Author: kaitiscotland

Emma and I wish you all a Happy and Prosperous New Year!

Adapted from BMJ 26 Oct 2024

Discover more at the 15min-City platform, which showcases how cities worldwide are embracing the 15-minute city concept, where services are accessible within 15 minutes by walking or biking.

https://whatif.sonycsl.it/15mincity/

Re-organising cities so that essential services are easily accessible on foot or by bicycle is an appealing idea. It could reduce carbon emissions, help people get fitter, and reduce inequalities and deprivation.

Apparently most European cities are already at or close to this ideal. However, most cities in North America and the Far East are not set up for this at all.

My nearest city is Glasgow. I lived there for thirteen years in all from the age of 10 to 23. My family didn’t have a car so we walked a lot and took the bus or train when the distances were more than around half an hour. I’m pleased to say that Glasgow does very well in the 15 minute concept. I do know, however, that certain areas eg the Castlemilk housing estate on the south of Glasgow, do not have a supermarket within walking distance. This affects the type, price and quality food that can be purchased, particularly fresh vegetables, meat and fruit.

Otherwise Glasgow does have many beautiful parks thanks to the foresight of the Victorian’s who built them. There are good shopping areas, libraries, museums, transport links, hospitals, doctors’ surgeries, dentists, schools, and sports and entertainment facilities.

The Ayrshire towns in which I have lived are also well set up for many activities but I’m sorry to see the loss of council run sports and library facilities that affect young people in particular.

There is a app called Libby. If you join a library, you can have a loan of e books and magazines totally free. You get them for three weeks before they disappear off your screen.

Emma and I wish you all a fuss free(ish), pleasant, Christmas Day.

This year, my husband was expected to be working off shore, so we are having our Christmas Dinner on Hogmanay. The four of us will all be here.

Like last year, I have bought a Marks and Spencer’s dinner, which only needs heated in the oven. It will be a seafood extravaganza with a chocolate dessert, as my younger son and I are seafood daft.

Unexpectedly my husband got back home off the boat, so there will be three of us, but we are going to stick to the original plan which is to delay the Gordon Ramsay Chili/Treacle Ham to Hogmanay. There is plenty of food and a Kobe beef steak pie if my husband doesn’t want the lobster and prawns.

Whatever you are doing, I hope you have an enjoyable time.

Particularly if you are on your own, I will raise a glass to toast you. If you are the cook and organiser, you do have my sympathy. Now that I’ve discovered the joys of a totally heaty up/ tin foil Christmas Dinner, there is no going back for me.

Dr Malcolm Kendrick

Dr Kendrick in an Aberdonian who works as a GP in England. He may be familiar to British readers as a so called “statin denier” as termed by a popular newspaper. Dr Kendrick and Zoe Harcombe PhD, sued the paper for libel, and after five years of litigation have finally won their case.

Dr Kendrick has been interested in the causes of ischaemic heart disease for about 20 years and published The Great Cholesterol Con about 15 years ago. This book delves into what does and does not cause coronary arterial plaque and heart attacks and recently he has also published another, The Plot Thickens.

His presentation at the Public Health Collaboration Conference in Glasgow explained what actually causes coronary plaque. He took us on a referenced revision of why previous theories, which have been accepted by many as fact, are not valid.

He spoke about the Minnesota Experiment. This has also been discussed in Gary Taubes’ books. Residents in Mental Health facilities in Minnesota were given different diets for several years and the outcomes were evaluated. In those days, indeed before neuroleptic drugs like Largactil and Haloperidol were invented, people with a diagnosis of schizophrenia could spend years of their lives in mental hospitals, so the population tended to be quite stable.

The intervention was the replacement of saturated fat with polyunsaturated fat. This was thought, by the influential Ancel Keys, to be the main cause of coronary artery disease, following the publication of his Seven Countries Study. (Although the data from 22 countries was available at the time). The patients’ cholesterol levels did indeed go down in the polyunsaturated diet group, but unfortunately the death rate went up.

Although this RCT should have led researchers to look elsewhere for the cause of coronary heart disease, the study results were simply not published, and the war on saturated fat continued, and still continues up to the present day.

The Q Risk 3 is the most up to date questionnaire that is administered by GPs or indeed yourself if you know your lipid blood results and blood pressure. It lists 20 risk factors for heart disease. These are really associations and are not necessarily causative. For example, your postcode is included.

The LDL result, when taken in isolation, shows no increase in risk. Other markers of dyslipidaemia such as low HDL and high triglyceride levels do.

The health of the Glycocalyx, which is like a shimmering brush border that lines all of our blood vessels, is key to the development of coronary plaque. If it is lush, it wafts our blood cells along, and stops them from sticking. It could be compared in some ways to Teflon. Certain things reduce the depth and function of the Glycocalyx such as: sugar, starch, alcohol, SLE, Hughes Syndrome, ageing, stress, smoking, diabetes, dyslipidaemia, and high blood pressure.

If the Glycocalyx is breached, the lining of the blood vessels can be injured, and to prevent bleeding, a vigorous platelet aggregation ensues. This is intended by nature to be helpful. The clotting cascade is controlled by just over 100 different cytokines and chemicals in the body. Endothelial progenator cells are released from the bone marrow, and these plug the holes in blood vessels. These form the basis of the plaque that covers the holes in the lining of blood vessels.

Plaque never forms in veins. It forms in arteries, especially where damage has occurred due to high turbulence, such as at forks in arteries. It is when plaques break off, and another burst of clotting ensues that heart attacks may occur.

Dr Scott Murray

Dr Murray is a Scottish Cardiologist who now works in England. His talk dealt with the practical things you can do to improve your cardiac risk and how he uses the Coronary Artery Calcification Score.

He says that a low carb or ketogenic diet is key to improving your lipoprotein type and size. Smaller and denser lipoproteins are more atherogenic than big fluffy ones. He showed pictures of healthy hearts compared to unhealthy ones that tend to have a lot of fat around them.

Taking at least 150 minutes of exercise a week including brisk walking and resistance exercise can reduce cardiac risk by 20-14%. Stopping cigarettes reduces your risk by 37%. A reduced carb diet can reduce your risk by 31-18%. Weight loss can reduce risk by 18%. Stress management can reduce risk by 41%.

Oestrogen use for women within ten years of the menopause also reduces cardiac risk. He advises you to keep thin if you possibly can.

If your CAC score is 0, your cardiac risk is 2.5%. If it is over 150, he advises a statin. These reduce plaque rupture.

This year’s Scottish PHC conference was as St Stephen’s Renfield Church Centre in Glasgow. The main theme of the conference was heart health. Many of the behaviours that improve heart health also improve health generally, and these will be familiar to readers of this blog. In this series of articles I will summarise some of the content of the day.

Dr David Unwin: Using continuous blood sugar monitors in Type Two Diabetes

David is a GP and he first started low -carbing ten years ago when he developed type two diabetes.

He got great results with low- carbing and persuaded his partners to join him in promoting the diet to type two diabetics in his practice. He has kept meticulous records of the transformations that have occurred in Southport, and also has tracked the savings he has made in medications that he would otherwise have had to use.

Lately, he been using the Dexcom continuous blood sugar monitor, which works very much like the Freestyle Libre. He has prescribed this in his practice for type two diabetics as well as type one diabetics, and has found that patients get faster and surer results when they can see immediate improvement when they stop eating sugar and starch and immediate high blood sugars when they do.

In the USA he has been advising United Healthcare Insurance on his findings and they are introducing the system for patients and will offer reduced premiums for users.

David was pleased to say that a recent innovation is a sensor that combines blood sugar testing and ketone testing in the same patch. This is going to be released by Abbott shortly. This is great news particularly for type one diabetics. I’m not sure if if will be useful or not for those on ketogenic diets, time will tell.

Jen Unwin PhD : Conquering Food Addiction with Low-Carb Eating

Jen is married to David. She is a Clinical Psychologist and is interested in people who struggle with low carb diets due to addiction to sugar and starch. Often processed food additives make the food irresistible to the person. Other food stuff addictions include nuts, dairy, breakfast cereals, and then of course there is alcohol.

She says that 10% of the general population are food addicted in some way.

20% of the population presenting to GPs are food addicted in some way.

55% of those with a binge eating disorder are addicted to food in some way.

She uses a modified Yale Addiction Scale for diagnosis.

There is a craving for the food and a compulsion to eat it. The person tends to increase the amount consumed over time to feel okay. “I can’t eat two biscuits, I have to have the whole packet”.

They neglect other activities in order to eat their food of choice. They feel a loss of control over their eating. They get withdrawal effects if they don’t eat it. Despite being aware that the food is causing them ill effects or harm, they continue to eat it in excess amounts.

Often depression and anxiety are the main symptoms.

In treating patients, Jen says that the person affected needs to clean up their diet, exercise to improve mental and physical health, and get back to healthy social habits. Gradually they can move to abstinence from the craved for food.

Those affected can’t have “cheat days”, like other people on diets perhaps can.

Jen has recently published a paper showing that control of Binge Eating Disorder is indeed possible with a low carb diet and reports that even a year after the intervention, the patients remained in remission from their compulsions.

She has released a book called Fork In The Road which explains how to gain mastery over food compulsion.

Dr Susan Pierce Thompson is a US psychologist who has also written, blogged and posted videos on this subject. She calls her programme Bright Line Eating.

Adapted from BMJ 19 October 2024

My comments: Decades ago it was found that newly diagnosed type twos who were put on insulin clamps for two weeks, recovered beta cell function, and had better blood sugars over the next two years, than their compatriots who had usual treatment.

For as long as I can remember, type twos, on diagnosis, have been given a step up regime. In this dietary strategies are employed, then metformin, then other drugs and eventually insulin. This procedure can last years.

In China, L Liu et al, they embarked on a trial of immediate insulin via insulin pumps for two to three weeks, and then randomised the patients to one of three oral medication regimes or lifestyle advice, who acted as the control subjects.

The study was conducted across 15 centres in China. 412 patients took part. The mean BMI was 25.8 and the duration of diabetes at onset was a median of one month.

The insulin pumps were sent to deliver a fasting or pre-meal blood sugar of 6.1 mmol/l and two hour post meal blood sugars of less than 8 mmol/litre.

The mean HbA1c was around 11% on diagnosis and on the pumps fell to around 9.4% after two weeks. At the twelve week mark all groups has HbA1cs of around 6 to 6.5%.

After 48 weeks the proportions of patients who still had HbA1cs under 7% were calculated.

The most successful intervention was Linagliptan 5mg + Metformin 1000mg a day. 80% of these patients had HbA1cs under 7%.

Next was Metformin 1000mg only at 73% closely followed by Linagliptan 5mg only at 72%.

Lastly came “lifestyle” only at 60%.

Other outcomes measured were beta cell function and insulin sensitivity.

Authors have shown that the intensive insulin treatment and step down approach gives excellent long term glycaemic control in patients with severe hyperglycaemia in newly diagnosed type two patients.

In patients who are willing to undergo training on pump using on diagnosis, surely this would be a better way to manage diabetes than our “usual” treatment.