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A ketogenic drink has been found to improve cognitive performance in those with mild cognitive impairment

Aug 3, 2022May 4, 2022 kaitiscotland1 Comment

Adapted from A ketogenic drink improves cognition in mild cognitive impairment: Results of a 6 month RCT by Melanie Fortier et al. Alzheimer’s and Dementia. 2021.

Brain energy rescue is being tested to see if it can reduce cognitive decline in patients with mild cognitive impairment. It has previously been discovered that the brain has problems using glucose for fuel even before symptoms develop, but brain ketone use remains constant in both Alzheimers (A) and Mild Cognitive Impairment (MCI). Increasing ketones available to the brain has been shown to improve cognitive symptoms.

A really easy way to increase blood ketone levels is to give a drink containing ketogenic medium chain fatty acids. This has been found to increase brain energy uptake via PET scans. This follow on trial was done to assess whether improvement in cognition after six months occurred.

This study was conducted in Quebec Canada. Very strict entry criteria were applied and the patients were randomised to the ketogenic drink or to a placebo drink. The drinks appeared and tasted identical.

122 participants were enrolled. In total 39 completed the ketogenic arm and 44 the placebo arm. They were well matched regarding age, sex, education, functional ability and cognitive scores, absence of depressive features, blood pressure, blood chemistry and APOE 4 status. ( A genetic variability that greatly increases the chance of developing dementia).

More participants dropped out of the ketogenic group mainly due to gastrointestinal side effects. The drop out rate overall was 32% and 38% in the ketogenic group. None of the side effects were serious.

The results showed that performance on widely used tests of episodic memory, executive function and language improved over 6 months in the ketogenic group compared to the placebo group. Improvement was directly correlated with the plasma level of ketones.

The dose used was 15g of kMCT twice a day.

This seems to be a very reasonable intervention for early cognitive decline particularly since no drugs are approved for MCI and drugs used for Alzheimers do not delay cognitive decline in MCI. It is possible that effects would be enhanced if patients also undertook a ketogenic diet. Further trials are now warranted to see if diagnosis of Alzheimers can be delayed in those suffering from mild cognitive impairment.

Sheri Colberg: exercise for living your best life as you age

Jul 28, 2022May 3, 2022 kaitiscotland1 Comment

Adapted from BMJ 30 Oct 21: A study from the Mayo Clinic indicates that cardiorespiratory fitness tests were a better predictor of of survival in older people than blood lipids, diabetes, smoking and hypertension.

6,500 people aged 70 or over were tested on treadmills. The fittest showed the lowest mortality rates ten years on, and the burden of other risk factors made no difference at all.

Adapted from Diabetes in Control 10 August 21: Sheri Colberg says: Aging successfully takes a lot of work, If you don’t use it, you lose it. Physical fitness peaks around the age of 25 and then declines. Balance gets worse after the age of 40, bones get thinner, muscle bulk diminishes, and even with training maximal aerobic capacity declines. Your reflexes get slower and recovery from workouts takes longer.

The good news is that you can’t stop the aging process but you can slow it down to some extent. This means paying attention to regular physical training, nutrition, sleep and stress management.

Her advice is:

In addition to regular activities like walking, cycling, and swimming, add in some faster intervals to any workout such as walking faster for ten to sixty seconds at a time during your normal walk or doing a hill profile on a cardio training machine. This will improve your cardio respiratory fitness and improve insulin sensitivity for longer. It is fine to to high intensity interval training once a week, but if you don’t already do this you need to work up to it slowly. You should vary the intensity of your workouts to allow recovery and reduce the risk of injury.

Pick at least eight to ten resistance exercises that cover the major muscle groups in the upper, core and lower body and do them two or three days a week. You can use your own body weight, weights, kettlebells, resistance bands or water bottles. Improving muscle mass and strength is critical to being able to live independently through your lifespan.

Improve your balance by standing on one leg for a minute at a time. Make sure you can grab something if you feel unsteady. Once you can do this, make it harder by moving the raised leg in different directions. My comment: Wii Fit has a lot of balance exercises included. Ballet and Yoga also include balance exercises and Tai Chi is a good starting point.

High blood sugars take a particular toll on the flexibility of joints and tendons. Stretch two or three times a week. The worse your flexibility and the older you are the longer you should hold the stretch. Up to a minute with each stretch may be necessary. My comment: There are lots of You Tube videos on stretching. You may like to use rubber bands and yoga blocks or use props such as chairs.

Weight bearing exercises to reduce bone loss can be achieved by weight training, carrying shopping in both hands, and hopping up and down on one leg at a time, and by doing body weight exercises such as press ups.

It is very important that you can get off of a chair as you get older. Practice standing up from the sitting position without using your hands. You can enhance your strength by sitting against a wall with your knees at 90 degrees. My comment: I used to do this for two minutes at a time. I would suggest 30 seconds to start with.

Last, but not least, pelvic floor exercises. You pull in all the muscles around your urethra and anus and practice a combination of long holds and pulses. This improves continence.

NICE: Use pillows to sleep on your side in the last 3 months of pregnancy

Jul 22, 2022May 3, 2022 kaitiscotland2 Comments

Adapted from BMJ 6 Nov 2021 NICE: Routine antenatal care for women and their babies.

Although the evidence base is small, evidence suggests that after 28 weeks of pregnancy, women who fall asleep on their backs, have an increased risk of having a baby born small for gestational age or even stillbirth.

They suggest that women use pillows to alter their position in bed so that lying on their side is easier.

This was the main new bit of information from this updated review which is important for women to know. The last review was published in 2008.

Women don’t need to go via their GP to access antenatal care. They can self refer, make an appointment with a midwife, any other appropriate health care professional, or via school nurses, community centre or refugee hostel. At a midwife led booking appointment she will be given information on all the things she can modify, by doing or not doing things to improve her chances of having a healthy baby. Partner involvement is considered to be helpful at all stages of pregnancy and delivery.

They also state that if a woman has vaginal bleeding after 13 weeks of pregnancy, she should be referred to hospital. (This normally happens and is not new advice).

Rates of maternal mortality and stillbirth are highest among women and babies from deprived areas, and higher among black, mixed ethnicity and Asian women compared with white women.

Routine ultrasound scanning is not recommended in low risk singleton pregnancies during the third trimester.

One third of young adults are following a specific eating pattern

Jul 16, 2022May 3, 2022 kaitiscotland3 Comments

Food Insight have published a survey of just over a thousand young adults aged 18 to 34 to question them about their dietary habits over the previous year. The study was published in 2018.

At that time a third were following some sort of diet. 16% were following some sort of low carb diet. The most frequent eating pattern was intermittent fasting coming in at 10% of those questioned.

In order of frequency the dietary patterns were:

Intermittent fasting, Paleo (10%) Gluten free, Low carb, Mediterranean, Whole 30, High protein, Vegetarian or Vegan (about 5%), Weight loss plan, Cleanse, DASH diet, Ketogenic or high fat diet, and other.

My comment: my personal diet is a mixture of Gluten fee, Low carb, Mediterranean, High Protein and High fat so I can see that there is certainly room for difficulty in assigning your diet a category. There seems to be a lot of publicity over Vegan and Vegetarian diets and I was surprised that there were not more young people on these. I would imagine that it would depend where the sample was from and other demographic information.

Healthy life expectancy falls for those in less affluent areas in the UK

Jul 10, 2022May 2, 2022 kaitiscotland2 Comments

*Photo by Andrea Piacquadio on Pexels.com*

Adapted from BMJ 30 April 2022

The National Office for Statistics from 2018 to 2020 show that men born in the poorest areas of the UK are expected to live ten years less than men from the most affluent areas. Poor men can expect to live a healthy life till the age of 52 and die around the age of 73. Wealthy men may expect to live in good health till they are 67 and die around the age of 83.

Women in the poorest areas can expect 19 fewer years in health compared to wealthier women. They can expect to be healthy in poor areas till they are 52 and this is 71 for wealthy women. Women in poor areas can expect to die around the age of 70 and wealthy women around the age of 86.

There has been a bit of a decrease in life expectancy generally in the last few years, pre-covid. David Finch of the Health Foundation says that improvement in incomes is needed to cope with the rising cost of living, secure jobs and decent housing.

My comment: What goes on at the doctor’s surgery and hospitals is just the tip of the iceberg regarding health. Housing, employment, a good diet, access to green spaces, social interaction, education, good transport, reduced pollution, clean water, freedom from violence, and good health behaviours such as diet and exercise habits, known collectively as the social determinants of health are much more important. Policies that will improve these factors are necessary to improve the situation. I would argue that living a healthy life is more important than an extra few years in a nursing home.

The USA want screening for diabetes and pre-diabetes to start at age 35

Jul 4, 2022Mar 30, 2022 kaitiscotland2 Comments

Adapted from JAMA Editorial August 24/31 2021 by Edward W Gregg and Tannaz Moin

The point for screening for diabetes is that early treatment will prevent complications.

In this article, the US Preventative Services Task Force (USPSTF) discusses its Recommendation Statement and its Evidence Review on screening for pre-diabetes and type two diabetes. They now recommend that adults aged 35 – 70 who are overweight or obese should now be screened and that those with pre-diabetes are referred for effective prevention interventions. Previously the age to start screening was 40 and they have also suggested that the drug metformin is used as a preventative intervention.

A recent study by Wang et al shows that 14% of the US population have diabetes and that there have been no consistent improvements in glycaemic control and risk factor management for 10 years. There has been also no improvement in diabetes care and outcomes.

The USPSTF actually found that there was little direct evidence that screening improves health outcomes for people diagnosed with diabetes. The rationale from screening relies largely on the 25 year old UK Prospective Diabetes Study Group which showed that glycaemic and blood pressure control in new diabetics reduced micro and macro vascular complications, myocardial infarction, diabetes mortality and all cause mortality. This was without the advantages of new drugs and monitoring techniques to boot.

More than 40% of the adult population will now be eligible for screening and a third of these are expected to be referred to an intervention programme. Young adults have had the biggest relative increase in diabetes prevalence, yet they get proportionately the lowest degree of preventative service and risk factor control and not surprisingly this has resulted in an increase in diabetes related complications.

An estimated 24.3% of young adults aged 18-44 have pre-diabetes. Only 44% of these reported being tested in the previous 3 years and they were less likely to be referred and to take up prevention services. Young adults also have more problem affording food, housing and medication. The new screening recommendations are an opportunity to improve this dire situation. Without effective intervention the burden of future diabetes complications will be immense.

Sorting this problem out calls for new ideas, new science and perhaps new frameworks. Metformin has shown to be cost saving, and most effective for pre-diabetes among younger, more obese patients and those with gestational diabetes but it tends not to be prescribed to these groups. More personalised prevention programmes may help. We must address the barriers to accessing effective risk factor management and this must be done throughout the lifespan of the affected group.

Human Papilloma Vaccination has almost eliminated cervical cancer in women born since Sept 1995

Jun 28, 2022Mar 30, 2022 kaitiscotland4 Comments

Adapted from BMJ 13 Nov 2021 and 19 Feb 2022

The HPV vaccination programme was started in England in 2008 on 1st September. According to an observational study vaccination has almost eliminated cervical cancer.

The women who have benefitted are now 26 years old or younger. 13.7 million years of follow up of women aged 20 to 30 showed that vaccinated women had much lower rates of cervical cancer compared to unvaccinated women in previous cohorts.

The reduction ranged from 34% in those who were offered the vaccine aged 16-18, 62% for 14-16 year olds and 87% for 12-13 year olds. There were even greater reductions in grade 3 cervical intraepithelial neoplasia and the trend was similar regarding vaccination age.

The results would suggest that the earlier the age of vaccination, the better.

Although this is great news for younger women, those over the age of 26 are still at risk of cervical cancer. Despite this 30% of women who were eligible for screening did not take this up in 2021.

A survey of 3,000 patients asked “Why?”

Embarrassment was the most common reason for 42%. Difficulty fitting in appointments was the reason for 34% and concerns about it being painful was the reason for 28%.

My comment: In my experience as a GP, all of these reasons have validity. However, losing your life or fertility to cervical cancer is devastating. Most cases are avoidable by regular screening and early treatment of cervical lesions, since we don’t know which ones will go onto cause cancer in any individual. Well woman clinics and family planning clinics are often open in the evenings if Practice Nurse clinics are not suitable. Remember that (almost) every woman has a vagina, including the nurse or doctor who does your smear. She knows what it is like! Muscle tightening can cause pain and to reduce this I would suggest putting a pillow under your bottom and possibly getting 5-10mg of diazepam from your GP. You would then need someone to drive you to and from your appointment.

Dr Mark Cucuzella: Online resources for low carbing for patients and doctors

Jun 22, 2022Mar 30, 2022 kaitiscotland1 Comment

Adapting Medication for Type 2 Diabetes to a Low Carbohydrate Diet- Frontiers 2021

https://www.frontiersin.org/articles/10.3389/fnut.2021.688540/full

The above link gives the full paper from Dr Cucuzella about the medication adaptations, including insulin adaptations that need to be done if you are transitioning to a low carb diet. There is a helpful traffic light summary. Some medications do not need altered and these are discussed too.

Diet Doctor video on article “Why deprescription should be your new favorite word”

What your new diet will consist of and how to avoid unnecessary expense or complicated recipes is fully discussed in the following links. They are the same booklet but in different formats.

Our new “Low Carb on any Budget – A Low-carb Shopping and Recipe Starter Begin a Life Free of Dieting and Indulge Yourself in Health” patient guide- Print and share with your patients

Pdf version

www.tinyurl.com/lowcarbanybudget

online flipbook

www.tinyurl.com/lowcarbanybudgetebook

For clinicians through guideline central

These booklets are quite complex and are for doctors who want to know more about low carb diets and fine tuning of medication and insulin. The first is in USA units and the second is the UK format. It does no harm for any diabetic or their carers to read these too but bear in mind that they do go into some depth.

-Guideline Central: Low-Carbohydrate Nutrition Approaches in Patients with Obesity, Prediabetes and Type 2 Diabetes

http://eguideline.guidelinecentral.com/i/1180534-low-carb-nutritional-approaches-guidelines-advisory/0?

UK version – http://eguideline.guidelinecentral.com/i/1183584-low-carb-nutrition-queens-units/0?

Sheri Colberg: Key exercises to help you age well

Jun 16, 2022Mar 2, 2022 kaitiscotland1 Comment

Adapted from Diabetes In Control Jun5 2021

Exercises can help maintain your physical abilities and independence during the aging process.

Aging successfully needs a lot of work. If you don’t use it, you lose it! Our body system peaks at 25 and declines thereafter. Even if you exercise diligently you will lose aerobic capacity as you age.

Balance also worsens from the age of 40. Bones also thin, particularly for women post menopausally. Muscles get smaller and weaker, reflexes get slower and recovery from workouts takes longer.

Although you can’t do that much about neurological decline but by regular physical training, nutrition, enough sleep, and stress management you can delay or prevent a lot of normal aging and even sometimes reverse damage done from inactivity.

These are my top tips for exercises to reduce aging:

Cardio workouts with faster training intervals. Apart from walking, cycling and swimming add in faster intervals lasting 10 to 60 seconds at a time. You can walk up hills deliberately or do a hill programme on a cardio machine. High intensity interval training can be done up to once a week but start low and build up.

Resistance exercises covering your upper body, core and lower body will help your muscles. Do 8 to 10 exercises covering these groups two to three days a week. You can use your body weight, dumbells, kettlebells, resistance bands. You should be able to get in and out of a chair without using your arms at the very least.

Standing on one leg at a time helps balance. My comment: one of my friends says doing this helped her not feel dizzy when riding on the London Underground.

Stretches for all of your joints helps your joint mobility and cartilage health. Do this two or three days a week. Diabetics are particularly prone to stiffness from glycation. Hold the stretch for up to a minute for each one.

Hopping up and down on one leg helps bone mineral density and so does carrying shopping in both hands. Press ups, against a door or kitchen counter are a good start.

Pelvic floor exercises are good for the prevention of stress incontinence.

Physical activity can improve cognitive function if you have type two diabetes

Jun 10, 2022Feb 28, 2022 kaitiscotland1 Comment

*Photo by Polina Tankilevitch on Pexels.com*

Adapted from Diabetes in Control Aug 10 2021 by Macrina Ghali, Pharm D candidate, Florida.

Hyperglycaemia has been linked to reduced cognitive function and can impair life through impairing memory and language. Mistakes with medication are more likely. Some studies have shown that exercise can reduce the risk of dementia on the long term.

The meta-analysis sought to answer the question, does cognitive ability change from baseline, while on the exercise programme compared to the non-exercising controls? Just over 2,500 patients with diabetes were analysed, almost evenly split to control groups and exercise groups.

The exercise group did aerobic exercise, resistance exercise and non aerobic exercise. The control groups did monthly telephone calls, stretching, gentle movement and education. The interventions ranged in time from 12 months to 9.8 years and sample sizes ranged from 47 to over a thousand.

Standard tests such as the mini-mental state examination, mental state examination and global cognitive score were undertaken.

Surprisingly the study found that the greatest change in cognitive scores between both groups was in the studies done for 12 months rather than longer periods. They were not sure if this was due to patient drop out or the development of dementia. They think that more studies would need to be done to clarify the issue.

Meanwhile they think that physical activity programmes should be started soon after diagnosis of type two diabetes to prevent a worsening of cognitive functioning as time goes on.