Nutrients and exercise can reduce cancer risk

Dec 13, 2022Nov 5, 2022 kaitiscotland3 Comments

Adapted from Nutrients and exercise affect tumour development by Carla Martinez May 27 2022 and

Three pronged approach may reduce cancer risk in the elderly by Nadine Ekert June 7 2022 Medscape

In a Madrid Oncology conference researchers discussed an update on lifestyle factors and cancer.

Diet and lifestyle can have an influence on each of the successive stages that occur in the development of cancer: initiation, promotion and progression.

A deficit of certain nutrients is one of the factors involved in the initiation stage. Various deficiencies affect different parts of cell metabolism adversely. Such nutrients include folate, B12, B6 and B3, Vitamin C, Selenium, Zinc, Magnesium and Vitamin D.

Aflatoxins from foods of vegetable origin are detrimental. The foods include cassava, pepper, corn, millet, rice, sorghum, wheat, sunflower seeds and peanuts, but the effect very much depends on how these foodstuffs are stored.

Added nitrates to foods such as processed meats and sausages because they become nitrosamines which affect cancer development. Natural nitrates in food however do not cause cancer.

Smoking causes 72% of lung cancer and 15% of all cancers. Eating processed meat causes 13% of intestinal cancers and 1.5% of all cancers. The most problematic foods for nitrosamines are cured meat, and smoked meat and fish. Cooking meats also causes polycyclic aromatic hydrocarbons especially chicken.

Various cooking strategies will reduce the formation or dilute the effects of polycyclic aromatic hydrocarbons.

Marinate mean in an acid solution for more than one hour.

Season meats and fish before grilling them. Good spices to use are: pepper, paprika, garlic, onion, ginger, turmeric, cumin, cinnamon, clove, fennel, and star anise.

Cook at a low temperature eg boiling.

Eat meats with lots of brassicas such as broccoli, cabbage, kale, turnip, brussel sprouts and mustard.

Grilled foods contain benzopyrene which can cause a mutation in DNA and thus cause cancer. Brassicas are rich in sulforphane which works on genes that produce glutathione s-transferase which promotes the elimination of benzopyrene.

Other factors that promote cancer include psychological stress, circadian disruption such as shift work, physical inactivity, obesity, hyperglycaemia, hyperinsulinaemia, gut bacteria disruption, and vitamin D deficiency.

The common factor here is increased inflammation. Some nutrients act as anti-inflammatories including the omega 3 oils EPA and DHA. Ginger, green tea, turmeric and broccoli all help too.

Daily rituals determine our health, so think about how you can optimise your routines.

The influence of exercise on cancer has only been studied in the last ten years.

Hypoxia is one of the main triggers of tumour aggression. Exercise has been shown to improve oxygenation and reduce hypoxia. Physical exercise in combination with chemotherapy has been proven to reduce tumour volume and progression. The best exercises in this regard are those that build up lactate in the muscle such as resistance exercise and cycling.

In the DO-HEALTH study, more than 2,000 healthy elderly people over the age of 70, were observed over three years. A combination of high dose vitamin D, omega 3 fatty acids and a simple home training programme reduced the risk of cancer by 61% compared to placebo.

The risk of getting cancer increases as you get older. Apart from not smoking and sun protection, getting appropriate vaccines and screening, there is not that much left to do. As Vitamin D, omega 3 fatty acids and physical exercise are all promising factors in cancer reduction, various combinations of them were tried. Blood pressure, physical performance, cognition, fractures and infections were looked at. They were divided into 8 groups looking at placebo, training only, and then various combinations and single interventions.

Most groups showed no difference from placebo but the combination of vitamin D, omega 3s and training did. The number needed to treat to prevent one cancer over the three years was 53 which is considered pretty good. Researchers thought the outcome was good enough to recommend this to any one over 70 who was looking to improve their health.

Co-enzyme Q10 in cardiovascular and metabolic disease

Dec 7, 2022Nov 4, 2022 kaitiscotland3 Comments

Adapted from Co-enzyme Q10 in Cardiovascular and Metabolic Diseases: Current State of the Problem, by Vladlena I Zozina et al. Current Cardiology Reviews 2018 Aug: 14(3) 164-174.

Co-enzyme Q10 (CoQ10) is an essential compound of the human body. There is growing evidence that it is tightly linked to cardiometabolic disorders. Supplementation can be useful in a variety of chronic and acute disorders. This review article discusses its role in hypertension, ischemic heart disease, myocardial infarction, heart failure, viral myocarditis, cardiomyopathies, cardiac toxicity, dyslipidaemia, obesity, type 2 diabetes mellitus, metabolic syndrome, cardiac procedures and resuscitation.

CoQ10 is made in the inner membrane of the mitochrondia. These are the little batteries which power your cells. It exists as ubiquinone which is oxidised and ubiquinol which is does not have oxygen attached. It is a key component of electron transfer in ATP production, which is how cellular energy is generated.

It is also an intercellular anti-oxidant. It also plays a role in cell growth and differentiation. There are many diseases and degenerative states associated with CoQ10 deficiency such as type 2 diabetes, atherosclerosis, hypertension, dyslipidaemia, muscular dystrophy, Alzheimer’s disease and Parkinson’s disease.

Administration of selenium and CoQ10 in a group of elderly people over 4 years resulted in significantly reduced cardiovascular mortality over the next ten years. This new review aims to sum up current possibilities in a variety of conditions with an analysis of the impact on health and quality of life.

CoQ10 is found in all organs but the highest concentrations are in the heart, kidneys, liver and muscles.

Three out of four patients with heart disease have low levels of CoQ10, particularly in ischaemic heart disease and cardiomyopathy.

In 2010 31% of all adults had hypertension. This rate is rising, particularly in low income countries.

CoQ10 has a direct effect on the lining of blood vessels, the endothelium, which dilates the blood vessels in hypertensive people and so reduces blood pressure. It also has a blood pressure lowering effect via the angiotensin effect in sodium retention and lowers aldosterone. Blood pressure can be lowered as far as normal levels with CoQ10 and has been measured as reducing systolic bp by 11 mmHg and diastolic by 7mmHg.

Giving 300mg daily of CoQ10 has been shown to reduce inflammatory markers and raise anti-oxidant enzyme activity. It is well known that a pro-inflammatory effect is a major component of chronic disease.

In 2013 cardiovascular diseases were a worldwide leading cause of death causing about a third of all deaths. A randomised study showed that in patients with myocardial infarction and hyperlipidaemia, supplementation resulted in lower blood pressure and a beneficial rise in HDL. After primary angioplasty after a heart attack, patients with higher levels of CoQ10 had better ventricular performance at 6 months follow up.

In rat studies infusion of CoQ10 results in less cardiac damage when their cardiac vessels are occluded to provoke cardiac ischaemia.

Heart failure causes less blood to be pumped out of the heart with every heart beat. This can be from a combination of structural and functional heart problems. HF is the cause of a huge amount of hospitalisation and cardiac impairment. Deaths from HF range from 10% to 50% per year. The plasma level of CoQ10 has been found to predict mortality in HF patients. Supplementation has been found to be beneficial in raising the level and decreasing mortality rates.

CoQ10 helps the heart muscle beat with more power. 100mg given three times a day to HF patients showed a reduction in cardiovascular mortality (9% v 16%), all cause mortality (10% v 18%) and number f hospital stays. Exercise tolerance was improved at the end of 2 years observation.

In those patients on the waiting list for heart transplants, CoQ10 users had a significant improvement in functional status, clinical symptoms and quality of life. Although the drugs for HF are still essential, there can be some additional benefits to CoQ10 supplementation.

Atrial Fibrillation is increasing worldwide year on year and is associated with symptoms and mortality. Supplementation has been found to reduce arrhythmias after surgery or drugs to stimulate the heart muscle after surgery.

In mice studies survival rate was higher in those given CoQ10 than those who were not when they had viral myocarditis. In humans both CoQ10 and trimetazidine have been found to be effective.

Cardiomyopathy is associated with a high mortality and poor quality of life. It is linked to increased oxidative stress. Supplementation has been found to improve both cardiac structure and function. Fatigue and breathlessness improved. These studies have been done in both adults and children.

Cardiac toxicity is an unwelcome side effect for certain cancer drugs used in chemotherapy. CoQ10 and L-carnitine together have been found to be cardio-protective.

Supplementation has been found to reduce side effects of statins in heart failure patients. This is because statins deplete CoQ10 levels.

Although low CoQ10 has been found in type 2 diabetes patients, supplementation had no effect on glycaemic control, lipid profile or blood pressure. Triglyceride levels were reduced.

In patients with metabolic syndrome had a beneficial effect on insulin levels with supplementation.

Women with polycystic ovarian syndrome had a beneficial effect on glucose metabolism, and cholesterol levels with supplementation.

Studies have been done during and after cardiac surgery and in the management of post cardiac arrest care. In one study hypothermia plus supplementation resulted in considerably improved outcomes compared with hypothermia without supplementation. The three month survival was 68% v 29%.

Supplementation studies have shown a potential role in septic and haemorrhagic shock patients.

Further research needs to be done to establish the optimal doses to give for various conditions and situations.

Levels of 100 -300mg of CoQ10 per day seem to be effective for a wide range of problems.

BMJ: What is junk food and what is the harm?

Dec 1, 2022Nov 4, 2022 kaitiscotland5 Comments

*Photo by Polina Tankilevitch on Pexels.com*

Adapted from: BMJ 3 Sept 22 People need nourishing food that promotes health, not the opposite by Carlos Monteiro et al.

Everybody needs food, but nobody needs ultra- processed food with the exception of infants who are not being breast fed and need infant formula.

The foods that are “ultra- processed” include: soft drinks, packaged snacks, commercial breads, cakes and biscuits, confectionery, sweetened breakfast cereals, sugared milk based and fruit drinks, margarine and pre-processed ready to eat or heat products such as burgers, pastas and pizzas.

These foods are industrial formulations made by deconstructing whole foods into chemical constituents, altering them and recombining them with additives into products that are alternatives to fresh and minimally processed foods and freshly prepared meals.

In low amounts, they wouldn’t necessarily be a problem. But most ultra- processed foods are made, sold and promoted by corporations, typically transnational, that formulate them to be convenient, ready to eat, affordable, due to low -cost ingredients, and hyperpalatable. These foods are liable to displace other foods and also to be overconsumed.

Systemic reviews of large well -designed cohort studies worldwide have shown that consumption of ultra-processed foods increase: obesity, type two diabetes, hypertension, cardiovascular and cerebrovascular diseases, depression, and all- cause mortality.

Other prospectively associated conditions include dyslipidaemias, gout, renal function decline, non-alcoholic liver disease, Crohn’s disease, breast cancer and in men colorectal cancer. They also cause multiple nutrient imbalances.

It is calculated that ingestion of these foods compared to fresh ingredients, matched for macronutients, sugar, sodium and fibre adds a typical 500kcal daily, which leads to the inevitable fat accumulation.

US investigators have found that dietary emulsifiers and some artificial sweeteners alter the gut bacteria causing greater inflammatory potential, so replacing sugar with these isn’t a good idea either.

In the UK policies to limit promotion and consumption of ultra-processed food have recently been rejected, mainly because of the belief that in our current economic situation people need access to cheap food. As no one really wants to support foods that cause illness, the obvious solution is to promote foods that are fresh and minimally processed, available, attractive and affordable. Such a strategy would improve family life, public health, the economy and environment.

Diabetes UK and British Dietetic Association finally recognise value of low carb diets for diabetics

Nov 25, 2022Nov 3, 2022 kaitiscotland2 Comments

I have personally been campaigning for low carbing for diabetics since 2003. I’m pleased to say that FINALLY Diabetes UK and the BDA have accepted low carbing as a valid option for management of type two diabetes. Presumably they will catch up with Type 1 diabetes in another 20 years or so.

Here are the main points from a paper that they issued on the subject in 2021.

Dietary strategies for remission of type 2 diabetes: A narrative review

Adrian Brown,Paul McArdle,Julie Taplin,David Unwin,Jennifer Unwin,Trudi Deakin,Sean Wheatley,Campbell Murdoch,Aseem Malhotra,Duane Mellor

First published: 29 July 2021

https://doi.org/10.1111/jhn.12938

Abstract

Type 2 diabetes (T2DM) is a growing health issue globally, which, until recently, was considered to be both chronic and progressive. Although having lifestyle and dietary changes as core components, treatments have focused on optimising glycaemic control using pharmaceutical agents. With data from bariatric surgery and, more recently, total diet replacement (TDR) studies that have set out to achieve remission, remission of T2DM has emerged as a treatment goal. A group of specialist dietitians and medical practitioners was convened, supported by the British Dietetic Association and Diabetes UK, to discuss dietary approaches to T2DM and consequently undertook a review of the available clinical trial and practice audit data regarding dietary approaches to remission of T2DM. Current available evidence suggests that a range of dietary approaches, including low energy diets (mostly using TDR) and low carbohydrate diets, can be used to support the achievement of euglycaemia and potentially remission. The most significant predictor of remission is weight loss and, although euglycaemia may occur on a low carbohydrate diet without weight loss, which does not meet some definitions of remission, it may rather constitute a ‘state of mitigation’ of T2DM. This technical point may not be considered as important for people living with T2DM, aside from that it may only last as long as the carbohydrate restriction is maintained. The possibility of actively treating T2DM along with the possibility of achieving remission should be discussed by healthcare professionals with people living with T2DM, along with a range of different dietary approaches that can help to achieve this.

Practice points

Type 2 diabetes (T2DM) remission should be considered as a treatment goal for people living with T2DM (especially for those within 6 years from being diagnosed). The ability to achieve this may be influenced by duration of diabetes, weight loss and gender. Therefore, it should be positively discussed with this in mind.
Based on the evidence from clinical trials weight loss (typically 15 kg or greater) is the main driver and predictor of remission. However, more data are needed so that it is more reflective of an ethnically diverse population.
Based on evidence from clinical trials, maintenance of weight loss appears to be the main driver of continued remission, and this therefore needs to be a key focus of the planning and delivery of all services designed to achieve remission. If a diet low in carbohydrate is sustainable to the individual, normoglycaemia may be maintained in the absence of weight loss, although evidence is limited and loss of remission is likely to occur if carbohydrate restriction ceases.
Total dietary replacements (TDR) and low carbohydrate diets have been demonstrated as being effective in facilitating weight loss and remission of T2DM. Evidence of effectiveness beyond 2 years is limited. The dietary approach should be one which the individual can maintain for the long term.
TDR and low carbohydrate diets, if appropriately supported, are considered safe and should not be avoided in suitable individuals who find these approaches acceptable. Clinicians should therefore aim to support their use within clinical practice as part of person-centred diabetes care.
Programmes supporting people toward achieving remission need to be structured and offer continued, regular support, including the involvement of dietitians (mandated by the National Health Service England).

There are physiological reasons why your brain feels full up after a day’s work

Nov 19, 2022Nov 3, 2022 kaitiscotland7 Comments

*Photo by Andrea Piacquadio on Pexels.com*

Adapted from Medscape, Why our brains wear out at the end of the day, F Perry Wilson Aug 15 2022

We can all recognise from our own experience that as a long day goes on, our performance on mental tasks gets worse. In chess players for example, as the game goes on over several hours, they take longer to make decisions, and they make more mistakes. This is known as cognitive fatigue.

It has been found that the cognitive control centre in the brain is in the left, lateral, prefrontal cortex.(LLFC).

The LLFC is responsible for higher level thinking. It is what causes you to be inhibited. It shuts down with alcohol and leads to impulsive behaviours. It has reduced activity in functional MRI studies as you become more and more cognitively fatigued. The LLFC helps you think through choices. So how does cognitive fatigue happen? As a matter of interest the role of glucose has already been studied and it has been found that this does NOT vary in non- diabetic subjects.

Researchers did experiments with people to induce cognitive fatigue. They had to look at letters and indicate whether the letter was if it was a consonant or a vowel if it was red or if it was upper or lower case if it was green.

Both groups did this for six hours, but one group had much less switching around than the other, so that there was an “easy” group and a “hard” group. They all sounded terribly tedious to me!

The hard group made more mistakes than the easy group, but of course the task was harder to start with. The hard group got a little bit more tired at the end, but both groups were pretty fatigued. The hard group took longer to respond all through the testing hours, but they didn’t take longer by the end of the task. So, overall, there was no clear indicator that could determine who had done the easy tasks or the hard tasks.

The researchers then started adding a new game after the six hours. The subjects were told that they would now play a “reward game”. For instance:

Would you rather have a 25% chance of earning $50 or a 95% chance of earning $17.30?

Would you rather earn $50 but your next task session will be hard or earn $40 and your next task session will be easy?

It has been previously shown that as people become more fatigued they will tend to pick the low- cost choice over the high- win choice. Perhaps we all recognise that after a difficult workday we may be more likely to go with the flow and do something easy rather than the “best” thing. We often don’t feel we have much decision- making power left. I know this is a factor for prescribing more antibiotics on a Friday afternoon.

Interestingly pupil dilatation is a physiologic measure that demonstrates when your brain is “full up”.

When you are interested in something your pupils dilate a little. In the hard group, as time went on, pupil dilatation stopped and constricted in some people. In the easy group however, the dilatation continued through the tasks.

By doing a very fancy labelled hydrogen MRI on the subjects they looked at differences in brain metabolites in the LLPC area of the brain during the tasks.

They found that the level of glutamate and glutamic acid rose in the LLPC but not other metabolites and not in other parts of the brain. They also found that the glutamate leaked from inside the cells to outside the cells.

It is statistically significant that the higher the levels of glutamate in the LLPC, the more likely you are to just make the easy decision as opposed to really think things through.

Perhaps a good night’s sleep is clearing out the excess glutamate in the LLPC and allowing you to perform well the next day.

My comment: The hours pilots and air traffic controllers work are highly regulated because of the effect of fatigue on decisions and performance. Yet, this does not extend to GPs and hospital doctors to anything like the same extent. It is considered important for lorry drivers. For all drivers and for all students, particularly before exams, it is a good idea to recognise that we are all human. Tiredness isn’t something that you can really overcome with will power.

Beta blockers and diuretics are not the best choices for hypertension

Nov 13, 2022Sep 13, 2022 kaitiscotland2 Comments

Adapted from Medscape 2 Sept 2022. Hypertension: Real world efficacy of beta blockers versus other anti-hypertensives by Vinod Rane BS Pharm

Patients with hypertension who were treated with ACE inhibitors, Sartans and Calcium Channel blockers such as Amlodipine and Lercanipide had a lower risk of all- cause mortality than those treated with beta blockers.

The risk of all- cause mortality was no different between beta blocker users and those using diuretics.

Cardiovascular mortality was lowest in those treated with ACE inhibitors compared to beta blockers, Sartans, calcium channel blockers and diuretics.

Adapted from Sue Hughes Medscape August 26 2022 TIME: Cardiovascular events similar with evening or morning dose of blood pressure medications.

A five year trial looking at outcomes in those who took their blood pressure medications at night or in the morning showed no difference.

Previous studies have concluded that there could be a benefit to taking anti-hypertensives at night. Dundee researchers headed by Professor Tom MacDonald looked at hard outcomes which included vascular deaths, and non-fatal heart attacks and strokes.

They found “not a smidge of difference” between the two groups.

The study also showed that falls, fractures, or dizzy spells were no more common between the groups. The main thing he said was to take the medications every day at the same time and pick the time that suits you best.

The group tested had an average age of 65, 14% had diabetes,4% smoked,13% had prior CVD and the mean blood pressure at entry was 135/79. The patients were recruited from both primary and secondary care. The duration of follow up was between 5 and 9 years.

My comments: I am aware of the controversies regarding day and night time anti-hypertensives. Some doctors think that blood pressure control is better if drugs are taken at night and some think compliance is better if they are taken in the morning. I take my medication twice a day by splitting the dosage. That way I get good 24 hour coverage and if I forget a dose there is another one coming along in 12 hours or so.

Self- compassion can help students

Nov 7, 2022Sep 13, 2022 kaitiscotland2 Comments

Adapted from Human Givens Vol 29 No 1 2022

Over two thirds of university students don’t get enough sleep and this has knock on adverse effects on cognitive function and mental health.

Students have been found to get very stressed and blame themselves for poor academic performance. This leads to anxiety, depression and poor sleep quality. Researchers wanted to find out if treating yourself with kindness and understanding when you are having difficulties improves sleep quality.

Almost 200 students in the University of Manitoba completed questionnaires measuring self- compassion, sleep quality, and emotional regulation.

The researchers found that self- blame was the most important factor which affected low- self compassion. This also affected sleep quality the most. Students who avoided self- blame were also less likely to resort to other unhelpful cognitive strategies when under stress, such as denial, rumination, not making an action plan, catastrophising and assigning negative judgements.

Food factors affecting children

Nov 1, 2022Sep 13, 2022 kaitiscotland2 Comments

Adapted from BMJ 20 Nov 21 Vegan diets have mixed effects on children’s health

Dr Malgorzata Desmond from Great Ormond Street Institute of Child Health has studied the effects of a vegan diet in children.

The positive side is that children on vegan diets had less body fat and had a healthier cardiovascular profile but there were also disadvantages.

The vegan children were on average 3cm shorter, had around 5% less bone mineral content and were three times as likely to be deficient in vitamin B12 than meat and dairy eating children.

The findings were from a study of 187 healthy 5 to 10 year olds in Poland. The groups were 63 vegetarians, 52 vegans and 72 meat eaters.

Dr Desmond said that she was also surprised to find that much of the vegan children’s diet came from processed food. She suggests that vegan parents consider giving B12 and Vitamin D supplements to their children.

Adapted from Chang K JAMA Pediatr 14 Jun 2021

Researchers from the Avon Longitudinal Study of Parents and Children Birth Cohort studied children born in the early 1990s from age 7 to 24 years. Three day food and beverage diaries were completed when the children were 7, 10 and 12. Over 17 years BMI, weight, waist circumference and body fat were measured. This is the first study to look at longitudinal associations between ultra processed food intake and health outcomes.

The foods they were looking at included for example: frozen pizzas, mass produced bread, fizzy drinks and ready meals. The groups were split into quintiles for analysis.

The lowest quintile ate 23% of their diet from ultra processed foods and the highest 68%.

The children in the higher consumption groups got fatter quicker. By the age of 24, compared to the lowest ultra processed group, they had a higher BMI by 1.2 kg/m2, higher body fat by 1.5%, were 3.7 kg heavier and had a waist circumference 3.1 cm bigger.

Author Professor Christopher Millet said: We often wonder why obesity rates as so high among UK children and this study gives information why. One in five children are consuming 78% of their calories from ultra processed food.

He suggests that measures to reduce the promotion of these foods and to encourage the eating of normal foods are urgently needed in the UK and globally.

Adapted from Medscape ECO 2021 Parental emotional distress linked to excess weight and fat in offspring 14 May 2021

So are the parents who supply ultra processed food to their children just too overwhelmed to home cook?

Around a third of children in the UK live with at least once parent who experiences significant emotional distress. More than a third of UK children also become overweight or obese by the age of then years.

In the UK Millenium Cohort Study, 19 thousand families born between 2000 to 2002 were tracked. Only two parent households were included in the analysis into parental distress.

Distress in mothers was associated with higher BMIs in girls from the ages of 5 to 14. Distress in fathers was associated with higher BMIs in both girls and boys, compared to undistressed parents.

Supplements for neuropathy, retinopathy, cancer and migraine reduction

Oct 26, 2022Sep 9, 2022 kaitiscotland2 Comments

Photo by Nataliya Vaitkevich on Pexels.com

Adapted from Medscape 17 Nov 20, 13 June 21, 20 June 2022 and 26 July 22

Vitamin D

Vitamin D deficiency was significantly associated with an increase in sight threatening diabetic retinopathy (STDR). There was no association seen between vitamin D deficiency and non- sight threatening diabetic retinopathy (NSTDR).

UK researchers conducted a meta-analysis of 12 studies which had enrolled over 9 thousand patients who had type one and type two diabetes who did not have diabetic retinopathy.

Vitamin D deficiency was significantly associated with an increased risk of STDR (OR 1.8 95%)

My comment: For UK residents, particularly in Scotland, it is a good idea to supplement with vitamin D and vitamin K2 at least over our long winter if not all year round. There are many articles about this in previous blog posts which you can search for.

Melatonin

A short- term study of just over 100 patients was undertaken to see if the addition of melatonin to prescribed pregabalin for painful diabetic neuropathy made any difference compared to placebo plus pregabalin.

The groups were split evenly and 6mg of melatonin was tested over an eight -week period compared to an identical placebo.

Sleep improved in both groups but more so with melatonin. Pain also improved for each group and again this was more so in the melatonin group.

On the other hand day- time sleepiness was more pronounced for the melatonin group as was transient dizziness. More patients discontinued in the melatonin group compared to placebo.

My comment: In the UK melatonin is only available on prescription and except for ADHD patients, usually children, it is only given short term to those who have insomnia mainly due to expense. It is available cheaply and widely in supermarkets and pharmacies in the USA and Canada however. For sufferers of painful diabetic neuropathy who live in North America there doesn’t seem much to lose by a trial of treatment. Apart from aiding sleep, which has a host of benefits on its own, Melatonin is an important anti-oxidant. The authors of the study Shokri M et al have not offered an explanation of how they think the melatonin works to reduce pain in the excerpt in Medscape. The full report is at: Shokri M et al, Adjuvant use of melatonin for relieving symptoms of painful diabetic neuropathy: results of a randomised, double blinded, controlled trial. Eur J Clin Pharmacol. 2021 Jun 13.

Ginger

Patients treated with ginger reported significantly less pain, nausea and vomiting compared to placebo in a meta-analysis of 13 RCTs.

Ginger has already been found to improve the pain of osteoarthritis, period pain and muscle pain but had previously given conflicting results regarding migraine.

227 patients were analysed. There were no side effects from the ginger compared to placebo.

My comments: Again, what would you have to lose by trying this if you are a migraine sufferer?

Resistant starch

There is a familial condition called Lynch Syndrome where there is a genetic susceptibility to bowel and other cancers. Recently it has been found that apart from aspirin, resistant starch supplements reduce bowel cancer in this population if taken long term.

Resistant starch is found in oats, breakfast cereal, cooked and cooled pasta or rice, peas and beans and some other starchy foods.

Lead author John Mathers, professor of human nutrition at Newcastle University explains that although resistant starch is a carbohydrate, it is not absorbed in the small intestine and ferments in your large intestine, thereby giving your gut bacteria a good feed. He thinks that it works to reduce bowel cancer by changing the gut bacteria metabolism of bile acids to reduce the kind that damage DNA and eventually cause cancer.

The CAPP2 trial has been following almost one thousand Lynch Syndrome people for between ten and twenty years. They have been taking over this time either: placebo or aspirin or resistant starch. The resistant starch dose is the daily equivalent of eating one unripe banana.

At the end of the first two years there was no difference in effect between the placebo and resistant starch groups on bowel cancer, but cancers in other parts of the body were reduced by 60% in the resistant starch group. The reduced cancers were in the upper gut and included oesophageal, gastric, biliary, pancreatic and duodenal cancers.

Aspirin meanwhile reduced bowel cancer rates by 50% and there was no effect in the placebo group.

Professor Burn said, 30g daily of resistant starch appears to have a substantial effect in Lynch syndrome on non- colorectal cancers and Aspirin works to reduce bowel cancer.

My comments: I wondered if there were resistant starch supplements available but didn’t find any. Eating the sorts of food recommended gave me terrible wind and I gave up!

Genetic discoveries for Motor Neurone Disease and Joint Replacement failures

Oct 20, 2022Sep 9, 2022 kaitiscotland2 Comments

Photo by Fayette Reynolds M.S. on Pexels.com

Adapted from Medscape 20 June 2022 and 24 June 2022

Throughout my professional career, doctors have never known why some people develop Motor Neurone Disease. This is a devastating condition which leaves the brain intact but weakens the musculature of the body so that most people will have progressive weakness leading to respiratory failure and usually a death from pneumonia within a few years.

Andrew Crosby from Exeter University and others report that a specific gene TMEM63C, affects lipid and cholesterol processing pathways inside brain cells. The area of metabolic dysfunction is between the endoplasmic reticulum and mitochondria.

Dr Julien Prudent PhD states that it is necessary for different organelles within our cells to communicate together by exchanging lipids for example is critical to ensure cellular homeostasis to prevent disease.

There are also other genes known to cause Motor Neurone Disease. It is hoped that more effective diagnostic tools and treatments will eventually have an effect on the impact of the condition in people’s lives.

In another study scientists have discovered a genetic link that shows why some patients develop pain and early failure of their joint replacements.

Cobalt chrome (CoCr) is used in about 70% of artificial joints that are implanted throughout the world.

When a joint replacement fails it causes pain, tissue damage and repeat surgery.

Dr David Langton from Newcastle University explains that a large percentage of joint failures are caused when wear and tear cause small particles from the joint implant to be released into the blood stream and stimulate an immune response in the body. The action is similar to when a person with an organ transplant rejects it. Up until know the reason why some joints are rejected has been unpredictable and unknown.

It has been found that people with some HLA genotypes are at greater risk of CoCr metal sensitivity. This amounts to 10% of the European population.

A collaboration between centres in Newcastle, New York and Perth Australia have produced a machine learning tool called Orthotype which can predict which patients are at higher risk of joint rejection prior to surgery by scanning the patient’s genotype.

In future a great deal of patient misery and expense could be prevented by routine blood testing prior to joint replacement to allow the surgeon to choose the best implant for the individual patient.

At the moment about 10% of the UK population will undergo at least one joint replacement. This number is expected to increase if our weight problems increase too.