Should you get tested for coeliac?

From Allergy and Autoimmune Disease for Healthcare Professionals October 9 2019

Apparently 70% of people who have coeliac have yet to be tested for it.

Who may have it?

4.7% of those with irritable bowel syndrome.

20% of those with mouth ulcers.

8% of infertile couples.

16% of type one diabetics.

7.5% of first degree relatives of people with coeliac.

About 50% of people who are diagnosed have iron deficiency diagnosis  at the time of coeliac diagnosis.

Other people who need to be tested may have:

Pancreatic insufficiency

Early onset osteoporosis or osteopenia

vitamin and mineral deficiencies

gall bladder malfunction

secondary lactose intolerance

peripheral and central nervous system disorders

Turner’s syndrome

Down’s syndrome

Dental enamel defects

persistent raised liver enzymes of unknown cause

peripheral neuropathy or ataxia

metabolic bone disorders

autoimmune thyroid disease

unexplained iron, vitamin D or folate deficiency

unexpected weight loss

prolonged fatigue

faltering growth

second degree relative with coeliac disease

My comment: I had years of  the mouth ulcers, iron deficiency anaemia and irritable bowel symptoms which all resolved completely on a wheat free diet. The problem is that if I did want tested I would need to go back on wheat for a minimum of six weeks to give my antibodies a chance to build up sufficiently to test positive.  Thus, best to get a test BEFORE you go on a wheat free diet.

 

 

Jovina cooks seafood: New England Clam Chowder

America’s Culinary Food Stories-New England Clam Chowder
by Jovina Coughlin

From Manhattan to New England, clam chowder is known for its competing varieties as much as for its comforting briny flavor. It seems every state on the East Coast has its own take on the popular soup.
New England clam chowder is the most well-known and popular clam chowder. Though it’s named after New England and associated most with Massachusetts and Maine, food historians believe that French, Nova Scotian, or British settlers introduced the soup to the area and it became a common dish by the 1700s. The soup continued to gain popularity throughout the years and, according to “What’s Cooking America”, was being served in Boston at Ye Olde Union Oyster House (the oldest continuously operating restaurant in the country) by 1836.
New England clam chowder, occasionally called “Boston Clam Chowder,” is made with the usual clams and potatoes, but it also has a milk or cream base. It is usually thick and hearty; Today. the soup can be found all over the country but is still most popular in the North East.
New England Clam Chowder
Yield: 8 to 10 servings
Ingredients
3 strips thick-cut bacon
1 tablespoon unsalted butter
1 medium onion, cut into 1/4-inch cubes
1 medium leek, washed and sliced
2 celery ribs with tops cut into 1/4-inch slices
1 teaspoon chopped fresh thyme leaves
2 bay leaves
1/2 teaspoon seafood seasoning (Old Bay)
3 medium-size white potatoes, peeled and cut into 1/2-inch cubes
1/2 cup all-purpose flour (optional, you can thicken the soup by using double cream and cut down on the seafood stock)
4 cups seafood stock or bottled clam juice, divided
1 pound chopped fresh clam meat with juices or 2 (6.5 oz) cans of clams in broth
Kosher salt to taste
2 cups half & half
1 teaspoon white pepper
Chopped fresh parsley for garnish
Directions

Place a 4- to 6-quart pot over medium-low heat. Add the bacon and cook, turning occasionally, until crisp, 10 to 12 minutes. Remove the bacon, leaving the fat in the pot, and crumble into small pieces onto a plate; set aside.
Add the butter, onion, leek, celery, thyme, seafood seasoning and bay leaves to the pot. Cook, stirring often, until onions and potatoes are tender, 6 to 8 minutes.
Return the bacon to the pot and increase the heat to medium-low.
Dissolve the flour in 1 cup of the clam broth or seafood stock. Add the mixture gradually, stirring continuously, until incorporated. Stir and cook 5 minutes. (or you can take the worry about lumpy soup by not using it at all!)
Increase the heat to medium and slowly add the remaining clam broth or stock, 1 cup at a time, incorporating it into the mixture before adding more.
Increase the heat to medium-high and add the clam meat with its juices. Keep stirring 5 minutes, until the clams are tender.
Add the cream slowly; then stir in the white pepper.
Discard the bay leaves before serving. Garnish each serving with chopped parsley.
Note
Many USA supermarkets carry frozen, chopped clam meat in 1-pound containers, which is fresher than canned and just as convenient. Simply defrost before using.

My comments: I’ve had the pleasure of having several different versions of clam chowder in various parts of the USA and the creamy version without added tomatoes is my favourite. I’ve had it in New England and San Francisco.  I can’t remember where I had the one that had tomatoes in it, but I was rather disappointed. How you make this soup will depend on how low you wish to cut carbs and how tolerant of wheat you are. Clam chowder is very filling so you will need only light accompaniments eg a salad or fruit.

 

NICE: Hydrogen peroxide for impetigo

 Adapted from :NICE issues antimicrobial prescribing guidance for impetigo

curated by Pavankumar Kamat UK Medical News 28 Feb 2020

National Institute for Health and Care Excellence (NICE) recently published antimicrobial prescribing guidance which describes the antimicrobial strategy for adults, young people and children aged ≥72 hours with impetigo.

According to the new NICE guidance, GPs should prescribe topical hydrogen peroxide 1% instead of topical antibiotics for patients with localised non-bullous impetigo.
The guidance states that hydrogen peroxide 1% cream is as effective as topical antibiotics in patients with localised, non-bullous impetigo, provided they are not systemically unwell or at risk for complications.

If hydrogen peroxide 1% cream is not suitable or if symptoms have worsened or not improved, a short course of a topical antibiotic may be considered.
A topical or oral antibiotic is recommended for patients with widespread non-bullous impetigo, provided they are not systemically unwell or at risk for complications. Oral antibiotic treatment is recommended for patients who have bullous impetigo or if they are systemically unwell or at high risk for complications.
NICE does not recommend a combination of topical and oral antibiotic. There is no evidence that the combination works more effectively than a topical treatment alone.
The primary choice of topical antibiotic is fusidic acid 2%, and the secondary option is mupirocin 2%. The drug of choice for first-line oral antibiotic therapy is flucloxacillin, with clarithromycin and erythromycin (for pregnant women) as secondary choices.

References
Impetigo: antimicrobial prescribing: NICE guideline [NG153]. National Institute for Health and Care Excellence. 2020 February.

My comment: Impetigo is a common skin infection caused by staphloccus which tends to colonise up people’s noses. It spreads rapidly in the nursery and primary school environments. Previously it was treated with oral penicillin. Children are advised to stay off school to reduce spread. Any effective topical, non antibiotic treatment, is welcome as this will help reduce antibiotic resistance.

Low carb store: Aubergine bake

AUBERGINE BAKE

INGREDIENTS
2 shallots, peeled & chopped
100g mushrooms, sliced
2 garlic cloves, peeled and crushed
2 large tomatoes, thinly sliced
1 aubergine
1 tin chopped tomatoes (400g)
2 tbsp fresh basil leaves, torn
Sea salt & black pepper
3 tbsp olive oil
1 mozzarella ball, roughly chopped
100g strong cheddar, grated

CREATE IT
1. Heat 1tbsp of olive oil in a large frying pan and soften the shallots over medium heat.
2. Add the mushroom and cook until beginning to soften (use more oil if needed).
3. Add the garlic and cook for a further 1 minute.
4. Drain most of the liquid from the tinned tomatoes and add to the pan with a pinch of salt and pepper, keep on a low heat whilst you cook the aubergine.
5. Slice the aubergine into rounds about 1/2cm thick and use the remaining olive oil to brush each side.
6. Cook the aubergine in batches in a hot griddle pan to soften and colour, turning half way through (2-3 minutes each side). Place on a plate to uselater.
7. Take an oven dish and add a layer of the tomato sauce to just cover the base.
8. Layer half the aubergine on the sauce and top with the tomato slices.
9. Scatter the chopped mozzarella on the tomatoes.
10. Use the remaining aubergine to add another layer.
11. Stir the basil through the remaining tomato sauce and pour over the aubergine.
12. Top with the grated cheddar cheese.
13. Place in a pre-heated oven on medium heat for 30-40 minutes until the cheese is melted and bubbling.
14. Serve with a fresh green salad.

Dr Michael Eades: Omega 6 fats make you fat way beyond their caloric value

There is a hypothesis gaining ground which is that the omega 6 fats in vegetable oil disrupt metabolism and promote fat gain way beyond their simple caloric value.

Dr Michael Eades explains the epidemiology which suggests that this is the case and then the biochemistry which provides a plausible explanation.

This video is 45 minutes long and is quite technical in parts.

 

Abstract and video here:

https://denversdietdoctor.com/dr-michael-eades-a-new-hypothesis-of-obesity/

 

 

 

 

Sheri Colberg: Motivate yourself to exercise

From Diabetes in Control: Getting and Staying Motivated to Be Physically Active
Jan 4, 2020

Author: Sheri R. Colberg, PhD, FACSM

Every New Year all of the fitness clubs and gyms run specials to bring in new members, and they know—and even count on the fact that—most of those people will no longer be regularly attending classes or doing workouts by the time spring hits. How do you avoid becoming one of those exercise dropouts?
Even elite athletes have some days when they are not as motivated to exercise. You know those days—the ones when you have trouble putting on your exercise gear, let alone finishing your planned workout. For the sake of your blood glucose and your health, do not use one or two bad days as an excuse to discontinue an otherwise important and relevant exercise or training routine.
Here is a list of motivating behaviors and ideas for regular exercisers and anyone else who may not always feel motivated to work out:
Identify any barriers or obstacles keeping you from being active, such as the fear of getting low during exercise, and come up with ways to overcome them.
Get yourself an exercise buddy (or a dog that needs to be walked, you can borrow one!).
Use sticker charts or other motivational tools to track your progress.
Schedule structured exercise into your day on your calendar or to-do list.
Break your larger goals into smaller, realistic stepping stones (e.g., daily and weekly physical activity goals).
Reward yourself for meeting your goals with noncaloric treats or outings.
Plan to do physical activities that you enjoy as often as possible.
Wear a pedometer (at least occasionally) as a reminder to take more daily steps.  You can get free pedometer apps that turn your mobile into a pedometer.
Have a backup plan that includes alternative activities in case of inclement weather or other barriers to your planned exercise.
Distract yourself while you exercise by reading a book or magazine, watching TV, listening to music or a book on tape, or talking with a friend.
Simply move more all day long to maximize your unstructured activity time, and break up sitting with frequent activity breaks.
Do not start out exercising too intensely, or you may become discouraged or injured.
If you get out of your normal routine, and are having trouble getting restarted, take small steps in that direction.
As for other tricks that you can use, start with reminding yourself that regular exercise can lessen the potential effect of most of your cardiovascular risk factors, including elevated cholesterol levels, insulin resistance, obesity, and hypertension.

Even just walking regularly can lengthen your life, and if you keep your blood glucose better managed with the help of physical activity, you may be able to prevent or delay almost all the potential long-term health complications associated with diabetes.
From Colberg, Sheri R., Chapter 6, “Thinking and Acting Like an Athlete” in The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities. Champaign, IL: Human Kinetics, 2019.
Sheri R. Colberg, Ph.D., is the author of The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities (the newest edition of Diabetic Athlete’s Handbook), available through Human Kinetics (https://us.humankinetics.com/products/athlete-s-guide-to-diabetes-the), Amazon (https://amzn.to/2IkVpYx), Barnes & Noble, and elsewhere. She is also the author of Diabetes & Keeping Fit for Dummies. A professor emerita of exercise science from Old Dominion University and an internationally recognized diabetes motion expert, she is the author of 12 books, 28 book chapters, and over 420 articles. She was honored with the 2016 American Diabetes Association Outstanding Educator in Diabetes Award. Contact her via her websites (SheriColberg.com and DiabetesMotion.com).

 

Jovina bakes low carb: Banana bread

Banana Bread
Ingredients
1 banana
1 and 1/2 cups + 1 tablespoon almond flour (ground almonds)
3 eggs
2 tablespoon unsalted butter, melted
2 teaspoons cinnamon
1 teaspoon baking powder
1/4 teaspoon salt
1 teaspoon vanilla extract
1/4 cup low carb sugar substitute
1/2 cup finely chopped walnuts plus 15 walnut halves
Directions
Preheat the oven to 350 degrees F.
Mash the banana with a fork.
Process the eggs together with the mashed banana and the melted butter with a hand
blender or hand mixer to a smooth dough.
Mix the dry ingredients in another bowl. Pour into the bowl with the egg and banana
mixture and stir well.
Add the chopped walnuts and fold into the batter.
Line an 8-inch bread/loaf pan with baking paper/parchment with the paper extending over the ends of the pan. Coat lightly with cooking spray. Pour in the bread dough into the pan and place the walnut halves in five rows across the top of the dough.
Bake the bread for 45 minutes or until an inserted knife comes out clean. Check the bread after 30 minutes. If the top is brown, cover it loosely with aluminum foil to prevent the low-carb banana bread from burning.
Let the banana bread cool and then lift out with the aid of the parchment paper. Cool completely before slicing.

Jovina bakes low carb: Ricotta cheesecake

Ricotta Cheesecake
Makes one 8-inch square cheesecake, to serve 12
Cheesecake Ingredients
2 cups ricotta cheese
1 cup sugar substitute ( I use monk fruit)
1 teaspoon vanilla extract
6 eggs
Zest of 1 orange
Blueberry Topping
2 cups fresh or frozen blueberries (10 oz)
1/4 cup water
1 tablespoon lemon juice
3 tablespoons low carb sugar substitute
2 teaspoons cornstarch or arrowroot powder mixed with 2 teaspoons water
Directions

Preheat the oven to 375°F.
Grease an 8-inch square baking pan with butter or cooking spray.
In a medium bowl, stir together the ricotta and sugar. Add the eggs one at a time until well incorporated. Stir in the vanilla and orange zest. Pour the batter into the prepared pan.
Bake for 45 to 50 minutes, until set. Let cool in the pan on a wire rack for 20 minutes. Cover. Refrigerate overnight. Serve chilled with the blueberry topping.

Do you have a chronic disease or a long term condition?

Adapted from BMJ 23rd Nov 19. A chronic problem with language by Dr Helen Salisbury

Helen is a GP in Oxford she writes…..

Some years ago I was told the term “chronic disease” had been replaced by “long term condition”. When I asked my non medical friends about it, they thought that both “chronic” and “acute” both meant “severe”.  My comment: whereas they mean something more like “long lasting” and “short lasting” to a doctor.

So a chronic disease sounds like one likely to harm or kill you, whereas a long term condition sounds like something you live with but not die from. As doctors now copy patients into their letters, then perhaps we need to be more responsive to their beliefs?

Impaired renal function, from natural ageing is one of the problems that has arisen from the misunderstanding of the term “chronic kidney disease”.  It can cause people real worry because they imagine that they are a candidate for dialysis or death, yet they are unlikely to be affected symptomatically, nor is it likely to hasten death. Heart failure is another term that causes a lot of distress.

Sometimes doctors need to be precise in their speech and letters to each other so we can’t abandon all technical language.  Copying clinic letters to patients is good practice, even if patients sometimes struggle to understand them completely, because they have a record of the consultation and a chance to clarify the decisions made.

Sometimes we could use more lay terms to reduce confusion. Abandoning “chronic disease” is a good start.

 

 

Jovina cooks: Tomato and vegetable soup

My comment: this dish needs some advanced preparation to make the tomatoes easy to peel or you could use tinned tomatoes if the summer glut is over.

Homemade Tomato Soup
Ingredients
1/4 cup extra virgin olive oil
2 leeks, white and light green parts, diced
2 carrots with green tops, diced including the tops
3 stalks celery with leaves, diced
The top of one fennel bulb with fronds, diced (save the bulb for another recipe)
4 cloves garlic, minced
5 lbs fresh plum tomatoes
4 cups  chicken stock

salt and freshly ground black pepper
2 teaspoons honey (or a teaspoon of sugar)
A few dashes of hot sauce eg Tabasco
Directions
I freeze the tomatoes and then defrost them overnight. The skins slip off easily. Or you can bring a large pot of salted water to a boil; add the tomatoes to the boiling water and cook 4-5 minutes, or until skins loosen. Carefully remove tomatoes from the water with a slotted spoon. Set aside until tomatoes are cool enough to handle; carefully slip off the skins and discard. Chop the tomatoes and set aside.

Heat the oil in a heavy Dutch Oven ( Le Creuset casserole dish or similar) over medium-high heat; add the garlic, leeks, carrots, fennel, celery and sauté 3-4 minutes, or until vegetables are soft. Season with salt and pepper to taste. Add the chopped tomatoes.

Add the broth and honey. Simmer for 15 minutes. Use a handheld stick blender and process until smooth and creamy. Add the hot sauce and serve.