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Experts alert to rising cases of chronic diseases in midlife

By Chukwuma Muanya
07 February 2022   |   2:43 am
.Ikechukwu Chukwuma is 46-years old and weighs 127 kilogrammes. Chukwuma could hardly walk because of excruciating pains in his knees and ankles. After medical examination...

•Why most adults are coming down with painful waists, joints, locomotive diseases
•Intermittent fasting and high-protein diet could improve joint pain caused by arthritis

Ikechukwu Chukwuma is 46-years old and weighs 127 kilogrammes. Chukwuma could hardly walk because of excruciating pains in his knees and ankles. After medical examination, he was diagnosed with osteoarthritis and erectile dysfunction.

Iyabo Ayodele is 49 years old and weighs 70 kilogrammes. Ayodele, a mother of five children, has recurrent back pains. She is also diabetic and hypertensive. Ayodele was also diagnosed of osteoarthritis.

Osteoarthritis (OA) is progressive joint disease characterised by joint inflammation and a reparative bone response and is one of the top five most disabling conditions that affect more than one-third of adults, commonly affecting hands, feet, spine, hips, and knees.

Chukwuma and Ayodele represent millions of people between 40 and 60 years suffering from two or more chronic health conditions in middle age, such as recurrent back problems, mental ill-health, high blood pressure, diabetes, and high-risk drinking.

President, Nigerian Medical Association (NMA), Prof. Innocent Ujah, said the situation is due to issues of ageing and affluence, which are associated with overweight. “There is no doubt that there are many Nigerians that are overweight and we are not exercising,” he said.

The obstetrician and gynaecologist said one of the greatest medicines is physical therapy such as physiotherapy and massaging. “Also, supplements with painkillers are useful but should not be used always because they can damage the liver,” Ujah said.

The physician further explained: “It is all about ageing. As you age, the cartilage in the vertebra column begins to wear out that is the meniscus. The bones are getting close to each other. But we can ameliorate that with exercises. We should not eat much because the consequences of overweight are over loading the kidneys and heart. You will be able to maintain basic care with exercises. Instead of overloading ourselves with carbohydrates and beer, we should eat more of fruits and vegetables. Unfortunately, many Nigerians think overweight is sign of good living.”

A professor of medicine and medical director, Medical Art Centre (MART), Oladapo Ashiru, blamed the situation on environmental toxins. “As someone in reproductive biology and medicine for over four decades, the toxins also cause infertility and erectile dysfunction. In terms of general well-being today people also present with arthritis, neuromuscular incoordination, abnormal gaits, disorders of the mid brain and cerebellum, requiring walking sticks, wheel chair,” he said.

Ashiru, who is also President, Academy of Medicine Specialties, Nigeria (AMSN), said the shift of chemical production to developing countries might increase related health and environmental risks.

A consultant Obstetrician and Gynaecologist and Medical Director, Optimal Specialist Hospitals Limited, Surulere, Lagos, Dr. Celestine Ugochukwu Chukwunenye, told The Guardian that midlife crisis can be described as the challenges men and women pass through in transiting from young adults into adults in their old age. He said the age when this transition occurs is usually given as between 40 and 60 years but like every natural event, can start much earlier and end much later in some individuals.

“‘My people perish from lack of knowledge’ is a popular saying from the Holy Bible. Midlife crisis is real and not a myth, however the way each individual experiences it varies in content and severity,” he said.

Chukwunenye further explained: “Midlife crisis occurs in both men and women. The cause may be described as unknown but is associated with unattained expectations of young adulthood, and in women, also coincides with hormonal changes in their bodies that end in menopause. The unattained expectations include educational, health, sociocultural, religious/marital, political, economic/financial. One or more of these factors may be operating in one individual at the same time.”

He said each of the identified factors has its symptomatology but “let us focus more on health, which may be the final common pathway to disease and death.”

The physician said the health symptoms include: sleeplessness, sadness, anxiety, myalgia, arthralgia, headaches, hot flushes, irrational talk and behaviour, and outright depression.

Chukwuneye added: “Yes, stages have been described in midlife crisis. The beginning stage is characterised by denial, anger, frustration and constantly talking about it, the middle stage is when the individual tries to overcome the limitations being imposed on him or her by aging process, and leads to depression and withdrawal of the person, and the final stage is when the person accepts the changes and is fully adjusted to old age. Six stages of midlife crisis have also been described as follows: denial, anger, replay, depression, withdrawal and acceptance.

“Duration of midlife crisis varies between individuals, from a few months to many years. It tends to last longer in men than women. The best way to deal with midlife crisis is to first get knowledgeable about it through reading and or counselling. Thereafter, applying the gained knowledge and wisdom in dealing with it, and if married, in supporting the spouse.”

He said there is no doubt that midlife crisis is a period of scary, monumental shift in the thinking of an individual and the best approach is to stay positive while passing through it, and this becomes easier when one knows it is for a finite period. “A negative approach will lead to a lot of untoward outcomes,” Chukwuneye said.

The medical director said there is a difference between depression, which is a severe, endogenous, psychological disorder and midlife crisis. He said the depression of midlife crisis is reactive and mild, a neurosis.

Chukwunenye said most people do not need any treatment and psychosocial counselling will do the job. He said midlife crisis should be taught in senior secondary schools and higher educational institutions. “Young adults need to be informed ahead about midlife crisis and be prepared to face it with a positive attitude,” the physician said.

MEANWHILE, recent studies have established that over a third of adults have multiple health problems in midlife.
A midlife crisis is a transition of identity and self-confidence that can occur in middle-aged individuals, typically 45 to 65 years old. The phenomenon is described as a psychological crisis brought about by events that highlight a person’s growing age, inevitable mortality, and possibly lack of accomplishments in life. This may produce feelings of intense depression, remorse, and high levels of anxiety, or the desire to achieve youthfulness or make drastic changes to their current lifestyle or feel the wish to change past decisions and events.

According to University College London (UCL), United Kingdom (U.K.), researchers, more than one in three British adults are suffering from two or more chronic health conditions in middle age, such as recurrent back problems, mental ill-health, high blood pressure, diabetes, and high-risk drinking.

The new study, published July 2021 in the BMC Public Health journal showed that among Generation X – adults born in 1970 – those who grew up in poorer families are at much greater risk of having multiple long-term health problems in their late 40s. The research also revealed an association between physical and mental health conditions in childhood and adolescence, and chronic health problems in middle age.

Lead author and researcher at UCL Department of Epidemiology and Public Health, Dr. Dawid Gondek, said: “This study provides new evidence about the state of the nation’s health in midlife. It shows that a substantial proportion of the population are already suffering from multiple long-term physical and mental health problems in their late 40s, and also points to stark health inequalities, which appear to begin early in childhood.”

The researchers analysed data collected from a nationally representative group of around 8,000 British adults who have participated in the 1970 British Cohort Study (BCS70) since they were born, more than 50 years ago. At age 46-48, in 2016-18, they took part in a biomedical survey, where nurses measured their blood pressure and took a blood sample to check for diabetes. Participants were asked to report whether they had various chronic physical health conditions, such as recurrent back problems, asthma, heart problems, and arthritis. Mental health and high-risk drinking were also assessed, using separate questionnaires.

At age 46-48, 34 per cent of adults had multiple chronic health problems, with more than a quarter (26 per cent) engaged in high-risk drinking, more than one in five (21 per cent) reporting recurrent back issues, and just under a fifth (19 per cent) experiencing mental health problems. One in six (16 per cent) had high blood pressure, more than one in 10 (12 per cent) were suffering from asthma or bronchitis, one in 13 (eight per cent) had arthritis and one in 20 (five per cent) had diabetes in midlife.

The study also revealed the most common combinations of chronic health conditions experienced by adults in middle age. More than four per cent had mental ill-health and high blood pressure, three per cent suffered from mental health problems and asthma, 2.5 per cent had mental ill-health and arthritis and two per cent had diabetes and high blood pressure.

The research team used the rich longitudinal data collected from study participants throughout their lives to investigate the links between family background, cognitive development and health in childhood and adolescence, and physical and mental health in midlife.

They found that adults from the poorest families were at 43 per cent greater risk of having multiple long-term health conditions in midlife compared to those from the most privileged families. They had almost three and half times higher risk of suffering from mental ill health and arthritis, and around three times the risk of having poor mental health and high blood pressure in their late 40s.

Lower birth weight, higher body mass index and lower cognitive ability at age 10, and worse emotional and conduct issues at age 16 were all linked with increased risk of having multiple chronic health problems in middle age.

Gondek said: “Compared to previous generations, it appears that the health of British adults in midlife is on the decline. With earlier studies finding links between poor health in adulthood and lower life satisfaction, lower earnings and early retirement, public health guidance should focus on helping the population improve their health in midlife so they can age better, stay economically active and continue to lead fulfilling lives.”

Also, researchers have established the association between menopause and osteoarthritis. The study was published in Journal Mid-life Health 2018. The researchers from Department of Medicine, Government Medical College, concluded: “In conclusion, the menopause is associated with the onset and progression of osteoarthritis (OA) in women, and Hormone Replacement Therapy (HRT) can render help in such patients by reducing symptoms and progression, increasing bone mineral density, reducing bone, and radiological abnormalities in OA, but presently it cannot be recommended the first-line treatment with the current level of evidence.”

INTERMITTENT fasting may be the one simple change one needs to make to reduce joint pain and improve quality of life.

While many people with chronic pain caused by arthritis believe that they just don’t have a choice but to live with chronic pain and to take medication, the latest research shows that  a natural and healthy way  to reduce pain could be to practice intermittent fasting.

Intermittent fasting (IF) is a lifestyle where eating is restricted to a certain period. For instance, the hours of the day that one may eat would be restricted to 10, eight or even less hours per day.

MEANWHILE, medical experts are unanimous that there is need for massive enlightenment of the population on midlife crisis, associated ailments and how to prevent and treat them. It is believed that Nigerians such as Chukwuma and Ayodele would be better prepared to go through midlife crisis if they were better exposed to it.

Other longer fasting periods could be practiced in more extreme types of intermittent fasting.

Fasting has actually been practiSed in different ways and forms in many cultures for centuries. If one thinks about the Jewish Yom Kippur or the Muslim Ramadan, both of these religious fasting periods are actually types of intermittent fasting, exercised by millions of people over many hundreds of years.

However, intermittent fasting has now become the latest lifestyle and wellbeing trend worldwide. It is even reported to have anti-aging benefits!

Intensive research has been going on to try to figure out the cellular, genetic and other physiological processes, which are activated during fasting. These fasting induced processes seem to be very beneficial for the body in many different ways. One of the most relevant effects is that during fasting, one’s body initiates important repair processes within the cells. Fasting seems to reduce oxidative stress, excessive oxidative stress damages the molecules and cells. In addition, different hormones are activated during fasting – for example the hormones responsible for mobilising body fat and losing weight are activated. Most relevant for arthritis patients though, are that intermittent fasting has also been shown to reduce inflammation.

A study at the University of Oslo found that people with arthritis benefited from intermittent fasting. Fasting can also be used as an adjunctive therapy for chronic pain and chronic fatigue syndromes.

A study published in Journal of Clinical Orthopaedics and Trauma found that obesity and Knee Osteoarthritis (KOA) has a proven association. It noted: “The obese individuals are likely to have early and more severe KOA, and the complications and overall results of surgery are also inferior. Hence, weight reduction is of paramount importance for these individuals. Due to the inability to do intense physical activities, these individuals cannot lose weight and instead perpetually kept gaining weight. Hence, intermittent fasting as a non-operative means of weight reduction is an attractive and viable option.”

MEANWHILE, medical experts are unanimous that there is need for massive enlightenment of the population on midlife crisis, associated ailments and how to prevent and treat them. It is believed that Nigerians such as Chukwuma and Ayodele would be better prepared to go through midlife crisis if they were better exposed to it.