If you have type 2 diabetes, as so many people do these days, then going for a walk after eating may help.

Were you told you should rest after meals? If you are over a certain age, it’s quite likely you have been following this advice since childhood – but it may be wrong.

After a meal, the level of glucose – a type of sugar – increases in your blood. One of the problems with diabetes is controlling this raised glucose level. Now there is some objective evidence from a small study* showing the benefit of low level physical activity after a meal.

The study involved 10 people older than 60 years who were asked to walk in a laboratory for 45 minutes at roughly 2½ mph either in one sustained session or as 15-minute sessions after each of their three main meals. Researchers compared their glucose levels afterwards. Both regimes improved the overall control of glucose levels over the whole day, but walking for 15 minutes after eating was better at controlling the rise in glucose after meals.

This was a small study, but it suggests that even a relatively modest amount of walking after meals – which is within the capability of older people and those less physically able or active – is beneficial for those with type 2 diabetes. Higher levels of activity might bring even greater benefit, but it is good to know that even this low level of exercise helps.


*Link to a summary of the study:


Link to the study abstract:



There have long been health warnings over eating too much red meat. Initially the concern was over its fat content, and more recently there has been interest in whether the way red meat is broken down in the body might be behind an increase in the risk of heart disease and, to a lesser extent, stroke. Eating red meat has also been shown to have links with bowel cancer.

Now it may be the turn of type 2 diabetes, a rapidly increasing disease that not only brings its own problems but also contributes to the risk of heart disease.

Researchers* have used health data collected in nearly 150,000 American men and women who were followed up over more than 7 years. Among these, there were 7,450 new cases of type 2 diabetes.

In addition to the already known factors that might have explained these new cases, the researchers looked changes in the amount of red meat the participants ate. Those who increased their consumption by an average of half a serving of red meat a day for a four year period were more likely to get diabetes during the subsequent four years than those who didn’t. And those who cut their red meat consumption over the first four years were then less likely to go on to develop diabetes.

This wasn’t the whole story as there were changes in body weight – which is known to be a factor in diabetes – to take account of. But there was enough evidence to suggest red meat played a part in these people developing the condition.

However, a word of caution is needed. A study of this sort that looks retrospectively through data that wasn’t specifically collected for the purpose is not enough to establish cause and effect, or to say how such an effect arises.

For researchers, it raises interesting questions about red meat and how it might have led to this finding. For the rest of us, it is a useful reminder that we should be conscious of what we eat and of maintaining an appropriate body weight, and that those of us who consume a lot of red meat might consider the already current advice to replace some of it with fish, chicken, pulses or vegetables.

*Link to the study abstract: http://archinte.jamanetwork.com/article.aspx?articleid=1697785



Dementia is a frightening condition. It’s not surprising that many elderly people express concern about it – particularly if they find themselves becoming forgetful. But how worried should they be?

The first thing to keep in mind is that most people – of all ages – are forgetful at times. Think how often parents have to remind their children to take all the kit they need to school. And memory declines as we get older, simply as part of the ageing process. Memory loss certainly isn’t the same as dementia, although it is one of the symptoms.

Indeed, there’s a lot of confusion about what dementia actually is. For a start it’s not due to a single disease as many people think. Alzheimer’s disease is the best known, but it is only one of the causes. Unfortunately, we still don’t have an easy way to diagnose dementia as a whole, let alone the different variants.

What sets dementia apart from normal ageing is the loss to a greater or lesser extent of a range of ‘cognitive skills’, such as reasoning ability and use of words. Memory loss is often the symptom that is spotted first, partly because it interferes with social functioning and partly because this is the symptom most easily noticed by the sufferers themselves, as well as their friends and family.

So how can you tell whether memory loss is simply part of a decline with age or a sign that someone is already marked out for dementia?

Unfortunately, it seems we can’t. One recent study suggested that memory generally does not decline much before the age of 60. Memory loss before this age might therefore have been a useful marker for dementia. However, this has been questioned by the results of an extensive long-term UK study* that showed a general decline in memory and other cognitive skills even at the age of 45.

In the United States, a long-term study** carried out by phone survey – the Behavioral Risk Factor Surveillance System – has shown the scale of the issue. The results suggest that 1 in 8 people aged over 60 living at home have experienced confusion or memory loss in the previous 12 months to the extent that one third of them sought help from friends and relatives. Few, though, had sought professional advice.

These results highlight the need to find ways to differentiate those with memory loss who go on to develop dementia from those others where it is simply an inevitable result of ageing. This is important for those individuals, and also for society more widely in planning potentially expensive treatment and social needs.

We now have a significant population of people over 65, with their number increasing rapidly. All forms of dementia increase with age, especially in those over the age of 80 years. Differentiating people with normal ageing from those who are developing dementia is going to become increasingly important.

Until reliable diagnosis and effective treatments are available, the best bet is to take steps known to avoid dementia or delay its onset such as regular physical activity (especially during middle life), maintaining a lively mind, continuing manual and mental skills into older life, and keeping an active social life.


*Link to study:  http://www.bmj.com/content/344/bmj.d7622

**Link to study: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6218a1.htm?s_cid=mm6218a1_w



There’s compelling evidence that keeping active has very great health benefits, helping to prevent many of today’s common diseases. But how much do you need to do? And does it matter what activity you choose?

A recent study* has provided some interesting evidence. Over a 6-year period, researchers compared 16,000 walkers with 33,000 runners to see what difference physical activity made to their risk of high blood pressure, diabetes and level of blood cholesterol – factors linked with heart disease.

They grouped the walkers and runners according to the average amount of activity they did. To do this, they used a measure (“metabolic equivalent”) that took account of the weight of each person and the calories they burnt. This allowed the amount of activity done by the walkers and the runners to be compared directly. The highest-activity group was doing the equivalent of an hour or so of brisk jogging every day (or a couple of hours of brisk walking), while the lowest-activity group was averaging around an hour of gentle walking a day in total (or the equivalent in jogging). There were two categories in between these, and all four levels were compared with people who did little activity at all.

The results showed that, broadly, the more activity people did, the greater the benefits in terms of high blood pressure, diabetes and blood cholesterol levels.

What was particularly interesting, though, was that the results for walking and running were very similar. A given amount of activity – whether running or a longer period of walking which expended the same energy – seemed to result in similar health benefits.

This study offers encouragement to those unable (or unwilling!) to get into higher levels of exercise. And it backs up all the previous research showing that even some physical activity is certainly more beneficial than none.


*Link to the study abstract: http://atvb.ahajournals.org/content/early/2013/04/04/ATVBAHA.112.300878.



Sometimes new research really makes you sit up and think – even when it’s too soon to know whether it will turn out to be certain enough for us to change our habits.

Researchers* have recently shown how one of the proteins in red meat – carnitine – is broken down by bacteria normally present in the gut to produce a chemical that’s converted into something that has been shown in animals to damage arteries in the heart, brain and elsewhere in the body.

That chemical is TMAO (which, if you are interested, is short for trimethylamine-N-oxide), and it causes the damage through atherosclerosis**, the process that causes a build-up of material in artery walls and eventually leads to blockages that cause heart attacks. For many years, this process was blamed on saturated fat; but perhaps it’s the red meat that does the harm.

The experiments showed that TMAO was present in the blood of meat eaters but not in that of vegans. Its level rose after a hearty meal of steak.

If their observations are repeated and prove to be correct, this could explain why some meats, for example chicken, are less hazardous than others. It could even lead eventually to recommendations to change our eating habits. Another possibility might be that a course of antibiotics could eliminate some of the gut bacteria responsible for production of TMAO, making eating red meat less hazardous for those who like it.

For now, it is too soon for this interesting research to form the basis of recommendations. More work involving greater numbers of people needs to be done. But it suggests a need for a search for other sources of carnitine in our diet, and it raises an interesting observation: perhaps, even in this era of antibiotics, bacteria may still be a cause of major human diseases.


*Link to the study abstract: http://www.nature.com/nm/journal/vaop/ncurrent/full/nm.3145.html

Link to a story in the New York Times: http://www.nytimes.com/2013/04/08/health/study-points-to-new-culprit-in-heart-disease.html?pagewanted=all&_r=0

**More on atherosclerosis and heart disease: http://www.how-to-live-to-110.com/Chaps/A01_avoid_heart_disease.html


Prof Brian Kirby, Co-author of How to Live to 110: Your comprehensive guide to a healthy life www.how-to-live-to-110


Almost everyone likes sugar. Many people like it a lot – a fact that hasn’t escaped food manufacturers.

No longer is sugar simply something to be added at table or used in cakes, biscuits and jams. It has become ubiquitous: you now find it in all sorts of unexpected places – sauces and salad dressings, cured meats, breakfast cereals, curries and ready meals. And, of course, large quantities are added to many fizzy drinks.

There is currently a debate about how much sugar people consume in the industrialised nations. The sugar industry would like us to think it is modest; but – based on the amount of raw and refined sugar produced per year, supported by surveys of populations – it seems that over the past 45 years there has been at least a threefold increase in sugar consumption. In recent years, the increase has been even faster at about 4 to 5 percent per year.

Bangladesh appears to be the country with the lowest sugar consumption at 8 kg per person per year and Israel the highest with an astonishing 66 kg per person per year. Given that this is an average figure, some Israelis must be consuming considerably more – virtually the equivalent of their entire body weight in sugar!

With rising levels of obesity in industrialised and emerging nations alike, and an alarming increase in type 2 diabetes around the world, the question arises of whether these alarming health trends have anything to do with our bodies becoming swamped by sugar.

Recent studies have been examining this. In one*, data from 175 countries showed that levels of diabetes increased with increased availability of sugar, even after taking into account body weight and physical activity levels. The researchers therefore concluded that there was a probable relationship between diabetes levels and sugar consumption, but stressed that their methodology could not prove it. (Reaching secure conclusions about cause and effect requires vast long-term studies.)

In an unrelated study**, the American Heart Association has estimated that sugar-sweetened drinks are responsible worldwide for around 180,000 deaths per year: 133,000 from diabetes, 44,000 from heart disease and 6,000 from cancer. The researchers expressed concern; but again commentators have cautioned about drawing premature conclusions about cause and effect.

Evidence is certainly mounting that sugar consumption at today’s levels may be a major contributor to poor health. Indeed, some communities in the United States are already considering ways of reducing sales of sugary drinks through taxation or banning large portion sizes. Perhaps we should be doing the same on this side of the Atlantic.

Certainly, though, we could each do with a hard look at the stunning amount of sugar we may be consuming. Cutting down will do us no harm, and may prove to be great for our health.


*Link to the diabetes and sugar study: http://dx.doi.org/10.1371/journal.pone.0057873

**Multimedia resources, including taped interviews with an AHA expert offering perspective on the science, are available on the right column of this link http://newsroom.heart.org/news/180-000-deaths-worldwide-may-be-associated-with-sugary-soft-drinks?preview=b39f71c47418e98ba6ebd2660b859f96



Today, Sunday 7 April, is World Health Day, and this year’s theme – chosen by the World Health Organisation – is raised blood pressure. The WHO has issued a brief on this subject, which is readable and well worth a look*.

More than a billion people worldwide have raised blood pressure (or “hypertension”). Over the past 25 years, numbers have been steadily increasing all around the world in wealthy and developing countries alike.

In Britain up to one in five men have it – and most don’t know, as there are no symptoms until a complication arises, which is why it is often referred to as the “silent killer”. Many of the complications are serious, often causing long-term disability and, eventually, death. Arteries bear the brunt of raised blood pressure and, over time, the heart, brain, limbs and kidneys can become damaged, and this can lead to heart attacks, stroke and kidney failure, as well as other diseases.

While raised blood pressure runs in some families, no single gene for it has been discovered. Indeed, genetic make-up is unlikely to explain the extraordinary numbers of people with this condition or its increase in so many different countries.

Researchers have instead made a compelling case that these increases are related to the amount of salt we consume, a reduction in physical activity, the increased drinking of alcohol and the stress arising from industrialisation. In addition, smoking is known to make it worse. Arteries become stiffer with ageing – which contributes to raised blood pressure – and so countries with older populations and those where diabetes is becoming more prevalent are seeing an increasing problem. Within individual countries, communities with social deprivation face the greatest problem.

The World Health Organisation has calculated that raised blood pressure accounts for 20 per cent of health expenditure on diseases of the heart and blood vessels. It has a high impact on a country’s health system, and for individuals and their families the cost of being unable to work due to the aftermath of untreated high blood pressure can be devastating.

The WHO is planning recommendations for action by its member states. Any strategy needs to be affordable, sustainable and effective. In many countries, including our own, it will mean promoting life-style changes. The two measures that can make the greatest contribution are increasing physical activity levels and reducing salt consumption. The long-standing WHO recommendation on salt is that we should each consume less than 5 g per day. In many countries, salt intake is 9 to 12 g per day, and even in the UK most of us consume well above the target level.

Achieving the recommendation will require considerable cooperation from the manufactured food industry. Many companies are already working to reduce the salt content in their products, but this would be accelerated if we as consumers put pressure on them by cutting down or avoiding salt-rich foods. It’s worth, in particular, checking the salt in your bread, processed meat, snacks and condiments.

There’s more we can do as individuals. Physical activity helps reduce the risk of getting high blood pressure, as well as helping to control it if you already have the condition. If you haven’t had your blood pressure measured recently, it’s worth getting it checked by your GP, pharmacist or other health professional. This is simple, quick and painless. If it turns out you have raised blood pressure, catching it early means it can be controlled before it does your body any great harm. For a few people, it may even be a sign of a specific cause for their high blood pressure, such as kidney disease, that needs treating.

In the UK we have the means to do something both as individuals and as a country; let’s follow the WHO’s lead.

Happy World Health Day.

* A global brief on hypertension: silent killer, global public health crisis: http://www.who.int/campaigns/world-health-day/2013/en/index.html


Prof Brian Kirby, co-author of “How to Live to 110: your comprehensive guide to a healthy life” (which includes a chapter that explains high blood pressure and what you can do to avoid it or keep it under control).



Do you remember the days, back in the 20th century, when the advice was not to eat eggs because they were rich in cholesterol?

Back then, the relationship between cholesterol and heart disease was first emerging. The theory in those days was that the more cholesterol there was in your diet, the higher the cholesterol level would rise in your blood; and the higher that went, the more likely you were to have a heart attack.

This idea seems to have stuck. Even though our understanding of heart disease has moved on, you still sometimes see recommendations that suggest keeping the amount of cholesterol you consume to less than, say, 300 mg per day. (A large egg contains about 210 mg, a significant proportion of that target.)

These days, we know far more about how the body handles the cholesterol we eat, and fats in general. In particular, we know that the cholesterol we eat has only a small effect on the cholesterol level in the blood. High cholesterol levels are due to other causes.

Indeed, a recent study* has again confirmed that eating an egg a day does not lead to heart disease or stroke. This study analysed the results of 17 earlier studies on heart disease or stroke, which together involved more than 7 million people. The results showed that people who ate one egg a day were no more likely to die of heart disease or stroke than those who didn’t. (Those with an underlying disorder of fat metabolism are an exception, and it has been suggested that the result might not apply to people with diabetes.)

With Easter coming soon, and eggs in people’s minds, this is timely reassurance.  Eggs are a readily available, inexpensive, low-calorie food. They contain vitamins, minerals, proteins and unsaturated fats; and there is even some evidence that eating eggs increases levels of beneficial HDL-cholesterol in those on low carbohydrate diets.

We can all enjoy an egg for Easter.


*Link to the study: http://dx.doi.org/10.1136/bmj.e8539



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


The Norovirus infection made Christmas and New Year very unpleasant for over 150,000 people. They were unlucky enough to spend the holiday period with vomiting and diarrhoea, and in some cases stomach pains and a temperature. Numbers of cases now seem to be declining, but this is no cause for complacency. We should all keep taking precautions.

This is a highly infectious disease caused by a virulent virus that changes from year to year. Any immunity people gained from having the infection in the past subsides as each new variant comes along. Last autumn was a particularly bad time, with schools, hospitals and workplaces needing to close for short – but disruptive – periods of time. The Health Protection Agency estimated that more than a million of us have had it during the current outbreak.

Fortunately, most people recover within 2 or 3 days. But anyone who doesn’t will need professional advice, as will frail elderly people, young children, people with chronic diseases and pregnant women. These need to make sure they stay well hydrated by drinking plenty of fluids.

It’s a mammoth task to clean thoroughly all potential contaminated surfaces as the Norovirus can survive for up to 5 days. It’s not just public lavatories and the like that need attention; surfaces on public transport can become contaminated many times in a day.

The Norovirus is probably the World’s commonest cause of gastroenteritis (stomach bug), and its spread and variants are under worldwide surveillance. So far there is neither a medicine to deal with it nor immunisation against it.

What can be done? If you catch it stay away from other people until you are better. In particular, avoid crowds or places where you can readily pass it on to others. Thorough hand-washing several times a day is important, and especially after touching anything potentially contaminated. There is debate about the value of hand disinfectants, which are probably useful in places where you cannot wash your hands. But washing with good old-fashioned soap and water for at least half a minute is still the best standby.

Although this virus may at last be on the decline, it’s still worth taking the precaution of washing your hands regularly and thoroughly – and not just because of the Norovirus. We become complacent about infections at our peril. This may have been a short-lasting one, but there are others that are more persistent or dangerous.

Hand-washing offers simple, effective protection, and the facilities are readily available. Why not use them?


Link to an article on Norovirus in The Lancet:  http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(13)70016-1/fulltext?elsca1=ETOC-TLID&elsca2=email&elsca3=HTDJ35F


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