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Supported exercise significantly improves life expectancy after colon cancer

Oct 16, 2025Jul 30, 2025 kaitiscotlandLeave a comment

Adapted from BMJ 14 June 2025

Observational studies have shown that colon cancer patients who increase their physical activity after treatment have a lower risk of recurrence and death compared to those who don’t. Now, a randomised controlled trial, the first of its kind, has shown the same thing.

A three year programme of structured exercise reduced the relative risk of disease recurrence, new primary cancer, or death, by 28% in patients with stage III and high risk stage II colon cancer. The magnitude of the benefit is on a par to many standard drug treatments.

The Challenge Study randomised 889 patients with resected colon cancer and adjuvant chemotherapy to either the structured exercise group or a health education group. The exercise group had face to face coaching sessions and behavioural support every week for the first six months and then once a month. The health education group were given information about healthy eating and exercise but not the personal coaching.

The exercise group managed to get people to do the equivalent of 40-60 minutes brisk walking or 25-30 minutes of jogging, three or four times a week.

After 8 years follow up, disease recurrence, new primary cancer, or death had occurred in 93 of the 445 people in the exercise group, compared with 131 of 444 people in the education group. 90% of the exercise group were still alive, compared to 83% in the education group.

Vicky Coyle, consultant medical oncologist at Queen’s University Belfast, who led the research, hopes that exercise will be embedded in future treatment plans for patients.

It is thought that exercise works by regulating hormone levels, reducing inflammation and strengthening the immune system.

One of the commonest questions patients ask their doctors is what they can do to reduce their risk of a cancer recurrence. A vigorous, structured exercise programme fits the bill.

The link between poverty and poor health is complex

Oct 10, 2025Sep 19, 2025 kaitiscotlandLeave a comment

*Photo by Photo By: Kaboompics.com on Pexels.com*

Adapted from BMJ 26 July 2025

Mothers and children in low income households have poorer health than those from high income households. A trial in four cities in the USA compared results when monthly unconditional cash transfers were made. In theory, those given more money should see an improvement in health.

A total of 1,000 mothers were randomised to receiving either $333 dollars or $20 a month until their child was six years old.

After four years, no difference between the groups was found n maternal mental health, maternal or child BMI, or maternal report of the child’s health.

My comment: I would have thought that an extra $333 would have led to some improvements in diet, house heating, clothes and shoe provision. It could also have led to less paid work being necessary for the mother to do, which I would also have expected to help. I am surprised that health outcomes didn’t improve at all. Perhaps, much more money is needed? Or is it being spent on things that don’t improve health?

Weight loss drugs have unintended side effects

Oct 4, 2025Jul 27, 2025 kaitiscotland1 Comment

Adapted from BMJ 14 June 2025

Weight loss drugs have considerable advantages but as use grows unexpected side effects are occurring too.

For the child bearing years, usually 15-45 years of age, weight loss drugs seem to render oral contraceptives less effective.

Therefore, should you wish to delay or prevent conception, it is best to add a barrier method such as condoms or a diaphram to the combined or progestogen only pill.

Should a pregnancy occur, the weight loss drugs need to be stopped because there is insufficient knowledge about how these drugs can affect a developing baby. Animal studies indicate that there could be adverse fetal outcomes.

For those in older age groups, it has been found that people with diabetes have twice the likelihood of developing neovascular age related macular degeneration, than diabetics not on weight loss drugs.

Dr Rangan Chattergee: Baked salmon fishcakes

Sep 28, 2025Jul 24, 2025 kaitiscotlandLeave a comment

*Photo by RDNE Stock project on Pexels.com*

Adapted from Dr Rangan Chatterjee’s website.

Baked Salmon Cakes

These fishcakes are an easy way to nourish your body and enjoy a flavourful meal.

1 tablespoon avocado or olive oil

6 oz can of wild salmon or 6 oz of cooked salmon

1/2 medium red onion finely chopped

1 large egg, beaten

1/4 cup finely chopped almonds

1/2 teaspoon of salt

1/4 teaspoon finely ground black pepper

1 cup ground almonds

one lemon cut into wedges (optional)

finely chopped parsley leaves (optional)

Mayonnaise (optional)

Method

Pre-heat the oven to 425 degrees. Grease a baking sheet with oil and put it in the oven to heat.

In a medium bowl, shred the salmon into small flakes with two forks. If you are using canned salmon add the liquid into the bowl.

Add the onion, egg, chopped almonds, salt and pepper and mix well.

Stir in the almond meal. If you are using canned salmon, the mix could get a bit slushy, and if this is the case, add additional ground almonds.

Form two large patties.

Put in the oven on the top rack. Bake for 10 mins. Then take out and turn over the patties. Bake for a further 10 minutes.

Serve immediately with lemon wedges and parsley garnish or mayonnaise.

Falling is the main cause for excess injuries in people with diabetes

Sep 22, 2025Jul 23, 2025 kaitiscotland1 Comment

Adapted from BMJ 24 August 2024

An Australian study has shown that people with both type one and type two diabetes are hospitalised for injury more often than the general population.

Most of these injuries happened due to falls.

People using insulin have 60% more chance of being hospitalised for injury. Type two diabetics who take sulphonylureas have also a raised risk.

My comments: These findings tend to indicate that hypoglycaemia is a cause of falls. There could also be other reasons. I recall visiting a woman who had two broken wrists. She had fallen in the street and had fallen off the kerb. I asked why she thought she fell. She said, “I can’t feel my feet.” As a fractured hip in older age is a major reason for losing independence it is important for diabetics to aim for as best blood sugar control as appropriate for them, but also to take care to reduce hypoglycaemia.

Marks and Spencer now supplying stoma underwear

Sep 16, 2025Jul 21, 2025 kaitiscotlandLeave a comment

Adapted from BMJ 24 August 2024

Marks and Spencer has partnered with Colostomy UK to launch an underwear line design for people with a stoma.

About 100,000 women in the UK have a stoma, but many find that underwear options were very limited to specialist online retailers.

They have produced a more affordable, accessible panty range that can keep a stoma bag in place by day and night.

Obituary: Vincent Marks

Sep 10, 2025Jul 18, 2025 kaitiscotlandLeave a comment

Adapted from BMJ 9-16 Dec 2023

Vincent Marks was a pioneering researcher into insulin and hypoglycaemia who became an important expert witness in cases against nurse Beverly Allitt, who was convicted of several child murders, and Claus Von Bulow, who was acquitted of the attempted murder of his wife.

Vincent Marks was born in 1930 and died of metastatic thyroid cancer in 2023.

The Von Bulow case centred around the cause of the coma suffered by his wife, Sunny. She spent 27 years in a coma prior to her death. It was alleged that her husband had injected her with insulin. She had considerable wealth compared to him. The “sleeping beauty murder” was the first major trial to be televised. Events were described in the book, Reversal of Fortune, and a film starring Jeremy Irons and Glen Close followed. Jeremy received an Oscar for his performance.

Vincent was a professor of clinical biochemistry and head of clinical biochemistry and metabolic medicine in Royal Surrey County Hospital in Guildford. His laboratory was the first to offer insulin assays to NHS hospitals throughout the UK.

A sample from Nottingham revealed that children had low blood sugar and high insulin levels and this revealed the deliberate harm done to children by nurse Beverly Allitt.

Vincent was the first to develop a method to accurately measure blood sugar at low concentrations. Up until then some patients had been given erroneous diagnoses of neurological disorders when they really had hypoglycaemia.

In 1995 Vincent retired from clinical medicine in order to devote his time to teaching medical students and post-graduates. He published widely including Insulin Murders, which spanned 50 years of legal cases.

Vincent was born in a London pub which was owned by his father. He had an elder brother John, who also became a doctor. During the war, he was evacuated to a farm in Devon. Although brought up in Judaism, he became a Humanist.

His wife Averil and he were married for 66 years, had two children, six grandchildren and four great grandchildren.

Education is a major factor in determining future health

Sep 4, 2025Jul 17, 2025 kaitiscotlandLeave a comment

Adapted from BMJ 3 Feb 2024

A study in Lancet Public Health has found that every year spent in a classroom improves life expectancy, while not attending is as deadly as smoking or heavy drinking.

Researchers from Norway and the USA examined data from 59 countries including Brazil, China, the UK, and the USA. They found that all cause adult mortality fee by 2% for every year in full time education.

Compared to no formal education, if you reached college or university level education, your total mortality fell by 34%. But not attending school was equivalent to smoking 10 cigarettes a day or drinking 5 or more alcoholic drinks a day for ten years. The effects were similar in rich and poor countries regardless of sex, social class or demography.

Money is part of this effect. Education leads to higher lifetime earnings and that in turn improves housing and diet. It also helps you access and understand information that can guide you to make better life choices.

For women, higher educational levels reduce maternal and child deaths, better child health and lower fertility rates. Educated women tend to use contraception, marry later, have fewer children and be better informed about their children’s needs.

AI history taking is as good as a real doctor

Aug 29, 2025Jul 16, 2025 kaitiscotlandLeave a comment

Adapted from BMJ 3 Feb 2024

Most doctors agree that taking a medical history from a patient not only improves rapport but is essential to accurate diagnosis.

History taking is a skill that takes time and practice. Part of this is knowing when to delve more deeply and when you can take things at face value or leave parts out. Now, AI assistants have been trained to do it too.

A randomised, controlled, double blind trial was done with actors, simulating the patients, the Articulate Medical Intelligence Explorer, and primary care physicians. To keep everyone blinded as to who was “the doctor”, text chat was used instead of face to face interviewing.

The AI machine was as good as the doctors.

My comment: I could see this being very useful in clinical practice as a way of reducing consultation times and prioritising urgency of appointments.

Testosterone replacement didn’t seem to reduce diabetes onset.

Aug 23, 2025Jul 13, 2025 kaitiscotlandLeave a comment

*Photo by SHVETS production on Pexels.com*

Adapted from BMJ 17 Feb 2024

Around a third of US adults have impaired glucose tolerance also known as pre-diabetes. Many of the men also have low testosterone levels. This is known to cause fat accumulation, insulin resistance and type two diabetes.

Testosterone therapy is known to improve muscle mass, reduce fat mass, and improve insulin sensitivity. One would imagine that giving men who have low testosterone and pre-diabetes, hormone replacement therapy, would reduce the onset of type two diabetes.

For unknown reasons, doing this didn’t work.

In men over the age of 45 with low testosterone and pre-diabetes, testosterone gel was no more effective than placebo in reducing the onset of type two diabetes after two years. (13.5% in the active group and 15.7% in the placebo group.) Glycaemic control also failed to improve.

The trial also found out that testosterone replacement therapy also didn’t reduce fractures in hypogonadal men, even though skeletal mass is known to improve with testosterone.

My comment: I’m sure the researchers were disappointed to see this result. My practice was to treat these men with TRT and I am baffled as to these results, as treatment is usually very well tolerated.