Posts Tagged ‘health’

I’ve been running some numbers based on the situation reports provided by the World Health Organisation. It is not a fun read. But the situation should improve once the first shipment of thoughts and prayers arrive in Europe.

I’m happy to take feedback on these. I’m not a statistician (although there is a lot of stats in psychology), and if you are one and think my graphs are terrible and misleading, I’m open to being corrected.

Deaths per day

China has the most deaths because they have been dealing with this for a long time. People have been dying for 7 weeks now. But not many people and their levels have been going down. The deaths per day in Italy and Spain is far out-racing anything than China saw.

To clarify, this is not cumulative. Even a flat line represents a lot of people dying. A line going up suggests the problem is getting a lot worse.

China still has a problem

This shows the number of deaths per day in China over the past two weeks.

The media are reporting that life in China is going back to normal and that any remaining cases are from people arriving in China. It is true that life is starting to return to normal and people are going outside again. Emergency hospitals have closed and travel restrictions have gone.

However, people are also still dying and the World Health Organisation still reports local transmission.

How far in are we?

This shows the cumulative number of deaths since the 10th death. I followed the Financial Times’s lead on adjusting it this way as, for example, France had one death very early on and then none for a long time. Once you reach the tenth death, you get a far more accurate picture to compare against. Unlike the FT graph, it is not logarithmic. Their graph is just better, to be honest.

At this stage, it is pretty difficult to predict what the UK curve is going to do. We’re only on day 9, compared to day 26 for Italy, day 14 for Spain and day 60 for China.

Let’s review where we are so far. 2020 is a write-off, so I am going to attempt to summarise what has gone wrong.

First, a bunch of people are dead. Sure, so far, many more people are dying of regular flu, cancer, heart disease, the effects of global warming, and capitalism. But those are everyday deaths that we’re used to. This is something new.

Also, a lot of people are ill and having a bad time. Many of the rest of us are torturing ourselves with anxiety because we are unable to switch off the news.

There is no toilet paper or paracetamol. In fact, many supermarket shelves are empty. There is no rice, pasta, bread, tinned food or a wide range of other items. God help you if you don’t have a stockpile of hand wash, and even if you have some ibuprofen, nobody knows if it is safe to take it anymore.

The government says get your groceries delivered, but here is the availability when I checked:

• Sainsbury’s: no delivery slots at all
• Morrisons: no delivery slots for 3 weeks
• Ocado: no delivery slots for 3 weeks
• Waitrose: no delivery slots for 2 weeks

We’re not allowed to see our friends. Social gatherings are discouraged. Social activities and hobbies are cancelled. We’re deprived of human contact. We all have to work from home, and every company is finding out their VPN can’t handle the load after all.

Nobody is buying anything and so businesses are going bankrupt. That means people are losing jobs. Other companies are terminating people before it comes to bankruptcy.

All the schools and nurseries are closing, meaning that most people cannot go to work and are either having to take unpaid leave (possibly for up to six months!) or losing their job. Nurseries cannot afford to lose fees, so they’re charging parents for childcare they’re not providing.

All holidays are cancelled as borders close. Some people are stuck elsewhere.

All participatory sport is cancelled. Pools and gyms are closing. Running club, triathlon club, cycling club have all suspended activities indefinitely. All of our races are getting cancelled as far as June. Almost nobody is talking about a refund. Which is a big deal when Ironman are charging £400 per head.

All professional sport is cancelled. The Giro is “postponed”, but where else are you going to fit a three-week cycling race? Football is cancelled, even though Leeds are at the top of the league. F1, triathlon, marathons, ice hockey, everything is cancelled or postponed. Everything we look forward to relaxing with is gone.

Even the misery of being stuck at home is being made more miserable by the EU demanding Netflix reduce streaming quality to “help the internet cope”. And no Eurovision!

On the bright side

So far, it’s been pretty rubbish. But there are good things, too.

People are following social distancing advice and going out less. The roads are quiet. Fit, young people who have little to lose personally are still mostly staying at home to protect vulnerable people.

People have been getting together on video chats for pub nights and virtual group rides on Zwift.

Supermarkets are creating thousands of jobs as they try to keep up with demand.

It turns out we can work from home and that those meetings were not necessary. It’s too late to put the genie back in the box.

The Conservative government have turned out to be raving socialists.

There has been a significant reduction in pollution as planes stop flying and cars stop driving. Dolphins have returned to the canals of Venice.

Corona beer is available for large discounts.

Summary so far

Not the 2020 we all wanted. But we can get through this together. I mean, together as long as we maintain at least two-metres distance. And it may change society for the better.

Of course, in the UK, we’re really just at the start of things. I may be writing another blog post in eight weeks saying “why did I try to put a brave face on things; everything is burning!” Or, I may write nothing, because I am dead.

But until then, stay strong and see you soon.

Back in August, my friend Jenny and I set up a social “run and chat” type group for people working at Leeds Dock to encourage them to get out from behind the desk each Wednesday lunchtime.

Seven months later and we’re still running. We run for around 30 minutes, heading down the navigation towpath for 15 minutes, turning around and running back. It’s been lovely to chat to different people and see people go from strength to strength as their running improves week on week.

Sadly, the COVID-19 crisis looks like it will put the club on pause for a while, and I’ll be finishing with my client down at Leeds Dock, so that’s probably it for me. But it’s been a blast and I wish them many happy runs in the future.

I recently completed my course in Macronutrients and Overnutrition with Wageningen University. I didn’t realise just how good Wageningen was until I looked them up in the league tables: around 50th in the world (Leeds is around 100th) and the top-rated university in the Netherlands.

The course covered macronutrients: carbs, proteins and fats, as well as some of the reasons we eat too much and why weight management can be an issue in the obesogenic environment.

Final grade: 95%. Pretty happy with that.

In April I did my first body analysis at the gym and came out with a body fat percentage of 16.5%. A few weeks ago I did another and discovered I had increased my body fat percentage to 18.3%. Bad times.

With them being so far apart, it’s impossible to say when it changed. But after an entire summer of triathlon and running, I wasn’t expecting it to go up. I’ve also lost muscle mass, entirely from the upper body, while gaining it in my legs.

It’s the off-season now so I will be gaining body fat as I eat a lot much ice cream. But come January it’s probably time to look at my strength work.

The Lancet has published a global study looking at alcohol consumption and the news for drinkers is not good.

Previous research indicated that alcohol consumption came with protective benefits and led to moderate drinkers living longer than non-drinkers.

However, this new paper that takes data from 195 countries over a 16 year period finds the opposite: all-cause mortality is correlated with increased alcohol consumption and in order to gain the most years of disability-free life, you should abstain from drinking.

Many people have reacted with a sarcastic “wow, putting poison into your body is a bad thing? Who knew?”

I think it is important to tackle such views because they are potentially dangerous. What someone suggesting when they say that is that they believe that the intuitive explanation should take precedence over what the evidence says.

Consider a parallel between vaccinations. An attenuated vaccine is a vaccine that uses a live strain of the disease. For example, when you have the MMR vaccine, you’re literally having a little bit of measles, mumps and rubella pumped into you. If you didn’t understand the science behind it you would say “it’s obviously a terrible idea to inject a disease into myself.” But, of course, every intelligent person now agrees that it is a good idea.

In this case, though, it would seem that the balance of harm from alcohol may outweigh the benefits. Good news for people like me who struggle to hit their alcohol consumption quota.

The idea that being overweight is bad for you is well established. Being overweight takes years off your life, so it’s important to eat right and exercise to keep your weight under control. More recent evidence, however, has challenged this.

For example, a 2013 paper in the Journal of the American Medical Association found that overweight people had a lower level of all-cause mortality than people of a healthy weight. The paper was not well-received, but nobody seems to have been able to poke any holes in it, either.

Similarly, a 2009 systematic review published in Deutsches Ärzteblatt International concluded that:

The prevailing notion that overweight increases morbidity and mortality, as compared to so-called normal weight, is in need of further specification.

So, should we give up with the diets and let our waistlines expand a little? Maybe. But even if more evidence goes on to support these findings, there are some good reasons for sticking with the current line on what a healthy BMI is.

Overweight vs obese

Something that all the studies agree on is that people have worse health outcomes, including death, if they are obese. Overweight is one thing, but being obese is bad for you in any study.

And you might be surprised how easy it is to reach the category of obese. Consider that my BMI hovers around 24. 25 is the line between healthy weight and overweight. So, I’m nearly in the overweight category. And I look like this:

Not the buffest individual, that’s for sure, but I don’t look like I’m carrying around any extra weight either. And you only have to move up to a BMI of 30 to go into the obese category.

All-cause morality

As the NHS points out, these studies typically look at all-cause mortality, which means people dying of anything. The problem is that this contradicts individual studies of any topic. For example, if we look at heart disease or diabetes. Whenever we look at the individual causes, we find it is better to be a healthy weight.

There is a huge amount of evidence to support this, so in order for us to accept an alternative view, it would ideally need to explain this discrepancy.

Quality of life

The second problem is that these studies just look at mortality. But that is never the way that NICE or Public Health England have looked at how to provide the most efficient healthcare system.

We measure outcomes in quality-adjusted life-years (QALYs). It’s not enough just to be alive. Modern medicine allows us to keep pretty much anybody alive indefinitely. But sitting in a medically induced coma on a ventilator isn’t a life that any of us would choose.

As a study in Nature points out, being overweight is associated with fewer years of disease-free life. In short, you might experience a longer life, but it won’t be a happier or more fulfilling one.

Indeed, this could help explain the findings. If people are already inside the medical system because they’re having to be treated for obesity-related illnesses, we may be better at spotting other diseases. Or it may be that carrying around some extra weight will reduce your quality of life but also help you to stick around for an extra week when you become seriously ill because you have larger fat reserves.

Conclusion

There is genuine evidence that you will live longer if you are a little overweight (but not obese). However, so far we have been unable to explain why this is. And, more importantly, you will also have a reduced quality of life. Therefore, the current guidelines on maintaining a healthy BMI are still relevant.

Since I hurt my foot in November, it has taken a long time to get running again. So, I decided to invest in some injury prevention. Top of that list was a running gait analysis.

I could go to a running shop where they would put me on a treadmill and analyse what was going on. However, there is a severe risk that what would happen is that it would magically turn out I needed a new, £100+ pair of trainers. In fact, that’s exactly what did happen to me.

So, I was looking for somewhere that might be able to give me some better advice. I found David at West Leeds Practice. They are a physiotherapy clinic based in the city centre and one of the services they offer is a running gait analysis.

It’s certainly thorough. We started off with some strength exercises, testing the differences between my left and my right side. My left was weaker, and this was no surprise to me, but having measured it, David has then been able to give me a strengthening routine tailored to improving it.

Then I hopped on the treadmill and we did a video analysis. I ran for a little bit and then we analysed what was going on with my arms and legs from a range of different angles. There was some stuff here, too, such as my crossing my legs over the centre was I run. I think this was exhibited by the rather small size of the treadmill, but it’s something I’ve been mindful of ever since.

Finally, he gave me a set of foot pods to place on my trainers and monitor my running for a week. I went back a week later to get the analysis (all of which was included in my session) and we reviewed my cadence, ground contact time and oscillation. I’m working on improving my cadence at the moment. It’s too early to say whether it is working or not, though the few test runs I have done made things go from red to green on my Garmin run reports.

All in all, I like what they do. David was very evidence-based and the analysis is certainly in detail: we looked at a lot of different things and reviewed all the ways I could improve my technique and reduce the chance of future injury. If you run a lot, it is worth investing in.

Do you see that slight reddening on my nose and cheeks? That’s sunburn. November sunburn.

Admittedly, it’s very slight. But I still think it’s impressive that I managed to get sunburnt in November. Though, I am the person who was off work with acute sunburn after returning from Iceland.

It’s thanks to the Abbey Dash being both freezing and sunny.

BMI is much despised by the public. However, before it is written off completely, we should consider what the implications are for the medical world.

People are constantly railing against BMI. They insist that it is simply stupid and insulting to label them as obese and that BMI doesn’t mean anything anyway.

But is that the case?

The answer is somewhere in the middle. From a medical perspective, there is little doubt that BMI is useful. A 2016 study published in the British Medical Journal (BMJ) confirmed that a high BMI was indeed associated with an increased risk of death.

However, a 2006 paper by the U.S. National Bureau of Economic Research, points out that there are some serious flaws in the simplicity of BMI as it fails to distinguish between fat from muscle.

Another paper in the BMJ suggested that BMI was indeed useful, but that what was considered a “normal” weight should be redefined. A weight of 18.5 to 20, for example, is defined as normal, but could actually be correlated with higher mortality.

Therefore, it seems BMI is a useful tool, but only when taken as a guide. It could be that the normal weight needs to be adjusted upwards slightly and that those with high muscle density will find they have an inaccurate reading.