Author: Dr J Hugh Coyne MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

  • Balancing Academic Stress and Mental Health

    Balancing Academic Stress and Mental Health

    In London, as parents and children gear up for the 11-plus exams, the academic pressure can be palpable. The pursuit of academic excellence, while commendable, brings with it a level of stress that can profoundly impact our children. Amidst this academic hustle, the importance of mental health cannot be overstated. This is particularly the case when research shows that maintaining physical fitness could be a key component in supporting mental well-being.

    Understanding the Connection Between Fitness and Mental Health

    A comprehensive study from Taiwan observed over 1.9 million young participants. It highlights a compelling link between physical fitness and reduced risks of mental disorders like anxiety, depression, and ADHD. This decade-long research meticulously monitored children from the age of 10 through their formative years. It focuses on various aspects of physical fitness including cardiorespiratory fitness, muscular endurance, and muscular power.

    Fitness as a Counterbalance to Academic Stress

    The findings revealed that children who engaged in regular physical activity and scored higher in fitness tests were less likely to develop mental health issues. Specifically, enhanced cardiorespiratory fitness, demonstrated by quicker 800-m run times, significantly lowered the incidence of anxiety and depression. This was especially noted among female students. Improved muscular strength also correlated with decreased mental health risks across all participants.

    These results suggest that while academic achievements are important, incorporating physical fitness into a child’s routine can provide a critical balance. The mental resilience built through regular physical activity not only helps in managing academic pressures but also fosters overall well-being.

    Practical Tips for Parents

    For parents navigating the stresses of the 11-plus exams, here are some actionable tips to integrate fitness into your child’s routine:

    1. Encourage Daily Physical Activity: Simple activities like walking, cycling, or playing in the park can be effective. Aim for at least an hour of physical activity a day, which can be broken down into manageable segments. 
    2. Incorporate Exercise into Family Time: Whether it’s a weekend hike, a family game of football, or a dance-off in the living room, making exercise a family affair increases enjoyment and commitment.
    3. Balance Routine: While study schedules are important, ensure that your child has enough time for physical activities. This not only breaks the monotony but also increases blood flow to the brain, potentially boosting cognitive functions.
    4. Monitor Stress Levels: Stay attuned to your child’s emotional state. High stress can reduce academic performance and affect mental health. Encouraging regular physical activity can be a natural stress reliever.
    The Bigger Picture

    Schools and sports clubs play a pivotal role by providing adequate facilities and opportunities for sports and other physical activities. These institutions can be instrumental in emphasising the importance of a balanced approach to education and health.

    Conclusion: Holistic Development

    As London’s parents and children navigate the challenges of academic preparations, it’s crucial to remember that success is not just about passing exams but also about developing a well-rounded, healthy individual. Physical fitness should be as much a priority as academic preparation, not only for mental health benefits but also for instilling a lifelong habit of wellbeing.

    While the academic rigours of the 11-plus exams are important, integrating physical fitness into your child’s daily routine could be the key to a happier, healthier, and more successful student. Let’s ensure that our children’s journey towards academic excellence includes a healthy dose of play and physical activity.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Child Health Guides
  • What Is The Best Shingles Vaccine?

    What Is The Best Shingles Vaccine?

    Let’s explore a topic we are often asked about, shingles vaccines. Specifically, Shingrix and Zostavax. Understanding these vaccines is crucial. Shingles, is a reactivation of the varicella-zoster virus, the same virus that causes chickenpox. It affects many people, particularly as they age.

    Shingles: A Brief Overview

    Shingles, or herpes zoster, manifests as a painful rash. The rash usually follows the path of a single nerve group. It’s a consequence of the reactivation of the dormant varicella-zoster virus in the body. While not generally fatal, shingles can lead to serious complications like post-herpetic neuralgia, a severe chronic pain condition.

    Shingles Vaccines: Zostavax and Shingrix

    • Zostavax: This was the go-to shingles vaccine for many years. It’s a live attenuated vaccine, meaning it uses a weakened form of the live virus. Zostavax effectively reduced shingles cases but less so in those over 70. Also, it couldn’t be used in immunocompromised individuals.
    • Shingrix: The newer player in the field, Shingrix is an inactivated recombinant vaccine. It contains only a part of the virus, making it safe even for those with weakened immune systems. Its efficacy surpasses Zostavax, offering better protection against shingles, even in older adults.

    Comparing Effectiveness

    • Efficacy Over Time: Shingrix has shown higher and longer-lasting effectiveness compared to Zostavax. This is particularly so in the older population.
    • Safety for Immunocompromised Individuals: Unlike Zostavax, Shingrix is suitable for those with compromised immune systems.
    Dosage and Side Effects
    • Shingrix requires two doses, spaced 2-6 months apart, while Zostavax was a single dose.
    • Side Effects: Shingrix may have more frequent mild side effects. But these are generally short-lived and manageable.
    Recommendations for Those Vaccinated with Zostavax
    • Given Zostavax’s reduced effectiveness over time, it’s recommended that individuals previously vaccinated with Zostavax consider getting re-vaccinated with Shingrix.
    My Perspective

    Given the higher efficacy and broader suitability of Shingrix, it stands out as the preferred choice for shingles vaccination. Remember, shingles is not only painful but can also lead to debilitating long-term complications. Consider that one in three people may develop shingles in their lifetime. Thus, opting for the most effective vaccine available seems a prudent choice.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Longevity & Healthspan Guides
  • Nutritional Strategies for Effective Muscle Growth

    Nutritional Strategies for Effective Muscle Growth

    It’s a well-accepted tenet in fitness circles that protein reigns supreme when it comes to building muscle. Protein remains the cornerstone of muscle hypertrophy. However, a recent study from the University of Padova has shed light on an assortment of other nutrients that play critical roles in enhancing muscle response to resistance training. In this blog, I’ll delve deeper into how these nutrients support muscle growth and repair.

    Protein: The Foundation of Muscle Synthesis

    Protein is the most potent nutritional stimulus for building muscle. In scientific terms building muscle is described as muscle protein synthesis (MPS). The body uses the amino acids from dietary protein to repair and build muscle fibres. Current guidelines suggest varying levels of protein intake. A minimum of 0.8 g/kg of body weight has been suggested as being generally sufficient for non-active individuals. While as much as 2.4 g/kg is proposed for those engaged in rigorous strength training. However, the lower end of this spectrum is often considered inadequate for optimising muscle hypertrophy. This is particularly the case in those actively training. These levels of protein intake might not fully support the enhanced demands for muscle repair and growth in people who are training. And everyone who does not have an illness should be training. Studies suggest that people building muscle mass and strength need at least 1.7 g/kg of protein on non-training days to optimise muscle hypertrophic response. Even the need of protein to support muscle repair for an endurance athlete may be higher than it was previously thought. It should be (1.6–1.83 g/kg) and even higher the day following a training session.

    Dietary protein supplementation stimulates MPS and is essential for hypertrophy. Key studies like those by Moore et al. (2009) highlight that protein intake after resistance training significantly enhances MPS. Optimal protein intake per meal is suggested around 20-25 grams to maximise muscle growth. Just this year a study by Trommelen and colleagues (2023) investigated consuming even higher doses of protein. They showed that the ingestion of 100 g of protein resulted in a greater and more prolonged (>12 h) anabolic response when compared to the ingestion of 25 g of protein. These findings suggest that the anabolic response to protein ingestion likely has no upper limit.

    Carbohydrates: More Than Just Fuel

    While their primary role is to replenish muscle glycogen, carbohydrates also enhance muscle recovery and growth. They do this by spiking insulin level. Yes, spikes in insulin are not all bad! Insulin is a potent anabolic hormone that improves glucose and amino acid uptake by muscles. Thus, facilitating muscle repair and growth after training.

    Carbohydrates do not directly contribute to MPS but play a supportive role. Studies such as those by Glynn et al. (2013) indicate that consuming carbohydrates and protein post-exercise can enhance the insulin response. This likely increases MPS indirectly through improved nutrient delivery and anabolism.

    Creatine: Enhancing Energy and Growth

    Creatine supplementation increases phosphocreatine stores within the muscle. These are essential for ATP regeneration during short, intense bursts of activity such as lifting weights or sprinting. This increase in available energy can significantly enhance muscle strength, power, and size. Creatine also helps increase muscle cell volume. This plays a role in muscle growth signalling pathways.

    Creatine supplementation has been very widely researched. Numerous studies have supported its efficacy in improving strength and muscle mass. For instance, research by Branch (2003) demonstrates that creatine enhances phosphocreatine recovery between sets. Therefore, creatine allows greater work output and training volume. These are both critical for stimulating MPS.

    The International Society of Sport Nutrition (ISSN) and the IOC consensus statement have released updated position statements on creatine monohydrate (CM). These suggest that the most effective strategy for increasing creatine stores is splitting supplementing into different phases. The first phase is the so called “loading phase.” During this phase 20.9 ± 4.5 g/day should be divided into four equal daily doses (5 g/dose or ~0.3 g/kg body weight). The loading phase lasts for 5–7 consecutive days. The subsequent phase of the protocol requires a “maintenance phase.” In this phase, 3–5 g of CM is taken daily for the entire duration of the supplementation period. Consuming carbohydrates and proteins (~50 g of proteins and CHO) increases the retention of creating muscle. An effect that is mediated via insulin.

    A second protocol involves the ingestion of 3 g/day of CM for 28 days. This is the approach that I take as it has fewer gastrointestinal side effects. But, until muscle creatine levels are completely saturated, it has lesser effects on exercise performance.

    Long term use of creatine has shown no negative health effects. (around 4 years of consequent supplementation).

    Omega-3 Fatty Acids: Anti-inflammatory Effects

    Omega-3 fatty acids, particularly EPA and DHA, are known for their anti-inflammatory properties. They help modulate the inflammation induced by rigorous training. This attenuation of inflammation supports muscle recovery and growth. Omega-3s also enhance the insulin sensitivity of muscles. This can further support muscle health by improving muscle nutrient delivery and reducing muscle breakdown.

    Omega-3s have been shown to not only reduce inflammation. It has been suggested that they increase MPS. Smith et al. (2011) found that omega-3 fatty acid supplementation effectively increased the mTOR pathway’s sensitivity to amino acids in humans. mTOR plays a vital role in muscle protein synthesis. Hence Omega-3 fatty acids stimulate muscle protein synthesis and may be useful for this purpose as a supplement.

    Vitamin D: A Direct Role in Muscle Function

    Vitamin D is crucial for more than just bone health. It directly influences muscle function and strength. It enhances the transcription of genes involved in muscle contraction and protein synthesis. Furthermore, vitamin D is involved in calcium regulation. Calcium is a key mineral in muscle contraction and signalling pathways related to muscle growth.

    Vitamin D’s role in muscle health extends beyond bone metabolism. Studies like those by Girgis et al. (2013) suggest that adequate vitamin D levels are linked to improved muscle repair and function. This impacts MPS through enhanced muscle cell proliferation and differentiation.

    The evidence for protein, carbohydrates, creatine, omega-3s, and vitamin D is robust. Yet, several other nutrients have been studied for their potential supportive roles in muscle health and hypertrophy:

    Emerging and Supportive Roles in Muscle Health

    1. Magnesium and Zinc: Both are essential for muscle function and protein synthesis. Magnesium plays a pivotal role in energy production and electrolyte balance. These are crucial during intense training sessions. Zinc is critical for hormone regulation, including testosterone. Of course testosterone significantly impacts muscle growth and repair. However, the evidence linking direct supplementation with enhanced muscle hypertrophy is less conclusive than for the primary nutrients.
    2. Chromium: This mineral is known for enhancing insulin action. This potentially affects muscle protein synthesis by improving nutrient delivery to muscles. Still, direct impacts on muscle mass or strength are not well-supported by current research.
    3. Polyphenols: Found in fruits, vegetables, and teas, polyphenols like resveratrol and quercetin have anti-inflammatory and antioxidant properties. They may help reduce oxidative stress and support muscle recovery post-exercise. However, their direct impact on muscle growth is less understood.
    4. Prebiotics and Probiotics: These influence gut health. Our gut health can indirectly affect nutrient absorption and inflammation. Both of these factors are important for muscle health. While promising, the direct evidence linking these supplements with improved muscle hypertrophy is still emerging.

    Conclusion

    To truly optimise muscle growth and recovery, it’s crucial to consider a broad spectrum of nutrients beyond just protein. Protein, carbohydrates, creatine, omega-3s, and vitamin D form the backbone of a muscle-friendly diet. Yet, emerging evidence suggests that other nutrients like magnesium, zinc, chromium, polyphenols, and gut health supplements can also play supportive roles. Tailoring your diet to include a wide range of these nutrients can help maximise your training results. This will ensure that every workout brings you closer to your strength and muscle growth goals.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Nutrition & Lifestyle Guides
  • Physical Fitness and Mental Health in Young People

    Physical Fitness and Mental Health in Young People

    Mental health issues among children and adolescents are climbing at an alarming rate. Understanding and leveraging lifestyle factors could be key to stemming this tide. It has been argued that a decline in unstructured, independent play has contributed. The rise in mental health problems in young people also corresponds with increasing mobile phone usage. As summer rolls into autumn, the focus turns to younger children and their 11 plus. Then, it is all about getting into the right school. Play, exercise, fun and fitness take a back seat. Academic excellence is the driver. 

    A comprehensive nationwide cohort study sheds new light on how physical fitness might play a pivotal role in preventing mental disorders in young people. The study was based in Taiwan and spanned a decade.

    Study Overview

    This extensive study observed over 1.9 million participants. Each participant was aged between 10 and 11 years at the outset. There was an even distribution across genders. These young participants were monitored for at least three years and the average follow-up period was six years. Their physical fitness was assessed through various exercises. These measured cardiorespiratory fitness (CF), muscular endurance (ME), muscular power (MP), and flexibility.

    Findings on Fitness and Mental Health

    The findings were striking. There was a clear, dose-dependent correlation between higher levels of physical fitness and fewer mental health issues. The mental health issues included anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD). For instance, improvements in fitness, marked by faster 800-m run times, significantly reduced the risk of anxiety and depression. This was particularly the case in females. Similar beneficial effects were noted for ADHD in both genders.

    Muscular endurance also showed a robust association with mental health. An increase in performance on the bent-leg curl-up test correlated with a decreased incidence of depression and ADHD. Again this was particularly prominent in female participants. Similarly, enhanced muscular power, evidenced by better performance in the standing broad jump, was linked to reduced risks of anxiety and ADHD across the board. It also correlated with notably lower depression rates in males.

    Implications for Prevention

    These results underscore a potentially transformative insight. Physical fitness could be a powerful, natural, and accessible tool in improving mental health in children. Given the ease of integrating fitness into daily routines compared to the complexity of treating mental disorders once they’ve developed, the implications are profound.

    What Does This Mean for Parents and Educators?

    For parents and us healthcare providers, the message is clear. Promoting and maintaining physical fitness in children isn’t just about physical health. It extends to mental well-being, offering a double benefit.

    A Note on Implementation

    It’s tempting to rush headlong into new fitness programs for kids. However, this study serves as a stepping stone, not a conclusion. It invites further exploration. We now need to delve into how tailored fitness regimes can be most effective for different age groups and individual needs. That way we can find a balance that keeps our young ones both physically agile and mentally resilient.

    Conclusion: A Call to Action

    This research is a persuasive call to embed physical fitness into the fabric of daily routines for the younger generation. As we fret over 11 plus exams, and school places, let’s carve out a significant place for exercise. It’s not merely a school subject. It’s a lifeline to a healthier, happier future for our children.

    In essence, the hustle and bustle of modern education demands excellence in academic study. But let’s not sideline the profound benefits of a sprint, a jump, or a curl-up. After all, a healthy mind thrives in a healthy body. As this study shows, the path to mental well-being might just begin with a pair of trainers and a bit of time in the playground.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Child Health Guides
  • Energy Drinks and Student Well-being

    Energy Drinks and Student Well-being

    It’s early summer 2005, Dr Lucy, Dr Kat and I stand outside Wilson House in Paddington. We are about to walk into the examination hall to sit our medical final exams, six years of study are leading up to this. Some of our fellow students laugh nervously, sharing jokes among themselves. Others frantically leaf through textbooks in search of last-minute medical revelations. Many hold in their hand a highly caffeinated energy drink. The magical elixir that they hope will give them the edge in the battle against the examiners. 

    Energy drinks have an undeniable allure. This is particularly the case among under-prepared students seeking a mental performance edge. They are marketed as modern-day elixirs of vitality and focus. These beverages are often seen as the essential fuel for late-night study sessions and intensive exam preparations. But, recent findings from the SHOT2022 study highlight the impact of these ubiquitous drinks on young adults’ sleep and overall health. SHOT2022 was a comprehensive survey of Norwegian students’ health. 

    The Study at a Glance

    The SHOT2022 study delved into the daily habits of over 53,000 young adults. It was conducted across a broad demographic of full-time students in Norway. The study explored the murky, sticky, sweet-smelling waters of energy drink consumption. This ritual was followed by 3.3% of female and 4.7% of male students each day. The study revealed a troubling association between energy drink intake and sleep disturbances. It suggested an urgent need to reassess our reliance on these potent brews.

    Energy Drinks and Sleep: A Fraught Relationship

    The allure of energy drinks lies in their promise of instant alertness. This is, of course, attributed primarily to their high caffeine content and sometimes, their taurine content. However, the study’s findings suggest that this short-term gain comes at a potentially high cost to long-term health. Regular consumers of energy drinks reported significantly shorter sleep durations and more frequent insomnia than their peers who abstained or indulged only occasionally.

    Interestingly, even infrequent consumption of energy drinks was associated with poor sleep outcomes. This highlights the potent effects of their ingredients. The stimulants in energy drinks go beyond caffeine to include sugars and other stimulants like guarana. These components can disrupt sleep patterns and decrease sleep quality. They ultimately leave students tired and offset the very gains in alertness and performance students seek.

    Gender Differences in Consumption and Impact

    The study also shed light on gender-specific responses to energy drinks. Men generally reported higher consumption rates. In addition, men showed stronger correlations between energy drink intake and disrupted sleep patterns. This included delayed bedtimes and reduced sleep efficiency. The study suggests that energy drinks tend to exacerbate the natural tendency among young men to engage in other behaviours that can also impair sleep. For example, men tended towards increased screen time and irregular sleep schedules.

    Navigating a Healthier Path

    For health-conscious individuals and those advising them, the takeaway is clear. Energy drinks can offer a temporary boost, but their long-term effects on sleep health are concerning. Instead of relying on these quick fixes, we should consider more sustainable methods to enhance academic performance and energy levels. Regular physical activity, balanced nutrition, and consistent sleep schedules are far more effective in fostering true cognitive and physical vitality. Of course, rigorous academic preparation is also crucial. 

    The broader implications of this research suggest advocating for healthier lifestyles among students. Rather than relying on the crutch of energy drinks, natural energy boosters and strategies that support both academic success and overall well-being should be emphasised. Encouraging a shift from energy drinks to wholesome alternatives would not only enhance students’ academic performance but also their quality of life.

    Conclusion

    We continue to establish the collateral health damage of modern dietary habits. Studies like SHOT2022 provide invaluable insights into the often-overlooked consequences of popular choices like energy drinks. Energy drinks reflect a more general trend in society towards quick fixes rather than perseverance and hard work. For students and young professionals navigating the demands of high-level education and early career challenges, understanding these impacts is crucial. It invites a reevaluation of how we fuel our bodies and minds. We should be aiming for sustained energy and focus. That would support not only academic and professional success but also long-term health and wellness.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Nutrition & Lifestyle Guides
  • Vitamin D: A Ray of Prevention in Colorectal Cancer

    Vitamin D: A Ray of Prevention in Colorectal Cancer

    Rickets is the archetypical disease of vitamin D deficiency in children. It was ubiquitous in the industrialised cities of the UK. Theobald Palm finished studying medicine at the University of Edinburgh in the 1800s. The son of Scottish Presbyterian missionaries, he was born in Ceylon, now Sir Lanka. Following medical school, began medical missionary work in Japan. There he noticed that rickets was virtually absent. Had Palm remained a medical missionary, nothing might have transpired. But he returned to the UK and there he noted an epidemic of rickets in large towns that had limited sunlight exposure. As with many groundbreaking medical discoveries, for many years, Palm’s observations were largely ignored. Ultimately, following Palm’s shrewd observations, it was recognised that the production of vitamin D in the body was contingent on exposure to UVB.

    What is Vitamin D?

    Perhaps surprisingly, vitamin D is not a vitamin at all. It is actually a prohormone involved in the tight regulation of calcium and phosphate levels. Hence, it is vital for healthy bones, effective muscle contraction, immune function and other important cellular functions.

    So vitamin D has long been celebrated for its role in bone health. Yet its influence on broader health outcomes is garnering increasing attention. This is particularly the case in preventing early-onset colorectal cancer (CRC). Recent research leveraging the extensive UK Biobank data provided compelling insights into how vitamin D might play a pivotal role in warding off CRC, especially among adults under 50. The UK biobank is a huge repository of biomedical data that can be accessed by medical researchers worldwide.

    A Closer Look at the Research

    The study in question delved into the health records of 236,382 Korean adults. It tracked a range of health metrics, including serum 25-hydroxyvitamin D [25(OH)D] levels. The follow-up period averaged 6.5 years. In this time the researchers discovered that higher levels of vitamin D were associated with significantly reduced risks of developing colorectal cancer. These were findings that held strong even after adjusting for numerous potential confounders.

    Vitamin D and Its Protective Mechanisms

    What’s particularly intriguing about this study is its implications for both young and older adults. For those under 50, maintaining higher levels of vitamin D was linked with a nearly 60% reduction in CRC risk. This protective effect, although slightly attenuated, was also evident in the older cohort. Hence, the study suggests that vitamin D’s benefits span age groups.

    The biological underpinnings of vitamin D’s protective effects relate to its regulatory role of our DNA. Vitamin D helps orchestrate the expression of several genes. This includes those involved in cell growth and repair. Such mechanisms are vital for cancer prevention. Essentially, vitamin D acts much like a fastidious manager within a complex system. It ensures that everything runs smoothly and efficiently. Importantly, it also shuts down potential problems before they escalate.

    Practical Implications and Lifestyle Integration

    Given the association between vitamin D levels and reduced CRC risk, particularly among younger adults, there is a strong case for assessing your vitamin D status. This is especially the case for those with a family history of colorectal cancer. Here’s how you can incorporate this knowledge into a proactive health strategy:

    1. Regular Screening: Consider regular checks of your vitamin D levels as part of your routine health assessments. This is especially pertinent during the darker months. It’s also particularly important if your lifestyle limits sun exposure.
    2. Mindful Supplementation: If your vitamin D levels are found to be lacking, supplementation could be a key strategy. It’s a simple, safe way to potentially reduce your risk of serious health issues like colorectal cancer.
    3. Dietary Sources: Sunlight is the primary source of vitamin D. However, incorporating vitamin D-rich foods like fatty fish, fortified dairy products, and certain mushrooms can also help boost your levels.
    4. Understanding Your Genetics: The study highlighted that genetic factors might influence how vitamin D impacts us. Engaging with genetic screening could provide personalised insights, tailoring your approach to supplementation.

    A Final Thought

    We have to navigate a plethora of dietary advice and health strategies. Understanding the nuanced role of nutrients like vitamin D in disease prevention is crucial. This isn’t just about taking a supplement. It’s also about integrating a scientifically backed approach into your daily routine for long-term health benefits.

    Theobald Palm extolled the virtues not only of sunlight. He urged the use of open spaces, especially playgrounds for children. This is something we should take to heart. A vitamin D supplement may be beneficial. But the benefits of safe sun exposure, movement and nature compound to maximise health benefits. 

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Cancer Health Guides
  • Multivitamins and Memory: The COSMOS Study

    Multivitamins and Memory: The COSMOS Study

    The debate around multivitamins (MVs) has been as divisive as pineapple on pizza. Now, I believe that pineapple on pizza is fundamentally wrong. I am also of the belief that nutrients derived from whole foods are likely better than does derived from pharmaceutical companies. However, to repeat a quote often attributed to John Maynard Keynes “When the facts change, I change my mind. What do you do, sir?” Enter the COSMOS trial, stepping into the fray like a peacekeeper, armed with data rather than diplomacy. The study’s latest findings suggest that daily multivitamin-mineral (MVM) supplementation might be the secret sauce to preserving our cognitive zest as we age. But was it enough to change my mind on multivitamins?

    From The Farm to The Pharmacy

    An ideal multivitamin is derived from whole foods. These not only deliver vitamins and minerals but also fibre that nourishes our microbiome and slows our absorption of sugar. The Iowa Women’s Health Study suggested that regular MVIs might actually increase mortality in older women. This brings us to the COSMOS trial. The initial COSMOS trial was an investigation into whether Centrum Silver or a supplement of cocoa and green tea flavonoids, could improve health outcomes.

    COSMOS: A Universe of Data

    Sponsored by the titans of industry, Pfizer and Mars Edge, the COSMOS study lasted 3.6-years and included 21,000 participants. The cocoa and green tea flavonoids were found to reduce cardiovascular mortality by 27%. The spotlight then turned to MVIs and their role in our cognitive health. In the later COSMOS-Mind paper, there was no cognitive protection with the consumption of flavonoids. However, there was a trend towards a lower incidence of mild cognitive impairment and dementia in the MVI group.

    This latest study featured an ensemble of subsets from the COSMOS trial. There participants had been assessed for cognitive changes over two years. It found that those on the MVI regimen showed modest improvements in global cognitive function and memory. This effect suggested a slowing of cognitive ageing by about two years. A modest but significant victory in the battle against time.

    The Ingredient List: A Culinary Adventure

    Examine the ingredient list of an MVI you’ll find a melange of fat-soluble vitamins, the B’s and C’s of the vitamin world, and a mineral ensemble. The COSMOS MVI (Centrum Silver) also boasted lutein, which can be beneficial for eye health and lycopene, a constituent of tomatoes that has been linked to lower blood pressure.

    To Pop or Not to Pop?

    So, should we turn to MVIs as our cognitive shields against the ravages of time? While the risk-benefit ratio of MVIs appears favourable, one can’t help but wonder if we’d be better off investing in a cornucopia of fruits and vegetables. I would prefer supporting our local farmers rather than the pharmaceutical giants.

    A Plant-Forward Path to Cognitive Health

    In the end, the COSMOS trial adds a few more threads to the ever-expanding tapestry of health research. It whispers, rather than shouts, the potential benefits of MVIs on our cognitive well-being. Perhaps the true takeaway is a reminder of the holistic approach to health. A diet rich in natural vitamins and regular physical activity might just be the recipe for a vibrant mind and body. Where a multivitamin is likely to be of benefit is for those people who are unable to access fresh or frozen fruit and vegetables.

    The best multivitamin might just be a sun-ripened tomato from your greenhouse (or Bayley and Sage in my case) or a crisp apple from the local orchard (or Fulham Greens). In the quest for cognitive longevity, it’s not about the pills we pop, but the foods we savour and the lifestyles we embrace.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Longevity & Healthspan Guides
  • Harnessing the Power of Youth: A Long-term Look at Physical Activity and Heart Health

    Harnessing the Power of Youth: A Long-term Look at Physical Activity and Heart Health

    Legend has it that Finn McCool is not dead at all. Or it may be that Fionn MacCumhaill, often anglicised to Finn McCool, died in old age in battle, or having hit his head on a rock. What isn’t in doubt is that he must have lived to an old age. What was his secret? Well, perhaps it was that he did so much exercise in his youth.

    Today, if you spend any time on social media, advice on exercise seems to be extraordinarily complex. Yet one golden seam in the tapestry of health advice seems to stretch further and stronger with each passing study. That is the undeniable link between physical activity and heart health. The American Heart Association has long championed the mantra of achieving at least 150 minutes of moderate-to-vigorous physical activity (PA) per week as a beacon for cardiovascular disease prevention. But let’s face it, tracking our weekly quota of physical exertion can sometimes feel like taking a toddler to a Sunday pub lunch —unpredictable and overly optimistic.

    The Coronary Artery Risk Development in Young Adults study, decided to investigate how young adults’ dedication to physical activity (PA) could shape their cardiovascular destiny. This study sought to unearth the relationship between sustained physical activity in youth and the risk of heart-related events later in life. To do this it used a metric known as time in target range (TTR).

    The study corralled 2,902 participants into four groups based on their PA TTR. The underachievers (<25%), the middling masses (25% to <50%), the diligent doers (50% to <75%), and the overachievers (75% to 100%). TTR was calculated across a span of 15 years. This period was presumably filled with vigorous padel games and possibly ill-advised attempts at parkour.

    As the participants gracefully aged into their 40s, with a median follow-up period stretching nearly 19 years into the future, the fruits of their youthful exertions began to show. The overachievers, those with a TTR of at least 75%, flaunted a 40% lower risk of cardiovascular events compared to their less active counterparts. It seems that maintaining a high level of physical activity during those formative years could significantly shield one’s heart from future woes.

    But there’s a kicker. For every 1-SD increase in TTR, there was a 21% decreased risk of heart-related events. This suggests that even incremental improvements in sticking to exercise guidelines can pay dividends for future heart health.

    So, what’s the takeaway? Maintaining recommended levels of physical activity throughout young adulthood isn’t just a good idea. It’s a potentially life-altering strategy for warding off cardiovascular diseases later in life.

    Imagine if we treated our physical activity habits like a high-yield savings account for our health. The more we deposit in our youth, the richer we become in terms of vitality and longevity. This study underscores the importance of a life course approach to managing our heart health. It suggests that the seeds of cardiovascular well-being are sown early. These seeds need to be nurtured with the same zeal we apply to our careers, relationships, and Netflix binges.

    But what about those of us who may have missed the memo in our youth? It’s never too late to start. After all, in the journey of heart health, every step counts, no matter when you begin. Here’s to a heartier, healthier future, fueled by the enduring power of endurance exercise.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Child Health Guides
  • A Closer Look At Calcium Supplements

    A Closer Look At Calcium Supplements

    Humphrey Davey wanted to study medicine. He was an apprentice to a surgeon and apocathery. But Davey never did study medicine. Instead, he became a self-taught chemist and he discovered several elements including calcium.

    The narrative surrounding calcium supplementation is as complex as it is fascinating. Calcium supplementation has roots deeply embedded in both science and societal beliefs. Calcium, the stalwart of bone health, has been championed for decades as a critical component of a healthy lifestyle. This has been particularly the case in improving bone health. This belief has not only permeated clinical guidelines but also the public consciousness. Consequently, a significant portion of the population, especially older women, incorporate calcium supplements into their daily regimen. In the United States alone, a striking 61% of women over 60 were taking calcium supplements between 2003 and 2006. This widespread adoption has catapulted calcium supplementation into a billion-dollar industry. Millions of people across various age groups seek to bolster their health through calcium supplements.

    Are Calcium Supplements Safe?

    Yet, the message of “more calcium equals better health” is increasingly being questioned. Initial studies posited that dietary calcium had a more pronounced effect on bone building compared to its supplemental counterpart. This is presumably due to its better absorption. Yet, the reality of dietary habits and the availability of calcium-rich foods means not everyone can achieve sufficient calcium intake through diet alone. All the more so with the recent trend towards milk substitutes. This underscores a potential role for supplementation in cases of dietary inadequacy.

    But as the practice of calcium supplementation has grown, so too have concerns about its safety. Recent years have seen a burgeoning debate. The discourse has been fueled by studies suggesting potential risks associated with indiscriminate calcium supplementation. Notably, a meta-analysis by Bischoff-Ferrari et al. highlighted an increased risk of hip fractures. A review of randomised clinical trials found that calcium supplementation did not correlate with a reduced risk of fractures among older adults. So, there was certainly evidence to suggest an either negative or at best neutral effect of calcium supplements on the risk of hip fractures. Remember, the main reason to take calcium is to avoid a devastating hip fracture. However, this discourse took a more concerning turn than merely suggesting a lack of benefit. Other findings suggested a significant increase in cardiovascular disease associated with calcium supplements. This was particularly the case in men.

    Are Calcium Supplements Harmful?

    Amidst this backdrop, the recent findings from a study leveraging the expansive UK Biobank dataset provide a nuanced perspective on the intersection of calcium supplementation and cardiovascular health. The research examined the associations between calcium supplementation and cardiovascular disease (CVD) events and mortality. In particular, it examined supplementation in individuals with and without diabetes. The results painted a stark picture for those with diabetes. Regular calcium supplement intake was linked to higher risks of heart disease and death in diabetics. No significant risk increase was observed in participants without diabetes.

    This dichotomy between individuals with and without diabetes underscores the need for a more tailored approach to calcium supplementation. It also challenges the prevailing “one-size-fits-all” mentality. The study’s implications are profound. It suggests healthcare providers weigh the potential adverse effects of calcium supplements against their benefits, particularly among diabetic patients.

    The dialogue surrounding calcium supplementation, once dominated by an uncritical endorsement of its benefits, is evolving. It calls for a reevaluation of how we perceive and prescribe these supplements. I would advocate for a balance that prioritises dietary sources of calcium. Supplementation should be recommended judiciously. The study serves as a reminder of the importance of personalised healthcare and the value of diet over supplements.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Nutrition & Lifestyle Guides
  • Sitting and Longevity

    Sitting and Longevity

    Bernadino Ramazzini became interested in occupational diseases while still a medical student in Parma. He carefully observed the diseases experienced by different workers. He noted that although some were caused by occupational exposure to chemical or physical agents many occupational illnesses were due to prolonged postures, sudden movements or lack of motion. He observed that sedentary tailors were more likely to succumb to disease than flighty messengers. 

    Ramazzini made his shrewd observations in the early Enlightenment period. Now, a sedentary lifestyle has become the norm, especially in the workplace. A recent groundbreaking study, following in Ramazzini’s footsteps, has shed light on the health risks associated with prolonged occupational sitting. This research was conducted over two decades in Taiwan. It explores the silent but substantial impact of sitting for extended periods at work. The study also examines how modest increments in physical activity can counteract the detrimental effects of prolonged sitting.

    The Silent Threat of the Modern Workplace

    In recent years, the mantra “sitting is the new smoking” has echoed through the both corridors of public health and the echochambers of social media. In keeping with this, public health offcials and social media influencers urge us to reevaluate our sedentary habits via our mobile deives. The 2020 World Health Organization guidelines took a definitive stance (no pun) against prolonged sedentary behaviour. The guidelines highlighted its adverse health consequences. Yet, the specific dangers of occupational sitting, especially when combies with low levels of physical activity, remained relatively underexplored until now.

    The Sitting Study Cohort

    The study analysed the health outcomes of 481,688 participants. It revealed a stark contrast between the health of those who sit extensively at work and their more active counterparts. Individuals entrenched in sedentary occupations faced a 16% increase in all-cause mortality risk. In addition, they had a staggering 34% rise in cardiovascular disease mortality when compared to those whose jobs involve more standing or movement.

    However, there’s a potential silver lining. Alternating between sitting and standing at work, or incorporating just 15 to 30 minutes of additional leisure-time physical activity (LTPA) daily, can significantly mitigate against these risks. This finding introduces a new narrative. The idea that small, consistent changes in our daily routines can combat the health risks posed by a sedentary job.

    Get Up, Stand Up. Stand Up for Your…. Health

    The conversation around occupational health is slowly evolving. Standing desks and walking meetings are becoming more commonplace. This study does provide some validation for these trends which have often, reasonably, been thought of as faddish. It also highlights the necessity for a broader cultural shift in our workplaces and working practices. To some extent, it’s a call to action for employers and employees to embrace more dynamic work environments where movement is integrated into the fabric of our workdays.

    The Role of Personal Activity Intelligence (PAI)

    One of the most compelling aspects of the study is the introduction of the PAI metric. This is a personalised measure of physical activity. PAI considers the intensity and duration of exercise. Every time your heart rate increases you earn PAI points. The higher your heart rate goes up, the faster you accumulate PAI points. According to the study, achieving a PAI score greater than 100 was a robust strategy for counteracting the health risks associated with prolonged sitting. Indeed, Norwegian University of Science and Technology research suggests that people who achieve a PAI score of over 100 every week live an average of 8 years longer than those who don’t. PAI, therefore, offers a more tailored approach to health that goes beyond bland and generic recommendations. How do you achieve a PAI of over 100? Well, slightly annoyingly, there’s an app involved. However, it doesn’t take much to get a score of over 100. 2 hours of exercise at 80% of your maximum heart rate per week will get a PAI score of over 100. The beauty of PAI is that is adjusts to your fitness levels. The fitter you are, the harder, or longer you have to workto achieve your PAI. 

    Moving More, Sitting Less

    The implications of this research are clear. In combating the hazards of that come as the collateral damage of our sedentary modern life, every step counts. Whether it’s taking a brief walking break, choosing a stand-up desk, or dedicating a proportion of our free time to physical activity, these actions can collectively mitigate some the health risks posed by prolonged sitting.

    In essence, this study serves as a reminder that our health is in our hands (and feet). We have choice, agency, in how we move our bodies at work. It challenges us to rethink our daily routines, to find balance in movement, and to prioritise movement in the workplace and beyond. Ramazzini exhorted people in sedentary professions to take physical exercise…. and so to counteract the harm done by many days of sedentary life.” Today, as we continue to tackle the demands of modern work and living, be mindful that movement is not merely a part of life, it’s essential to living well.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Longevity & Healthspan Guides