Lancet: Aspirin only works if it is the right dose for your weight

Low dose aspirin 75-100mg daily are only effective in reducing cardiovascular events in those who weigh less than 70kg found researcher Peter Rothwell.  This is the dose range used in the UK and the USA but 80% of all men and 50% of all women weigh more than 70kg.

Higher doses of aspirin are only effective for cardiovascular prevention in those over 70 kg and don’t work in those who weigh less than this. Therefore recommending the higher dose range won’t suit everyone either.

Some people also use aspirin to reduce the chances of other diseases such as colorectal cancer. The effects are thought to be dose related as well.

The take home message is that if you weigh less than 70kg stick to 75-100mg of aspirin a day, but if you weigh 70kg or over you should increase your dosage. For most people in the UK this will mean doubling up on 75mg to 150mg and in the USA where 82.5 mg is standard, upping this to 165mg daily.

Lancet doi:10.1016/S0140-6736(18)31133-4

 

 

 

 

 

 

BMJ: It doesn’t take much alcohol to damage your brain cells

Adapted from BMJ 24 February 18 Alcohol link to dementia is “robust” by Jacqui Wise

Chronic heavy drinking should be recognised as a major risk for dementia say French researchers.

They looked at over 31 million French adults discharged from hospital between 2008 and 2013. Over 1.1 million people had been diagnosed as having dementia.  In 57% of those with early onset dementia alcohol use was considered to be the cause.

Drinking more than 6 units of alcohol a day for a man and 4 units for a woman put you in the risk category of “heavy drinking” according to the World Health Organisation. This level will make both men and women more than three times more likely to develop dementia than they otherwise would.

Michael Schwarzinger said, ” The link between dementia and alcohol use is likely a result of alcohol leading to permanent structural and functional brain damage. Alcohol disorders also increase the risk of high blood pressure, diabetes, stroke, atrial fibrillation, and heart failure, which in turn increase the risk of vascular dementia. Heavy drinking is also associated with smoking, depression and low educational attainment which are also risk factors for dementia.”

Clive Ballard from the University of Exeter Medical School said, ” This study is immensely important. This evidence is robust and the public need to know about the relationship between alcohol consumption and dementia.”

My comment: I was really sad to read this report in the BMJ as I do love a nice glass of full bodied red when I’m eating a big lump of fatty spiced meat or a smelly gorgonzola. I was also dismayed to see what they regard as heavy drinking. 175 mls of most wines will be 2 units so two of them a day and you are three times more likely to get dementia, if you are a woman. I dread to think what a two week all inclusive holiday does to your brain. It is  always best to know these things before you get too batty to care. 

Low carb store: Strawberries and cream cake

This cake serves 8 and has 5.4 g of carb and 176 kcals a slice.

Ingredients

110g ground almonds

40 butter melted

50g inulin powder (or granulated sugar substitute)

2 eggs

1tsp vanilla extract

30mls double cream

100g strawberries

 

Method

Combine the ground almonds, melted butter, eggs and vanilla in a large bowl. Add the double cream and inulin. Chop the strawberries and add them to the mixture combining gently by hand. Pour into a buttered cake tin and bake in a pre-heated oven at 180 degrees for 18-20 minutes.

Robert Carrier’s Rare Roast Beef

Robert Carrier was a very popular television chef in the 80s. He was famous for ladling on butter, cream and booze onto anything on a plate and in due course fell out of favour with the fat police in the later stages of the 80s and into the 90s. Fortunately one of my flatmates bought me Carrier’s Quick Cook for a Christmas present in 1983 and I’ve used it ever since. As you know, we are not afraid to chuck fat or booze on our food and the lower the carbs in your diet, the more we encourage you to do so.

A few weeks ago I was visiting my son in Leeds and off we went for an outing to Harewood House. This elegant house is in amazing grounds landscaped by Capability Brown. It is a thought that this man laid out many Victorian gardens but never lived to see them attain their full glory.

The grounds include a gem of a second hand bookshop and there I purchased Robert Carrier’s New Great Dishes of the World.  I already have his original Great Dishes of the World and was thrilled to have more boozy, creamy, meaty recipes at my fingertips.

I am now going to describe the late, great, Robert’s method to get perfect, rare roast beef with minimum effort.  He insists that you must have at LEAST 2.5 kg of boned and rolled meat.  I bought  a stunningly expensive rib eye joint of this weight and having never had a disappointment in 34 years of cooking from Carrier’s books entrusted it to his experience.

This is what you do.

Take the meat out of the fridge at least 2 hours before cooking time and hide it from your cats.

Preheat the oven to 250 degrees centigrade or 500 Fahrenheit or gas 10 for at least 20 minutes ahead of time. The oven must be roasting hot.

Rub the joint with salt and pepper and spread it with dripping or butter. This could be about 4 tablespoons or so. Don’t skimp.

Put the meat on a rack in a roasting pan in the oven and cook for 5 minutes per 450g/lb and then switch OFF the oven BUT DON’T OPEN THE DOOR.

Leave it all on its own for two hours.

Touch the meat with your fingers. If it is warm take out and serve. If it is cool but the oven back on at 250 /500/10 for ten minutes or so to warm it before serving.

Enjoy!

 

 

 

BMJ: Diabetic foot

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Summarised from BMJ Clinical Update Diabetic Foot by Mishra et al Mumbai and London 18 Nov 17

Foot disease troubles 6% of people who have diabetes and includes infection, ulceration or destruction of tissues of the foot. It can affect both social life and work. Up to 1.5% of diabetic people will end up with an amputation. Good foot care, screening and early treatment of ulceration is hoped to prevent a foot problem developing into a need for amputation. This article gives an update on the prevention and initial management of the diabetic foot that can be expected from primary care.

A combination of poor blood sugar control, foot neglect, lack of appropriate footwear, insufficient patient education and failure to find and treat pre-ulcerative lesions cause increasing foot damage and worsens the outlook.  Nerve and blood vessel damage make damage more likely to go unnoticed and more difficult to heal.

A careful examination of the feet by the patient or carer every day is a good idea. A careful examination by health professionals also detects problems early. Fungal infections, cracks and skin fissures, deformed nails, macerated web spaces, callouses, and deformities such as hammer toes, claw toes, and pes cavus increase the risk of ulceration.  Cold feet can suggest poor blood supply and warm feet can be an indicator of infection.

Monofilaments are often used to detect neuropathy at annual assessments. Pain after walking a certain distance and pain at rest suggest peripheral arterial disease.

Assessments every three to six months is needed for medium risk feet and every one or two months for high risk feet.

As neuropathy is difficult to reverse once established, prevention is key. Optimal glycaemic control is extremely important. Smoking cessation, maintaining a normal weight and continued exercise help the circulatory system.  Patients also know how to check their feet and who to get help from if they find problems. New shoes should be worn in gradually to prevent blisters.

Health care professionals need to send urgent cases to a specialised diabetic foot centre if at all possible. Such cases would include foot ulceration with fever or any signs of sepsis, ulceration with limb ischaemia, gangrene,  or suspected deep seated soft tissue or bone infection.

Ulcers are best washed in clean water or saline with a moist gauze dressing.  Anti-microbial agents can be cytotoxic  and can affect wound healing. Weight bearing on the area needs to be avoided. Tissue will be taken for bacterial culture and antibiotics prescribed due to local policies.

Referral within a day or two is needed for rest pain, an uncomplicated ulcer or an acute Charcot foot. (suspected fracture due to neuropathy).

Patients with rest pain and intermittent claudication need vascular referral.

Here are the top tips for patients:

Inspect your feet daily including between the toes and if you can’t do it yourself get someone else to do so

wash your feet in warm but not hot water daily and dry carefully especially between the toes

use oil or cream on dry feet but not between the toes

cut nails straight across and if necessary go to a podiatrist for this

Don’t do home treatments for corns and callouses

Check your shoes for objects or rough areas inside them and wear socks with them

avoid walking barefoot

get your feet examined regularly by a health care professional

notify the appropriate health care professional if you develop a blister, cut, scratch or sore on your feet

Public Health Collaboration Conference 2018: a great success for Lifestyle Medicine

I was delighted to attend and speak at the third PHC conference in London this year.  We met at the Royal College of General Practitioners in London on the sweltering weekend of the Royal Wedding. Apart from superb international speakers we were treated to low carb, high protein food, such as one would typically eat on a ketogenic diet. Instead of picking at our dinners as we often have to do with mass catering  we could eat the whole lot. Great!

Dr Peter Brukner from Australia started off the weekend with a review of what was happening in the low carb world. There are more and more reports coming out describing the advantages of ketogenic and low carb diets to different groups of people but the establishment are fighting back viciously as can be seen by the attack on Professor Tim Noakes in South Africa.  Indeed if his defence lawyers and expert witnesses had not worked for free he would be bankrupt.  This is a terrible way to wage war on doctors who are acting in the best interests of their patients.

Dr Aseem Malhotra also described bullying tactics that had been used against him when he was a junior doctor and first becoming publicly engaged in the low carb debate. I have been subjected to this as well.  Professor Iain Broom showed that the proof that low carb diets are superior to low fat diets goes back 40 years.

Dr Zoe Harcombe gave us an explanation of how the calories in- calories out idea just doesn’t add up. The well known formulas about how many calories you need to avoid to lose weight don’t work in practice because of the complex compensatory mechanisms we have to avoid death from starvation.  How you put this over to patients and give them useful strategies for weight loss and blood sugar control was explored by Dr Trudi Deakin.

Food addiction is a real issue, at least it is for the majority of the audience in attendance, who answered the sort of questions usually posed by psychiatrists when they are evaluating drug addiction.  Unlike drugs, food can’t entirely be avoided but ketogenic diets are one tool that can be used to break  unhealthy food dependence. This worked for presenter Dr Jen Unwin who at one point had a really big thing for Caramac bars.  I haven’t seen these in years but they did have a unique taste.

Dr David Unwin showed clearly that fatty liver is easily treatable with a low carb diet.

Dr Joanne McCormick describes how her fortnightly patient group meetings are making change accessible for her patients and how many GPs in the audience could broach the subject in a ten minute consultation.

The website Diabetes.co.uk will shortly be starting up a type one educational programme online that all are welcome to join. I discussed the issue of what blood sugar targets are suitable for different people and how they can achieve this with dietary and insulin adjustment.

Dr David Cavan spoke about reversing diabetes in patients in Bermuda. Although Bermuda looks idyllic the reality is that good quality food is about five times as expensive in the UK as it is all shipped in. Many inhabitants work their socks off but barely cover their costs and cheap sugared drinks and buns are their staple diet. Despite these setbacks he managed to persuade a lot of diabetic patients to ditch the carbs and this had favourable results even after the educational programme had stopped.

A cardiologist Dr Scott Murray described the effects of metabolic syndrome on the heart and really why sticking stents in diseased arteries is too little, too late. He is convinced dietary change is needed to reverse and prevent heart disease. This is the first time I have been told that certain types of heart failure and atrial fibrillation are direct effects of metabolic syndrome on the heart.

The importance of exercise for physical and mental well being was not neglected and we had Dr Zoe Williams describing the great benefits that even the minimum recommended exercise can produce.

Dr Simon Tobin and Tom Williams spoke enthusiastically about Parkrun. This is a free event that runs every Saturday morning in parks all over the world. You can choose to walk, jog or run the course.

Claire McDonnell-Liu is the mother of two children who have greatly benefited from a ketogenic diet. The conditions are urticaria and epilepsy.  Although NHS dieticians do help families with childhood epilepsy who want to use a ketogenic diet, they can’t do it unless drugs have failed, as this is NICE guidance. I wonder how many children would benefit in fit reduction without side effects of drugs if this guidance was changed?

This was a fabulous conference with a positive enthusiastic vibrancy. Thanks to Sam Feltham for organising this event especially since he has become a new dad as well.

The Public Health Collaboration are putting all the talks on You Tube.

I was interviewed about diabetes and women’s health issues for Diabetes.co.uk and Diet Doctor and these interviews and many others will be available for you all to see to improve your lives with diabetes.

 

 

 

Jovina cooks: Easy fish and vegetable foil parcels

Fish and Veggie Grilled Packets

Until I started cooking fish on the grill with this method, I never realized how delicious and moist the fish would taste.
4 servings
Ingredients
16 oz Mahi Mahi fish fillets, about 1/2 inch thick and cut into 4 equal pieces
8 extra-large shrimp, cleaned and peeled
4 large sea scallops
4 fresh thyme sprigs
4 garlic cloves, finely minced
1 small red onion, cut into eighths
2 bell peppers, each cut into 12 thin slices
12 grape tomatoes, cut in half
Paprika, salt and pepper
2 tablespoons chopped chives
Extra-virgin olive oil

 

Directions
Preheat grill to medium.
To make the packets: lay two 18-inch sheets of heavy-duty foil on top of each other (the double layers will help protect the contents from burning); generously coat the top piece with olive oil cooking spray. Repeat with six more pieces of foil.
Divide the onions and bell pepper equally on bottom of the 4 pieces of heavy-duty foil.
Place a piece of fish on top. Sprinkle with salt and pepper, Add 2 shrimp and 1 scallop to each packet.
Sprinkle with salt and pepper.
Add tomatoes, garlic and chives to each packet.
Drizzle with olive oil.
Bring the short ends of the foil together, leaving enough room in the packet for steam to gather and cook the food.
Fold the foil over and pinch to seal. Pinch seams together along the sides. Make sure all the seams are tightly sealed to keep steam from escaping.
Grill the packets until the fish is cooked through and the vegetables are just tender, about 15 minutes.
To serve, carefully open both ends of the packets and allow the steam to escape. Use a spatula to slide the contents onto plates. Serve with the lemon sauce.

Lemon Sauce
1 stick unsalted butter, at room temperature
2 cloves garlic, minced
2 tablespoons chopped fresh flat-leaf parsley
2 tablespoons lemon juice
Dash or two of hot sauce
Kosher salt and freshly ground black pepper to taste
Directions
Place all the ingredients in a small saucepan. Heat on the grill or on the stove. Serve with the fish packet.