Wellbeing for Real Life: what is resilience and how do we build it?

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I was recently asked to write a module on resilience for clients of a healthy lifestyle service provider. We had previously put together modules on anxiety, depression and stress management. The feedback that we were getting from some team members delivering the modules was that they found the subjects rather complex and difficult to discuss and there was a risk of ending up focussing on the negative. We therefore decided to simplify the modules, fuse them together where appropriate, and to take a more positive tone discussing fitness rather than illness. As I put the module together I was reminded that teaching something is a great way of learning something , and so thought I would share what I have learnt in the hope that it is useful to you.

Let’s start with some questions people commonly ask. What is resilience? Do I have it? How do I know? Can I measure it? If I don’t have it, can I get it, or improve it? How can I help my kids to have it?

Defining resilience

A very basic definition of resilience is the ability of a substance or object to spring back into shape after trauma. To make it more human, we could describe it as the ability to cope with setbacks, or the ability to overcome difficult experiences and to be shaped positively by them. It might be described very simplistically as physical or mental strength or fitness.

Resilient people are not just born, they can be made

As my wife pointed out to me during the writing of this post, anyone who has had a few children can tell you that we are all in different places on the scale of natural resilience. It’s undeniable. However, where we end up is not inevitable. Nurture has at least as important a role as nature. I used to be a bit daunted by the people in the weights section at the gym, heavily muscled and confident specimens stalking around the equipment as if they owned the place, occasionally grabbing hold of some colossal bits of metal and wrestling them into submission before grunting and moving on to the next unsuspecting piece of apparatus. This was until I realised that they hadn’t become like this spontaneously but had developed themselves over time, with regular practice and commitment and maybe some pain. I’ve heard physios encouraging people to keep doing their exercises, advising them that they should be aiming to stretch their muscles and cause them to ache because that’s the only way they will ever strengthen them. When you exercise, you need to get your heart rate up for it to do you some good, which isn’t always comfortable.

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So it’s good news for all of us, particularly if we are feeling life’s challenges. The route to resilience is adversity – getting through it, and learning from it. Machine parts are tested before they leave the factory, to ensure they are strong enough. In the same way that a person who never makes a mistake never learns anything, you can’t be resilient if you have never suffered any setbacks. I’m not suggesting you go seeking adversity, or deliberately make decisions that are likely to have a bad outcome, but its ok and indeed necessary to endure traumas to build resilience. In the same way however that an athlete would prepare to compete, there are of course things that we can do to prepare ourselves for life’s challenges.

My top tips for developing resilience, based on my own life and what I have learnt from others, include:

  1. Self nurture. Sleeping well, being physically active and eating a healthy varied diet will mean that we are physically and mentally in as good a place as possible to take on whatever comes our way each day. Relaxation is an important part of this too, setting aside some regular time that is just for you. That could include reading, listening to music or meditating.
  2. Good connections. With friends, family and other people that you have a shared interest with. Prioritise the positive relationships with people that encourage and support you, and who you can do the same for. Put dates in the diary to make sure it happens, or it won’t. If you have kids, make sure that they have positive, nurturing relationships in their life. These could be with friends, teachers, relatives, health care practitioners and of course…parents! It can be vital to be able to ask others for help when we feel we don’t have the strength for ourselves.
  3. Positive action. Take a positive attitude towards your abilities and encourage yourself, especially in difficult situations. Be assertive and open in your relationships, whether personal or professional. Set goals in the short, medium and long term and make a plan for how you are going to achieve them, breaking it down day by day and moment by moment if need be.
  4. Develop new skills and hobbies. You could learn a new language or take up an instrument. This is good for your brain, encourages further social networking and helps with practising delayed gratification. This is particularly important for children who have been born into this era of instant gratification and rarely having to wait for anything for any significant length of time.
  5. Learn from challenges. Whether it’s a mistake that you made, or something beyond your control that happened, take time to reflect on how it made you feel and what you can learn from it or do differently next time. If you have kids, it’s important to let them make decisions and live with the consequences. Obviously you have to pick and choose depending on the stakes for their immediate health and wellbeing. Resist being a helicopter parent. It’s understandable but rubbish preparation for life and not in your child’s long term interests. If you wrap them up in cotton wool, they will just break later in life when you may not be around to support and encourage them. Better to let them make mistakes at a younger age and be stronger and wiser for it.
  6. Practice gratitude. This is such a simple and yet profound thing to do. I would be willing to bet that if you are reading this blog you have at least one thing in your life to feel grateful for, no matter how bad today or this week or month has been. You can start with the very basic stuff (like being born!), narrow it down a bit (like living in a democratic society in here in the UK where you are allowed to express and practice your beliefs) and then focus on the more personal and specific things you are thankful for like the place where you live, your friends and family…maybe even your job!

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I hope you have found some of these tips helpful. Remember – we should not and cannot avoid adversity in life. It’s the route to resilience and can make us stronger.

Wellbeing for real life: it’s all about connections

Three Manchester United legends together

Those of you that follow football may be aware that last night was a pretty big night in the Champions League, especially if like me you are a follower of Manchester United. I was raised in Manchester and have supported United all my life. Growing up, I was spoilt by having Sir Alex Ferguson, the greatest manager in premiership history, manage my team. It was an era of legends with players like Eric Cantona and at one stage arguably the best club midfield in the world with the likes of Giggs, Scholes, Keane, Butt and Beckham. Fergie, the team and the fans expected and demanded success. The promised land was reached in 1999 when United won the holy grail of the treble: the premier league, the FA cup and the champions league. No english premiership team had ever done it before and almost twenty years later it has yet to be repeated. The winning goal was scored by Ole Gunnar Solskjaer in injury time. I remember being on my knees, screaming at the television just before he scored it. There were many more trophies over the years to come, but for me that was the high watermark.

Sir Alex retired in 2013. Since then, it’s been pretty uninspiring. A few more trophies, lacklustre football and a series of uninspiring managers, the last of which was sacked in December 2018 when the team were at an all time low. One of the accusations made by the fans was that these managers didn’t understand the history and traditions of the club. On December 19th, Ole Gunnar Solskjaer was appointed as interim manager, largely out of desperation. I don’t think anyone seriously expected what happened next. Three months later, United have played 15, won 12, drawn 2 and lost 1. They are undefeated in the premier league, and still in the hunt for the FA cup and the Champions league. Last night they made european football history by coming back from 2-0 down in the previous match, scoring 3 goals to defeat their opponents and qualify for the quarter finals.

What’s the secret? How has a team of dispirited individuals, performing as so much less than the sum of their very expensive parts, been transformed? Does Ole have a magic wand? The answer, partly at least, is connections. He is legend of the club, whose name was still sung by the fans even before he returned as manager, and he is a connection to the glorious past. He is connected to arguably the club’s greatest manager as he once played under him and considers him his mentor. He is connected to the team by his understanding of and passion for the game, and his ability to inspire and motivate them. As a result, the players are once again connected to each other. Last night there were ten players unavailable through injury, including their world class midfielder Paul Pogba, and yet because they were connected they actually played together as greater than the sum of their parts, some of whom were teenagers out of the academy. He’s connected to the fans who sing “Ole’s at the wheel” endlessly, home or away.

Connections are vital for all of us. This week I have been listening to two of Dr Rangan Chatterjee’s best ever episodes of the Feel Better Live More podcast. It’s a two part conversation with Johann Hari, about understanding the real causes of depression. I cannot recommend these two episodes enough. Johann shares so many insights and important messages. I was struck by some in particular that I will list without commenting:

We have evolved to live in a tribe but nowadays often try to live without it.

Home is where someone notices when you are not there.

People are happier thinking collectively than individually.

Social media is fine as a way station to real life, offline encounters but if it’s the last stop on the line, then there’s a problem.

Speaking of social media, my friends and I use a WhatsApp group to organise our man-cave evenings. Last night they brought some beers and crisps, as per man-cave rules. We played some really terrible pool. We talked about our week, our work and our personal lives. Some did more talking, others more listening. The only thing I used my phone for once we were all together was a mancunian music playlist as we watched champions league history unfold in front of our eyes. Regardless of our tribal football affiliations, or lack thereof, we all enjoyed the evening. I’d like to think that at the end of evening I was the happiest person in the room, for obvious reasons. However, my friend Darren was a close second. He’s a West Ham season ticket holder who had decided to pop down the bookies beforehand and place a bet on United winning. To be honest, he had more faith than I did. He got fantastic odds. Next time we connect, the drinks are on him.

Wellbeing For Real Life: How to do a work place workout that doesn’t feel like work

One of the commonest new year’s resolutions that I hear my friends or my patients make is to be more physically active. “I will re-join the gym/start exercise classes/get 10,000 steps a day”, I hear them declare through slightly gritted teeth, looking slightly miserable, with a facial expression that suggests they are very likely to be declaring the same thing for their 2020 new year’s resolution.

One of the commonest reasons for people’s resolutions not coming to fruition is that they feel that they just don’t have the time. Time and again, people tell me that at the end of the day when they get home from work they just don’t have the time, inclination or energy to exercise. It’s another onerous task, another chore, another thing to tick off the to-do list.

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Today is your lucky day. I am the bearer of good news! You can cancel the gym subscription, throw away the unflattering lycra and uninstall all those exercise apps (you know, the ones that you don’t ever use) from your phone. Forget all this talk about no pain and no gain. Physical activity should be a simple, pleasurable, achievable and integral part of your life. For most of us this means working it in around our work. Evidence suggests that simply being less sedentary at work gives you at least the same health benefits as being sedentary and then doing a gym workout at the end of the day. So today I give you – the Work Place Workout! It’s a list of tips to enable you to spend your day being physically active , getting the benefits of a workout without having to actually do one.

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  1. Start the day before. Give yourself a good night’s sleep, aiming for 7-8 hours. It feels much better to start the day by waking naturally than being jarred from sleep by an alarm and the glare of your mobile phone screen.
  2. Give yourself enough time. Getting up a little earlier can work wonders for your working day. Having enough time to avoid rushing, to savour your coffee, enjoy breakfast or meditate for five minutes before you go to work will put you in a great frame of mind, focussed and full of energy for the day ahead.
  3. Work out on the way to work. If you are a commuter, think about how you can use this to your advantage. Could you walk or cycle to work instead of using the car or public transport? If you are on the bus, the train or the tube, why not get off a stop early and walk the rest of the way? When you walk, walk briskly so that you can feel your heart rate increase and you feel slightly out of breath. If you can’t manage that for the whole walk to work, start with 5 or 10 minutes at this intensity and build on that over time.
  4. Walk before work. As a result of getting up a little earlier, I can get to work, turn on my computer and then take a walk into town and back before I start surgery. It’s a good time to enjoy uninterrupted peace and quiet. This can also be a good time for getting your creative juices flowing and coming up with good ideas. If there are any green spaces near your workplace, I recommend you include them as part of your route if you are able. We all feel better for spending time in nature. Doing this, I can hit 3000 steps or more before I’ve made my first phone call of the day.
  5. Live a work life of inconvenience. My job is pretty sedentary and I could just sit at my desk all day. So I will go up and down a flight or two of stairs (or a circuit of the surgery car park) in between seeing patients. It’s a standing joke in our practice. Our pharmacists see me coming up the corridor and ask how many steps I’m on for the day. If I have a prescription that needs delivering to the pharmacy or a letter for reception, I take it myself as and when I can instead of waiting for someone to collect it. Over the course of a day, it probably takes about 10-15 minutes of my time to do this. However, it does leave me feeling more alert, energetic and focussed so I think this is a good investment of my time for me and my colleagues. Think about how you can do the same in your work environment. This might be as simple as getting up from your desk to go and talk to a colleague instead of sending them an email. This is likely to lead to improved work relationships so you get a double benefit from this.
  6. Use your breaks to be physically active. I can guarantee you will feel better for getting up and moving around in your break, rather than spending it sitting at your desk where you are already spending the rest of the day. I try to go for a walk at lunchtime. We have talked in my practice about having a walking group at lunchtimes. We might not be able to do this every day, but some will work better than others. Apart from reducing the risks of inactivity (now thought to be about the same as the risks of smoking), it can also help you clear your mind and remind yourself that there is more to the world than your desk and screen-sized bit of it!
  7. Fit in a micro-bursts of physical activity. This does depend upon your physical environment to a degree, but there will be some things that everyone can do. You can use your office or workspace as a gym. When I’m triaging on the telephone as the duty doctor, I will often be using a hands free headset. This means that whilst talking to patients I can do short bursts of exercises such as lunges, squats, tricep dips or even press-ups, using my examination couch, desk or chair. You might feel a bit self conscious in an open plan office but there are probably other spaces that you could find. You can even do a short burst of star jumps or burpees which will really energise you without reducing you to a sweaty, dishevelled mess. If you work from home, you could always just do 5 minutes of moderate intensity exercise a couple of times during the day.
  8. Stay out of your chair as much as you can. Looking back over the sweep of history, the invention of the chair has probably been one of the greatest public health disasters. Clearly there are times of when we have no choice but to be sitting down and at our desk. Try taking brief breaks when you can, use a standing desk and have phone conversations or meetings standing or walking when this is appropriate. Interestingly, there is evidence to support standing/walking meetings as not only being better for your physical wellbeing but also shorter and more productive. They definitely reduce the risk of death… by Powerpoint.
  9. Get into good habits. If you can work out a plan for your working day that involves some of these approaches and manage it for at least a few weeks, it is very likely to become a habit…one that you will want to stick to as you start to feel the benefits of being more active and ultimately more effective at work.

That’s it for my workplace-based workout tips. How many of these do you already do? How many could you adopt? If you make this a part of your working life, you need never darken the doors of a gym ever again. Just think about all the money you can save on membership fees and what you might like to spend it on instead…maybe a nice standing desk?!

That’s it from me for this week. As ever, please do feel free to contribute with your comments and feedback which are most welcome. Until next time, take care of yourself!

Dr Richard Pile

Wellbeing for Real Life – all change for the new year!

alcohol alcoholic beverage celebrate

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Having had a few weeks to take stock over the festive season, I have decided to make some changes to blog for the new year.   I have lots of plans for 2019 which promises to be an exciting year, for the blog and in other related areas too.   In order to fit it all in and practice what I preach when it comes to wellbeing for real life, I will be making a few adjustments.

The world of wellbeing is a fascinating one but seismic shifts in evidence and practice don’t tend to occur every week and I am keen to keep content fresh and relevant rather than reporting on the same issues if not much has changed.  As a result  I will be posting a little less frequently on news updates and more on specific topics (including topics suggested by you, the followers of this blog) and trying to keep the posts shorter, easier to digest and even more practical and user friendly.

As ever, your feedback is vital in helping me develop the blog so that it is as useful as possible, whether you be a professional practising in the world of lifestyle medicine and wellbeing, or a person interested in this for yourself or for others.   Please send your questions and suggestions for topics in and I will do my best to accommodate.   If I have enough questions on particular topics then I will put together a Frequently Asked Questions section as a permanent resource for all blog readers.

On January 16th, I will be presenting with my colleague at a New Year, New You event on healthy weight and wellbeing at Spire Hospital in Harpenden, Hertfordshire.  If you live locally and would like to attend, more information is available here.  We will be covering a number of areas of wellbeing including diet, movement, sleep and relaxation (including the chance to take part in a taster session of meditation and and mindfulness).

Good news! The further you’ve got to go, the easier it is to get started.

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I will finish today’s post with one of the key messages that I will be giving at the event.  It’s one about change.  Lots of us use the opportunity of the start of a new year to reflect on the last one, think about our wellbeing and what we would like to change or improve over the coming year.  Some of us succeed, some don’t.    It can be pretty daunting when considering making a big change to your life such as stopping smoking,  losing weight, drinking less,  doing more physical activity or learning to relax.   You may feel you have a mountain to climb.  You may look enviously at your friends and work colleagues with apparently perfect body mass indexes, turning up to work on their bikes with a yoga mat on the back, eating their healthy salads at lunchtime and talking about their plans for a dry January.

What I want to share with you is that if you feel you have a long way to go and big changes that you would like to make…it’s really, really easy to get started!  No one  climbs Mount Everest in a day.  People start at low altitude and gradually acclimatise.   The greatest benefits to health and wellbeing are seen in those who move slightly from being at high risk of these problems…to slightly lower risk.  To base camp, not the summit. If you are more or less completely inactive and break into a sweat at the thought of breaking into a sweat, just 10 minutes a day of walking could reduce your risk of heart disease or stroke by 30 or 40%.  If you are permanently stressed out and anxious, just starting with 5 minutes a day of relaxation (such as reading, listening to music, being out in nature or using a mindfulness app) will make a big difference to how you feel.   If you are chronically sleep deprived, cutting out caffeine after midday avoiding alcohol and not using your phone for an hour or two before bedtime could really improve the quality and quantity of your sleep, which will mean you wake up each day transformed with more energy and better mood.  Thinking small can make a big difference.  Why not talk about the changes you would like to make with your friends, family or doctor?

That’s it for this week.  Until next time, take care of yourself!

Dr Richard Pile

 

 

The Weekly Wellbeing Round-Up is away…Merry Christmas!

In the spirit of practising what I preach and maintaining a good work/life balance as we head into the festive season, I will be taking a break for the next week or two. I would like to thank you for reading and supporting this blog. I hope that you are finding it useful personally and, if you are a health professional , for your patients. I’m looking forward to making it even better in 2019. Any comments you have to make are much appreciated and help me develop it further. Please share the blog with your friends, family, colleagues and patients if you think they might find it helpful. Remember, when it comes to wellbeing, it’s all about keeping it real.

Merry Christmas and a happy new year!

Dr Richard Pile

The Weekly Wellbeing Round-Up #27 – More…or less?

Hello and welcome back to my weekly wellbeing round-up!  This week’s post from the world of wellbeing focusses on what we should be doing more of,  what we could be doing less of,  and where the evidence isn’t quite so clear.  Sufficiently intrigued?  Good…let’s dive in!

MORE OF…

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Physical activity. 

I thought I’d start with a nice easy one.   No surprises here.  Sport England have published their first activity survey for children and young people (2017-18).  It reveals that one in three children in England does fewer than 30 minutes of physical activity a day – half the amount recommended by government guidelines (60 minutes a day, 30 in and 30 out of school).  Girls are less likely to be as active as boys, with 13 to 16-year-olds the least active age group.  This correlates with the findings of this study which looked at the dropping levels of physical activity by age, identifying a key age of 11 after which physical activity may drop off more sharply.

This week the Health Survey for England (2017) was published by NHS Digital.   The scale of the challenge we face individually and collectively is sobering.  Five key risk factors for health were identified as physical inactivity, obesity, drinking more than 14 units a week of alcohol, smoking and eating less than five portions of fruit or vegetables a day.  Headline stats include:

  • 68% adults are overweight or obese
  • Children who have obese parents are three times more likely to be obese than children of healthy weight parents.
  • Less than 20% of children eat five portions of fruit and veg a day
  • 19% of adults had three or more out of the five risk factors for health
  • 90% of adults had one or more of the five risk factors for health

So when and how should we address this challenge and who is responsible for doing so?  My answers are as early as possible and everyone.  As humans, we are made to move.   Before we had chairs we walked, we ran, we stood, we squatted and we sat on the floor…something that now seems “unnatural” to many of us.  In my opinion, to sit still should be seen as an unnatural exception to the norm, necessary for a few hours of the day only for certain work and social activities that can’t be easily done standing or on the go.  When parents are worried about their ill child, one of the most common things they will say is that their child is quiet, sitting on the couch and not moving around freely like they normally do.  It’s a sign something is wrong.  When kids go to school, they are expected to sit still in a chair for hours at a time and get told off if they move around.

Clearly I’m being deliberately provocative here, but I’m trying to make the point that to address the considerable challenges we have largely made for ourselves as a society in pursuit of a life of convenience, we need to flip this situation on its head and establish a new norm.   As parents, we should not just be encouraging our children to spend more of their time physically active but modelling it too them as well.  If we tell our kids to turn off the games console and “do something”, as we sit slumped on the couch, we should be  unsurprised if they are unconvinced.

We need to choose to live lives that at times are a bit less convenient.  This could be choosing to walk up and down the stairs more at home or at work, not taking the lift, walking or cycling to the shops/school/work,  getting off a stop or two early from the tube or bus, taking short breaks to walk around and stretch our legs at work, using standing desks or having standing meetings.  I can guarantee it would make the latter considerably shorter and more focussed!  This year I’m going to get a standing desk for work and offer my patients the choice of standing or sitting when we consult.  A number of my colleagues have already done this and found that it works well for them and their patients.

It may be that you feel some of these options are realistic and some not…that’s fine, we are all individuals in unique situations at home and at work and there are always simple opportunities for us to become more active.  Interestingly, one of the common findings from looking at the world’s blue zones (where people have unusually long life expectancy and good health) is that the communities are generally active but in a modest and gentle way – walking for an hour a day, for example.  There aren’t many gym-bunnies or HITT practitioners amongst the centenarians of  Okinawa.

LESS OF…

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Statins for primary prevention.

I need to make a confession.  When NICE dropped the threshold for recommending prescribing a statin for primary prevention (preventing heart disease or stroke in people who have not yet had one) from a risk score of 20% to 10% in 2014,  I felt profoundly uneasy.  To put this simply, GP’s were effectively being advised to treat every man over 60 and every woman over 70 as being diseased and statin-deficient, requiring a drug to lower their cholesterol.  This felt instinctively wrong to me.

According to the NNT (numbers needed to treat) website, taking statins to prevent these things happening does not make you less likely to die as a result.  217 people need to take statins for one person to avoid a (non-fatal) heart attack and 313 people need to take statins for one person to avoid a (non-fatal) stroke.  For every 21 people who take statins, one will experience muscle pain and damage and for every 204 people who take statins, one will develop diabetes.   As a result of all of this, I do have conversations with my patients about the NICE guidelines, the issue of medicalising the ageing process, and the risks and benefits of statins for primary prevention.  I offer them the drugs.  The majority decline and we usually agree to them making some lifestyle changes and to have the conversation again in a few years’ time.

The findings of this study into the use of statins for primary prevention, published in the BMJ, suggest that the current NICE threshold for offering treatment is too low. For men and women over 70, benefit seems to occur in those with a risk score > 20%, and for people in their forties, benefit seems to occur from a risk score of 14% or more for men and 17% or more for women.  I am greatly encouraged by this.  It’s always nice to have some actual evidence to back up gut-based practice!

Arthroscopies for meniscal (knee) problems

This study looked at exercise therapy vs arthroscopy (inserting a camera inside the knee joint) for degenerative knee problems in middle-aged patients.  The conclusion was that exercise was at least as good a treatment option as surgery.   My question would therefore be – why would anyone opt for an invasive hospital procedure with the associated risks of complications including infection? It does of course does depend appropriate advice and support being given re exercise.  Just like physical activity is available on prescription in the community, it needs to be taken seriously by hospital specialists, motivated primarily by the best outcomes and least risk for their patients.  It’s important that all health professionals in whatever setting, community or hospital, are either knowledgeable about what advice to give or can signpost to someone else who can.

SLEEP

white bed linen

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As promised this week, I’m finishing off with something a little less clear cut.  Regular readers of this blog know that I’m a big fan of sleep and have made some changes to my lifestyle as a result of learning more about it.  If you haven’t read it yet, I recommend for your christmas stocking the excellent Why We Sleep by Matt Walker.   One of the questions that my patients and colleagues often ask me is – how much sleep do we need?  This study looked into sleep duration and associations with death and major cardiovascular events.  Six to eight hours per day was associated with the lowest risk of deaths and major cardiovascular events. Daytime napping was associated with increased risks of major cardiovascular events and deaths in those with more than six hours of nighttime sleep but not in those sleeping less than six hours.  My interpretation of this is if you are sleep deprived a nap is a good thing, whereas excessive daytime sleepiness in people who are already sleeping quite a lot at night may indicate possible underlying health issues causing these symptoms.   This would also potentially explain why increased risk was also associated with sleeping more than nine hours at night.

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That’s almost all for this week.  I wanted to finish with some podcast recommendations for you.  I cycled an hour each way to work one day this week and one of the great things about that (other than the benefits to my wellbeing, of course!) was that I got to catch up on my listening and fill my brain up a bit more.  They have both inspired me in the writing of this week’s post.

My first recommendation is TED Radio Hour, the Fountain of Youth.  It’s all about the secrets of ageing and longevity and what we can learn from studying the blue zones.

My second recommendation is episode 39 of Dr Rangan Chatterjee’s Feel Better Live More Podcast, entitled How to Stay Pain Free with the Foot Collective.  It’s all about how we are made to move, and should do so as naturally as possible.  It’s about much than just feet!

I hope you have enjoyed reading this episode of the weekly wellbeing round-up as much as I have putting it together.  It will, of course, return.  Until next week, take care of yourself!

Dr Richard Pile

 

The Weekly Wellbeing Round-Up, Episode #26

Welcome back to my weekly wellbeing round-up.  As usual, I have been scouring the news from the wellbeing world over the last seven days and found the most interesting, relevant and useful stuff to present it on a plate for your delectation.  This week’s topics include food labelling, diets to reverse diabetes, the benefits of eating together, population health and which interventions provide the best return on investment in reducing cardiovascular disease. Let’s dive in!

Prevention at scale

A different vision for population health

This article from the King’s Fund highlights the shift that is taking place in the burden of disease from mortality (death) to morbidity (illness) with people living for many years with chronic conditions, in pain and in poor physical and mental health.  Much of this is preventable.  The challenge for us as users, health professionals and commissioners, is to shift our mindset of viewing the NHS as a treatment service for sickness, to one which offers a more comprehensive approach to keeping us well.  This needs to apply to general practice, with clinicians and patients practising lifestyle medicine together, as well as to our commissioning decisions about what services we are going to spend money on.

So what should we be spending our money on to prevent disease?

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Public Health England have released this  helpful tool to help us understand which health interventions give the best return on investment when it comes to the prevention of cardiovascular disease (heart disease, stroke and diabetes) in larger populations.  Just in case you don’t have time to read the whole thing or spend hours playing with spreadsheets, my summary is as follows:

The best short term outcomes are obtained by detecting and managing people with a QRISK (cardiovascular disease risk) score of > 10% and using statins to lower cholesterol (£216 million saving by year 2).

The best long term outcomes are obtained through each of the following: increasing the detection of people with diabetes, optimising blood pressure control and having an annual review.

Most lifestyle interventions are not cost-saving within the 20 year time horizon of the model…however, this does not rule them out of being cost saving beyond this horizon.  The one exception to this is the excellent National Diabetes Prevention Program, which is shortly to have online versions rolled out for those who find it difficult to attend sessions due to work or family commitments.

My take home messages from this are

  1. We should continue to carry out risk assessments in primary care (and secondary care?).  NHS Health Checks are a great way of doing this and don’t need a doctor to do them.
  2. It’s much better to detect pre-diabetes or early diabetes and intervene as soon as possible with lifestyle changes to avoid a lifetime of complications and increasingly expensive drug treatments.  The National Diabetes Prevention Program is a shining example of how this can really work. 
  3. If people argue against spending money on other lifestyle interventions, they should be asked whether they would also not spend money on medication for diabetes, since the evidence on return on investment over 20 years is no better!

Very low calorie diets to reverse diabetes

As well as enhancing the NDPP offering, Simon Stevens has announced that very low calorie diets will be piloted at scale by the NHS for the first time from next year, after the success of the DiRECT and DROPLET trials in demonstrating weight loss and reversal of type 2 Diabetes.   In my view, whilst this is a potentially useful tool for carefully selected patients, we need to remember that an 800 calorie a day diet is not a long term sustainable option.  Follow up of these patients and assisting them in transitioning back into a healthy, natural diet will be key. 

Food

Food labelling

This week, Kelloggs has agreed to use the traffic light labelling for food introduced by the government’s voluntary scheme in 2013.  This indicates how much salt, sugar and fat foods contain.   This can only be a good thing as hopefully it will increase pressure on other food companies to do the same.  The scheme is already used by most supermarkets and some other companies such as Nestle and Weetabix.  It will begin to come into effect from Jan 2019.  

Whilst this is welcome news, remember that the vast majority of cereals are, to quote Dr Mark Hyman (author of Food: WTF Should I Eat?) “breakfast candy” – highly processed and full of sugar.  As a rule of thumb, any messaging on the packet about how good it is for you and how many of your five a day it contains is at best deceptive and at worst an outright lie.  For breakfast I usually choose from eggs (I eat them most days, usually poached), oily fish, avocado, vegetables (I love mushrooms and peppers)… and bacon if I want to treat myself.

Big Food and its influence over what we eat. 

On a related note, this article in the BMJ about food industry influence is worth a few minutes of your time.  It includes details of paper that will soon be published, examining 4000 peer-reviewed nutrition studies.  Researchers found that only 14% properly disclosed financial ties.  60% reported results favourable to the study sponsor, while only 3% reported unfavourable results.  Take home message?  We should assume that we face at least as big a challenge with industry influence on research, standards and guideline development from Big Food as we do from Big Pharma.  

Some good food news about family dinners

To finish this week on a positive note, I was encouraged after reading this article in the New England Journal of Medicine which suggests that adolescents and young adults who eat dinner with their families more often have healthier diets – regardless of how well their families function in general.  We already know that sharing meals together is good for our overall wellbeing, particularly our mental health.  It helps us be live mindfully, not just viewing food as fuel to be gobbled down as quickly as possible whilst staring at the screen of our mobile phone and thinking about what’s up next.  It now also appears to result in healthier diets, even if there are a few squabbles over the dinner table!  I have a busy weekend ahead with extended hours on Saturday and an out of hours urgent care shift on Sunday,  but as a family we will do our best to at least have some of our meals together.   If you don’t have family around you this weekend, why not invite friends or neighbours to share a meal with you? 

That’s it for this week.  Never fear…the weekly wellbeing round-up will return.  If you have enjoyed reading this blog, please share it with your friends, family and colleagues.  As every , your feedback is very much appreciated.  Last week’s blog focussing on mental health was the most viewed since I started the round-up!  

Until next time, take care of yourself.

Dr Richard Pile