Category: health

Jovina cooks Greek: Chicken with Tzaziki

kaitiscotland4 Comments

Chicken Tenders

4 servings

Ingredients

1/2 cup plain Greek yogurt

1 tablespoon extra virgin olive oil, plus extra for the grill pan 

1/2 tablespoon fresh lemon juice 

1/2 teaspoon dried oregano 

1/4 teaspoon coriander 

1/4 teaspoon paprika 

1 clove garlic, minced

Kosher salt and freshly ground black pepper

1 pound chicken tenders, about 8

Directions

Mix the yogurt, oil, lemon juice, oregano, coriander, paprika, garlic, 1/4 teaspoon salt, and 1/4 teaspoon pepper in a medium bowl until fully blended. Add the chicken and mix to coat. Cover and refrigerate for 2 to 4 hours.

Now make your cucumber sauce, Tzaziki and put it in the fridge as well.

When you are about one hour before your meal take out the chicken mini fillets and allow to reach room temperature, about 30 minutes, then fry in olive oil till cooked. They can be kept warm in the oven.

Cucumber Sauce

Ingredients

1 cup plain Greek yogurt

1 peeled and seeded cucumber, finely diced 

1 1/2 tablespoons freshly squeezed lemon juice 

1 tablespoon chopped fresh dill or 1 teaspoon dried

1 clove garlic, grated

¼ cup feta cheese

Kosher salt

Directions

Combine the yogurt, cucumber, lemon juice, dill, garlic, feta cheese, and 1/4 teaspoon salt in a medium bowl. Chill, covered, for at least 30 minutes to let the flavors blend.

Serve the Tzaziki with your cooked chicken.

Noise worsens blood sugars

kaitiscotland2 Comments
From Diabetes in Control

Noise Exposure Leads to Hyperglycemia

Aug 15, 2020 Editor: Steve Freed, R.PH., CDE
Author: Sameen Khan, Pharm.D. Candidate, USF College of Pharmacy 

Stress hormones triggered by noise exposure affect insulin secretion and sensitivity, leading to increased hyperglycemia risk. 

Studies have reported an association between exposure to high noise levels and the activation of stress hormones such as cortisol, which reduces pancreatic insulin secretion and decreases insulin sensitivity throughout the body, leading to increased risk of developing type 2 diabetes. This association is alarming for those with occupations that cause high levels of loud noise exposure regularly. Concerns have been validated by researchers; for example, in a 2011 cross-sectional study, which linked noise-induced hearing loss with impaired fasting glucose levels. Also, the 2014 U.S. national survey associated elevated body mass indexes (BMI) with patients that self-reported occupational noise exposure.

A 2012 retrospective cohort study investigated the incidence of hyperglycemia in machinery and equipment manufacturing workers exposed to increased noise levels over one year. Researchers recruited study participants from four job sites, excluding those with a history of diabetes or who were unable to follow up with researchers after one year, culminating in 905 total study participants. A health examination was performed at the commencement of the study, which required that participants undergo an overnight fast so that baseline fasting plasma glucose levels could be determined. Noise exposure levels were determined through a walkthrough survey that utilized a personal noise dosimeter to report sound levels in decibels from the working hours of 08:00 to 17:00, excluding 12:00 to 13:00. An eight-hour time-weighted average (TWA) was then calculated. Participants were then classified into “high” (≥ 85 decibels), “medium” (70-85 decibels), and “low” (<70 decibels) exposure groups. The study’s primary endpoints were diagnosis of prediabetes, initiation of hypoglycemic medication, or end of the one-year study period.

Demographics between the exposure groups varied considerably. Those in high occupational noise exposure jobs were mostly male and had lower educational levels than those in the low-exposure groups. Only 23.25% of those in the high exposure group had an education level of greater than 12 years, while 82.4% of those in the low exposure group did.  Smoking was more common as sound exposure increased. The high-exposure group had the highest incidence of smoking and reported 38.9% as smokers, the medium-exposure group had 28.6% smokers, and of the low-exposure group, only 15.9% were smokers. Statistical analysis utilizing the Cox proportional hazard regression model found that participants exposed to high levels of noise defined in the study as ≥ 85 decibels were at significantly higher risk of developing hyperglycemia than their low (<70 decibels) noise exposure counterparts. The high exposure group had a 1.80 risk ratio for developing hyperglycemia, reported with a 95% confidence interval (1.04-3.10) compared to the low exposure group.  

Awareness that high levels of noise exposure are a risk factor for hyperglycemia is an essential step in combatting it, particularly for those for whom it is unavoidable due to it being a byproduct of their occupation. Hearing-protective devices are critical in reducing the risk of developing hyperglycemia, which could lead to a chronic condition such as type 2 diabetes. This study‘s greatest strength was in the retrospective cohort design, which provided information based on a longitudinal follow-up of workers exposed to various noise levels. However, it did have limited knowledge of noise exposure that workers may have had outside of work, and was limited to one year. Additionally, researchers only measured the pre-prandial blood glucose levels. They did not measure postprandial levels, and these levels were only taken at the beginning and end of the study. The study would have benefited by having more measurements to correlate noise exposure to blood glucose levels strongly. For this reason, researchers recommend using animal models to study the impact of noise on hyperglycemia further. 

Practice Pearls: 

  • Noise levels greater than or equal to 85 decibels are highly correlated with an increased incidence of hyperglycemia. 
  • Those in jobs with high noise level exposure are likely to be males, smokers, and have a lower education status than those in jobs with reduced noise exposure. 
  • Hearing protective devices may be used to help protect against the development of diabetes. 

Chang, Ta-Yuan, et al. “Occupational Noise Exposure and Its Association with Incident Hyperglycemia Retrospective Cohort Study.“ Nature, 22 May 2020, doi:10.2139/ssrn.3284860. 

Sameen Khan, Pharm.D. Candidate, USF College of Pharmacy

Medscape: Next generation insulins

kaitiscotland1 Comment

Adapted from Medscape interview with Ulrik Pedersen-Bjergaard MD

Dr Pedersen-Bjergaard is based in Denmark.

Once weekly insulins are under development and are at the pre-clinical study level. These are expected to be a lot more convenient. Novonordisk’s is at the most advanced stage. They are basal insulins that cause no change in the HbA1Cs or body weight when used in type two diabetics. (Who still produce some insulin in their pancreatic beta cells). The new insulin called Icodec has been trialled against Glargine / Lantus and it is equally safe.

Blue tooth technology has been developed that will tell you how many units of insulin you injected and when you injected it, via an integrated pen unit. The unit will have automated titration recommendations via your blood sugar meter. This will give improved glucose readings and HbA1Cs.

Ultra rapid insulins are being developed. These reduce the one and two hour blood sugar spikes after meals but have not been optimised for pump use yet.

Insulin Degludec shows reduced hypos compared to Glargine/Lantus in type ones.

Jovina cooks: Sea bass, stuffed tomatoes and sweet potato cakes.

kaitiscotland2 Comments

To assemble the meal you will need to start with the sweet potato cakes.

olive oil cooking spray

one large egg

half teaspoon salt

1/4 teaspoon black pepper

1 teaspoon honey

some fresh or dried thyme

1/4 cup minced spring onions

1/4 cup or 1oz of almond flour

2 sweet potatoes

Microwave your sweet potatoes for approximately 7 minutes (depends on your oven and size of potatoes)

Pre-heat your oven to 400 degrees F.

Line a rimmed baking sheet with parchment paper or a silicone sheet and spray with oil.

In a medium bowl whisk the egg, salt, pepper, honey, spring onions and thyme.

Add the ground almonds and cooked and mashed sweet potato.

Mix well.

Form six patties and flatten on the baking sheet with your hand or a rolling pin or spatula.

spray with oil and bake for 15 minutes.

Then turn, spray with oil again and bake for another 10 minutes.

Now make your Sweetcorn Creamy Stuffed Tomatoes.

4 medium sized tomatoes

2 cups of sweetcorn either tinned or cut from 4 fresh ears.

4 tablespoons mayonnaise

3 tablespoons minced spring onions

salt and black pepper

1 cup grated cheddar cheese

1 tablespoon fresh parsley

pre-heat oven to 400 F

cut the top off the tomatoes, remove the seeds and pulp with a spoon.

turn upside down and dry on kitchen towel

Combine the corn with the remaining ingredients

Fill the tomatoes with the mixture and bake for 15-20 minutes till the cheese bubbles.

Now make the Sea Bass with Caper Sauce

one pound of sea bass cut into smaller portions

salt and pepper to taste

caper sauce

3 tablespoons lime juice

3 tablespoons avocado oil

2 teaspoons red wine vinegar

one spring onion minced

1 tablespoon of capers drained and chopped

1 de-seeded jalepeno pepper minced

one glove garlic

mix all of these sauce ingredients together.

fry the fish fillets for two minutes each side.

Then add the sauce ingredients and turn the heat down for 5 minutes

Serve immediately.

The fish is the most time critical of the components of this meal.

Enjoy.

Over 40s can benefit from red light therapy

kaitiscotland2 Comments

Adapted from Shinhmar H et al. J Gerontol A Biol Sci Med Sci 29 Jun 2020

It sounds like a hoax, but staring at a deep red light for three minutes a day has been found by researchers to significantly improve declining eyesight in people aged over 40.

This is the first study of its kind in humans and it was conducted in the UK.

At around the age of 40, human retinal cells start degenerate increasingly rapidly and this causes visual deterioration.

It had already been discovered that retinal photoreceptors in animals improved if they were exposed to 670 nm deep red light.

For the study 24 people aged between 28 and 72 with no retinal disease were recruited. The gender balance was equal. The function of their rods and cones on the retina were tested. Then they were given a special pen torch which emitted the deep red light and they were told to use this for three minutes a day for two weeks.

The light had no effect in the under 40s but after this colour sensitivity improved by up to 20 per cent, particularly in the blue parts of the spectrum, which is particularly affected by ageing. Rod sensitivity also improves. This helps people to see in low levels of light.

Lead author Professor Glen Jeffrey said,” Our study shows that it is possible to significantly improve vision that has declined in aged individuals using simple brief exposures to light wavelengths that recharge the energy system that has declined in the retina cells, rather like re-charging a battery.”

My comment: I am very shortsighted and as a result of my eye shape I have very poor night vision. If these little torches were made available I would definitely use one.

Whole almond consumption is associated with improved dietary quality

kaitiscotland2 Comments

Adapted from Dikariyanto V et al. Whole almond consumption is associated with better dietary quality and cardiovascular disease risk factors in the UK adult population. National Diet and Nutrition Survey 2008-2017. Eur J Nutr. 2020 May 16.

Almonds are known to be a highly nutritious food, but they must be imported and they are expensive. They require sunshine, water and pollination by bees. The UK imports them from California and Spain. Almond consumption is low in the UK.

As in all observational studies, association does not mean causation. People who eat a lot of almonds, like me, are probably more health conscious, may be avoiding wheat and other grains, may be on a low carb diet, and may be more affluent and may also be doing more exercise.

The researchers looked at 6802 people who completed at least three days of a four day food diary between 2008 and 2017.

7.1 % of the population reported eating almonds with an average consumption of five grams a day (a very small amount). This group reported eating higher intakes of protein, total and unsaturated fats, fibre and micronutrients including vitamin E, thiamine, riboflavin, folate, pantothenic acid, biotin, vitamin C, potassium, magnesium, phosphorus, iron, copper and zinc, manganese and selenium. They also had lower intakes of trans fats, total carbohydrate, sugar and sodium than non consumers.

Almond consumers had a slightly lower body mass index and waist circumference compared to non consumers. There was no blood pressure differences.

The actual differences were BMIs of 25.5 versus 26.3 and waist sizes of 88.0 cm versus 90.1.

The authors concluded that, “Encouraging snacking on nuts, including almonds, to replace snack foods high in saturated fatty acids, refined sugars and free sugars may contribute to the sum effect of a healthy dietary pattern on reduced risk of cardiovascular diseases”.

I eat a lot more than 5mg of almonds a day, usually in the form of low carb baking. We have lots of almond based recipes on this site. If you like eating the nuts, go ahead. They are often conveniently packed in small bags and are very handy if you are travelling. Bear in mind that they do tend to get stuck between your teeth so bring some dental tape with you too.

Low carb kitchen: Spiced yoghurt chicken

kaitiscotland5 Comments

INGREDIENTS

4 chicken legs, skin on
1 tbsp olive oil
5 tbsp natural yoghurt

For the marinade:

1 tbsp fresh ginger (peeled and minced)
5 garlic cloves, peeled and crushed
1 fresh chilli, deseeded and chopped (optional)
1 tsp garam masala
1 tsp hot chilli powder
½ tsp ground cumin
½ tsp turmeric
½ tsp paprika
½ tsp sea salt

CREATE IT

1. Preheat oven to 180°C and use the olive oil to grease a baking sheet. 
2. In a large bowl combine all the ingredients for the marinade and stir in the yoghurt.
3. Coat each chicken leg evenly with the yoghurt mixture ensuring to cover the top and underneath.
4. Place the chicken on a plate in the fridge and marinade for a minimum of 30 minutes.
5. Add the chicken to the prepared baking sheet and place in the centre of the preheated oven for 50 minutes.
6. Sprinkle with fresh coriander (optional) before serving. 
7. Great with roasted cauliflower or wilted spinach. 

Blood pressure difference between arms can be a risk factor for cognitive decline…as well as other things.

kaitiscotland4 Comments

From Systolic inter-arm blood pressure difference and cognitive decline in older people, a cohort study. Christopher E Clark. BJGP July 2020

 

A prospective study was done in 1,113 Italians whose average age was 66.4 years. Even a difference of only 5 degrees between the arms was associated with a greater level of cognitive decline.

My comment: In UK GP practices, only one arm is used to check the blood pressure. In my case, it was the arm that was nearest to the desk. Perhaps we should check both ? Inter-arm BP differences are both associated with cardiovascular disease, and this in turn affects dementia. Then of course, is the question, what can you do about it? For a further discussion of the subject here is Pharmacist Antonio Bess from Diabetes in Control.

Cognitive Decline: Just Life, or a Preventable Disease?
Feb 22, 2020

Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Antonio Bess, Pharm D Candidate, Florida Agricultural & Mechanical University School of Pharmacy

Cognitive decline is associated with many diseases and medications, but the exact mechanisms are not clearly understood.
Diabetes, obesity, and declining cognitive function are all associated with increased prevalence with increasing age.

Diabetes is a known risk factor for eye, kidney, neurological and cardiovascular diseases, but its effect on declining cognitive function has been in question. Previous studies have found associations between patients who have diabetes and poor glycemic control and significantly faster cognitive decline. Other studies have demonstrated a pattern in which diabetes, high blood pressure, and high body mass index in midlife predict dementia in late life.

In this prospective study, individuals were followed for up to ten years to find associations between indices in diabetes, insulin resistance, obesity, inflammation, and blood pressure with cognitive decline. The indices of interest were measured separately among those with and without central obesity.
The Monongahela‐Youghiogheny Healthy Aging Team is a population‐based cohort of participants recruited randomly from 2006 to 2008, who were 65 and older, and were from a group of small towns in southwestern Pennsylvania. The study is focused on the epidemiology of cognitive decline and dementia in an area that still has not recovered economically from the collapse of the steel industry in the 1970s.

Participants were analyzed at study entry, and annual follow up. To measure cognitive function, participants were given a panel of neuropsychological tests tapping the domains of attention/processing speed, executive function, memory, language, and visuospatial function. At study entry and annually, BP, BMI, waist‐hip ratio, and depressive symptoms  were measured.
Key variables at the time of blood draw, including age, sex, race (white vs. nonwhite), education (high school [HS] or less vs. more than HS), APOE*4 allele carrier status, mCES‐D score, BMI, WHR, systolic BP (SBP), and the following laboratory assay variables: CRP, glucose, HbA1c, insulin, HOMA‐IR, resistin, adiponectin, and GLP‐1 were all reviewed to identify predictors of cognitive decline.
Among 1982 participants who were recruited and underwent full assessment at baseline from 2006 to 2008, only 478 individuals were able to provide fasting blood samples. Of this group of individuals, the median age was 82 years; 66.7% were women; 96.7% were white, and 49.0% had more than HS education.

Compared to the 1504 original participants without fasting blood data, at baseline, these 478 were significantly younger (74.6 vs. 78.6 years; P < .001); more likely to be women (66.7% vs. 59.2%; P = .004); more likely to be of European descent (96.7% vs. 94.1%; P < .001); more likely to have at least HS education (49.0% vs. 38.6%; P < .001); but about equally likely to be APOE*4 carriers (19.3% vs. 21.5%; P = .350).
In unadjusted analysis in the sample as a whole, faster cognitive decline was associated with greater age, less education, APOE*4 carriage, higher depression symptoms (mCES‐D score), and higher adiponectin level. HbA1c was significantly associated with cognitive decline.

After stratifying by the median waist-hip ratio, HbA1c remained related to cognitive decline in those with higher waist-hip ratios. Faster cognitive decline was associated, in lower waist-hip ratio participants younger than 87 years, with adiponectin of 11 or greater; and in higher waist-hip ratio participants younger than 88 years, with HbA1c of 6.2% or greater. Higher adiponectin levels predicted a steeper cognitive decline in the lower waist-hip ratio group.
Abdominal obesity plays a crucial role in cognitive decline in those with diabetes. The microvascular disease may play a more significant role than macrovascular disease. Midlife obesity contributes to cognitive decline but there was no midlife data in this study. Future studies should include a large minority, midlife population. Adiponectin levels need to be carefully assessed as well.

Practice Pearls:
In individuals younger than 88 years old, central obesity can lead to faster cognitive declines.
Obesity, diabetes, and aging contribute to cognitive decline, so it’s hard to distinguish the most significant risk.
Adiponectin may be a novel independent risk factor for cognitive decline and should be reviewed.

Ganguli, Mary, et al. “Aging, Diabetes, Obesity, and Cognitive Decline: A Population‐Based Study.” Journal of the American Geriatrics Society, John Wiley & Sons, Ltd, Feb. 2020, p. jgs.16321, doi:10.1111/jgs.16321.
Ganguli, Mary, et al. Aging, Diabetes, Obesity, and Cognitive Decline: A Population-Based Study. 2020, pp. 1–8, doi:10.1111/jgs.16321.
Tuligenga, Richard H., et al. “Midlife Type 2 Diabetes and Poor Glycaemic Control as Risk Factors for Cognitive Decline in Early Old Age: A Post-Hoc Analysis of the Whitehall II Cohort Study.” The Lancet Diabetes and Endocrinology, vol. 2, no. 3, Elsevier Limited, Mar. 2014, pp. 228–35, doi:10.1016/S2213-8587(13)70192-X.
Cukierman, T., et al. “Cognitive Decline and Dementia in Diabetes – Systematic Overview of Prospective Observational Studies.” Diabetologia, vol. 48, no. 12, Springer, 8 Dec. 2005, pp. 2460–69, doi:10.1007/s00125-005-0023-4.

Antonio Bess, Florida Agricultural and Mechanical University College of Pharmacy

Low carb kitchen: cheese crackers

kaitiscotland7 Comments

Ingredients

100g almond flour

1 egg

40g unsalted butter

250g extra strong cheddar cheese grated

half a teaspoon of oregano

Method

pre-heat the oven to 180 degrees and line a baking sheet with parchment paper

In a large bowl mix the almond flour with the egg, butter and oregano

Add the cheese and combine to form a dough using your hands if you need to

split the dough into two rough balls and place between two pieces of parchment paper one at a time

flatten with the palm of your hand and then a rolling pin till they are about 4mm thick

Place these flat in the fridge or freezer to allow the dough to cool and harden a bit

When ready, say 30 mins, use a cutter or shaped container eg egg cup to form your biscuits and put them on the prepared baking sheets

bake in the oven for 10 -12 minutes till golden

allow to cool on the sheet before removing and eating.

Some symptoms are more predictive of long Covid than others

kaitiscotland2 Comments
Adapted from Sudre CR et al medRxiv 19 Dec 2020

This paper has not been finalised for peer review yet and could change. I decided to publish this because many of us are wondering why some people, especially younger people, seem more prone to long Covid than others. This paper does not yet tell us why, but gives some information on the pattern of symptoms that seems more linked to prolonged symptoms.

The findings were that if you have six or more symptoms during the first week of Covid-19 there tends to be a higher risk of long Covid. The 5 most predictive symptoms are: fatigue, headache, breathlessness, hoarseness and muscle pain. In adults over the age of 70, loss of smell was most predictive.

Of 4182 patients who were interviewed prospectively about their symptoms using a phone app from the UK, Sweden and the USA:

13.3% had symptoms for a month. 4.5% for two months. 2.6% for three months. 38% had “short-Covid”.

Factors that increased the possibility that recovery would be prolonged were: being a woman, having pre-existing asthma and having five or more symptoms.

In the over 70s, loss of sense of smell, fever and hoarseness were most predictive.