In Medicine – Less Is Often More

I have previously written about problems with long-term use of medications particularly those used for lifestyle related conditions. It looks like The American Medical Association agrees with me. The Association’s Archives of Internal Medicine Journal has highlighted the often-unpublicized downside of tests and treatments in a recent edition.

In an editorial titled “Less is more: How Less Health Care Can Result In Better Health” the spotlight has been turned on how extra tests and unnecessary treatments not only do not help but can cause significant harm. The fractures and diarrheal illnesses associated with long-term proton pump inhibitors (used for heartburn) were one of the cases highlighted. According to Dr Deborah Grady of the University of California, San Francisco “There just seems to be this assumption that the more health care you get, the better”.

This is an incredibly important issue. The Archives Journal will have a regular “Less is More” feature looking at where treatments have expanded to the point where harm outweighs benefit. Doctors and patients have become conditioned to the notion that if tests are good, more are better and that pills are the answer for just about everything. Yet there is never such a thing as a free lunch. All pills have side effects. These can be justified when the benefits outweigh the risks and when no other treatment is available. When simple changes in lifestyle will have the same effect though they cannot be justified. The issue of cost is a whole other component of this.

Tests are also seen as wonderful because of their capacity to find “unexpected” serious illness such as cancer. Tests are fallible though and many people go through further tests and even surgery because of a finding in a test which may in fact be meaningless but “once found must be acted on”. Mass screenings add to this problem. Issues with PSA testing led the tests inventor to describe PSA testing for cancer as being like flipping a coin. The benefits of mammography screening have also been significantly overstated.

So what drives the test and pop agenda? There are two main drivers. One is litigation and the use of defensive medicine. Ordering unnecessary tests on 1000 people will not get a doctor sued, regardless the cost and inconvenience but the one person where a diagnosis is missed may well sue. The other is commercial and vested interest.

Obviously the pharmaceutical industry has a legitimate interest in selling its products and is clever at marketing. It also drives a lot of research. If a study is done looking for a use for a drug there is a fair chance it will be found. Extending the number of people classified as needing treatment (for example by lowering cholesterol target levels) boosts sales.

Whole industries have sprung up behind screening too. Those involved in the mammography business dismiss any criticism of mammography, usually as an attack on women. Unnecessary surgery on breasts is not seen in the same light.

There is no point saying that there is an across the board clear-cut answer. And herein lies the real issue. One size fits all models do not fit all. Attempts to screen or treat everyone the same has led to this problem. Over emphasis on guidelines and protocols stop doctors (and patients) considering the individual circumstances of each case. Well meaning scare campaigns convert everyday bodily functions into danger signs of cancer leading to a race to exclude what was never there.

The answer then is in fact simple. Focus on being healthy rather than enter the obstacle course of avoiding disease. Have faith in your own body and what it is telling you. It knows more than most tests. Ask your doctor about the downside of tests and side effects of medications. Take the non-pharmaceutical option first.

Do not buy into scare campaigns or disease mongering.

 

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Live Longer And Enjoy The Ride

Whilst the search goes on to find new “scientific” ways of living better for longer, there are two very simple things that you can do today to achieve exactly this. And there are two bonuses.

Last year Australian research showed, that there was a direct correlation between time spent being sedentary, and risk of dying. In fact there was a 10% increased risk of death for every hour beyond two per day that you spent continuously sitting down.

Just in case we needed more scientific proof, an American study of 120,000 people over 14 years showed that women who sat for six hours per day had a 37% higher risk of death than those who spent less than three hours a day sitting. For men the difference was 17%.

For those who did no exercise the death risk rates were increased by 94% for women and 48% for men.

Doing even a little exercise helped reduce this risk but prolonged periods of sitting is an issue in itself which is not totally offset by exercise even though exercise makes a big difference as seen above.

Yet the answer here is very simple. Just get up out of your chair on a regular basis and move around. Consider standing at your desk or standing whilst you read the paper. The simple act of standing instead of sitting causes a whole set of stabilizer muscles to be active which does not happen whilst you are sitting.

The simple act of standing instead of sitting for part of the day or at least getting up from your desk to stand, stretch or walk significantly impacts on health.

The other long established way to live longer is to eat less. Caloric restriction, time and again has been shown to correlate with reducing disease of all forms and with longer life in animals and humans. This is not about going hungry. It is as simple as eating (as the Japanese recommend) to 80% and leaving the table feeling that you could eat more.

This is helped by eating slowly, which allows the brain to keep up with the stomach. People who eat slowly are at least 30% less likely to be obese than those who eat quickly and 50% less likely than those who eat quickly till full.

So living longer and being healthier is as simple as eating a bit less and moving a bit more.

Now for the two bonuses. Firstly losing body fat and getting to a good weight helps the immune system so you will get sick less often. The second bonus is that being unhealthy and overweight affects your sex life. French (who else) researchers found that for both men and women who are overweight have less sex and more sexual problems than those of healthy weight.

So if living longer, and avoiding diseases like heart disease, cancer and diabetes does not provide motivation, maybe the prospect of a better sex life will.

 

 

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Five Tips To Make Your Goals a Reality

The universe goes in seasons and cycles. The earth goes around the sun. The moon goes around the earth. The seasons follow in order; summer after spring and winter after autumn (fall). Night follows day and the month’s click around to December, which is followed by January and the start of a new year.

People’s behavior also has cycles.

The start of the year is typically the time when resolutions to change are made. Yet it is worth noting that you can resolve to make changes at any time of year. Birthdays are another time when the passing of a year can lead to reflection on how we do things and can we do them differently.

Our goal is indeed to do things differently than we have done them before. When smoking was more prevalent, quitting smoking was the most popular new years resolution. Today losing weight or getting fit are the most common.

The problem is that after a week or two things are usually “back to normal”. Why is this the case? We all know what to do. There is no shortage of information available about eating and exercise. There is no shortage of products or programs available to help us.

The problem is that we are creatures of habit. We do things a certain way. When we focus we can go against our habits but as soon as our minds are on other things (e.g. work or the family) we subconsciously revert to our default behaviors – the ones we have been doing for years. We reach for the biscuit instead of the fruit. We drink the soda instead of water.

Habits can be changed and the reversion to our default can become a positive not a negative. It is also known that it takes three months for new habits to become firmly established.

 

To help you achieve your new years goals here are five tips.

1) Before you start – make a plan. Setting goals without having a plan is like trying to build a house without a plan. The bricks won’t put themselves together and in the pattern you want. Neither will your new eating plan or exercise regimes just create itself. Write your plan down and consult it regularly. You can adjust it as you go too.

2) Do simple mathematics. Count and measure what you eat. With any change in eating patterns you need to measure calories and portion sizes till you start to intuitively “get” how many calories are in different foods. With exercise you need to count the minutes and do your exercise at set times so it becomes ingrained in your schedule and not something on the “to do” list. Find out how many minutes of exercise are needed to burn off a biscuit – you may be surprised and it will help you resist the temptation.

3) Enhance your willpower. It has been shown that those who believe they have willpower have more. It is not something that “other people have” and it can be learned. Even simple affirmations can get you started. Things like “I exercise regularly”. Believe you have willpower and you have more of it. As Henry Ford said, “whether you believe you can or you cannot – you will be right”.

4) Focus and discipline. When aiming to change aspects of the body you need to train the brain too as it needs to develop new neural pathways for your new behaviors. Meditation helps people focus better.

5) When you fall off the horse get back on. Thomas Edison failed 10,000 times before inventing the light bulb. So what if you have a day when you overdid the chocolate. You will lapse. What matters is what you do next. Do you use this as an excuse to say I failed or do you see it as a temporary setback and a learning opportunity?  Draw a line in the sand at midnight and start a new the next day.

 

This is not is difficult. You do not require three tertiary degrees. You will not need thousands of dollars nor months worth of spare time. Changing our behavior is a matter of changing your mindset, creating a plan, actioning it and most importantly staying the course.

Follow the five steps outlined above and you can turn your resolutions (new years or otherwise) into reality.

 

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Six Tips For A Longer Life

OK its now “official” – being sedentary does actually kill you. The negative impact of a sedentary lifestyle on our health has been observed for many years but it has now been clearly shown and quantified.

An Australian study of 8800 people over six years found those who spent four hours or more watching TV each day had a 46% higher chance of dying and were 80% more likely to die of cardiovascular (heart) disease than those watching two hours or less per day. There was a steady increase in risk of death of 11% per hour spent in front of the TV. A study of 123,000 Americans over 14 years showed a 20% (for men) and 40% for women, difference in death rates between those who sat for over six hours per day versus those sitting for less than three.

Another American study showed people who were sedentary found it harder to lose weight even when taking in the same amount of calories. Small incidental movement (not formal exercise) like taking the stairs had a significant effect. In this study the groups did the same amount of “exercise”. It was the group that did more movement in their daily life, which had fewer problems with weight.

No doubt the studies can be criticized but the key findings confirm what we have really known for a long time.

The human body is designed to be active. Until fairly recent times this was not optional. To eat you needed to catch or gather food. To get from place to place you needed to walk. Most work was physical. Today we have so many labor saving devices that most of the “incidental” movement and exercise we got even one generation ago is gone.

Thirty years ago you needed to get out of the car to open your garage door and, dare I say it, get up off the couch to change the TV channel. Now it is important to note that sitting in front of a computer or video game or even sitting reading is still being sedentary so it is not the TV as such that is the issue.

Interestingly, and this is a new finding, even those who did some regular exercise were still affected by being sedentary for long periods. There are metabolic changes that occur in our bodies whilst we are “still”, that amongst other things, slow down the burning of fat.  Sugar and cholesterol metabolism is also affected.

So whilst regular exercise remains vital for your health, being sedentary for long periods is a separate risk factor in poor health. The two do not seem to cancel each other out. “Exercise is not a perfect antidote for sitting” says Marc Hamilton an inactivity researcher at Pennington Biomedical Research Centre (quoted in The New York Times).

The good news then is that the answer to prolonged inactivity is fairly simple. Here are some simple ideas to incorporate into your life.

1 Take the stairs instead of the escalator or lift.

2 Park in the furthest rather than nearest spot at the mall.

3 When working at your computer, get up and wander around for a minute every  30 minutes.

4 Limit your TV time to two hours per day maximum. Get up and wander around the room during the ads. Get up to change the channel.

5 Do some housework each day. Chores like ironing, hanging out the washing, even cutting vegetables are being “active.”

6 See what you can do standing instead of sitting. The simple act of standing uses muscles that sitting doesn’t.

It is great when medical science catches up with what we all really know anyway.  Movement is a bit like medicine but without side effects or cost.

 

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Twelve Simple Tips For Better Sleep

The human body needs sleep. Over the last century the amount of sleep people get has declined by over an hour. It is estimated that at the turn of the twentieth century we averaged nine hours per night. Today the average is under eight hours per night.

It is fair to say that life has changed. The invention of the electric light has allowed us to be active after the sun goes down. For most people before this invention there was not a lot to do after dark except go to sleep. Furthermore people in most instances were tired after a hard days work.

Today we have a 24/7 society where the electric light allows for a multitude of activities to be done after dark. Even sports that were once played only during the day can now be played under lights. Many people continue to work after dark. Of course electronics allow us to be entertained when the sun goes down too.

Nobody wants to turn back the clock, yet there also is no such thing as a free lunch. Tiredness is one of the commonest complaints I hear from patients. In turn, lack of sleep is the commonest reason for this. There are many health issues associated with lack of sleep. Even our chances of becoming obese or getting high blood pressure are influenced by our sleep patterns.

Many people complain of the difficulty getting to sleep or staying asleep.

Whilst asleep every part of the body is “active” except the conscious mind. The lungs breathe, the heart pumps, the kidneys filter the blood and so on. To get to sleep means we need to slow the mind down. We need to reduce external and internal stimuli. It is the “chatter “ of the mind the keeps many awake.

So what can you do to sleep better?

There are two categories here. The first group is what you do during the day to help you sleep better at night.

1) Do regular exercise.

2) Take up meditation yoga or tai chi.

3) Eat more fruit and vegetables and less refined processed carbohydrates.

4) Manage your stress.

The second group is things you do in the lead up to, and the time of going to bed. Not everything works for everybody, so use what works for you.

1) Have a routine. Go to bed around the same time each night.

2) Switch of screens, be it TV or computer at least 45 minutes before bed time.

3) Burn some fragrant candles with a calming scent.

4) Do not drink caffeine after 6pm.

5) Listen to calming forest music or play a guided relaxation.

6) Have a comfortable mattress and pillow.

7) Make the bedroom dark and quiet.

8 ) Drink a calming tea like chamomile tea.

This sounds so obvious but when you are tired in the evening-go to bed. We would not dream of not having a drink when you are thirsty so why do we not sleep when we are tired Changing sleep patterns also takes time. Sleeping tablets, other than for VERY occasional use, are not the answer and can even make the situation worse. You need to allow three months to establish a new sleep pattern.

The first step to sleeping better is making it a priority in your life rather than something you do when everything else is finished. You will be amazed at how much better you will look and feel when you get enough sleep.

 

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