the times | Tuesday October 20 2020 1GT 7
bodyhealth&soul
workout with ten 60-second intervals
at an intensity that left them puffing
hard) produced similar benefits. “We
also found our volunteers enjoy this
form of exercise as it didn’t take long
to do,” she says.
Fast once or twice a week
There are few studies to support the
idea that intermittent fasting —
such as the 5:2 approach — benefits
immunity in ageing adults, but that’s
not to say it doesn’t work. “Fasting
places the body under mild stress and,
as a consequence, it kills off tired old
immune cells when you fast and kick-
starts the production of new ones once
you resume eating,” Macciochi says.
Lord says that a twice-weekly fast
“does appear to have beneficial effects
on the gut microbiome, with one study
in humans showing that fasting twice
a week encouraged the growth of
health-promoting bacteria” that
will help to fight off infection.
Get on your bike
Staying active throughout your adult
life can have a marked impact on
immune function. The thymus organ,
situated between the lungs behind the
breastbone, makes T cells, which help
the immune system to respond to new
infections. From age 20 the thymus
tends to start shrinking, producing
fewer of these disease-fighting cells.
GETTY IMAGESHowever, in a study on 125 men and
women cyclists aged 55 to 79, Lord
found that thymuses of the committed
cyclists — men able to ride 100km in
under six and a half hours and women
to cycle 60km in five and a half hours
— were making as many T cells as
younger people. “The exercisers had
high levels of a hormone called
interleukin 7 [IL-7], a critical growth
factor for T cells and helps to stop the
thymus from shrinking,” Lord says.
Would there be a positive effect
if cycling were taken up at any age?
“We don’t know for certain, but my
guess is yes,” Lord says. “Studies in
mice have shown that if you give them
IL-7, the thymus can be restored, and
we think that active muscles will make
more of this hormone and keep the
immune system, and especially the
thymus, young.”Take a vitamin D supplement
“Vitamin D is critical for the immune
system,” Macciochi says. “It’s a steroid
hormone and our immune cells have
receptors for it on their surfaces, plus
it helps some immune cells function
much better.” Take it daily.Eat 30g of fibre a day
Our body’s biggest microbial load
sits in the gut. “It is connected to and
influences everything,” Macciochi says.
“It really is true that 70 per cent of our
entire immune system resides in the
gut.” A diverse, high-fibre diet is now
considered paramount. “When your
gut microbes chow down on fibre,
they produce by-products known as
‘postbiotics’. These by-products act
as an interface between diet and
immunity, changing the personalities
of our cells, and circulate in the blood
to affect the whole body regulation of
our immune system.”
The postbiotics from dietary fibre
help to fight infection by tuning up
virus-fighting cells, studies have
shown. Yet most of us consume too
little of it: women in the UK amass a
daily average of 17.2g of fibre and men
20.1g, far less than the recommended
30g. So increase your intake of fruit,
vegetables, wholegrains, nuts, seeds
and pulses to make the mark.Maintain good oral hygiene
Since the mouth is the entry to your
gut, oral health is vital to immunity.
“Every time you swallow you ingest
thousands of bacteria — some bad,
but, most importantly, some good,”
Macciochi says. “And your oral
microbiome speaks with your immune
system, just like the bugs in your gut.”
Thorough brushing and flossing
daily are essential, although
“some mouthwashes tend to
eliminate beneficial bacteria in
the mouth”, Macciochi says.
“Mouthwash containing chlorhexidine
has the potential to disrupt levels
of good bacteria.”Do push-ups and lift weights
Resistance work using weights or
exercises such as lunges, push-ups and
squats is vital. Lord says: “When
muscle is moving it can improve the
immune system, for example by
producing hormones called myokines
such as IL-6 that help immune cells
to function and keep inflammation
down.” Increased inflammation with
age is one of the factors that increases
the risk of age-related conditions such
as heart disease. “Strength work is an
absolute essential as we get older,”
Macciochi says. “It really can
rejuvenate your immune age.”Rise of the over-the-counter
opioid addicts By John Naish
no longer take on anyone new. “We
are dealing only with existing cases.”
Although codeine is prescription-
only in more than 25 countries, it is
freely available here, combined with
other painkillers such as ibuprofen
(for instance, in Nurofen Plus) or
paracetamol (Solpadeine Plus), as
a “better than ordinary” analgesic.
Last year an Aberdeen University
study in the journal Pharmacy found
that codeine-containing analgesics
are the most common over-the-
counter (OTC) drug of dependence
seen in substance-misuse treatment
services. In February the chairman
of the UK’s Commission on Human
Medicines opioid expert working
group urged a ban on OTC sales.
Jamie Coleman, a professor of clinical
pharmacology at the University of
Birmingham, said that for most adults
the weak dose allowed for OTC sale
“is associated with more of the adverse
effects, such as constipation, nausea,
with little beneficial effects”.
The Medicines and Healthcare
products Regulatory Agency (MHRA),
the UK drug-safety agency, says it has
kept a watching brief on whether OTC
codeine should be banned. Instead it
has required only stronger addiction
warnings on packets, saying the drugs
are for three days’ maximum use.
Meanwhile, you can buy endlessly
vast amounts of codeine from
overseas via the internet —
quite legally, as long as an
EU-accredited doctor
employed by the overseas
pharmacy website signs
you a prescription,
sight unseen. “This is
the biggest source of
addiction problems
we see nowadays,”
Grieve says. Two years
ago the MHRA told
me it was looking into
closing this loophole.
Last week the agency told
me that this is not actually
part of its remit.
There is no established publicly
funded support for people who
become addicted to prescribed opiates.
A service in north London was
defunded in 2017, leaving a few tiny
charities such as Over-Count.
Two years ago Public Health
England announced a review into
helping patients addicted to prescribed
medicines such as codeine after
a stinging parliamentary report. It
promised to publish a strategy by early- Nothing has emerged.
Last month NHS England told
campaigners that a “national oversight
group” had been formed to steer
action, but after two months of asking,
no one seems to know who is on it.
“I’m struggling to track the names
down,” a spokesman tells me.
Meanwhile, unless codeine-addicted
patients have sympathetic GPs willing
to fund withdrawal treatment, they
are left only with costly private rehab
clinics to help them. Or if they
continue on codeine, long-term use
can cause depression and anxiety as
well as liver and kidney damage. All
for a drug that the official treatment
watchdog says has “little or no
evidence” of efficacy on chronic pain.
C
odeine sounds harmless
enough. You can buy
the painkiller without
prescription in any British
chemist. Yet it is an opioid
that our livers turn into morphine, the
basis of heroin, and last week in the
journal PLOS One investigators at
Manchester University warned that
powerful-strength GP prescriptions
for the drug have jumped fivefold in
a decade, from 484 per 10,000 in 2006,
to 2,456 per 10,000 in 2017.
Codeine, like morphine, can block
pain-transmitting opioid receptors in
the brain. It also mimics natural
“feelgood” endorphin brain chemicals,
only more intensely, and the brain can
develop a tolerance, causing cravings
for more. Experts warn that you can
become addicted within a fortnight,
and fear that Britain will emulate the
US, which recorded more than 70,
opioid-related deaths last year.
“Chronic pain is estimated to affect
more than 40 per cent of the UK
population,” says the epidemiologist
Professor Will Dixon, one of the new
report’s authors. “This problem’s
frequency hasn’t changed noticeably
in the last decade, yet our results show
that the use of opioids for treating
pain have escalated considerably.”
And while codeine prescriptions
might be the only practicable remedy
GPs can offer to chronic-pain
sufferers, leading pharmacological
experts say that it doesn’t work
and is dangerous. In August
the UK treatment
watchdog, the National
Institute for Health and
Care Excellence (Nice),
issued draft guidelines
stating that alternative
treatments needed to be
prescribed, including
exercise programmes,
psychological therapy
and acupuncture.
Despite chronic pain being
common, particularly in
middle-aged and older people, its
causes often appear mysterious. Nice
experts believe that patients’ original
acute pain symptoms are intensified
by emotional distress such as anxiety,
stress or depression.
Professor Martin Marshall, the
chairman of the Royal College of GPs,
says that while Nice’s draft guidelines
“have the potential to be beneficial for
patients”, access to alternative
therapies is patchy across the country.
Nice plans to publish definitive
guidance next year. GP resistance
might kill the codeine ban. There’s
a precedent. In 2014 draft guidance
told GPs to stop giving high-dose
paracetamol on safety grounds. They
protested that they had no practical
alternative. The draft was withdrawn.
Codeine is also prescribed for acute
pain, such as after an operation or
an injury. The new Manchester data
shows that one in seven patients with
first-time opioid prescriptions
subsequently became a long-term user.
David Grieve, a retired nurse, set up
the codeine addiction charity Over-
Count in 1993 after he had become
addicted to cough mixture taken for his
bronchitis. He has been contacted by
100,000 people since, he says, and canoverseas via
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