More fat = more kidney failure

From BMJ 12th January 2019

Chang AR et al The CKD Prognosis Consortium BMJ 2019;364:k5301

Between 1970 and 2017 a huge number of people were assessed for fatness using body mass index, waist circumference and waist to height ratio. The outcome was that the fatter you get, the more your kidney function declines. This was true whether you started off  with normal or impaired kidney function.

The lowest kidney disease was seen in those with a BMI of 20 and this barely changed till a BMI of 25 was reached. After this was a linear progression. By the time your BMI is 40, you have double the risk of kidney function impairment.

The results were adjusted for age, sex, race and current smoking.

My comment: This is a new risk factor for obesity as far as I know.

 

 

 

Natural and Low Carb Kitchen: Chocolate mug cake

Ingredients
3 tbsp almond flour (you can switch for coconut flour if preferred)
3 tbsp cocoa powder
2 tbsp butter
1 medium egg
1 tsp vanilla extract
1 tbsp milk
1 square dark chocolate (over 70% cocoa)

Create It
1. Add all dry ingredients to a mug and mix.
2. Add butter, milk and vanilla extract and mix well.
3. Place mug in the microwave for 2-3 minutes. (Every microwave varies on cooking time so keep an eye on this)
To serve – whip up 2 tbsp double cream and top with berries.

Jovina cooks: Seafood chowder

Seafood Stew
Ingredients
3 tablespoons butter, divided
1 garlic clove, minced
1 large shallot, diced
1/2 cup chopped onion
1 cup chopped celery
1 thin carrot, diced
1/2 cup diced red bell pepper
2 cups cauliflower, cut into small florets
½ cup diced rutabaga (or potato)
2 cups homemade or store-bought low-sodium chicken broth
1 teaspoon seafood (Old Bay) seasoning
1/2 teaspoon dried thyme
1/4 teaspoon freshly ground black pepper
1/2 teaspoon salt
1/2 teaspoon crushed red pepper flakes (chili)
2 tablespoons apple cider vinegar
1 large plum tomato, seeded and diced
3 lbs firm boneless fish fillets (such as halibut, cod, red snapper, sea bass, grouper), cut into small cubes
8 oz medium shrimp, shelled, deveined and tails removed
1 cup heavy cream
1/4 cup minced fresh parsley
Directions

In a large saucepan over medium heat, melt 2 tablespoon butter. Add the onion, shallot and garlic. Saute for a minute or two and them add the carrot, celery and bell pepper. Cook until the vegetables are tender, 3-4 minutes.

Add the rutabaga and cauliflower. Stir into the vegetables. Pour in the chicken broth and bring to a simmer. Cover the pan and cook the vegetables until the rutabaga and cauliflower are tender.

Remove the cover and add the: salt, pepper, chili flakes, seafood seasoning, thyme, tomato and vinegar. Sir well.
Add the cream, fish cubes and shrimp. Cook stirring the mixture gently for 4-5 minutes or until the fish and shrimp are cooked. Add the parsley and remaining tablespoon butter, heating until the butter is incorporated. Serve in large individual  bowls.

My comments: this is a particularly delicious chowder. If you don’t have all the ingredients some are optional. Morrison’s supermarket sells a packet of frozen “fish pie mix” for about £4. Using this with extra prawns,  garlic, onion and cream also produces a lovely basic fish stew. Remember my son’s tip about using frozen pre chopped onions if you are short of time or don’t like your hands getting oniony. Jovina’s recipe is more sophisticated. 

BeTravelFit: Ultimate travel workout

From: BeTravelFit blog:
While I was traveling I saw myself faced with situations in which I didn’t have access to any sort of gym, not even a bar to do Pull-Ups with, hell, not even a damn park bench to do Tricep-Dips on because every single bench in the park was used by loved up couples and other people who don’t work out because they actually do have a social life and other things do to then lifting (what a bunch of losers).
So here’s a workout that you can perform anytime, anywhere, with absolutely no equipment needed – just as promised.
The workout consists of three different circuits with three different exercises in each circuit. The exercises in each circuit are to be performed directly one after another with no rest in between. That way the heart-rate stays elevated over an extended period of time and more calories are burned as a result.

Circuit 1: Upper Body (Chest, Shoulders and Triceps) – To be performed 5 times, 60 secs rest
Hindu Push* up x 5
Diamond Push-Up x 5
Push-Up x amrap (as many repetitions as possible)
Circuit 2: Lower Body (Quads, Glutes, Hamstrings and Calves) – To be performed 5 times, 30 secs rest
Single Leg Box Squat x 10
Single Leg Romanian Deadlift x 10
Single Leg Calf-Raise x 15
Circuit 3: Core (Abs And Lower Back) – To be performed 5 times, 30 secs rest
Oblique Crunch x 10
Crunch x 20
Plank for 60 secs
And there you go, here’s your first full body, zero equipment, bodyweight only workout!
It burns a ton of calories, engages all major muscle groups and keeps you occupied for at least an hour to an hour and a half. Feel free to add extra repetitions or sets to make the workout more challenging as you progress and don’t feel intimidated if you can’t perform as many repetitions as suggested in the routine. Just give it your best shot and you’ll be fine!

 

  • Assume the downward dog position. Move your upper body backwards,  into child’s pose, and then move your head and trunk forwards taking your weight in your arms till you then extend your head up with your trunk in the upward dog position.

Hypoglycaemia: the neglected complication

Adapted from Hypoglycaemia: the neglected complication by Sanay Kalra et al.

Indian J Endocrinol Metab. 2013 Sep-Oct; 17(5): 819-834

Hypoglycaemia is an important complication of glucose lowering therapy in patients with diabetes mellitus. Attempts made at intensive glycaemic control invariably increases the risk of hypoglycaemia. A six fold increase in deaths due to diabetes has been found in patients with severe hypoglycaemia compared to those not experiencing severe hypoglycaemia.

Repeated episodes can lead to hypoglycaemia unawareness. Complications  of hypoglycaemia include stroke, heart attacks, cognitive dysfunction, retinal cell death and loss of vision. Apart from this there are the effects on quality of life regarding sleep, driving, employment, exercise and travel.

To maintain good glycaemic control, minimize the risk of hypoglycaemia and thereby prevent complications, there are steps that need to be taken: recognise risk factors for hypoglycaemia, use appropriate self monitoring of blood sugar, select treatment regimens that have little or no risk of incurring hypoglycaemia and teach health care professionals and patients how to avoid hypoglycaemia.

Although the DCCT showed that complications were reduced when blood sugars were brought under a HbA1C of 7%, other trials have noted a three fold risk of hypoglycaemia when the level is reduced under 6.5%. This tends to negate any improvements in long term complications.

Insulin users are most at risk. Those who have had diabetes for more than 15 years are particularly at risk. The DARTS study showed that the risk of severe hypoglycaemia was 7.1% for type one patients, 7.3% for type two patients and 0.8% for type twos on sulphonylureas. This causes increased cost for their healthcare as hospitalisation for around a week is needed in the average case.

The majority of hypos are due to medications but there are other potential causes such as: pancreatic or islet cell tumours, dietary toxins, alcohol, stress, infections, sepsis, starvation and excessive exercise.

In diabetics not eating enough food was the most common cause. Others were physical exercise, insulin miscalculation, stress, overtreating a high blood sugar, and impaired glycaemic awareness.

Nocturnal hypoglycaemia is seen in half of diabetic children, particularly under the age of 7. Dead in bed syndrome causes 5-6% of all deaths in type one youngsters.  Contributory factors are increased exercise that day or delayed meals.

In type two patients additional causative factors are alcohol ingestion and liver disease and duration of insulin over ten years. As in type ones there tends to be more hypoglycaemic unawareness as the person ages. In type twos  there is a 9 fold increase in deaths in those with hypoglycaemic unawareness.

Severe hypos in elderly patients increase the risk of dementia, functional brain failure and cerebellar ataxia. There are clear signs of neuronal death in specific brain areas at post mortem in these patients and a history of fits make these more extensive.

Hypos in elderly patients promote cardiac ischaemia. Arrhythmias are more likely due to catecholamine release during hypos. Prolonged QT intervals lead to increased heart rate, fibrillation and sudden cardiac death.  Inflammatory cytokines are released during hypos, abnormalities of platelet function and the fibrinolytic system occur.

Hypos can cause double vision, blurred vision and dimness of vision.  Blindness can occur due to retinal cell death.

Recurrent hypos make people feel powerless, anxious and depressed. Acute hypos cause mood swings, irritability, stubbornness and depression.  Quality of life scores are worse in patients with recurrent hypos.

Driving ability is affected by hypos. The affected driver can inadvertently cross lanes and speed and generally drive worse.

Hypos at night may be recognised by sleep disturbance, morning headaches, chronic fatigue and mood changes. In young children fits and bed wetting may occur.

Hypos at work can be awkward, embarrassing and frightening. Hypos are particularly dangerous for those who work at heights, underwater, on railway tracks, oil rigs, coal mines, handling hot metals or heavy machines.

Expert medical advice and planned action counselling can help workers. So can self blood glucose testing, healthy food options in canteens, flexible meal times, arrangements to carry and use emergency glucose/sugar, storage and disposal sites for medications and sharps, and time off for medical appointments. Work time and productivity due to hypos can be reduced and nocturnal hypos can also have a knock on effect the next day.

Hypos in children tend to be increased in summer months when they are more active. In adults, intense prolonged exercise following an episode of recent severe hypoglycaemia can damage skeletal muscle and the liver and can cause severe neurological symptoms.

Travelling long distances, particularly over times zones can cause insomnia, tiredness, stress, reduced appetite, nocturia,  gastric disturbance, muscle aching and headaches. Psychological symptoms include low mood, irritability, apathy, malaise, poor concentration. These deficits in both physical and mental performance can profoundly affect decision making.

The fear of hypos can affect patients more profoundly than the fear of long term complications.  Withholding of insulin can occur. Sometimes patients refuse to start it when they need it and sometimes they miss out their doses.

About 30% of type one patients are affected by hypoglycaemia unawareness and under 10% of type two patients are thus affected. Duration of insulin use is the main common factor.

Educating patients about how to detect, treat and prevent hypoglycaemia must be understandable to the patient and their family.

In 2013 the ADA recommended that insulin users test their blood sugars 6-8 times a day.

Basal insulin needs to be matched to the patients needs. If hypos persist, particularly overnight, switching to pump therapy may help.

Newer diabetic medications, which do not cause low blood sugars such as the gliptans and gliflozins, may be preferable in type two patients who have multiple co-morbidities, are elderly,  who live alone, are at high risk of falls, and who have hypoglycaemia unawareness or who otherwise could not effectively deal with a hypo.

 

 

 

Bring back the 50s ?: Mothers in full time work are significantly stressed

Being a working mother doesn’t just feel stressful, it alters your physiology.

Researchers at the universities of Manchester and Essex studied 6025 people. They collected information about their working and home lives. Hormonal levels and blood pressure were checked too.

When 11 biomarkers of stress were tested, these were 40% higher in women who worked full time and were raising two children at the same time. One child raised the levels by 18%.  Part time workers, job sharers and those with flexible working arrangements were fewer hours were worked had less stress.  Flexible working or remote working with no reduction in hours did not lower stress levels.

The authors said, ” Work-family conflict is associated with increased psychological strain, with higher levels of stress and lower levels of well being. Parents of young children are at particular risk of family-work conflict.

http://www.manchester.ac.uk/discover/news/working-mothers-up-to-40-more-stressed/

Dietary calcium doesn’t make your bones stronger after all

Although it is current practice to prescribe vitamin D and calcium together, particularly in post menopausal women, a six year study shows that the added calcium has no value.

The women were all over the age of 65 and had osteopenia. This is the stage before osteoporosis. 1,994 women were randomised to take zolendronic acid or placebo.  Bone mineral density was measured at the spin, total hip, femoral neck and total body three times at intervals.

The baseline BMD was unrelated to dietary calcium after controlling for age, height, weight, physical activity, alcohol intake, smoking and past HRT use when a cross section of women were studied.

Loss of BMD over the next six years was not related to the amount of dietary calcium ingested.

Bristow SM et al. Dietary Calcium intake and bone loss over six years in osteopenic post menopausal women. J Clin Endocrinol Metab. 2019 Mar 21.

My comment: Maybe time to ditch the calcium?

And while we are on the subject of bones, I’m pleased to say that another study has shown that high dose vitamin D supplementation does NOT increase kidney stone risk.

Over just over 3 years of taking 100,000 iu of vitamin D3 each month did not increase excess calcium in the blood or the onset of kidney stones in adults aged between 50 and 84 years.

This dose is equivalent to 3300 iu vit D3 a day, similar to what many of us in the know take.

158 people took part in the randomised trial. The number of people developing kidney stones was similar in each group and no one in the intervention group developed hypercalcaemia.  The groups self reported stones. No ultrasound was done which the authors say could have been more accurate.

Malihi Z et al. Monthly high dose vitamin D supplementation does not increase kidney stone risk or serum calcium: results from a randomised controlled trial. Am J Clin. Nutr. 2019 Apr 21