Benign paroxsymal positional vertigo is characterised by brief attacks of dizziness brought on by a change in head position. It is thought to occur from debris entering the balance mechanism in the middle ear.
Observational studies links these attacks to osteoporosis and vitamin D deficiency.
A trial of oral supplementation with vitamin D and calcium appears to give fewer attacks of the dizzy episodes compared to no treatment over the course of the next year.
My comment: The Epley movements are also a treatment but they need to be given in person and by someone who knows how. You tube videos of this are available.
There is no single optimal diet for every individual. Whether you look through the lens of evolutionary biology or biochemistry the conclusion is that the natural human diet contains both animal and plant foods.
The term nutrient density refers to the concentration of micronutrients and amino acids in any given food. Although there tends to be a high intake of calories in the standard western diet, this population tends to lack vitamin A, B6, B12, C, D, folate and iron. Deficiencies of any of these essential nutrients can contribute to the development of chronic disease and shorten lifespan. Animal foods tend to be higher in B12, iron, zinc, EPA and DHA and plant foods tend to be higher in flavinoids, carotenoids, diallyl sulphides, lignans and fibre. Therefore it makes sense to eat a range of both.
Vegetarian and especially vegan diets are lower in several essential nutrients including A, B12, D, calcium, iron, zinc, iodine, choline, selenium, creatine, taurine, methionine, glycine, EPA and DHA. For instance 92 % of vegans and 77% of vegetarians were deficient in B12 compared to 11% of omnivores in a recent study.
Omnivores and vegetarians have the same lifespan as each other and both outlive people on a standard western diet.
Both vegetarian and vegan diets are safe in pregnancy but young children are at risk of short and long term effects if their diet is too restricted.
There is no association between eating foods that are high in cholesterol and the development of heart disease. Low carb diets, that tend to be high in saturated fat, are beneficial for certain cardiovascular disease markers including body weight, triglycerides, fasting glucose, blood pressure, body mass index, abdominal circumference, plasma insulin, HDL and C-reactive protein. Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.
Red meat has been associated with an increase in heart disease and cancer in several studies but correlation does not mean causation. Studies show that people who eat more red meat tend to have a higher BMI, are more likely to be overweight or obese, smoke cigarettes, be physically inactive, less likely to eat fresh fruit and vegetables and and less likely to have higher than a high school education. All of these variables are associated with a higher risk of heart disease and cancer, so it becomes difficult to isolate red meat as the cause. Red meat, particularly grass fed, is rich in B12, zinc, iron, CLA, EPA and DHA that are commonly deficient in the population.
There have been ten meta-analyses of low carb diets. All ten showed that low carb diets were as effective or more effective than low fat diets for weight loss. Some individuals of course may do better on a moderate carb or even high carb approach.
For type 2 diabetics, low carb diets are more effective than high carb diets for weight loss and also improve cardiovascular markers. Low carb and ketogenic diets are more effective than hypo-caloric or low fat diets for improving glycaemic control in type 2 diabetes.
Meanwhile politics, religion and poor science used in nutritional epidemiology have resulted in a lag in change from many institutions who give advice on diet such as the American Dietetics Association, American Heart Association and the American Diabetes Association.
In studies the Paleo diet has compared well against the Mediterranean and low fat diets.
Studies have found that ketogenic diets improves cardiovascular risk factors and have been shown have a beneficial effect in Parkinson’s disease, Alzheimer’s disease and dementia, and epilepsy, and also traumatic brain injury.
The carnivore diet is an “all meat diet” is gaining traction. Although this may improve chronic health problems in the short term, the long term effects are not known. Further research is required.
In general, on urine testing, animal foods are acid forming and plant foods are alkaline forming. However the blood pH is tightly controlled regardless of what you eat.
The low fat, vegan and Paleo diet advocates all don’t eat full fat dairy for various reasons. Dairy is the only food group that has more saturated than unsaturated fat. Meat, including red meat, pork and eggs all contain more unsaturated than saturated fat. Studies show that people who consume more full fat dairy products have either the same or a lower risk of obesity, diabetes and cardiovascular disease.
There is a degree of controversy over the environmental cost of meat eating. There are certainly harms from intensive meat rearing. On the other hand properly managed live stock can regenerate grassland ecosystems and reduce carbon emissions.
It is fully understandable that people who love animals and don’t want to see them mistreated embrace veganism and vegetarianism. Better animal husbandry and methods of transport and slaughter need to be more widespread.
By Matsumyama Y et al. J Am Geriatr Soc 1 May 2021
Older adults with more natural teeth are better able to perform everyday tasks such as cooking, taking medications, managing money, making a telephone call or going shopping, according to research from University College London.
Data from 5,631 adults from the English Longitudinal Study of Aging between the ages of 50 and 70 was analysed. Activities of daily living were self reported.
Being exposed to fluoridated water from age 5 to 20 was found to be associated with having more natural teeth in later life.
Professor Georgios Tsakos said, ” We know from previous studies that tooth loss is associated with reduced functional capacity, but this study is the first to provide evidence about the causal effect of tooth loss on the activities of daily living among older adults in England. This effect is considerable.
Older adults with ten natural teeth are 30% more likely to have difficulties with shopping for groceries or working around the house or garden compared to those with 20 natural teeth.
Even after you allow for factors such as educational qualifications, self rated health and their parents’ educational level, we still found that the more natural teeth a person had, the better their functional ability.”
My comment: Interesting. Would dental implants make a difference?
There are several main factors that can reduce your chances of getting bowel and rectal cancer. Weight optimisation, a good diet, exercise, vitamin D supplementation and regular colonoscopies.
A study co-funded by the World Cancer Research Fund, Cancer Research UK and Diabetes UK found that although being over weight was a factor in causation, that body fat position made a difference between men and women.
A higher BMI was more risky for men but for women, carrying the weight on the abdomen compared to the hips was worse. Only a 5 point increase in BMI for men increased bowel cancer by 23% in men but only 9% in women.
Higher fish and fish oil intake was associated with a 7% lower risk of bowel cancer in a European study.
Consuming flavinoid rich foods such as apples, tea and pears reduces both cancer and cardiovascular disease mortality particularly in those who also smoke and drink a lot of alcohol in a Danish study. The effects levelled off at around 500mg a day for all cause and cardiovascular mortality and 1000mg a day for cancer related mortality.
If you are unfortunate and get colorectal cancer, an Edinburgh analysis of seven RCTs has found that Vitamin D supplementation produced a 30% reduction in adverse outcomes.
Vaughan-Shaw et al. The effect of vitamin D supplementation on survival in patients with colorectal cancer: systematic review and meta-analysis of randomised controlled trials. Br J Cancer 2020 Sep 15.
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.
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.
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.
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.
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.