Wednesday, October 28, 2009

A Glass of Wine is OK

One of the reasons that public health messages struggle to get through is that they are presented as very black and white, a bit like in George Orwell’s Animal Farm -“four legs good - two legs bad”. Yet with virtually all matters of health it is not that simple. There is usually a right amount. Too little or too much is a problem.

Even essentials like air and water come under this rule. If you breathe too quickly you get anxious and light headed. There is a “right” amount of air that the body needs. Too much water can be a problem as is too little.

Most public health messages are based on the tobacco principle. Tell people its bad and don’t allow any wriggle room. It is fair to say that tobacco is not healthy in any amount (although like with all poisons less is better than more). However with foods and alcohol the situation is not as clear-cut.

Now the problems associated with alcohol abuse and misuse, dwarf the combined problems from all illicit drugs. The problems include violence, road trauma, relationship breakdowns and of course numerous health problems from liver disease through to dementia. These are problems from excessive consumption of alcohol.

Yet consumed in smaller quantities these problems do not occur. Furthermore it is likely that the consumption of red wine is actually good for our hearts. This idea has been around for a while but has struggled to get much coverage as the public health people are terrified that if the public are told that a glass or two of wine is healthy that they will drink much more than that.

The really interesting thing is that those who drink harmful amounts of alcohol are not wondering about the health effects of their behavior, be it good or bad, and no one who doesn’t like wine will suddenly start drinking it for medicinal purposes.

So lets just stick to the facts. It has long been observed that the French have lower rates of heart disease despite eating diets higher in fats compared to Anglo-Saxon countries. Attempts to explain this have always come back to the consumption of red wine. This has been documented many times. There are a few mechanisms-the main one being Resveratrol. There are some “cardio protective” effects from this including an increase in HDL or good cholesterol.

Resveratrol is now marketed as a supplement and this likely has some benefits. However, it is also likely that the benefits from red wine are not just due to Resveratrol and that there are other bio-active compounds working in with it. Reducing nature to one working part will generally mean something is left out.

So what is the take home message in all this? A glass or two (1-2 for men 1 for women) of red wine a few days a week is not only not bad for you but probably good for you. Is this a reason to take up wine? —No. Is more better? —No it’s worse.

Can you enjoy a glass of wine with your meal and not feel guilty? –absolutely.

Monday, October 19, 2009

If it wasn't a pill that caused it...

It is reported in The New York Times(see link) that 3 new diet drugs are lining up for regulatory approval. It is estimated that Americans spend $59 billion annually on a range of weight reduction measures from diet books to stomach surgery.Yet as the paper reports only a very small amount of this is spent on prescription drugs.

There are two main reasons for this. Number one is that they don’t work particularly well and secondly there is a track record of diet tablets being taken off the market due to safety concerns. The new drugs have shown some “positive” results over a one-year trial. This is not a long time though and the safety issues with previous drugs only became apparent after they were used by a much larger number of people.

Given the huge potential profits it is easy to see why the pharmaceutical industry may be keen to get involved (the drugs are owned by biotech firms looking for a pharma partner). This is despite sales of current weight loss pills being small and the safety/liability issues. There is also the FDA concern of them being used “recreationally” by people who are not overweight but say want to drop one clothes size.

Here is something to think about. If it wasn’t a pill, which made you put on weight why do you, need a pill to reverse the process. It is always interesting to hear when people say diets didn’t work. Diets have no moving parts .The only way it can “work” is if the individual sticks to it.

Now herein does lay the issue. Many “diets” are considerably removed from what people normally eat each day. Hence the change is too hard to sustain. Even when people stay the course for long enough to reduce weight, they then revert to the previous eating patterns, and not surprisingly this takes them right back to where they started.

Whilst this should not come as a surprise it usually does.

So is there a solution? Of course there is. It starts with taking personal responsibility. You must accept that it is your own actions, which have led you to this place, and that it is only your own actions that can take you to a different place.

The solution is to change your eating patterns. It is no use repeating the same thing and expecting a different result. You need to change the way you relate to food . For example, if you comfort eat then recognize this and deal with the underlying issue. If you have a sweet tooth (like I do) accept this and allow yourself some small treats rather than going without for so long that you end up binging.

Keep at the front of your mind this simple concept. The body stores energy it does not use up as fat. The only way to reduce weight is to use up more energy each day then you put in. This gives you two dials to adjust. Use more energy by being active and consume less energy(calories).

Do not go hungry. Choose foods, which provide nutrition without excess calories. In simplest terms this will be whole food. Food that till recently was moving around, or growing somewhere.

Cut down on processed and packaged foods. Drink mainly water. For sustainable change these must become what you do daily not just a “diet” for a few weeks.

It has been done, it can be done and you can do it if you so choose.

Friday, October 9, 2009

Live Better for Longer

Two interesting pieces recently on longevity caught my eye. It was reported in The Lancet (link 1) that life expectancy is continuing to increase and that a large number of babies born this century will live to be a century.

I was first shown statistics like this in 2003 at an anti aging conference in Singapore run by The American Academy of Anti-Aging Medicine (A4M). The statistics showed that life expectancy in the developed world has been steadily increasing at the rate of one quarter of year per year (1 year each 4 years) since the late 1800s and that the graph was not plateauing. These latest findings confirm this.

Many reasons are cited and not surprisingly there will be many lining up to take the credit. It is due to a combination of many factors. One of the main ones is that average life expectancy is strongly influenced by childhood deaths. As these have bee reduced significantly the average has gone up. Better food, sanitation and living conditions have helped too. Modern medicine has had a role but less than it might claim.

Life expectancy still differs in different countries. Japan has one of the longest life spans and it is thought that half of its 80 year old women will make it to 90.It is also estimated that in very near future the number of people over 65 will exceed the number under 5.

The second article (link 2) looks at the effects of recession on life span and shows perhaps surprisingly that bad economic times correlate with greater increases in longevity. In other words health increases in bad times more than good. Again there are many reasons put forward. Less stress is a key factor .If people have less work to do they slow down, get more sleep and may make more time for exercise. Now there are downsides to recessions too so this effect is not across the board. However the overall effect on the health of the population is positive.

Averages reflect numbers on both sides of the “average”, the question then becomes what are the people who live longer than “average” doing and what can be learned from them. From my experience as a doctor talking to thousands of people over the years, those who live healthiest longest are looking after their bodies. They are putting in the right fuels, they are active on a regular basis, they get enough sleep and relaxation, they keep themselves hydrated, they have good relationships and they enjoy what they are doing. None of this is difficult or beyond the reach of anyone

What matters most is quality of life. Living more years if you are in pain or immobile or have lost your memory is not appealing to most people. The good news is that looking after your health means you enjoy a better life and it in turn makes it more likely that you will live longer and enjoy those years.



Thursday, October 1, 2009

Let the Sun Shine

Without the sun there would be no life on earth. Yet somehow over the last 30 year the sun has become something evil to be feared and avoided at almost all costs. Lets be very clear up front -getting sunburnt is not a good idea and if you do it often enough there is an increased chance of you developing skin cancer

Much like there is a difference between your steak being raw medium rare or burnt; there is a difference between getting adequate sun exposure, too little and too much. In the rush to avoid the sun at all costs there have been an unexpected problem. Many (estimated up to 40%) are now deficient in vitamin D. -the active form of which (D3) is produced in the body under uv light exposure.

Classic vitamin D deficiency (rickets) was associated with underground miners in the late 1800’s. It was thought that in the modern era, such deficiencies of vitamins would be unheard of in the developed world.

European studies on trials involving 57,000 people published in the Archives of Internal Medicine, showed vitamin D had an important role in helping protect against colon and breast cancer as well as diabetes and heart disease. The trials found that those with adequate levels of vitamin D had a 7% lower overall death risk during the six year period of the trial. The results prompted Professor Edward Giovannucci from the Harvard School of Public Health to call for a debate on the merits of “moderate sun exposure”.

The Moore’s Cancer Centre at the University of California suggested that up to 600,000 breast and colorectal cancers could be prevented each year if vitamin D3 levels among populations worldwide were increased.

Inadequate vitamin D may also have a role in the development asthma, osteoarthritis and Alzheimer’s

So the obvious question becomes, how can one get the right amount of sunlight so as to get the benefits of adequate vitamin D in the body but not get excessive exposure .The exact amount of time doesn’t seem to have been determined yet, however, it is likely that something between 10-15 minutes per day on 4-6 days per week of sun exposure to the arms and face is likely to be enough for most people.

In other words, it is not about laying for three hours sunbaking. In particular, the best time to be out in the sunshine is before 10am or after 3pm. At this time, the risk of burning is reduced. The closer to sunrise and sunset, the longer one can stretch this out as the rays aren’t as strong and the risk of burning is lessened.

Unfortunately, the public health people are still paranoid about sunlight .For those doing DIY health the take home message is get the right amount of sun without getting burnt. This means getting a ”healthy” tan but not burning.