High doses of Statins tend to worsen osteoporosis, so more monitoring in susceptible patients will be required.

Jan 13, 2024Dec 7, 2023 kaitiscotland5 Comments

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Clinical science
Diagnosis of osteoporosis in statin-treated patients
is dose-dependent
Michael Leutner et al. Department of Internal Medicine. University of Vienna.
Ann Rheum Dis 2019;78:1706–1711.

Key messages

What is already known about this subject?
► There is a relationship between statins and
osteoporosis.

What does this study add?
► Osteoporosis is underrepresented in low-dose
statin treatment.
► There is an overrepresentation of osteoporosis
in high-dose statin treatment.

How might this impact on clinical practice or
future developments?
► In clinical practice, high-risk patients for
osteoporosis under high-dose statin treatment
should be monitored more frequently.

Abstract
Objective: Whether HMG-CoA-reductase inhibition,
the main mechanism of statins, plays a role in the
pathogenesis of osteoporosis, is not entirely known so
far. This study was set out to investigate
the relationship of different kinds and dosages of statins
with osteoporosis, hypothesising that the inhibition of
the synthesis of cholesterol could influence sex-hormones
and therefore the diagnosis of osteoporosis.
Methods Medical claims data of all Austrians from
2006 to 2007 was used to identify all patients treated
with statins to compute their daily defined dose averages
of six different types of statins. We applied multiple
logistic regression to analyse the dose-dependent risks
of being diagnosed with osteoporosis for each statin
individually.

Results: In the general study population, statin
treatment was associated with an overrepresentation
of diagnosed osteoporosis compared with controls (OR:
3.62, 95%CI 3.55 to 3.69, p<0.01). There was a highly
non-trivial dependence of statin dosage with the ORs
of osteoporosis. Osteoporosis was underrepresented
in low-dose statin treatment (0–10mg per day),
including lovastatin (OR: 0.39, CI 0.18 to 0.84, p<0.05),
pravastatin (OR: 0.68, 95%CI 0.52 to 0.89, p<0.01),
simvastatin (OR: 0.70, 95%CI 0.56 to 0.86, p<0.01) and
rosuvastatin (OR: 0.69, 95%CI 0.55 to 0.87, p<0.01).

However, the exceeding of the 40mg threshold for
simvastatin (OR: 1.64, 95%CI 1.31 to 2.07, p<0.01),
and the exceeding of a 20mg threshold for atorvastatin
(OR: 1.78, 95%CI 1.41 to 2.23, p<0.01) and for
rosuvastatin (OR: 2.04, 95%CI 1.31 to 3.18, p<0.01)
was related to an overrepresentation of osteoporosis.

Conclusion: Our results show that the diagnosis
of osteoporosis in statin-treated patients is dosedependent.

Thus, osteoporosis is underrepresented
in low-dose and overrepresented in high-dose statin
treatment, demonstrating the importance of future
studies’ taking dose-dependency into account when
investigating the relationship between statins and
osteoporosis.

Book Review: Forever Strong by Dr Gabrielle Lyon

Jan 7, 2024Oct 30, 2023 kaitiscotland3 Comments

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Forever Strong: A new science based strategy for aging well by Dr Gabrielle Lyon.

I read this book when it came out in October 2023. It costs £16.99 from Amazon in paperback.

Dr Lyon has worked in psychiatry, geriatrics and nutrition. She thinks that over fatness is less of a problem to being under muscled when it comes to general health, ageing and efforts to live longer in better shape.

She advocates a high protein diet of no less than 100g of protein a day for all adults. This can be more depending on a person’s ideal lean body weight. It is also a lot higher for those who aim to build more muscle.

She offers three different eating regimes. The first is for longevity. For this she recommends higher protein meals for breakfast and dinner and a lighter protein snack at lunch time. Carbohydrates are generally restricted to the same number of grams as the protein spread over the day. These can be increased for those engaged in more than one hour’s vigorous exercise a day. Fat is eaten according to the remaining calories available to maintain weight.

For those wanting to lose weight, she recommends that protein is spread evenly over three meals a day. Carbohydrate should be no more than 30g per meal. Fat intake should be low as the aim is to cut back by 10-20% of maintenance calories daily. She thinks that it is crucial to prioritise dietary protein as this reduces muscle loss and improves satiety. Carbohydrates should be low sugar fruit and low starch vegetables in order to minimise calories and insulin response.

For those who want to gain weight, protein intake is higher and usually needs to be spread over 4 meals. Carbohydrate and fat can be increased as the aim is to exceed maintenance caloric intake. A well planned exercise regime needs to be undertaken and this will usually require a personal trainer at a gym.

The exercise regime offered is based at the beginner in the book but she offers different programmes from her website. I wasn’t able to find these when I looked but perhaps they are still undergoing development.

The book covers the science behind her nutritional advice, a discussion of the mental roadblocks that stop people taking control of their diet and exercise regimes, baseline measurements that will help you figure out what exactly you should be eating and some recipes.

I exercise daily and have been weight training since the age of 27. I also have been low carbing for 20 years. Did I learn anything? YES.

I’ve been making several big mistakes regarding my diet and exercise regime.

Firstly, although I eat about double the protein that I see my friends eating, this is still not likely to be high enough for optimal muscle gain.

Secondly, I really should be eating a lot more protein first thing in the morning so that dietary leucine levels come up to the threshold that prevents muscle breakdown and ensures the best use of protein in the body and for muscle development.

Thirdly, like a lot of low carbers my fat intake is very high, and I pile it on oblivious of the caloric intake.

Fourthly, I do indulge in the odd sugar /starch item and during weight loss efforts these would be better cut out entirely. Same for alcohol.

Fifthly, my weight training regime needs altered. I used to do alternate days resistance training and something else but various injuries and back pain led me to experiment with more stretching and back exercises and this led to a definite improvement in my chronic back pain. I have altered my regime again to add in more resistance work. Dr Lyon thinks that three times a week is best. I’ll see how this goes but at my age I need to consider the injuries and degenerative problems that accumulate.

Overall this is a very helpful book for those who seek the best of physical health and contains information that I was not previously aware of.

Merry Christmas!

Dec 25, 2023Oct 30, 2023 kaitiscotland8 Comments

Merry Christmas all Readers!

It’s come round again. Christmas time. Emma and I wish you all good cheer and best wishes this winter season whatever your religious leanings are.

For the first time in many years my family will be split up on Christmas day this year.

My husband will be working on a boat in the North Sea and he is hoping they don’t serve sheep’s head for dinner this year. I’m not kidding. This is a Norwegian “speciality” and it is very much a Marmite thing. Another thing he can’t stand, but could be faced with is fish that has been buried for a while in the ground. Here is hoping that your holiday feast will be better than traditional Norwegian fare.

My diabetic son will be staying in London with his girlfriend so she won’t be spending Christmas alone. She is a midwife in a London hospital and has a lot of shifts rostered over the period.

My younger son will be travelling home for Christmas so we will have a nice meal of some kind but don’t intend to do our usual Gordon Ramsay’s ham in mustard and treacle as we will have Christmas dinner on New Year’s day instead. This is where my fantastic low carb/gluten free tiramisu also shines.

It will be a bit sad this year because two of our four cats died this year of cancer. One death was long expected at age almost 17 and the other was quick and unexpected at 9.5 years. The usual bevvy of expectant wee faces will be missing this year.

Recently I bought the Meta Quest 3 so I won’t be getting any expensive stuff this year (since I’ve already done the deed). I had bought myself the Quest 1 four years ago but it is now obsolete. I absolutely love the upgraded visual effects and expect the boys to love it too.

I hope you all have an enjoyable day, and if you are unable to celebrate on the actual day, like many other workers, patients, or simply due to transport problems, I hope your proxy fun day is just as good as you hope.

Low carb diets have almost all the nutrients you need

Dec 22, 2023Oct 30, 2023 kaitiscotland1 Comment

Adapted from BMJ Open Access: Assessing the nutrient intake of a low carb high fat diet: a hypothetical case study design.

Abstract
Objective: The low-carbohydrate, high-fat (LCHF) diet
is becoming increasingly employed in clinical dietetic
practice as a means to manage many health-related
conditions. Yet, it continues to remain contentious in
nutrition circles due to a belief that the diet is devoid of
nutrients and concern around its saturated fat content.

This work aimed to assess the micronutrient intake of the
LCHF diet under two conditions of saturated fat thresholds.

Design: In this descriptive study, two LCHF meal plans
were designed for two hypothetical cases representing the
average Australian male and female weight-stable adult.

National documented heights, a body mass index of 22.5
to establish weight and a 1.6 activity factor were used to
estimate total energy intake using the Schofield equation.

Carbohydrate was limited to <130 g, protein was set at
15%–25% of total energy and fat supplied the remaining
calories.

One version of the diet aligned with the national
saturated fat guideline threshold of <10% of total energy
and the other included saturated fat ad libitum.

Primary outcomes: The primary outcomes included all
micronutrients, which were assessed using FoodWorks
dietary analysis software against national Australian/New
Zealand nutrient reference value (NRV) thresholds.

Results: All of the meal plans exceeded the minimum NRV
thresholds, apart from iron in the female meal plans, which
achieved 86%–98% of the threshold.

Saturated fat intake was logistically unable to be reduced below the 10%
threshold for the male plan but exceeded the threshold by
2 g (0.6%).

Conclusion: Despite macronutrient proportions not
aligning with current national dietary guidelines, a wellplanned LCHF meal plan can be considered micronutrient replete.

This is an important finding for health
professionals, consumers and critics of LCHF nutrition, as
it dispels the myth that these diets are suboptimal in their
micronutrient supply. As with any diet, for optimal nutrient
achievement, meals need to be well formulated.

My comments: Achieving nutritional completeness is almost impossible on a high carb, low fat, low protein diet. Despite the nutritional superiority of a well formulated low carb diet, there are some take home notes from the dieticians involved. 1. Your requirements for Vitamin D cannot be met solely by diet. You either need year round sun exposure or nutritional supplementation with a Vitamin D/K2 supplement. 2. In women of childbearing age, they may need extra iron in the diet, even if they eat red meat regularly. This is due to the effects of menstruation and pregnancy. This may involve eating red meat with fruit juice, avoiding tea with meals, and taking extra iron supplements. Latest thinking is that iron supplementation on alternate days or even less often reduces the bowel problems such as constipation that are usually caused.

Changes to Ancestral Diets have produced a lot of ill health and sugar and starch are mainly the problem

Dec 16, 2023Oct 27, 2023 kaitiscotland4 Comments

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SYSTEMATIC REVIEW article

Front. Nutr., 09 February 2022
Sec. Nutritional Epidemiology
Volume 9 – 2022 | https://doi.org/10.3389/fnut.2022.748305

Dietary Transitions and Health Outcomes in Four Populations – Systematic Review

Mariel Pressler¹ Julie Devinsky¹ Miranda Duster¹ Joyce H. Lee¹ Courtney S. Glick¹ Samson Wiener¹ Juliana Laze¹ Daniel Friedman¹ Timothy Roberts² Orrin Devinsky¹^*

¹Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
²NYU Health Sciences Library, New York, NY, United States

Importance: Non-communicable chronic diseases (NCDs) such as obesity, type 2 diabetes, heart disease, and cancer were rare among non-western populations with traditional diets and lifestyles. As populations transitioned toward industrialized diets and lifestyles, NCDs developed.

Objective: We performed a systematic literature review to examine the effects of diet and lifestyle transitions on NCDs.

Evidence Review: We identified 22 populations that underwent a nutrition transition, eleven of which had sufficient data. Of these, we chose four populations with diverse geographies, diets and lifestyles who underwent a dietary and lifestyle transition and explored the relationship between dietary changes and health outcomes. We excluded populations with features overlapping with selected populations or with complicating factors such as inadequate data, subgroups, and different study methodologies over different periods. The selected populations were Yemenite Jews, Tokelauans, Tanushimaru Japanese, and Maasai. We also review transition data from seven excluded populations (Pima, Navajo, Aboriginal Australians, South African Natal Indians and Zulu speakers, Inuit, and Hadza) to assess for bias.

Findings: The three groups that replaced saturated fats (SFA) from animal (Yemenite Jews, Maasai) or plants (Tokelau) with refined carbohydrates had negative health outcomes (e.g., increased obesity, diabetes, heart disease). Yemenites reduced SFA consumption by >40% post-transition but men’s BMI increased 19% and diabetes increased ~40-fold. Tokelauans reduced fat, dramatically reduced SFA, and increased sugar intake: obesity and diabetes rose. The Tanushimaruans transitioned to more fats and less carbohydrates and used more anti-hypertensive medications; stroke and breast cancer declined while heart disease was stable. The Maasai transitioned to lower fat, SFA and higher carbohydrates and had increased BMI and diabetes. Similar patterns were observed in the seven other populations.

Conclusion: The nutrient category most strongly associated with negative health outcomes – especially obesity and diabetes – was sugar (increased 600–650% in Yemenite Jews and Tokelauans) and refined carbohydrates (among Maasai, total carbohydrates increased 39% in men and 362% in women), while increased calories was less strongly associated with these disorders. Across 11 populations, NCDs were associated with increased refined carbohydrates more than increased calories, reduced activity or other factors, but cannot be attributed to SFA or total fat consumption.

Key Points

Question: What dietary factors contribute to non-communicable chronic diseases (NCDs) among populations transitioning from their original to westernized diets?

Findings: Our systemic literature review examined four populations that transitioned from their original to a more westernized diet and lifestyle. We also reviewed seven additional populations that underwent a similar transition. We identified a strong association between NCDs and increased sugar and refined carbohydrate consumption, and weaker associations with increased total calories with reduced physical activity. Neither fat nor saturated fat intake were associated with risk of developing NCDs in any of the populations.

Meaning: Increased consumption of sugar and refined carbohydrates were strongly associated with the development of NCDs in all four populations. Increased calories and decreased physical activity were less strongly correlated although both of these measures are imprecisely defined and not quantified in any of these group. Neither fat nor saturated fat intake were associated with NCD risk in any population.

BMJ: Cutting sugar and starch from the diet is associated with long term weight control

Dec 10, 2023Oct 27, 2023 kaitiscotland2 Comments

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Sadly this is NOT a post about how eating these gorgeous looking cup cakes will make you slim!

Adapted from BMJ 30 Sept 2023

Association between changes in carbohydrate intake and long term weight changes. Wan Y et al.

This study looked at the association between changes of different types of carbohydrate and weight changes measured at four yearly intervals.

The data was retrieved from the Nurses Health Study, Nurses Health Study 2, and the Health Professionals Follow up Study. These studies were done between 1986 and 2015.

The participants at the start had to be in good health and aged 65 years or younger. They then completed follow up questionnaires every four years. They were asked about personal characteristics, medical history and lifestyle. Carbohydrate type and amount was calculated from validated food frequency questionnaires. The weight changes were self reported every two years.

Over 136 thousand health professional were questioned over the years.

On average participants gained 1.5 kg every four years amounting to 8.8kg on average over 24 years.

Foods higher in glycaemic index and glycaemic load tended to produce more weight gain. For example, a 100g a day increase in starch or sugar was associated with 1.5kg and 0.9kg greater weight gain over four years. A 10g a day increase in fibre however, tended to result in 0.8kg weight loss over four years. Other foods that increased weight were refined grains and starchy vegetables such as peas, corn and potatoes. The foods that tended to reduce weight were whole grains, fruit, and non starchy vegetables.

For example, over 4 years a 100g daily increase in non starchy vegetables a day equated to 2.6 kg extra weight. If non starchy vegetables increased by 100g a day the weight loss was 3kg.

The effects were more noticeable in women and in those who were already overweight or obese.

This study shows that not all carbohydrates have an equal effect on body composition. For long term weight management limiting added sugar, sugar sweetened beverages, refined grains and starchy vegetables would seem prudent. These can be helpfully replaced with whole grains, fruit and non starchy vegetables.

Artificial Intelligent Computers can accurately diagnose diabetic retinopathy

Dec 4, 2023Oct 27, 2023 kaitiscotlandLeave a comment

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Adapted from BMJ 30 Sept 2023

Nature has reported that an AI model called RETFound has been successfully trained to diagnose diabetic retinopathy from eye scans.

1.6 million unlabelled retinopathy pictures were used to teach the computer what a retina looked like. After this it was taught to diagnose specific conditions using a much smaller selection of images. The machine was excellent at diagnosing diabetic retinopathy and progress has also been made in teaching it to diagnose cardiac failure, stroke and Parkinson’s disease.

How clever is that!

Jovina cooks: Classic Manhattan Clam Chowder (the one with tomatoes)

Nov 28, 2023Oct 27, 2023 kaitiscotland2 Comments

Classic Manhattan Clam Chowder

Ingredients

1 tablespoon olive oil
2 carrots, peeled and diced
2 celery stalks, diced
1 onion, diced
1 medium bell pepper, seeded and diced
1 pound Yukon gold potatoes, peeled and diced
1 garlic clove, minced
1 sprig of thyme
1/4 teaspoon celery seed
2 bay leaves
15 oz can chopped tomatoes
2 cups of seafood broth or clam juice
2 10-ounce cans of diced clams, drained with juice reserved
Salt and black pepper to taste
Chopped parsley
Saltine crackers for serving

Directions

Heat the oil in a dutch Oven, Add vegetables and garlic, and cook, stirring frequently, until the vegetables are soft but not brown, approximately 10 to 15 minutes. Add drained clam broth, seafood broth, thyme and celery seed, and bay leaves.

Partly cover the pot, and simmer gently until potatoes are tender approximately 10 minutes.

When potatoes are tender, stir in tomatoes, and heat them through. Add chopped clams, stirring to combine. Add black pepper to taste. Let chowder come to a simmer, and remove from heat. Fish out the thyme and the bay leaf, and discard. Taste and adjust the seasoning.

The chowder should be allowed to sit for a while to develop flavor. Reheat it before serving, then garnish with chopped parsley. Serve with oyster crackers.

Type 2 Diabetics lose 3 to 4 years for every decade that they have the disease.

Nov 22, 2023Oct 27, 2023 kaitiscotlandLeave a comment

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Adapted from BMJ 7 Oct 23

An analysis of data from 1.5 million people from 19 countries indicates that for every decade that someone is diagnosed with type two diabetes, they will lose 3 to 4 years of life expectancy.

In the USA if you are a 50 year old man, you would be likely to lose 14 years if you had been diagnosed at age 30, 10 years if you were diagnosed age 40 and 6 years if you were diagnosed aged 50, compared to someone who was not diabetic.

My comment: Given that there is a big rise in type 2 diabetes diagnosis in children and young adults, this is pretty concerning. Of course, there are ways to effectively manage the condition and even put it into remission. There are more effective drugs available but cutting out refined carbohydrates and regular exercise are two of the most effective thing that people can do for themselves.