Thought about taking up a musical instrument? Need another reason to encourage your children to play music? It could be good for the brain in the long term, helping to reduce mental decline. And with people living to older ages, it’s not surprising there’s an avid interest in anything that may slow down mental decline.

Mental decline is different from dementia. It is something that affects all of us; there’s evidence that a gradual decline in memory and thinking abilities starts in early middle-life and accelerates as we grow older. Dementia, on the other hand, is due to specific disorders that affect only a proportion of people.

It is understandable that, when people first notice some forgetfulness, they may worry that dementia is on its way – especially if others in their family have suffered from the condition. But dementia is much more than simply a loss of memory, and the forgetfulness may not even be part of mental decline! Many children and teenagers frequently forget seemingly silly things of everyday life.

Mental decline, though, can become annoying and troublesome, and there have been plenty of suggestions for keeping it at bay. There are the advocates of crossword puzzles and other brainteasers such as Sudoku. Others feel card games, chess and conversation are the secret of keeping an active mind. There’s increasing evidence that regular exercise retards mental decline; and there’s also evidence that speaking two or more languages helps.

Music may also hold a key. Astonishingly, many musicians can remember  long pieces of music note for note and retain complex motor skills – skills often far beyond what the rest of us could ever do – until well into their advanced old age, sometimes even beyond a hundred years old.

Researchers in Toronto have now compared mental performance in 18 professional musicians and 24 non-musicians in late middle life*. The non-musicians were carefully selected to match the musicians – for example in education, general health and language skills – so that they differed only in musical skills. Most of the musicians played more than one instrument.

As might be expected, the musicians did better in tests of auditory skills than the non-musicians. They also did better in many of the other tests, including a composite measure of thinking ability. The results suggest that sustained music training or involvement is associated with improved aspects of mental functioning in older adults. People who have played musical instruments for many years seem to have less mental decline than their non-musical counterparts.

This was a small study with relatively few participants; but the researchers make the point that finding these differences in a small group is promising.

And even if you or your children don’t end up with a better-functioning brain in later life, playing music is a lot of fun.

*Link to study:  http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0071630 

 

Microbes have a bad name. Most people just think of them as carriers of disease. Indeed, bacteria and other microscopic organisms are often pictured in TV adverts as tiny evil humans that every home-loving person should buy powerful antiseptics to eradicate.

Of course, a few microbes are the cause of major diseases, and some others bring less serious upsets. But it’s unfair of us to think of all microbes as harmful. Many of them fulfil useful purposes in the environment, such as breaking down waste to release chemicals for plants and animals to re-use. And some are vital for our health.

Each of us carries around a whole personal environment of different microbes ¬¬ –on our skin and inside our body. Researchers have coined the term ‘Human Microbiome’ for this, and recently they have been showing how individual it can be and exploring how it affects our health.

We acquire our first microbes as we are born, and our exposure to them increases rapidly over the first few years of life and continues into adulthood. As adults we carry around 10 microbial cells for every one of our own cells. That’s about 100 trillion microbe cells! Our gut alone contains about 2 kg of microbes.

These are not causing us any harm, and many are more than just passive passengers, coming along for the ride. We have learned a lot about the gut microbes, for example. They produce anti-inflammatories, pain killers and some vitamins as well as beneficial antioxidants. Recent research* has shown that people with cancer developing in their colons have a different microbial makeup in their colons to healthy people, which suggests some microbes may be protective against this. And fascinating laboratory work in mice** has suggested that some microbes might be implicated in body fatness, with other interesting work*** opening up about their association with metabolic changes related to type 2 diabetes.
With much of this work it’s far too early to suggest that actively changing gut microbes might be beneficial for humans. But these are interesting findings, and they undermine the simplistic view that microbes are there to be eradicated.

*Link to study on the Human Gut Microbiome and Risk of Colorectal Cancer  http://dx.doi:10.1093/jnci/djt300

**Link to study on the gut microbiome and obesity in mice  http://dx.doi.org/10.1126/science.1241214

***Link to study of the human gut microbiome and metabolic markers  http://dx.doi.org/10.1038/nature12506

Link to study on dietary intervention impact on gut microbial gene richness  http://dx.doi.org/10.1038/nature12480

 

In the old days, when many medicines were taken in liquid form, chemist’s shops advertised themselves with large glass jars filled with brightly coloured liquids. The medicines they sold were often coloured too, but whether this actually made any difference to their effectiveness is debateable. However, older physicians thought so and many patients were convinced.

Something that colour certainly did help with was identification. Doctors assisting patients with repeat prescriptions could ask “Which colour medicine have you been taking?” A recent study suggests this is an issue still relevant today.

Of course, these days we have become more sophisticated. Your doctor should provide you with the names of the medicines you are taking, and doctors and pharmacists keep considerably better records. But the number of effective medicines has grown enormously over the past 50 years – so much so that the need for identification has increased. One way of doing this has been to use colour. Indeed, there is a psychology of colour which the marketing industry takes advantage of.

But we all know this is just superficial. It should make no difference to us if our tablets change colour. Right?

A recent study looked at patients with epilepsy. This is a condition where regularly taking the prescribed medicine is particularly important both for everyday living and, in some cases, for being allowed to drive. Yet 1.2% had stopped taking their medication. That might seem a low percentage – and we do not know how long they stopped for – but it is a result with serious implications.

The researchers carefully compared more than 11,000 patients who had stopped their medication with 50,000 others who hadn’t and looked for reasons why. It turned out that one reason was a change in colour and/or shape of the tablets. About one-third of the patients who stopped had been changed to the same anti-epileptic medication but with a different appearance.

It is increasingly common for people on repeat prescriptions for all types of ailment to see a change in the colour of their tablets. Often, this is because a branded product is replaced by a cheaper equivalent that does exactly the same – so called ‘generic prescribing’. This can happen when the patent taken out by the company that discovered the medicine runs out and other companies can start marketing an identical product. With the constant need to keep medical costs to a minimum, doctors and pharmacists are expected to provide patients with the cheapest form of the medicine.

This can often mean that patients who have been taking a coloured tablet for some time suddenly find they have been given a white or off-white tablet in its place. Unless their doctor or pharmacist has explained what’s going on, they may become suspicious that they’re not getting the same medication – and sometimes stop taking it.

Often, it can then take some time before they tell their doctor about this or it’s discovered they are no longer taking the tablets. Sometimes this can be of great importance.

The study brings home how important it is that doctors and pharmacists carefully explain to patients any changes in the appearance of their medicines and reassure them they are still getting the same effective treatment.

And if you or a family member sees a change in the appearance of tablets you are taking, don’t be surprised and don’t stop the treatment, but go and ask your pharmacist or doctor about it if you are at all concerned.

 

Link to the study: http://archinte.jamanetwork.com/article.aspx?articleid=1487287

 

Just when most of us have got it fixed in our heads that being overweight is bad for us, along comes a major scientific paper* suggesting that being somewhat overweight actually reduces our risk of dying. What’s going on?

The researchers looked systematically at around 100 previous studies that together involved 2.88 million participants (of whom around 270,000 died during the study period). Each study divided the participants up according to their Body Mass Index (BMI), putting them into the standard categories of “underweight”, “normal weight”, “overweight” and three levels of “obesity”. The studies then worked out how likely it was – compared with people in the normal weight category – that people in each of the categories would die within a given period of time (such as one year or five years). In statistics this likelihood is referred to as the “hazard ratio”.

For a long time it was thought that the normal weight people would be the least likely to die in a given period. But when the data from all the studies were pooled together, the people with the lowest risks of dying turned out to be those in the overweight category and the lowest level of obesity category!

The effect is quite a small one – it’s only about a 5% lower risk. And the risk of dying climbs steeply for the level 2 and 3 obesity categories, where it is about 30% higher than for normal weight people.

Nevertheless, this result seems surprising. It’s sometimes referred to as the “obesity paradox”. What should we make of it?

The most important point, as most scientists would agree, is not to conclude that we should all start piling on the pounds. There is strong evidence that increasing levels of body fat can lead to all sorts of potentially harmful changes in the body. Diseases such as heart disease and diabetes become more likely. These may not result in death, but they can still be disabling and unpleasant. And once you start to build up body fat, it becomes harder to get rid of, so it is wise to take action straightaway to avoid any possibility of ending up in the high-risk obese categories.

But how do scientists explain the slightly lower risk of dying among those who are overweight? So far, there is no clear explanation, although several factors may contribute.

Firstly, the measure used – the BMI – is less than ideal. It is a simple calculation of your body weight (in kilograms) divided by your height (in metres) squared. “Normal weight” is agreed internationally to be a BMI score of 18.5 to 25, while “overweight” is 25 to 30. One big problem with this is that people with a lot of muscle but not much fat – such as men who get fit through weight training – end up being classed as “overweight”, even though they are in great shape. Highly muscular sportsmen can even be classed as “obese” by this measure! Having some fit, healthy people in the overweight category could well affect the results.

Many of the studies focused on older people, and the finding is even stronger among the over-65s. Being in the overweight category makes it around 10% less likely an older person will die in a given period compared with older people in the normal weight zone. It is possible that some extra body fat could help older people survive serious illnesses.

It is quite likely there are other processes going on as well. People’s bodies may perhaps handle excess fat in different ways. Or it might be that something like fitness is ultimately a more important factor than body weight. And some of the people in the overweight category may well have been taking action to lose body fat, which has been shown to bring health benefits. There’s plenty still to explore. For example, the lower end of the normal BMI range is associated with higher mortality than the upper part. There’s no clear explanation for this.

This study has certainly raised intriguing questions. Hopefully, future research will start to answer some of the questions and provide a better indication of the dangers and benefits of body fat. Until then, though, the basic advice doesn’t change. To stay healthy and avoid future disease, watch your weight!

 

 

*Link to the study:  http://jama.jamanetwork.com/article.aspx?articleid=1555137

 

Periodic screening for diseases and health check-ups seem a good idea. Spotting warning signs early can save lives and help prevent serious illness. Cervical screening, for example, has significantly reduced deaths from cervical cancer. And watching out for the precursors of heart attacks has led to many people taking action to reduce their likelihood of getting one.

But it is not universally agreed that all periodic screening is beneficial. Prostate cancer is one of the commonest cancers in men but screening for it has become mired in controversy over beliefs and facts – not all of which are firmly established even now. Early detection of bowel cancer is widely advocated in North America but less so in the UK. Questions are even being asked about breast screening, which until recently was thought to be beneficial.

Why the doubt about check-ups? They bring benefit when they can detect signs of illnesses for which there is good evidence that doing so can help stop the condition progressing. Unfortunately, even with all the modern methods of detection and treatment, achieving this aim is far from straightforward. Over-diagnosis and over-treatment are not free from hazard. Over-diagnosis increases patients’ anxiety unnecessarily, and unwarranted treatment carries risk. What is the benefit of detecting conditions where the value of treatment is questionable, such as the continuing uncertainty over prostate cancer screening? Or where the there are questions over what actually is the best treatment, such as how vigorously Type2 diabetes should be treated?

To help doctors and patients, the Cochrane Collaboration and the National Institute for Clinical Excellence have been compiling the best possible evidence base for making rational decisions about screening. A recent Cochrane review has resulted in some provocative questions about the value of periodic health checks.

Researchers pooled together all the available high quality studies (excluding participants over 65 years old). Altogether, these studies included 183,000 participants in 16 trials, of which nine gave data on deaths. The analysis, which looked specifically at heart disease and cancer, showed that periodic screening led to an increase in the number of new diagnoses, as would be expected – but they found no overall benefit for ill health or death rates!

So, what’s to be done?

First, anyone who has symptoms of any degree should seek medical advice. These findings in no way change this. Second, those enrolled in schemes for cancer prevention, diabetes detection, blood fat monitoring or surveillance for high blood pressure should continue attending.

But the idea that the human body should have periodic checks like the MOT for cars remains uncertain for those under 65. (The study recognised that there could be value in regular check-ups for those over this age.) Much depends on your personal attitude to risk. Some people may gain reassurance from check-ups, while others may become unnecessarily worried. For medical practitioners there’s a continuing need to look critically at what they are doing.

 

Link to review: BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7191

http://www.bmj.com/content/345/bmj.e7775

 

Over recent years, there’s been an increase in magazine advertising and direct mailing to the public about tests to screen for a range of diseases. Assuming you can afford these tests, should you go for them? Is this advertising helping people to control their own health or is it simply exploiting deep-seated fears?

It’s true that early detection of a disease often offers the best chance for effective treatment. Cervical cancer provides a good example: detecting the earliest signs of the cancer itself – or of its precursor – has saved many lives. But screening for diseases can raise some tricky issues.

Even with cervical cancer – for which there is good epidemiological data and wide agreement over diagnosis and treatment – not everything is as straightforward as you might expect. For example, there are differences between the four UK countries about the age at which screening should start.

The complexity of screening more generally is illustrated by some major questions about the value of mammography screening for breast cancer, where ‘false positive’ results can cause unnecessary distress for women. There are also doubts about using the blood test PSA in screening for prostate cancer – and, indeed, in the best way to treat this cancer if detected. There’s no point in detecting a condition if it’s uncertain what should be done about it.

A range of other conditions can be screened for and it’s likely the range of tests will continue to expand. For example, checking blood glucose levels can reveal type 2 diabetes, and checking cholesterol levels may show a liability to heart disease. Lifestyle advice and, where appropriate, medication can then significantly reduce the risk of the disease; but even with these there is continuing debate. For something like an ultrasound scan of the carotid arteries in the neck, which is now available, it is far from established that there are benefits for the patient if an abnormality is discovered.

Within the NHS there is a process, aided by independent authorities, for evaluating such tests and giving the best guidance on their use. To establish the usefulness of a screening programme takes detailed scientific work extending over several years. Even then, doubts can arise.

Scans – such as CT, MRI and ultrasound – are now widely used in clinical practice where they have revolutionised diagnosis in a way that was unimaginable 50 years ago. These work best when the clinician has an idea of what’s being looked for. For example, using CT to scan smokers for lung cancer has been shown to detect early cancer and there’s some evidence it improves the outcome for the patient.

But it’s probably not worth investing in a whole-body scan – as is now available at a price – especially if you have no symptoms of disease. No one has shown any clear overall benefit for this. Indeed, it would take a very large study of several years duration to establish efficacy, and this hasn’t been done. It’s worth noting that CT scanning exposes the body to significant irradiation and, if repeated, the cumulative dosage can rise to a dangerous level. MRI scanning is often unpleasant for those with claustrophobia.

More important, though, is the question of what you might want to do with an unexpected finding? Do you seek out further tests or proceed to treatment? The cascade of further investigations may not be without hazard, and there is the fear and uncertainty even when nothing abnormal is found in the end.

There is also an issue with scans that don’t show any problems. This is not the same as proving the scanned person is free from all disease, but it can potentially lead to them believing they are and ignoring symptoms they might otherwise have told their doctor about.

Normally a scan or test is planned with a medical adviser who can explain it, why it’s being done and what is proposed if it turns out abnormal. Doing tests blindly is different. Purveyors of directly marketed tests talk about referring on to another practitioner without clear indication of who this might be. Many of them will do no more than send results to your usual doctor.

Some people are bound to benefit occasionally from tests such as these bringing something to light, but overall is it worth paying to have these tests if you don’t have any symptoms? Probably not. Even in the United States, with their very different medical care system, doubts have been expressed about the sense of these commercially provided tests. In the UK your money would be better spent elsewhere.

If you have symptoms then it’s best to talk to your doctor about them. He or she can then arrange investigation through the NHS – or privately – with the advantage that there will be someone who can interpret for you what any findings mean and can arrange whatever further care or observation you might need.

 

Link to a discussion of the ethics of commercial screening tests:  http://annals.org/article.aspx?articleid=1355172

 

Where is the healthiest place to live?

People have been suggesting answers to this for hundreds of years. For example, Hippocrates wrote in 400 BC about the importance of choosing somewhere healthy, based on factors such as location, prevailing wind and water supply. And during the Industrial Revolution, people pointed to the healthiness of life in the countryside compared with overcrowded and polluted cities.

In the 19th Century, emphasis was placed on the recuperative and health benefits of coastal air and sea bathing – with the result that many workers took their annual holidays at the seaside. Charities were stimulated to open tuberculosis hospitals and convalescent homes in country and coastal locations.

Even today, many people head to the coast for holidays or to live after retirement. Intuitively, that might seem a healthy idea – but is it?

Recently, a group of researchers looked into this*. They were based in the South-West of England, an area much visited by holiday-makers and which attracts a lot of retirees.

The researchers compared health statistics across England with where people lived, and showed that living near the coast was indeed associated with better health. Interestingly, they found that people who were more socially deprived gained the greatest health benefits. The explanation they suggested for the results was that living near the coast gave greater opportunities for stress reduction and physical activity.

Plainly not everyone can live at the seaside, but the study does show the continuing need for us to think carefully about our built environment and the impact it has on our health.

 

*Link to the study: http://dx.doi.org/10.1016/j.healthplace.2012.06.015

 

Professor Brian Kirby, co-author of How to Live to 110: Your comprehensive guide to a healthy life

 

The Commission for Improving Dignity in Care today published a draft report that highlights the importance of respecting the dignity of old people.

They are right. It is all too easy to make assumptions about older people, or to talk down to them.

This was brought home to me a long time ago by some young medical students in a hospital ward where I worked. One of the students tried to engage a patient – an old, rather deaf man – in conversation.

“Now then, dad, what did you used to do for a living?” he casually shouted in the old man’s ear.

“I, laddie, was a Professor of Medicine,” came the stern – and unexpected – reply.

It turned out the old man in front of them had been perhaps the foremost medical professor of his generation, and the author of a textbook almost every medical student owned in those days.

“Have you got my book?” he asked. “Well, bring it in and I’ll sign it for you.”

The next day, the six students each proudly possessed a signed copy of the professor’s book. And each book was inscribed with a note hoping the owner would remember for the rest of his professional life that the old were once young, productive members of  society. After that lesson, I’m sure they did.

It’s easy to fall into bad habits, but it is up to everyone to do our bit to preserve the dignity of older people.

And perhaps it wouldn’t be so bad to extend this to younger people too!

(To see and comment on the Commission for Improving Dignity in Care’s draft report, click here.)

 

Professor Brian Kirby, author of How to Live to 110: Your comprehensive guide to a healthy life.

 

 

These days, when you have a book to sell you need a website. But when we were building our site, we realised it could be much more than a boring old marketing tool.

So what we’ve done is put together a site full of information we hope will be of value to everyone, whether or not you buy our book How to Live to 110. It outlines what to do now to keep yourself healthy, so you live longer and end up in great shape throughout your later years.

We’ve given an overview of all the main diseases covered in the book – heart disease, cancer, high blood pressure, diabetes, lung disease, infections, dementia and so on – and suggested some of the steps you can take to avoid these. We also give advice and suggestions on physical activity, burning calories, foods that help protect you from disease, avoiding hunger, losing weight permanently and giving up smoking.

People are living longer these days. Everyone really should be taking steps to make sure their old age is rewarding and healthy rather than years of illness and frailty. The website can’t go into depth on this, like our book does, but we hope it will still prove helpful. And, unlike some websites, all the suggestions we make are based on scientific studies

Of course, we’d love it if people buy our book. After all, we spent two hard years researching and putting it together, and we’re really proud of how it turned out! But if our website gets some people thinking about their future health – and perhaps contributes to a reduction in the diseases caused by modern living – then that’s great too.

(Our website is www.how-to-live-to-110.com – or click on the tab at the top of the blog.)

 

Professor Brian Kirby, author of How to Live to 110: Your comprehensive guide to a healthy life.

 

© 2012 How to Live to 110 Suffusion theme by Sayontan Sinha