Category: health

Fit to serve: Chocolate sour cream cupcakes

kaitiscotlandLeave a comment

chocolate muffins

Low Carb Chocolate Sour Cream Cupcakes
Ingredients
4 ounces unsweetened chocolate
2 cups of sugar substitute (I use Swerve)
1 cup of finely milled almond flour
½ cup of coconut flour
2 teaspoons of baking powder
½ teaspoon of sea-salt
1 cup of strong coffee
½ cup sour cream
½ cup of melted butter cooled
2 eggs
Directions
1. Pre-heat oven to 350 degrees. Line two muffin tins with cupcake liners.
2. Melt the chocolate in a double broiler and allow to cool.
3. Combine the sugar substitute, almond and coconut flours, baking powder and sea-salt. Set bowl aside.
4. In a small bowl combine the hot coffee, sour cream and melted butter.
5. In a large stand-up mixer set to low add the coffee mixture to the dry ingredients. Mix till well combined.
6. Add the eggs and mix till fully incorporated.
7. Lastly, add the melted chocolate to the batter and combine till blended.
8. Pour batter into the cupcake tins and bake for 20-25 minutes until an inserted toothpick comes out clean.
9. Allow to cool before eating. May be frosted with your favorite low carb frosting or left bare.

Damon Ashworth: At your most lonely you can still reach out for help

kaitiscotland2 Comments

For Anyone Who Has Ever Struggled With Thoughts of Suicide and Death

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Suicide

In Australia in 2015, there were 3,027 deaths due to suicide for the year. This equates to 12.7 per 100,000, or 8.3 deaths by suicide each day.

76% of those who died by suicide were male, a ratio of more than 3:1. This ratio stays pretty steady for nearly all age groups, with males always dying from suicide at a higher rate than females.

According to the World Health Organisation, a person dies from suicide somewhere in the world every 40 seconds. Guyana has the highest suicide rate of any country in the world, with 44.2 per 100,000, but South Korea (28.9 per 100,000), Sri Lanka (28.8 per 100,000), Lithuania (28.2 per 100,000) and many other countries are also way too high. Based on the 2012 WHO findings, Australia was the 63rd highest country with 10.6 deaths by suicide per 100,000.

The most alarming thing about these findings is that our suicide rate is increasing, an extra 2.1 per 100,000 in only five years. The rate of suicide has also increased in the US by 24% from 1999 to 2014, after consistently declining the 14 years prior to that, according to data from the Centers for Disease Control and Prevention (Aboujaoude, 2016).

In the US it’s meant to be increasing due to the increasing use of antidepressants and their link to suicidality, to poor health insurance coverage, to the global financial crisis, increased divorce rates, greater opiate drug use, and the internet (Aboujaoude, 2016).

I’m not sure if all of these factors apply in Australia, but if over 11% of suicide-related search results are pro-suicide (Recupero, Harms & Noble 2008), then we need to counter-balance this with as much material as possible showing that suicide is neither the best option or the only option.

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Death

Homo sapiens, or humans, as far as I know, are the only species in the animal kingdom that are aware that one day they are going to die.

The first time I heard this it fascinated me, and made me wonder if life would be easier not being aware of the fact that one day we cease to exist.

Imagine it. Life is going well. Then suddenly it is no more. No worry about what the future holds. We are born. We experience life. Then suddenly we are no longer there. No fear. Just nothingness.

Being aware that we are going to die shapes and influences our lives much more than we would like to admit. A lot of our anxieties and phobias at their core are a fear of some type of loss or death.

Irvin Yalom says that whilst the actuality of death is the end of us, the idea of death can actually energise us.

If we don’t know when we will die, being in touch with the fact that one day everything will end is enough to overwhelm some people and make them panic.

For others, it is enough to make them follow the maxim of carpe diem and helps them to seize the day by appreciating everything that they have so that they can make the most of the precious time that they have left on this planet. Time that is really just a bright spark of lightness between two identical and infinite periods of darkness – one before we are born, and one after.

Death is the ultimate equaliser, for no matter how much we have achieved or done with our time on this planet, the truth is that we will all one day die.

It is also true that we will not know exactly when death will happen. It might be with a car accident tomorrow, from cancer in ten years time, motor neurone disease in twenty years time, a heart attack in thirty years time, a stroke in forty years time, or during our sleep in fifty years time. Who knows.

What I do know is that people struggle with the idea of death. Much like they struggle with the idea of life.

With so much uncertainty, how can we possibly plan for the future? How can we get the most out of life? and more importantly, is it even worth it?

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These are questions that I struggled with for a long time…

My Experience

I think I was about ten years old when I first expressed a desire to kill myself. I remember my mother saying that childhood should be the happiest time in my life, as it only gets harder after that, with more pressures and more responsibility. I’m pretty sure she meant that I should try to enjoy life whilst I’m young if I could, but all I heard was “LIFE SUCKS! IF YOU AREN’T COPING NOW, YOU NEVER WILL!” I became petrified of the future.

It didn’t get much better after that for me. I never felt like I fit in at school. I was 6″3 by the start of 9th grade, and felt like a freak; physically different from others and emotionally disconnected from my friends and family.

My happiest times growing up were when I became sick with croup and needed to be rushed to hospital on several occasions. During these times it suddenly it seemed like I was important. That people cared. They visited me. They asked me questions. They brought me gifts. And I could ask for whatever I wanted. Even a strawberry milkshake for breakfast. The best part was no pressure or expectations for once, and as many computer games as I wanted. It was pure bliss.

Once I became physically well again, it was back to performing however. To being what I thought everyone else wanted me to be. The result was that I became cut off from the real me, felt empty inside, and entirely miserable.

When I was younger, there was a death in my family from suicide on my mum’s side. It was devastating for everyone. It also contributed to a fear of mental health problems within our family. I don’t even know if it really started there, or if it just escalated after that. What I do know is that depression and suicide were scary things that we didn’t talk about, so I suffered alone.

I struggled with frequent suicidal ideation from the age of 10 until 25. Most of the time it was just when I was feeling stressed and overwhelmed, but it wouldn’t take much for me to think of death and ending it all as a way out of the emotional pain that I felt. Sometimes I would imagine crashing my car into oncoming traffic, but I really didn’t want to cause any harm or sorrow to anyone else. I thought of jumping off a bridge, or crashing my car into a tree, but worried about injuring myself without ending my life, and feared how much harder life would be if I also didn’t have my physical mobility on top of my mental health difficulties.

A much more common fantasy was developing a terminal illness that didn’t give me much time left to live. I would imagine people feeling sorry for me, telling me that they cared, and not putting any pressure on me so that I could finally live the life that I wanted to live rather than the life that I felt people wanted for me. Life generally seemed to suck. And death seemed like a great option…

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The Turning Point

But here is the thing. Life didn’t always suck. Being caught inside my head did. So did feeling alone and disconnected from others and the real me.

I now know that life is actually precious. And it isn’t as long as we’d sometimes like it to be.

The first thing that helped me realise this was when my host brother, who I lived with in California for a year when I was 16 and 17, was diagnosed with Ewing Sarcoma whilst I was doing my undergraduate studies at La Trobe University.

I had wished for a terminal illness for so long because I thought I was so bad and evil and such a worthless piece of crap, and here was a guy who was an absolute legend, suddenly sick with a life threatening illness. He didn’t want this, and neither did his family. It wasn’t fair, and it made me question a lot of things about life and our purpose in it.

In 2005, he was granted a wish by the Make-A-Wish foundation for he and I to go for an all expenses paid trip to Europe for two weeks. In Paris, walking along the Seine river, even though his body was riddled with cancer, he said to me “I just don’t get why people become depressed when there is so much beauty and good in the world!” I couldn’t believe what I heard. For the first time ever I felt and realised that it wasn’t what was happening in our life that shaped how we felt about it, but how we chose to view it.

When he passed away the following year, I was more devastated than I have ever been in my life. I still would do anything to be able to switch positions with him, as he truly was a great man, but what I do know is that his memory will never be forgotten.

Since then, especially after I sought psychological therapy during my Doctoral degree, my mission in life has been to reduce the level of distress felt by individuals who are struggling with mental health issues. I have tried the best I possibly could, but I am fully aware that I have also fallen way short at times of having the influence that I would love to be able to have to make a real difference in this world.

Just today I had the first client of mine that I am aware of who has recently tried to kill themselves. I am saddened by this, but also understand that we can never completely stop someone who is determined to do what they think is the best action for them to take.

All we can do is try to help them to stay safe, get them to see that all experiences generally pass, even the bad ones, and that if things have sometimes been not as bad as they are now in the past, then there is also a very good chance that things will once again not be as bad in the future.

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TO ALL.THOSE WHO ARE STRUGGLING:

Life sometimes sucks

So do other people

And so does the world

But you do not

I care about you

Even if I don’t know you

I want your life to get better

And I know that it can

If you are suffering

That is okay

Many people do

You are not alone

There are many things that can be done

Death is not the best option

Please seek help today

Life is worth living

It can get better

It did for me

I have not felt suicidal for the last six years

I have still experienced much pain

But I have also experienced much joy

And the ride has been worth it!

If you are struggling with the fear of death, please check out the book:
  • “Staring at the Sun: Overcoming the Terror of Death” by Irvin D. Yalom.
If you are struggling with lack of meaning and purpose in life, please check out the following books:
  • “Finding Flow: The Psychology of Engagement with Everyday Life” by Mihaly Csikzentmihalyi
  • “Finding Your Element: How to Discover Your Talents and Passions and Transform Your Life” by Ken Robinson and Lou Aronica
  • “Man’s Search for Meaning” by Viktor Frankl.
If you are being held back by fear and self-doubt, please check out the following books:
  • “The Confidence Gap” by Russ Harris and Steven Hayes
  • “Feel the Fear, And Do It Anyways” by Susan Jeffers
  • “Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead” by Brené Brown
If you are struggling with grief, please check out the following books:
  • “Why Bad Things Happen to Good People” by Harold S. Kushner
  • “On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss” by Elisabeth Kübler-Ross and David Kessler
If you want a more in depth analysis and understanding of the unsolved dilemmas of life, please check out the book:
  • “Existential Psychotherapy” by Irvin D. Yalom

 

DISCLAIMER: If the content of this post upsets you or you are struggling with suicidal ideation, planning or intent, please contact an appropriate help service where you live. If you are in Australia and cannot ensure your safety, please contact your local crisis and assessment treatment team (CATT) or call the following services:

  • Beyond Blue Helpline –   Call 1300 22 4636 24 hours / 7 days a week  
  • Suicide Help Line – 1300 651 251
  • Suicide Call Back Service – 1300 659 467
  • Lifeline – 13 11 14
  • SANE Australia – 1800 187 263
  • Relationships Australia – 1300 364 277
  • Mindset Clinic – 1800 614 434
  • Headspace – 1800 650 890 (ages 12-25)
  • Kids Helpline – 1800 551 800 (ages 5-25)

Start ’em young

kaitiscotland1 Comment

 

kid

 

A survey of UK school children has shown that children as young as nine and ten are already showing signs of markers for type two diabetes.

It is known that the more screen time a child has, whether this is computer games, video games or television, the fatter they get. There is a dose / response effect.

Insulin resistance also increases and also shows a dose / response effect. The surprise is how early the changes occur.

Achiv Dis Child doi:10.1136/archdischild-2016-312016

Jovina cooks from the Med: Versatile vegetable dips

kaitiscotland2 Comments

.

 

Marinated Olives

Ingredients

1½ cups mixed black and green olives, a combination of Sicilian green olives, Greek Kalamata olives and Spanish green olives
4 tablespoons extra virgin olive oil
1 tablespoon fresh squeezed lemon juice
1 sprig fresh rosemary,
1 teaspoon lemon zest
1/4 teaspoon fennel seeds
1 pinch crushed red pepper
1 clove garlic, sliced thin

Directions

Remove the needles from the rosemary sprig. Discard the stem and chop the needles.

Mix all ingredients together in a bowl until thoroughly combined. Cover and refrigerate for at least 12 hours, stirring occasionally.

Remove the olives from the refrigerator 1 hour before serving to allow them to come to room temperature. Store any leftover olives in the refrigerator, covered, for up to a week.

Red Pepper Hummus

Ingredients

2 cloves garlic, roughly chopped
¼ cup lemon juice
¼ cup water
15 oz canned chickpeas (garbanzo beans)—rinsed and drained
½ cup tahini
1 teaspoon sea salt
½ cup jarred or homemade roasted red peppers, chopped
¼ teaspoon red pepper flakes (chili)
Extra virgin olive oil

Directions

Place all ingredients in a food processor or blender and process until smooth, scraping the sides occasionally. Pour into a serving bowl and drizzle a little extra virgin olive oil.

Tzatziki

Ingredients

1 cucumber, peeled and cut in half lengthwise
2 cups Greek yogurt
2 cloves garlic, minced
1 tablespoon lemon juice
1½ tablespoons finely chopped fresh dill or mint
1 tablespoon extra virgin olive oil
1 teaspoon salt
¼ teaspoon freshly ground black pepper

Directions

Scrape the seeds out of the cucumber halves using the pointy end of a teaspoon and discard.

Grate the cucumber flesh into a bowl then squeeze out any excess moisture using your hands,(a small handful at a time.

Place the grated cucumber into a large bowl and add the yogurt, garlic, lemon juice, olive oil, dill, salt and pepper. Stir well to combine.

Place the tzatziki in the refrigerator for at least 2 hours (and preferably overnight) to let the flavors blend.

All-Purpose Dressing

Ingredients

2½ tablespoons extra virgin olive oil
1½ tablespoons red wine or balsamic vinegar
½ clove garlic, grated
¼ teaspoon each of sea salt and freshly ground black pepper

Directions

Shake together all the ingredients in a jar until well combined.

Tapenade

Tapenade can be used to season grilled fish or chicken. It is also delicious spread on toasted baguette slices and topped with chopped tomatoes or simply serve it with crackers or crusty bread and vegetable crudités for dipping.

Ingredients

1 clove garlic, roughly chopped
1 tablespoon lemon juice
2 tablespoons extra virgin olive oil
¾ cup pitted black olives
1 tablespoon capers
2 anchovy fillets
¼ teaspoon freshly ground black pepper

Directions

Place all ingredients in a food processor or blender and process until smooth. Serve at room temperature.

Peppers and Onions

Ingredients

6 bell peppers, a variety of colors
2 thinly sliced garlic cloves
1 thinly sliced medium onion
1 teaspoons sea salt
1/2 teaspoon coarsely ground fresh black pepper
2 tablespoons red wine vinegar
1/4 cup extra virgin olive oil, plus 1 tablespoon for cooking
1 tablespoon coarsely chopped flat-leaf parsley

Directions

To blister the peppers, place them on a hot grill or under the broiler. Turn on all sides until the skins are completely blackened.

Immediately transfer to a large resealable plastic bag or place in a large bowl and cover the top with plastic wrap to seal. Let sit for 30 minutes, or until cool enough to handle.

Working with one pepper at a time, transfer to a work surface. Remove the skin, stem, and seeds.

Cut the peppers into 2-inch strips.

Heat 1 tablespoon of olive oil in a large frying pan (over medium-high heat).

Add the sliced onions and sauté until the onions soften. Reduce heat to low heat and add the garlic and the sliced peppers. Add the salt and black pepper

Cover the pan and let the mixture stew together for about 5 minutes. Pour the mixture into a storage bowl.

Let sit at room temperature for at least 1 hour, or up to 4 hours to allow the flavors to develop.

Toss with the olive oil, vinegar and parsley just before serving.

Sautéed Greens

Ingredients

3 lbs fresh greens, stems removed and washed in several changes of water
3 garlic cloves, finely chopped
¼ cup extra virgin olive oil
¼ teaspoon red pepper flakes (chili)
Sea salt to taste
1 tablespoon fresh lemon juice.

Directions

Place the greens with the washing water still clinging to the leaves in a large pot.Cook on low until completely wilted and tender, depending on the type of greens used.

Drain and cut the leaves into smaller pieces.

Place the olive oil, garlic and chili in the empty pot and heat over low until the garlic is tender but not brown.

Add the drained greens and cook just until hot. Remove the pan from the heat and stir in salt to taste and the lemon juice.

Thinking clearly: What is mindfulness all about?

kaitiscotland2 Comments

Do you ever just wish you could get someone who knows virtually everything that’s known about the brain and quiz them about mindfulness? Well, I do – a lot – and I just got my wish!

It is my pleasure to present this interview with John McBurney MD. A practicing physician with of over 35 years’ experience, he is board certified in Neurology, Clinical Neurophysiology and Sleep Medicine. Dr. McBurney maintains a daily mindfulness meditation practice as well as home yoga practice.

Could you describe the neurological response to mindfulness practice?

Mindfulness practice ultimately comes down to the concept of neuroplasticity.

In mindfulness, in cultivating awareness of the breath and voluntary moment by moment awareness of the brain, we are training the brain – just like when you are learning to play the violin or any other complex skill – we are training to break out of those self-referential ruminative recursive mental states and to achieve an orientation toward the outer world and in the present moment rather than anticipating the future or reliving the past.

contemplative neuroscience mechanisms behind mindfulness

 Could we be losing something by focusing more on the external realities rather than the self?

Occasionally, we do hear of adverse experiences arising from mindfulness. With any robust intervention there are always potential risks.

How long does it take for mindfulness to have a noticeable effect?

The results can happen almost immediately, however, they are also cumulative. We are still figuring out what the minimum effective dose is. 

What is the relevance of the changes in functional connectivity in the brain in someone who has devoted  a monumental amount of time to meditation, such as Tibetan monks, who may put in more than 10,000 hours in to their practice, compared to the likes of you and me?

A very neat study was published by David Cresswell in Biological Psychiatry in 2016. They invited individuals with high level of stress, unemployed adults, to a weekend retreat experience. They were randomised to in 2 groups:

  • a 3 day mindfulness retreat (the treatment group) and
  • a 3 day relaxation retreat where they read stories, told jokes and had a good time (the control group).

The study was conducted in one centre over one weekend, so it is well controlled. Initially, both groups rated the interventions as being equally helpful to them, subjectively.

The researchers looked at the functional connectivity between the dorsolateral prefrontal cortex and the cingulate gyrus. They also looked at Interleukin-6, a known marker of inflammation, that has been previously shown to be elevated in stressed out unemployed people.

Even with this brief weekend mindfulness intervention, the treatment group developed increased connectivity between the dorsolateral prefrontal cortex and the cyngulate gyrus. There was a neuroplastic response even after a 3 day mindfulness retreat. This was also associated with a decrease in the marker IL-6. Even after 4 months, IL-6 was decreased in the treatment group, but in the control group, IL-6 levels continued to rise, independent of whether they managed to get a job or not.

This is also relevant to doctors, who are at high risk for burnout. Because of their work commitments, the mindfulness retreat for doctors was condensed from the standard 8 week model developed by John Kabat-Zinn to a weekend intervention. The question was: does the weekend model work? The research at the University of Wisconsin where this was developed was reassuring: the residents are less stressed out, more effective and have a greater level of satisfaction.

We still don’t know the absolute minimum dose, but it seems that a weekend of mindfulness can be life-changing for the brain.

Another paper published in PLOS ONE from the Benson-Henry Institute for Mind Body Medicine in Harvard looked at the practices such as meditation, prayer, mindful yoga, Tai-Chi, Qi Gong, etc, i.e. ones that elicit a relaxation response (as opposed the stress response).

This study showed that in both novice and experienced practitioners of relaxation response modalities, there were changes in the epigenetic transcription of the genome. There was upregulation of pathways associated with mitochondrial integrity, downregulation of inflammatory pathways, improved insulin-related metabolism and improved nitric oxide signalling.

Long term potentiation, the standard mechanism for memory formation, strengthens existing neural connections. This happens immediately, as you read this. Over time, long term potentiation leads to formation of new connections,through synaptogenesis, dendritic arborisation and neurogenesis i.e. brain structure changes. In turn, this affects the most neuroplastic neurons located in the hippocampus.

mindfulness minimum effective dose response neurology

In reference to this fascinating recent study of the fight or flight response, it seems plausible that breathing regulates our stress levels much more than conscious thought. Could you explain the significance of this in terms of mindfulness?

The ancients believed that emotions reside in the body. This comes up a lot in serious yoga classes.

This highly innovative study shows that the control of the adrenal medulla – the main effector of the stress response – is not from the conscious ruminating thinking centres, but by the motor and sensory cortex.

This explains why breathing, as well as yoga and Tai-Chi, are an important part of meditative practice. In my experience, these kind of interventions do affect the stress response in a beneficial way.

Mindful exercise exists in many form. For example, weightlifters need to be very mindful to maintain perfect form. Cycling is another example: it is vital to concentrate on every pedal stroke and maintain an even cadence. Once you start to day dream, you notice straight away that your output is way worse. This overlaps with the concept of flow. It is about getting in the zone. There is a very inspiring TED talk by Judson Brewer MD, Ph.D. that explains the physiology behind flow and how it is augmented by mindfulness. Mindfulness is work, and it does require discipline. There is a paradox here of non-striving and non-doing while also being disciplined.

You are a sleep medicine expert. Could you comment on the relationship between mindfulness and sleep?

Insomnia is a complex problem with many causes. However, for most people with idiopathic insomnia, the cause is these self-referential recursive ruminations. They aren’t able to “turn their brain off”. Through mindfulness practice, they are generally able to tame the default mode network that’s responsible for ruminating and daydreaming. A simple strategy would be to lie in bed and concentrate on the breath. This would ease the transition between wakefulness and sleep.

mindfulness default mode network neurological basis for the self

Mindfulness is a mainstay treatment for many mental health disorders. What about use of mindfulness in the treatment for organic pathology of the brain usually treated by neurologists?

There is some preliminary data that mindfulness training has a beneficial effect of seizure frequency in patients with epilepsy. It is a medical condition associated with tremendous anxiety and stress, so mindfulness could have a significant benefit in more than one way. It may even have a benefit it terms of remembering to take medication on time, etc.

Some robust studies show that the frequency of relapse in multiple sclerosis decreases with mindfulness intervention. The effect from mindfulness is similar in magnitude to the effect from beta-interferon. 

John Kabat-Zinn used to take the patients who suffered from chronic pain or had diseases for which we had no answer, and those patients got better. Even beyond neurology, there is some evidence that mindfulness can have benefits in psoriasis. We are probably only at the bottom of this mountain.

Dr McBurney has given me so much to think about. I will follow up with part 2 of our discussion that focuses more on the philosophical and life experience aspects of mindfulness once I wrap my head around it.

neurological path mindfulness default mode network adrenal medulla

Chicken ‘Cordon Bleu’ Rolls

EmmaLeave a comment

Deliciously simple idea for a low-carb chicken dish.

nourishedpeach's avatar


Ok, so this is basically a result of crap, what am I going to make for dinner? I had chicken tenderloins in the fridge and no plan in sight and, truth is, we all need a ‘recipe’ that really doesn’t call for a recipe at all. Something we can just throw together thoughtlessly with no fuss that we can remember off of the top of our heads. So here she be.

My kids love anything that involves ham and Swiss cheese and we had both in the fridge so I threw it all together and let’s just say I’ll certainly be making this one again.

No pounding out the chicken, no cutting slits to stuff it, nada. Just a chicken tenderloin wrapped arpund ham and Swiss in the middle. And baked until the cheese gets gooey and the chicken is cooked to juicy perfection. So stinking basic, but that salty…

View original post 177 more words

The link between hypoglycaemia, cardiac arrythmia, and dead in bed syndrome

kaitiscotland1 Comment

ecg

 

Arrhythmia incidents differ in nocturnal and diurnal hypoglycemic patients.

In young adults with type 1 diabetes (T1D), severe hypoglycemia may increase the risk of all-cause mortality and cardiovascular diseases.

According to Peter Novodvorsky, from the University of Sheffield in the United Kingdom, and his colleagues, there are differences in arrhythmic risk and cardiac repolarization during nocturnal versus daytime hypoglycemia. Hypoglycemia may exert proarrhythmogenic effects on the heart by sympathoadrenal stimulation and hypokalemia. The dysrhythmias induced by hypoglycemia have been associated with the “dead-in-bed syndrome,” a devastating condition that is rarely heard of. In this study, the effects of nocturnal and daytime clinical hypoglycemia are examined through electrocardiogram (ECG) in young people with T1D.

In an observational study, 37 participants were recruited from Sheffield Teaching Hospitals outpatient clinics with a median age of 34 years with T1D for at least four years. The purpose of this study was to examine the effect of clinical hypoglycemia in T1D patients age 50 or less and compare it with matched euglycemia on the frequency of cardiac arrhythmias, HRV, and cardiac repolarization.

Participants were told to avoid vigorous exercise, caffeine, and smoking 12 h prior to monitoring. Hypoglycemia awareness was assessed using a visual analog scale of 1 to 7. All subjects underwent 96 h of simultaneous  ECG and blinded continuous interstitial glucose monitoring (CGM) while continuing daily activities and symptomatic hypoglycemia were recorded.

The researchers obtained 2,395 hours of simultaneous ECG and CGM recordings with 159 and 1,355 hours designated hypoglycemia and euglycemia respectively. The median duration of hypoglycemia was longer during the night (60 min) than daytime (44 min) [P =0.020]. Overall, there were 24.1% of nocturnal and 51% of daytime symptomatic episodes respectively.

Bradycardia (low heart rate ) was more frequent during nocturnal hypoglycemia in comparison to matched euglycemia with an incidence rate ratio [IRR] 6.44 [95% CI, 6.26-6.66; P <0.001].

During daytime hypoglycemia, bradycardia was less frequent with an IRR 0.023 [95% CI, 0.002-0.26; P =0.002], while atrial ectopic was more frequent (IRR: 2.29; 95% CI, 1.19-4.39; P =.013). Moreover, during nocturnal and daytime hypoglycemia there was decreased T-wave symmetry, but prolonged QTc and T-peak to T-end interval duration.

The study confirmed that asymptomatic hypoglycemia commonly occurs in T1D. This causes abnormal heart rhythms and these are more abnormal at night, more frequent  and last longer.

 

Practice Pearls:

  • Hypoglycemia is pro-arrhythmogenic.
  • The study confirmed that there is high frequency of hypoglycemia, particularly of nocturnal asymptomatic episodes among young people with type 1 diabetes.
  • Hypoglycemia-induced mechanism is independent of the type of diabetes, age, or cardiovascular risk profile.

References:

  1. American Diabetes Association. 5. Glycemic targets. Diabetes Care. 2016;39 (Suppl. 1):S39–S46
  2. Nordin C. The case for hypoglycaemia as a proarrhythmic event: basic and clinical evidence. Diabetologia. 2010;53:1552–1561
  3. Novodvorsky P, bernjak A, Chow E, Iqbal A, Sellors L, Williams S, et al. Diurnal differences in risk of cardiac arrhythmias during spontaneous hypoglycemia in young people with type 1 diabetes. Diabetes Care. 2017, Feb 17.

From Diabetes in Control  18th March 2017

 

Fit to serve: Cinnamon coffee cake

kaitiscotland4 Comments

coffee cake

Low Carb Sour Cream Cinnamon Coffee Cake

by fittoservegroup

 

Low Carb Sour Cream Cinnamon Coffee Cake

Ingredients

2 cups of almond flour finely milled

1 ¼ cup of sugar substitute

2 tablespoons of baking powder

2 1/2 teaspoons of ground cinnamon

1 teaspoon of sea salt

¼ teaspoon of baking soda

¼ teaspoon nutmeg

½ cup (1 stick) melted butter cooled

1 cup of sour cream

2 eggs

Low Carb Crumb Topping

Ingredients

1 cup of almond flour (I used finely milled)

½ cup of coconut flour

½ cup of sugar substitute (I used Swerve)

½ cup of your favorite low carb nuts (I used pecans)

½ cup (1 stick) cold butter sliced thinly

2 teaspoons of ground cinnamon

¼ teaspoon of sea salt

Instructions

  1. Pre-heat oven to 350 degrees. Butter a 9-inch spring-form cake pan.
  2. Make the crumb topping: In a small bowl, combine the sugar substitute, almond flour, coconut flour, pecan nuts, salt and cinnamon. To the dry ingredients add I thinly sliced cold butter and cut in the butter until the mixture resembles coarse crumbs. Set aside.
  3. Cake batter: In a large mixing bowl, combine the almond flour, sugar substitute, spices, baking powder, baking soda, sea salt. In a small bowl, stir the cooled melted butter, sour cream, and eggs until they are well combined. Fold the butter & sour cream mixture into the batter dry ingredients. Mix until well incorporated. Spread the batter into the spring-form pan and sprinkle the crumb topping over the cake.
  4. Bake the cake for 45 minutes to 1 hour, or until the crumbs are lightly browned and until an inserted toothpick comes out clean.
  5. Cool the cake for 20 minutes before slicing and serving.

Serves 15  3.6 net carbs per slice

Enjoy in good health!

 

Lost to follow up diabetic patients do badly

kaitiscotland2 Comments

 

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People with diabetes who had annual diabetes checks in the previous seven years had half the mortality rate of those who did not attend. 

This study  in England and Wales for the National Diabetes Audit 2015-16 also revealed that type ones have a mortality rate 127.8% more than the general population and those with type two diabetes are 28.45 more likely to succumb earlier than they otherwise would.

My comment: These seem very disturbing figures especially for type ones. Of course type ones are still not being guided about having normal blood sugars. There could be a reverse causality here going on as well, with the least fit people, perhaps housebound or with amputations or with visual problems less able to attend clinics. In my area there is a good deal of effort put into tracking down children who don’t attend clinics, but once they move to the adolescent and adult clincs there does not seem to be the provision of liaison nurses to do outreach work. 

 

Adapted from news article BMJ 22 July 17

 

Avocado Stuffed Salmon

Emma1 Comment

A delicious idea for salmon and avocado!

nourishedpeach's avatar


Hey you! How can it be that we’ve been this out of touch?! Are you getting into the swing of your fall routine? This summer seemed to fly by in the blink of an eye. I hope you have been enjoying this crazy, hectic time!

All is so very well over here. We are feeling like we’ve got this “new start” thing down. Georgia is literally jumping with joy about kindergarten so far. She’s been an absolute champ with all of the newness and I couldn’t feel more proud of her. Jude’s doing his part time preschool thing and is loving his own special time with a wonderful teacher and friends…he’s such a little sponge and has an amazing, curious nature. And Rocco, well, chubby, happy and the most sweet spirited little human I’ve ever known. He brings so much joy to all of us.

Having been away from blogging…

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