It’s no secret that a healthy lifestyle greatly improves our chances of a healthy old age. That’s what this blog is about, after all! Living disease-free for as long as possible is a goal for all of us, and would be enormously beneficial for the NHS, as I blogged here a few weeks ago.
Yet the people whose job it is to keep us alive are taught next to nothing about the impact lifestyle has on our long-term health. A tiny section of a doctor’s training, if any, is dedicated to the importance of healthy eating and exercise for patients. This seems absolutely crazy considering the impact that lifestyle changes can have on chronic conditions like diabetes and heart disease. Cancer Research’s current ad campaign points out that obesity is the second biggest preventable cause of cancer – after smoking. Their research shows that only 15% of the public are aware of this link. So why don’t doctors remind us of it every time we see them? Surely it would make an incredible difference to the health of the nation if every GP visit started with a couple of quick questions about nutrition and exercise? The argument against is, apart from the time it would take, that doctors are trained to treat acute conditions, not take responsibility for everyone’s day-to-day health.
Which is why all of us as individuals have to take responsibility for our own health, living the best life we can. There’s so much information out there it can be quite overwhelming, we know. That’s why we started the blog. But the key points – a healthy diet, exercise and sleep – are universal.
In addition, there is a movement among some doctors to integrate so-called ‘lifestyle medicine’ into their general practice. Books by doctors Rangan Chatterjee and Rupy Aujla have topped the best-seller lists in recent months. Their message is essentially: look after yourselves, then we won’t have to.
We like Dr Chatterjee’s book, The Four Pillar Plan, because it details simple lifestyle changes that make a huge difference, like stretching while watching TV rather than slumping on the sofa. He advocates ‘movement snacking’ that can be done anywhere, including your kitchen or office. It could be tricep dips at your desk or squats while veg steam on the hob. And there’s a simple step work out which can be done on your lowest stair at home. Annabel absolutely loves this and does it all the time!
Dr Aujla book, The Doctor’s Kitchen, is packed with simple, accessible recipes. Many of them are inspired by his need to eat well on the go when working in hospitals. He’s now set up Culinary Medicine UK, which aims to train healthcare professionals about nutrition, and how to cook themselves. And this, in turn, will help medics help their patients.
There was a terrific edition of The Food Programme on Radio 4 a couple of weeks ago on this topic, entitled Doctor’s Orders: Getting Tomorrow’s Medics Cooking. It’s still available to listen to and features both Drs Chatterjee and Aujla. http://www.bbc.co.uk/programmes/b09wr9q9
Another of our favourite books at the moment is Be Good To Your Gut by nutritionist Eve Kalinik. We’re very proud that’s she’s our ‘stablemate’ (dreadful term!) at Piatkus books, who will be publishing our book The Age-Well Project next year. There are lots of delicious recipes in Eve’s book, all designed to maximise gut health. Our age-well journey has taught us how important gut health is. But how long before our GPs starting talking to us about our microbiome?! This recipe is a slightly simplified, kid-friendly version of one from Be Good To Your Gut. Miso is fermented, so is, as Eve says ‘an excellent source of beneficial bacteria for the gut’. It’s been used in Japanese cooking for over a thousand years. And, as we’ve written about here and here, a healthy gut is a great way to keep the doctor at bay!
MISO COD WITH ROASTED BROCCOLI – serves 4
- 1 large head of broccoli, cut into florets
- 4 tbs sweet white miso paste
- 4 tbs sake (I didn’t have any so used mirin)
- 2 tbs soy sauce or tamari (Eve uses coconut aminos)
- 4 cod fillets
- 2 tbs butter
- 2 clove of garlic, peeled and finely sliced
- 2 tbs sesame seeds
- Noodles to serve, cooked following packet instructions, optional
Pre-heat the oven to 180C. Line a baking tray with baking parchment. Put the broccoli florets on the baking tray.
Mix together the miso, sake (or mirin) and soy/tamari sauce. Place each piece of cod on a separate piece of baking parchment and spread one quarter of the miso mixture over each fillet. Carefully wrap the paper around the fish and fold over the ends so the miso mixture doesn’t leak out of the sides. Put the fish parcels on a separate baking tray, and place both trays in the oven for 18 minutes.
Leave the cod to rest for a few minutes while you finish the broccoli.
In a shallow pan, heat the butter or ghee, add the garlic and broccoli and stir-fry for three minutes.
Serve the broccoli with the cod, and noodles – if using. Pour over the juices from the parcels and sprinkle over the sesame seeds.
Susan
Whilst some ingredients here many be healthy you will be ingesting up to three grams of salt in a portion of this. Be cautious if you have difficulties with salt and no one should add further soy sauce to the finished dish.
That’s a very good point Susie. In the original recipe, Eve Kalinik uses coconut aminos but we try to avoid hard-to-find ingredients. She suggests soy sauce as an alternative, so I used that. But a low-salt soy sauce would work as well and the recipe has lots of flavour so will taste great even if you use less.
Susan, it’s a wonderful thought that each consultation should start with questions and advice about nutrition. GPs do take a holistic approach to medicine and often need to elicit the hidden agenda for a consultation. This is often completely different from the problem first presented. GPs are also advised to try and let the patient talk for the first two minutes, before the GPS ask any questions. This should put the patient at their ease and make them feel they are being listened too. Questions about lifestyle can be seen as challenging and blaming the patient and get them offside. Patients are often nervous at the start of a consultation. The doctor-patient relationship is a delicate one.
GPs do spend a lot of their time dealing chronic disease and health promotion. Diet, smoking, exercise, mental health and life balance being part of that . I particularly like to emphasise areas when patients can take control and help themselves, including of course diet. We are all up against the might of huge corporations promoting very unhealthy foods in an enticing way. Similarly there is a huge challenge with promotig exercise in the face of increasing technology encouraging children especially to be sedentary.
There are also other parts of the NHS dedicated to health promotion and health visitors have an important role with families under 5.
These comments are not meant to undermine your health message, Susan, but as a explanation of role of GPs in the NHS which is sadly under-funded, over-worked and with the lowest morale I have known in over 20 years working in the NHS.
Annabel here. That’s very interesting. I’ve had some fantastic experiences recently with the doctors my family visit, to such an extent that I wondered if they’d all just been on a training course. Not only have they probed and questioned (in a very sensitive way) but they refused to prescribe anti-biotics or sleeping pills or any of the things they used to speedily prescribe 20 years’ ago. A real sea change in our surgery. But as patients we’re acutely conscious of the queues, the long waiting times, the brevity of our allocated slot – and so very reluctant to go into the sort of detail they probably need. Nevertheless, it’s been very encouraging!
Thank you so much for taking the time to respond, Helen. I know it is very easy for us to lob in thoughts and ideas from sidelines, and very different for you in the frontline as a GP. My point was about doctor’s training as much as anything and why there is little emphasis on the importance of nutrition, when diabetes, for example, costs the NHS billions. And I’m interested that some doctors are taking this into their own hands, writing books and setting up training schemes for other medics.
You are absolutely right that the worst thing would be to make patients feel negative or defensive about their health or lifestyle. It’s heartening to hear how much you are able to do to help your patients take responsibility for their health, and saddening how low morale is in the NHS.
We’ll keep banging the healthy lifestyle drum and hope that we don’t need to trouble the NHS too much!