve a purpose and yet almost all animals spend a third of their life in this state, then it’s the biggest mistake that the evolutionary process ever made. Thought provoking stuff.

That’s it from me for this week.  Until next week…look after yourself!

Dr Richard Pile

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