It's when we hit mid-life that we often suddenly become aware of our mortality. Depending on how long you expect to live, somewhere around the 45 mark will come the realisation that half your life is behind you — and if the second half is going to race by at the same speed, it might be a good idea to look after the vessel you've been walking around in and quite possibly ignoring, if not downright mistreating.
This is when we tend to see people embarking on the mid-life health overhaul. These days you could argue that the new mid-life crisis isn't about leaving the wife and buying a sports car; it's going paleo and training for a marathon.
Extreme measures like this are not for everyone, of course. But there are some things that can do a middle-aged body good — and some things we accept as common wisdom that might not, in fact, be so good.
Middle-aged spread is part of the deal
We can't really do anything to slow an expanding waistline as we age, right? For men, after years of eating whatever you want and apparently burning it off, it can come as a surprise to see a belly appearing. Inactivity, alcohol and indulgence on the food front are usually to blame. In women, perimenopause and menopausal hormonal change cause oestrogen levels to drop and, combined with less movement and more food, lead to weight gain around the middle.
We might feel comfortable with a spare tyre — and even more so when everyone around us looks pretty much the same — but fat around the abdomen is problematic, as it tends to be what's known as visceral fat: fat hugging our organs. This is associated with inflammation, heart disease and insulin resistance.
While bodies change with time, and hormones have their impact, there are those who say we don't have to gain weight and lose condition as we age.
The founder of Auckland gym Bodytech, Peter Rana, says in middle age we have to face up to the consequences of our choices. "It seems inevitable, because everyone gets the spread," he says. "But that's because of lifestyle. If we say 'I want to eat dessert while watching movies for six hours of my downtime,' that's going to have a consequence."
Our bodies naturally tend towards decay but there is a way to slow that process down, Rana says. "Get really, really fit. It's not really that hard."
We need to eat well and also "recognise that you don't just have a heart and lungs; you have muscles. The stronger and the better condition your muscles are in, the better you're going to function."
We don't do that with a bit of easy walking. Short, intense, strength-training exercise works better.
"It is vitally important for middle-aged and older adults to do strength training — they need it more, and they potentially benefit more, than their younger counterparts," says Rana. That's because muscle mass keeps our metabolism working at a higher level. The more muscle we have, the better we burn calories.
"Keep it hard and do it slow. Strength training is not fun. It shouldn't be, if it's working."
A little tipple is good for us
We love to believe that a glass of red wine is good for the heart. Unfortunately, we're probably doing more harm than good with our therapeutic wine sessions. The World Health Organisation classifies alcohol as a Group 1 carcinogen — the same grade as asbestos. It's noted as a cause of at least seven types of cancer, including the big ones that hit at middle age: colorectal and breast cancers.
So far, so depressing. But don't all those Mediterranean types live to 100 by having red wine every day?
While it's true that certain populations appear to benefit from moderate drinking, it seems the benefits are often overstated. The Heart Foundation says the relationship between alcohol and cardiovascular disease is complex, and for most people there will be little, if any, benefit. Don't start drinking to get heart-health benefits, is their advice.
We don't necessarily have to go teetotal, although if we do it's probably a health plus. If you do drink, the Ministry of Health recommends no more than two standard drinks a day and no more than 10 a week for women; and three a day and 15 a week for men — plus at least two alcohol-free days. A standard drink is not a generous restaurant pour, either; it's a sherry-glass-sized amount of wine (100ml) or less than a bottle of beer (250ml).
It's worth noting that alcohol is broken down more slowly in the body as we age, so the effects are greater — probably the reason why hangovers feel worse. And if that doesn't send you reaching for the low-alcohol beer, think of the weight effects: three large glasses of wine are equivalent in calories to about six slices of bread.
Supplement your bad diet
The supplement market in New Zealand is huge: we spend more than $200 million every year on pills and potions promising to cure all that ails us. This is despite diet surveys showing we get good nutrition from our food and probably don't need them. One persistent belief, say experts, is that a multivitamin will "fill in the gaps" if we don't happen to eat a healthy diet every day, like a nutritional insurance policy.
Nutrition Foundation nutritionist Sarah Hanrahan says a pill is not a shortcut to health. "In the first instance, it's better to get the nutrition we need from food," she says. "It's not even that difficult to do. Half a plate of vegetables with your evening meal; a couple of pieces of fruit, some protein and some carbohydrate. I don't think you need an insurance policy — it's better just to eat well."
There are some supplements Hanrahan says might be worth considering, though; fish oils for omega-3, for example. "But there can be issues with quality. Because it's a fat, it can go off."
She recommends getting good advice before buying. The same goes for supplements aimed at joint health, such as glucosamine. "I wouldn't just go and buy it off the shelf. I'd talk to your doctor or pharmacist first and find out if that's a good way to go for your particular problem. But certainly there's evidence they can work."
The same applies to therapeutic vitamins such as calcium and vitamin D. In most cases, Hanrahan says, we're better off spending money not on supplements, but on "plenty of vegetables and fruit".
Sex in midlife winds down
As we get older, our sex lives go downhill, right? It can certainly happen; lack of interest in sex can come with the stress of work, kids and life. Health conditions that come with middle-age like obesity, hypertension and diabetes can also kill desire. But science tells us a sexual decline is not an inevitable part of middle age.
Research published in the Annals of Family Medicine in 2015, looking at women's sexual satisfaction in mid-life, found "a considerable proportion of mid-life and older women remain sexually active if they have a partner available". And ageing wasn't really a factor in how satisfied the women were. Things like relationship satisfaction and communication with a romantic partner mattered more to sexual satisfaction than age.
Perhaps unsurprisingly, we're also more likely to have a good sex life if we're generally healthy. A study published in the British Medical Journal found middle-aged men who were in good health had more sex, and a better overall sex life. People in very good or excellent health were almost twice as likely to report an interest in sex than those in poorer health; and both sexes gained several years of "sexually active life" when they were in very good or excellent health. Bottom line: the fitter and healthier you are, the healthier your sex life is likely to be.
Creaky joints are part and parcel
Getting up out of a chair can start to feel harder when we're in our 40s and 50s; we may notice ourselves uttering involuntary sounds on sitting and rising, and our knees may start making creaking noises of their own. It's partly down to wear and tear; ligaments and tendons become more brittle and cartilage thins, leading to stiffer joints.
Loss of muscle strength also plays a role, putting increased stress on joints like the knees and making us prone to osteoarthritis. But we can offset this with exercise. Again, building muscle will help. Strong muscles protect joints and help them function better and with less pain.
"Weight training — especially in the negative part of the movement [as in letting down a weight] engages the whole joint structure — the ligaments, the musculature, the synovial fluid", says Peter Rana.
"When you target the muscles, it indirectly affects the joints, too."
Middle age health boosters
Five things that will keep us in tip-top condition from our 40s onwards:
Eat a bit less (processed food)
Eating less overall is not a bad idea as we age. In older age especially, our calorie needs go down and our nutrition needs go up. That means cutting the junky and refined, and choosing whole, nutrient-dense foods.
Eat a bit more (plant food)
Eating more plants is a sure-fire way to boost your chances of staying fighting fit. Adding more veges and fruit will probably mean you'll automatically cut out a bit of meat; not a bad thing since it's associated with some of our most common cancers.
Give up on diets
If you've reached your 40s and have never been on a diet, good for you. If you have dieted, you're old enough to know they don't work. So ditch the detox or juice fast. The only weight-loss solution that really works is to make small, sustainable changes to how you eat that you can keep going for the whole second half of your life.
Take up strength training
Avoiding age-related muscle loss (and accompanying fat gain) can be as simple as getting into moving some heavy weight around. Muscle helps burn fat and protects bones and joints. Switch a couple of your long walks for weight-training sessions.
Cut down on alcohol
Give up on the "it's good for my heart" story. Although moderate drinking is associated with good health, it needs to be very moderate. Less is more, and alcohol-free days are important. Familiarise yourself with a standard drink: it's probably not as much as you think it is.
Niki Bezzant is a food and nutrition writer and editor-at-large for Healthy Food Guide.