Dr Peter Tippett: Prevent a second covid wave

Saving Your Health, One Mask at a Time
Published on April 7, 2020

Peter Tippett MD PhD
CEO careMESH; Chairman DataMotion; ex Presidential Advisor; Norton Antivirus creator

We all hear the same things: wash your hands, don’t touch your face, stay at home, stay 6 feet away from others. Viruses live on boxes and plastic and doorknobs and… EVERYWHERE.
How does the average person decide what measures to follow unless they truly understand how these things work or have a clear set of “rules” they can abide by?
I am an Internal Medicine-certified, Emergency Room MD with a PhD in Biochemistry. I have also spent much of my professional life in the high-tech world helping people understand how risk, infection, and the growth of infection behaves. So I thought it might be helpful to folks in my network to explain how personal protection from a virus like SARS-CoV-2 (the formal name of the virus that causes COVID-19) actually works, how any given measure individually lowers risk, how various countermeasures work together, and most importantly, to give you some simple guidelines for day-to-day living in this new COVID world.
Bottom Line on Masks & Gloves:
Wear a mask when you are in “exposure” zones (mainly places with other people).
Treat your home, car, and yard as safe places (no mask or gloves).
Be on high alert on what you are doing with your hands when you are in “danger zones.” This is when you must not touch your face.
Consider wearing gloves (even winter gloves or work gloves can be helpful) but only for short periods of time and only when in “touch exposure” danger zones.
Remove your gloves (and mask) when you return to your safe place.
Wash your hands every single time you take off your gloves or mask or move from a danger zone back to a safe zone.
When you are at home and after washing up, you can relax, scratch your nose, rub your eyes and floss your teeth…without worry.
Protections Work Together
All protections or countermeasures are only partially effective. For example, wearing the seat belt in your car reduces the likelihood of dying by about 50% compared with not wearing it. You can think about that as horrible (“it will fail half the time!”), or as great (“it cuts the risk of dying in half!”). For everything we care about, in all aspects of life, we solve this “risk” problem by using countermeasures together to improve their collective effectiveness. Independently, air bags reduce the risk of dying by about 30-40%. When added together with seatbelts, they are synergistic and reduce risk together by 65-70%. We add licensing, speed limits, anti-lock brakes, police enforcement and other things to achieve very good risk reduction (well into the upper 90s). We need to be even more careful when we drive in more dangerous situations, such as in a snowstorm. Protecting yourself (and society) from COVID works exactly the same way—you just can’t see the snow.
Getting Infected is Not “Black and White”
A tiny number of virus organisms placed in the back of a person’s throat one time is not likely to lead to the average person getting “sick” with COVID. If we placed a tiny number of live viruses in the throats of 1,000 people, less than half would probably get sick. If we placed 1,000 or 1,000,000 viral organisms, the average person probably would get sick. And if we placed a tiny number of organisms 10 or 100 times in a week, the average person would also likely get sick because of the multiple exposures. This is because even in your throat, your body has protective countermeasures such as mucus and cilia and your blood and other fluids likewise have generic immune and other protections. They are just not as strong as we need them to be. Even as people get and recover from COVID or get a future vaccine, 100% of the population won’t be 100% protected, but collectively we will be safe.
Your nose reduces the risk of viral particles getting to your throat. A mask reduces the risk of the viral particles getting to your nose, and social distancing reduces the risk of them getting to your mask. Together, these countermeasures work very well.
If your nose reduces the risk by 80% (see Caveat 1), and a mask by another 80% and the six-foot distance by 80% more, then collectively, the failure rate would be (0.2*0.2*0.2 = .008) = 0.8%. In other words, the collection of countermeasures would be (1 minus the failure rate) = over 99% effective in reducing your chances of getting sick. In this example, any two together would be 96% effective and any one alone would be 80% effective.
So based on this example calculation, if you are standing with your mouth closed and normally breathing close to a COVID carrier as they are speaking to you, you may have a 20% chance of getting sick from that exposure. Add a mask and that would go down to 4%, add distance and that goes to under 1%. Add repeated individual exposures from other people, and your risk gets worse. Add more countermeasures and your safety improves. The power of each individual countermeasure is much less important than their collective power in protecting you.
So How Does a Mask Really Work?
It hasn’t been measured for COVID, but I suspect that almost any mask, no matter how poor, is more effective than a seat belt is in your car. Masks that are FDA-cleared have been tested against a benchmark and have a rating. N95 masks have been shown to reduce 95% of passage of a certain size particle over a certain time period in specific laboratory conditions.
When I worked in a pre-COVID ER, I would change masks 6-12 times in a shift. However well it works in the test lab, wearing the same mask (N95 or not) for a 12-hour ER shift is definitely not as strong as using a fresh one—let alone using the same mask for a week. But it is far stronger than not wearing any mask at all. N95s have benefits over the simple dust masks typically used during construction work, for example, such as: (a) they are more comfortable to wear, (b) the air is more likely to go through the mask than around it, (c) exhaled air is less likely to fog your glasses, and (d) inhaled air is a bit less restricted.
These are similar characteristics to the beneficial properties of cloth masks. So, I am a big fan of cloth masks, even very simple ones. Any mask has 3 main protective properties:
They make it hard to touch your nose and mouth, thus providing great protection for what is the biggest infection vector in most situations — hand-to-face transmission.
They reduce the exposure of your nose and mouth to viruses in the ambient air (directly breathing in viral spray or viral fog).
They reduce the chance that others will get infected from you when you are sick and don’t know it (and when you are sick and do know it!).
Great masks and poor masks can both stop water droplets. Most coughs and sneezes are really composed of a fine spray of water droplets soaked with virus. Stopping the droplets also stops the virus. Dry virus “dies” (see Caveat 2) very quickly so even though individual virus particles are extremely tiny and can enter in the air around a mask, or even go through the mask, they are less likely to infect you than a droplet teeming with viruses being kept “alive” by the droplet. The most likely way a dose of virus will get in your nose or mouth is:
Via touch of your own hand (most likely by far)
Via water droplet-laden virus (cough, sneeze or even breathing)
Via free (or dry) virus “particles” (least worrisome)
The Nuance Behind Mask Testing
I’ve seen many articles that totally miss the mark on the benefits of masks. Many say things like “good to keep your germs from hurting others, but not very good at protecting yourself” or “we tested 1,2,3 layers of different materials and found x% of particles the size of viruses goes right through; therefore these are better than those”.
The testing that matters is way too difficult for anyone to actually do. It would test 1,000 people who wear “certified masks” versus 1,000 who wear homemade masks of different types and see what percentage of each get infected and what percent get hospitalized or die. Proving that virus-sized particles “go right through” old bandannas is mostly irrelevant if the most likely way you will get sick is by hand-face touching, where a bandanna might be 98% effective; or by virus-laden water droplets where the bandanna folded 4-times might be 90% effective; even though it is relatively poor at blocking dry, individual virus organisms, which is the least likely way you will get sick.
How and When You Are Likely to be Exposed
It is best to think of exposure scenarios. Scoring them relative to each other helps to illustrate the relative risk. (numbers are for illustrative purposes only)

Is a Hospital Mask Better Than Homemade?
In many respects, for home users, a mask made of cloth is comparable to a paper-based, certified medical mask. The first reason they are comparable is because the protection math works well whether the mask is 70% effective or 90% effective. In the example above, the total risk reduction would be somewhat better (99.6% vs 98.8%) between using a great mask and a good one when using it as part of a short list of countermeasures working together. That example math did not include other countermeasures you are likely to also use like washing your hands, or wearing glasses or a shield, or sometimes wearing gloves, or avoiding exposure in the first place. All of which would drive the total theoretical risk reduction well above 99% no matter which mask you wear.
First, countermeasures only work if you use them. If you keep a cloth mask in your pocket or purse or hanging around your neck, then when you get near a danger zone you will be more likely to use it. The N95 and similar masks don’t do well after being scrunched up in your pocket. Second, when you are back to your safe place, you can toss your cloth mask in the washing machine and use it again tomorrow. Or better yet, buy or make a couple of masks so one mask is always clean.
Treat masks like underwear: use a fresh one every day (and whenever things happen that make you want to change).
Cloth masks can be fitted, or folded, or worn as a bandanna. Two layers are much better than one, and three are somewhat better than two. Older cloth is likely to pass air better, making it easier to breath if you are wearing it tightly, which prevents air from escaping around the edges. If you are going to have air escape around the edges, arrange your mask so air escapes below your chin. Air turning more corners on the way to your nose makes it tougher for contaminated air to reach your nose, which improves protection.
Consider the inside of your mask as clean, and the outside as contaminated. When you remove it, you have just touched something contaminated so wash your hands, and then clean the mask as soon as it is practical.
Should I be Wearing Gloves, Too?
Wearing a mask uniformly reduces risk. Unfortunately, the case for non-medical people wearing gloves is much less clear because it can be totally useless. They become contaminated just as your hands do. Therefore, wearing gloves for long periods doesn’t help protect others. Both a contaminated glove and contaminated hand can pass a virus either way. If you handle money or touch a door that others will touch, you will both pick up the virus on your gloves and transfer it to the next object or person. If you touch your face wearing gloves, you will be just as likely to drive a virus to your eyes, nose or mouth as if you touched your face with an ungloved hand. Wearing gloves might help you avoid touching your face, but masks are much better for this.
Gloves are best for temporary situations in which you expect “touch exposure”. Use them, allow them to be contaminated, and when you are away from the touch exposure zone, take them off, wash your hands and get on with life.
So, use them for short periods of time for a specific purpose. For example, I recommend wearing gloves (and a mask) when you go to a store. Put them on when leaving your car, feel free to open doors, touch things, move things, with abandon, however, never touch your face when you are wearing gloves. Use them when paying, and when typing your pin or signing for your purchase. When you leave the store remove them and if they are disposable, throw them away. When you get to your car, open the door, clean your hands with your sanitizer or wipes, and go back to your safe zone.
My 90-something mother lives in an elder-care apartment complex. There are others there who have COVID. Her apartment is her safe zone. She wears a mask (just the sleeve from an old shirt) and winter gloves when she ventures into the hall and down the stairs to a common area to pick up her mail.

She can hang on to the railings, punch buttons, open doors and breathe freely as she does her work outside of her safe zone. When she gets back to the apartment, she removes the mask and gloves, puts the mask in the wash (she has the others available if she needs a clean dry one), washes her hands and gets comfortable in her safe zone. By the way, the winter gloves will become un-contaminated over time as long as they are dry (see below), and they can be used again the next day since the inside is going to stay clean. If you really want to decontaminate them, they can be put in a 250-degree Fahrenheit oven for a half hour or set out in the sun.
What About Grocery Bags?
You can go crazy worrying about the bags and store items and packages you bring into your safe zone. In general, if they are dry, they are relatively safe. You can make them safer by letting them sit for an hour or more. Bright sunlight or dry air are both virus killers. Keep your hands away from your face while you are unpacking and wash your hands after you have finished putting things away, then consider yourself safe. No one is going to succeed at perfect sterile procedures in the real world, so make a routine that makes sense.
Hand Washing & Sanitizers
Wash or sanitize your hands whenever you enter your safe zone every single time, and when you finish working on things that have a chance of being contaminated. For example, if you are going to do the laundry, get everything loaded in the washing machine and then wash your hands. Same for unpacking the mail, or groceries, or an Amazon package delivery. While you are working on anything that is potentially contaminated, and every time you are in an unsafe environment, pay attention to your hands. When you are shopping or in other danger zones, it is not the time to scratch your nose or rub your eyes. And you should be wearing a mask anyway. Once you are back in your safe zone, wash up, and scratch your nose and rub your eyes all you want. You are in your safe place.
Washing with soap is better than using a sanitizer or wipes, but obviously you need a sink and soap for washing. Keep a pump or wipes in your car and at your home entrance to do a quick job on the way into your safe zones—mainly to keep your safe zone safe.
If you accidentally shake someone’s hand, or touch something worrisome, keep track of your hands, and keep them off of your face until you can wash or sanitize them. In some situations, you might consider letting one hand become contaminated while trying to keep the other relatively clean. You might use the same hand to open doors, for example and the other to do less dirty work until you can wash or sanitize them both.
But in general, if you are home or in another safe zone, quit worrying and don’t bother thinking about washing and face touching. No one can stay sterile for any extended length of time. Save those worries for shorter periods when you are in danger zones.
What about packages and mail delivered on the front porch?
Viruses are always dying. Viruses only “grow” (replicate making more viruses) when they are in the inside of an infected person (or a bat) cell. Everywhere else, they are dying. Depending on where they are and their local environment, they die quickly or they die slowly, but they constantly die. This is the big difference between viruses and bacteria. If you put a million viruses in a drop of water, they will start dying immediately. And there will never be more individual virus particles than you started with. Bacteria, on the other hand, can be in “standing water” with enough other environmental help to replicate and make a big, stinky, slimy mess. Just one or two bacteria double to 4, 8, 16, 32, 64, 128, 256, 512, 1024 eventually to millions of individual bacteria, in your soup, or milk, or pasta sauce, or whatever. Viruses never do this. Outside of the infected person they start dying and keep dying. We can take advantage of this fact to help keep us safe.
For those who think in exponential math, Viruses tend to die via a half-life. Just like bacteria grow exponentially in the soup, viruses grow exponentially in populations of people. Exponential growth is described with a “doubling time”. Similarly, exponential death is described as a “half-life”. Radioactive material has a constant, unchangeable half-life. The half-life for death of viruses, on the other hand, is a good property in the everyday world and is also easy to speed up, and easy to trust.
The half-life of virus particles might be a minute or two on a package on a dry warm day sitting in direct sunlight, or a half hour or more for the same package sitting in a cool humid environment like your basement. So, with these hypothetical numbers, for the package on the porch in the sun, ten half-lives kill off 99.9% of those virus particles in 20 minutes. The same package in your basement might need five hours to accomplish the same kill-off benefit. Sunlight (UV light), heat, dryness, soap, alcohol, peroxide, bleach all rapidly kill viruses.
So even if the outside of the box of Cheerios was contaminated a few hours ago by a sick shopper touching it, by the time you get it home, 99.9% of it is probably already dead, and by the time you eat breakfast tomorrow, after the box sitting in your dry cupboard, another 99.9% of it is likely dead.
Please don’t get sucked into breathless worry because the scientist who (correctly) shows that it is “possible” to find some live virus on cardboard after 2 days. Although true, the risk is infinitesimal. That scientist can find the last two living viruses, but you need a much bigger dose to cause any harm and, in most cases, that all went away yesterday.
But I work in a Grocery Store (or Warehouse)
Please wear a mask! Wear glasses instead of contacts. Wear something over your shirt or blouse that you can take off in the garage or other staging area before entering your safe zone car or home. Wear gloves or not (your employer probably has a requirement). Either way, wash your hands when you take your mask off and when you take your gloves off. When you quit work, wash before you get to your car. Take your outer layer off and gloves off before fully entering your car. Sanitize your hands on entering your car. Do it all over again in your garage or mudroom before getting inside your house. Put your clothes and mask in the wash and take a shower when you get home.
Key Takeaways
Social Distance—Stay six feet from people is a good thing. Ten feet is even better.
Safe Zone—For most folks, your house is a safe zone.
For you, and for family living with you, your yard is likely a safe zone.
When outside, and with no other people nearby, you are in a safe zone
For most people, your car should be a safe zone.
Masks—The easiest, most reliable precaution you can take when out of your safe zone
If you work with the public, you should absolutely be wearing a mask on the job.
If you are in a safe place, a mask has low value, because the risk is already low.
If you are going to put the same mask on and off, then treat the outside as contaminated and the inside as safe.
If you handle the outside of your mask, then consider your hands as contaminated, and wash them.
Don’t touch the inside of your mask with your hands or anything else dirty.
Put the cloth mask in the laundry at least daily. (or wash with warm water and soap).
Have at least two masks so one can be in the wash and the other clean when needed
Don’t bother boiling masks before you wear them. The detergent in your washing machine is easier, stronger, and more likely to succeed by far.
And above all—enjoy your safe zone with your family, friends, cat or dog.
Be Well,
Peter

Caveat 1: I will use statistical examples and numbers to illustrate how this works. The numbers I use are estimates only. I am using them because the exact numbers in each case can be off by huge margins, and the resulting understanding, recommendations and behavior will not change even if a particular situation or study shows instances that are quite different from my examples.
Caveat 2: I know that viruses are not “alive” nor “dead” but I will use “dead” to mean that they are no longer capable of infecting anyone and “alive” to mean they still can.
Reprints: Feel free to republish as you need for educational, public health, public good, and other nonprofit-making purposes. If you repurpose any of this document, then please give attribution to: “Peter Tippett, MD, PhD, CEO careMESH”

My comment: I made a mask out of sock and it looked terrible. I then bought some cotton masks from Amazon for £2.50 each and keep them in a drawer in the house.  I have one in my coat pocket and use it when I am shopping. I have disposable surgical masks that I can wear at work. On return home, I put the used mask in the shopping basket and put a clean one in my coat pocket.

 

Nina’s plea: Would you write to Congress and change USA food guidelines?

This is a message from Nina Teicholz, writer and low carb activist:

My highest concern about the existing USA Food Guidelines is for the people who have no choice but to eat the food that they are given, which is based on what is thought of as “a healthy diet”. There are many essentially ‘captive’ populations in schools, hospitals, and prisons. Many of these people are the most disadvantaged among us. Native Americans on reservations have no choice about the food assistance they receive.

I’ve spoken with the Native American woman who for years has been trying to change the USDA food they get, and she cannot get even the tiniest change. They desperately need the food, yet it’s more than 50% carbs, and something like 40% of the kids on these reservations have diabetes.

The same is true for poor people, education programs, and feeding programs for the elderly. These people have no choice.  No other food  is given to them. Many doctors also say they have no choice, because  they are required to teach the guidelines to patients. It is the same thing in most federally funded institutions.

Thus, my hope is, if we have to have Guidelines for the time being, that they do as little harm as possible. The Guideline is coming up for review, but the committee have already decided not to review the evidence on low carb diet studies.  We are seeking to change this, and there is already some support for our position, that these studies should be included in the evaluation. Could we get in a low-carb option? Could we force them to consider all the science on saturated fats? This next set of Guidelines will come out by the end of this year, and I think there is still time to try to force change. Our actions now would build awareness around the issue that there is something wrong with the Guidelines. There is so little awareness of the problems. And actually I’m hopeful,  because in the last few months, we’ve worked with a number of groups to raise awareness to a level it’s never been before.

Here’s what I would suggest for now.
Both my group, The Nutrition Coalition and the group Low-carb Action Network,  have webpages that make it very easy for you (if American) to write/call your Members of Congress. This is super important and I urge everyone to do this. USDA is not budging. Congress is really the only body of power interested in change, and they need to hear from people. So I would urge everyone to contact their members of Congress. It can take just a few min.

Thank you,

Nina

My comment: If the USDA food guidelines are changed, it would make it so much easier for the UK to follow. The photograph shows the breakfast given to a diabetic patient in a US hospital who had just had a heart attack. The UK also dishes out abysmal food to its patients. Wouldn’t it be great if they had a low carb option?

HRT risks need to balanced with benefits

Adapted from Editorial BMJ 19 October 19 by Janice Rymer et al.

In the UK most women go through the menopause aged between 45 and 55. About half of them will get symptoms such as flushes, sweats, low mood, anxiety, joint and muscle pain, vaginal dryness, reduced sex drive, and hip fractures in later life. Hormone replacement therapy can turn these symptoms around.

Women’s health specialists are concerned that a meta-analysis published in the Lancet does not evenly show the benefits of HRT compared to the risks and think that the NICE guidance in 2015 looked more comprehensively at all the available evidence. They don’t want either women or doctors to stop HRT unnecessarily.

The Lancet showed that in the UK one in 16 women who have never taken HRT will develop breast cancer between the ages of 50 and 69.  If a woman of normal body mass index (under 25) starts HRT in her 40s or 50s the additional risk of getting breast cancer is one in 200 for oestrogen only HRT, one in 70 for daily oestrogen and progestogen for part of the month, and one in 50 for preparations with a mix of oestrogen and progesterone daily.  But body weight and alcohol have a greater effect on getting breast cancer than HRT. For instance, being overweight or obese will increase the rate of breast cancer six times compared to combined HRT.

The Lancet study looked at how many cases of breast cancer started but did not look at the mortality rate. A recent systematic review did. This showed that if a woman started HRT close to the menopause there was an apparent reduction in all cause mortality and cardiac death with no evidence of an increase in deaths from breast cancer.

The womens’ health specialists are concerned that the bone benefits and cardiac benefits, especially for women going through an early menopause, will be ignored if undue weight is put on the small increase in breast cancer diagnosis, over the symptomatic benefits and improvement in total mortality.

BMJ 2019;367:15928

 

Paleo Canteen recipe book

Ally and John are Scottish chefs who have a van in Glasgow from which they sell reasonably priced, interesting, low carb fare.

Paleo canteen recipe

They are releasing their first recipe book in the next few weeks and you can get  a sample version of the book  here:

bit.ly/cooklowcarb

paleo canteen

They both have extensive educational backgrounds, having both studied for PhDs before leaving physics and philosophy behind them,  to take up chef’s whites and knives.  Both have worked across a range of cooking genres at excellent restaurants such as Ottolenghi’s in London  and Rogano’s in Glasgow.

Their full book includes meat, particularly moderately priced meats, poultry and fish, vegetables, soups, salads, sauces and desserts. They are aware that low carbing has a reputation for being pricey and they want to make delicious meals with the five star touch accessible to all.

 

 

 

Don’t rush to hospital with a burn

It’s now barbeque season, and with this in mind, new research has shown that the best first aid for a burn is to run cool water over the affected skin for at least 20 minutes.This should be started as soon as possible after the event.

In a study of 2,500 children, those given the full 20 minutes treatment were less likely to need hospital admission and half as likely to need a skin graft.

 

My comment: In my childhood my mother put butter on burns. Don’t do this! It does not work. The area that I notice most people have burns is on their wrists on the thumb side. This is from removing hot dishes from the oven and brushing their arm against the hot door or oven sides. Of course you are carrying a hot, full dish of food, so can’t pull back as fast as you would like. Although many of us then run our arms under a tap, it would be a good idea to do this for longer than it takes for the immediate pain to subside. You can also use oven gauntlets in preference to gloves or folded up tea towels as these are longer in the arm. 

BMJ 2019; 367:1572

Emma Porter: Cheesy bread pizza base

Emma has more recipes at http://www.thelowcarbkitchen.co.uk and is the co-author with Dr David Cavans of “Type 2 Diabetes Low Carb Recipes” which is available at bookshops and Amazon.

As promised this is Emma’s recipe for a cheesy bread recipe that can be eaten on its own or used as a pizza base. You can watch her make this on the PHC conference 2020 on You tube.  The recipe is at the end of the video and also here.

Ingredients:

180g grated mozzarella (150g for the dough and 30g to put on the top at the end)

3 garlic cloves

75g ground almonds

3 tablespoons Greek Yoghurt

Some fresh parsley

one teaspoon garlic powder (optional)

olive oil

salt

butter

one teaspoon baking powder

 Method: 

Preheat your oven to 180 degrees

Fry the finely chopped garlic cloves in olive oil.

Then add the 150g mozzarella gradually to melt it a bit.

Take it off the heat and start making your dough.

Add a little salt, 3/4 of the parsley, yoghurt, one teaspoon garlic powder (optional for more garlicky tasting base) and  baking powder. Mix thoroughly.

Now add in your almonds, and beaten egg and form the dough.

Form a ball then roll this out on a sheet of greaseproof paper or baking parchment or silicone liner.

Form into a rectangle, oval or circle according to your plans.

Bake for only 5 minutes.

Now take out and add the rest of the cheese and parsley for the cheesy bread.

If this is your aim put it back in the oven for another 5 minutes. Then take it out and eat.

If you would like to make a pizza,  don’t add the extra cheese topping after 5 minutes. Keep the dough in the oven for the full ten minutes. Once it is fully cooked, add the toppings such as cheese, THEN passata or tomato puree, more  cheese and then whatever you fancy/have available such as  mushrooms, ham, prawns, or peppers and then put it back in the oven for 5 minutes. Passata directly on the base can make the pizza a bit soggy in the middle.

You are then ready for your pizza or cheesy bread.

 

 

 

Public Health Collaboration conference online a great success

The Public Health collaboration online conference 2020  was very successful.  The videos are available on You Tube for free making the conference even more accessible for everyone who needs advice on what to eat to stay healthy.

If you are able to contribute to the PHC fund to keep up our good work please do so. Sam Feltham has suggested £2.00.  This is via the PHC site.

This year there were contributions from mainly the UK but also the USA.

Visitors to this site will be very pleased to know that keeping your weight in the normal range, keeping your blood sugars tightly controlled, keeping your vitamin D levels up, and keeping fit from activity and exercise, are all important factors in having a good result if you are unfortunate enough to be affected by Covid-19. We have been promoting these factors in our book and website for several years now, mainly with the view to making life more enjoyable, especially for people with diabetes, now and in the future. The reduction in the severity  to the effects of   coronavirus is a side effect of these healthy living practices.

Several talks went into the factors and reasons for this, but in a nutshell, if you are in a pro-inflammatory state already, you will have a much more pronounced cytokine inflammatory response to the virus than is useful for clearing the virus, and you end up with inflammed lung tissue which leaks fluid thereby impairing your blood oxygen levels.

A talk that I found particularly apt was the talk from a GP who had had a heart attack at the age of 44 despite a lack of risk factors except for massive stress. He gives a list of self care practices that helped him. I would also include playing with your animals. Emma and I are cat lovers and can vouch for this!

My talk is about VR Fitness, which was the only talk this year which was specifically exercise related. The Oculus Quest has only been out a year and has been sold out since shortly after New Year. I was fortunate enough to buy one in anticipation of my imminent retirement, and it has been great as an exercise tool over the long, cold, dark winter and more useful than I had ever anticipated over the lockdown as a social tool.

There were several very professional cooking and baking demonstrations on the conference this year, and indeed, this could not have otherwise happened on a traditional stage format.  We had low carb “rice”, bread, pancakes and pizza demonstrations which may well help you if you prefer to see how it is done step by step or if you want to broaden your repertoire.

I was particularly taken with the pizza base idea from Emma Porter and I will follow up with this in a later post.  The whole video is available from the PHC  site which takes you to all the videos on You Tube.

 

 

 

Self caring during illness

Adapted from online presentation by Beverly Bostock ANP 7 May 2020

If you have diabetes you are more at risk of serious complications from Covid-19 and should seek medical advice early in the illness.

Any febrile illness can raise your blood sugars, including the prodromal phase when you don’t otherwise have symptoms. Once you are aware that you are coming down with something there are some useful ways of remembering how to monitor yourself.

Particularly for insulin users:

S – SUGAR – check your blood sugar more frequently than usual. For instance, if you would normally check your blood sugar every 5 hours during the day, double this to every 2.5 hours.

I – INSULIN – Adjust your insulin according to your blood sugars to keep within your target blood sugar level.

C – CARBOHYDRATE – If your blood sugar is low eat or drink more glucose or sugar/starch food items. If your blood sugar is high, drink plain water or more diet drinks.

K – KETONES – Use blood ketone stix or urine ketone stix to monitor your ketones if you are a type one diabetic every 4 hours or so. This is particularly important if you feel very ill, are nauseated, vomiting or have abdominal pain. If your ketones are high consider extra insulin, keep well hydrated and alert medical staff sooner rather than later.

Particularly for type twos:

It is important to keep well hydrated when you experience any illness but particularly an illness where you are febrile, or have  vomiting, limited oral intake, or severe diarrhea.

Some drugs can worsen your response to dehydrating illness and you may need to seek advice from a doctor, nurse or pharmacist about stopping certain drugs and when it is appropriate to restart them.

You can remember what they are with the mnemonic: SADMAN

SGLT2 inhibitors, ACE inhibitors, Diuretics, Metformin, ARBs, and Non- steroidal anti-inflammatory drugs.

 

 

 

Over eating and drinking is causing liver damage in one in five young adults

Adapted from Abeysekera KWM et al. Prevalence of steatosis and fibrosis in young adults in the UK: a population based study. Lancet Gastroenterology and Hepatology. 2020 Jan 15.

A new study highlights just how common liver disease is becoming in young adults in the UK. One in five had fatty liver, known as steatosis. One in 40 had fibrosis, also known as cirrhosis. And the average age was only 24.  These results show how harmful unhealthy eating and drinking habits can be.

Subjects for the study were recruited through the Avon Longitudinal Study of Parents and Children. Transient elastography and controlled attenuation parameter scores were used for assessment of steatosis and fibrosis.

Steatosis was found in 20.7% of the participants and this was severe in 10% of those affected. Being overweight or obese was the main factor for causing this after adjusting for alcohol intake, social class and smoking.

Fibrosis was reported in 2.7% of the participants. This risk was significantly higher in those who also had an alcohol problem or addiction and already had steatosis after adjusting for smoking and social class.

The authors conclude that the obesity epidemic is affecting the current and future health of young adults by increasing their risk of non alcoholic steatohepatitis related cirrhosis, hepatocellular carcinoma, and complications of metabolic syndrome.