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.

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!

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.

Adapted from BMJ 16 April 2022

To reduce the chances of your developing type two diabetes, it is best to keep your belly measurement to less than half of your height. You don’t need a tape measure. A bit of string will do.

NICE say that BMI may still be useful to define overweight and obesity, although it does have considerable limitations in muscular people and in old age. As it is not a direct measure of belly fat which is the driver for diabetes, hypertension and cardiovascular disease it must be interpreted cautiously.

In people of south Asian, Chinese, other Asian, Middle Eastern, black African or African-Caribbean backgrounds NICE are now stating that a BMI of 23 can be considered as overweight and 27.5 can be considered as obese.

These parameters may be important when treatments are being limited by BMI category.

Adapted from Medscape May 25 2022. Why is long term weight loss so difficult? It’s biology, not willpower! by Donna Ryan MD.

When people lose weight changes occur in food regulation hormones and subjective hunger increases. This drives an increase in food intake. The hormones that make you feel full after a meal reduce and the ones that make you hungry increase. Reduced energy expenditure also occurs and this also drives weight regain.

Even when both diet and exercise strategies are applied, regain of more than half of the lost weight occurs by 2 years and 80% of lost weight is regained by 5 years.

People who defy these norms report that they do very high levels of physical exercise, eat low calorie and low- fat diets, have very high degrees of eating restraint, and have low levels of disinhibition. They also tend to weigh themselves several times a week. So, they work really, really hard at it, and can never let up.

The medications that reduce weight work if they are taken for long enough, but on discontinuation, weight gain returns.