Thursday 8 December 2016

Dr Michael Mosley: 10 tips for men to stay young and vigorous for as long as possible

The man behind the popular 5:2 Diet outlines 10 steps to follow to stay young and vigorous for as long as possible

Michael Mosley

Published 26/09/2016 | 02:30

Middle-aged men are prone to self-delusion, thinking they are slimmer, fitter, healthier and far more handsome than they really are.
Middle-aged men are prone to self-delusion, thinking they are slimmer, fitter, healthier and far more handsome than they really are.

I have an obvious interest in this subject because I am a man and I am middle-aged. Though, to be honest, I am technically only “middle aged” if I live till I’m nearly 120.

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Like most people, I’m keen to stay as young and vigorous as possible for as long as possible. No male member of my family has lived longer than 74 years, a record I am keen to break.

Although I trained as a doctor, I have spent the last couple of decades making films for the BBC (programmes such as Trust Me I’m a Doctor and Horizon), during the course of which I’ve been able to pick the brains of health experts all around the world. As a result of what I’ve learnt, I have changed how I live. The following advice is not necessarily what you’ll hear from your doctor, but it is based on the latest science.

1 Measure up

Dr Michael Mosley, inventor of the 5:2 Diet
Dr Michael Mosley, inventor of the 5:2 Diet

Middle-aged men are prone to self-delusion, thinking they are slimmer, fitter, healthier and far more handsome than they really are. A reality check is useful, and if you keep a record of your measurements you can also tell if your new health regime is working.

A good place to start is with your heart rate, measured first thing in the morning.

Having a resting heart rate over 80 is a bad sign. A recent study of 11,000 people found that those with a heart rate above 70 beats per minute had significantly shorter lives than those who were noticeably below that figure. A top athlete will have a resting pulse of 40 or less. Mine is currently around 60. Losing weight and getting fitter will bring your pulse rate down

Next, whip out a tape measure and measure your stomach. This means measuring high up, around the belly button. Men, because they rely on trouser size, typically underestimate their stomach size by around 5cm. Your waist size is one of the best predictors of future health, a far more useful measurement than weight. Ideally it should be less than half your height.

The problem with having a large stomach is that is suggests you have lots of visceral fat, the fat that builds up inside the tummy. This is the worst sort of fat because it infiltrates your internal organs, such as your liver and pancreas, leading to type two diabetes, heart disease, hypertension and liver failure. The best way of getting rid of visceral fat is with a rapid weight-loss diet and high-intensity exercise regime. More on those below.

You can, and should, also weigh yourself. Knowing your height, go to any relevant website and calculate your BMI (Body Mass Index). A BMI over 25 and you’re officially overweight. Over 30 and you’re obese.

2  Go for blood tests

Having a blood test will give you useful information about what is going on inside your organs. It should include your blood sugar and cholesterol levels.

Measuring blood sugars is particularly important because it will tell you if you have type two diabetes or prediabetes (where your blood sugars are elevated but not yet in the diabetic range), rates of which are soaring in Ireland and the rest of the world.

Symptoms of raised blood sugar include thirst, frequent urination and sores that won’t heal, but often you will have none of these. At least a quarter of men with type two diabetes don’t know they have it, and the figure is nearer 90pc for prediabetics.

Four years ago I discovered I was a type two diabetic as a result of a random blood test. Rather than start on medication I made a TV programme (Eat, Fast, Live Longer) with myself as the subject, during the course of which I invented a new way of dieting, called the 5:2, or Fast Diet. On this diet you eat normally five days a week and cut down to around 600 calories on the other two days. I lost 9kgs in 12 weeks and my blood sugars went back to normal, where they have stayed.

If I hadn’t had the blood test I wouldn’t have known I was diabetic until it had done far more damage to my body, by which point it would have been harder to reverse.

The actor Tom Hanks was recently diagnosed with type two diabetes, caused, he believes, by his poor diet. He told an interviewer: “I thought I could avoid it by removing the buns from my cheeseburgers. Well, it takes a little bit more than that.” Hanks is hopeful that if he loses enough weight he can beat the disease. “My doctor says if I can hit a target weight, I will not have type two diabetes any more.”

It is also important to know if you are prediabetic because unless you act, you are very likely to progress on to diabetes. Studies show that if you are prediabetic but lose 10pc of your body weight (particularly belly fat) this cuts your risk of becoming diabetic by 90pc.

Men, especially those over 50, with a waist size over 90cm and with a family history of diabetes, are at greatest risk.

3 Look after your heart

Heart disease is still the biggest killer of Irish men. The basic tests are relatively straightforward. Cholesterol, blood sugar levels, height, weight and blood pressure.

Once you have these numbers you, or your doctor, can feed them into something like the Q Risk calculator (qrisk.org/2016). When I did this the answer came back that I had a 10pc risk of having a heart attack or stroke over the next 10 years. This doesn’t sound great, but it is better than average for someone my age (59).

Once you know your risk, what can you do? Well clearly there are lifestyle changes such as losing weight, exercise, better diet, more on which later. But there are also drugs, in particular statins.

Like many middle-aged men I have an ambivalent attitude to statins. On the one hand I know that taking statins significantly cuts the risk of a heart attack or stroke if you have proven heart disease. But I also know the benefits are less clear if you are currently healthy and I’m not keen on swallowing pills.

Nonetheless I’m taking them, not least because of other benefits. A recent review of 41 studies involving nearly a million patients (ncbi.nlm.nih.gov/pubmed/25890842) concluded that taking statins will cut your risk of dying from cancer as well as heart disease. It’s not clear why. There is also decent evidence that taking statins reduces your risk of Alzheimer’s and vascular dementia (the sort caused by poor blood supply to the brain).

4  Say no to cancer

After heart disease, the next biggest widow-maker in Ireland is cancer, with lung cancer, bowel cancer and prostate cancer topping the list. The dangers mount rapidly in middle age. The best way to cut your risk is by a judicious mix of lifestyle changes and screening.

In the case of lung cancer it is all about giving up smoking. Smoking kills half the people who do it. If you are a 40-year-old smoker and give up then you will add 10 years to your life expectancy. Plus you won’t spend the last decade of your life coughing your guts out. The best way to give up is with nicotine patches or e-cigarettes (vaping). Despite all the negative publicity around e-cigs, they are much, much safer than inhaling burnt tobacco.

The next biggest killer, bowel cancer, tends to affect men over the age of 50, though it can strike at any age. The actor Ben Richards, star of Hollyoaks and Footballers’ Wives, was diagnosed with bowel cancer at the age of 39.

You can reduce your risk by eating less processed meat (bacon, sausage, salami), but the most important thing is to detect pre-cancerous changes early, which means getting screened.

Ireland’s Bowel Screen programme currently offers free home-test kits to people aged 60 to 69. The test looks for tiny amounts of blood in your faeces which are not visible to the eye. If there are signs of blood, then you are off for more tests.

In England, they’re more aggressive about bowel cancer, rolling out a programme called ‘bowel scope screening’.  It’s aimed at everyone over 55 and I recently had it done as part of a Horizon film called Are Health Tests Really a Good Idea?

I went into hospital, had a lovely enema, then a charmingly enthusiastic nurse stuck a flexible tube with a tiny camera up into my colon, while the film crew looked on with interest. The nurse had a good look round my bowel, removed a small polyp (which fortunately was benign) and that was that. Apparently that gives me a clean bill of health for the next 20 years.

It wasn’t glamorous, but it was one of the few cancer screening tests that all the experts agreed was a good idea. And as a TV reviewer for The Guardian newspaper put it, “I’ve always wanted to know what it looks like up Michael Mosley’s bum. Yay! Now I’ve found out.”

Although cancer experts are enthusiastic about bowel screening, they are much less keen on prostate cancer screening. The commonly used PSA (prostate specific antigen) test is also known in the trade as the ‘Promoting Stress and Anxiety Test’.

The problem with the PSA test is it is unreliable. It can miss tumours, giving you a false sense of security, or tell you that you have a problem when you don’t, which can lead to painful and unnecessary investigations.

So how can you reduce your risk? Well, there is some evidence that eating a diet rich in lycopenes (found in tomatoes and other red fruits and vegetables) and selenium (found in Brazil nuts, fish, and seafood) may help. These foods also form a key part of the Mediterranean diet (see below).

5 What to eat

I am less obsessed by eating or avoiding particular foods (though I tend to shun sweet and heavily processed foods) than by eating the right combinations of foods. For me the best overall diet is the Mediterranean diet. And I’m afraid that doesn’t mean pasta and pizza.

One of the most important diet studies ever done was the Predimed trial (Prevencion con Dieta Mediterranea), which began in 2003 and is still ongoing. For this trial, Spanish researchers recruited over 7,400 middle-aged people and randomly allocated them to a Mediterranean or a low-fat diet.

Both groups were encouraged to eat lots of fresh fruit, vegetables and legumes (such as beans, lentils and peas). They were also discouraged from sugary drinks, cakes, sweets or pastries and from eating too much processed meat (like bacon or salami).

The main difference between the two diets was that those allocated to the Mediterranean diet were asked to eat plenty of eggs, nuts and oily fish and use lots of olive oil. They were also encouraged to eat some chocolate, preferably dark and made with more than 50pc cocoa, and to enjoy the occasional glass of wine with their evening meal.

The low-fat group, by contrast, were encouraged to eat low-fat dairy products and eat lots of starchy foods, like bread, potatoes, pasta and rice.

The result? Those on the Mediterranean diet were 30pc less likely to die from a heart attack or stroke. They were 50pc less likely to develop diabetes. They were also less likely, as they got older, to develop dementia or cognitive impairment (that’s when you struggle to learn new things, remember or make decisions) than those trying to eat a low fat diet. Most important of all, people found the Mediterranean diet far more enjoyable and much easier to stick to than the low-fat diet.

The actor John Goodman has apparently lost almost 50kgs on it. His motivation? Well he told a recent interviewer: “You look in the mirror everyday and go, ‘I gotta deal with this the rest of the day, I gotta deal with this schmuck?’”

6  What to drink

After years of being demonised, it turns out that coffee is positively good for you, as is tea. A study where they followed 130,000 men and women for more than 20 years found that those who drink moderate amounts of coffee or tea lived longer than those who don’t. The most effective ‘dose’ is two to five cups a day. It doesn’t matter if it’s caffeinated or not.

When it comes to alcohol, it seems that a modest amount is unlikely to do you harm and may do you good. In the Predimed study, those allocated to the Mediterranean diet were allowed a glass or two of wine with the evening meal. Try, however, to limit yourself to a couple of units at a time and aim to have an alcohol-free day at least once a week. The evidence is that red wine is healthier than the rest, but not hugely so.

As for non-alcoholic drinks, minimise the sugary stuff, and that includes fruit juice and fruit smoothies as well as the more obvious things like fizzy drinks. A glass of orange juice has similar amounts of sugar as a regular Coke and though it may be ‘natural’, it is still packed with calories and will pump your blood  sugars up.

Instead, drink plenty of chilled water, perhaps with a slice of lemon, lime or cucumber floating in it to add flavour. Drinking water burns calories (your body has to heat it to body temperature) and it also means you will get up regularly to go to the lavatory, which is a good thing, as you’ll see in a moment.

7  Keep your weight down

The curse of the middle-aged man is the spreading middle-aged paunch. Visceral fat, fat which collects round the gut, is the worst sort of fat. Losing it and keeping it off is tough, but I am living proof it can be done.

As the author of The Fast Diet, I am naturally enough a fan of intermittent fasting and in particular the 5:2 approach. It seems to appeal particularly to men, perhaps because it is so simple and straightforward. I suspect men also like the idea that they are ‘fasting’ (which sounds spiritual) rather than ‘dieting’ (which hints at vanity). Fans include Benedict Cumberbatch, Martin Clunes, Miranda Kerr and Beyonce.

An alternative approach which I’ve  recently written about (The eight-week Blood Sugar Diet) is to go for more aggressive and rapid weight loss. This involves 800 calories for eight weeks. In clinical trials people lose an average of 14kgs in two months, some far more.

Rapid weight loss has a bad reputation, yet as America’s leading obesity experts pointed out in a recent review article in the New England Journal of Medicine “numerous trials have shown that more rapid and greater initial weight loss is associated with lower body weight at the end of long-term follow-up”. In other words, if you want to diet successfully it can be better to lose weight quickly rather than slowly.

It’s not suitable for everyone, and if you are on medication do talk to your doctor before starting, because if you are being treated for high blood pressure or raised blood sugars then you will almost certainly need to reduce your medication.

8  Stand up for science

The evidence that sitting kills goes back to the 1950s when a study was done comparing bus conductors (who stand) with bus drivers (who sit). It turned out that the bus drivers had twice the risk of developing heart disease. Since then we have become a lot more sedentary. We sit at work, in the car and at home — moving only to shift from one seat to another. Many of us spend more than half our waking lives sitting on our bottoms looking at computers or watching television.

The effect on our bodies is dire. One of the largest studies ever carried out involving nearly 800,000 people found that those who are sedentary have twice the chance of developing type two diabetes and twice the chance of dying from a heart attack or stroke

It’s not just the time spent sitting that matters, but time spent sitting continuously. So if you watch a lot of TV, go for a stroll during the advert breaks. If you do a lot of work at the computer, set a timer to get up and walk every 30 minutes. Drinking lots of water is a great idea because it will force you to have regular loo breaks.

9  Get Fit with HIT

Everyone knows they should be doing lots of exercise but few of us get around to it. Walking is an excellent, easy way of getting some exercise, but it isn’t going to make you particularly fit. To do that you need to get your heart rate up to at least 50pc above its resting level on a regular basis, which involves something far more intense.

I favour the short, sharp approach. I have a particular HIT (high intensity training) regime which I was introduced to by Professor Jamie Timmons of Kings College, London. It consists of three minutes of intense exercise on my exercise bike, done three times a week, plus a few minutes of strength exercises (things like press ups and squats) done most mornings.

To do my HIT regime I get on my exercise bike, warm up by doing gentle cycling for a minute, then start to pick up the pace. At the same time I increase the resistance to maximum, so I am going flat out against maximal resistance for 20 seconds. I then cycle gently for a couple of minutes, long enough to catch my breath and allow my pulse to drop below 120, then do another 20 seconds at full throttle. Another minute or so of gentle cycling, then a final 20 seconds going hell for leather. A total of just one minute of intense exercise, but I have to lie down on the sofa afterwards because it is really tiring.

Studies have shown that doing a HIT regime like this can give you many of the most important benefits of exercise (such as increased aerobic fitness and improved insulin sensitivity) in a fraction of the normal time.

If you are not particularly fit you should start gradually, doing perhaps one burst of 10 seconds. If you are already fit, add it to your regime, or simply do more bursts. There is more information in my book, Fast Exercise. Or you can download an app of the same name from the app store.

10 Mindfulness

Too much stress is bad for you on so many levels. I try to counter mine by practising mindfulness. Mindfulness is a modern take on the ancient practice of meditation. You can buy books about it, but I recommend joining a group or downloading an app like Headspace, which will guide you through the process.

When I’m doing a mindfulness session I sit in a comfortable chair, turn on my app, rest my hands on my thighs and close my eyes. Then, guided by the app, I spend the next few minutes trying to focus on my breath. I pay attention to the sensation of the breath going through my nostrils, filling my chest, expanding and contracting my diaphragm. I try to treat thoughts like balloons that drift into my consciousness; once I have noticed they are there I simply allow them to drift way. Like any skill, it takes practise.

Dr Michael Mosley is a middle-aged man. He is the author of ‘The Eight Week Blood Sugar Diet’ and an accompanying recipe book.

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