Changing our lives: Whose responsibility is our health? June 2014

Changing our lives: Whose responsibility is our health?

“The treatment of a disease represents an admission of failure. Prevention is the goal of medical research and clinical practice.”

Professor Peter Elwood, Cochrane Institute, Cardiff University,

Apologies to those loyal readers, who read and comment on my occasional health related blogs. I am a couple of  months late in my self-appointed task of sharing ideas every couple of months, but last month got rather busy while I attended the 50th anniversary International meeting of the International College of Applied Kinesiology, (AK) in Washington D.C.,USA.

Capitol Hill, Washington, where lobbyists manoeuver their politicians into mostly obstructive, destructive, obfuscation, and not much changes for the better!

 

The late Dr. George Goodheart, the founder and genius behind Professional Applied Kinesiology

 

 

 

 

 

A chance for  350 clinicians from 14 countries from around the world to gather and both share their new research as well as honour and remember the genius of Dr. George Goodheart the inventor/discoverer of AK.

It is always a pleasure to learn and share amongst old friends from all over the world who share a passion with such enthusiasm.

No sooner had I returned on the red eye flight from Washingtion and done a couple of days work than, at the request of my rock musician daughter, we were off to Glastonbury. This daughter  had enjoyed many gigs playing  at Glastonbury in the past, (for heavy rock music fans check out her band, here. )

So before we were irredeemably decrepit wanted us to experience the atmosphere of this unique event down on the farm in Somerset. Discussions of our experiences of the Glastonbury Music Festival will have to remain for another time and place,  here but although I am not particularly into music,  the most fun music I stumbled across, were the lively, Melbourne band ‘The Woohoo Review’ a brilliant cross between Klesmer, Mariachi and Jazz, check them out here  here.  But enough…

Whose responsibility is our health?

On July 5th the National Health Service had its 66^th birthday.  With an ageing population, and the ever-increasing cost of medical interventions, there’s more pressure on the NHS, which is why we need changes to services to focus far more on health prevention out of hospitals, and use the range of talented clinicians more beyond the limitations of the over pressed GP’s as Goldstein and Weeks have suggested in America were they make a strong case for greater integration of

Various kites are flown by politicians, such as the idea that everyone in the UK should start paying a £10-a-month NHS “membership charge” to save it from sliding into a decline that threatens its existence. While advances in modern science and engineering have nearly doubled our lifespans in only four generations, our quality of life has not reached its full potential. We need radical change towards true preventative medicine that goes well beyond screening and public health programs.
The Emerging field of Functional Medicine, as practiced by a growing core of advanced clinicians, including here at Helix House, seeks to pinpoint and prevent the cause of illness, rather than treat its symptoms. What is Functional Medicine you may ask and surely it is no different from the prevailing medical model?

Functional Medicine, like Professional Applied Kinesiology and Osteopathy which share many of the key principles,  is an integrative, science-based healthcare approach that treats illness and promotes wellness by focusing on the bio-chemically unique aspects of each patient, and then individually tailoring interventions to restore physiological, psychological, and structural balance.

Functional Medicine focuses on understanding the fundamental physiological processes, the environmental inputs, and the genetic predispositions that influence health and disease so that interventions are focused on treating the cause of the problem, not just masking the symptoms.

There are seven basic principles underlying functional medicine which include the following:

• Science-based medicine that connects the emerging research base to clinical practice.
• Biochemical individuality based on genetic and environmental uniqueness.
• Patient-centered care rather than disease-focused treatment.
• Dynamic balance of internal and external factors that affect total functioning.
• Web-like interconnections among the body’s physiological processes also affect every aspect of functionality.
• Health as a positive vitality, not merely the absence of disease.
• Promotion of organ reserve.

Managing chronic diseases accounts for three quarters of our total healthcare costs, because too often we’re masking these illnesses with palliative pills and temporary treatments, rather than addressing their underlying causes. Worse, only treating symptoms leads us down the path of further illness. But with all the public discussion of the funding of the NHS, such issues are, almost never, publicly aired despite the frustrations of many well-meaning clinicians within and outside the NHS..

At one stage, governments tended to consider matters of health and disease were the concern of the individual.

‘The Great Stink’ might be seen as one landmark in our slow progress towards communal care of our health and the realization that serious public investment in infrastructure was equal or more important, than the medical treatment of disease. It was the summer of 1858 during which the smell of untreated human waste was so strong in London that the huge task of building the London sewers was taken on for the benefit of all. Gradually over the next ninety years more and more efforts were made to invest publicly in fighting disease culminating in the founding of the National Health Service on July 5^th 1948.

The modern health challenges we now face as a society are both societal and individual, as a recent study by the Institute of Primary Care and Public Health show. Lead by Professor Peter Elwood, of the Cochrane Institute, Cardiff University, Healthy Living: Healthy Ageing, known as, The 30-year Caerphilly Cohort Study, was a long-term study of a large representative sample of men.

A number of ‘healthy’ behaviors were defined: non-smoking; a low BMI; regular exercise; a plant-based diet and alcohol consumption within the guidelines. Combinations of these behaviors were referred to as ‘healthy lifestyles’. In this paper the health benefits of a healthy lifestyle were examined and some interesting findings were discovered. As they say in the report;

“It is my decision whether or not I smoke, what body weight I maintain, whether or not I exercise regularly, what diet I take and how much I drink”.

All perfectly true and yet since these five healthy life style choices were chosen for the study thirty years ago, we know a lot more about, for example, the influence of social relations and social inequality on survival. Good, supportive social relations alone are at least as important as that of smoking, and much more important than heavy drinking, physical activity or obesity. So do get out there and talk to your friends and make some more!

Higher levels of income inequality damage the social fabric that contributes so much to healthy societies and can, sometimes, militate against good social relations. Now, a major new review of the evidence from almost 150 studies confirms the important influence of social relationships on health. People with stronger social relationships were half as likely to die during a study’s period of follow-up as those with weaker social ties.

As the work of epidemiologists Richard Wilkinson and Kate Pickett have shown, in their brilliant book, The Spirit Level, first published in 2009; 

“The weight of the evidence, and its continued rapid accumulation, make the important link between income inequality and social dysfunction inescapable”.

When discussing some of the more disingenuous criticisms of their work on equality, Wilkinson and Pickett point out in a recent article New Statesman | Yes, we are all in this together;

“In their book Merchants of Doubt, the American academics Naomi Oreskes and Erik Conway suggest that the defense of a kind of free-market fundamentalism is the most plausible explanation of why the same individuals and institutions are often involved in attacks on research in areas as diverse as tobacco control and the evidence on climate change”.

You could add to this, without any criticism of good drugs and surgery medicine, the tedious attacks on all kinds of non-drug based medicine, whether they are osteopathic, acupuncture or functional medicine. The same coterie of dodgy, obtuse scientists and mendacious journalists can usually be found to have links back to the vast corruption and multi-layered conflict of interest between the practices of medicine, medical science and the $1.3 trillion drug industry.

The Caerphilly Cohort Study showed how extraordinary changes in disease rates and life expectancy can occur if individuals can just follow five, basic, healthy life choices, they found;

“Few men in our cohort followed all five behaviors, but in those who consistently followed a lifestyle which included four or five healthy behaviors experienced reductions, on average, of about 73% in new cases of Type 2 diabetes, similar reductions in heart disease and stroke, and, most remarkable of all, about 64% less dementia! Non-smoking was associated with a reduction in cancer of 39%”.

However, sadly, in the study it was also found that despite the expenditure of £280M/year on Public Health and Health Promotion in Wales in recent years, there has been virtually no change in healthy living over 30 years! As Wilkinson and Pickett show, across whole populations, rates of mental illness are five times higher in the most unequal compared to the least unequal societies. Similarly, in more unequal societies people are five times as likely to be imprisoned, six times as likely to be clinically obese, and murder rates may be many times higher.

“In a recent survey of 15,000 adult subjects in Wales, 19% of adults reported that they were following three healthy behaviors, 7% were following four and only 0.5% were following a lifestyle based on all five behaviors. Thirty years previously, when the Caerphilly Cohort Study was set up, the proportions had been almost identical (19%; 5% and 0.1%). Similar findings have been reported from studies of workers in healthcare (!) in the USA, and though better, the proportion following all five behaviors was reported to be only about 3%”.

 

 

 

 

 

 

So to conclude, we have to see changes both in individual behavior and find ways of organizing society towards greater equality. Reigning in the destructive food, alcohol, drug and tobacco industries as well as building better and more houses and encouraging good jobs.

We find ourselves with our own 21^st century Big Stink!

As Wilkinson and Pickett show, see diagram, Social problems are closely linked with inequality amongst rich countries, and this is not just bad for the poor but bad for everyone.  Our own malodorous predicament consists in wealthy, advanced societies with growing, destructive inequalities within, and equally huge and dangerous inequalities without.

 

 

These pernicious  global inequalities suck young, desperate, individuals to risk all on treks across the Sahara or dangerous boat trips to reach the shores of richer, freer countries. While many in those advanced countries squeal at the incomes, they often fail to identify or act on the vast and growing underlying internal and external inequalities driving such epic migrations and the social anxiety and conflict such, too rapid and dramatic, upheavals, naturally tend to generate.

The challenge remains. Poverty, culture and inequality strongly militate against building the kind of society that can protect us from our own poor choices in matters of health. The world has recently tipped over to one where there are more people living in cities than on the land and more suffering from the effects of obesity than starvation. Babies born today can expect to live in a global world of three or four billion more people.

What was once the skewed, lifestyle-driven, sickness of the rich world is now rapidly plaguing the developing world. There are still enough medical mysteries out there without the majority of us killing ourselves, voluntarily, long before out time, with our own destructive personal and political choices.

Let us end this month by giving the final words to Wilkinson & Pickett;

“The health of our democracies, our societies and their people, is truly dependent on greater equality”.

 

July Blog: Dementia

July Blog

This month I want to think with you about the important and disturbing subject of dementia. But don’t think it is all doom and gloom, because there is encouraging evidence that we may be able to start preventative action now to reduce the risk of this miserable condition.

Back in the day, (now when did that phrase creep into common usage? Maybe it comes from Afro-American music lyrics from the 70’s, or even earlier) there was a time, thirty years ago, when awareness of dementia was not nearly as pressing as today.

According to the Alzheimer’s Society,

•    There are currently 800,000 people with dementia in the UK.

•    There will be over a million people with dementia by 2021.

•    The proportion of people with dementia doubles for every 5-year age group.

•    60,000 deaths a year are directly attributable to dementia.

The financial cost of dementia to the UK was over £23 billion in 2012. Some fearsome statistics, but what is dementia. It is several different diseases characterised by a set of symptoms that include both, loss of memory, mood changes, and problems with communication and reasoning. Alzheimer’s along with vascular dementia are by far the commonest forms of dementia.

A large and depressing subject, far too big for a little blog, but having seen my mother fade away over fifteen years with vascular dementia, it is a subject close to home, not only for me, but sadly for far too many of us today. As we age the chances of developing dementia increase.  As we are able to live longer, one of the unintended consequences of the happy extension of our life expectancy is the growing risk of suffering dementia.

The World Health Organization estimated that in 2000 the total number of people with dementia stood at 22 million. The average life expectancy in the UK has increased in the last two decades by 4.7 years for men and 5.1 years for women. But as the average world population increases, with better life expectancy, by 2050 the numbers suffering from dementia are expected to reach 114 million worldwide.

As you will have noticed, if you are a regular reader of my blogs, a common theme running through much of them is, what we may be able to do, practically, to reduce the risks of such negative outcomes. Today I am, briefly, going to look at what we know, and what we suspect, might help us, reduce the risks of dementia.

If genes load the gun and our environment pulls the trigger, it behoves us, if not for ourselves, then for the future generations who are likely to have to carry the huge burden of sadness and expense, to do all we can now, to weigh the chances in our favour.

Apart from some rare types of dementia, genetic factors may not play as big a causative part, as we might think.

Once upon a time, no one knew what to do about the heart attack epidemic spreading through the western world. Now, decades later, things have changed. While, along with strokes, heart disease is still the major cause of death, better understanding means we can see the links to lifestyle factors, like diet and smoking and, painfully slowly, we are beginning to reverse some of those fatal choices we made that led to this twentieth century heart disease epidemic. Gradually we are seeing that dementia is less a random horror, like we used to see heart disease, and it is starting to look like any other disease, with some understandable and even may be, preventable, antecedents and triggers.

Recent studies suggest that vascular disease may contribute to the cause of Alzheimer disease (AD). Since elevated plasma total homocysteine level is a risk factor for vascular disease, it may also be relevant to AD.

OPTIMA (Oxford Project to Investigate Memory and Ageing) Professor David Smith, suggests that far from being an inevitable part of normal aging, dementia is a true disease, and therefore we can tackle the causes of the disease, and, if not cure it, due to the loss of parts of the brain inherent in the disease, find ways of preventing it.

While thousands of millions of pounds are being spent by drug companies on drugs to cure the disease, almost nothing is being spent on researching the prevention of the disease through lifestyle changes. Many of the clues that may, in part, link these to dementia, are starting to look hopeful. Yet governments are reluctant to spend the kind of money that would verify such scientific hunches, and, of course, the drug companies have no financial incentive to do so.

Evidence shows brain shrinkage, occurs five times faster than normal in dementia patients. This seems linked to levels of the amino acid homocysteine in the blood, which, in turn, is linked to the body’s ability to safely detoxify itself. Happily reducing your homocysteine level is easily and cheaply done with the right level of certain B vitamins. With those with an initial high homocysteine score (below 6 is ideal) who were supplemented with B vitamins showed a significant reduction of brain shrinkage.

 Health Journalist Jeremy Burne recently summarized some of the issues around these ideas. Some are skeptical as you might expect, and this caution is, in a way, understandable, and yet such skepticism, so often shown to lifestyle preventative aspects, are not so forthcoming when drugs are concerned.

While most prescriptions cause no great harm and some are truly life saving, a 2004 study by the University of Liverpool, suggested that as many as 10,000 patients annually were dying in the UK because of adverse reactions to drugs. Sugary drinks (soda) may account for 180,000 deaths world wide per annum, the risks, from eating a healthier diet, moving more, or even taking a few supplements, are infinitesimally small, in comparison.

Food For the Brain champions optimal nutrition for the mind. While the experts fight over the minutiae of the arguments, there seems good enough evidence to turn our attention to key areas of health that we can influence, by changes of our own life, let alone the kind of wholesale changes to our economy that would encourage and facilitate these simple, individual, changes. 

Until the facts are all known, in many decades time, the hopeful areas we can all have some impact on are:

•   Insulin and glucose control, metabolic syndrome and diabetes
•   Smoking
•  High Blood Pressure
•   Possibly, High cholesterol
•   Poor education
•   Lack of social interaction
•   Levels of Essential Fatty Acids
•  Antioxidants
•   Homocysteine levels
•  Chronic inflammation

Nearly all these are amenable to change but are mostly unlikely to respond to ‘magic bullets’ of the drug variety.  However they will require, changes, in society, in the way we organize and prioritize our health service expenditure, use our tax system to encourage good and discourse damaging eating, drinking, education and farming practices and the individual choices we make every day.

I will end with just one, of many, examples of research that underpins this thinking, with an encouraging trend of research findings. Over ten years ago, Morris et al. found that eating fish once a week can slash your risk of developing Alzheimer’s by as much as 60 per cent. As well as following peoples diets, always difficult over the long term, several animal based studies have shown encouraging changes in mouse brains with this kind of essential fatty acid enhanced diets, but science is never quite as straight forward as that, and along come other studies that produced more equivocal results.

What we don’t know, and there are few enough dietary studies anyway, is what would happen if you changed all the above factors at once, would this produce any enhancement of these sometimes encouraging results? For my own part, I don’t intend to wait around for the next few decades to see what the results are, simply because, changing all these risk factors have such multi factorial benefits beyond dementia, and, compared to the alternative, very low risks. So, why not run the experiment on yourself and see?

My aim is to die young, at a very old age, but one can never know for certain what is in store for individuals. What seems very likely is, if the present trends of longer survival but extended disability, continues, is a new and, possibly, unsustainable burden of disability of body and mind.  As populations age worldwide this is going to put impossible burdens on our children and grandchildren . So lets get moving and eating differently and see what happens. What have you got to lose?

 Book of the Month

The Alzheimer’s Prevention Plan: 10 Proven ways to stop memory decline and reduce the risk of Alzheimer’s

By Patrick Holford pp.256.  Published, 2007.

 This is another of Patrick’s well researched and explained, popular and sane books, outlining what is known and what is supected, but as yet not proved beyond doubt, on the encouraging side of the subject. He covers the  quite complex ground with elan.  Broken down into three parts,  Part 1,  explores why Alzheimer’s and memory decline are preventable. Part 2 tackles the ten ways to enhance your memory, Part 3, entitled, in tradmark Holford journalistic style, ‘Say No to Memory Decline,’ focuses on diet, suppliments and exercises to help keep your mind sharp. Packed with useful and reasonable guidance and facts on both the nutrtional science that underpins the growing body of research into this area, as well  helpful quizzes to assess your state and quickly evaluate your possible deficiencies, this is a hopeful guide to what we know so far on ways to prevent this scourge. The picture  for possible prevention is, perhaps, a little  more hopeful than some might think. And certainly Patrick takes this tack without being outragious. For those who want more there are a couple of hundred scientific references to explore.

I have been at nutritional science conferences when people, who know a lot less than Patrick about nutrition, have felt it quite legitimate to rubbish him as a mere suppliment salesman. Such is Patrick’s reach with his million selling books, that there are whole websites set up, by the loony scientism sects, devoted to slandering and  fault-finding with his books. I dare say, not every word he has written has turned out to be correct, but no one is perfect.  I supect his main crime is being a successful populariser. Like TV history dons, such success is bound to attract the carpers.

Over the decades, when ever our paths have crossed, I  have been impressed with Patrick, not only for his entreprenerial skills, and ablility to get interesting, top-flight scientists, to speak at his conferences and take him seriously, but for his skill in  taking the complex area of nutritional medicine and turn it into readerable books for those interested to learn and change their life. This  book is another one.

Some would urge caution in not singing too loudly of the hopeful signs, until much more is known.  I like his optimistic, can-do style. Such jaunty confidence could be seen as to be riding, too blithly, over the endless caviates and cations that the complex web of contradicting evidence  science throws up. But there is a place for diseminating these ideas to the public happy to take responsibility where they can for their own health.

Clearly he is in the business of putting a slight gloss on things to slant his book into the hope-ful rather than hope-less camp. But then even with this seemingly depressing topic,  there are some reasons to be hopeful, even if, sometimes, implimenting the changes, for many, seems too difficult. Old habits do die hard.

Too many, for fear of stepping out of line in the cut throat world of science, are often afraid to say anything at all, for fear of being laughed at in the caviate-laden world of modern science. Patrick, being a maverick, if free to do as he pleases. Over the last thirty years he has pioneered the nutritonally hopeful, science based, self help book.  Here is another, it is worth a read.