This is the third and final part of my trilogy of blogs on preventative medicine. The other two are titled over-the-counter drugs and screening
Promoting healthy living has become an industry but like vitamins and minerals which are too often 21st-century snake oil there is a lot of fake news. So what can we do to stay healthy?
A number of studies have looked into the benefit of exercise. They have shown that exercise for 20 minutes two or three times a week reduces the risk of heart attacks and strokes. More recent studies have shown that exercise actually improves our lipids which are the fats in the blood. Exercise can also reverse early maturity onset diabetes. Given that diabetes carries a risk of both cardiovascular problems and cancer this is exciting news.
A study I am less keen to report took some volunteers and subjected them to increasing amounts of exercise. At the top end the volunteers were exercising for eight hours a day, seven days a week. The level of benefit continued to increase as the amount of exercise increased with no limit!!! It makes me feel tired just thinking about it, but we can all fit in a few sessions a week. I am not a great advocate for jogging and running having treated a number of patients who have been run down running on the streets. Running also puts considerable stresses on the knee joint building up problems for the future. Swimming, cycling and the gym avoid these problems
Turning to diet, I don’t think I will surprise anybody by suggesting we should cut down on saturated fats. Less well-known is the effect that carbohydrate can have on our bodies. White bread, white rice, potatoes and pasta all increase the risk of maturity onset diabetes. Wholemeal bread, brown rice, sweet potatoes and wholemeal pasta are far healthier. Sugar is less important in preventing maturity onset diabetes but is unhealthy and leads to weight gain. The problem with all these recommendations is that people often find it difficult to know what they can eat and food labelling remains far from perfect. Salads, vegetables and anything with wholemeal, together with regular fish seems like a healthy diet and the occasional ‘bad’ meal is not going to do us that much harm
It is now a half a century since Professor Doll’s research showing that cigarettes cause cancer. Add in the risk of heart disease and strokes and tobacco would never be legalised if it were introduced today. Less well-known is the fact that risk is not linearly related to the amount smoked. Just one or two cigarettes at the weekend dramatically increases the risk of illness and especially cancer. There is also some evidence that risk increases with pregnancies so that women who smoke ‘socially’ at the weekend are more at risk that they realise.
Nicotine is highly addictive so people who smoke regularly do need professional support. The NHS has a brilliant system of smoking cessation clinics. They are always my first recommendation and of course they are free. Your chances of giving up are much higher if you do not live with people who smoke and therefore it is always a good idea to sign up for the smoking clinic at your local NHS hospital with your partner if he or she smokes
Patients often ask me about vaping. Vaping is much safer in terms of cancer but still involves nicotine with its risks to the cardiovascular system. I think vaping is a useful bridge between smoking and giving up but not something to do long-term.
Alcohol.
Politicians seem to detest alcohol. I presume this is because of the cost of dealing with binge drinkers and drunkenness. There is no doubt that you can become addicted to alcohol. Alcoholism does kill and is very difficult to treat partly because many alcoholics tend to hide their problem and resist help. Nevertheless, the vast majority of people are not alcoholics but sit on the spectrum from teetotal to heavy drinkers. The main risk of alcohol for these people is an increased risk of solid tumours such as cancer of the breast and bowel. The risk does seem to be linear and to be higher in people who drink continuously but I don’t agree with politicians who say they worry about getting cancer every time they have a glass of wine. Indeed, the evidence is that low doses of alcohol may reduce heart failure and may even have a beneficial effect on the brain. I am not promoting alcohol as being medically beneficial but like so many things in medicine it is not as clear-cut as some would suggest. What concerns me is that almost all my patients tell me they do not drink at all. Making people feel guilty and driving them to becoming secret drinkers is certainly not going to help

About the author

Dr Aubrey Bristow is a consultant anaesthetist in central London. These articles are his personal views and reflect individual issues of interest to patients. They are not a comprehensive review of the subject nor a substitute for a consultation with your anaesthetist.