Umbilical hernias, caused by diastasis? And "exercise does not help you live longer"??

On this week's episode I talk umbilical hernias.

A lot of postpartum women have an umbilical hernia but there seems to still be a lot of confusion about whether there is a causal link between diastasis recti and umbilical hernias.

Can you repair an umbilical hernia by exercise, as some personal trainers would have you believe?
Is a hernia "Just diastasis on steroids"??
Should you be worried about having an umbilical hernia?
Can you manage a hernia?
How can they be repaired?
etc. etc.

After that I have a little look at this paper from Finland that you might have seen flying about online (or in the Daily Mail) which concludes that Exercise does not help you live longer.

But does it though, does it really say that?
Or might there be one or two other things in there that mean it's a bit more nuanced like that.



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Playing us out this week "Sky Walker" by Grace McCoy

Transcript

Peter Lap: 0:00

Hey, welcome to the healthy postnatal bo the podcast your postnatal expert, Peter Lap. That, as always, would be me I am talking umbilical hernias, do today those dinosaurs are actually called the hernia. That's one of the questions I was asked. And how can exercise help you get rid of an umbilical hernia? And finally, the second bit that I'm doing "in the news this week, so to speak. Remember when I used to do that in the news this week? Michael mostly had a Daily Mail article, and this paper is doing the round Everybody now saying exercise does not help you live longer. I am going to have a look and that's finished. Study the paper that came from Finland, because it's quite an interesting one, because is it really true what they are saying? Is that really what they are saying? Let me put it that way. So, without further ado, here we go. Hey, and welcome to the Elfie Postnatal Body Podcast with Little Old Me. This is the podcast for the 17th of December 2023 and at least next week. It's Christmas time. I haven't decided yet whether I'm putting an episode out on Christmas Eve or not, because what's the point? You must have better things to do than listen to the little podcast on Christmas Eve, right? Also, christmas Eve, of course, is when it's Christmas proper, right, that's when it starts for a lot of you people. So you know, I'm not sure yet. I am here with all the fluffies today. Bob is here, kitty is here, buddy is here and even Polar Bear is here. They are all behaving well right now, so let's hope that holds. I hope you are well.

Peter Lap: 2:01

I had a question this week about umbilical hernias and whether exercise can actually help you get rid of an umbilical hernia. There were a couple of things on Fred's doing around and someone sent me a little email. I am h , by the way, right, the Healthy Postnatal Body. I don't use Instagram much and I don't use Facebook much at all, really, Threads Fred's I am a bit more active on. So if you insist on not emailing me peter@healthypostnatalbodcom .. o but you'd like to get in touch via social media, if you think that's easier for you, then that's what you do.

Peter Lap: 2:51

Anyways, lots of emails from people, lots of discussion this week about umbilical hernias, because you know, diastasis, recti and umbilical hernias kind of, according to some people, they go hand in hand a piece and a pod and all that sort of stuff. And the question was does diastasis cause the hernia or not? And can you exercise the hernia away if you have an umbilical hernia postpartum, and can you do that by doing diastasis recti exercises? That was the question. Now I'm saying lots of emails. I was one email about that and then there was a lot of discussion, a lot of discussion on the internet, because if you Google this type of stuff you'll come across various articles, various people selling you programs, that and again caveat, I obviously have my little program Selling your programs to tell you that their program will help you get, help you reverse an umbilical hernia. I'm not quite sure what they mean by that, but sure have you reverse, help you reverse an umbilical hernia and turn your belly button from an outie back into an innie. I've seen that and I've seen comments saying umbilical hernia is like diastasis recti on steroids. You have to work a bit harder at it but it's all possible. And then you have people just saying that you know, if you have diastasis recti you'll likely also have a hernia and all that sort of stuff. Now I'll just be very blunt. You can't exercise away a hernia. That is not what tends to happen. What you can do is exercise all the muscles around the hernia and if you have a tigitigy hernia, then you know that can look like it goes away, that's fine. But if you have a decent size umbilical hernia and I know some of you have really good ones the surgery really helps for that.

Peter Lap: 5:01

Diastasis also doesn't cause a hernia. It is what they call a concomitant disorder. It's an illness that exists at the same time as another. It means the definition of concomitant and I had to paste this Right so I get the definition right. It means a company or associated. It's an associated illness. So if you have, you know, if you have a diastasis recta, you could also well have a hernia, but that doesn't mean that the diastasis caused the hernia, if you know what I mean.

Peter Lap: 5:42

The trickiness, of course, is if you have diastasis recta and the hernia, as with most of these things, your primary problem is the diastasis, and that's the one that you could very easily see. Then that may. If you have a little hernia on top of that, or even a big hernia on top of that, that makes treatment of the diastasis a bit more difficult, because you have to be a little bit more careful Right, because you don't want to increase the pressure too much. This is why I always talk about how the solution to recovering from diastasis recti is managing the pressure on your core. That's fundamentally what it is.

Peter Lap: 6:29

As I always say, diastasis recti is not caused by pregnancy as such. Diastasis recti is caused by internal pressure and that's important to understand. There's more than one way to get diastasis. Is all I'm saying. I'm not saying your pregnancy didn't cause your diastasis, but fundamentally it's because the baby kept growing and, as I always say, you keep growing the baby. The baby is bigger, the pressure increases and therefore these muscles have to move a little bit. So that's managing of pressure is really important when you do. That just becomes a bit more important when you have a hernia.

Peter Lap: 7:17

Now, like I said, diastasis e isn't a hernia, it's one of those, but the hernia can be there at the same time and quite often what happens is that women who have, who still have, diastasis dysosus recti recta, but have a small tummy and spoke about this quite a while ago right, diastasis dysosus recti recta does not mean you still look pregnant Three, four, five, six months postpartum, or a year or two years postpartum. If you have diastasis Dysosus recti recta, you can have D recta while having a flat stomach. It's purely, it's a gap thing. You can have a little pouch and all that sort of stuff. You can have a little, a little rounder belly. Most people have that in day to day life anyways.

Peter Lap: 8:05

Right, the usually what happens with these things is that a lot of women go to the doctor when they have a sticky outie bit which is a hernia. So they don't necessarily go into the doctor's office or they don't necessarily seek help because they have diastasis, right, the mom-tom sort of horrible and still makes me shiver whenever I use that phrase. That that is not the reason they go to the GP or or at the other medical health professional. They go to the GP because they have a sticky outie bit and that's a hernia and that then needs replaced and all that sort of stuff. Right, but there is no evidence as that. I have come across that limit little caveat for you there that shows that there is a causal link between diastasis and the hernia.

Peter Lap: 9:01

The hernia is not the same thing as diastasis recti s. So we have to make sure that when we're exercising, if you have a hernia and you Diastasis recti rectitis, you have to make sure that you're a little bit more careful. But you can heal Dysostasis for exercise, bring everything together and all that sort of stuff. That doesn't mean that your hernia will be fixed, right? That is a separate problem. Is what I'm saying. If you're having surgery, you can have them both addressed at the same time, right? If you have Dysostasis surgery and you have little hernia, we have a big hernia or whatever they can. They can sort all that out. That is a different beast altogether.

Peter Lap: 9:45

So when people tell you that they have an exercise program for you and this is the main reason why I'm bringing this up today that they have an exercise program for you that helps you recover from your hernia I didn't help you repair your hernia, let me put it that way. That is not really accurate. I'm being very nice about this, so that is just not true. You can't reverse a hernia just by exercising. That is not how that is not at all how that works. What you can do, of course, if you've had hernia operation, well, hernia surgery and all that sort of stuff, you'll need to do some exercises afterwards to help your recovery. And a lot of these programs that sell the reversing of a hernia kind of tag on to the websites of the Search Engline n Optimization Optimization type stuff, of the websites of reputable surgeons and all that sort of stuff saying these are here are some good exercises to do for your hernia recovery stuff. But that is after surgery. So that's an important distinction. I'm not going to name any names or lists and all that sort of stuff. I'm not going to list any people and programs that come out with claims like a hernia is just diastasis on steroids. So if you Google it you'll come across it. But you know those people are not really being completely honest with.

Peter Lap: 11:28

Your hernia is something if it bothers you, of course for which you go see your doctor and you ask for a referral and they can get you a referral and then a surgeon will take that to the next level and there's a personal trainer in the world that will be able to reverse your hernia for you, make it manageable. Yes, sure, right, so that is. It's always a good idea to exercise and to. If you have a little hernia it doesn't bother you too much and you know you're not that keen on surgery and all that sort of stuff. So it's always a risk of a reoccurring hernia. That if you have one, chances are. You know we'll fix that it could come back and all that sort of stuff or something like that, could come back. You're at higher risk of that Not saying it's guaranteed to happen, just higher risk. So it's if it doesn't bother you too much and there's only a little one, you can exercise the area. You can strengthen the whole area up and do loads of core related exercises and support that make of the woods a little bit better. Right, that is always a good idea, doing the right exercises, working with a professional like little caveat there. But that is different from reversing a hernia for exercise and on that phrase is something that we really really have to ban. Speaking of things we have to ban. Oh, that's a nice little, nice little segway.

Peter Lap: 13:03

Michael Mosley Michael Mosley was, as he used to be known, Dr Michael Mosley, but I think he's given that up Wrote an article in the Daily Mail. I'm not going to link to it again. I took some screenshots of on threads. I don't want to give the Daily Mail any more clicks than required. Basically, he came out with a whole bunch of statements in the article. This was one of those clickbait things that he's very good at writing, which is why he made it on in my top three of worst people in the health and fitness world a couple of years ago.

Peter Lap: 13:37

If you remember that little fiasco, exercise doesn't make you live longer. That is the claim. A new study from Finland says that basically, exercise is pointless if you want to live longer. That's pretty much how Michael Mosley phrased it, and you know that's a claim and a half, isn't it? Exercise does not help you live longer. That kind of goes against everything we kind of think we know about about exercise. So that makes me question one or two things. So I Google this and I know several other people on social media have also been sent this study. So I found this study because it's not that difficult to find and again, I'll obviously link to it in the podcast description and I have it open here on my website because, on my thing, the associations what is it called? The Bing-Ops at the top, right, this is a reprint, it's not yet peer-reviewed, right.

Peter Lap: 14:45

So the associations of long-term physical activity in adulthood with later biological aging and all-cause-partality, a prospective twin study and this is a really interesting paper. It really is. I like the paper well enough. You know basically what they did. They took 22000,. They had a look at the Finnish twin cohort study. Basically what they said. To summarize it, a lot of the previous studies that say exercise is good for you, right, and will keep you alive for longer, and all that sort of stuff is based on observational studies and is not measured over a prolonged period of time, so an infinitum. They have the Finnish twin cohort study, which is over 22,000, 22,000, people, 22,750, yeah, 22,750 people who were between 18 and 15 years old when they started this thing, and they have three points. So their data points were mailed out. The questionnaires were mailed out in 1975 and 81, and a follow-up questionnaire in 1990. So they basically sent everybody three questionnaires and quite a few people completed that. And the nice thing about working with twins is that, genetically at least, a lot of them are obviously closer together than I am to my wife, for instance. So you can control the study a bit better. That's kind of what the thinking there was, and 22,000 people is obviously it's a massive number, right? So that's awesome.

Peter Lap: 16:53

The conclusion they came to being active may reflect a healthy phenotype instead of causally reducing mortality, and phenotype is basically your genetics in your environment and all that sort of stuff, right? So the study looked and this is important to single this out the study looked at causally reducing mortality. That is all they looked at and that is important when you want to draw conclusions from this thing, because there are some issues here with the study, so I'll just go through a few bits and pieces of it. Right? So they looked at leisure time, physical activity, ltpa, and again I will link to the study. So they said you know in the introduction, the association between leisure time, physical activity and a lower risk of mortality from all causes and cardiovascular diseases is frequently reported.

Peter Lap: 18:02

However, the evidence is generally based on observational studies and LTPAs typically assessed at single time. But what is it? Slower biological aging? They looked also into that, saying if you're active, will you? You know, if you're active, will your age slow or something. Michael mostly also used to be really big often, although apparently now he dumped it. You know, when there was a book to sell he was a big fan and I know I have it in for him a little bit. Right, that's fair enough Basically.

Peter Lap: 18:35

So what they were looking at, they were looking at self reporting. So a physical activity. They send out questionnaires to people. Say now, active in your leisure time and how do you get to work? You're commuting activity. So those are there. That's what. That's what they were looking at.

Peter Lap: 18:54

Right, they did not include the type of work they did in this study, as far as I can tell, which is a little bit odd for me, or that that's maybe it was impossible, I don't know. But someone who's sedentary for eight hours a day, working at desk, who walks to work for half an hour and who then goes to play squash for half an hour or something like that so these active for an hour, whereas a lumberjack, because it's on his bum all night watching Netflix, but who hacks at trees all day, is active for eight hours. And as far as I can tell, they did not include that. That's a bit of a pickle, because it kind of says we're only looking at stuff you did outside your work, right, leisure time, physical activity, and again, it might be wrong. So, peter at healthyplusnatocom, if you happen to know any of the of the people that wrote the study and whether they took that into account, I couldn't find anything in the study that said they did so.

Peter Lap: 19:57

Over a third 38.8% of the participants for the sedentary class died during the mortality follow up period, compared to 30%, 29 and 25 and a half from the more active classes respectively. Active classes had 15 to 23% lower all cost mortality risk compared to the sedentary class, and after accounting for other health related factors, the reduction in mortality risk was a maximum of 7%. Now, as I said when I first skim the study, I don't think 7% is insignificant. But the next line is kind of important. Overall, the favorable associations of LTP were more consistent with short term rather than long term mortality. In particular, high activity was associated only with low, lower, short term mortality. And then one day, when they looked at other health related issues, that 7% also dropped to virtually zero is what they were saying.

Peter Lap: 20:55

For some reason I didn't highlight that bit and said I can't find it and I'm not going to make you listen to the whole thing. Oh yeah, here's it. Moderately active classes low risk all cause mortality. After additions, after additionally adjusting the model for other lifestyle related factors, the differences were considerably attenuated. But the moderately active and active classes exhibited lower risk of all cause mortality compared to the sedentary class within all pairs and MZ pairs. So that would make me think that exercise works. That last, that last sentence. So there's a lot happening in that statement by the way Over, so I'll go through it a little bit in a bit, and I know I'm jumping a bit and I know that that's annoying when there's no video, but there you go.

Peter Lap: 21:46

Overall, the favorable associations of long term leisure time physical activity were more consistent with short term than long term mortality. Yes, of course I think that this is an absolute no brainer. In particular and I will get to that in a little bit in particular, high activity was associated only with lower short term mortality. Yeah, very, very active lifting loads of very heavy things or you're walking loads this month might not make a lot of if you run a marathon. This is what I always say if you run a marathon in 1998, that doesn't mean you still be healthier by 2010. Right, it is. That is the short term benefit.

Peter Lap: 22:28

You have to remain active and this is kind of what one of the weaknesses of the studies, which they highlighted as one of the weaknesses, is that the leisure time physical activity data points were not there for people in across all three points. So I would want to know how many people who are active in the first two measuring points were still active at point three. You know what is the adherence rate? Because, like I said, if I'm active if I'm 18 years old when the studies started and they sent out the send out this and I'm active until I was kind of 40 years old or God knows what 35, I'll have hit two of these data points and I missed the third. And then I sit on my bum all day. I'm still going to die. I'm going to have some of the benefit of having had a healthier life, for sure, right, I would have thought so. But I'm not necessarily then going to have the benefit of having run a marathon 10 years later, right, that is and that's important to remember that what you're doing today keeps you healthier today and tomorrow, but it doesn't keep you necessarily much healthier to three, 10, 20 years from now. Right, this is why we need to keep it up, right.

Peter Lap: 23:47

This is kind of a no-brainer, right, as they're saying here, in a model adjusted only for health status at within the within pair level. So the analysis showed that the moderately active and active classes exhibited lower risk of all-course mortality compared to the sedentary class within all pairs Right. After additionally adjusting the model for other lifestyle-related factors, which again now okay, there we go the differences were considerably attenuated, but the moderately active and active classes exhibited lower risk of all-course mortality compared to the sedentary class within all pairs, right. So moderately active and active classes exhibited lower risk of all-course mortality compared to the sedentary class. Again, we're putting aside what these people did for a living. We're saying that if you have some form of leisure activity and your health you're on your commute to work I think you don't drive and all that sort of thing you will exhibit lower risk of all-course mortality compared to people who don't have none. That backs up the idea that exercise works. Be an active and better than sedentary, right. Then I say model 2 was additionally adjusted for education body mass, in-next smoking, alcohol use at the within-tree and pair level.

Peter Lap: 25:07

Now, obviously, this makes sense when you solely look at the benefits of exercise on longevity. However, we know that as humans, we have to take into account that often people who exercise make other, healthier lifestyle choices as well. And vice versa. If you are healthy and this is one of the things the study mentioned. That's why I said that I quite like this paper. At least it's a challenging one people who are healthy are finding it easier to exercise. So and this is the point that the paper makes a little bit when they say, yeah, but you know it's your genetics. If you are healthy, then you are likely to be more active and therefore you are likely to live longer, and therefore it's your genetics that drives up much more than it's the physical activity is.

Peter Lap: 26:02

And that's the point of the paper is that you can't prove a direct causal link. And you can't because this is remarkably complicated. This is so complex and this is why I always say, with regards to like diastasis recti and postpartum exercise programs, there will never be a study that proves X works because X. There's plenty studies that say things don't work. But for certain things things are what they are right. Diastasis recti, for instance, if you just look at the narrow definition, most women recover from that postpartum within the first year. 20% don't.

Peter Lap: 26:45

But if I therefore start exercising with somebody three months postpartum and the exercise I trained with me and they don't have diastasis recti seven, eight months postpartum, we can't definitively prove that it was my program that did it. It might have happened all by itself, it might have happened anyways, all by itself, right. So we have to take into account that healthy people, people who are genetically healthier, might just be more active anyways and therefore that is what the driver for longevity is, rather than the actual exercise. But we know that from when I say we know, we know that from I see that with my clients and we know that us people and various studies have been done to prove this, or I can't find them because I didn't because I could find them, but I haven't looked for them and it's 15 minutes before this podcast needs to come out, so I'm in a bit of a rush.

Peter Lap: 27:46

If you exercise in the morning right, which a lot of people do chances are you'll have a healthier breakfast rather than a big mug for breakfast or a mug muffin or whatever. Whatever those things are right. Dietary adherence is also different in higher and health. It's easier to stick to a healthy diet when you're exercising plenty and all that sort of stuff. People tend to make healthier food choices when they're more active, whether that is their environment which again, the study says a lot of this is the environment that people are raising, or whether that is, that's a completely different matter.

Peter Lap: 28:29

So for longevity, the paper says listen, you can't prove that that exercising keeps you alive for longer. Now what I would argue and this is what I've always argued is that and this is what this paper is missing from. Again, from what I can see, the paper didn't look at health spam. How long were people who exercise regularly healthier reported? How long were they healthier? How long did they report fewer aches, pains, niggles and illnesses and all that sort of stuff? Right, that's what I, that's what matters. If you tell me I'm gonna drop dead by the time I'm 85., yeah, but am I gonna have been sick for 20 years or am I gonna have been healthy for 20 years? Also, we have to take this into account. We know this again because remember when I had a lot of disagreements with people in the fat acceptance movement that went too far, not because of the fat acceptance and not wanting to body shame and all that sort of stuff, but when the fat activists and all that sort of stuff were. It's quite a while ago. Listen again. See my top three worst people in the health and fitness industry. At the time it was included in that one.

Peter Lap: 29:45

When people get sick at the age of 50, we're really good at not having them die, right, we're really really good. These days, when someone is 50, who's relatively unhealthy, they can go to the doctor and the doctor will keep them alive for a long, long time Not necessarily in the best of health, though, right. So that matters. Again, I don't really see anything that, and I don't know how they would do it, but I didn't see anything in the paper that said, yeah, we've compensated for this, right, so you have to kind of take that you have to kind of take that into account as well that the medical intervention, so to speak, that we are able to make now for people who are not as healthy means that we can keep them alive longer, and that gap between healthy people healthy people's lifespan and unhealthy people's lifespan is getting shorter all the time and, overall, if someone says to me, listen, you'll drop dead at 85 or 83, whatever the average lifespan is these days in the UK.

Peter Lap: 31:13

The life expectancy is in the UK these days. Yeah, I'm happy with that. If I'm healthy, yeah, I'm gonna pop my clothes, walk in the dogs one day, you know, or in my sleep, ideally that sort of thing. That's different from having been sick for a long, long time. And it would seem to me that, as this article, as this paper, points out, that the benefits of exercise are relatively short term. So if you're exercising, you're healthier in the moment, yeah, but if you keep exercising, you'll be healthier for a prolonged period of time, right, and therefore, by definition, you'll be healthier for longer. Staying out of hospital for 10, 15, 20 years how soon and it matters when you say, whether exercise keeps you alive for longer, matters if you then say, yeah, but the last guy is only. Pete lived until he was 85 years old myself, as an example. Pete lived until he was 85 and he was healthy. But someone who was very unhealthy lived until he was 85. Yeah, but how long was he basically kept alive by medication, right? So, like the paper says, the eugenetics in your environment have a massive impact on whether, on how long you live.

Peter Lap: 32:41

We know this health wealth is health, right, this is a no-brainer. You see this in every nation. The middle class, plus the upper middle class and all that sort of stuff. They're overall, generally speaking, in better health because they have access to more stuff. They can afford a David Lloyd gym membership. They can afford a diet status, right. They can buy Mutu, right? I didn't even mean to turn this into a why Mutu sucks, sort of thing, but they can afford to work with a personal trainer. They can afford to buy healthy food. They can afford to eat fresh every day. They can afford to go to a private school. They can afford to live a more stress-free life. They don't have two, three, four jobs that they need to work Of course that matters. They can afford to have leisure time, physical, effing activity Right, that matters. Of course it does. It always matters more.

Peter Lap: 33:43

Anybody who's ever thought that exercise would be more important than genetics or environment for a lifespan is out of their mind. That's the same, that must be the same brigade as people who think that weight management is 70% diet and 30% exercise. It's not brigade, it's oversimplifying and massively overestimating the effect exercise has on this. Stuff which, I'm mentally, personal trainers are prone to do, right, yeah, that's my little rant. I didn't mean to go off the rail, sarah, but I did so. There you go. That's what you're stuck with. Of course genetics and environment matter more for life expectancy, but that doesn't mean that exercise doesn't matter at all, and that is not really what the paper says.

Peter Lap: 34:45

The paper does not claim that exercise does not keep you fit for longer, doesn't keep you healthier for longer. It just kind of says if you're exercising, that within itself is no guarantee that you'll live longer, and I think that is something we can all get on board with other than Michael Mosley who basically said, yeah, there's no point. He's massively wrong on that Right. So that, my friends, is important to remember. I just did a whole lot longer on this than I was going to and a bit a lot of it is incoherent rambling, so apologies for that, but I hope that clears it up a little bit. And this is just the short takeaway of that paper Exercise keeps you healthier for longer. The paper doesn't say that it doesn't. In fact it says the opposite. It just doesn't necessarily running a little bit in your leisure activity every day, as your leisure time activity doesn't keep you alive for longer. They think that's a different beast altogether from, like I said, from. It doesn't matter at all Anyway. So I'm starting to repeat myself, so I'm going to call it quits there, because we're 36 minutes in.

Peter Lap: 36:09

Peter healthy @healthy bodycom. If you have any questions, any comments, want to call me a jackass, whatever you do, like I said, I'm on Fred's, Threads I'm active on Fred's, I'm on everything, but that's where I'm active. Next week we have a guest again. If I put one out next week, otherwise it will be the week after New years. You're not going to listen to New Year's Day either, are you? Yeah, we'll see. Anyways, new bit of music for you. Have a tremendous week, take care of yourself. Bye now. Your secrets are burning up. Can't pretend to cover up the demons Inside your lungs, inside your guts.

Peter Lap: 37:26

You're walking and you're up for a ride. Small talk about your acting mind. You're walking, taking on no style, even from the tip. You're gonna watch her lose your grip. You're walking and you're up for a ride. Small talk about your acting mind. You're walking, taking on no style, even from the tip. You're gonna watch her lose your grip. You're so reckless all of them pretty cool and deep inside you're broken. Got two questions. I've got two inner searches. Make you turn your sentence.

Peter Lap: 38:05

Small talk about your acting mind. You're walking, taking on no style, even from the tip. You're gonna watch her lose your grip. Small talk about your acting mind. You're walking, taking on no style, even from the tip. You're gonna watch her lose your grip. You're walking, taking on no style. You're walking, taking on no style. You're walking, taking on no style. Stay walking and you're up for a ride. Small talk about your acting mind. You're walking, taking on no style, even from the tip. You're gonna watch her lose your grip. You're walking and you're up for a ride. Small talk about your acting mind. You're walking, taking on no style. You're walking, taking on no style.