Public Health Collaboration Edinburgh

I attended the PHQ conference in Edinburgh on 17 March 23. This was the first such meeting in Scotland and it was well organised, interesting and well attended.

Moira Newiss is on your far left of the photo in her navy dress and black boots. Moira organised the meeting and also spoke about her experience of having post viral fatigue twice in her life. This led her to explore the functioning of the mitochondria in our cells. She found that the mitochondria don’t function normally and become depleted in chronic fatigue syndrome and fibromyalgia but that primitive pathways in the cell using ketones for fuel are still active. She started a ketogenic diet and recovered completely from her chronic fatigue syndrome. She now runs for a hobby.

Dr David Unwin is standing next to her and is wearing a bow tie and suit. He is now 65 years of age and has been promoting low carb diets in his practice for the last ten years with great results. He is having so much fun that he doesn’t want to retire!

He found that in many cases type two diabetics can reverse their condition completely by the adoption of a low carb or ketogenic diet. Statistical analysis showed that the people most likely to reverse their condition had had been diagnosed in the previous 18 months. There is thus a great window of opportunity for advice and coaching to be provided to these patients at the earliest opportunity after diagnosis.

Results after 18 months are more variable, with a great improvement in diabetes seen, but sometimes not to the extent that complete remission occurs. Some medication support is often still necessary. Insulin may be able to be substantially reduced or stopped but some alternative medication may still be required.

Monitoring of patients blood sugars will still be required for both groups lifelong in case high blood sugars return. This can be due to secondary beta cell failure and may require tightening up of the diet, the addition of medication and sometimes insulin. If higher blood sugars and weight loss is reported, pancreatic cancer requires consideration and this is detected by urgent MRI scans. Sometimes a patient has been wrongly diagnosed as type two when they are really type one. In all cases they will need to see their GP for diagnosis.

Dr Iain Campbell is standing next to Dr Unwin and is wearing a waistcoat and white shirt. Iain told us about his struggles with bipolar disorder. There certainly could be a creative advantage to this illness, as Iain spent his young day in a rock band and even now is a successful composer. He has now settled into fatherhood and medicine and since starting a ketogenic diet has been mentally stable. My comment: Dr Christopher Palmer in the USA has also researched this phenomenon and there is a blog article on this site about him. Iain works at the university of Edinburgh, and has done preliminary studies in other patients who have bipolar disorder and has found that anxiety, depression, mood swings and impulsiveness all improve with a ketogenic diet. Further research is planned.

Dr Rachel Bain, on your far right, is a psychiatrist and works with Ally Houston, who is standing beside her, to promote coaching for mental health patients in the low carb diet. The site is metpsy.com.

Rachel explained that the gut and brain are very intimately connected and share the same neurotransmitters. The gut microbiotica are affected by what we eat. This affects our mood. If leaky gut occurs inflammatory substances can gain access to our blood vessels and cross the blood /brain barrier to cause neuro-inflammation. This is one cause of degenerative brain conditions such as Alzheimer’s disease and Parkinson’s disease. The foods most likely to disrupt the junctions between the gut cells are sugar, starch, gluten and alcohol. She and Ally as well as other team members treat people who have Attention Deficit Disorder, Obsessive Compulsive Disorder, Binge Eating Disorder, Bipolar Disorder and Schizophrenia. They don’t aim for a person to stop their medication so much as to gain control of their lives.

Ally Houston used to be a physicist but is now a chef and low carb coach. Comment: Ally also appears in a previous blog post on the site. He explained what coaching was and wasn’t. It isn’t telling someone what to do. It is exploring with the person how their life works now and how they can introduce positive changes around eating sugar, starch, vegetable oils, exercise, stress reduction and sleep.

The services at met.psy.com are out with the NHS and there is a fee for the services, but it is very reasonably priced.

PHQ are expecting videos of the conference to be available on You Tube now or very shortly.

Total mortality rates are improved when type two diabetics follow a low carb diet

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Adapted from Diabetes in Control March 24 2023

Mortality Reduced With Adherence to Low-Carb Diet in Type 2 Diabetes

Mar 24, 2023

Lower mortality seen with increases in total, vegetable, and healthy low-carbohydrate diet score

By Elana Gotkine HealthDay Reporter

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FRIDAY, March 24, 2023 (HealthDay News) — For individuals with incident type 2 diabetes (T2D), a greater adherence to low-carbohydrate diet (LCD) patterns is associated with lower mortality, according to a study published online Feb. 14 in Diabetes Care.

Yang Hu, Ph.D., from the Harvard T.H. Chan School of Public Health in Boston, and colleagues calculated an overall total LCD score (TLCDS) among participants with incident diabetes identified in the Nurses’ Health Study and Health Professionals Follow-up Study. Vegetable (VLCDS), animal (ALCDS), healthy (HLCDS), and unhealthy LCDS (ULCDS) were also derived.

The researchers documented 4,595 deaths, of which 1,389 cases were attributable to cardiovascular disease (CVD) and 881 to cancer among 10,101 incident T2D cases, contributing 139,407 person-years of follow-up. Per each 10-point increment of postdiagnosis LCDS, the pooled multivariable-adjusted hazard ratios for total mortality were 0.87, 0.76, and 0.78 for TLCDS, VLCDS, and HLCDS, respectively. Significantly lower CVD and cancer mortality was seen in association with VLCDS and HLCDS. From the prediagnosis to postdiagnosis period, each 10-point increase in TLCDS, VLCDS, and HLCDS correlated with 12, 25, and 25 percent lower total mortality, respectively. For ALCDS and ULCDS, no significant associations were seen.

Our findings provide support for the current recommendations of carbohydrate restrictions for T2D management and highlight the importance of the quality and food sources of macronutrients when assessing the health benefits of LCD,” the authors write.

Age Related Macular Degeneration could probably be prevented by avoiding processed food

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Adapted from The Displacing Foods Age Related Macular Degeneration by Chris A Knobbe. Medical Hypotheses 109 2017 184-198

Chris A Knobbe from the University of Texas has studied factors that are thought to be important in the causation of Age Related Macular Degeneration. (AMD).

AMD is the leading cause of irreversible blindness in developing nations. In 2020 some 196 million people were affected worldwide. And Dr Knobbe thinks this is almost always down to dietary factors, in particular the consumption of processed food such as sugar, vegetable oils, refined white flour and trans fats.

Historically, between 1851 and 1930, AMD was a rarity. It rose modestly in the 1930s but became an epidemic in the UK and USA by 1975.

By 2009 63% of the American diet consisted of processed sugars, starch and oils. My comment: Dr Google now puts this at 73%hyper-processed foods”.

By looking at the food intake and AMD in 25 nations, it was seen that as the traditional diets were replaced with processed foods, the incidence of new onset AMD correspondingly rose.

If sugar intake is moderate but polyunsaturated fat ingestion is rare, AMD does not rise.

It would therefore appear that processed and nutrient deficient foods are toxic to the retina.

AMD could probably be entirely preventable through reverting back to ancestral dietary patterns, should that be feasible, or eliminating processed foods that have become ubiquitous. Avoidance of these foods is likely to be extremely important for people who have been diagnosed with early or moderate AMD.

My comment: I was recently at a Hospice ladies lunch group and was sitting at a table with six other women who were about 10-20 years older than myself. Five of them were currently getting eye injections for AMD. Diets that are considered the healthiest by Dr Google are the Mediterranean, Japanese, South Korean and French. None included processed foods.

You will eat 150 fewer calories a day if you get a good sleep at night

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Adapted from Medscape Get More Sleep, Lose More Weight: A Randomised Trial by F. Perry Wilson MD MSCE.

Feb 7 2022

A study in JAMA Internal Medicine has shown that you can lose more weight just by lying in bed, having a good sleep. Because, if you sleep poorly, you will eat more the next day.

The whole thing becomes a vicious circle. Sleep loss leads to poor impulse control, and a preference for hypercaloric food. Long term stress can even increase eating disorders such as emotional eating.

Sleep loss increases Ghrelin and decreases Leptin which increases the appetite. Stress increases the Hypothalamus and Pituitary hormones and this increases Cortisol which attempts to dampen these down. Weight increases due to more calories being ingested and insulin resistance increases. Adiponectin decreases and you store more of your calories as fat. Your risk for obesity and diabetes increases.

My comment: When I worked as a Police Surgeon and GP I was often working all day, then a lot of the night, then all day. At 5 am when I often got home from a call out, I would crave toast, butter and Marmite. I have this about once a year now that I’m retired and when I wake through the night I may have a cup of tea, but I don’t feel like eating anything at all.

Dr Esra Tasali from the University of Chicago randomised 80 people, all of whom were overweight and getting less than 6.5 hours of sleep a night, to get personalised sleep recommendations to boost their sleep time or routine study visits where nothing was advised.

The suggestions were to decrease ambient light, create a bedtime routine, limit phone and TV use in bed, decrease caffeine intake and increasing daytime exercise. Each person was given a goal bedtime and wake up time schedule.

After two weeks, wrist monitors indicated that the intervention group was sleeping an extra 1.5 hours a night, which is approximately one full sleep cycle. This was maintained over the next two week monitoring period.

The calorie intake and output in the subjects was also measured by using doubly labelled water. Don’t ask me how this works!

They found that the extra sleep randomised group consumed 150 fewer calories a day. There was no increase in energy expenditure. On average they lost a pound in weight over the study period. They also reported being more alert, having a better mood and having more energy through the day.

Another tip I’ve heard elsewhere to improve sleep is to get outside in the morning for a bit of light exposure and exercise, even if it is winter or raining.

Men are noticeably less fertile from age 45 onwards

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Adapted from Medscape The Male Biological Clock- How to Tell the Time by Mark Trolice MD

Most women know that their fertility declines from the age of 30 onwards. From then on it will become more difficult to become pregnant and there will be an increase in the rate of miscarriage and in infants with chromosomal abnormalities. Yet, due to our modern lifestyles, the availability of contraception and the economic situation, first births in women aged 35 to 39 has increased six fold. To give an increased chance of conception women are increasingly freezing their eggs in their late twenties and early thirties.

Men are also becoming fathers for the first time at later ages. Over the last 40 years this has increased by 3.5 years.

Men over 45 years need five times longer to achieve a pregnancy than men under 25 after their female partner’s age is adjusted for. Sperm counts start to decline from the age of 41 and sperm motility decreases. Chromosomal abnormalities in sperm also increase.

At all ages, being overweight, alcohol consumption, cigarette and e cigarette smoking, can lead to impaired semen production.

The first treatment will be to correct lifestyle factors and then consider ovulation induction and intrauterine insemination. Men over 45 have lower pregnancy rates and higher miscarriage rates with Intrauterine Insemination Treatment.

During IVF cycles injecting the sperm into the egg can improve fertilization rates but in men over 45 there is still reduced fertilization rates and decreased embryo development to the blastocyst stage.

The offspring of older men have higher rates of stillbirth, low birth weight, preterm birth and birth defects. Men older than 40 to 45 have twice the risk of having an autistic child and three times the rate of schizophrenia.

A consideration is that men consider sperm freezing at younger ages, similar to what women do. Another way to tackle the problem is pre-implantation genetic testing of embryos from older men.