Friday 30 August 2013

Maintaining Good Health

During the 1800's life expectancy was only about 40 years. Today that figure has almost doubled. If the current trend continues 1 in 3 babies born today can expect to live to be 100. However, although life expectancy is now around 80 years, healthy life expectancy is somewhat lower at 63.5 years according to the Office for National Statistics. Prof Les Mayhew, of the Cass Business School at the City University, London argues that although people are living longer, there are concerns about our ability to continue to work up to the new UK full state pension age (68), because of poor health.

Poor health comes in many guises. In recent years stress (and mental health problems) and musculoskeletal problems (of which back pain makes up a significant proportion) have been the main causes of long term absence from work. As we all live longer, it seems there may never have been a more important time to consider ways to maintain good health. In earlier blog posts I've discussed the importance of diet and exercise with respect to keeping healthy. I also believe chiropractic may be able to provide another small part of the good health equation.

In my practice I see more patients with back pain than any other condition. Over recent years there have been a number of studies supporting the treatment offered by chiropractors for this very common problem. Until recently however, support for chiropractic preventative care was more anecdotal than research led. In 2011 however, two important papers were published which begin to build support for preventative or 'Maintenance Care' for chronic back pain sufferers. Chronic back pain is generally defined as back pain which has been present for greater than 3 months. Chronic back pain can be tremendously debilitating for those suffering from it and can put a huge burden on general health resources.

The first of these 2 studies was conducted by Senna and Machaly and published in the journal Spine. Study participants (who had at least a 6 month history of low back pain) were randomised into one of 3 groups:

1. Sham spinal manipulation x 12 over 1 month, plus prescribed back exercises.
2. Spinal manipulation x 12 over 1 month, plus prescribed back exercises.
3. Spinal manipulation x 12 over 1 month, plus prescribed back exercises; plus maintenance care (treatment with spinal manipulation every 2 weeks).

Study participants who received spinal manipulation were significantly better than the sham treatment group at 1 month, however only the spinal manipulation + maintenance group were still significantly better on all outcome measures at 10 month follow-up.

Spinal manipulation is effective for nonspecific chronic low back pain. Best outcomes are achieved in the longer term when maintenance treatment and exercise are included.

The second study by Cifuentes, Willetts & Wasiak was published in the Journal of Occupational & Environmental Medicine. This study examined how health maintenance care provided by chiropractors, physical therapists and physicians affected recurrences of low back pain in workers following treatment for an initial episode of back pain. Of the 3 treatments, those who received chiropractic maintenance care had the lowest disability recurrence rate.

In practice, I have found that patients most suited to receiving maintenance care are those who have chronic or recurring back pain. The frequency of maintenance care is something that is highly individual but may vary from a treatment every few weeks in the worst cases to every few months in patients with less unstable back problems. As the first study above indicates, regular exercise to improve spinal stability and flexibility is also an integral part of a health maintenance program.

By reducing back pain related disability, I believe chiropractic can play an important role in improving healthy life expectancy. Chiropractic - helping you be healthy and happy into old age!

Thursday 8 August 2013

Isn't That Sweet?

This week I came across a video on YouTube called 'Sugar - The Bitter Truth'. This is a presentation by Dr Lustig, a paediatric endocrinologist at the University of California in San Francisco. If you have the time, it's a fascinating watch.

He talks about the rising problem of obesity and links it with the massive increase in the use of high fructose corn syrup (HFCS) as a sweetener in many foods and soft drinks. Diets with high HFCS content can decrease your ability to feel full (so you eat more). Fructose is readily turned to fat by your liver. Not all fat is the same, but the large amounts of fat produced in the liver when HFCS is metabolised can be deposited in your blood vessels increasing the risk of heart attacks. Other problems such as high blood pressure, type 2 diabetes, liver dysfunction, and pancreatitis are also associated with HFCS.

Dr Lustig recommends 4 effective lifestyle interventions in an attempt to combat this problem:
1. Get rid of all sugared liquids from your home or work; only drink water or milk.
2. Eat your carbohydrates with fibre (remember, highly processed food often contain little fibre).*
3. If you want seconds, wait 20 minutes.
4. Buy your screen time (TV, computer, etc) minute for minute with physical activity (i.e. 30 minutes of surfing the net costs you 30 minutes of exercising or cleaning or walking, etc). Another great reason to use a treadmill desk - immediate payback!

Fortunately, UK diets contain a good deal less HFCS than diets in the USA. I've taken to looking at food labels more closely this week and you'd be surprised what foods are being sweetened. Low fat foods are particularly vulnerable as we find low fat food less palatable, and to increase palatability, the food is often loaded with sugars, which may then be metabolised in the liver into even more unhealthy forms of fat than the fat for which the sugar was substituted. This one reason why dieting is often so ineffective.

Watch the presentation. It will change the way you think about your food and drink and your lifestyle as a whole.

*Wherever there is fructose in nature (in fruit for example) there is also lots of fibre. Fibre is essential because it slows the rate of carbohydrate absorption and increases the speed of transit of intestinal contents, helping us feel more full and less hungry.