Getting healthy, staying healthy

smoking

Please don't smoke. Stopping smoking, and being a non-smoker, reduce your risks of developing cancer, heart disease, and lung disease. For smokers, the 'number one best thing' they can do for their health is to stop smoking.

GPs can help smokers with quitting by one or more of the following: Providing advice, discussing motivation, discussing behavioural strategies for quitting, referral, prescribing nicotine replacement therapy, and prescribing medication which helps with quitting.

An excellent resource is the Quit Program. This includes a phone helpline, the Quitline, 13 QUIT (13 7848)


exercise

Exercise has been shown to reduce the risks of developing obesity, diabetes, heart disease, and some cancers (eg bowel cancer). Exercise can improve mental health and general wellbeing, and it can help to reduce the effects of stress.

Exercising for health requires 30 minutes of moderate intensity exercise daily. With 'moderate intensity exercise', you should be breathless to a level where you can still talk normally, but cannot sing (try it!).

Another way to determine 'moderate intensity exercise' is to measure your heart rate or your pulse during exercise (not easy to do without a device). The 'target heart rate' (THR) for 'moderate intensity exercise' is obtained from the following calculation:

THR = (220 - your age)/2, beats per minute. So, for example, for a 40 year old person, THR = (220 - 40)/2 = 180/2 =90 beats per minute

This is based on a THR of 50% of your maximum heart rate (which is 220 - your age). For moderate intensity exercise, the THR can be up to 70% of your maximum heart rate - however, you should discuss your exercise with a health professional before aiming to exercise at greater than 50% of your maximum heart rate.

To measure your heart rate or your pulse rate, you can use a device (heart rate monitor, pulse monitor, or 'smartwatch'), or you can count the pulse at your wrist for 30 seconds:

Pulse rate = (2 x number of pulses counted) per minute

If you don't know how to check your pulse, ask a health professional to show you how to do this. There are plenty of online videos which demonstrate how to check one's pulse, but these are of variable quality.

Suitable activities for 'moderate intensity activity' include brisk walking, jogging, light running, cycling, and swimming. However, these activities are not exclusive, and there are many more activities which provide 'moderate intensity activity'.


relaxation

Relaxation has been shown to improve mental health, to improve general wellbeing, and to reduce stress. Try to make time for 20-30 minutes of relaxation activities every day. Sitting and watching a screen doesn't count as a relaxation activity.

Relaxation techniques include controlled breathing, mindfulness, meditation, yoga, and 'progressive muscle relaxation'


have fun!

Fun is a good thing in itself, but it's also good for mental health and physical health. It may be difficult to have fun due to stress, relationship problems, financial problems, and employment problems. It may be difficult to have fun because of circumstances - for example, the COVID-19 pandemic. If we can make time for fun, we'll benefit from this. Fun activities are personal - whatever you enjoy,


stay connected

It's been shown that compared to social isolation, social connection improves mental health and wellbeing. It may reduce the risk of heart disease. 'Social connection' is about relationships and interactions with family and friends.


alcohol

To reduce the risk of harm from alcohol-related disease or injury for healthy men and women, drink no more than 10 standard drinks per week and no more than 4 standard drinks on any one day. The less you choose to drink, the lower your risk of alcohol-related harm.

Alcohol-related harm includes heart disease, liver disease, increased risk of some cancers (mouth, throat, oesophagus, colon, liver, and breast), dementia, and damage to the nerves in the limbs.

A standard drink contains 10 grams of alcohol - the amount your body can process in one hour. 'Standard drinks' are also called 'units'. As a guide:

  • 375mL of 5% beer = 1.5 standard drinks
  • 150mL of 13% wine = 1.5 standard drinks
  • 30mL of 40% spirits = 1 standard drink

Please refer to the Standard Drinks Guide for more detailed information


diet

Diet is a controversial topic. What's not controversial is that the 'Mediterranean type' diet has been shown to be associated with reduced risk of heart disease, diabetes, and some cancers. The 'Mediterranean type' diet isn't a strict diet. It describes the principles of a healthy diet. A healthy diet is a varied diet based on these principles. The Australian Dietary Guidelines are based on the 'Mediterranean type' diet. In a healthy diet, there are five food groups:

  1. Wholegrains
  2. Fruit
  3. Vegetables, and legumes and beans (legumes and beans are also 'protein' foods)
  4. Lean protein (fish, poultry, lean red meat, eggs, legumes, beans, nuts, seeds)
  5. Dairy

3 serves of dairy meet the daily requirements for calcium (for healthy bones)

Water is an important component of a healthy diet. Adults should aim for 2.5 to 3 litres of water today, either as plain water (preferable) or as tea or coffee. To avoid excessive caffeine intake (which may be associated with increased risk for heart disease and some cancers), aim for no more than 4 cups of coffee per day.

We need some salt in our diet for good health. We get most of the salt we require in the foods that we eat. Excessive salt intake can lead to high blood pressure. It's recommended that we don't have more than 5g of salt per day (1 teaspoon of salt per day). It's advisable not to add salt to cooking, and not to add salt to food on the plate. Some foods have a high salt content, for example, bacon, sausages, processed and packaged foods, sauces, some breakfast cereals, and some canned foods. It's worth checking the food labels. These foods should be 'occasional' foods, not 'everyday' foods.

You won't get any benefit from taking vitamin supplements or mineral supplements. They are expensive, and unnecessary. Supplements for specific vitamins or minerals may be recommended by a GP, specialist, or dietitian for people who have nutritional disorders, some medical conditions, or proven deficiencies - for example, Vitamins B1, B3, B6, B12, D, Folic Acid, and Iron. Folic Acid 400 micrograms daily is also recommended for women who are planning to conceive and for women in the first trimester of pregnancy,


weight

Normal weight is associated with good health. Being overweight increases the risks of developing diabetes, heart disease, osteoarthritis, and some cancers (eg breast cancer and bowel cancer). Being underweight increases the risk of developing osteoporosis ('thin bones'), muscle weakness, lowered immunity, and infertility (in women).

For good health, you should aim to have normal weight. 'Medical' weight is assessed by 'Body Mass Index (BMI)' and by waist circumference. Please refer to 'Check-ups and screening' below for details about weight.

To maintain a steady weight, your energy expenditure (metabolism, activity, and exercise) needs to be the same as your energy intake (food and drink).

To lose weight, your energy expenditure (metabolism, activity, and exercise) needs to exceed your energy intake (food and drink).

For weight loss, you should initially aim to get to your 'target weight' (as determined by 'BMI'), or to lose 5% of your body weight, whichever is the lower weight loss. Don't overdo it.

The 'energy equation' underpins the approaches to weight loss. Aim to increase energy expenditure by increasing exercise. Aim to decrease energy intake by modifying your diet (food and drink). A Mediterranean type diet is ideal (see above). Quantities and portion size are important in determining the energy intake from your diet. Aim to eat less - this can make a big difference.

Many 'special diets' are promoted for weight loss. Some examples include: The 5:2 diet (fasting on two days per week); The Dukan Diet; The 'Low Carb High Fat' Diet; the DASH diet; and the Paleo diet. There are also many weight loss programs. Some examples are: Weight Watchers; and Lite n'Easy.

Some people lose weight with these special diets and/or with these weight loss programs. Some people don't lose weight with these special diets and/or weight loss programs. There is no evidence that any one of the special diets or weight loss programs is superior to any of the others. It's likely that any weight loss achieved with a special diet or with a weight loss program is because energy intake has been reduced.

For a great way to lose weight, and to improve wellbeing and fitness:

  • have a portion-controlled Mediterranean type diet
  • do moderate intensity exercise for at least 30 minutes every day
  • drink no more than 10 units (standard drinks) of alcohol per week

Some medications can cause weight gain, for example, steroids, some antipsychotic medications, some antidepressant medications, and some medications that are used to treat diabetes. If weight is a problem, and you're taking one or more of these medications, please continue to take the medication, but discuss this with your doctor.

Rarely, overweight can be caused by hormone disorders, for example, underactive thyroid, and high cortisol. If you have difficulty losing weight despite attempts at weight-loss, then it may be necessary to do blood tests to check for hormone levels.

In the past, 'weight loss tablets' have been prescribed for patients. These should not be prescribed. They are not effective, and they are potentially dangerous.


safe sun exposure

Sun exposure is necessary for the body to make Vitamin D. Vitamin D is essential for healthy bones. Deficiency of Vitamin D can lead to thinning of bones, and an increased risk of fractures (osteoporosis). Vitamin D is also thought to be necessary for mental well being and for a good immune system. However, excessive sun exposure increases the risk of getting skin cancer.

In winter, healthy sun exposure is no more than a total of 3 hours over a week. Sunscreen should be worn if the UV index is 3 or higher.

In summer, healthy sun exposure is no more than 10 minutes per day, avoiding 11am to 3pm, and wearing sunscreen if the UV index is 3 or higher.


check-ups and screening

Check-ups and screening are about identifying the risk factors for disease, and identifying the early stages of disease, so that interventions can be made that lead to better health. It's a good idea to 'check in' with your GP at least once a year, for a 'check up'.

Weight

This is assessed in two ways.

Body Mass Index (BMI). This is the ratio of your height (in metres) squared to your weight (in Kg). You can calculate your BMI here

Normal weight is a BMI between 19.5 and 25

Underweight is a BMI below 19.5

Overweight is a BMI between 25 and 30

Obese is a BMI between 30 and 35

Morbidly obese is a BMI over 35

Waist circumference

A healthy waist circumference is less than 80cm for women, and less than 94cm for men. Waist circumference is measured around the abdomen at a level which is midway between the lower border of the rib cage, and the upper border of the pelvic bone.

Being overweight or obese are risk factors for developing diabetes, cardiovascular disease, and some cancers (eg bowel cancer)


Blood pressure

A healthy 'systolic' pressure (the upper figure) is less than 140.

A healthy 'diastolic' pressure (the lower figure) is less than 90

So, a healthy blood pressure is less than 140/90 (140 over 90).

Systolic pressure is the pressure in the bloodstream when the heart beats

Diastolic pressure is the pressure in the bloodstream between heart beats

High blood pressure is a risk factor for cardiovascular disease (heart attack, angina, stroke). It is a risk factor for heart failure.


Blood tests

Depending on your age, your medical history, and your family history, it may be appropriate to have a blood test periodically (eg every 1 to 5 years) to check for cholesterol, diabetes, kidney function, iron level, and blood count.

Mammogram

This is an X-Ray examination of the breasts. It's a 2-yearly screening test for breast cancer for women aged 40 to 74. Different tests and screening intervals apply for women who have had breast cancer, and for some women who have a family history of breast cancer (this should be discussed with a GP)

Cervical Screening Test

This is a 5-yearly screening test for cervical cancer for women aged 25 to 74.

Bowel Cancer Screening Test

This is a 2-yearly screening test for bowel cancer for people aged 50 to 74. For some people with a family history of bowel cancer, the screening test is 5-yearly colonoscopy. This should be discussed with a GP.


immunisation

It's recommended that all children get immunised according to the National Immunisation Program

Influenza vaccination is recommended annually for everyone from the age of 6 months.

Pneumococcal vaccination (the 'pneumonia' vaccination) is recommended for everyone at age 65 (unless they have received it previously)

The shingles vaccination is recommended for people at age 70 (it is not recommended for people who are immunocompromised, or people who are taking immune suppressing drugs)