Dr Rupa Joshi has been a GP for 19 years and practices in Berkshire. She is a Co-Clinical Director of her Primary Care Network and Workforce Development lead for Berkshire West. She has a keen interest in Lifestyle Medicine, Coaching and Quality Improvement in patient care. She is part of the 'Time for Care' faculty (part of NHS England and NHS Improvement) and is also a member of the Primary Care Network Clinical Director board for NHS Confederation. Asian Voice spoke to Dr Joshi in the light of the festive week and the measure we need to take as a community in the post-Covid world.
1. How do you think the existing lifestyle of the Asian community can contribute in preparing for the post pandemic world?
Lifestyle plays a huge role in our health and well-being, and can be classified into 5 ‘pillars’: Nutrition, Movement, Relaxation, Sleep and Social Connection.
If we think about the pillar of nutrition first, a diet with plenty of fresh fruit and vegetables will contribute to a healthy immune system. The ‘rainbow diet’ includes eating all the colours of the rainbow from fruit and vegetables every day. A good tip is to write the colours on your fridge and tick them off as you eat. Reducing sugar, saturated fat and switching to a whole grain diet are also beneficial (Moving to brown flour/ bread, brown rice, brown pasta). Healthy fats include olive oil, avocado, linseeds (flax) and walnuts. Some traditional staple ‘treats’ should be just that (Indian sweets, samosas, fried foods like pakoras and bhajis etc.) It’s all about moderation, not do’s and don’ts so treats are fine once or twice a week and on special occasions.
The power of community cannot be underestimated and whether it is through a social club or a place of worship, these networks give great comfort to many and can be invaluable to make sure that word gets around in terms of helping the most vulnerable, online exercise classes, or making sure that everyone knows about something important like the local flu campaign. Please ensure you have your flu vaccination if you are in an at risk group.
2. People with existing lifestyle diseases are more prone to the virus and many unforeseen medical conditions that may arise as a result of the pandemic. Please make our readers understand this concept.
The pandemic has highlighted health inequalities in BAME populations. Statistics have shown a higher rate of infection and poorer prognosis for those diagnosed with Covid-19. There are theories that higher rates of infection might be due to the increased likelihood of people living in urban areas, occupational hazards, deprivation and the number of members in households.
Some people are at higher risk of complications due to certain conditions. The government will have sent a personal letter to you if you are in this category. Those at moderate risk are: over 70’s, people with severe lung conditions, heart disease (e.g. heart failure), chronic kidney disease, liver disease, neurological diseases, people taking steroids, those with a BMI of over 40 and pregnant ladies.
The poorer outlook once the virus is contracted, is thought to be due to the increased prevalence of illness such as cardiovascular disease, Type 2 diabetes and high blood pressure. If these conditions are not looked after properly then they can lead to heart attacks, strokes and other complications. The good news is that by paying attention to the five pillars and taking medication as prescribed will stand you in good stead. In essence, eat well (as above), sleep early, move or exercise daily, connect with others and make sure you can switch off when you need to. All these practices will help to control inflammation in the body and ensure our immune systems are working as well as they can and reduce the burden and risk of these conditions.
Risks are also higher if people have uncontrolled high blood pressure and very high sugars in Diabetes. And being from a Black, Asian or minority ethnic background can make you more likely to get seriously ill from coronavirus. There appear to be some genetic factors involved in this.
3. Since many companies have now declared that work from home will be a part of the future work culture, how do you think one must alter their lifestyle to maintain a healthy life?
Working from home can suit some people but doesn’t always suit everyone. On the one hand the stresses of commuting and the time it takes disappear, but not everyone finds working from home easy. Making sure that you have a separate space or room for work is important. You don’t want to be distracted - very easy when you’re at home, particularly if the rest of the family are at home interrupting your video calls!
There are 4 types of exercise; cardiovascular, strength or resistance training, flexibility and balance. The recommendations are 150 minutes of moderate intensity walking or other aerobic activity per week if possible. Strength and balance exercises are particularly helpful in the elderly as falls prevention. Over the pandemic, we have seen a greater incidence of muscle wasting which has led to complaints of more pain from knee and hip osteoarthritis. Standing on one leg, or using ankle weights to do lifts and stretching are a good way to gain flexibility and strength.
You are still able to meet with one other person outdoors, with social distancing. Going outdoors is also very important for vitamin D levels. People with darker skin tones have a higher requirement for vitamin D as the UK is at a high latitude and you may wish to consider taking a supplement. You can ask your local health store or pharmacist for advice on this but The National Institute for Health and Care Excellence suggests supplements for these groups:
-infants and children aged under 4
-pregnant and breastfeeding women, particularly teenagers and young women
-people over 65
-people who have low or no exposure to the sun, for example, those who cover their skin for cultural reasons, who are housebound or confined indoors for long periods
-people with darker skin, for example, people of African, African-Caribbean or South Asian family origin.
4. How much does mental health contribute to a healthy lifestyle? What according to you are some key signs that one must not ignore?
Key signs not to ignore:
- constant feeling of sadness or feeling tearful
- feelings of hopelessness or morbid thoughts like those of suicide
- friends or relatives saying they are really worried about you
- not being able to sleep or concentrate on the simplest things
-not finding enjoyment in anything
-loss of appetite coupled with any of the above
Please also be vigilant over our children’s mental health which has also been affected by the pandemic. If you are concerned about your mental health or for the mental health of someone else, please reach out and contact your GP surgery, Samaritans, mind.org.uk
5. Give some advice to our readers on adapting to a new normal once the vaccine comes.
Top tips in a post-Covid vaccine world would be:
Take nothing for granted. Use lifestyle measures to look after your own health and the health of your nearest and dearest, for coronavirus and beyond.
Once we have the vaccine, still take precautions around infection control like hand washing until we fully understand how effective the vaccine is.
Remember that each of our own actions affect the rest of society and we must work together. Stay in touch and value your friends and community by remembering the power of the social connection, look out for those who are most vulnerable and stay safe.
To say the vaccine has been trialled and tested and we are expecting this to be effective, but just to make sure, it’s advisable to follow precautions such as washing hands.
