Exercise

“Fit and fat is better than being unfit and thin.”

Forget pills, staying active is the best medication.
After-all, when it comes to being healthy, there is almost nothing else that comes near it in terms of its effectiveness.

There is a quote from a health promotion consultant called Dr Nick Cavill that seems to pop up more and more regularly these days – ‘If exercise were a pill, it would be one of the most cost effective drugs ever invented.’ When you look at the statistics, it is difficult to disagree.

There is strong evidence to suggest that exercise reduces the risk of the following conditions by the following percentages…

Coronary artery disease and stroke – 35%
Type 2 Diabetes – 50%
Colon cancer – 50%
Breast cancer – 20%
Osteoarthritis – 83%
Depression – 30%
Dementia – 30%
Hip fractures – 68%
Falls in older adults – 30%

These are not insignificant numbers as I’m sure you will appreciate. Exercise really is good stuff and also helps with self esteem, sleep quality and energy levels.
The government’s aim is for everyone to be doing around 150 minutes of moderate aerobic exercise each week. Moderate exercise is something that essentially causes you to breath faster, increase your heart rate and feel warmer – a good way to gauge it is if you are breathing too heavily to sing the words to a song. Examples might be going for a brisk walk or hike or playing a game of volley ball. Only half of us in the UK are reaching that target. It doesn’t take too much of an imagination to consider the effect it would have of all of us matching this target on the mortality rates for all of the conditions above.

It goes deeper than this though. We are a species that evolved as hunter gatherers, constantly on the move, but in world with televisions and remote controls, motorised vehicles, and robots that do your hoovering for you, it comes as no surprise that we are suffering from the effects of a sedentary lifestyle. As such, even if we are reaching our exercise targets, if we spend the rest of the time sitting or lying down (and the average person in the UK sits for 7 hours a day, 10 hours if you’re over 65 years old) then those benefits are lost or at least have less impact on the risk of adverse health conditions.

It is therefore key for us to move about every now and again even if we’re not exercising. The recommendation is that every half an hour, we should get up and move about for 2-3 minutes. Practically I know sometimes it may seem difficult but actually when you think about it, is it really? Sometimes only the smallest things need adjusting to achieve this, whether it be an agreement with your boss to get up and walk around the office once in a while or maybe even (as horrifying as this sounds) keeping the remote in the shed at the bottom of the garden. Essentially we’ve all got a bit lazy and our bodies are experiencing the consequences.

For those thinking, ‘well my knee hurts too much for me to do any exercise’, or ‘the local volley ball court is too far away,’ I’m afraid that’s no excuse. Remember, moderate aerobic exercise is anything that gets you breathing and increases your heart rate, so if your knee hurts, do some swimming or even some armchair aerobics, likewise if you can’t get to your local sports centre easily, go for a brisk walk down the road or around the garden for 30 minutes every day. There is a mode of exercise for almost everyone.

Why does exercise and activity help you may ask? Recently, research has revealed quite in depth benefits that we were previously unaware of. Much of this has to do with the anti-inflammatory effects of activity. At the cellular level, our bodies are in constant turnover. Each cell in our body has something called a mitochondria which is essentially a mini power plant. It is here that we produce energy to be used in various processes throughout the body. Each mitochondria will build up a charge and if we are not using energy, they stay charged. The longer they do, bits of charge will gradually escape in the form of ‘free radicals’. These free radicals are bad news and contribute to cell and mitochondrial damage, aiding the ageing process and generally making us less healthy. It is thought that this process causes microscopic inflammation throughout the body.

Activity and exercise helps by utilising this energy and preventing release of free radicals but also produces anti-inflammatory substances from muscle that help to mediate the inflammation at a cellular level. That is not to mention its effect in increasing insulin sensitivity of cells, reducing risk of conditions like diabetes, along with strengthening heart muscle to reduce average heart rates and contributing to lower blood pressure and cholesterol.

There is a lot of focus these days on weight loss when it comes to exercise. This is quite a damaging concept and is reinforced by many commercial diet plans and courses. Although it is important to maintain a good weight and avoid obesity, weight loss is not the be all and end all. There are two types of fat. Subcutaneous fat (sub – beneath; cutaneous – skin) is the stuff that pads out our waist lines and is the most visible. However, arguably far more important is the fat that surrounds our organs like the liver and the heart. This is called visceral fat (viscera meant ‘internal’ in latin) and build-up of this visceral fat has significant implications for our general health. Even if our exercise seems to be doing nothing to our subcutaneous fat, it will be having far greater effects on our visceral fat and this is very important. Therefore we mustn’t measure the success of our exercise or indeed any form of activity with weight loss. Fit and fat is better than being unfit and thin.

The Problem with Antibiotics

Our honeymoon period with antibiotics and their undeniable benefits ended long ago, but since their inception we have created a deep seated culture of dependence.

Many thanks for your responses to my article last time around – keep those suggestions for topics coming. Shortly after I had finished the article about the common cold, I developed a cold of my own, so I have decided to postpone indefinitely my planned article on smallpox.

Our topic this week is antibiotics – a subject which is garnering more and more attention in the media. Since 2015, there has even been an annual ‘world antibiotic awareness week’ which, appropriately, was last week.

Why the fuss? Well I am sure most people by now have heard all sorts of stories in the news about antibiotic resistance and the emergence of ominously entitled ‘superbugs’. This is all for good reason as I will expand upon.

To begin with, let’s focus on antibiotics and what they actually are. Prior to their discovery and development in the early half of the twentieth century, we had no really effective ways of treating bacterial infections. Historically, all manner of approaches were used, from the rather dramatic process of blood-letting (thought to stabilise the balance of the perceived four humours: blood, phlegm, yellow bile and black bile), to the use of things like willow bark by the ancient Greeks for curing fevers and pains. (Willow bark actually contains salicin, which is chemically related to modern day aspirin).

Things all changed when the Scottish botanist Alexander Fleming returned to his laboratory in 1928 after a family holiday and noticed that mould had grown in his petri dishes of staphylococci bacteria. The mould in question (penicillium) had killed off the surrounding areas of the bacteria prompting Fleming’s famous response – ‘That’s funny’.

The rest, as they say, is history and since then many different families of antibiotics have been developed to fight off bacterial infections that had once been, at best, troublesome and, at worst, fatal. As we approach a century of antibiotic use, we can look back upon a vast improvement in our ability to treat infections such as pneumonia, syphilis, tuberculosis, meningitis and many more. This has no doubt had a vast social and economic impact. However, now we come to the problem.

Antibiotic resistance is a process that has been developing from the very beginning. In broad terms, let us consider a group of bacteria exposed to an antibiotic. In any reproducing population, there will always be random mutations that occur in the genes of certain individual bacterial cells. Sometimes these mutations happen to protect the bacteria from the effects of an antibiotic. Bacteria without that protection die, leaving the resistant bacteria free to multiply without competition. Over time, these populations spread from person to person, meaning that, when the same antibiotic is used repeatedly, it becomes less and less effective in controlling these bacteria. That’s it in a nutshell.

We are now at a stage in which no new class of antibiotic has been found since 1987 and there are thought to be around 12,000 deaths each year in the UK as a result of bacteria resistant to antibacterial treatment. If this trend continues without further action, the World Health Organisation (WHO) state that the global mortality from such infections could be as much as 10 million people a year by 2050. Advancements and achievements in modern medicine such as chemotherapy, organ transplants and routine operations like caesarean sections and hip replacements – all of which rely heavily on the availability of effective antibiotics – are now potentially at risk.

Development of resistance is and always was a natural and unavoidable process but our use of them has unequivocally made things worse than they could have been. In 2015, it is thought that around 25% of antibiotics were taken unnecessarily in the UK. When you factor in un-regulated use of antibiotics in farming and the availability of antibiotics over the counter in some countries, one begins to see how much of a global issue this is.

On a personal note, I have certainly seen strikingly inappropriate use of strong antibiotics prescribed in other countries for even the most trivial of ailments. There is most definitely a responsibility amongst us as healthcare professionals to monitor what we are prescribing. Having said that, there have been surveys suggesting that up to 90% of GPs have experienced pressure from patients to prescribe antibiotics even when this was not appropriate and would serve no purpose. While this obviously differs from area to area (and to be fair you’re a pretty good bunch), we all share a certain responsibility in tackling this issue.

I don’t want to sound too gloomy, and thankfully there has been some international recognition of the issue. The WHO endorsed a global action plan in 2015 (though lamentably it will certainly now have to make do without the help of Robert Mugabe) and since then 193 countries have given further political endorsements via the UN to install tighter regulation and encourage further research into new antibiotic classes.

As often is the case with such gradual phenomena, the effects of such crises are not always immediately apparent. However, in this case, the signs have been there for a long time and Fleming himself warned about the potential for resistance. Now those signs are becoming ever more obvious and we must face up to the inconvenient truth. We stand to lose a lot if we refuse to do so.

Hygiene both in the community and in hospitals is vital to prevent the spread of bacteria. Responsible and restrained prescribing from doctors both here and all over the world is also required. Research into new antimicrobial agents is ongoing but slow, and techniques to bolster our existing agents is important for our short term management of the more serious infections. Crucially, educating people as to why it is often inappropriate to prescribe an antibiotic is just as important – after all we’re all in this together.

Our honeymoon period with antibiotics and their undeniable benefits ended long ago, but since their inception we have created a deep seated culture of dependence. This will be difficult to withdraw from, especially considering the advances we have built around it. Over the coming years, we must now consider whether or not an even more dramatic shift in our utilisation of such medicines is required before nature takes the matter out of our hands.