The idea of conducting a ‘full medical’ is an appealing one. A kind of NCT for our health, one that can deliver a comprehensive all-clear. Sadly, in reality it is scarcely possible. We are too complex, too sophisticated and delicate for such a thing. Even the most ‘executive’ of health checks cannot reckon with our entirety, and may not even be a good thing.
“The simple answer,” says Dr Mary Favier, GP in Cork, “is that there is very little evidence to suggest that broad-based check-ups have value.” For example, the NHS, which offers a free check-up every five years to those aged between 40-74, concentrates on spotting early signs of stroke, kidney disease, heart disease, type 2 diabetes or dementia, rather than aiming to check ‘everything’.
In fact, there is plenty of evidence to suggest that too-detailed health checks can be detrimental to health – human bodies are full of anomalies, and excessive screening throws up the kinds of results that can result in a sequence of events that ends in unnecessary intervention, as well as heightened anxiety. Also, increasing diagnosis doesn’t always mean better outcomes.
That said, the broad, general indicators of good health certainly can, and should be, checked up on regularly, and January is a good time to do this. Much of the checking can be done by ourselves, for free, without anything more technical than simple paying attention and being honest.
The risk factors that commonly-available checks are trying to identify are high blood pressure, poor diet, high cholesterol, obesity, smoking, alcohol and drugs, poor kidney function, lack of exercise and air pollution.
Six out of the ten are within our own power to answer and affect. After all, assuming responsibility for our own health is the first step towards improving it, and no one needs a PhD to establish good habits in their life. As Dr Favier points out, “The most important indicators do not require your GP. They are: Not smoking, maintaining a healthy weight, not drinking too much alcohol, and having a largely plant-based diet, and taking exercise. These are the biggest general indicators of health.”
Of which the single most important is to stop smoking. As for exercise, “as a general rule, take the stairs instead of the lift, walk or cycle instead of the bus. If you can be active, be active. Park at the far end of the car park and walk the difference. Get off the bus two stops early. Whatever it is, build more activity into your day.”
Diet, then, means “nothing faddy. Avoid processed foods as much as possible, particularly processed meats as there is evidence that they are detrimental to heart health and bowel health. Make your diet as plant-based as possible, avoiding too much focus on red meats.”
Next, Dr Favier emphasises “looking after your mental health. That has become almost a throw-away term, but what it means is, accepting social engagement rather than declining it. Getting involved in things rather than not. Having an activity you’re interested in – anything from bird-watching to crochet – ideally one that involves other people, and that requires you to give of yourself. Volunteering – even if it’s the local clean-up committee once a month – makes people feel better and improves mental health. Engaging in their social structure makes people feel their lives are worthwhile.”
She also mentions, “remembering to resource and nourish your friends. We tend to do this with our family, and friends can get a little moved aside, but they are very important: Someone to talk to who gets you. Those relationships need to be worked on, and they particularly need to be worked on when you have children and life settles, and you can get fractured from your community – and particularly as you age. Social isolation as people get older is very problematic.”
So, when should one go to the doctor? “If you have thoughts or concerns that something has changed in your health. If you have lost weight you didn’t expect, gained weight you didn’t expect, had bowel changes, more headaches, and so on. The new year is a good time to reflect on those things, and compare with last year. The most important thing is that you go to your GP when something changes.”
That said, she recommends getting your blood pressure checked regularly. “Most of us should get our blood pressure checked at some stage during the year.” You don’t always need to go to the doctor to do this – many pharmacies will do it, as will medical student volunteers on the street. “There is very strong evidence to show that managing and controlling blood pressure, particularly at moderate to high level, reduces the risk of stroke and heart disease,” says Dr Favier, “And there is increasing evidence to show that even mildly elevated blood pressure, if untreated over a period of time, can cause cognitive impairment as we age.”
What about requesting blood tests? “The general answer is don’t, unless you have a particular health concern or family history. There is no value in random blood testing.” Even for cholesterol? “Cholesterol has to be particularly elevated before it is treated. The risk factors for heart disease are: smoking, high blood pressure. Then, whether you are diabetic, and your family history. The last, and least significant of these, is, your cholesterol level. But people up-end it and think about cholesterol first.”
Vitamin D testing is also often requested, but here too, the advice is to hang back. “Many of us are a little bit insufficient in vitamin D, but there is very little evidence that supplementing improves quality of life or outcome. It might be more useful to make sure you get 15 minutes of daylight every day, do weight bearing exercise – like walking – and make sure you have a good source of calcium.”
So ‘random’ blood tests are not advised. Screening, however, is. “People should participate in any screening programmes that are offered. Cervical Check has obviously had a bumpy road, but it’s still a really important part of women’s health. Breast Check, for women from the age of 50-68; Bowel Check, for men and women aged 60-69.”
What exactly is ‘a family history’? “A first-degree relative, meaning a parent or a sibling. First-degree anything is significant: cardiovascular disease, heart attack and stroke, especially if it occurred under the age of 60. For example, if a parent or sibling has had bowel cancer, the rule is that you should have a colonoscopy 10 years earlier than the age of that person when they were first diagnosed.”
Finally, what does she think of genetic testing, of the kind that is increasingly available online? “In terms of checking for genetic diseases, I would advise absolute caution. First, what is the reliability of a kit you buy online? But also, what is the counselling that goes on, and the understanding of what that diagnosis can bring? What might be the effects on you? On your children if you have them? What will you do with the information, how will you process it? What difference will knowing make to your life? To your insurance? Not all knowledge is useful.”
Do try these at home… And don’t cheat
⬤ Caveat: if any of these results is well outside the normal range, do not do any more tests, and consult your GP.
⬤ Find your resting heart rate. You’re looking to fall in the range of 60-100bpm, or 40-60bpm for athletes.
⬤ Calculate your BMI. This is an indicator of how healthy your weight is, and is calculated by dividing your weight in kilograms by your height in metres squared. There are plenty of online tools to help with this. The ideal range is 18.5 to 24.9. A higher reading will indicate obesity, which raises risks of a range of diseases, from diabetes to cancers.
⬤ Check your waist measurement. This is a better indication of diabetes than BMI alone. Measure around your belly button, and don’t suck your tummy in. Men should measure less than 37in and women less than 31.5in.
⬤ Calculate your height to waist ratio. This will show whether you are carrying too much fat compared to muscle. Measure your height, and then the circumference of your waist. Divide your waist by your height to get your vital statistic. Anything under 0.5 is good, anything over 0.5 is cause for concern.
⬤ Time yourself running 1.5 miles. This is a test of your level of fitness, not your running skills, and mainly your lungs and heart. Men in midlife should be under 17 minutes; under 14.5 minutes is good, and under 11 minutes is excellent. For women, the upper band is 20 minutes; below 19 minutes is good and under 16 minutes 30 seconds is excellent.
⬤ Test your core strength. Time yourself doing the plank (if you don’t know how, look up instructions online). Less than 45 seconds is poor; average is 45-75 seconds; good is 75-120 seconds and excellent is more than 120 seconds, for men and women.
⬤ Test your balance. How long can you stand on one leg with your eyes closed? This assesses your proprioception, (the ability to tell, with your eyes shut, where your body is in space), which worsens with age and is one of the main reasons for falls. Anything over 20 seconds is very good.
⬤ Consider getting your sight and hearing tested. Many high-street opticians and audiologists do this very effectively.
Health & Living