kaitiscotland

Liraglutide and Semiglutide aid weight loss not just for diabetics

Jun 15, 2021Mar 22, 2021 kaitiscotland1 Comment

Adapted from Pulse Feb 2021

NICE has approved Liraglutide for use in the NHS for weight loss. There are a list of requirements before it will be given though.

They also say that a calorie controlled diet and exercise will be necessary.

The person being considered for it must have a BMI of 35 or 32.5 for certain groups such as South Asians, Chinese, black African or African-Caribbean, who are at higher cardiovascular risk for any given BMI.

The person should have diagnosed pre-diabetes, equivalent to a HbA1c of 6.0 to 6.4% or a fasting blood sugar of 5.5 to 6.9.

They should also have a high risk of cardiovascular disease based on risk factors such has hypertension and lipid abnormalities.

Liraglutide will be provided by a specialist multi-disciplinary weight loss service.

The drug is a once weekly injectable. My comment: in my diabetic GP patients they found it easy to use and very effective for weight loss. It will be an alternative to other measures such as Orlistat and bariatric surgery.

A major problem is that the types of clinics that supply these services are over subscribed in the first place. From my own experience, many patients will meet the criteria, and many would welcome an opportunity to improve their health, appearance and sense of well being by this method. The clinics expect that patients will remain on the drug for two years. The problem is that to maintain the weight loss the drug may be needed lifelong. Currently the British Medical Association are against the introduction of the drug because they think that this will drive up the needs for blood test monitoring and referrals from GPs.

The original study was published in the New England Journal of Medicine by Wilding J et al in 2021. The mean bodyweight reduction was minus 14.9 % for the treatment group and just minus 2.4 % for the placebo group. Blood sugars and lipids improved considerably too. Nausea and diarrhea were the main side effects of the drug but these results tended to be mild and short lived.

In another study of the drug Semiglutide, by Davies M et al, published in the Lancet on March 2 2021, the importance of dose was assessed. They found that the higher dose had better effects on weight and blood sugar than the lower dose but also that the side effects were more frequent.

Oldies need to exercise more to improve their sleep

Jun 9, 2021Mar 22, 2021 kaitiscotland8 Comments

A randomised controlled trial in older adults with insomnia found that 12 weeks training in Tai Chi improved both subjective and objective measures of sleep quality. Although the effect size was modest it persisted for over two years.

Sleep quality also improved in groups that took part in brisk walking programmes and muscle strengthening exercises.

My comments: With consideration to my last post, about the importance of sociability in brain health, I do wonder if it is the exercise or the social factors that improve sleep.

See your pals once every week or two, or maybe get a dog?

Jun 3, 2021Mar 22, 2021 kaitiscotland1 Comment

Adapted from Human Givens Volume 27 No2 2020

Frequent social contact has been associated with better health and longer life but is there an optimal contact frequency?

The European Social Survey results suggested that monthly or weekly was enough to see benefits among 350 thousand people over 35 countries.

A second German study found that more contact than this was not associated with better health and in some cases was related to worse health and greater mortality risks. My comment: Of course, friends and relatives may have been visiting more frequently BECAUSE their friend was indisposed.

Psychological and Personality Science 2020

Researchers from Ontario, Quebec and Oxford found that having strong interpersonal relationships was critical for survival across the entire lifespan. Social isolation is a significant predictor of the risk of death. Insufficient social stimulation affects reasoning and memory, hormone balance, brain structure, connectivity and function, and resilience to physical and mental disease.

Feelings of loneliness can cause negatively skewed social perception and in older people it can precipitate dementia.

Professor Dunbar from Oxford said, ” Loneliness has accelerated in the past decade. Given the potentially severe consequences, exacerbated by national policy responses to Covid-19, we have launched the Campaign to End Loneliness. This is a network of over 600 national, regional and local organisations that want to create the right conditions to reduce loneliness in later life.

https://www.campaigntoendloneliness.org

Bzdok D and Dunbar RIM (2020) The neurobiology of social distance. Trends in Cognitive Sciences.

If you are at the other end of the age spectrum, particularly an only child, a pet can be a great advantage to you.

The Longitudinal Study of Australian Children found that children who had pets had lower emotional symptoms, fewer problems relating to other children and had more positive social behaviour compared to the non pet owning children. The positive social behaviour effect was magnified in only children.

Christian H et al. Pets are associated with fewer peer problems and emotional symptoms and better prosocial behaviour. Findings from the Longitudinal Study of Australian Children. J Pediatr 2020;200:200-206.

Tim Noakes: Nutrition Network Courses for Health Professionals

May 28, 2021Feb 15, 2021 kaitiscotland2 Comments

Homepage | Nutrition Network (nutrition-network.org)

Tim Noakes shot to fame in the low carb community by being accused of malpractice by two South African dieticians for giving dietary advice when he was not a registered dietician. After five long miserable years and the support of international colleagues he won the case. Anna Dahlquist, a Swedish GP had gone through the same thing a few years before this, and not only won her case, but managed to get the Swedish food guidelines for people with diabetes changed.

Professor Noakes has established online training for health professionals covering a variety of useful topics. Participants can be from all over the world and will receive accreditation. The full list of topics can be found by clicking on the homepage in BOLD above.

University College London: Diabetes has trebled in England in the last 25 years

May 22, 2021Feb 15, 2021 kaitiscotland7 Comments

Researchers from UCL analysed the results the latest results from the Health Survey for England.

Data from 8,200 adults and 2,000 children living in private households showed that diabetes has risen in men from 3% to 9% and from 2% to 6% in women since 1994.

Those from poorer households and those with obesity are much more likely to be affected than the slim and affluent. 16% from the poorest homes had diabetes compared to 7% in the highest income group. If you are of normal weight there is a 5% chance of diabetes, 9% if you are overweight and 15% if you are obese.

Obesity is a marker for poverty. 39% of women in deprived areas were obese compared to 22% from least deprived areas. The weight of children was closely correlated with their parents.

Professor Jennifer Mindell said,” Diabetes has become more common in both high and low income countries over the last few decades. It increases the risks of circulatory diseases and cancers. This year we have also seen a rise in serious infection and death such as with Covid-19. Obesity reduction would help all of these problems.”

The survey also asked about GP visits. 69% of men and 82% of women had consulted a GP in the previous six months. GP consultations are more common in older ages, especially among men and those who are overweight or obese. 84% said they went about their physical health problems, 11% for physical and mental problems and 5% for an emotional or mental health problem. Women tended to seek more help for mental health problems than men.

Echoing all the other parameters, consultations for mental health problems were more frequent in those with lower incomes. 25% consulted from the lowest income group compared to 15% from the most affluent group.

Elizabeth Fuller, Research Director at NatCen said, ” One in five women and one in eight men screened positive for a possible eating disorder. This can mean eating too much or too little, obsessing with weight or body shape, having strict routines around food or purging after eating. People who are obese, younger adults and women are more likely to be affected.”

Free You Tube sites to help you look and feel your best

May 16, 2021Feb 15, 2021 kaitiscotland2 Comments

The Times recently published a long list of exercise sites that you can get for free or pay for. Being a home exercise enthusiast I read this carefully and decided to try out the sites they listed as being FREE. These were my favourite ones. All had a variety of exercises eg low and high impact aerobics, walking, weights, rubber bands, stretching, relaxation and even dressing, hair and make up tips.

Top of the pops was Fabulous 50s. There are over a hundred workouts on this site. All are one to one, and set in beautiful Australia. This lady’s house is so clean, tidy, uncluttered that I was immediately pea green with envy. Of course, if I moved into her house, it wouldn’t stay that way for long. There is a fantastic range of exercises and from the ones I have tried, they were well produced and constructed, and even if you are a complete beginner, are pretty easily done. They range in time from 5 minutes to 30 minutes really giving you plenty of options no matter how hard pressed you are for time.

Mad fit, Lucy Wyndam-Read and Fitness Blender also are free and have multiple workouts in terms of types and durations. They seemed more tuned to the younger or fitter age group than Fabulous 50s and I have only done a few of them being 61 with some unfortunate back issues right now. They are not quite as beautifully produced as Fab 50s but they are free!

You will get adverts popping up during all these workouts. Now this is where you have to be careful because the marketing folks know who they are aiming at here and the top products seem to be wrinkle cream, make up and chocolate. It doesn’t matter how lucious it looks. Do not buy it. Because you will eat it.

Adriene is purely a yoga site. This is free too, and she sometimes has her dog with her. Again, there are a lot of different length and types of workout.

Now, if you have a smart phone, a tablet, a pc or a smart television, whatever your favourite form of home exercise is, and even if you only have five or ten minutes, you can workout for free at home.

Public health collaboration online conference 2021

Featured kaitiscotland2 Comments

PHC FREE Virtual Conference 2021 – Saturday 8th & Sunday 9th May

Sam Feltham has done it again. This year’s conference is now available on you tube right now.

Last weekend there were many contributors from diverse fields including members of the public, doctors, academics, and the scientific journalist Gary Taubes who gave the opening talk about ketogenic diets.

The courses that particularly interested me were about the experiences of type one diabetics who had adopted the low carb approach, how to achieve change, and how to increase your happiness.

There are talks about eating addiction and eating disorders, statins, and vegetable oil consumption.

Much of the material will be familiar to readers of this blog. There are some new speakers and topics which do indicate that a grassroots movement in changing our dietary guidelines is gaining ground.

Craving Zone: Tuscan Chicken

May 10, 2021Feb 15, 2021 kaitiscotland3 Comments

This is a delicious American Italian recipe

Prep time is 10 minutes

Cooking time is 30 minutes

Serves 4

Ingredients for chicken

200g boneless chicken breast

half teaspoon each of salt, black pepper and garlic powder

1 tablespoon of olive oil and 2 of butter for grilling

1 tablespoon of chopped garlic

for the creamy sauce:

1 tablespoon butter

1 tablespoon chopped garlic

1 teaspoon of green chillies chopped

half a litre of double cream

1 chicken stock cube or small amount of chicken stock

half a teaspoon of chilli flakes

1 teaspoon mixed herbs

For vegetables:

7 medium mushrooms

5 tablespoons boiled spinach chopped

half a cup of tomato chopped

(or use what you have in the fridge!)

to garnish:

half a cup of mozzarella cheese grated

quarter cup of parmesan cheese grated

1 teaspoon oregano

To make:

season the chicken with salt, black pepper and garlic powder.

Saute each side in olive oil and butter mixture with chopped garlic till cooked. Set aside.

Saute the chopped garlic and green chillies in the same pan.

Then add the cream and mixed herbs, chicken stock cube or liquid, and chilli flakes and simmer gently till it thickens.

Now add back in the chicken pieces, juices that they have been sitting in, and chopped vegetables till they are tender.

Sprinkle oregano, mozzarella and parmesan till just melted and serve immediately with salad, cauliflower rice or on its own.

Home BP monitors as good as surgery ones

May 4, 2021Feb 9, 2021 kaitiscotland2 Comments

Adapted from Hodgkinson JA et al. Accuracy of blood pressure monitors owned by patients with hypertension (ACCU-RATE study): a cross sectional, observational study in central England. Br J Gen Pract. 2020 June 2

More and more of us are checking our own blood pressure and telling our GPs what the result is over the phone or via skype. Home monitoring has been increasing in the last ten years and has greatly accelerated with the Covid pandemic making avoiding face to face consultations a virtue.

Blood pressure checks are done to diagnose and monitor hypertension but are also a matter of routine for contraceptive pill checks, hormone replacement therapy checks, and diabetes checks.

This study was conducted on just under seven thousand general practice patients in the Midlands of England.

Those who used home blood pressure monitors had them tested against a reference monitor and those who were not within 3 mm Hg were considered to have failed. This is a pretty strict test. The cuffs were also assessed.

In all 76% of the monitors passed on the monitors and cuffs. 86% passed the monitor tests. The monitors that failed mainly tended to over estimate the blood pressure.

In general monitors that have been validated (should say so on the monitor) were more accurate than those that were not. Monitors that cost more than £10 were more accurate than those over £10. Monitors that were under four years old were more accurate than those that were older.

The authors say that BP monitors are very likely to be accurate if they have been validated and are over 4 years old.

BMJ: Low carbing for six months can put type two diabetes into remission without adverse effects.

Apr 29, 2021Feb 9, 2021 kaitiscotland2 Comments

Adapted from Efficacy and safety of low and very low carb diets for type two diabetes remission. Systemic review and meta-analysis by Goldenber JZ et al. BMJ 2021;372:m4743

My comment: Now, we all know this, but there still is a great deal of resistance to the idea that cutting out sugar and especially starch from your diet, can put type two diabetes into remission. Lately there has been a lot more emphasis that very low calorie diets are good for diabetes remission, but let’s face it, starving yourself is no fun at all, and eventually, even if you do manage to keep to a very low calorie diet for many months, you need to do something to maintain that remission, rather than yo-yo back into diabetes. This is why I was pleased to see this report in the BMJ.

This study looked at randomised controlled trials that evaluated low carb diets for at least 12 weeks in adults with type two diabetes. Their definition was less than 130 g of carb a day or 26% of the diet from carbohydrates. A very low carb diet was defined as less than 50g of carb a day or 10% of dietary carbs a day.

They wanted to see if remission was achieved. This was deemed to be a HbA1c of less than 6.5% or a fasting blood sugar of less than 7.0 mmol/L with or without the use of diabetes medication. They also looked at weight loss, HbAIc, fasting glucose and adverse events.

Compared to control diets, low carb diets produced remission at six months in 57% versus 31% in the control diets.

The population studied were 1,357 people aged 47 to 67 years of age and most were overweight or obese. 23 studies were looked at and 14 of these included patients who were on insulin. There was very little in the way of adverse consequences.