Tuesday, May 18, 2010

Children Do Better In School With Regular Exercise

The human genome (our genes) has changed very little over the last 10,000 years. How we live our lives has changed dramatically over that time and particularly in the last 50 years. A day in the life of a child growing up in the 1920’s would be completely different to one growing up the 1960’s and would bear almost no resemblance to a child growing up today. Yet a child growing up in the 1620’s may have had a similar experience to one in even the 1820’s.

The two biggest changes are of course what we eat and how much movement we get. This affects adults as we see with rates of obesity and other lifestyle related diseases. It also impacts on children and can have unexpected consequences. In turn people then tend to look everywhere for the answer rather than where it actually lies.

The most “visible” affect our children of a diet high in processed foods and a lack of activity is the increasing rate of diagnosis of ADHD. The improvements seen with putting the right fuels into little bodies and allowing them to run around like, well…children is often dramatic.

There are more subtle effects too. A report presented to the American Heart Association showed that children who are fitter do better in school. Assessments on test scores in math’s science and social studies were made in year 5 and followed up in year 7 in a West Virginian county. The children who did best in their test scores had the highest levels of fitness. Those who improved their fitness, by and large improved their scores over the two years. This does not mean they were Olympic athletes. It basically meant they did some regular sport or physical activity. Another study in California on high school students found exactly the correlation.

Showing the practical application of this, a school near Chicago has made gym class the first session of the day to “kick start” the brains. The Napperville School also has bikes and balls in the classroom to keep the children on the move. According to the University of Illinois, children do 10% better at problem solving after a 30-minute stint on the treadmill. Exercise makes the brain “ready to learn” and it is good for attention.

The results speak for themselves. Reading and mathematics scores are up significantly. Exercise has got to be better for children than Ritalin and of course there are other benefits as well.

A study looking at children with genes “associated with obesity” found that in the group which did regular exercise, the gene did not express itself. In other words even if one has genes, which may predispose to obesity (and remember our genes have not really changed in 10,000 years for most of which time obesity was not a problem) then regular exercise overcomes it.

This fits completely with the growing understanding that genes are like light switches. Presence or absence means less than whether they are switched on or off. And what influence whether genes are switched on or off? Our lifestyles and in particular stress, diet and exercise.

So the answer to better grades is the same as the answer to obesity and to a large degree the answer to attention problems. The answer is not complex. The answer is not in a pill. The answer is regular exercise and healthy eating patterns.

Friday, May 14, 2010

Healthy Bones Need Sunshine And Exercise Not Pills

One of the reasons that “healthcare” is so expensive is that the expensive option is usually researched more and pushed more than inexpensive options. Falls, particularly in the elderly are a major cause of illness and can at times be the trigger for admission to a care facility for someone who previously lived independently. This is not just because of the fall as such but is compounded by a hospital stay, which is always debilitating.

Governments, are often interested in ways to prevent falls and hence save themselves some dollars. We have also seen the creation of osteoporosis as a disease to be treated with the notion being, that doing so prevents fractured bones. There are a number of drugs, which are used to “treat” osteoporosis. Indeed the widespread use of hormone replacement therapy, which has now been discredited, was justified on the basis of preventing osteoporosis.

Osteoporosis is a “thinning” of the bones as we age. Like many aspects of the body there is change over the years. However it is not a function of age alone. It is a function of how we look after our bones along the way. The condition, like many in medicine, is defined statistically. In much the same way as someone is the shortest in the room, someone will have the least “dense” bones.

Of itself it is (with exceptions) a painless condition which of itself (again with exceptions) does no harm. Problems arise because of fractured (broken) bones. However this can occur in any age group including children so is not confined to the elderly.

So if our aim is to reduce fracture rates, then we should be interested in ways to prevent falls. Placing a whole lot of people on drugs does not do this. The best way to prevent fractures is to prevent falls. The best way to do this is through regular exercise so that muscles and coordination remain as good as they can be. Recent studies have shown that older people who participate in martial arts classes or regular dancing reduce their fall and fracture rate. Both are obviously forms of exercise. In addition to this they both, in different ways, emphasize co-ordination and balance. These are important in preventing falls.

Furthermore if we are really interested in our bones then we can be doing things to care for them. Adequate intake of green vegetables for calcium and minimizing sugary foods (which leach calcium out of the bones) is important. Regular aerobic and resistance exercise keeps the bones and muscles strong. The other key component is vitamin D, which is free form the sun.

One of the tragedies of aged care is to see elderly people denied fresh air and sunshine. Rather than giving them tablets for their bones, how about letting them sit in the sun for 15 minutes or so per day so they do not become vitamin D deficient.

So rather than see loss of bone strength as a disease needing pills, we need to see it as a consequence of not looking after our bones. Whilst sooner is better, it is never too late to start caring for your bones with simple measures as we have seen above.

Tuesday, May 11, 2010

Cancer - What If You Have A Say In It ?

It is amazing how discoveries, which are simple, do not make big news. If a pill which reduced breast cancer by one third was released it would be big news. There would be massive demand and the company, which made it, would see profits and the share price rocket.

There is of course no pill, which does this. The same effect can be achieved, by eating less, exercising more, and having only moderate alcohol intake. Regular exercise alone leads to a halving of lifetime risk of breast cancer. Does it really matter if the way to reduce your chance of getting breast cancer by one third is by taking a tablet or doing other simple things? Apparently it does.

Whilst this finding, which came from The University of Milan, made some newswires it was hardly the front-page story that the release of a pill would be. Why is this? In my opinion there are two reasons.

Firstly we have become conditioned to look for technological solutions rather than simple ones. In the long and thus far unsuccessful “war” on cancer hundreds of billions of dollars have been spent looking for new breakthroughs. If the solution is something we sort of knew all along and is not a “breakthrough” then people tend to switch off. We also tend to think, “it can not be that simple”. When answers are obvious or right in front of us we tend to be dismissive, as we have become conditioned to look for the complex.

There is a second reason and this highlighted in some of the reaction to this. A spokesperson for a British cancer charity said their agency was very careful about issuing similar lifestyle advice. Ian Manley from Breast Cancer Care told Fox News “We would never want women to feel responsible for their breast cancer”.

How exactly does this help women? If there are things that they are doing which makes it more likely they get cancer then surely taking responsibility and doing something different would be the way to go. We are not talking force fields which mean you can not possibly get cancer but a one third reduction in risk is certainly worthwhile. Many in the health arena are paranoid about what is called “blaming the victim”. This essentially portrays anyone who has disease as an innocent bystander who is totally helpless and has been struck at random by forces completely beyond their control.

What about if we rephrase this as, “the actions of an individual lead to certain consequences”. Hence if by eating certain foods, being overweight and not exercising you have significantly increased your chances of getting cancer then those are choices you have made and cancer may be one of the consequences.

To use an analogy, if you stand in the middle of a freeway your chances of getting hit by a car are much greater than if you stand on the sidewalk. On the road the cars may avoid you and it is possible to be hit by a car, which leaves the road and hits you on the sidewalk. However you know where the odds of getting hit are greater. If you deliberately do certain things which increase your chances of getting cancer (or any disease) then it not really a random action beyond your control if that disease eventuates.

The great thing about being responsible for your health is that it puts you in charge. You can make the changes and in turn change your odds of “getting hit”. It is a no brainer to walk on the sidewalk rather than down the middle of the road. Doing regular exercise, maintaining a healthy weight, eating mainly “real” rather than processed food and moderating alcohol intake are collectively the same no brainer when it comes to breast cancer.

Friday, May 7, 2010

Disease Is A Profitable Business

Sometimes useful insights come from unexpected places. Fortune Magazine publishes an annual report on Americas top 500 companies. Included in this is an overview of business sectors and how they have fared the previous year. Not surprisingly, 2009 was not a great year for many businesses.

There are of course exceptions. To quote Fortune, “For the drug industry it is as if the recession never happened”. Earnings in the pharmaceutical industry were up by one-third last year. Even sales of Botox came in at $1.3 billion; slightly down on 2008. A numbers of reasons were given for this. The most significant one in my opinion was that the industry is credited with the ability to raise prices even in tough times.

Given that this all occurred against the backdrop of major debate over health reform, lack of insurance cover for many, and the costs of healthcare in general, makes it all the more remarkable. So why is the pharmaceutical industry able to raise prices and make money when times are tough?

There are a few reasons for this. It is held that people are more likely to get sick in hard times, although this has been strongly disputed. Medications are seen as essential so people may cut back on other items before pills. However given that much of the cost is borne by insurers this is not the whole answer either.

In my view the reason is simple economics 101-supply and demand. There is an increasing demand for medications and this allows the suppliers a greater degree of price control than in areas where demand for product is less. Doctors, many of whom unfortunately see pills as the answer to most problems, drive much of this demand.

This was illustrated perfectly by a letter I got from a cardiologist in which he extols primary care physicians on the importance of treating diabetics with high doses of statin medication together with at least two blood pressure medications. As usual this advice is based on “evidence” which comes from trials. Whether or not pharmaceutical manufacturers funded these trials is not clear.

The letter did not mention weight loss, exercise or stress management. It also did not mention the study earlier this year, which showed once again that weight loss leads to lower blood pressure. The lead author of this study concluded, that it was important for people to know that they can try diet instead of pills and get the same results.

Other studies have shown reduced rates of heart disease and stroke in people who ate more foods containing vitamin B6 and folate. Those who ate more processed foods and foods with added sugar had higher rates of heart disease. Olive oil reduces inflammatory activity, again reducing heart disease as we see in those following a Mediterranean diet.

People see the world through their own eyes. Unfortunately doctors, in many instances have become conditioned to see pharmaceuticals as the answer to lifestyle related conditions. For some people there will be a role for pharmaceuticals. However the best solution to lifestyle related conditions are lifestyle changes.

These will not boost the profits of the drug industry though.

Tuesday, May 4, 2010

Improving Hospital Food

As an amateur chef, I like to watch some of the cooking shows, which are so prevalent on television these days. Putting the right fuels in the body, is so important for good health, yet it is sometimes the perceived difficult to do this. It is always good to see chefs who use real food and teach us that cooking is simple, fun and that using good produce is not expensive. Of course the end result is a meal that we would all like to eat.

Some celebrity chefs have branched out and taken up broader issues related to food and its role in our lives. Jamie Oliver is probably the chef who has been at the forefront of this with his Ministry of Food and Food Revolution. He has ventured into areas where hardly anyone knows how to cook and taught them simple healthy recipes. He has also tackled school canteens in the UK and more recently the USA.

This is all good TV and sells books-fair enough. If people neither watch his shows or buy his books the message does not spread. A bit of publicity either favorable or the “get out of our town” variety also helps this process.

Now another chef has taken up the issue of hospital food which, by and large, does not provide either good nutrition or even taste to people who are sick and in need of good nourishment to aid their recovery. Many elderly people are malnourished as it is, due to not eating enough fruits and vegetables and often relying on packaged foods. The situation in aged care facilities is generally little better. When in hospital, it is an opportunity to provide them with some good nutrition. This opportunity is almost always wasted.

Heston Blumenthal whose Fat Duck restaurant was named third best in the world will team up with The University of Reading and the Royal Berkshire Hospital to find ways of making meals more flavorsome and nutritious. Whilst there is no need for Michelin star foods or fusion dishes on hospital menus, there is much that can be done to improve the quality of hospital meals. When a meal is appetizing and flavorsome, we are more likely to eat it. Of course, when we do the meal needs to provide our body with the nourishment and fuels we hope.

Of course providing a large number of meals simultaneously is not logistically simple and there will be a range of issues to address. However once there is a will, a way will be found. The first aim of the collaboration is simply to improve the flavor of simple meals like Shepherds pie.

My late mother spent some weeks in hospital after a hip fracture and the food she was served was awful. You cannot repair a house without the right materials,so how we expect the body to repair when it is not provided with the right nutrition is beyond me.

The body needs the right fuels at any time but arguably more so when ill. This move in the UK will hopefully generate plenty of publicity and start people down a similar path in other parts of the world too.