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

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

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Is there really a problem?

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

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

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

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

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

Symptoms and signs of the problem

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

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

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

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

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

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

Dr Richard Pile.

The Weekly Wellbeing Round-Up #12: my week of learning more about low carb diets.

As those of you that read the Weekly Wellbeing Round Up will be aware, there was a bit of a scuffle last week in  the media about the low carbohydrate diet.  This all kicked off due to the  publication in the Lancet Public Health of a prospective cohort study and meta-analysis which suggested there might be an association with lower carbohydrate diets and increased mortality.  This gave rise to sensationalist headlines in the press, linking low carb diets to a grim, early death.  The low carb vs low fat battlelines were already drawn up and ready to go of course, so volleys of invective were being fired each way sooner than you could type twitterspat.  It was a particularly unedifying spectacle to outside observers, to whom it may have appeared that the anti-low carb lobby were crowing triumphantlythat this was the nail in the coffin whilst the low-carbers circled the wagons and sat with their fingers in their ears.

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So in this week’s post I am attempting to make sense of the evidence, pointing out a few obvious things and making practical recommendations about the place of low carb diets.

I will start with a disclaimer:  I am currently eating a low-ish carb diet.  I mentioned this in a previous post about my real life wellbeing week.   I have lost about half a stone in weight having never managed to lose any in the past by just cutting back on the calories.  I’m not a fanatic.  I have friends and family who have found this approach similarly helpful.  I haven’t written a book on low carb, I don’t run a expensive private clinic or have any merchandise to sell.  I will occasionally raid the biscuit tin in reception when I am peckish. I still enjoy a beer and some nibbles with my colleagues in the pub on a friday.   It’s one of the best parts of my working week.  If the price I pay for this is indeed a grim and premature death, then I consider that an acceptable trade-off.

The Evidence

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The problem with the evidence is that there’s both a lot of it and not enough of it.  Plenty of cohort studies asking people what they think they ate 25 years ago.  Not so many randomised controlled trials comparing low carb to very low carb to moderate carb to low fat etc, with long term outcomes that affect people’s lives (e.g. heart attack, stroke etc).  In fact for not so many, read none at all.  Plenty of data around effects on blood sugar, cholesterol and blood pressure, but not the really important outcomes.    There are lots of meta-analyses looking at the same subject which have come to quite different conclusions.  This is due either to the variable quality of the studies that were included or how the analysis was done.  The latter in turn may be affected by where the person or persons conducting the meta-analysis stood on the issue.  It is widely agreed that more good quality long term data is needed.

The negative

It’s important that advocates of a low carb diet be honest about the lack of clinically significant long term outcomes from properly conducted studies (i.e.  randomised controlled prospective studies).  Anyone that can tell you their low carb diet plan has been proved to result in fewer heart attacks and strokes is at best wildly optimistic and not understanding of what constitutes proper evidence, confused by the difference between causation and association , or just lying.   Quite a few meta analyses have found that the low carb diet is not superior to the low fat diet.  Fair enough.  Let’s think about that though…”not superior to”.  Which may also mean “just as good as”.  As in these position statements from Diabetes UK and the NHS UK website.  Drug companies make new drugs that are better than placebo and equivalent to many existing products and they get licensed, accepted and used widely..so why do we have to prove the low carb diet is better than anything else to consider using it?

To be clear, there is no credible evidence that low carb diets cause harm.   Anyone intellectually lazy enough to have read the Lancet publication and newspaper headlines and said “well, that’s that then” deserves a intellectual kick up the backside.  The study is worth discussing but it simply cannot hold all the weight that some seem to be requiring of it and it does not prove causation.  A drug would not be licensed if it couldn’t be proved it caused a positive outcome and neither would it be withdrawn unless it could be proved it caused negative outcomes (and sometimes not even then…that’s another topic!).   Here is a link to Dr Zoe Harcombe’s excellent detailed analysis of the study.

The positive

Whilst there are meta-analyses that can be drawn upon by both sides  it seems clear to me that that there is reasonable evidence from both meta-analyses and individual studies that the low carb diet is at least equivalent to the low fat diet in effectiveness and may even be slightly better in specific patient groups.  That’s as strongly as I’m putting it.  Proponents of the low carb diet should not claim it is a magic bullet, and sceptics should not dismiss it purely because it isn’t one.   The areas where there is, in my view, sufficient evidence to consider it as part of the dietary tools available to us are diabetes (including possibly gestational diabetes), pre-diabetes and obesity.  Relevant links below if you would like to do some further reading.

Diabetes

Improved HbA1c, triglycerides and HDL in Type 2 Diabetes

Best dietary approach for reducing HbA1c in Type 2 Diabetics

A low glycaemic index diet improves glycaemic control in women with gestational diabetes, and reduces birth weight of their children

Obesity

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PLOS One meta-analysis of LCD vs LFD in obese or overweight patients

Long term weight maintenance is superior on a higher protein LCD.  A modest persistant effect was shown with less lean muscle mass lost compared to a LFD

LCD’s result in decreased fat mass, if not a greater long term weight loss than LFD’s.

Reflections

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Everyone has either a starting position, personal experience, bias or vested interest in this area.  We should acknowledge this. For most people, a low carb diet inevitably involves calorie restriction, which will clearly contribute to weight loss.   Low carb diet advocates should acknowledge this.  There are a variety of dietary options that are available to us and some will work better than others for each individual…so health professionals and individuals need to explore what is likely to be the best option in each individual and their situation e.g. I would not recommend low carb high fat diet in someone with Familial Hypercholesterolaemia (an inherited condition causing very high cholesterol).  Neither would I recommend a moderate to high carb intake in someone with diabetes.  We need the right tools for each situation.

We are not coming from a healthy, normal baseline in developed western societies such as UK and US…we massively over-do beige carbs and our rising obesity and overweight figures bear witness to this.  It feels intrinsically right to me that we aim to reduce the portion of our diets that has very little if any nutritional value and is clearly contributing significantly to the rise in obesity and related conditions. Evidence changes all the time.   When I was a junior doctor, I would have failed my exams for membership of the Royal College of Physicians for recommending betablockers to patients with heart failure, which was considered dangerous at the time.  Now it is recommended by NICE and GP’s are expected and incentivised to do exactly this.

In reality, very few people are going to follow a very low carb diet for practical and financial reasons.  A very low carb diet (< 50g per day) is unrealistic in the general population.  A low carb diet (<120-130g a day) is more sustainable.

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Extreme views and practices of whatever kind are unlikely to be useful, safe or achievable in real life.  As a GP and commissioner I am interested in getting the greatest amount of bang for my buck.  When it comes to physical activity, the greatest health gains (and risk reduction) comes from people moving from doing nothing to doing something.  When it comes to diet then from a public health perspective the greatest benefit would come from large numbers of people at significant risk of cardiovascular disease adopting a modest, sustainable reduced carbohydrate diet rather than a smaller number of people (many of whom are already highly motivated and “healthy”) adopting a more extreme, harder-to-sustain, very low carbohydrate diet.

The best medicine is the one that a person will take.  The best diet is one that a person can stick to and lose weight.

That’s it for this week. The weekly Wellbeing Round up will be back next week. Until then…take care of yourselves!

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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 #9

Good morning from lovely, sunny Verona. We are having a family break and so in the interests of wellbeing, I am taking a (sort of) break from weekly Wellbeing Round Up. So instead of spending hours reading through and summarising the wellbeing news of the last seven days, I am posting holiday photos! Well, it always used to work for one of our anatomy lecturers at medical school.

Snacks and reading material for the flight to Verona

Getting 10,000 steps ….in 35 degree heat!

Shade and rehydration (I’ve checked and apparently beer does hydrate you…not as much as water, but more than wine!)

The Teatro Romano. We have booked to see the MOMIX dance show tomorrow evening. If I’m not being physically active myself then clearly the next best option is to watch someone else who is

Panorama of Verona

Lovely meal in a stunning setting at Re Teodorico. The good folk of Verona are very keen on their meat. Vegetables…not so much ! Have decided carbs on holiday don’t count

Verona sunset

That’s all from the weekly round up this week, folks. Hope you have a good week. Normal service resumed next week. Until then…take care of yourselves!

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