kaitiscotland

Nick Norwitz:Ketogenic diets may be used to treat mental illness in the future

Feb 22, 2022Feb 14, 2022 kaitiscotland2 Comments

Adapted from Ketogenic diet as a metabolic treatment for mental illness by Nicholas Norwitz et al

Wolters Kluwer Health Inc. http://www.co-endocrinology.com 2020

Ketogenic diets have been used to treat drug resistant epilepsy in children for over one hundred years.

Now they are being used for other neurological conditions such as schizophrenia, depression, bipolar disorder and binge eating disorder.

There is strong evidence that common biological pathologies underlie these conditions such as abnormal glucose metabolism, neurotransmitter imbalances, oxidative stress and inflammation. These factors are all improved with a ketogenic diet.

Controlled clinical trials have shown improvement in: Obesity, Type Two Diabetes, Multiple Sclerosis, Epilepsy, Alzheimer’s disease and Autistic Spectrum Disorder.

Uncontrolled clinical trials have shown improvement in: Parkinson’s disease and Schizophrenia.

Case series and animal models have shown improvement in: Cardiovascular Disease, Binge eating disorder, Major Depressive disorder, Bipolar disorder and ADHD.

It is estimated that people who have mental illness live around 7 to 10 years less than those who do not have a mental illness. Sometimes this is due to suicide, but more often it is due to concurrent diabetes, heart disease, respiratory disease, infectious disease and cancer. All of these conditions are raised in people with mental illness. Sometimes this is due to poor health behaviours such as smoking or other lifestyle issues, and drug side effects can also cause problems. But even in people of a healthy weight and who are not on drugs, if they have mental illness, they are also more likely to have physical illness. Could switching the body and brain away from glucose use towards fat and ketone use improve matters?

Cerebral glucose hypometabolism and insulin resistance are features of Alzheimer’s disease, Parkinson’s disease, Schizophrenia, and Epilepsy. In one recent Cochrane review of epilepsy, as many as 55% of patients had complete remission of their fits on a ketogenic diet.

GABA/glutamate imbalance is a feature of Epilepsy and Schizophrenia. Oxidative stress is a feature of Schizophrenia, Bipolar disorder and Major Depressive Disorder. Oxidative stress and inflammation are mutually reinforcing processes. Major Depressive Disorder, Schizophrenia have these issues.

The Virta Health Group has demonstrated that a ketogenic diet is a well tolerated and effective strategy for treating type two diabetes. It reversed the condition in 54% of patients compared to 5% who received standard care. Alzheimer’s patients also improved on a ketogenic diet and also benefitted from medium chain triglyceride supplementation. (MCTs). Parkinson’s disease, Huntington’s disease and Multiple Sclerosis patients also showed improvement in studies. About 50 to 80% of patients with Alzheimer’s disease have cross over symptoms with schizophrenia, Bipolar disorder and major depressive disorder. These conditions all share common metabolic abnormalities.

It is thought that the ketogenic diet affects the gut microbiome and gut issues are thought to influence Autistic Spectrum Disorder. Two clinical trials reported sometimes complete symptom remission in patients with Childhood Autism when treated with a ketogenic diet.

Some case studies involve psychiatric patients who embarked on ketogenic diets for weight loss and gut problems, only to find a massive improvement in their mental conditions as well. Dr Christopher Palmer reported about an elderly woman with over 50 years of schizophrenia who was able to stop all her antipsychotic medication and has been symptom free for over 12 years. Another middle aged woman who had schizophenia and depression went into complete remission and was able to get her degree and a full time job in the last four years. Both remain unmedicated and on their ketogenic diets.

Results with Binge eating disorder have also been impressive. These patients are usually on 20-30g of carbohydrate a day.

Chris Kresser: How to eat red meat without worrying about your health

Feb 16, 2022Feb 14, 2022 kaitiscotland1 Comment

Adapted from article by Chris Kresser 16 April 2021

We seem to be told on a regular basis that eating red meat is bad for our health. Recent studies have clarified this stance somewhat.

A study published in the American Journal of Clinical Nutrition examined both fresh and processed meat intake from almost 135,000 participants from 21 different countries.

They found no association with fresh red meat intake and the risk of early death, heart disease, cancer and stroke but did find a small association between processed meat consumption and a higher risk of cardiovascular disease and death. A strength of the study is that they carefully matched the groups that ate more or less meat with each other so that they were similar in sex, age, body mass index, smoking and drinking.

Another study was a meta-analysis of 59 systematic reviews published in the Annals of Nutrition and Metabolism which examined the association of dietary fat intake and a variety of health outcomes.

They found no association with total fat, monounsaturated fatty acids, polyunsaturated fatty acids, and saturated fatty acids with risks of chronic diseases.

Since we don’t eat food in isolation, there could be important differences depending on whether you eat red meat in a dietary background of highly processed and refined foods or with a whole foods diet.

The contextual importance of meat as part of an overall dietary pattern is important and here are some information to explain this.

Some amines in meat have been shown to increase cancer risk but eating cruciferous vegetables and spices, and cooking meat at lower temperatures such as stewing or low temperature roasting, lowers amines too.

The increased absorption of iron from meat from the gut has also been flagged as a possible reason for excess cancer risk, but eating fruits and vegetables reduces iron absorption in the gut.

Eating vegetables with meat seems to have a protective effect against cancer. Thus eating a nutrient dense, whole foods diet with a broad variety of both animal and plant food is probably the best diet for the majority of the population. If you do choose to eat a lot of red meat or processed meat, keep cooking temperatures low if you can, and enjoy vegetables as part of your meal.

Commememucho: Guinness stew

Feb 10, 2022Feb 7, 2022 kaitiscotland3 Comments

Adapted from recipe Meatloaf and Guinness

900g beef cut into 2.5 cm cubes

25g butter

one tablespoon olive oil

2 large onions thinly sliced

2 large carrots sliced 1 to 1.5 cm

2 teaspoons Worcester Sauce (or sherry vinegar or red wine)

2 teaspoons tomato puree

500mls Guinness or other strong dark beer

300mls meat broth

2 teaspoons sugar

salt and freshly ground black pepper to taste

Heat the oven to 180 degrees if you prefer to use your oven rather than the stove top for later stages of cooking.

In a large bowl mix the salt and pepper into the beef.

In a large casserole, simmer the butter and oil until the butter has melted. Add the meat in batches and brown it quickly, about a minute each batch. Set aside the browned meat.

Fry the onions and carrots for two minutes.

Put the meat back in the casserole and add the Worcestershire sauce, tomato puree, Guinness, hot meat broth and sugar. Add more black pepper and salt and bring to a boil.

Cover the casserole, reduce the heat, and cook slowly on the stove top or oven according to your preference.

Fibromyalgia likely due to autoimmune attack

Feb 7, 2022 kaitiscotlandLeave a comment

From Geobel A et al Journal of Clinical Investigation 1 Jul 2021

Many of the symptoms in fibromyalgia syndrome (FMS) are caused by antibodies increasing the activity of pain sensing nerves throughout the body according to new research led by the Institute of Psychiatry, Psychology and Neuroscience at King’s College London.

This is at odds of the currently held view that the condition arises centrally in the brain.

The researchers injected mice with antibodies of people who have FMS and saw that the mice rapidly developed increasing sensitivity to pressure and cold as well as reduced movement grip strength.

In contrast, mice who were injected with antibodies from healthy people were unaffected.

The injected mice recovered from their symptoms after a few weeks once they had cleared the antibodies from their systems. The researchers wonder if treatments that would reduced antibodies in patients with FMS could become an effective treatment.

Dr David Andersson, the lead investigator said, ” Treatment for FMS is currently focused on gentle aerobic exercise, and drug and psychological therapies designed to manage pain, although these have been proven to be ineffective in patients. There is an enormous unmet clinical need. Our work has uncovered a whole new area of possible therapeutic options and should give real hope to fibromyalgia patients”.

Chronic headache sufferers often have poor social support

Jan 29, 2022Jan 3, 2022 kaitiscotland1 Comment

Photo by Andrea Piacquadio on Pexels.com

Adapted from Westergaard et al Cephalalgia 23 June 2021

People with a history of chronic headache are significantly more likely to have poor social support and loneliness than those without a headache history.

Other chronic illnesses, mental illness and indeed death, are also more common when a person lacks social relationships.

This study was undertaken in Denmark in over 55 thousand people.

2.7% of people reported chronic headache and in 66% of these medication over use was a major factor. Poor social support was cited by 20 % of the participants who did not have chronic headache and in almost 37% of those who did.

Loneliness was reported by almost 8% of the people without headache and in almost 24% of those who did have chronic headache.

Stress was reported by 24% of those with no headache and in almost 61% of those who did.

The researchers did not differentiate between different headache diagnoses such as migraine and tension headaches.

My comment: As a GP, I was surprised that only 2.7% of the population said they had chronic headache, because it feels like a lot more in the surgery. It is a very common presentation to GPs. I can understand why poor social support could make stress more difficult to bear and produce headaches, and I can also see that people with headaches may want to limit social interaction. What doctors don’t tend to do is to look at improving social interaction as a means of ameliorating headache in patients.

Low birth weight and high adult weight both contribute to hypertension

Jan 23, 2022Jan 3, 2022 kaitiscotland1 Comment

Photo by Vidal Balielo Jr. on Pexels.com

Adapted from Zhang Y et al. Frontiers of Cardiovascular Medicine 1 Jan 2021

Just under two hundred thousand participants in the UK Biobank with data on birth weight were studied. Researchers looked at the correlation between birth weight and hypertension as adults. They also looked at the patients’ obesity indexes.

They found that the lower a baby’s birth weight, the higher the risk for hypertension as an adult. The highest risk was for babies under 2.88kg which is 6 pounds 2 oz.

When it came to adult obesity and hypertension risk, those with a BMI of over 30 were at the highest risk.

This is a lot of babies and adults!

They think that a birth weight of between 3.43 kg and 3.80 kg is the most healthy. This is between 7lbs 5 oz and 8 lbs 4 oz.

We can’t really choose our birthweight, but we can do something about our weight as adults, so you will be pleased to see that adult BMI was a lot more influential in producing hypertension than low birth weight.

My comment: I was only 2 pounds 3 oz when I was born, so I was very pleased to make it past babyhood at all. The association between low birth weight and hypertension and metabolic syndrome in adulthood has been studied for many years. Factors that make the baby more likely to survive placental failure unfortunately programme the body to respond less favourably in adulthood.

Active students are happier students

Jan 17, 2022Jan 3, 2022 kaitiscotland1 Comment

Adapted from Human Givens No 1 2020 BMC Psychiatry 2020

The less physical exercise students take, the more likely they are to suffer from mental ill health, and think about or attempt suicide, according to a Norwegian study.

Researchers questioned over fifty thousand students to assess frequency, intensity and duration of physical exercise and self reported depression, suicide and self harm. Low frequency, low intensity of exercise and low duration of exercise all had a significant role.

My comment: Lockdown and online classes will have exacerbated these risk factors. Home exercise, VR exercise, online exercise, You tube classes, and getting out to run, walk, take out neighbour’s dogs will all help.

Chemotherapy can make you confused

Jan 11, 2022Dec 22, 2021 kaitiscotland2 Comments

Adapted from Chemotherapy induced cognitive impairment from the forensic medicine perspective: A review of the updated literature. Stefania Turrina et al. Journal of Forensic and Legal Medicine Nov 2020

Chemotherapy treatments for cancer may cause physical weakness due to changes in ability to think clearly and precisely, think and react speedily and may thus impair daily life activities, working memory, and organisational ability.

Chemotherapy induced brain fog has been recognised since the late 1980s, but the neurobiological reasons for it are still poorly understood.

Research has shown that certain drugs are more likely to cause it including: doxorubicin, cyclophosphamide, cytarabine, methotrexate, 5-fluorouracil and cisplatin. The drugs affect the central nervous system causing both physical weakness and mental confusion. The duration can be long or short. 35% of patients have an extended period of brain impairment. This can affect the validity of such legal issues as any will that is changed or undertaken during this period of time.

The sorts of impairments described are similar to those experienced with fibromyalgia and chronic fatigue syndrome.

Older patients seem to be more at risk of post chemo cognitive impairment compared to younger patients. If oestrogen and testosterone are depleted as well, such as with breast and prostate cancer treatments, the mental impairment is worse. Ongoing anxiety and depression also worsen the condition. Previous cancer treatments also have been shown to worsen mental impairment. It is not unusual for patients to have more than one cancer successfully treated. My comment: I had one very fit woman patient in her sixties who had been cured of five different unrelated tumours. As some of the treatments cause brain impairment but don’t cross the blood brain barrier it is thought that peripheral inflammatory cytokines have a role to play as well as other mechanisms.

Studies have found that in colon cancer, the brain impairment starts with the onset of the disease process, is worsened by chemotherapy and is worse the longer the treatment continues. The working memory, verbal learning and speed of information processing are all affected. As with other cancer patients these can go on to affect educational attainment and the ability to do certain jobs. Many countries classify cancer patients as having a disability for which reasonable adjustments need to be taken by the employer.

Legal contracts entered into by someone suffering from brain impairment due to cancer or cancer treatment may not be considered valid. It is up to a person who contests the validity of the agreement or contract to prove that the person was so impaired that they did not understand the implications of what their decision was. Certain age based factors such as appearing a little confused and disoriented cannot be considered symptomatic of testamentary inability, so the burden of proof is with the person contesting the contract.

My comment: We never know what is in front of us, so regular review of Power of Attorney, your will, and financial planning when you are healthy will make it easier for you and your relatives should you or your family be affected by cancer in the future.

Can a ban on junk food advertising reverse our childrens’ unhealthy food intake?

Jan 5, 2022Dec 14, 2021 kaitiscotland6 Comments

From the BMJ 3 July and 21 August 21

Advertisements for unhealthy food and drink will be banned before the 9pm watershed by the end of 2022 in television and on demand programmes in the UK.

Chris Thomas, a research fellow at the Institute for Public Policy would have liked to have seen measures going further, by taxation of these foods. He says that money raised could be used to fund free nutritious food for those who need it. This improves both health and the economy.

In the USA, children get two thirds of their energy intake from ultra processed foods. The proportion of calories from such food is rising steadily. In 1999 it was 61.4% and in 2018 it was 67%. As the amount of wholesome, home cooked food reduces, the levels of childhood obesity increase. Ready meals are responsible for 11.2%, and sweet snacks 12.9%. The trend is now reducing for sugary drinks, sauces and oils.

Yoga and dance give pain relief for functional abdominal pain in girls

Dec 30, 2021Oct 24, 2021 kaitiscotland1 Comment

*Photo by Jaime Chambers Fausnaugh on Pexels.com*

Abdominal pain in childhood is associated with increased risk for persistent long term pain and severe mental illness in adulthood. Therefore, it is good to see that a simple intervention of involvement in dance and yoga were considerably more effective in dealing with functional pain than in girls who received standard care.

This was a prospective, multicentre, randomised controlled trial. 121 girls aged between 9 and 13 with functional abdominal pain syndrome or irritable bowel syndrome had standard care or participated in dance and yoga intervention twice a week for 8 months. 55% of the intervention group continued for the whole 8 months of the study.

The dance group were more likely to report a decrease in the maximal abdominal pain at 4 months and 8 months. At 8 months 46% of the dance group reported less pain compared to 17% in the control group.

Hogstrom et al. Dance and yoga reduced functional abdominal pain in young girls. A randomised controlled trial. Eur J Pain. 2021 Sept 16.