Wondering if fasting is worth the pain?

Carbohydrate restriction regulates the adaptive response to fasting
S. Klein and R. R. Wolfe 
Department of Internal Medicine, University of Texas Medical Branch, Galveston.
The importance of either carbohydrate or energy restriction in initiating the metabolic response to fasting was studied in five normal volunteers.

The subjects participated in two study protocols in a randomized crossover fashion. In one study the subjects fasted for 84 h (control study), and in the other a lipid emulsion was infused daily to meet resting energy requirements during the 84-h oral fast (lipid study).

Glycerol and palmitic acid rates of appearance in plasma were determined by infusing [2H5]glycerol and [1-13C]palmitic acid, respectively, after 12 and 84 h of oral fasting.

Changes in plasma glucose, free fatty acids, ketone bodies, insulin, and epinephrine concentrations during fasting were the same in both the control and lipid studies.

Glycerol and palmitic acid rates of appearance increased by 1.63 +/- 0.42 and 1.41 +/- 0.46 mumol.kg-1.min-1, respectively, during fasting in the control study and by 1.35 +/- 0.41 and 1.43 +/- 0.44 mumol.kg-1.min-1, respectively, in the lipid study.

These results demonstrate that restriction of dietary carbohydrate, not the general absence of energy intake itself, is responsible for initiating the metabolic response to short-term fasting.

CrossFit: exercise, diet and research

CrossFit is a website which you may enjoy visiting.

In one site you can find detailed exercise advice, often in the form of videos, for strength training, recipes, and research findings related to health and dietary composition.

There is information on the low carb diet, which is particularly helpful for those with diabetes, who wish to lose body fat, or who wish to reduce their cardiovascular risk.

Lectures by a wide variety of speakers are also included.

https://www.crossfit.com/essentials

Walking is a miracle cure

Adapted from BMJ  Sept 19 Promoting physical activity to patients by Christine Haseler et al.

The Academy of Medical Royal Colleges has described walking as a miracle cure. Despite this many of us are not as active as we should be and inactivity is thought to result in as many deaths as smoking. More than a quarter of UK adults do less than 30 minutes physical activity a week.

Quantified, these are the benefits of just plain walking:

30% lower all cause mortality, even 10 minutes a day is worthwhile.

20-30% lower risk of dementia.

Better relief from back pain than back exercises

30% lower risk of colon cancer

30% reduction in falls for older adults

22-83% reduction in osteoarthritis

even lower body fat than playing sports

20-35% lower risk of cardiovascular disease

20% lower risk of breast cancer

30-40% lower risk of metabolic syndrome or type two diabetes

 

 

The people who need to see their GP before undertaking exercise are few but include people with unstable angina, aortic stenosis or uncontrolled severe hypertension.

In pregnancy the sort of activities that need to stop are: impact activities, lying on the back for long periods, high altitude activities and underwater activities.

Metformin improves side effects of steroid treatment

From Pernicova I et al. Lancet Diabetes Endocrinol 25 Feb 2020

Long-term glucocorticoids, most often prednisolone, are prescribed for about 3% of European adults. The long term exposure can raise metabolic, infectious and cardiovascular risks.

This was a trial of 53 adults who had inflammatory disease treated with prednisolone but did not have diabetes, who were given either 12 weeks of metformin or a placebo.

The dose of prednisolone was 20mg or more for the first month and then 10mg or more for the next 12 weeks. The dose of metformin given was up to 850mg three times a day.

What improved:

Facial fatness was in seen in 52% of the placebo group but only 10% in the metformin group.

Increased blood sugar was seen in 33% of the placebo group and none of the metformin group.

There was improvement in insulin resistance, beta cell function, liver function, fibrinolysis, carotid intima media thickness, inflammatory parameters and disease activity severity markers in the metformin group.

There were fewer cases of pneumonia, moderate to severe infections and all causes of hospitalisation for adverse events in the metformin group.

What got worse:

Diarrhea was worse in the metformin group.

What didn’t get better:

Visceral to subcutaneous fat ratio was unchanged between the groups.

My comment: Looks like a clear winner for adding metformin to long term prednisolone treatments.

Statin study shows no memory loss

From BMJ 18 Jan 2020

An Australian study looked at how 1,000 community living Australians aged between 70 and 90 got on with memory and cognition tests over a six year period.

It found no differences between people who took statins and those who had never taken them. If anything, statin use reduced decline in memory especially in those with heart disease or who were carriers of apolipoprotein E4.

Magnetic resonance imaging of some of the group detected no effects of statins on total brain volume or on hippocampal or para-hippocampal volumes.

BMJ 2020; 368:m52

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.

 

Younger women more likely to get urine infections with Flozins

From Univadis Nakhleh A et al. Journal of Diabetes Complications 18th April 2020

It is well known that patients on Flozins are much more prone to urine infections and thrush due to the extra sugar in the urine which is excreted by taking these drugs, also known as SGLT2 inhibitors.

An Israeli study of over 6 thousand women with type two diabetes sought to clarify who was more or less likely to be affected by this very annoying problem.

They found that those most likely to get urine infections were:

Women who had existing gastro intestinal problems

Pre-menopausal women

Women who had been taking oral oestrogen in the form of the contraceptive pill or HRT

Women less likely to be affected:

were older (over 70)

had prior existing chronic kidney disease

My comment: From my GP experience I found that these drugs were highly effective and generally well tolerated. A few patients were indeed badly affected by recurrent urine infections and thrush and had to discontinue the drugs.

 

 

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.