Category: health

Adapted from Which February 2025

Which recently surveyed their readers about their personal use of the Zoe app. As a reader, I contributed too, but was dissuaded from buying the App as I have wheat intolerance and irritable bowel syndrome, both of which make their food recommendations impractical. I was impressed with their integrity about this, as they could easily have taken my money, and then given me advice that wouldn’t have helped me.

Zoe is a self testing and nutrition plan, headed by Professor Tim Spector. Zoe has signed up more than 120,000 people so far. 241 Which members contributed to their survey about it.

67% said that they wanted to find out about their gut microbiome. 44% wanted dietary advice. 37% wanted to improve their health. 30% wanted to lose weight.

The top five changes that they made to their diets after using the app were:

They ate fewer carbohydrates, ate more protein, ate more nuts and seeds, ate more vegetables, and ate less red meat.

The response was generally very positive with most people getting out of the app what they wanted.

78% had a better idea of what to eat, 48% said their guts worked better, 42% said they felt healthier, and 41% had lost weight.

29% said it was good value for money. 46% said it was reasonable value for money and only 20% said it was poor value for money.

Subscriptions to Zoe costs between £400 for four months and £600 for a year.

When you join up, you have to eat various biscuits that they supply, and then send off faecal samples and blood samples. After this you get feedback on the variability of the bugs in your gut, and how well or not you handle fat and sugar in your body.

For the next stage, you log in all your meals, snacks and drinks. You are advised as to whether they are “green”- go ahead, “amber”- just now and then, or “red” -you really should avoid. One user was advised to eat more avocado, green lentils and olive oil, and to avoid canned chicken soup, rice, white bread and ice cream. She was also advised to add wholegrains, vegetables, nuts and seeds. Reading this, I could understand why I had been advised not to purchase it.

The app contains tutorials, information, recipes, and support groups. To increase meal “scores” you generally need to eat more plant food, less refined carbs, sugar, processed meat and processed food. Such advice is common to many healthy diets, so whether it is truly individualised, is difficult to ascertain.

Although the Zoe app also measures blood sugars, for most people who are not diabetic, this becomes unnecessary, when sugars and starches are restricted, as these are the culprits when it comes to blood sugar spikes.

In general, users are advised to increase the range of plant foods that they eat, such as lentils, pulses, legumes, nuts, wholegrains and seeds. Reduce ultra processed foods. Include fermented foods such as kefir, kimchi, kombucha, cheese, yoghurt, coffee and some teas.

Finally they also advise lifestyle improvements such as being active, managing stress, get enough sleep, and look after your mental health.

Adapted from BMJ 11-18 Jan 2025

Dementia is perhaps the disease we all most dread. It kills you slowly and gradually. You stop being able to learn new things, you forget a lot of your past and relationships, and your personality changes along with your physical abilities.

Bruck CC et al, searched for longitudinal studies on survival and admission to nursing homes, in people who had been diagnosed with dementia. Studies had to include at least 150 people and follow them up for at least a year.

Median survival from diagnosis seemed strongly dependent on age, ranging from 8.9 years, mean age 60 in women to 2.2 years at a mean age 85 for men.

Overall, women survived for fewer years than men, but this was due to them being diagnosed at later ages than men. The mean difference between the sexes was 4.1 years.

Median survival was 1.2 – 1.4 years longer in Asia, than in the US or Europe. My comment: I wonder if this is due to the tendency for older people to be looked after in extended families there.

Survival time with Alzheimer’s disease was 1.4 years longer than with other types of dementia.

One the whole, survival tends to be longer now than it was pre-2000.

The median time to nursing home admission was 3.3 years. 13% of people were admitted in the first year after diagnosis, increasing to 57% after five years. About a third of the time of remaining life expectancy was spent in a nursing home.

These figures are averages, and are potentially helpful when it comes to health and social care planning for governments, health boards and councils. The individual prognosis, however, is highly dependent on personal and clinical characteristics, offering potential for individualised prognostic information and care planning.

My comment: In my work as a GP, I often was consulted by worried relatives about suspected dementia. I would assess the patient, and particularly if I knew the patient well, I could be pretty sure that there had been a definite cognitive deficit, and I would refer to the memory clinic. More often than not, the patient would come back with no diagnosis. 18 months to two years later, I would refer again, and this time the dementia diagnosis would be made. It seems to me that the tests used for diagnosis are not that accurate in getting a diagnosis in the early stages. Dementia symptoms can have a lot in common with other problems such as depression. At the same time, there are still no good treatments for it. There has been a little success with ketogenic diets and ketone supplementation. Meanwhile, what tends to be good for your blood vessels, tends to be good for your brain.

Adapted from BMJ 7 Dec 2024

If given the choice, you will not experience more immunisation side effects if you decide to get a covid-19 vaccine at the same time as a flu shot.

Three hundred people were randomised to receive either vaccine plus a placebo injection or to have both together. The placebo or real vaccine was then given two weeks later. (That was very sporting of the participants!)

Adverse reactions were reported by a quarter of participants but were not more likely when vaccines were administered together or separated by two weeks.

My comment: In my health board area, the vaccines are offered together, probably to improve uptake. I was able to have them both in the same, non- dominant arm. I was given the option of different arms.

Adapted from BMJ 7 Dec 2024

Advances in diagnostic technology have increased the variety and volume of direct to consumer commercial tests without clinical consultation. In the USA these have surged from $15m in 2010 to $1.15 billion in 2022. These include such tests as covid-19, genetics, HIV, prostate, thyroid, food sensitivity and cancer markers.

It can be argued that these tests provide choice, accessibility and privacy. They can however trigger unnecessary investigation for false positives or false reassurance. The Royal College of Obstetricians and Gynaecologists does not support over the counter tests to measure follicle stimulating hormone to detect the menopause due to poor accuracy. The anti-mullerian hormone test, advertised as being able to predict the chance of conception, is not supported by evidence.

HIV tests have been found to be not accurate enough to rule out infection. Thus a person could be falsely reassured.

In Australia, 40% of online tests are marketed as “health checks.” Testosterone levels can be a gateway to selling testosterone to “optimise” levels. The market for testosterone is $400m in the USA. The American Urological Association has warned that inappropriate use can cause infertility and the Food and Drug Administration is concerned about cardiovascular side effects.

Multicancer early detection tests aim to detect multiple cancers before they become symptomatic. They measure various substances including abnormal DNA. They have not been shown to reduce mortality or to extend life expectancy.

In the USA, the US Preventative Services Task Force recommends screening for breast, cervical, colon and lung cancer. Multi-cancer tests claim to detect over 50 types of cancer. NHS England has announced the purchase of a million of these tests.

In the USA over 6,000 people in seven US medical centres were followed up for one year after having a multi-cancer test. The sensitivity of the test increases as the stage of the cancer worsens, because small cancers tend to shed fewer, harder to detect, fragments of abnormal DNA than larger cancers. Therefore, these tests tend to detect cancers at advanced stages, which tends to limit the benefits of pre-symptomatic diagnosis.

In this group 19 solid tumours were detected, 10 of which already have their own screening tests, and all were late stage, either III or IV. In 57 of the 92 people who had a positive cancer signal, the results were a false positive. To find out what was going on, 88% of the positive group had invasive procedures lasting two to eight months. The economic and emotional costs are considerable.

For some patients, these tests are found helpful due to the difficulty in getting GP appointments. There are calls from various bodies to provide clear information to users as to usefulness and what to do when results are abnormal. Currently most jurisdictions do not have clear definitions, clinical guidelines or regulatory frameworks for direct to consumer tests.

My comment: My husband and I have both used direct to consumer testing and have found them helpful. The reasons we have used them is difficulty in getting GP appointments, as have many others. Popular testing can include blood sugar levels, thyroid levels, lipid testing, and haematinics. Have you found them helpful?

Adapted from BMJ 7 Dec 2024

Research published in Nature Human Behaviour, has found that labelling restaurant and takeaway food to show calorific content does not seem to change people’s eating behaviour.

Mandatory calorie labelling came in for certain types of restaurants in England in 2022. The idea was that people would look at the calories they intended to eat and choose more wisely and healthily.

Surveys on 6,578 customer before and after the change, indicated that there was no significant fall in self reported calories purchased or consumed.

My comment: An epic fail then! For myself, I tend to eat a double cheeseburger quarter pounder at Burger King, if I am stuck without an eating option. I put the bottom burger on the top of the cheese, mayo, lettuce and tomato, and eat it with my hands like a very messy, greasy, meat sandwich. I discard the bun as I don’t tolerate wheat. This comes in at around 1,000 kilocalories, but doesn’t stop me. It does fill me up for many hours. I have not changed my order since the rule came out. Has it changed your order pattern at restaurants?

Adapted from BMJ 19 Oct 2024

Paternal use of Metformin during the period of sperm development is not associated with congenital malformation in the offspring. Thus men who have type two diabetes mellitus, and who are prescribed the drug, can continue using it.

These results were found from a large study conducted in both Norway and Taiwan.

Metformin is used in metabolic syndrome and type two diabetes. In the UK 24 million prescriptions were issued for it. It is also used in diabetic pregnant women. Although it crosses the placenta, it does not cause fetal harm. These studies in both the mothers and fathers should give reassurance to both patients and clinicians, particularly as type two diabetes is occurring at earlier ages in the adult population than previously.

Adapted from BMJ 16 November 2024

The NHS Targeted Lung Cancer Programme, which has been running in England since 2019, has led to earlier diagnosis of lung cancer in 5037 people.

This programme uses mobile scanning trucks to visit areas of with high rates of lung cancer. Current and ex-smokers are encouraged to attend. In depth tests are done.

This has led to lung cancer being detected in 76% of people at stages 1 and 11, when the cancer is potentially curable by surgery and chemotherapy.

My comment: A colleague of my husband’s from Holland, was a very heavy smoker in his young day, and was so worried about it that he managed to persuade his GP to give him an annual Chest X Ray. He was diagnosed with cancer, and had surgery to remove one lung. He got back to work, and all seemed fine, but he then developed cancer in the remaining lung. He had vigorous chemotherapy but eventually succumbed. I do thing that this prolonged his life. He never made it to retirement age.

Emma and I wish you all a Happy and Prosperous New Year!

Adapted from BMJ 26 Oct 2024

Discover more at the 15min-City platform, which showcases how cities worldwide are embracing the 15-minute city concept, where services are accessible within 15 minutes by walking or biking.

https://whatif.sonycsl.it/15mincity/

Re-organising cities so that essential services are easily accessible on foot or by bicycle is an appealing idea. It could reduce carbon emissions, help people get fitter, and reduce inequalities and deprivation.

Apparently most European cities are already at or close to this ideal. However, most cities in North America and the Far East are not set up for this at all.

My nearest city is Glasgow. I lived there for thirteen years in all from the age of 10 to 23. My family didn’t have a car so we walked a lot and took the bus or train when the distances were more than around half an hour. I’m pleased to say that Glasgow does very well in the 15 minute concept. I do know, however, that certain areas eg the Castlemilk housing estate on the south of Glasgow, do not have a supermarket within walking distance. This affects the type, price and quality food that can be purchased, particularly fresh vegetables, meat and fruit.

Otherwise Glasgow does have many beautiful parks thanks to the foresight of the Victorian’s who built them. There are good shopping areas, libraries, museums, transport links, hospitals, doctors’ surgeries, dentists, schools, and sports and entertainment facilities.

The Ayrshire towns in which I have lived are also well set up for many activities but I’m sorry to see the loss of council run sports and library facilities that affect young people in particular.

There is a app called Libby. If you join a library, you can have a loan of e books and magazines totally free. You get them for three weeks before they disappear off your screen.