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Epub ISBN: 9781473538467

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Published by Century 2016

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Copyright © Sir Muir Gray
Illustrations © David Mostyn
Cover photo © Getty Images

Sir Muir Gray has asserted his right to be identified as the author of this Work in accordance with the Copyright, Designs and Patents Act 1988.

First published by Century in 2016

Century
The Penguin Random House Group Limited
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www.penguin.co.uk

Century is part of the Penguin Random House group of companies whose addresses can be found at global.penguinrandomhouse.com

A CIP catalogue record for this book is available from the British Library

ISBN 9781780896625

Foreword

As Chief Medical Officer, I commonly look at health issues and risk factors that affect the entire population. In my 2013 Annual Report, for instance, I examined infectious diseases and, in particular, the threat of antimicrobial resistance. If left unchecked, this will shake the foundations of modern medicine for us all.

There is also value in focusing on specific sections of the population to take a demographic, rather than a thematic approach. This allows me to knit together strands of evidence to form a coherent picture of the health of groups within the population, and thus influence public policy in order to improve their health. Recognising that the importance of addressing their health issues, risk factors and needs is often underemphasised, I began a piece of work in 2015 to examine the data around the health of people commonly referred to as the ‘Baby Boomer’ generation. My forthcoming 2015 Annual Report will describe this work and give a snapshot of health for this group.

In this context, a work such as Dr Gray’s is very welcome. By promoting understanding of the health issues faced by those in midlife, it should encourage people to improve their health at this stage in life and reduce their risk of disability and dementia on reaching old age. If this were achieved, it would not only increase their quality of life but also reduce the burden on their offspring when they reach midlife themselves. I welcome Dr Gray’s work and hope you enjoy reading this book.

Professor Dame Sally C Davies FRS FMedSci

Chief Medical Officer

Department of Health, London

At 20, most of us feel immortal – or at least we act that way.

At 50 – and I’ve just marked that birthday – the penny has begun to drop. By then, maybe you’ve had a health scare. Or a close friend, or brother or sister has. At the very least, perhaps you’ve finally succumbed to reading glasses, you’ve noticed your jeans getting tighter and you’re a bit less agile kicking a football around the park with your kids.

So, now’s the time to smell the coffee. Muir Gray – one of our country’s leading doctors – sets out smart advice in this short but compelling volume. It’s packed with advice on staying healthy, enjoying life and living well. The good news? Make a few impactful lifestyle changes, and the chances are we’ll be the longest-living generation in human history. Lose some weight by eating less, and better. Dial back on the booze. Walk and exercise a bit more. Get your blood pressure checked, have a bowel cancer check-up when invited, ‘know your numbers’ on your body mass index.

Worldwide, life expectancy is rising by five hours a day. And since the 1950s, in western countries that’s mostly been due to improvements in middle-aged and older people’s health. Some of that is thanks to what the NHS has done for us, but much of it depends on what we choose to do for ourselves. Our wives, husbands and partners, our children and grandchildren, are all cheering us on.

Simon Stevens

CEO of NHS England, Simon is also responsible for NHS Choices and the Diabetes Prevention and the blood pressure programmes.

Introduction

I did not own or have the use of a car until I was 28. For the first 25 years of my life, neither my family nor I had the money to run one. When I was 26 and 27, I was too busy working in hospitals to need a car. In fact, I did not even think about owning one during this time.

However, at the age of 28, I got a job which required me to use one. So I bought a second hand Vauxhall Viva van into which I could load the love of my life, my bike.

From what I had learned about health and wellbeing as a result of my medical studies and the diploma in preventive medicine that I had acquired, it seemed to me that the start of a life dominated by the car and a desk job was the start of the downhill journey.

The job I had at 28 involved two things. The first was the health education of young people and the second was organising care for the elderly. As I got to know a large number of these patients, I was struck by the huge variation in ability. Some in their eighties were very disabled and dependent on others, whereas there were people the same age who were lively, driving cars, working, and performing an invaluable role in supporting their spouse or loved one. I thought to myself, ‘what made the difference?’

When I discussed this with my elderly patients it became clear that, for many, the problem was caused by disease or diseases that were not preventable. So, a bit of luck is important. However, other diseases were the same ones that we were educating, or trying to educate, young people to avoid. The second factor was loss of fitness which, for many people, could be traced to 45 years of sitting at a desk job from about the age of 20 to 65.

I could see change happening in people from the age of 20 on. By starting an office job, the effects of sitting all day might not take effect until the forties. But, there are often many other stresses in their lives: work, children and elderly parents.

For years we have assumed that everything was plain sailing for the ‘grown ups’ and the medical establishment has focused on the needs of children and old people. But in recent years it has become clear that midlife is a tough time. It is also clear that people in midlife can regain lost fitness and lose weight, so they can feel better, look younger and live longer. It is also clear that the changes that are needed are also changes that will reduce the risk of problems in the years to come.

Midlife is the end of the beginning, not the beginning of the end and I wrote this book, with the help of a number of experts, to help midlifers regain control.

Sir Muir Gray

1.

Forty to Sixty: The Midlife Challenge

Last year, a friend called me in a state of dismay. He had just had his 54th birthday and he had stopped working at his job. But rather than enjoying his freedom and doing all the things he has always wanted to do, he felt trapped. He felt defined by his age, as though his life had passed him by. This shouldn’t sound unfamiliar. Maybe the same thing has happened to someone you know, or maybe it happened to you when you approached midlife.

Despite what people think, there is no age at which ‘midlife’ starts. Broadly speaking, though, the term is used for people who are aged between 40 and 60. But, don’t worry, you won’t wake up on the morning of your 40th birthday and become suddenly middle-aged. It’s just a broad term that is used to identify a certain demographic. Even so, there is no escaping midlife. From books to magazine articles, blogs to news reports, everyone is talking about it and everyone seems to offer something to help you during this stage of your life. Midlife was even the focus of a recent report by the National Institute for Health and Care Excellence (NICE), the key government body advising us what does and doesn’t work to improve our health.

It used to be the case that when you reached your forties or fifties, you were halfway through your working life. People were very aware and very concerned about whether or not they had ‘made it’, or ‘would make it’, or, perhaps, ‘would never make it’. Often the ‘it’ is not quite clear. To make matters worse, they may see younger people being promoted ahead of them. The pressure that can build on people to succeed before they have retired can be overwhelming. The crisis that we’re so often told about is more of a social element than a medical one. Your doctor, for example, won’t diagnose you with ‘the midlife crisis’. The midlife crisis has its origin in the simple three-stage model of life that has dominated much of the 20th century.

When we think about midlife or, rather, are told about midlife, it is usually partnered by the concept of ‘crisis’. For many people, my friend included, midlife is the time when the heart begins to sink, the time when it looks as though it’s downhill all the way to old age. But a crisis can happen at any time – it’s not explicitly related to age. A career setback, an illness, a divorce or a death in the family are all events that have nothing to do with ageing. One of the popular misconceptions about midlife crises is that they are spurred by the sudden realisation that you are no longer as young as you used to be and the aspirations you once had are not achievable now you are in midlife. However, this simple three-stage model is vanishing fast as a result of dramatic changes taking place in society. The ‘age of longevity’ has begun. Whilst midlife is a time in which we take on new responsibilities, it is also a time to look for new adventures. Midlife is a time to be celebrated and embraced.

This book is not meant to fill you with dread, or highlight the problems with ageing. No, this book is a kick-starter. Midlife is a time to begin a new lifestyle. It is a time to make the appropriate changes in your life that will leave you feeling healthier, happier and more energetic.

People are waking up to the problems of midlife. In the past, attention has been focused on children and the elderly, and rightly so. But what about those in between? In one of her major 2016 Annual Reports, the Chief Medical Officer, Dame Sally Davies, recognised the need to highlight the midlifer which conventionally stretches from the age of about 40 to 60.

For many people, midlife is expected to be a phase of decline, with loss of fitness, weight gain and labels such as ‘high blood pressure’ being stuck on to add to the gloom, but this need not be the case. For people in their forties and fifties, the aim should be to get fitter, feel better, and look and feel like they did at 30. Jamie Oliver transformed his life at 40 and lost two stone; Chris Evans did it at 50, and he went to great lengths to reverse ‘midlife decline’ – 26 miles 385 yards to be precise, because he chose the London Marathon as a stimulus. Cameron Diaz wrote an excellent book on longevity when she became 40, and Margaret Webb wrote a powerful book on ‘what women runners can teach us all about living younger, longer’, telling how she and her 55-year-old sister became marathon runners. The title of her book is Older, Faster, Stronger.

The key is to look at midlife not as a stage of life in which you just have to try to cope better, but as a stage of development. It should be a stage in which you reflect on what you have achieved so far and then develop a plan for how you can change and adapt this for the 2020s, 2030s and 2040s.

This book is a travel guide, or a route map, to help you on that journey through your forties and fifties. After 40, you really have to look after yourself. When you’re under 40, you can get away with ignoring what is happening to you (although, the ageing process actually starts in your twenties and thirties). But in the following decades you need to take action. Not against ageing, but against the three other processes that cause the problems which many people ignore because they assume that everything that happens from 40 on is due to ageing. When in reality, it’s not.

Here is what many midlifers believe is happening:

People (and this may include you) think it is all about ageing from 40 onwards, with diseases like high blood pressure creeping up and being responsible for decline. This is not the case. Ageing, as we shall see throughout this book, is relatively unimportant.

This is what happens to most people:

The most distinctive change is in attitude. People (and again, this might include you) go from being positive to negative and pessimistic, and this leads many people to give up looking after themselves and staying fit. Instead, midlifers give priority to other age groups – younger children or elderly parents, for example.

This book explains how to lengthen your odds, how to increase your chances of living longer and better and decrease the risk that you will come to a bad end! The bonus is that the changes you make to live longer and better will also help you feel better within weeks and you can become as fit as you were ten years ago.

The first step is to help you think about yourself. You need to reflect on where you are now and where you want to get to, not in your job but in your life. This also involves reflecting on how much pressure you are under and how you could find more time and space to look after yourself.

The second step is not to bombard you with information but to help you think about how you can reduce the stress in your life, because it is stress that makes it difficult for people to make the changes that will transform their health, now and in the future.

After that I will give you information that you can use to reduce your risk of disease and look after your body, with specific sections on:

• stress
• sleep
• exercise
• diet
• everyday health

Finally, as in any good guidebook, I will give you information about where to find help and support not only through the NHS but through many other services that can help you reduce your risk of disease and feel better.

Always remember: the most important person is you. It’s time to tackle midlife.

2.

The Science of Midlife

The newspapers are full of information about how people aged 40 or 50 can reduce the risk of cancer or heart disease. What newspapers fail to mention, though, is that people aged 40 or 50 (or indeed of any age) differ from one another. You are unique. The knowledge that we now have about staying healthy and reducing risk of disease has to be related to your particular circumstances. The things that you care about and the pressures that you are under are vastly different from someone else’s. There is only one you and the general information about risk has to be personalised. The NHS Health Check that people over the age of 40 are offered is designed to help you relate the risks to your particular situation. It also offers testing that you cannot do yourself – a blood test, for example. In addition, the One You project launched in 2016 has an online ‘How Are You?’ quiz designed especially for this purpose.

This book will supplement what you will have learned, as well as help you take action, if you have had an NHS Health Check or completed the How Are You quiz. It provides you with knowledge about steps you can take which will help you stay young, feel better and live longer even if you have not had an NHS Health Check. You have to relate the information offered here to your own particular situation and turn it into useful personalised knowledge.

Firstly, here is the checklist from the online How Are You quiz. Put a ring round the number that best describes you in the range from 5 at the bottom to 1 if you feel in tip-top form.

If you scored:

• 6, that’s great. Even 12 or less shows that you are doing well.
• 13 to 20, you are doing not too badly but could feel better as well as reducing the risk of long-term problems by taking action.
• 20 or more, don’t despair. You can feel a great deal better and the good news is that the steps you take to reduce your risks of disease in the long term will also help you feel better within a month.

When you do the online quiz, your score starts to identify your risk profile so that it personalises the information, advice and encouragement it gives. I would suggest that you search online for ‘One You’ and see for yourself what you score.

For now, let’s get an assessment of how you rate your health right now.

If you rated your health as bad or very bad, what would you say is the principal cause or causes?

Now look at the boxes that you have highlighted. If you have ticked one or more boxes, you will need to tackle the cause, or causes, directly. Think about why you feel that way and what you can do to change. Reducing your risk of disease, or getting fitter, will help you feel better overall. Even if you have one or more of the problems listed above, you can overcome them.

The proportion of people with one or more long-term conditions increases each decade. By the age of 40, roughly one-third of the population are diagnosed with one long-term condition or ‘morbidity’. By 50, it is half and by 60, roughly two-thirds have at least one chronic health problem. That being said, all the information is as relevant to people with one or more long-term health problems as it is to people who do not have any.

Midlife is a tough time, but no matter how tough life is today or how pressing the problems you face, just take a few minutes to think about your future 20 or 30 years down the road.

There is a chance that you haven’t thought about your future health and well-being and that’s OK. Your day-to-day pleasures are important and life gets in the way. But it’s important not to forget that midlife is quickly approaching. So, what do you hope or fear will happen to you in the future? Take a couple of minutes to think about this.

Dropping dead suddenly on the last day of a wonderful holiday on which you have spent all your savings might seem to you to be a great way to go, but it has its downside. It can be very tough for those left behind, particularly if you have not told them how much you love them. Most people, however, are not obsessed with living as long as possible. It is the quality of life that is more important. Being dependent on your family for years, stuck in a chair and unable to get to the toilet in time is a miserable prospect, but the good news is that it is not inevitable. In any journey you need to decide where you are going and this is as true for the journey through life as for one behind the wheel of a car, or when buying a ticket via the Internet. Set out below are some options for your long-term destination, in particular what your last months and years may be like when they come. Put your preferences (1), (2) and (3) in the first column for what you would like to happen, and then in the second column what you think will happen.

The first option seems the most laid-back and sensible but the probability is that if you do nothing and wait and see, you will finish up with the third option – housebound, perhaps chair-bound, and reliant on others for the tasks of daily life. We are all dependent on other people. Even the wealthiest, fittest and strongest 50-year-old is dependent on others. However, there is a difference between being dependent on telephone companies, supermarkets, airline pilots and train drivers and being ‘depressingly dependent’ – that is, dependent on other people for getting up, washing, bathing and getting enough to eat. But before you get depressed here are two bits of good news.

The good news is that you can change your destiny by taking action, starting now, when you are 40, 50, 60, 70 or even 80. There is also some research showing that people in their nineties can regain lost strength through training. Of course if you are under pressure and feeling the effects of stress you may be more concerned about your finances next Friday than thinking 30 years ahead. But (and here is the second piece of good news) the changes you make to help you live longer and better will not only help in the long term, they will also help you feel better in the short term.

Obviously, people who take up the offer of an NHS Health Check do so for health reasons. But that’s not the only reason why people take a Health Check. Being healthy is much more than the absence of disease, so using the checklist from the How Are You quiz will help you to reflect on other reasons for trying to change.

Fortunately what you need to do to achieve all your long-term hopes will help you feel better in the short term; not necessarily immediately but within about a month you will start feeling healthier, younger and invigorated. Many people face pressing problems in their life that make change difficult, so let’s identify the principal obstacles.

The questions from the How Are You quiz help you identify some of the barriers which are stopping you overcoming your goals by asking ‘What stops you taking care of yourself?’ This is a useful checklist but it implies that it’s your fault and that you have chosen to live in a way that is bad for your health, which isn’t entirely true. As we will discover, there are some aspects which are out of your control. The modern environment has increased the risk of heart disease and type 2 diabetes. But one thing to remember is that ‘ageing’ or ‘growing old’ is not the cause of these problems.

The ageing process

Sir Bradley Wiggins, at the age of 35, set a new world record for the distance cycled in an hour, 54.526 kilometres, but he probably will not set a new world record at the age of 40, no matter how hard he tries – although I hope he proves me wrong. For events which require endurance, athletes reach their peak in their early thirties if they have the right attitude, continue training and manage to escape injury. Paula Radcliffe set the women’s marathon record at the age of 30, Serena Williams won Wimbledon at the age of 34 and Roger Federer, despite injury, reached the Wimbledon semi-finals for the 11th time at the same age.

Ageing is a normal biological process – to be more accurate, a set of processes – which is not fully understood. The ageing process does have an effect on many body tissues and organs which reduces your ability to do things. For example, the maximum heart rate drops by about one beat per minute every year from the age of about 35, and this is one reason why Sir Bradley is unlikely to beat his record, even if he continues to train as hard between 35 and 36 as he trained between the ages of 25 and 35.

The other consequence of the ageing process is what people term a loss of resilience, or the power of homeostasis: not just the loss of the ability to do things but the loss of the ability to bounce back and respond when something goes wrong. For example, an individual’s ability to respond to losing their balance is reduced due to ageing, so a stumble may become a fall. It is inactivity that is perhaps the greatest threat that many of us face in an environment where most people spend most of the time either in bed or sitting down. Inactivity is a challenge and the effects of ageing reduce the ability to respond appropriately to inactivity.

A great deal of research is going on into ageing and there is a growing interest and investment in research to develop antidotes to ageing. The elixir of life was the name given to such an antidote by the ancients and it has played a part in fables for hundreds, perhaps thousands, of years. The Philosopher’s Stone is part of the Harry Potter saga and the term philosopher’s stone, sometimes used to describe something that could turn base metal into gold, was used on other occasions to describe the elixir of life.

There is serious money and brainpower going into this now, and that astonishing company Google has invested a lot of resources to set up a company called Calico (short for California Life Company), the aim of which is to create medicines that will keep us alive until – claims vary – the age of 142, 150, or beyond.

This type of science is leading to a new medical speciality called regenerative medicine, more advanced in the USA where the search for eternal youth has always been more ardently pursued. The Mayo Clinic website describes how their Center for Regenerative Medicine takes ‘three interrelated approaches’:

• Rejuvenation.
• Replacement. Replacement involves using healthy cells, tissues or organs from a living or deceased donor to replace damaged ones. Organ transplants, such as heart and liver transplants, are good examples.
• Regeneration. Regeneration involves delivering specific types of cells or cell products to diseased tissues or organs, where they will ultimately restore tissue and organ function.