Midlife guide: how to stay healthy over 40

If you thought that the gloomy trajectory of middle-aged life couldn’t get any worse, you’re wrong.

The news this week that strokes among those in their forties and fifties have soared because of obesity and lack of exercise — up by nearly 50 per cent in 15 years for men and by 30 per cent for women — has been followed by another grim finding: middle class drinking habits are now among the worst in the world. The revelations have brought into sharp focus previous predictions that almost two thirds of men over 40 will be obese by 2040, increasing their risk of type 2 diabetes and heart disease as well as stroke.

Women are making bad lifestyle choices and men are compounding them by not seeking help. “Part of the problem seems to be that middle-aged men haven’t grown up with the culture of being checked out by their GP,” says the consultant cardiologist Dr Charles Knight of Barts Health NHS Trust. “Women are used to going to their doctors as part of their routine — perhaps for contraceptive advice, when they’re pregnant and through the menopause. It’s more of a habit which men don’t seem to have acquired.”

Yet there are simple things that the middle-aged can do to stay healthy. And given that there are some things we can’t help — such as once we are over 50 our propensity for storing fat increases as we start losing muscle mass — the quicker we start doing them the better.
Know your chest pain
Chest pain should always be checked out because a heart problem might not feel as you’d expect. “Heart pain occurs as a crushing pain across the chest, not just on the left side as people mistakenly think,” says the consultant cardiologist Dr Glyn Thomas of the Bristol Heart Institute, “but breathlessness and nausea when exercising can also be a sign of heart issues.” Yet 40 per cent of women don’t experience chest pain — instead they might suffer flu-like symptoms, shortness of breath, upper back or stomach pain, nausea and fatigue. It’s important to get these symptoms checked out quickly.

Top up on vitamin D
Vitamin D is vital for good health in middle-age, including bone health since it helps the body to absorb calcium. Yet a Cambridge University study last year found that an average of one in ten people aged 40 to 80 were deficient. Eating oily fish two or three times a week will provide some dietary vitamin D, but its greatest source is the sun and we only need about 20 minutes a day of sunlight in summer to ensure that we have sufficient levels to see us through the year (the sunshine isn’t strong enough in the winter).
Photograph your moles
When you’re outside use sunscreen. Although it screens ultraviolet B, which triggers the production of vitamin D, a study in 2013 showed that this didn’t prevent the production of sufficient quantities of the vitamin.

And remember your bald spots: “Middle-aged men with thinning hair may forget that their scalp is exposed,” says Paul Banwell, a consultant plastic surgeon and skin cancer expert at the McIndoe Surgical Centre in East Grinstead. “They may also forget to wear a hat when doing outdoor exercise such as jogging or sailing.”

If you notice any moles that are raised, that bleed or have ragged edges, see your GP. “For men and women, if you have fair skin with a lot of moles, take pictures of them every four months and load them on to your computer,” says Banwell. “It’s a cheap and easy way to see if they have changed.”
Have lots of sex
Regular sex may be protective against prostate cancer in middle age. “There’s no doubt there is an association between the two,” says Professor Christopher Eden, consultant urologist at the Royal Surrey County Hospital, “but we have yet to find a concrete explanation as to why.” One theory is that sex may flush out cancer-causing chemicals in the prostate. It may also reduce the development in the prostate gland of calcifications — bits of accumulated calcium — which have been linked with cancer.

Load up on lycopene
Just ten helpings of fresh and cooked tomatoes a week could help to reduce the risk of prostate cancer by almost a fifth. Researchers from the universities of Bristol, Cambridge and Oxford, who carried out a study last year on 1,806 men aged 50-69, believe that protection against the illness comes from a key chemical: lycopene.

Cooked tomatoes — found in ketchup or pasta sauce — are particularly beneficial. “This is because lycopene is a fat-soluble substance, so its nutritional content is more readily available when tomatoes are cooked, which boosts absorption,” says Helen Bond, a spokeswoman for the British Dietetic Association. “Add a drizzle of olive oil to cooked tomatoes as fats in the oil help the body absorb lycopene more effectively.”

Don’t push yourself too far, too fast
To avoid the risk of a fatal heart attack, Mamils, or “middle-aged men in Lycra”, should be wary of going hell for leather on their bikes. “You should cycle, walk or whatever you choose to do with enough exertion to become mildly breathless, but you should still be able to talk in sentences,” says Hugh Montgomery, professor of intensive care medicine and director of the Institute for Human Health and Performance at University College London.

Eat more selenium
Brazil nuts are the highest dietary source of selenium, which contains a powerful antioxidant that may protect against cancer and heart disease. “Having seven brazil nuts is enough to give you all the selenium you need to get your recommended daily allowance,” says Dr Sarah Schenker, a nutritional scientist, who adds that there’s no additional benefit in having more. “It’s not a case of the more the better — too much selenium can be slightly toxic and is even linked to hair loss.”

Take advice on aspirin
Aspirin is an antiplatelet medicine, reducing the risk of clots forming in the blood and so cutting the chances of having a stroke or heart attack. Low-dose aspirin (usually 75mg a day) is prescribed to heart attack or stroke patients, but it shouldn’t be taken routinely without advice. “It’s not as straightforward as going into the chemist and buying aspirin,” says Dr Knight. “It can be very useful but your doctor needs to weigh up all the factors, such as family history. There needs to be a discussion first.”

Talk about your bowels
Researchers from Imperial College London found recently that just two weeks of eating lots of fatty food could “dramatically” increase the odds of bowel cancer. There is strong scientific evidence of a link between red meat and bowel cancer, so aim for less than 500g (cooked weight) a week. Processed meats (eg, ham, salami) should be avoided.

Dr Steven Mann, a consultant gastroenterologist at the Royal Free Hospital in London, also suggests that we shouldn’t shy away from talking about our bowels. “Middle-aged men in particular often ignore symptoms such as blood in their stools and changes in patterns of bowel behaviour,” he says. “They don’t want to have conversations about motions and consistency, but they need to.”

Test your prostate
In the UK there’s no national screening programme for prostate cancer, but Professor Roger Kirby, a consultant urologist at the Prostate Centre in London — himself a former prostate cancer patient — believes that every man over 50 should ask for an annual PSA test. This measures the amount of a protein called prostate specific antigen (PSA) in the blood, raised levels of which may be a sign of prostate cancer.

“If PSA is raised then, rather than a biopsy, patients should ask for a high-quality MRI scan, which can rule out tumours that don’t require urgent treatment in 95 per cent of men with prostate cancer,” he advises. “If an MRI shows a biopsy is needed it will pinpoint where this should be carried out. That way the damage to normal tissues during subsequent treatment can be minimised.”
Go to the sauna
Middle-aged men who take frequent saunas are about half as likely to die from heart conditions as those who do not, according to a new study by the University of Eastern Finland. Regular sessions also appear to protect against early deaths from any cause, lowering the risk by 40 per cent for those having a daily sauna. Although it’s not clear why, longer time spent sweating it out in each sauna session also enhanced the health benefits, with more than 20 minutes offering the most protection.

Stick to two drinks a day
Drinking more in middle age may raise your stroke risk more than traditional factors such as high blood pressure and diabetes, according to research in Stroke, the American Heart Association journal. If you do have a tipple, make it a glass of red. Middle-aged rats treated with the compound resveratrol, which is found in red wine, showed improved learning, memory and mood compared with animals given a dummy drug. This could be because resveratrol helps to reduce inflammation and triggers the growth of new blood vessels.

Think about your family
See your GP if your mother or sister had breast cancer.This includes men. Many don’t realise that there is a familial link between prostate cancer and breast cancer says Dr Isabel Syndikus, a consultant clinical oncologist at the Clatterbridge Cancer Centre NHS Foundation. “If you have a father or brother who has had prostate cancer then you are also at higher risk of developing the disease,” she says.

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