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Sheri Colberg: Statins and exercise

Jul 16, 2016Jul 6, 2016 kaitiscotland5 Comments

exercise bike — You’ll need to pedal harder than this if you want intensity…

I recently received an email from a person with type 1 diabetes living in Denmark (Guido) whose physician believes in prescribing many medications to manage cholesterol and high blood pressure in anyone with diabetes, regardless of need. Guido has been taking a statin (Atorvastatin, brand name Lipitor), along with at least four others for blood pressure control. He used to take Simvastitin (Zocor), but a year prior had been changed to Atorvastatin (and his dose doubled). That’s when his problems with exercise began.

Many prescribed medications can directly affect people’s ability to exercise or their responses to it, but most healthcare providers focus on the ones that affect blood glucose, particularly if they increase the risk of activity-related hypoglycemia. Another type really needs to be considered, though, because of the sheer number of patients who are being put on them and their potentially negative impact on the ability to exercise: statins. Statins are medications taken to treat high cholesterol levels or abnormal levels of blood fats, in an attempt to lower the risk of heart attack and stroke. Brand name examples include Altoprev, Crestor, Lescol, Lipitor, Livalo, Mevacor, Pravachol, and Zocor.

The cholesterol guidelines were recently updated, the result being that even more adults with diabetes and prediabetes are being prescribed various medications from this class. In individuals who are unwilling or unable to change their diet and lifestyles sufficiently or have genetically high levels of blood lipids, the benefits of statins for lowering cardiovascular risk likely greatly exceed the risks, or so the experts claim (1). If a person has a low risk for developing cardiovascular problems and does not already have type 2 diabetes, taking them is not advised (2), particularly because many statins increase the risk of developing type 2 diabetes (3).

Since one month after he started taking Atorvastatin, Guido confided that has been suffering from extreme stiffness and pain in his legs that occurs after running any distance (3 km or 20 km). The pain is in his lower leg/ankle (the right one hurts more, but the left leg is also very stiff) and occurs typically after his runs and decreases after 3 to 4 days, during which time he is unable to run at all. His legs have been scanned and are negative for any signs of fractures or inflammation, and they have ruled out compartment syndrome.

In his email to me, Guido stated: “I suspect it is the Atorvastitin. What do you think?”

My answer was, “I completely agree that your problems are probably coming from the Atorvastatin. As a group of medications, the statins are WELL known for causing muscle and joint issues. I would suggest considering going off of it completely and see if your symptoms resolve in a few weeks.”

Guess what? It worked! He emailed me a week later, stating “I have stopped using the Statins now for 5 days and after a 12 km run my legs feel completely different and back to normal.” That was great news to hear!

It’s not talked about enough, but undesirable muscular effects from statin use are commonplace, such as unexplained muscle pain and weakness with physical activity that Guido has been having, which may be related to statins compromising the ability of the muscles to generate energy. The occurrence of muscular conditions like myalgia, mild myositis, severe myositis, and rhabdomyolysis, although relatively rare, is doubled in people with diabetes (4). Others have reported an increased susceptibility to exercise-induced muscle injury when taking statins, particularly active, older individuals (5). Other symptoms, such as muscle cramps during or after exercise, nocturnal cramping, and general fatigue, generally resolve when people stop taking them. If people experience any of these symptoms, they need to talk with their healthcare provider about switching to another cholesterol-lowering drug that may not cause them.

Another major issue related to statins is that their long-term use negatively impacts the organization of collagen and decreases the biomechanical strength of the tendons, making them more predisposed to ruptures. Statin users experience more spontaneous ruptures of both their biceps and Achilles tendons (6-8); I personally know a physically active person with type 1 diabetes that simultaneously ruptured both of his Achilles tendons during a routine workout due to long-term statin use. Again, people should talk with their doctors about whether it may be possible to manage their cardiovascular risk and lipid levels without taking statins long-term for this reason and the aforementioned ones.

In my opinion, there’s nothing worse than a medication that is supposed to help lower your cardiovascular risk, but then likely ends up removing all of the potential benefits by taking away your ability to be physically active! Likely the greatest risk factor for heart disease is physical inactivity, so don’t prescribe statins that make people sit on the couch. At least have them try another medication to see if it a lesser negative impact on being active.

References:
1.Kones R: Rosuvastatin, inflammation, C-reactive protein, JUPITER, and primary prevention of cardiovascular disease–a perspective. Drug Des Devel Ther 2010;4:383-413
2.Taylor F, Ward K, Moore TH, Burke M, Davey Smith G, Casas JP, Ebrahim S: Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2011:CD004816
3.Mayor S: Statins associated with 46% rise in type 2 diabetes risk, study shows. BMJ 2015;350:h1222
4.Nichols GA, Koro CE: Does statin therapy initiation increase the risk for myopathy? An observational study of 32,225 diabetic and nondiabetic patients. Clin Ther 2007;29:1761-1770
5.Parker BA, Augeri AL, Capizzi JA, Ballard KD, Troyanos C, Baggish AL, D’Hemecourt PA, Thompson PD: Effect of statins on creatine kinase levels before and after a marathon run. Am J Cardiol 2012;109:282-287
6.de Oliveira LP, Vieira CP, Da Re Guerra F, de Almeida Mdos S, Pimentel ER: Statins induce biochemical changes in the Achilles tendon after chronic treatment. Toxicology 2013;311:162-168
7.de Oliveira LP, Vieira CP, Guerra FD, Almeida MS, Pimentel ER: Structural and biomechanical changes in the Achilles tendon after chronic treatment with statins. Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association 2015;77:50-57
8.Savvidou C, Moreno R: Spontaneous distal biceps tendon ruptures: are they related to statin administration? Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand 2012;17:167-171

As a leading expert on diabetes and exercise, I recently put my extensive knowledge to use in founding a new information web site called Diabetes Motion (www.diabetesmotion.com), the mission of which is to provide practical guidance about blood glucose management to anyone who wants or needs to be active with diabetes as an added variable. Please visit that site and my own (www.shericolberg.com) for more useful information about being active with diabetes.
by Dr. Sheri Colberg, Ph.D., FACSM Diabetes in Control April 2 2016

Diabetes Self-Care is Often at The End of the List for Patients. Why?

Jul 14, 2016Jul 12, 2016 kaitiscotland3 Comments

A team of Swedish medical researchers interviewed 24 people who had diabetes to see if there were factors that got in the way for self-caring behaviours that enhanced diabetes management. They found that some patients didn’t believe diabetes was all that serious, that it was way down the priority list compared to dealing with other life problems, that they didn’t believe it was under their control anyway and that it simply wasn’t worth sacrificing a good time for.

Any of this sound familiar?

Other illnesses, emotional distress, prioritising the needs of others and money problems all seemed to get in the way of getting to grips with self- care routines that are the crux of effective diabetes management.

For patients who are struggling with the condition, the authors think that medical professionals would be far better of focusing on what is desirable and realistic for individual patients rather than trotting out the “usual” advice, which is often perceived as being totally beyond the ability of some people and at some times in their lives.

Family support has been recognised as been a major factor in diabetes management adherence. The health care system and how easily it can be accessed is another environmental factor. Susann Strang, with her nursing background, understands that the patients’ life experiences, current situation, cultural background, beliefs and attitudes all affect their willingness and ability to follow treatment recommendations. If consultations are patient centred rather than protocol centred improvements in glycaemic control can be seen.

The patients who were interviewed for the study came from an area of Sweden with a high number of immigrants and a low socio-economic status. The number of smokers and amount of cardio-vascular disease was higher than more affluent areas in Sweden. A range of type two patients over the age of 18 were given in depth interviews. They were asked, “What does living with diabetes mean to you?”

Many people said that their lives had become more structured and limited by the diagnosis of diabetes. They were aware that food and medicine were basic issues in the control of the condition and had incorporated routines into their lives so that particularly those who had had diabetes for some time almost forgot about it. “For me diabetes is only something I have and I will have it as long as I live. I don’t think so much about it. It is like having a cup of coffee in the morning, or like going to the laundry.”

The lack of symptoms accompanying high blood sugars often led people to relax about diabetes management. Work responsibilities, home problems, lack of support, loneliness, and frank depression all reduced quality of life and put diabetes into the background. Immigrants often missed their old lives and countries or worried about relatives. Some had given up prior religious beliefs as a result of trauma they had witnessed.

Cardiac disease, high blood pressure, inflammatory problems, chronic obstructive lung disease and depression often seemed more important issues than diabetes, particularly when it was almost without any perceptible symptoms.

Some people thought that it was their fate to get diabetes. They also did not believe that changing their lifestyle was their responsibility. “The only thing the doctor complains about is losing weight. No matter how hard I try I can’t get below 84kg. I’m just like my parents. So it has to do with the genes. And you can’t change them.”

Respondents sometimes discussed feeling hopeless and resigned to the situation. One even thought that society was to blame for his lack of motivation to change his lifestyle.

Although most patients had had nutritional advice, most had trouble keeping to the plan. The social factors of enjoyment of food were seen as more important than eating right for diabetes control. The taste of food, perceived boredom of healthy food, and cooking ability all affected the degree to which people were willing to change their diet.

The majority of respondents were well aware of the positive effects of physical activity yet some took no exercise at all. To explain this they said they were lazy, exercise was boring, it was more convenient to sit on the couch or at a computer, it was painful to exercise, they were too tired, they were depressed, they had sleep problems, they had no idea how to go about it and they didn’t have enough money to exercise. Some worried that exercise was bad for the heart.

Sadly other studies by ST Miller and P Jallinoja also have identified the same unwillingness to change to a more beneficial lifestyle is not uncommon among people with diabetes.

The authors recommend that health care professionals learn about the way individual patients view living with diabetes and what type of care they really prefer. As patients can change their views over time, keeping the door open to change is recommended.

The Danish philosopher Soren Kierkegaard said, “If I want to succeed in bringing a person towards a specific goal, I must find out where she is and start from there.”

Adapted from Diabetes in the shadow of daily life: factors that make diabetes a marginal problem. Anders Agard, Vania Ranjbar, Susann Strang. Practical Diabetes March 2016.

Dana Carpender: Low Carbing on a Budget

Jul 10, 2016Jul 6, 2016 kaitiscotland3 Comments

Dana, how can you follow a low carb meal plan if you are on a tight budget?

Well, first, you’re going to have to cook. 🙂

A year or two after I went low carb, my husband started grad school, and had to reduce to part time hours. I was not yet writing for a living. The budget was definitely slim.

I find the greatest friend my food budget has is a freezer. Even a little one, maybe 5 cubic feet, lets you take advantage of loss-leader sales and markdowns. As I type this, mine is full of chicken thighs I bought at 49c/pound and pork shoulder I bought for 99c/pound – oh, and bacon that went down to $1.99. I am not above buying meat that’s been marked down because it’s nearing the pull-by date; that’s how we afford rib-eye steak now and then. One delirious day I got 10 pounds of bacon and 8 pounds of pork sausage because they’d all been marked down to 99c/pound for clearance. Indeed, I rarely buy meat at full price. Heck, I have a turkey in there that was marked down to 79c/pound after the holidays. It’ll be great smoked on the grill this summer.

You’re thinking “How do I afford a freezer?” Check Craigslist; our big chest freezer (and by “big” I mean I could fit a body in it if it weren’t full of marked-down meat) cost us $125 and the hauling; it has saved us that many times over. It’s run beautifully for 6-7 years now. Do shop for one that’s fairly recent vintage; it will cost you less in electricity. You can also shop scratch-and-dent stores. Prices run higher, but you may get a warranty.

Keep in mind that your body doesn’t care if you get your protein from those 49c/pound chicken thighs or from lobster tail. It will be just as happy with cabbage as with out-of-season lettuce. Speaking of seasons, even today there is some seasonal variation in food prices. Take advantage of them. We just stocked up on eggs when they were cheap at Easter; eggs are great any time of day. When Kerrygold butter went on sale, I bought 6 packages.

I’m a dinosaur; I still get a dead-tree newspaper daily, so I see the weekly grocery store flyers. As a result, I know when Aldi has avocados at 49c a pound, and when Lucky’s has a sale on prime rib – yes, I got a prime rib roast for $4.99/pound. That’s roughly half the usual price. I also try to be aware of who has the best prices on what on a day-to-day basis. We go through a lot of pork rinds, so it’s more than worth it to drive 20 minutes across town to Aldi, where they cost 99c a bag, instead of $2.99 a bag at the nearest grocery store. I buy them a case at a time. If you don’t get a paper, see if you can get the local grocery store circulars online.

Don’t waste food. As I said above, I eat leftovers a lot. I also save the bones from my chicken and steaks in plastic grocery sacks in the freezer, and turn them into broth when I have a bagful.

Most low carb speciality foods are pricey, and none of them are essential.

Two more thoughts:

One, many carby foods are expensive. I have long thought of cold cereal as a conspiracy to get suckers to pay $4 for 15c worth of grain. How much did the potatoes in that bag of chips cost? Why do you think pizza places keep bragging about their crust, or offering “free” Crazy Bread? They can appear generous while sucking dollars out of your pocket for something that cost them pennies. Cut the expensive carby junk out of your food budget, and you’ll have more money for bacon and eggs.

And two, any food that makes you fat, hungry, tired, and sick wouldn’t be cheap if they were giving it away.

Dana Carpender is the author of nine cookbooks, including the best-selling 500 Low-Carb Recipes.

Younger type one diabetics miss the most health checks

Jul 7, 2016Jul 6, 2016 kaitiscotland2 Comments

The England and Wales National Diabetes Audit is the largest annual clinical audit in the world and the most comprehensive of its kind. It gives information on how much of NICE policy is being implemented.

In the 2013-15 populations the percentage of registered diabetics has risen to 5.1% although it is thought that 7.1% of men and 5.3% of women have the condition from the Health Survey for England 2014.

Nine care processes are recommended by NICE. Overall 39% of type one diabetics and 59% of type two diabetics got all of the checks covered in the audit. Worryingly only 27% of type ones under the age of 40 got all the necessary checks. There is a large range in variability in performance. For type ones in some areas 17% had all the checks and the best managed 62%.

Overall diabetics have a good chance of getting their bloods taken and blood pressure taken. The offer of structured education for newly diagnosed type one patients rose from 17% to 76%. Although 78% of type twos are offered structured education, only 5% take it up.

Only 30% of type one diabetics have glycaemic values of 7.5% HbA1c or 58 mmol/mol. Only 8.7% of type ones got 6.5% or 48 mmol/mol or below. 29% of type twos achieved this target.

The quality of care seems to be worse for type one diabetics especially in the younger age groups. Most of these people will be seen by hospital teams rather than a General Practitioner. The reasons why structured education is sidelined by patients is also mysterious.

Based on an article by Steve Chaplin Medical Correspondent for Practical Diabetes March 2016.

Chicken Curry

Jul 4, 2016May 1, 2016 kaitiscotland4 Comments

1.25 kg chicken pieces, bone in 1 tsp salt

Black pepper 2 tbsp lemon juice

2 tsp fresh ginger 1 large clove garlic, crushed

5 tbsp full fat yoghurt 1 ½ tbsp ground coriander

2 tsp cumin ½ tsp cayenne

6 cardamom pods

2 tbsp finely chopped onion or shallot

Serves 4

Put the chicken in a large casserole dish in a single layer. Add salt, juice, lots of pepper, mix well and set aside for 20 mins.
Combine ginger, garlic, yoghurt, coriander, cumin, turmeric, cayenne and cardamom in a bowl. Mix well.
Rub chicken with mix, cover and put in fridge overnight.
Heta oven to 200C/gas 6.
Bring chicken to room temperature. Brush with oil, scatter with onion. Bake in middle of oven for 30 mins. Turn chicken over and put back in oven. Cook another 40 mins, basting every 10 with juices.

Depression doubles stroke risk even when treated

Jul 1, 2016May 1, 2016 kaitiscotland2 Comments

Persistent depression is associated with twice the risk of stroke in adults over 50.

Researchers interviewed 16,178 people every two years from 1998 over a 12 year period and assessed depressive symptoms and stroke. They showed that those people who scored significantly for depression on at least two consecutive interviews had double the risk of having a first stroke in the two years after the assessment compared to those with low depressive symptoms. The risk was slightly higher for women and those who had had previous depressive symptoms.

Paola Gilsanz of Harvard University said, ” Our findings suggest that depression may increase stroke risk over the long term. This risk remains elevated even if depressive symptoms have resolved, suggesting a cumulative mechanism linking depression and stroke. Physiological changes may lead to vascular damage over the long term. Depression is also linked to hypertension, ill effects on the autonomic nervous system and inflammatory responses that all cause vascular disease. In addition depressed people are more likely to smoke and by physically inactive.”

From Research News BMJ 23 May 2015

Dana Carpender answers: what if I can’t cook?

Jun 28, 2016May 1, 2016 kaitiscotland2 Comments

Dana, many of our readers find cooking from scratch a chore. Often they even lack the basic cooking skills. How do you help the low carber who says “I can’t cook!”

First of all, by saying, “Yes, you can. You just haven’t done it enough. It’s nowhere near as hard as you think.” It’s such a tragedy that cooking has been eliminated from school curricula. But truly, folks, I can remember making gravy and mashing potatoes when I had to stand on a step-stool to reach the stove. That’s pretty much the definition of “child’s play.”

Get a good, basic, simple cookbook, find the recipes in it that work for our nutritional plan, and give it a few tries. I think you’ll be surprised.

That said, you can be a low carber without cooking. There are low carb convenience foods to be had, although you’ll spend more money than you would cooking from scratch. Consider:

* Rotisserie chicken

* Steamed lobster (if you have the cash, many groceries will do the deed for you)

* Salad bar salads

* Bagged salads

* Frozen cooked shrimp

* Canned tuna, crab, sardines, and the like (put ‘em on top of some bagged salad).

* Frozen vegetables – microwave according to package directions

* Frozen hamburger patties – you do have to cook these, but you don’t even have to thaw them first. 3 minutes per side in a hot skillet works great. Get a non-stick skillet for easy cleanup.

* Frozen grilled fish fillets

* Deli meats and cheeses, rolled up with mayo and mustard sandwiched in between the slices. Read the labels for the ones with the least added carbohydrate.

* Hot wings, but only unbreaded ones – Pizza Hut makes these. Be careful about sauces; many are sugary. The Pizza Hut Garlic Parmesan, Cajun Rub, Ranch Rub, and Naked Traditional Bone-in Wings are all good choices. Skip the “boneless wings;”they’re breaded.

* Pizza with extra cheese and low carb toppings – peel off the toppings and eat them, discarding the crust.

My local grocery stores have “bars” beyond the salad bar. One of my favorites is the Mediterranean bar, with a selection of olives, marinated feta, and the like. The grocery store deli is worth browsing. You can’t have potato or macaroni salad, of course, but you may well find chicken or tuna salad with no high carb ingredients. I’ve found tasty roasted vegetables, too. Be wary of coleslaw; often it’s heavily laced with sugar, but it’s worth asking. With growing awareness of food sensitivities, many grocery store delis post signs listing ingredients with each dish.

Ironically, I find the Atkins frozen dinners to be higher carb than I’d like.

The Fuck-it switch

Jun 26, 2016 kaitiscotlandLeave a comment

We all do this…. at least from time to time.

EU exit: Winter is here

Jun 25, 2016 kaitiscotland7 Comments

The vote to take the UK out of the EU has chilled me to the bone. Social well-being is inextricably linked to health and a careless decision taken by a majority of around 52% of voters has just messed up our economic system on which our well-being as citizens and patients depends.

Scotland, Northern Ireland, central London and Gibraltar have unequivocally voted to stay in the EU. There are 1.3 million Brits who study, work or have retired to the EU, and many of these people were not able to vote in the referendum. If they had, the margin of success for Brexit would have been lessened considerably.

The people who voted to stay tended to be younger, have degrees, have jobs, and be wealthier. Those who wanted to leave tended to be older, be on benefits and perhaps feel that they will be more sheltered from the effects of their choice.

Economists, business leaders, bankers, most MPs, and the British Medical Association which represents the majority of UK doctors, all want to stay in the EU. Reasoned discussion has been going on for months in such papers as the Guardian and the Times. Pictures of the Union Jack, the Queen, and rants about immigration and the millions that could be diverted to the NHS have been on the front pages of the tabloids for months. On the very morning of the result, Mr Farage, leader of the UKIP party, admitted that the slogans on the buses and billboards about money going to the NHS from the EU were lies. “Nothing to do with me”, he said.

Meanwhile the UK has lost David Cameron as Prime Minister. He has been an emotionally stable, sensible, well informed, inclusive, solution seeking head of the government. Very far from Maggie Thatcher or Tony Blair in performance or nature, he has felt the need to step down, despite demonstrating an integrity that Farage and the likes do not appear to emulate.

So, what has the EU done for us? Quite a lot as far as I can see. Most of it beneficial.

We have a decimal currency, much easier than the old 12 unit system. We get cheap good quality food, particularly fruit, vegetables, wine, ham, olive oil, nuts and cheese. Many of these items feature heavily in a low carbohydrate Mediteranean style diet which is so important in keeping well if you have diabetes.

For doctors, the European Working Time Directive, which limits junior hospital doctors working hours to 48 hours a week was a God send. I used to work 120-145 hours a week as a junior doctor. It was described as “training” but it was slave labour. I was paid one third of my basic rate for the extra hundred or so hours I was on evenings and weekends. On Christmas day 1983 I earned 50 pence per hour and that was before tax. Older doctors and consultants didn’t care. They did nothing about it. If we did it and survived, you can too was the mentality. It took the EU to get doctors out of that mess and without the working directive it could easily revert back.

There is a workforce crisis in UK medicine as it is. Worsening of terms and conditions for doctors will lead even more of them to jack it in and head for Australia.

What of our working population generally? The EU have brought in laws to give reasonable hours, breaks, holidays and contracts to workers. Without the EU there will be more likelihood for zero hour contracts to become the norm, if you can even get a job.

When it comes to selling a house, the main thing that estate agents say are important are location, location, location. When it comes to the well -being of a countries citizens the important things are economy, economy, economy.

Like it or lump it, we are all part of a global economy now. The EU is not responsible for all the bad things that are happening that affect the economy. The immigration crisis is due to an undeclared third world war which is due to Islamic separatists destroying these people’s homes, countries and own economies.

A government can’t hand out money to sick people, the unemployed, the NHS or anyone else unless they have money raised from taxation. They can’t get this unless people have jobs. If the economists are right, and there is no reason to believe that they will not be, there will be fewer jobs, worse terms and conditions, less money able to be raised from tax and therefore less money for pensions, benefits and health care.

Leaving the EU is not a vote for prosperity.

What can we do about it?

To really improve things we need to get a review of the referendum decision. If it can’t happen for the whole of the UK, the best option in my view, then perhaps it can be achieved in Scotland. This would mean a difficult choice for Scots. Do we stay with England and Wales? Do we stay with Europe?

When people look across at Southern Ireland it would appear that they have not done very well in terms of economic prosperity by staying in the EU. On the other hand do we revert back to the dark ages with the working classes being over worked and underpaid with a deficient social care system but with an elite few at the top as could happen for England and Wales?

What do you think of the result of the vote? What do you think we can do to makes things less awful than what has been predicted for us all?

Dr Katharine Morrison

Children born after the 1980’s fatter than previous generations

Jun 25, 2016May 1, 2016 kaitiscotlandLeave a comment

Children born in the UK since the 1980’s are two to three times more likely to be overweight or obese the the age of 10 compared to those born in previous generations. This was found in an analysis of children’s weights from the 1940’s onwards.

The results of 56,632 children are concerning researchers who say that these finding indicate that these children are an an increased risk of chronic health conditions such as coronary heart disease and type two diabetes.

Based on an article by Susan Mayor BMJ 23 May 2015