In quieter moments, pondering the end of your life, how many years to you think you might be effectively house-bound with a number of chronic diseases before you pop off? The jargon for describing this unappealing state is YLD (Years of Living with Disability) and according to a big report in the Lancet earlier this week inhabitants of the UK are facing more YLDs than most other rich countries. We are 12 /19 and worse than both Italy and Greece.
Newspaper reports didn’t give actual figures but the ones we quote in the ‘10 Secrets of Healthy Ageing’ are about 7 YDLs if you’re male and 9 if you’re female. It’s a pretty grim prospect and reducing them was one of the reasons we wrote the book, which gives you a personal plan for staying mobile and limber for longer.
Health Secretary Jeremy Hunt immediately declared the UK’s YLD ranking ‘shocking’ announced he had a plan to improve it but I wouldn’t recommend you rely on it for your sunset years. In fact his proposals for heart disease look certain to push the YLD figure up.
That’s because it largely focuses on will be done to you when you already have heart disease – more training in the use defibrillators, more genetic testing, more joined up care, more health checks. This last one is particularly unimpressive since the conclusion of a Cochrane Collaboration analysis of health checks last year was that they hadn’t “found any beneficial effects” on measures such as dying or going to hospital. You may live a bit longer but how well?
For full details on what to do, read the book, but since we are all time-poor for you and for Minister Hunt here are ten more radical top tips on ways to drive down our embarrassing YLD total:
1/ Don’t rely on doctors
They are not trained to keep you healthy. Their knowledge of diet and exercise – the two essentials for staying well – is minimal, even though it’s what they dutifully recommend. Their skill is to diagnose your disorders and prescribe, according to guidelines, pills for each ill. The drawback is a rapidly increasing pill intake. Fifty per cent of people over 65 are on five or more pills – the medical five-a-day – and five at 65 means considerably more at 75. The higher your pill total, the higher the chances of damaging side-effects.
2/ But won’t the pills cut my risk of getting ill?
In theory. But even though cholesterol lowering drugs, blood pressure pills and low dose aspirin are handed out in vast numbers to healthy people your chance of benefiting personally is very small. It is anywhere between 1/100 and 1/1000 for statins and about the same for the aspirin, which comes with an almost equal risk of serious internal bleeding.If these were bookies’ odds you’d stay away.
3/Start with exercise and a healthy balanced diet – yawn!
Everybody pays this lip service and then effectively ignores it. Too often it means getting a diet sheet along with advice to move a bit more. Changing your diet and getting in the habit of exercise can stop diabetes and improve risk factors for heart disease, but it’s hard. You need regular support, good information and encouragement. Few GP surgeries are geared up to provide that. The amount of research into the best forms of exercise, the best dietary combinations is tiny compared to the billions spent on drug research. Ageing well is a life skill that you need to start learning.
4/Do get your blood glucose level tested
This is one of the most useful things you can do to check that your healthy ageing plan is on the right track. Blood glucose and insulin levels are not just about diabetes. Evidence is piling up for links with other chronic diseases such as cancer and quite probably Alzheimer’s. Insulin is a growth hormone and too much as you age may promote cancer. Animals kept on calorie restricted diets are healthy, live a long time, have low insulin and clear arteries. It’s a good way to be.
5/ Do not go on a low fat diet.
Like taking pills for disease prevention this is one of the fundamentals of the medical approach to ageing to avoid. Lots of evidence suggests that higher levels of fat in the diet pose no threat to your heart and are a more effective way of losing weight. Following a low fat diet means eating more carbohydrates and that includes more sugar. Processed foods sold as low fat have very often replaced the fat with sugar to make it palatable. Extra sugar is an effective way to raise your blood glucose level. Not wise.
6/ Have your vitamin D level tested
Almost everyone now knows that living as far north as we do, means not enough sun to make vitamin D for about half the year. You could eat four portions of fish a week but few will. It makes sense to supplement. Evidence is growing that adequate levels of vitamin D benefit the heart, improve the immune response and lower cancer risk. Find out what the optimum levels are and check if you are reaching them.
7/Check your homocysteine level
This amino acid is linked with a raised risk of Alzheimer’s and one high quality controlled trial has shown that people with high levels of homocysteine have a 50% reduction in brain shrinkage when they lower it with a high dose of B vitamins. That is the only way to do it – drugs can’t. That may explain why this trial, done in 2010, has not been repeated. High homocysteine levels are also linked with stroke and heart disease.
8/ Be aware of polypharmacy dangers
This means taking a lot of drugs. This is what happens to many older people and it is not backed up by any evidence. Clinical trials are done using a single drug on a group of people with a single disease. Giving eight or ten drugs to people with several disorders is guesswork – experienced guesswork if you are lucky. Keeping your drug intake to a minimum for a long as possible is a good reason for relying on lifestyle to stay healthy. If you are on lots of pills, check if any can be stopped.
9/Share information about drug side-effects
Officially about 40.000 hospital admissions a year are linked with drug side effects at a cost of 500 million in the UK . This is certainly a considerable underestimate. But adverse drug reactions are poorly reported and poorly tracked; when one is reported it is described as an “anecdote”, and not evidence the drug caused it. A new website aims to improve on this. It uses simple tests on reports to estimate the likelihood the drug caused the particular effect. Called Rxisk.org . it was set up by the campaigning psychiatrist Dr David Healy and also allows patients to swap information about drug experiences.
10/This is political as well as personal
Medicine is not so good at a number of things: helping people to lose weight, encouraging them to do the right sort of exercise, feeding them well in hospital. treating them with respect and understanding in “care” homes, dealing with stress and loneliness. All these need friendly and skilled human interaction and they only work well if society supports them. When research and treatment is dominated by drugs they become Cinderella services. Send them to the ball and we’d have a YLD score to be proud of.
Body of Evidence 
thanks Jerome for the encouragement! it is scary to ignore one’s doctor so we need you! and thank you for Patrick’s advice! read the book – am taking the supplements! and definitely feeling better! And eating colourfully! xx sue
Succinct and so good… I wonder how many more years people will blissfully ignore the possibility that they are being used for drug experiments by Big Pharma and the possibility that one way to make more money is to create a med which stops one thing.. but Oh dear, the side effects create another and then another drug is layered on top of that and so the poor person who may well have self healed with good nutrition, rest and a positive attitude has a painful death with years of incapacity caused by the cocktail of drugs….
And what about a prescription paid for in good faith that it will do what its been prescribed to do, failing, causing ghastly side effects and being told to stop taking it and get given another. No refund possible.
Anything else you pay for comes with statutory rights!
Yes indeed. There is a famous comedy sketch in which an apparently sweet TV interviewer asks a pompous self-satisfied psychiatrist how much he charges and he replies 120 dollars an hour. She she then asks if he guarantees his work. He’s flustered and says what do you mean and she replies this if his treatment doesn’t work, will he treat her for free till the problem is fixed. The psychiatrist is taken aback and says no, therapy is a process, an interaction between two people, you can’t guarantee it. The now very aggressive interviewer says: You mean you have the audacity to charge 120 dollars an hour for a job that may or may not work? My plumber charges nearly that and no one would hire him if he didn’t guarantee his work. Why should anyone use you?
Another way of looking at drug treatments and risk is to compare doctors with airline pilots. The difference between them is that doctors are often rather cavalier about them. All drugs come with side-effects, they say, may be adding jovially: if there aren’t any side-effects it’s probably not an effective. Pilots by contrast are very attentive to side effects which is this case are anything odd, unusual or possibly threatening that happens to the plane during a flight. When it does they write up a full report, it is investigated, maybe the plane is grounded until the problem has been identified and fixed. As a result of this process flying has become incredibly safe, the chances of your being in a plane crash is calculated in millions of air miles. Drug side effects by contrast are pretty constant. The difference is what’s been called “skin in the game”. Pilots are taking the same risk as their passengers, doctors don’t share the risk with their patients. It’s obviously not practical to suggest doctors share all their patient’s pills but psychiatrist Dr David Healy’s site Rxisk.org has an interesting and much more pilot-like approach to dealing with reports of side-effects.
Thanks Jerome – all good sense and the comments about taking responsibility as we age for good habits introduced in our lives will reduce disability free year. I remember a study that showed the link with daily walking and improved health. Keep up the good work. Good wishes, David Beales