Emma and I wish you all a fuss free(ish), pleasant, Christmas Day.
This year, my husband was expected to be working off shore, so we are having our Christmas Dinner on Hogmanay. The four of us will all be here.
Like last year, I have bought a Marks and Spencer’s dinner, which only needs heated in the oven. It will be a seafood extravaganza with a chocolate dessert, as my younger son and I are seafood daft.
Unexpectedly my husband got back home off the boat, so there will be three of us, but we are going to stick to the original plan which is to delay the Gordon Ramsay Chili/Treacle Ham to Hogmanay. There is plenty of food and a Kobe beef steak pie if my husband doesn’t want the lobster and prawns.
Whatever you are doing, I hope you have an enjoyable time.
Particularly if you are on your own, I will raise a glass to toast you. If you are the cook and organiser, you do have my sympathy. Now that I’ve discovered the joys of a totally heaty up/ tin foil Christmas Dinner, there is no going back for me.
Dr Kendrick in an Aberdonian who works as a GP in England. He may be familiar to British readers as a so called “statin denier” as termed by a popular newspaper. Dr Kendrick and Zoe Harcombe PhD, sued the paper for libel, and after five years of litigation have finally won their case.
Dr Kendrick has been interested in the causes of ischaemic heart disease for about 20 years and published The Great Cholesterol Con about 15 years ago. This book delves into what does and does not cause coronary arterial plaque and heart attacks and recently he has also published another, The Plot Thickens.
His presentation at the Public Health Collaboration Conference in Glasgow explained what actually causes coronary plaque. He took us on a referenced revision of why previous theories, which have been accepted by many as fact, are not valid.
He spoke about the Minnesota Experiment. This has also been discussed in Gary Taubes’ books. Residents in Mental Health facilities in Minnesota were given different diets for several years and the outcomes were evaluated. In those days, indeed before neuroleptic drugs like Largactil and Haloperidol were invented, people with a diagnosis of schizophrenia could spend years of their lives in mental hospitals, so the population tended to be quite stable.
The intervention was the replacement of saturated fat with polyunsaturated fat. This was thought, by the influential Ancel Keys, to be the main cause of coronary artery disease, following the publication of his Seven Countries Study. (Although the data from 22 countries was available at the time). The patients’ cholesterol levels did indeed go down in the polyunsaturated diet group, but unfortunately the death rate went up.
Although this RCT should have led researchers to look elsewhere for the cause of coronary heart disease, the study results were simply not published, and the war on saturated fat continued, and still continues up to the present day.
The Q Risk 3 is the most up to date questionnaire that is administered by GPs or indeed yourself if you know your lipid blood results and blood pressure. It lists 20 risk factors for heart disease. These are really associations and are not necessarily causative. For example, your postcode is included.
The LDL result, when taken in isolation, shows no increase in risk. Other markers of dyslipidaemia such as low HDL and high triglyceride levels do.
The health of the Glycocalyx, which is like a shimmering brush border that lines all of our blood vessels, is key to the development of coronary plaque. If it is lush, it wafts our blood cells along, and stops them from sticking. It could be compared in some ways to Teflon. Certain things reduce the depth and function of the Glycocalyx such as: sugar, starch, alcohol, SLE, Hughes Syndrome, ageing, stress, smoking, diabetes, dyslipidaemia, and high blood pressure.
If the Glycocalyx is breached, the lining of the blood vessels can be injured, and to prevent bleeding, a vigorous platelet aggregation ensues. This is intended by nature to be helpful. The clotting cascade is controlled by just over 100 different cytokines and chemicals in the body. Endothelial progenator cells are released from the bone marrow, and these plug the holes in blood vessels. These form the basis of the plaque that covers the holes in the lining of blood vessels.
Plaque never forms in veins. It forms in arteries, especially where damage has occurred due to high turbulence, such as at forks in arteries. It is when plaques break off, and another burst of clotting ensues that heart attacks may occur.
Dr Scott Murray
Dr Murray is a Scottish Cardiologist who now works in England. His talk dealt with the practical things you can do to improve your cardiac risk and how he uses the Coronary Artery Calcification Score.
He says that a low carb or ketogenic diet is key to improving your lipoprotein type and size. Smaller and denser lipoproteins are more atherogenic than big fluffy ones. He showed pictures of healthy hearts compared to unhealthy ones that tend to have a lot of fat around them.
Taking at least 150 minutes of exercise a week including brisk walking and resistance exercise can reduce cardiac risk by 20-14%. Stopping cigarettes reduces your risk by 37%. A reduced carb diet can reduce your risk by 31-18%. Weight loss can reduce risk by 18%. Stress management can reduce risk by 41%.
Oestrogen use for women within ten years of the menopause also reduces cardiac risk. He advises you to keep thin if you possibly can.
If your CAC score is 0, your cardiac risk is 2.5%. If it is over 150, he advises a statin. These reduce plaque rupture.
This year’s Scottish PHC conference was as St Stephen’s Renfield Church Centre in Glasgow. The main theme of the conference was heart health. Many of the behaviours that improve heart health also improve health generally, and these will be familiar to readers of this blog. In this series of articles I will summarise some of the content of the day.
Dr David Unwin: Using continuous blood sugar monitors in Type Two Diabetes
David is a GP and he first started low -carbing ten years ago when he developed type two diabetes.
He got great results with low- carbing and persuaded his partners to join him in promoting the diet to type two diabetics in his practice. He has kept meticulous records of the transformations that have occurred in Southport, and also has tracked the savings he has made in medications that he would otherwise have had to use.
Lately, he been using the Dexcom continuous blood sugar monitor, which works very much like the Freestyle Libre. He has prescribed this in his practice for type two diabetics as well as type one diabetics, and has found that patients get faster and surer results when they can see immediate improvement when they stop eating sugar and starch and immediate high blood sugars when they do.
In the USA he has been advising United Healthcare Insurance on his findings and they are introducing the system for patients and will offer reduced premiums for users.
David was pleased to say that a recent innovation is a sensor that combines blood sugar testing and ketone testing in the same patch. This is going to be released by Abbott shortly. This is great news particularly for type one diabetics. I’m not sure if if will be useful or not for those on ketogenic diets, time will tell.
Jen Unwin PhD : Conquering Food Addiction with Low-Carb Eating
Jen is married to David. She is a Clinical Psychologist and is interested in people who struggle with low carb diets due to addiction to sugar and starch. Often processed food additives make the food irresistible to the person. Other food stuff addictions include nuts, dairy, breakfast cereals, and then of course there is alcohol.
She says that 10% of the general population are food addicted in some way.
20% of the population presenting to GPs are food addicted in some way.
55% of those with a binge eating disorder are addicted to food in some way.
She uses a modified Yale Addiction Scale for diagnosis.
There is a craving for the food and a compulsion to eat it. The person tends to increase the amount consumed over time to feel okay. “I can’t eat two biscuits, I have to have the whole packet”.
They neglect other activities in order to eat their food of choice. They feel a loss of control over their eating. They get withdrawal effects if they don’t eat it. Despite being aware that the food is causing them ill effects or harm, they continue to eat it in excess amounts.
Often depression and anxiety are the main symptoms.
In treating patients, Jen says that the person affected needs to clean up their diet, exercise to improve mental and physical health, and get back to healthy social habits. Gradually they can move to abstinence from the craved for food.
Those affected can’t have “cheat days”, like other people on diets perhaps can.
Jen has recently published a paper showing that control of Binge Eating Disorder is indeed possible with a low carb diet and reports that even a year after the intervention, the patients remained in remission from their compulsions.
She has released a book called Fork In The Road which explains how to gain mastery over food compulsion.
Dr Susan Pierce Thompson is a US psychologist who has also written, blogged and posted videos on this subject.She calls her programme Bright Line Eating.
My comments: Decades ago it was found that newly diagnosed type twos who were put on insulin clamps for two weeks, recovered beta cell function, and had better blood sugars over the next two years, than their compatriots who had usual treatment.
For as long as I can remember, type twos, on diagnosis, have been given a step up regime. In this dietary strategies are employed, then metformin, then other drugs and eventually insulin. This procedure can last years.
In China, L Liu et al, they embarked on a trial of immediate insulin via insulin pumps for two to three weeks, and then randomised the patients to one of three oral medication regimes or lifestyle advice, who acted as the control subjects.
The study was conducted across 15 centres in China. 412 patients took part. The mean BMI was 25.8 and the duration of diabetes at onset was a median of one month.
The insulin pumps were sent to deliver a fasting or pre-meal blood sugar of 6.1 mmol/l and two hour post meal blood sugars of less than 8 mmol/litre.
The mean HbA1c was around 11% on diagnosis and on the pumps fell to around 9.4% after two weeks. At the twelve week mark all groups has HbA1cs of around 6 to 6.5%.
After 48 weeks the proportions of patients who still had HbA1cs under 7% were calculated.
The most successful intervention was Linagliptan 5mg + Metformin 1000mg a day. 80% of these patients had HbA1cs under 7%.
Next was Metformin 1000mg only at 73% closely followed by Linagliptan 5mg only at 72%.
Lastly came “lifestyle” only at 60%.
Other outcomes measured were beta cell function and insulin sensitivity.
Authors have shown that the intensive insulin treatment and step down approach gives excellent long term glycaemic control in patients with severe hyperglycaemia in newly diagnosed type two patients.
In patients who are willing to undergo training on pump using on diagnosis, surely this would be a better way to manage diabetes than our “usual” treatment.
I have prescribed Amitriptyline for years for irritable bowel syndrome so I was pleased to see this article that showed a recent RCT gave good results, with the hope that General Practitioners will use it more often.
First line treatments for irritable bowel syndrome include removal of the offending foodstuffs from the diet and the prescription of medication for such symptoms as constipation, diarrhea, and abdominal spasms. Should these not work, low dose anti-depressants including SSRIs and Amitriptyline may be used. This study named ATLANTIS compared Amitriptyline with placebo in patients who had not responded to dietary and simple prescriptions for symptoms.
The study took place in England over 55 practices. Patients described their symptoms as moderate to severe. The average age was 49 and 68% were female. 232 patients were randomised to take the active drug and the other 231 took and identical placebo for six months. The dose was 10mg in the evening increasing to two or three a day depending on symptom control and side effects. Dietary advice from the GPs continued. 338 patients completed the whole six months trial, 75% of the active drug group and 71% of the placebo group. A questionnaire was given to assess symptoms towards the completion of the study.
The Amitriptyline group score for symptoms improved by 99 points compared to 69 points in the placebo group. 61% of the active group reported relief from their symptoms compared to 45% in the placebo group. 58% of the active group thought the treatment was acceptable, compared to 47% in the placebo group. The anxiety, depression, work and social adjustment scores were similar in each group. 20% of the active drug group dropped out of the study compared to 26% in the placebo group.
The active drug users had more of a dry mouth and drowsiness but less insomnia than the active group. There were two “serious” adverse effects in the active group, compared to three in the placebo group. At six months 74% of the active group were still on the medication compared to 68% of the placebo group.
The researchers have said that this is the largest ever trial of Amitriptyline in irritable bowel syndrome. The drug is cheap, reduces symptom severity, is safe and is well tolerated. They hope that this drug will be considered more often for this debilitating condition.
My comment: a low carb diet with removal of wheat from the diet can also improve irritable bowel syndrome and acid reflux.
Adapted from BMJ 15 June2024Global burden of type 1 diabetes in adults aged 65 years and older. 1990-2019.
The number of people from 21 regions and 204 countries was collated in this study. The number of older adults with type one diabetes increased from 1.3 million in 1990 to 3.7 million in 2019.
This was due to a decrease in deaths from type one diabetes in young people, who therefore had the fortune to be able to grow old. There is also an increasing amount of type one diabetes occurring in the population both young and old. The older population of people with type one diabetes are also living longer and in better health. This is mainly a tribute to better diagnosis and treatment.
The prevalence (the total number of people counted who have the condition) increased from 400 to 514 per 100,000 people.
Mortality decreased from 4.74 to 3.54 per 100,000 people.
Disability life adjusted years (DALYs) decreased from 113 to 103 per 100,000 people.
Mortality rates fell 13 times faster in countries with a high sociodemographic index compared to low to middle index countries. The measures included education level, per capita income and lowest fertility rates.
The countries with the most older people with type one diabetes were in high income countries such as North America, Australasia, and Western Europe.
The highest disability rates were found in southern sub-Saharan Africa, Oceania and the Caribbean. A high fasting glucose level remained the highest risk factor for disability among older adults.
Some types of endometriosis can increase the risk of ovarian cancer by almost ten fold.
Endometriosis affects 11% of the female population and causes half of all cases of pelvic pain and female infertility.
A large cohort study from Utah found that women who were diagnosed with endometriosis were 4.2 times more likely to get ovarian cancer over their lifetime than those who had never been diagnosed.
Deep infiltrating endometriosis was associated with a 9.66 fold increased risk compared to superficial peritoneal endometriosis which gave a 2.82 increased risk.
In a separate Dutch study in 2021, Adenomyosis (related to Endometriosis) was also shown to increase cancer risk, the relative risk being 1.5.
My comment: The background risk of a woman developing ovarian cancer is 2%. Many women diagnosed with endometriosis will need surgery to remove it, to divide adhesions and in severe cases may opt for a hysterectomy. If they are having extensive surgery anyway removal of the ovaries seems a very good idea. Screening women for ovarian cancer has been tried and unfortunately has not been found to be successful. I wonder if studies in the subgroup of women with endometriosis is something that will happen in future.Adenomyosis is when the endometrial deposits are located in the uterine muscle and are found at hysterectomy.
A national Swedish cohort study of more than two million women has found that women who have experienced difficult pregnancies can be at higher risk of early death up to 46 years later.
Preterm delivery, small for gestational age, pre-eclampsia, hypertension and gestational diabetes, all were associated with increased mortality risks. The main causes of death were cardiovascular diseases, respiratory disorders and diabetes.
These factors were independent risks for premature mortality. Siblings of the women who had normal pregnancies were not at increased risk of earlier death.
Researchers suggest that women who have experienced these problems consider enhanced health checks, put effort into prevention and get treatment for chronic disease if diagnosed.
The EchoSOS phone app is an alert app that you load onto your phone PRIOR to a holiday abroad or before undertaking any sort of adventure activity particularly away from a city.
I found out about this from several readers of the Times who had responded in the comments section about the disappearance of a man in his sixties in a mountainous area of southern France. This follows on from the loss of several other tourists in Mediterranean countries over the summer.
One said that it had saved her life more than once.
It is a free app. You put in your personal details, contact numbers of relatives or friends, your blood group, medical history, allergies and medication. You then allow the app tracking and response permissions.
Should you have a medical or other emergency in your home, city, or outside location, you can press the emergency button. Obviously, you still have to have some sort of signal for this to work.
The app takes note of your details, your location and transfers this to the nearest emergency response number to your current location. This means that you should be able to speak to a relevant dispatcher without the palaver of finding emergency numbers.
Several tourists have died because they have not been able to contact emergency services or have not been able to give their locations if they did. For readers of this blog, many of whom have diabetes, the ability to contact emergency services fast and being able to be located precisely is of even more relevance.
Please pass this information on to anyone that you think will benefit.
Compared to people who sleep 7 to 8 hours each night, people who slept for five hours or less were more likely to develop type two diabetes. The risk increased in those getting 3-4 hours a night. This risk was present even when people eating a “healthy” diet were compared. This study was done in the UK Biobank participants.
It is already known that night shift workers have an increased rate of metabolic syndrome and cancer. They also have lower life expectancy rates.
If you are sleep deprived, you will also be aware that you tend to eat more, particularly carbohydrate containing foods.
For many people they don’t have a choice over whether they even get the chance to sleep. They may have long commutes, work shifts, work night shifts and have high noise levels when they are trying to sleep either by night or day. A new baby is a particular difficulty especially in the first year of life.
Socioeconomic deprivation is associated with poorer outcomes for many medical conditions. The scale of the problem for those with type one diabetes is stark. A UK study has shown that type ones are diagnosed with sight threatening diabetic retinopathy three times as commonly as those in the least deprived areas.
This could be due to many reasons. Food intake, attendance at clinics, care over injections, education, stress, leisure activities and support. It does point to the fact that changing what you do can make a substantial difference to health outcomes.80% of the money spent on diabetes is for treating the complications of diabetes rather than on prevention.
Diabetes Diet 