Melatonin is a hormone that is secreted by the pineal gland in the skull. It is also available in many foods that include cherries, olives, walnuts and goji berries.
A Japanese study evaluated the amount of dietary melatonin reports that over a 16 year period, those who had higher dietary melatonin intakes had slightly lower mortality form cardiovascular and non-cardiovascular mortality.
American Journal of Epidemiology
My comment: We already know that cherries are beneficial for gout, that olives contain healthy fats, and that walnuts have useful Vitamin E. Here is another reason to eat them.
Exercise training for resistant hypertension
A small trial from Portugal reports that blood pressure can be reduced by a moderate intensity aerobic programme. The participants were supervised in 40 minute sessions three times a week. The systolic blood pressure dropped by 7 mm Hg and the diastolic by 5 mm Hg.
Journal of the American Association of Cardiology
Blood sugar control affects cardiovascular mortality across the whole spectrum
A follow up of 300,000 people in the UK Biobank Study shows, as we know, type two diabetes substantially increases the risk of atherosclerotic cardiovascular disease, chronic kidney disease and heart failure. The gradient of severity of these conditions exists on a gradient of risk from pre-diabetes to poorly controlled type two diabetes. This indicates that we should strive for normal blood sugars if we reasonably can.
An Israeli study which looked at 33,000 mother – child pairs found that the higher a woman’s blood sugar in pregnancy the fatter the baby was when they were in late adolescence.
Even after they adjusted for the birth weight of the baby, and sociodemographic factors, the correlation remained.
The very fattest teenagers had the mums with the highest blood sugars.
My comment: This appears to be the result of some sort of programming in the womb. The woman’s blood sugar in her pregnancy is also likely related to the health of her own mother. It is something that is rather difficult to control for.
Adapted from Top Tips for Primary Care. Dr Victoria Barber scrutinises the role of primary care in the identification of Ovarian Cancer, an often overlooked malignancy. August 21 2023.
Ovarian cancer is often considered difficult to diagnose, particularly in the early stages, so women need to be aware of when they should visit their General Practitioner and what symptoms may occur.
The symptoms of ovarian cancer can occur with many other conditions too, and this can lead them to being overlooked by both patient and doctor. Yet, there are a group of symptoms that need attention. Ovarian cancer occurs more often in women older than the age of 50, but does occur in young women too.
The symptoms to look out for are: pelvic or abdominal pain, persistent abdominal distention also referred to as bloating, feeling full after very small meals or loss of appetite, and urinary urgency or frequency that is unusual for that woman. Frequent is considered to be more than 12 times in a month or 2 to 3 times a week. Persistent means beyond the time that you would expect a simple cause of a symptom to resolve.
Other symptoms of cancer in general are unexplained changes in bowel habit, unexplained weight loss, and unexplained fatigue. Ovarian, other bowel or pancreatic cancers, leukaemia, lung, and urological cancers can cause these. Further history and examination will help clarify the likely source of the problem and useful investigative tests and referrals.
If these symptoms are reported to the GP, the GP is best to examine the patient and also to take a blood test called the CA125. Next steps will depend on that blood level. Levels over 35 will usually indicate referral for an urgent ultra sound scan of the pelvis. If the scan is abnormal, an urgent “cancer suspected” appointment to gynaecology should be obtained. This is usually within two weeks in the NHS.
If the symptoms are not thought to be of a potentially serious nature or if a CA125 is not done, it can be helpful to arrange a review appointment for when the GP would expect resolution of the symptoms experienced. This is so that persistent symptoms are not missed.
Breast and ovarian cancer tend to run in families and genetic testing may be indicated in some patients.
Sometimes the urinary symptoms sound like a urinary infection but the dipstix test or bacteriological test will be negative. This can be a situation that calls for a CA125 tests for clarification.
Irritable bowel syndrome should not be considered as a new diagnosis in people over the age of 50. It is more likely to be something more serious such as bowel cancer, ovarian cancer, coeliac disease or colitis.
In young women, under the age of 50, bloating of the abdomen related to irritable bowel syndrome tends to come and go throughout the day, be related to meals or stress, and usually improves with having a bowel movement. In ovarian cancer, the bloating tends to last all day, can be there on waking, and is usually unaffected by passing a bowel movement.
Although we are always being told that having a BMI of 22.5 to 25 is optimal for most of a population’s health, this may not be as accurate as it could be.
A retrospective analysis of data from half a million adults in the USA found that those with a BMI of 25 to 30 had a lower all cause mortality.
In older adults there was no excess mortality until the BMI was above 35.
My comment: The BMI reading is designed for population studies and without specifically knowing about an individual, particularly about their bone and muscle mass, simple statements about BMI need thought about what it may mean to you. In general, wasting diseases, dementia, cancers and degenerative diseases tend to cause a steady fall in weight the longer the condition goes on. Thus there could be higher than expected mortality rate in thinner people. Muscle mass is related to greater fitness and longevity and is also correlated to bone mass. These can raise a person’s BMI to the 25+ and 30+ levels and be an indication of an extremely fit, well muscled person. You would expect someone like this to have a lower total mortality rate. Of course these people are rather rarer than the usual tubby individual who has a high individual BMI. Nonetheless this study seems to indicate that carrying a bit more muscle and fat than indicated by a BMI of 25 may not be such a bad thing after all, particularly if you are “older”. They didn’t say exactly what this meant.I would imagine over 55.
Clinical science Diagnosis of osteoporosis in statin-treated patients is dose-dependent Michael Leutner et al. Department of Internal Medicine. University of Vienna. Ann Rheum Dis 2019;78:1706–1711.
Key messages
What is already known about this subject? ► There is a relationship between statins and osteoporosis.
What does this study add? ► Osteoporosis is underrepresented in low-dose statin treatment. ► There is an overrepresentation of osteoporosis in high-dose statin treatment.
How might this impact on clinical practice or future developments? ► In clinical practice, high-risk patients for osteoporosis under high-dose statin treatment should be monitored more frequently.
Abstract Objective: Whether HMG-CoA-reductase inhibition, the main mechanism of statins, plays a role in the pathogenesis of osteoporosis, is not entirely known so far. This study was set out to investigate the relationship of different kinds and dosages of statins with osteoporosis, hypothesising that the inhibition of the synthesis of cholesterol could influence sex-hormones and therefore the diagnosis of osteoporosis. Methods Medical claims data of all Austrians from 2006 to 2007 was used to identify all patients treated with statins to compute their daily defined dose averages of six different types of statins. We applied multiple logistic regression to analyse the dose-dependent risks of being diagnosed with osteoporosis for each statin individually.
Results: In the general study population, statin treatment was associated with an overrepresentation of diagnosed osteoporosis compared with controls (OR: 3.62, 95%CI 3.55 to 3.69, p<0.01). There was a highly non-trivial dependence of statin dosage with the ORs of osteoporosis. Osteoporosis was underrepresented in low-dose statin treatment (0–10mg per day), including lovastatin (OR: 0.39, CI 0.18 to 0.84, p<0.05), pravastatin (OR: 0.68, 95%CI 0.52 to 0.89, p<0.01), simvastatin (OR: 0.70, 95%CI 0.56 to 0.86, p<0.01) and rosuvastatin (OR: 0.69, 95%CI 0.55 to 0.87, p<0.01).
However, the exceeding of the 40mg threshold for simvastatin (OR: 1.64, 95%CI 1.31 to 2.07, p<0.01), and the exceeding of a 20mg threshold for atorvastatin (OR: 1.78, 95%CI 1.41 to 2.23, p<0.01) and for rosuvastatin (OR: 2.04, 95%CI 1.31 to 3.18, p<0.01) was related to an overrepresentation of osteoporosis.
Conclusion: Our results show that the diagnosis of osteoporosis in statin-treated patients is dosedependent.
Thus, osteoporosis is underrepresented in low-dose and overrepresented in high-dose statin treatment, demonstrating the importance of future studies’ taking dose-dependency into account when investigating the relationship between statins and osteoporosis.
Forever Strong: A new science based strategy for aging well by Dr Gabrielle Lyon.
I read this book when it came out in October 2023. It costs £16.99 from Amazon in paperback.
Dr Lyon has worked in psychiatry, geriatrics and nutrition. She thinks that over fatness is less of a problem to being under muscled when it comes to general health, ageing and efforts to live longer in better shape.
She advocates a high protein diet of no less than 100g of protein a day for all adults. This can be more depending on a person’s ideal lean body weight. It is also a lot higher for those who aim to build more muscle.
She offers three different eating regimes. The first is for longevity. For this she recommends higher protein meals for breakfast and dinner and a lighter protein snack at lunch time. Carbohydrates are generally restricted to the same number of grams as the protein spread over the day. These can be increased for those engaged in more than one hour’s vigorous exercise a day. Fat is eaten according to the remaining calories available to maintain weight.
For those wanting to lose weight, she recommends that protein is spread evenly over three meals a day. Carbohydrate should be no more than 30g per meal. Fat intake should be low as the aim is to cut back by 10-20% of maintenance calories daily. She thinks that it is crucial to prioritise dietary protein as this reduces muscle loss and improves satiety. Carbohydrates should be low sugar fruit and low starch vegetables in order to minimise calories and insulin response.
For those who want to gain weight, protein intake is higher and usually needs to be spread over 4 meals. Carbohydrate and fat can be increased as the aim is to exceed maintenance caloric intake. A well planned exercise regime needs to be undertaken and this will usually require a personal trainer at a gym.
The exercise regime offered is based at the beginner in the book but she offers different programmes from her website. I wasn’t able to find these when I looked but perhaps they are still undergoing development.
The book covers the science behind her nutritional advice, a discussion of the mental roadblocks that stop people taking control of their diet and exercise regimes, baseline measurements that will help you figure out what exactly you should be eating and some recipes.
I exercise daily and have been weight training since the age of 27. I also have been low carbing for 20 years. Did I learn anything? YES.
I’ve been making several big mistakes regarding my diet and exercise regime.
Firstly, although I eat about double the protein that I see my friends eating, this is still not likely to be high enough for optimal muscle gain.
Secondly, I really should be eating a lot more protein first thing in the morning so that dietary leucine levels come up to the threshold that prevents muscle breakdown and ensures the best use of protein in the body and for muscle development.
Thirdly, like a lot of low carbers my fat intake is very high, and I pile it on oblivious of the caloric intake.
Fourthly, I do indulge in the odd sugar /starch item and during weight loss efforts these would be better cut out entirely. Same for alcohol.
Fifthly, my weight training regime needs altered. I used to do alternate days resistance training and something else but various injuries and back pain led me to experiment with more stretching and back exercises and this led to a definite improvement in my chronic back pain. I have altered my regime again to add in more resistance work. Dr Lyon thinks that three times a week is best. I’ll see how this goes but at my age I need to consider the injuries and degenerative problems that accumulate.
Overall this is a very helpful book for those who seek the best of physical health and contains information that I was not previously aware of.
1 tablespoon olive oil 2 carrots, peeled and diced 2 celery stalks, diced 1 onion, diced 1 medium bell pepper, seeded and diced 1 pound Yukon gold potatoes, peeled and diced 1 garlic clove, minced 1 sprig of thyme 1/4 teaspoon celery seed 2 bay leaves 15 oz can chopped tomatoes 2 cups of seafood broth or clam juice 2 10-ounce cans of diced clams, drained with juice reserved Salt and black pepper to taste Chopped parsley Saltine crackers for serving
Directions
Heat the oil in a dutch Oven, Add vegetables and garlic, and cook, stirring frequently, until the vegetables are soft but not brown, approximately 10 to 15 minutes. Add drained clam broth, seafood broth, thyme and celery seed, and bay leaves.
Partly cover the pot, and simmer gently until potatoes are tender approximately 10 minutes.
When potatoes are tender, stir in tomatoes, and heat them through. Add chopped clams, stirring to combine. Add black pepper to taste. Let chowder come to a simmer, and remove from heat. Fish out the thyme and the bay leaf, and discard. Taste and adjust the seasoning.
The chowder should be allowed to sit for a while to develop flavor. Reheat it before serving, then garnish with chopped parsley. Serve with oyster crackers.
Photo by Miguel u00c1. Padriu00f1u00e1n on Pexels.com
Adapted from BMJ 7 Oct 2023
Engaging with a hobby is associated with better self reported health, happiness and life satisfaction and fewer depressive symptoms.
The proportion of people who report having hobbies varied considerably between countries.
Almost everyone in Denmark said they had a hobby and half of those in Spain had a hobby.
My comment: Having a hobby is dependent on having the free time to have a hobby. There also may be some expense involved. Often hobbies are a way of engaging with other people and sometimes they are solitary pursuits. They are a way of carving out time for yourself, doing something that you enjoy and can even nourish your body, mind and soul. One of the great joys of retirement that I have found is finally having lots of time to enjoy myself. I hope you are able to fit in a bit of what you enjoy into your weekly or monthly routine too.
Mortality in vegetarians and comparable nonvegetarians in theUnited Kingdom
Paul N Appleby et al. Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
ABSTRACT
Background: Vegetarians and others who do not eat meat have been observed to have lower incidence rates than meat eaters of some chronic diseases, but it is unclear whether this translates into lower mortality.
Objective: The purpose of this study was to describe mortality in vegetarians and comparable nonvegetarians in a large United Kingdom cohort.
Design: The study involved a pooled analysis of data from 2 prospective studies that included 60,310 persons living in the United Kingdom, comprising 18,431 regular meat eaters (who ate meat 5 times/wk on average), 13,039 low (less-frequent) meat eaters, 8516 fish eaters (who ate fish but not meat), and 20,324 vegetarians (including 2228 vegans who did not eat any animal foods).
Mortality by diet group for each of 18 common causes of death was estimated with the use of Cox proportional hazards models.
Results: There were 5294 deaths before age 90 in .1 million y of follow-up. There was no significant difference in overall (all-cause) mortality between the diet groups: HRs in low meat eaters, fish eaters, and vegetarians compared with regular meat eaters were 0.93 (95% CI: 0.86, 1.00), 0.96 (95% CI: 0.86, 1.06), and 1.02 (95% CI: 0.94, 1.10), respectively; P-heterogeneity of risks = 0.082.
There were significant differences in risk compared with regular meat eaters for deaths from circulatory disease [higher in fish eaters (HR: 1.22; 95% CI: 1.02, 1.46)]; malignant cancer [lower in fish eaters (HR: 0.82; 95% CI: 0.70, 0.97)], including pancreatic cancer [lower in low meat eaters and vegetarians (HR: 0.55; 95% CI: 0.36, 0.86 and HR: 0.48; 95% CI: 0.28, 0.82, respectively)] and cancers of the lymphatic/hematopoietic tissue [lower in vegetarians (HR: 0.50; 95% CI: 0.32, 0.79)]; respiratory disease [lower in low meat eaters (HR: 0.70; 95% CI: 0.53, 0.92)]; and all other causes [lower in low meat eaters (HR: 0.74; 95% CI: 0.56, 0.99)]. Further adjustment for body mass index left these associations largely unchanged.
Conclusions: United Kingdom–based vegetarians and comparable nonvegetarians have similar all-cause mortality. Differences found for specific causes of death merit further investigation. Am J Clin Nutr 2016;103:218–30.
ObjectiveIt is well known that total cholesterol becomes less of a risk factor or not at all for all-cause and cardiovascular (CV) mortality with increasing age, but as little is known as to whether low-density lipoprotein cholesterol (LDL-C), one component of total cholesterol, is associated with mortality in the elderly, we decided to investigate this issue.
Setting, participants and outcome measures We sought PubMed for cohort studies, where LDL-C had been investigated as a risk factor for all-cause and/or CV mortality in individuals ≥60 years from the general population.
Results We identified 19 cohort studies including 30 cohorts with a total of 68 094 elderly people, where all-cause mortality was recorded in 28 cohorts and CV mortality in 9 cohorts. Inverse association between all-cause mortality and LDL-C was seen in 16 cohorts (in 14 with statistical significance) representing 92% of the number of participants, where this association was recorded. In the rest, no association was found. In two cohorts, CV mortality was highest in the lowest LDL-C quartile and with statistical significance; in seven cohorts, no association was found.
ConclusionsHigh LDL-C is inversely associated with mortality in most people over 60 years.This finding is inconsistent with the cholesterol hypothesis (ie, that cholesterol, particularly LDL-C, is inherently atherogenic). Since elderly people with high LDL-C live as long or longer than those with low LDL-C, our analysis provides reason to question the validity of the cholesterol hypothesis. Moreover, our study provides the rationale for a re-evaluation of guidelines recommending pharmacological reduction of LDL-C in the elderly as a component of cardiovascular disease prevention strategies.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Diabetes Diet 