Age Related Macular Degeneration could probably be prevented by avoiding processed food

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Adapted from The Displacing Foods Age Related Macular Degeneration by Chris A Knobbe. Medical Hypotheses 109 2017 184-198

Chris A Knobbe from the University of Texas has studied factors that are thought to be important in the causation of Age Related Macular Degeneration. (AMD).

AMD is the leading cause of irreversible blindness in developing nations. In 2020 some 196 million people were affected worldwide. And Dr Knobbe thinks this is almost always down to dietary factors, in particular the consumption of processed food such as sugar, vegetable oils, refined white flour and trans fats.

Historically, between 1851 and 1930, AMD was a rarity. It rose modestly in the 1930s but became an epidemic in the UK and USA by 1975.

By 2009 63% of the American diet consisted of processed sugars, starch and oils. My comment: Dr Google now puts this at 73%hyper-processed foods”.

By looking at the food intake and AMD in 25 nations, it was seen that as the traditional diets were replaced with processed foods, the incidence of new onset AMD correspondingly rose.

If sugar intake is moderate but polyunsaturated fat ingestion is rare, AMD does not rise.

It would therefore appear that processed and nutrient deficient foods are toxic to the retina.

AMD could probably be entirely preventable through reverting back to ancestral dietary patterns, should that be feasible, or eliminating processed foods that have become ubiquitous. Avoidance of these foods is likely to be extremely important for people who have been diagnosed with early or moderate AMD.

My comment: I was recently at a Hospice ladies lunch group and was sitting at a table with six other women who were about 10-20 years older than myself. Five of them were currently getting eye injections for AMD. Diets that are considered the healthiest by Dr Google are the Mediterranean, Japanese, South Korean and French. None included processed foods.

Insulin as a murder weapon: the case of Colin Norris

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Adapted from Journal of Forensic and Legal Medicine Feb 2023 Insulin murder and the case of Colin Norris by Alan Wayne Jones University of Linkoping, Sweden.

Although insulin is an essential medicine and a life saving drug, it has been used in many poisonings. These can be accidental, suicidal or to deliberately cause harm. An insulin overdose causes severe low blood sugars, and if untreated can lead to coma, irreversible brain damage and death.

Normally, in non- diabetic individuals, the beta cells in the pancreas secrete the same amounts of insulin and C peptide into the portal venous system. In the liver, the insulin is broken down faster than the C peptide, so normally there is more C peptide in the general circulation than insulin. When there is more insulin in the system than C peptide, that is a very strong indicator that insulin from a non- pancreatic source has been administered.

Sophisticated biochemical measuring systems can identify insulin analogues. This provided part of the evidence that convicted Colin Norris, a nurse, of injecting insulin into five of his patients, four of whom died as a result.

Clinical symptoms of low blood sugars occur when the blood sugars drop below 2.5 (UK) or 45 (USA), although the exact threshold can vary between individuals. If this is prolonged for up to 6 hours or more then the brain damage can be irreversible and death can occur. The hormonal response to correct low blood sugars also prolongs the QT interval in the heart electrical pacing mechanism leading to an increase in cardiac arrhythmias and sudden death.

Proof of insulin poisoning requires positive identification of the causative agent in plasma or serum samples taken from the victim before the low blood sugar is corrected.

The first proven case of murder by insulin occurred in the mid 1950s and forensic evidence was obtained from analysing tissue samples from around injection marks on the victim’s buttocks.

During an investigation into suspicious deaths caused by insulin, the entire case scenario and totality of the evidence must be carefully considered. Tissue samples around any injection marks need to be kept for later analysis of insulin and C peptide levels.

In a Leeds hospital, in September 2002, a Mrs Hall was recovering from a hip joint operation and seemed to be making good progress. In the early hours she was found unresponsive. A bedside test showed that her blood sugar was only 1.5. Although intravenous dextrose was given, she never regained consciousness and later died. She did not have diabetes. Assays showed that the insulin level was far higher than the C peptide level indicating that pharmaceutical insulin had been injected. It was believed that she may have been mistakenly injected with insulin which was kept for patients in an unlocked fridge.

Nurse Colin Norris became the prime suspect. As part of the investigation a retrospective review of other unexpected deaths and incidents which could have been due to insulin administration were found. Four incidents had occurred in the previous year when Colin Norris was on duty. Three earlier deaths had been attributed to natural causes at the time and there was no toxicological evidence that any of them had been injected with insulin. Colin Norris maintained his innocence throughout the investigation.

In October 2005 Colin Norris was charged with murdering four patients and attempting to murder a fifth by the injection of insulin. The trial started at Newcastle Crown Court in October 2007. In March 2008 he was found guilty and was sentenced to life imprisonment. He was described by the judge as a “thoroughly evil and dangerous man…arrogant and manipulative….with a real dislike of elderly patients. There cannot be any suggestion that you were motivated to hasten their ends to spare them suffering”.

After the first appeal against Norris’s conviction failed in 2009, clinical evidence emerged that spontaneous attacks of hypoglycaemia in elderly and frail patients are not as rare as the jury had been led to believe. Indeed, a literature review showed that 2-10% of elderly frail patients, who can be malnourished, with co-morbidities such as sepsis, liver disease, or kidney failure are vulnerable to attacks of hypoglycaemia.

Other weaknesses in the case were:

The insulin vials on the ward were not subject to any inventory.

No insulin or needles were found near Mrs Hall.

The fingertip blood sample showing low blood sugar was not verified with a venous blood sample.

The very high insulin level was found on an NHS assay machine, not a more accurate forensic one. Rigour in following chain of custody procedures were not done. A confirmatory sample had also not been done.

The low blood sugar had been corrected before the low C peptide versus high insulin was found.

Spontaneous hypos can indeed occur in the elderly and frail.

Another hypoglycaemia related death had occurred at the hospital but it had not been mentioned as Norris had not been on duty. Thus the police were suspected of cherry picking cases to incriminate Norris.

Toxicological evidence of hypoglycaemia was only found for Mrs Hall. Death certificates for the other suspected hypoglycaemia deaths had been attributed to old age and other natural causes.

The cause of death of Mrs Hall was brain damage due to insulin induced hypoglycaemia but it was not known if the pathologist had looked for any insulin secreting tumours.

One of the senior police officers had been involved in the Dr Harold Shipman case two years previously and he may have been primed to find another serial killer in the health profession.

The Criminal Case Review Committee, which is the official authority in the UK charged with looking into miscarriages of justice, have examined the evidence and recommended that the court of appeal have a fresh look at the case.

My comment: It will be interesting to find out what happens and what their reasoning regarding this case will be. Meanwhile, look after yourself, look after your diabetes, keep up a healthy lifestyle and keep out of hospital!

PHC: How low carbing can help the NHS, meeting in Edinburgh

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The Public Health Collaboration is hosting a morning meeting on Saturday 18th March in Edinburgh from 9 am till 1pm.

The morning speakers will be explaining the role low carbing has on:

Improving mental health and particularly the results with bipolar disorder.

Improving weight and glycaemic control in type two diabetes.

Reducing the costs of managing type two diabetes.

Public education and group coaching initiatives in Scotland.

The PHC Ambassadors are having an afternoon meeting to discuss their projects.

The meeting is at the Quaker Meeting House in the old part of Edinburgh at the bottom of the castle and the fee is £15.

Please contact Sam Feltham at the Public Health Collaboration for more details and to register for the event.

Nutrients and exercise can reduce cancer risk

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Adapted from Nutrients and exercise affect tumour development by Carla Martinez May 27 2022 and

Three pronged approach may reduce cancer risk in the elderly by Nadine Ekert June 7 2022 Medscape

In a Madrid Oncology conference researchers discussed an update on lifestyle factors and cancer.

Diet and lifestyle can have an influence on each of the successive stages that occur in the development of cancer: initiation, promotion and progression.

A deficit of certain nutrients is one of the factors involved in the initiation stage. Various deficiencies affect different parts of cell metabolism adversely. Such nutrients include folate, B12, B6 and B3, Vitamin C, Selenium, Zinc, Magnesium and Vitamin D.

Aflatoxins from foods of vegetable origin are detrimental. The foods include cassava, pepper, corn, millet, rice, sorghum, wheat, sunflower seeds and peanuts, but the effect very much depends on how these foodstuffs are stored.

Added nitrates to foods such as processed meats and sausages because they become nitrosamines which affect cancer development. Natural nitrates in food however do not cause cancer.

Smoking causes 72% of lung cancer and 15% of all cancers. Eating processed meat causes 13% of intestinal cancers and 1.5% of all cancers. The most problematic foods for nitrosamines are cured meat, and smoked meat and fish. Cooking meats also causes polycyclic aromatic hydrocarbons especially chicken.

Various cooking strategies will reduce the formation or dilute the effects of polycyclic aromatic hydrocarbons.

Marinate mean in an acid solution for more than one hour.

Season meats and fish before grilling them. Good spices to use are: pepper, paprika, garlic, onion, ginger, turmeric, cumin, cinnamon, clove, fennel, and star anise.

Cook at a low temperature eg boiling.

Eat meats with lots of brassicas such as broccoli, cabbage, kale, turnip, brussel sprouts and mustard.

Grilled foods contain benzopyrene which can cause a mutation in DNA and thus cause cancer. Brassicas are rich in sulforphane which works on genes that produce glutathione s-transferase which promotes the elimination of benzopyrene.

Other factors that promote cancer include psychological stress, circadian disruption such as shift work, physical inactivity, obesity, hyperglycaemia, hyperinsulinaemia, gut bacteria disruption, and vitamin D deficiency.

The common factor here is increased inflammation. Some nutrients act as anti-inflammatories including the omega 3 oils EPA and DHA. Ginger, green tea, turmeric and broccoli all help too.

Daily rituals determine our health, so think about how you can optimise your routines.

The influence of exercise on cancer has only been studied in the last ten years.

Hypoxia is one of the main triggers of tumour aggression. Exercise has been shown to improve oxygenation and reduce hypoxia. Physical exercise in combination with chemotherapy has been proven to reduce tumour volume and progression. The best exercises in this regard are those that build up lactate in the muscle such as resistance exercise and cycling.

In the DO-HEALTH study, more than 2,000 healthy elderly people over the age of 70, were observed over three years. A combination of high dose vitamin D, omega 3 fatty acids and a simple home training programme reduced the risk of cancer by 61% compared to placebo.

The risk of getting cancer increases as you get older. Apart from not smoking and sun protection, getting appropriate vaccines and screening, there is not that much left to do. As Vitamin D, omega 3 fatty acids and physical exercise are all promising factors in cancer reduction, various combinations of them were tried. Blood pressure, physical performance, cognition, fractures and infections were looked at. They were divided into 8 groups looking at placebo, training only, and then various combinations and single interventions.

Most groups showed no difference from placebo but the combination of vitamin D, omega 3s and training did. The number needed to treat to prevent one cancer over the three years was 53 which is considered pretty good. Researchers thought the outcome was good enough to recommend this to any one over 70 who was looking to improve their health.

Cardiovascular outcomes are improving for type two diabetics

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There have been large reductions in myocardial infarction, cardiac death, and all cause mortality over the last fifteen years in Denmark for type two diabetics. For instance, the cumulative seven year risk of myocardial infarction reduced from6.9% to 28%. These reductions occurred over a period of time when there has been a lot more emphasis on using drugs to reduce cardiovascular risk. (Diabetes Care 2021)

In Sweden blood was tested to see how much dairy products were being consumed. Those who consumed the most dairy fat had 25% less risk of myocardial infarction compared to the lowest risk.

As many dietary guidelines recommend limiting dairy products in order to limit saturated fat intake, perhaps they should take note.

An article in the American Journal of Clinical Nutrition suggests that if the carbohydrate – insulin model of obesity is correct, then instead of calorie control diets and exercise to reduce obesity, focus should be put on low carbohydrate diets.

What do white rings round your corneas indicate?

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Adapted from BMJ 23 Nov 2021

In a German study of ten thousand people aged between 40 and 80 years old, 21% of men and 17% of women had white rings round their irises of the eyes. You may have noticed these in your parents or yourself and may have wondered what this means.

The average age of the group was 60. Researchers noted that corneal arcus is more likely in men than women, increases with age, and increases with lipid levels.

Corneal arcus has no relevance to socioeconomic status, body mass index, arterial blood pressure or HbA1c levels.

A ketogenic drink has been found to improve cognitive performance in those with mild cognitive impairment

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Adapted from A ketogenic drink improves cognition in mild cognitive impairment: Results of a 6 month RCT by Melanie Fortier et al. Alzheimer’s and Dementia. 2021.

Brain energy rescue is being tested to see if it can reduce cognitive decline in patients with mild cognitive impairment. It has previously been discovered that the brain has problems using glucose for fuel even before symptoms develop, but brain ketone use remains constant in both Alzheimers (A) and Mild Cognitive Impairment (MCI). Increasing ketones available to the brain has been shown to improve cognitive symptoms.

A really easy way to increase blood ketone levels is to give a drink containing ketogenic medium chain fatty acids. This has been found to increase brain energy uptake via PET scans. This follow on trial was done to assess whether improvement in cognition after six months occurred.

This study was conducted in Quebec Canada. Very strict entry criteria were applied and the patients were randomised to the ketogenic drink or to a placebo drink. The drinks appeared and tasted identical.

122 participants were enrolled. In total 39 completed the ketogenic arm and 44 the placebo arm. They were well matched regarding age, sex, education, functional ability and cognitive scores, absence of depressive features, blood pressure, blood chemistry and APOE 4 status. ( A genetic variability that greatly increases the chance of developing dementia).

More participants dropped out of the ketogenic group mainly due to gastrointestinal side effects. The drop out rate overall was 32% and 38% in the ketogenic group. None of the side effects were serious.

The results showed that performance on widely used tests of episodic memory, executive function and language improved over 6 months in the ketogenic group compared to the placebo group. Improvement was directly correlated with the plasma level of ketones.

The dose used was 15g of kMCT twice a day.

This seems to be a very reasonable intervention for early cognitive decline particularly since no drugs are approved for MCI and drugs used for Alzheimers do not delay cognitive decline in MCI. It is possible that effects would be enhanced if patients also undertook a ketogenic diet. Further trials are now warranted to see if diagnosis of Alzheimers can be delayed in those suffering from mild cognitive impairment.

NICE: Use pillows to sleep on your side in the last 3 months of pregnancy

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Adapted from BMJ 6 Nov 2021 NICE: Routine antenatal care for women and their babies.

Although the evidence base is small, evidence suggests that after 28 weeks of pregnancy, women who fall asleep on their backs, have an increased risk of having a baby born small for gestational age or even stillbirth.

They suggest that women use pillows to alter their position in bed so that lying on their side is easier.

This was the main new bit of information from this updated review which is important for women to know. The last review was published in 2008.

Women don’t need to go via their GP to access antenatal care. They can self refer, make an appointment with a midwife, any other appropriate health care professional, or via school nurses, community centre or refugee hostel. At a midwife led booking appointment she will be given information on all the things she can modify, by doing or not doing things to improve her chances of having a healthy baby. Partner involvement is considered to be helpful at all stages of pregnancy and delivery.

They also state that if a woman has vaginal bleeding after 13 weeks of pregnancy, she should be referred to hospital. (This normally happens and is not new advice).

Rates of maternal mortality and stillbirth are highest among women and babies from deprived areas, and higher among black, mixed ethnicity and Asian women compared with white women.

Routine ultrasound scanning is not recommended in low risk singleton pregnancies during the third trimester.

Improved life expectancy for severe kidney disease on keto diets

Teresa Rodriguez is a Florida USA specialist dietician who has undertaken training with the Charlie Foundation to provide help to patients who have severe kidney disease of various types. Some conditions, previously thought to be untreatable, such as Polycystic Kidney Disease respond to the ketogenic diet and the quality of life and life expectancy for these people has been transformed.

Teresa sees patients in person and coaches them online and via Facebook. She is expecting her book, aimed at both physicians and patients, Keto for Kidney Disease, to be published in March 22.

Teresa comes from Puerto Rico and speaks fluent Spanish and American English and can provide learning in both languages.

I was one of several doctors who were treated to an online presentation by Teresa recently, and was amazed to see how different her approach and results are compared to NHS “usual” treatment and results.

I was taught that there wasn’t really much you could do about Polycystic Kidneys except for dialysis and transplantation when the kidneys eventually failed. She explained that PKD is actually a metabolic condition and that it responds to a ketogenic diet of usually 20g carbohydrate a day. There can be other aggravating factors such as oxalate overload and the kidney needs support to avoid the formation of kidney stones. Many patients will need to drink lemon juice in the mornings and have a much higher fluid intake than usual.

She optimises the patient’s diet based on the results of a detailed clinical history and blood and urine results. She finds that Cystatin C is a much more reliable predicator of kidney function than standard tests such as Creatinine Clearance. She often has to modify drug prescriptions. The blood pressure must be kept within normal limits to reduce deterioration in kidney function but Calcium channel blockers are not beneficial in PKD compared to ACE inhibitors and Sartans. Metformin, however is beneficial.

There is increasing interest in Ketogenic Diet Therapy and Therapeutic Carbohydrate Restriction worldwide.

Fibre is not the answer for diverticulosis prevention

Adapted from A high fiber diet does not protect against asymptomatic diverticulosis by Anne F Peery et al. Gastroenterology Volume 142, Issue 2, February 2012 Pages 266-272.

The complications of diverticulosis cause considerable morbidity in the developed world. Many physicians and patients believe that a high fibre diet and frequent bowel movements are the key to its prevention. We sought to determine whether low fibre or high fat diets that include large quantities of red meat, constiptation or physical inactivity increase the risk for asymptomatic diverticulosis.

We performed a cross sectional study of 2,104 adults aged 30 to 80 who were getting an outpatient colonoscopy from 1998 to 2010. Diet and physical activity were assessed in interviews using validated techniques.

As we expected the numbers of people with diverticulosis increased as they aged. High fibre intake did not reduce the prevalence of diverticulosis. Indeed, those in the highest quartile of fibre intake had more diverticulosis per person than the lowest. Risk increased with increasing amounts of total fibre, fibre from grains, soluble and insoluble fibre. Constipation was also not a risk factor. Those who had more than 15 bowel movements a week had a 70% higher risk compared to those with less than 7 bowel movements a week. Neither physical inactivity or intake of fat or red meat was associated with diverticulosis.

These results indicated that the generally accepted “risk factors” for diverticulosis need to be reconsidered.

For one poor man’s real life experience with this condition read:

He found that wheat products and seed oils were the main factor and he wishes he had found this out before having a miserable 15 years with gut pain and diarrhea.