Localised shock wave treatment has been used to treat patients with tendinitis, non-healing bone fractures, chronic leg ulcers, soft tissue wounds, post-stroke spasticity and spinal cord injury.
Now, Austrian researchers have found a small, but definite effect, in heart muscle regeneration in patients who have coronary artery bypass surgery.
An electric current is applied to electrodes in water, not the patient, so they get a sonic shock rather than an electrical shock. The sonic wave cannot be heard by humans. They say that this, “activates the innate immune system of treated cells, leading to increased DNA accessibility and cellular plasticity, together with the secretion of angiogenic cytokines and growth factors. This induces angiogenesis in the hibernating myocardium. Newly formed vessels then support the recruitment of chronically under-supplied myocardium.”
In a trial of 63 patients undergoing CABG surgery, some had the sonic treatment and others had sham treatment. After a year, left ventricular ejection fraction in the shockwave group increased by 11.3% compared to 6.3% in the control group. The treated group could walk further in six minutes compared to the untreated group and also reported a better quality of life.
Lead researcher Johannes Holfield said, ” for the first time, we are seeing the heart muscle regenerate in a clinical setting, which could help millions of people.” Larger trials are now planned for chronic ischaemia patients.
In the cathedrals of our minds resides the quality of our lives.
In this inner sanctum, we experience every moment and memory of our lives.
Whatever the duration of our lives or the degree of physical or cognitive quality we possess, it is how we experience our lives that matter most.
Fundamentally, the quality of our minds dictates the quality of our lives.
What Is Health?
In my view, health is the optimisation of three factors:
Lifespan – How long you live.
Health Span – The quality of your movement and cognition.
Soul Span – The quality of the experience of your life.
We are all too familiar with examples of those who have excelled in the domains of lifespan and health span but have seriously struggled in the domain of soul span.
When I speak of Soul Span, I am not referring to organic mental illness.
This is an entirely different matter that requires the input of trained medical personnel and often the use of mood-altering medications.
I am referring to our felt experience of the world.
Whether we feel engaged in a life that is meaningful?
Whether we experience periods of joy or happiness?
Because as Cicero once said:
“Diseases of the soul are more dangerous and more numerous than those of the body.”
The Formula
There are very clear formulas to optimise the domains of lifespan and health span.
I have covered these in detail over the last 100-plus articles here.
What these factors consist of have been discovered through the application of hard science.
Science can tell us a lot about the factors that determine our life experiences, but many of the answers reside in the domain of philosophy, art, and literature.
I do not profess to have the answer to this issue.
Minds far greater have struggled with the question for thousands of years, and no consensus has yet been reached.
Anything I say here is based on my own experience and reading.
The journey here is one you must traverse.
You and you alone.
As Rumi once said, “It’s your road, and yours alone, others may walk it with you, but no one can walk it for you.“
The question is whether there is a formula for optimising soul span similar to lifespan and health span.
Maybe there isn’t an exact formula, but the following are three key ideas I believe make a major difference to the factor of soul span and the quality of your life.
You Are Not Your Thoughts.
Each and every one of us has an internal dialogue in our heads.
All day.
Every day.
It’s probably chattering away right now.
“What is this guy talking about? I wonder, should I have a coffee now or later? Damn, I feel tired. I must not have slept well last night.”
If you spoke that internal dialogue out loud all the time, people would start avoiding you pretty quickly.
And yet, that dialogue is constantly pecking away inside your head.
And in the heads of everyone you meet.
But as Joseph Nguyen says, “Don’t believe everything you think”.
It does not take long for us to become identified with the chatter in our minds.
Without realising it, we become our thoughts.
They define who we are.
But those thoughts rarely glitter in praise of who we are and are more commonly an endless stream of low-grade negativity.
And we wonder why we are not happy.
We have no idea where our thoughts come from.
None.
We do not control our thoughts.
But…
We can control how we react to them.
We can learn to observe them.
Non-judgmentally and view them at a distance.
We can detach ourselves from our endless stream of thoughts and watch them.
Like we would a squirrel in our garden.
And when we learn how to do that we free ourselves from the negative chatter.
This is the purpose of meditation.
It is not to rid yourself of thoughts.
It is to stand at arm’s length from them.
And observe them.
For the strange and mysterious things that they are.
But in doing so, we free ourselves from being emotionally whipsawed around by them and can add some peace to our lives.
You are not your thoughts.
If you want to free yourself of them, learning to meditate is a must.
The Meaning Of Life.
Like so many others before me, I have spent years reading and learning in an attempt to discover the answer to the question:
What is the meaning of life?
The answer is…
There is no answer.
And that searching for one may not be helpful.
And might even be harmful.
As Albert Camus once said, “You will never be happy if you continue to search for what happiness consists of. You will never live if you are looking for the meaning of life.”
But do not confuse this with the idea that you cannot live a meaningful life.
Just because there may not be a precise answer to this question or we may never know what the ‘meaning of life is’ does not mean we cannot live a life that is imbued with meaning and purpose.
These are similar but, importantly, different concepts.
One is a definitive end-point answer.
The other is a process of discovery and experience.
We can live incredibly meaningful lives without knowing the specific answer to the question, “What is the meaning of life?”
Understanding this has been incredibly liberating for me.
We live in a time when the grander narratives of myth and religion have lost their foothold. This freedom has left many adrift without an answer to foundational questions we have as humans.
I do, however, believe we must all feel connected to something greater than ourselves.
As Carl Jung says, “The decisive question for man is: Is he related to something infinite or not? That is the telling question of his life.“
There is no doubt that this world is full of mysteries.
Why are we here?
Where did we come from?
Did we exist before birth?
What happens after we die?
Are we alone in the universe?
And so many other dizzying questions.
Simply staring up at the stars at night provides us with an immense sense of awe and beauty.
It connects us to the numinous, a sense that is ‘inexpressible, mysterious, terrifying”.
I know that life can be meaningful.
For me, that is enough.
Do Not Lie.
The opening scene of the HBO series Chernobyl starts with a question.
“What is the cost of lies? It’s not that we’ll mistake them for the truth.
The real danger is that if we hear enough lies, then we no longer recognise the truth at all. What can we do then?
What else is left but to abandon even the hope of truth and content ourselves instead with stories?
In these stories, it doesn’t matter who the heroes are. All we want to know is: “Who is to blame?”“
When I say, ‘Do not lie,’ most of all, I mean that we must not lie to ourselves.
We are the easiest to fool with our own lies.
And when we do, we often also look for someone to blame.
We are also the ones who will pay the greatest price for those lies.
What I have learned is the greatest lie is to not live the life you know that you truly should.
When asked on their deathbeds, this is people’s number one regret.
Above working too hard is the regret of not having the courage to live the life they knew they should have.
But didn’t.
Their greatest regret was lying.
Lying to themselves.
That they were someone different to who they knew they really were and convincing themselves to live a life aligned with the values of someone who they were not.
In the deepest recesses of our minds, we know who we really are.
But as Nietzsche says, “They fear their higher self because when it speaks, it speaks demandingly.”
We fear what our deepest selves tell us.
We fear the pain that pursuing that path would lead to.
But we forget the greater pain that will result if we do not.
We lie. To ourselves.
As Abraham Maslow says, “What one can be, one must be”.
To not become who you are is to lie.
And as the HBO Chernobyl series finishes, the protagonist who asked about the cost of lies refrains:
“Every lie we tell incurs a debt to the truth. Sooner or later, that debt is paid.”
You know what to do.
You know when you are lying.
We all do.
The question is whether you realise the cost of those lies.
Because sooner or later that debt will be paid.
A life well lived.
The journey of optimising soul span is fundamentally about a life well lived.
We can take guidance and counsel from greater minds that have reflected on this topic but in the end we must walk our own paths.
Maybe we can never know precisely what our destination may be, but I am confident that each and every one of us knows when we are on the right path.
When we are moving towards the manifestation of our highest selves we feel a sense of meaning.
A meaning that makes this life worthwhile.
But when we track away from what represents our highest selves, we suffer.
The goal, then, must be to identify your highest goals and then have the courage to move towards them.
Doing so will undoubtedly bring pain and suffering.
But not doing so will likely bring even more.
At least the pain and suffering we endure on the path to our highest selves will be worthwhile.
This life is short.
Lifespan and health span matter.
But for me, soul span matters most of all.
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As with all the material on this site it is not medical advice and is for general informational purposes only. None of the information provided constitutes the practice of medicine, or any professional healthcare services. No doctor patient relationship has been formed. Information contained on this platform is used at the readers own risk. Readers of this information should not delay or disregard in obtaining professional medical advice or treatment for any health related issue. The information presented is in no way a substitute for medical advice.
Adapted from BMJ 23 April 2023 and Medscape 20% of patients with Diabetes in Drug Free Remission with Low Carb Program by Becky McCall Nov 21 2022.
Diabetes UK say that the number of people with diabetes in the UK has reached 5 million for the first time. They say there is ” a rapidly escalating diabetes crisis”. They want the government to limit junk food advertising to children. 90% of those diagnosed have type two diabetes. The major risk factor for this is overweight and obesity. 64% of the adult population have this risk factor.
148,000 people under the age of 40 have been diagnosed with type two diabetes. The rate has increased by 23% over the last five years. Diabetes UK think that more people need to be referred to the NHS Diabetes Prevention Problem to reduce the year on year increase in the disease.
My comment: It is a pity that Diabetes UK did not heed the advice to ignore the detrimental Food Standards Agency so called “Eat Well Plate” recommendations decades ago. We are suffering the effects of pushing high starch, high fruit/juice diets that contain refined vegetable and seed oils and not enough protein and full fat dairy on the general population. With the increase in food prices, energy and housing in the last few years, that wages have not kept pace with, we are seeing more people sink into poverty. This means that they work longer hours to compensate, with less time to make healthy, non processed meals, and to undertake physical activity, and get sufficient restful sleep. I can’t see the situation being reversed for the foreseeable future.
At the Diabetes Professional Care Conference in 2022, Dr David Unwin presented the results of the low carbohydrate approach. 20% of his diabetic patients have gone into remission and no longer need any glucose lowering medication. His practice is in Southport. He has found that 50% of his patients will go into remission if they adopt a low carb diet. He has saved £68,000 on these drugs a year.
Weight dropped 10.3%, HA1c dropped by 33%, and blood pressure by 8.6%. Blood lipids also improved.
Remission was achieved in 77% if they started the diet in the first year after diagnosis. Rates after this fell, probably due to declining beta cell function, but 11% still went into remission even after 6 to 15 years after diagnosis.
Dr Unwin’s practice had 57 patients with type two diabetes in 1986 out of a list of 9,000. This is now 530, a tenfold increase. (Some of this could be due to better case finding). The UK spends around £10 billion a year on diabetes, 80% of this is to treat complications, and this is 10% of the health budget, similar to the budget for treating cancer.
Dr Unwin has been using the low carb approach since 2012, I was using it in my own practice about eight years before that. Without any extra funding, he has been educating his patients about this approach. He has found that the higher the person’s blood sugars, the more they improve on a low carb diet. He has had patient stay in remission for over ten years now. His oldest patient in remission is 92 years old. To his surprise, he has often found that older people do better on the diet, because they are organised, have time, and know how to cook.
His wife Jen Unwin, a psychologist says, “Older people are motivated to stay well. They don’t want to be ill. Their memory, energy and sleep, all improve remarkably. Some young people understand the diet and can implement it without too much trouble. But for others carbohydrate addiction really gets in the way. They are markedly affected by the obesogenic environment that has changed dramatically since the 70s. If you are really addicted to bread, as many people are, you can’t moderate it. Same for chocolate. Some people can’t have one biscuit. They have to eat the whole packet. They only way for these people is abstinence.
Jen continues, “Eating carbohydrates makes you hungrier. It also raises your blood sugar. When patients understand this they can sometimes make great improvements but teaching and learning takes effort and resources.”
The Public Health Collaboration have an online course that teaches the fundamentals of a healthy food approach. There is a link to the programme in a previous article in this blog site.
Adapted from JAMA Cardiology/ Original Investigation
Association of Lipid, Inflammatory and Metabolic Biomarkers With Age at Onset of Incident Coronary Heart Disease in Women. Sagar B. Dugani MD PhD et al. 2021.
A prospective group of US women health professionals, in the Women’s Health Study was conducted over 21 years. At the start over 28,000 women aged 45 years or older without known cardiovascular disease were recruited between 1993 and 1996. Data from over 50 biomarkers were tracked. Data was grouped from the under 55s, 55-65s, 65-75s and over 75s.
Results showed that diabetes and insulin resistance, hypertension, obesity and smoking were the strongest risk factors to cause premature onset cardiovascular disease. Risk factors became less important as later ages approached.
The relative risks for the various factors were:
Diabetes 10.7 in under 55s and 3.47 in the over 75s.
Metabolic syndrome 6.09 in under 55
Hypertension 4.58
Obesity 4.33
Smoking 3.92
Myocardial infarction in a parent before the age of 60 gave a 1.5-2 factor risk of a heart attack up till the age of 75.
Blood results (not all of these are tested for in the UK)
Lipoprotein insulin resistance 6.4
LDL cholesterol 1.38
Apoliprotein B 1.89
Triglycerides 2.14
Inflammatory biomarkers 1.2-1.8
For the group of women under 55, the average age was 48. Almost all were white. The mean BMI was 28.9. 38% of them were smokers. The average systolic blood pressure was 135. 57% were physically inactive. 30% reported that a parent had had a myocardial infarction under the age of 60. Of the 24 women who were post-menopausal, 17 were on HRT.
My comment: I’m surprised that even in the mid-1990s so many of this group of educated, white, female health professionals, were considerably overweight, physically inactive smokers! I wonder what a similar group would be like now?
Looking at the group over the age of 75, the average BMI had dropped a little to 26.1. Smoking was less at 12.8%. Physical inactivity was still high at 46.5% despite all of these women being retired. All would be post -menopausal and 35% of them were on HRT.
Premature coronary heart disease generally refers to the age under 65 in women and 55 in men. Mortality rates in this group reduced by 5.5% in men and 4.6% in women between 1979 and 1989. But over the next 20 years mortality for women went unchanged. Between 2010 and 2015 in the USA CHD mortality declined in all groups except for those aged between 55 and 65.
In Western Australia from 1996 to 2007 the yearly heart attack rate for women aged 35 to 54 increased by 2.3%. In British Columbia, Canada there was a yearly increase in acute MI of 1.7% in women aged 20 to 55. This increase was not seen in men. In the UK cardiac deaths also showed none or minimal improvement from 1985 to 2005.
Favourable factors that reduced cardiac risk were increased levels of HDL and higher levels of particle HDL size. Lower creatinine levels were also favourable. This is a measure of renal function.
The strongest associations for LDL were seen for small LDL particles, total LDL particles and smaller average LDL size. Large and medium LDL particles had almost no correlation to cardiovascular risk (1.02 and 1.13) . LDL particle average size indicated reduced risk at 0.64. Small HDL particles were associated with higher cardiovascular risk (1.60) and average to larger particles were associated with reduced cardiovascular risk (0.65 and 0.74).
A Finnish randomised, controlled trial, using placebos and active drugs found that Varenicline and nicotine containing electronic cigarettes were equally effective in producing smoking cessation.
458 moderate to heavy smokers joined the study. 12 weeks of treatment produced non-smokers at the six month point. Both active treatments were twice as effective as placebo. The rates were 40.4% for e cigarettes, 43.8% for Varenicline and 19.7% for placebo. There were no serious side effects.
The researchers think that on balance Varenicline is the one to go for. It weans people off of the habit of smoking and does not contain nicotine.
500 people with type one diabetes were randomised to three types of exercise and their blood sugars were monitored over a four week period.
Aerobic exercise led to the greatest fall in blood sugar compared to interval training or resistance training. In the 24 hours after exercise, regardless of the type of exercise, participants spent longer within a plasma glucose range of 3.9 to 10 mmol/l, compared to days when they did not exercise.
Adapted from Arthritis Care.
Four years of follow up in 3,000 adults found that osteoarthritis of the knee tended to worsen clinically and radiographically in people who gained weight. Conversely it improved in people who lost weight.
However, weight gain and loss had no apparent effect on osteoarthritis of the hip either symptomatically or on X ray.
Walking a well behaved dog in the countryside, green space or park can be a real joy. Dog owners are less lonely, make more friends, are fitter and slimmer than those who don’t walk their dog regularly. They can, however, sustain injuries in the process.
Researchers from John Hopkins University say that most accidents occur due to leads. If a walker is pulled forcefully, particularly when not expecting it, they can fall, and also their legs can get tangled up in leads. Therefore using short, non-retractable leads are suggested for all age groups of walkers. Those over the age of 65 are recommended to consider resistance and balance exercises to minimise falls.Older adults and women are particularly likely to be injured.
The researchers looked at 20 years of data from one hundred emergency departments in the USA. They found that 422,659 people had been injured in dog/lead related accidents. More than half the injuries were musculo-skeletal including fractures, muscle tears and abrasions. The commonest sites were the fingers, traumatic brain injury and shoulders.
Nutrition and Health News This Week by Nina Teicholz and Gary Taubes 20.4.24
What’s the Best Diet for IBS?
A clinical trial in Sweden published this week in The Lancet Gastroenterology and Hepatology, found that a low-carbohydrate diet was just as effective as the “low-FODMAP” approach for reducing symptoms of irritable bowel syndrome (IBS), and both were more effective than drug treatment.
Widely considered the standard of care for IBS, low-FODMAP diets restrict nuts, most dairy products, and several types of “fermentable” carbohydrates such as wheat, legumes and many fruits. The approach is usually combined, as it was in this trial, with general IBS dietary advice: to chew food thoroughly, eat regularly, and avoid excessive fat.
For the Swedish subjects, food was delivered to their homes for a month. The results were impressive for both diet groups: 71–76% of participants reported significant improvements in their gastrointestinal symptoms. Only 58% did in the drug treatment group. Six months later, the diet-group participants still had fewer symptoms than they did at the start of the trial, even though they followed the diet less closely.
The fact that both dietary approaches had similar benefits raises new research questions. FODMAP stands for “fermentable oligosaccharides, disaccharides, monosaccharides and polyols,” all short-chain carbohydrates that are absorbed poorly by the small intestine. These are thought to be the cause of IBS, yet people in the low-carb group continued to consume some fermentable carbs while still experiencing significant improvement in gastrointestinal symptoms. Additionally, they increased their fat intake, which is believed to exacerbate IBS.
The trial was funded by the Dietary Science Foundation, a Swedish non-profit whose mission is to fund clinical trials on diet and health. Since our own government has largely abandoned funding meaningful clinical trials on this important topic, grassroots science is now our best bet.
A large UK study using general practice records has found that cardiovascular diseases were around 50% higher in people who had autoimmune conditions.
The risk increased as the number of conditions increased. Systemic Sclerosis, Addison’s disease, Systemic Lupus Erythematosus and Type One Diabetes carried the highest risk.
The study compared half a million people who had been diagnosed with an autoimmune condition and matched them to a control group to age, sex, socioeconomic status and area of residence.
The current “Food As Medicine” movement harkens back to the adage “Let Food be Thy Medicine,” attributed to Hippocrates, yet maybe even the ancient Greeks sometimes wondered, ‘sure, but which foods?’ Fruits and vegetables, whole grains and lean proteins, aka, the cornerstone of the U.S. Dietary Guidelines, is now the usual answer, yet many experts believe that Americans, especially those of low socio-economic means, don’t have the knowledge or resources to follow this advice. For Food-As-Medicine advocates, one solution is to improve access, mainly to fruits and vegetables, by delivering free food— directly to people, in their homes.
The concept is championed by a powerhouse alliance of top-rank government, public health and industry actors. Rooted in a long history, the current movement started in about 2018, with a “Food As Medicine” working group on Capitol Hill. This led to a 2022 White House conference on Hunger, Nutrition & Health, resulting in a report recommending “food as medicine interventions for people with diet-related diseases.” In that same year, the Aspen Institute published its first “Food is Medicine” action plan, with a heady list of advisors. There’s also been “Food as Medicine” summits occurring nationwide since 2021. I (NT) havewritten with some skepticism about these efforts since the food industry has been central to virtually all of them.
From a scientific perspective, though, there’s the not-so-small problem that the Food-As-Medicine concept has barely been tested, and the few randomized, controlled clinical trials (RCTs) to date have yielded mixed results. This dearth of evidence was acknowledged in the 2022 Aspen report; An effort to get Congress in 2023 to spend $2 million on a “Food As Medicine” pilot program failed.
Then, on December 26 2023 – the day after Christmas always being a good day to bury bad news – results from the latest RCT on the concept were published in JAMA Internal Medicine. They were, to put it politely, not as expected. Five hundred “food insecure” adults with type 2 diabetes (HbA1c of 8.0% or higher) had been randomly assigned either to a control group that got “usual care” or an intervention group that received a year-long comprehensive program of dietitian consultations, nurse evaluations, health coaching, diabetes education and the delivery of “healthy” groceries for 10 meals per week for the entire household.
The groceries included “whole grains, fruits, and vegetables (with an emphasis on fresh as opposed to canned and frozen), lean proteins and low-fat dairy products, as well as staple items including salad dressing, cereal, brown rice and bread that are tailored to patients’ needs in consultation with the dietitian.” The dieticians used the American Diabetes Association “plate method,” which advises that one quarter of the plate be starches (carbohydrates).
If the food-is-medicine concept worked, the group getting free groceries along with the consultations and coaching should have seen their health improve noticeably. Yet they did not… at all. Their average blood sugar (the study’s primary outcome) remained no better than the controls; their LDL-cholesterol and HDL-cholesterol appeared, if anything, to worsen.
The study authors – public policy researchers, not nutritionists – relied on the dietary approach recommended to them by the large healthcare system with which they partnered for the study. “We are interested in health delivery systems,” Joseph Doyle, a professor at the Sloan School of Management at MIT, stressed in an interview. “I was hoping we would show improved outcomes, but the way to make progress is to do well-randomized trials to find out what works.” We agree with Doyle, of course, and his experiment should put to rest some of the chatter that proper clinical trials in nutrition can’t be done.
Yet Doyle’s trial can’t inform public health strategies if its results are ignored. Despite a news item on the study in JAMA this week, the “null results” have had little noticeable effect so far on the Food-As-Medicine juggernaut. In February, the Department of Health and Human Services hosted its first “Food As Medicine” summit, with three public-private partnerships already in place, while a dozen projects are underway at the new, partially industry-funded Food Is Medicine Institute at Tufts University.
Lamentably, until these programs better understand which foods are truly medicine, they will follow in the footsteps of other non-evidence-based programs, like listing calorie counts on menus, i.e., they’re very likely to fail…
Continue reading this post for free, courtesy of Nina Teicholz.
Diabetes Diet 