If you can avoid competitive eating as a child you will be thinner

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Adapted from Independent Diabetes Trust Newsletter Dec 2021 and BMJ 29 Jan 2022

In the journal of Clinical Obesity researchers have shown that people who eat faster tend to gain more weight and are at higher risk of obesity than slow eaters. This is because it takes at least 20 minutes for stomach hormones to tell your brain that your hunger is satisfied.

They also found that only children didn’t tend to eat as fast as children who had siblings. The fast eating habit tends to persist in to adulthood and thus weight gain compared to only children.

My comments: I was one of four children and we certainly ate fast. If you didn’t grab the food quick enough it disappeared! This stood me in good stead as a doctor when there was very little time for eating on the job. My husband was one of three and is great at competitive eating too! He said it helped when working off shore when meals were slotted in during less busy periods. I had forgotten most of the childhood meal behaviours till I went to one of my friends houses with her husband and noticed that he carefully guarded his plate with his arm. I recalled that this was common practice in our house but that I had stopped doing it since leaving home. He was one of four children again. He had simply never changed his eating posture since leaving home!

In the American College of Cardiology 2021 they report that teenagers who have high BMIs have a 9% greater risk of getting type 2 diabetes, and an 0.8% greater risk of having a heart attack in their 30s and 40s than normal weight teens. Regardless of their adult BMI, teens who were heavier went on to have a 2.6% greater risk of having poorer overall health in adulthood.

Want to pass that exam? Here’s how.

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Adapted from Human Givens No 1 2013 Dunlosky et al. Improving student’s learning with effective learning techniques. Psychological Science in the Public Interest.

Researchers have found that the best way to get good results in exams is to spread out your studying over time and to make sure that you quiz yourself on what you have learned.

They looked at ten common learning techniques and found that many of the most popular were of next to no benefit either in remembering information or passing exams. Some of these are the most common and are being recommended by teachers.

The most useless ways to revise are: highlighting and underlining, summarising, keyword mnemonics, use of imagery for memorising text and re-reading.

You may think you are doing something by adopting these, but you are kidding yourself!

NICE: all adults and children with type one diabetes to have real time continuous glucose monitors

Abbott’s Freestyle Libre

The fantastic news this spring is that ALL type one adults and children are to be offered real time blood sugar monitors in the NHS.

These machines encourage testing without the finger pricks, tell you the trend of your blood sugars, and make it much more accurate, easier and less painful to adjust your insulin to your blood sugar.

The monitors will also be offered to type two patients who use insulin.

NICE estimates that a quarter of a million type one patients alone will be put on the device. Research suggests that HbA1c levels tend to drop when using the technology without increasing the risk of hypoglycaemia.

My comment: My son Steven, was an early adopter or this method of blood sugar monitoring. I paid for the device and sensors for the first 18 months because it gave me more peace of mind, especially as he was living on his own away from home. It seemed crazy to me that he was excluded from NHS funding by virtue of having very tight blood sugar control mainly from his own efforts. Although it is a charge on the NHS for the sensors, the benefit is that there should be less hospitalisation from hypos and fewer complications later on.

Currently the NHS spends ten billion pounds a year on diabetes, which is ten percent of the total budget.

For those type ones or type twos on insulin who do not yet have this device they are asked by NICE to approach their diabetes teams.

Writing down your thoughts can boost your mood

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Adapted from Human Givens No 1 2013 Brinol P et al. Treating thoughts as material objects can increase or decrease their impact on evaluation. Psychological Science 24.1, 41-7. 2013.

Writing down negative thoughts, crumpling them up, and throwing them away, as often advocated by therapists, really does reduce negative thinking. Conversely, writing positive thoughts down, and keeping them safe in a purse or pocket helps you feel better.

Teenage School students in Spain were asked to write down either positive or negative thoughts about their bodies and then Mediterranean diet and they were then evaluated on how much they became influenced by their lists later on.

What they found was that people who threw the list in the trash right away were not influenced, those who kept the list in their desk were somewhat influenced, but that those who kept the list more personally in a pocket or purse were most influenced.

To see if the effect worked with word lists via a computer, the experiment was repeated. The thoughts were put into storage or the trash list. Repeating the experiment but simply asking the students to imagine putting the list in a particular location without physically doing anything was also done.

Professor Richard Petty, a co-author of the paper from Ohio University said, ” The more convinced the person is that negative thoughts are really gone, the better. Just imagining that you throw them away doesn’t seem to work”.

So, to get over a difficult event, write it down, and then bin it and be physical.

If you want to boost your mood, write positive facts or feelings and keep it close and personal.

Changing daily habits can have a calculated effect on your life expectancy

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Adapted from BMJ 22 Dec 2012

Cambridge University professor of biostatistics, David Spieghalter, has produced an easy to understand tool that can help you quantify your daily habits in terms of added or reduced life expectancy.

If you have got to 35 years of age, you could reasonably expect to live till age 80 if you are a man and age 83 if you are a woman.

For men this is how to live a shorter life:

Smoke 15-24 cigarettes a day cut 7.7 years For women cut 7.3

have one drink of alcohol a day ADD 1.1 years For women ADD 0.9 years

have another one up till six more CUT 0.7 years per drink For women CUT 0.6 years

For every 5 units above a BMI of 25 cut 2.5 years For women cut 2.4 years

for every 5kg above your optimal weight cut 0.8 years For women cut 0.9 years

Spend two hours watching the television cut 0.7 years For women cut 0.8 years

For every red or processed meat portion you eat, equivalent to a burger 3 oz cut 1.2 years Same for women

Now for the good news:

If you eat 5 or more fruit or vegetable portions a day men add 4.3 years For women add 3.8 years

If you drink 2-3 cups of coffee a day add 1.1 years. For women add 0.9 years.

For the first 20 minutes of exercise add 2.2 years. For women add 0.81 years.

For the next 40 minutes add 0.7 years. For women add 0.5 years.

Take a statin add 1 year for men. For women add 0.8 years.

If you live in a relatively unpolluted area, less than London for example, add 0.6 years for both genders.

How does this work out for you?

6.5 to 7 hours sleep a night is about average for adults

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Adapted from BMJ 13 Nov 2021 from American Journal of Epidemiology.

Measurements using an Actigraph were taken from 13,000 adults and children in the USA to determine what a “normal” sleep duration was. The amount of sleep taken by individuals can be highly variable, and this can also change due to their age and stage of life and occupation.

For females, the 50th centile, the middle of the sleep range, was 8.3 hours a night, starting from age 6. As a young adult, this reduced to just over 7 hours and stayed constant till there was a small increase at age 65.

For males, the middle of the sleep range was 8.1 hours at age 6 and reduced to 6.5 hours in early adulthood and increased slightly at age 60.

My comment: I’ve always needed a lot more sleep than this. 10 or 11 is better for me and in autumn, just after the clocks change, I can sleep for 14 hours a night if I am not disturbed. I perk up a little bit in the spring and can cope with 9 hours a night. For much of my life, particularly working as a doctor on call and having young children I had a lot less sleep than I really needed. I have seen that sleeping a lot is associated with a higher rate of dementia, but too bad!

In California, a longitudinal study of more than 50,000 women, looked at how environmental influences affected how long it took to get to sleep and how long the sleep lasted.

Shorter sleep duration was associated with exposure to artificial light at night and air pollution. (Associated with cities). Where there was a lot of environmental noise, it took longer to fall asleep.

Contrasting with this, living in areas with more green space led to women falling asleep faster and staying asleep longer.

Your glass of wine may have more sugar in it than you think

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Adapted from BMJ 19 Feb 2022

The Alcohol Health Alliance UK has called for better labelling on alcoholic drinks after an analysis found that wine from the ten leading brands contained as much as 59g of free sugars per bottle.

None of the bottles had the sugar content on the label.

Government guidelines recommend no more than 30g of free sugars a day for an adult (My comment: they conveniently forget about starch though!) This is equivalent to 6 teaspoons of sugar and it can be contained in just two medium glasses of wine.

In February at the Low Carb USA conference in La Boca, Florida, Gemma Kochis, who is a qualified Sommelier, who works at Keto-Mojo, presented information for those on a ketogenic diet who would still like to drink wine.

She says that for the most part, wines with the highest alcohol content will tend to have the highest sugar content. If you want to drink wine and stay in ketosis, you will need to test your blood ketones about 2 hours after trying a new wine.

In general she recommends wines that grown in cooler climates, mainly old world compared to new world. She thinks that you have to stick below 12.5% alcohol wines and that even then you may have to go lower.

Red wines that can be fruity and have a low alcohol content include Beaujolais and Gamay.

Reisling, Vinho Verde and Muscadet are good white wine choices and Champagne Brut is a good sparkling wine choice.

Statin “deniers” take the Mail on Sunday to court for defamation

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Adapted from BMJ 26 March 2022.

Dr Malcolm Kendrick who is a GP, and Zoe Harcombe who is a PhD researcher, have raised a court action against the Mail on Sunday, because they think that their reputations have been damaged by being called “statin deniers whose deadly propaganda has endangered lives.” Their influence was described as “being worse than the MMR scare.”

Mr Justice Nicklin describes the case as a most significant piece of defamation litigation. The claimants assert that they have been accused of putting many thousands if not millions of people at a greater risk of a deadly or debilitating heart attack or stroke by misleading them into the false belief that statins do not work and/or have debilitating side effects.

Both Malcolm and Zoe write blog articles, have given lectures and written books. Malcolm writes, “Readers will know there is not one cause of heart disease. Equally, you are not going to protect yourself against heart disease doing one thing. You need to do many.”

Associated Newspapers who own the Mail on Sunday, say that their articles are substantially true, express an honest opinion and also say that they are protected by qualified privilege or by the defence of publication on a matter of public interest.

My comment: I was most concerned when I read about this case. There is a lot of controversy over the use of statins and the public should be able to hear both positive and negative information on health matters, so as to help them make up their own minds, or to stimulate further personal research. Dr Kendrick and Zoe Harcombe are both highly intelligent, well informed and well meaning people. They both support low- carbing for health care, and we have corresponded and met up personally and online at discussions and conferences of common interest. I am concerned that there is financial resource asymmetry here and that this case will be potentially ruinous for them. I await the court’s findings with interest and trepidation.

Type 2 diabetes produces more severe complications than type 1

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Adapted from BMJ 11 March 2017

In an observational study reported in JAMA 1,746 type one patients were compared with 272 type two patients. All had developed their diabetes before the age of 20. My comment: It is not clear whether the duration of diabetes was adjusted for, as the onset of type one diabetes tends to cluster around puberty, although it can occur as early as soon after birth, and the onset of type two diabetes tends to arise in later teenage years. Thus if average 30 year olds were compared head to head in the study, for instance, one would expect the type 1 patients to have more complications purely based on having had the condition much longer on average than the type 2s.

Nevertheless, the prevalence of diabetic kidney disease, retinopathy and peripheral neuropathy was significantly greater in the type two group compared to the type one group, even after they adjusted for differences in glycated haemoglobin, body mass index, waist to height ratio, and mean arterial blood pressure.

This study provides information that early age of onset of type 2 diabetes is a real problem, as once established, it does a lot of damage, that is difficult to control with standard therapies.

Consistent exercise improves your survival if you have a heart attack

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Adapted from BMJ 27 Feb 2021

After a heart attack, the risk of sudden death is influenced by your past levels of physical activity.

People who performed moderate levels of leisure time exercise reduced their risk by 33% and those who performed high levels of exercise reduced the risk by 45%.

This study combined data from ten European longitudinal studies and found 30,000 people who had a heart attack. Around 5,000 people (18%) died within 28 days. Of these, 3,000 (62%) died instantly.

European Journal of Preventative Cardiology

Fish oil supplements however had no worthwhile cardioprotective effects according to a Cochrane Systemic Review done several years ago. A study looking at secondary prevention in 70-80 year olds, recently found similar effects. There was no difference between the omega 3 fish oil supplemented group and placebo over two years.

Cochrane Database Systemic Review and Circulation