Dr Ivor Cummings: Interview with Dr William Davis

In the last of our three part exploration of the cardiovascular disease epidemic, Irish doctor Ivor Cummings interviews Dr William Davis consultant cardiologist about what really prevents and reduces coronary artery atheroma. Also discussed is the most effective way to increase your magnesium intake which relaxes smooth muscle thereby reducing blood pressure.

Dr Cummings’s runs his blog  known as the Fat Emperor.

 

https://thefatemperor.com/ep37-william-davis-md-cardiologist-reveals-the-solutions-to-modern-chronic-disease/

Dr Aseem Malhotra: What is wrong with how we try to prevent cardiovascular disease

In part two of this series on cardiovascular disease Dr Aseem Malhotra, consultant cardiologist explains why putting faith in statins to resolve the cardiovascular disease epidemic is misguided. He explains that they only extend life by a matter of a few days yet need to be prescribed for years at considerable cost to the health service. Furthermore, he thinks that their side effects are not being explained to patients.

This is a medium length article which contains information on statins not readily seen in a single document.

https://www.europeanscientist.com/en/features/do-statins-really-work-who-benefits-who-has-the-power-to-cover-up-the-side-effects/

A little care goes a long way

Adapted from Annals of Family Medicine 2019 doi:10.1370/afm.2421

People diagnosed by their GP with type two diabetes had a 40-50% lower mortality rate over the next ten years if they experienced their GP and practice nurses as empathetic during the year after diagnosis, compared to those who considered that their primary health carers had low empathy.

This study looked at 879 patients recruited from 49 GP practices in the east of England.

My comment: The first year is when patients get their head round the fact that they have a long term condition that could affect how long they will live and the quality of the life they have left. At diagnosis many are willing to look at lifestyle changes. Encouraging them, helping them, and helping them set appropriate goals makes a good difference to a person’s ability to change their daily routines. If you are newly diagnosed and don’t get on with your health care providers for any reason, then maybe a change of provider makes sense in the light of this research. 

There are benefits to that pre-breakfast workout

Adapted from Edinburgh RM et al. Journal of Clinical Endocrinology and Metabolism 21 Oct 2019 

Research suggests that blood sugar levels can be better controlled by planned eating and exercise timings.

This study was conducted in Bath and Birmingham and involved a six week trial of 30 overweight or obese men. They were divided into three groups. One group ate breakfast before exercise, one group after exercise and the third group made no changes to their diet or exercise (or lack of it). Groups one and two swapped over after the first six weeks.

The researchers showed that you doubled the amount of fat burned during exercise if breakfast was delayed. This was mainly because the group had lower insulin levels due to their prolonged overnight fast. They could therefore burn more fat in their fat stores or muscle. The groups did not do more exercise than the pre-workout breakfast group.

Groups one and two swapped over after the first three weeks. The men’s BMI averaged at 30 and was closely matched in each group. Although insulin sensitivity was improved in the longer fasting group, there was not any significant weight loss.

The optimal HbA1C for non low carbing type ones could be 6.5-7%

Adapted from Lind M et al. BMJ 28 August 2019

In type one diabetes in adults and children there could be a sweet spot for blood sugar control.

Under 6.5% severe hypoglycaemia rates increase. Retinopathy and nephropathy risks are not lower however below 6.5% compared to 6.9%. My comment:  In low carbers however, they have considerable protection against severe hypoglycaemia due to more precise meal/insulin matching, although they do experience more episodes of mild hypoglycaemia.

Risks for mild complications begin at levels over 7.0% and severe complications rise with levels over 8.6%.

Current guidelines vary in their HbA1C recommendations, anywhere from 6.5% to 7.5%.

The complication rates were based on 10,398 adults and children with type one diabetes on the Swedish National Diabetes Registry who were diagnosed between 1998 and 2017.

 

 

 

Soldiers improve their physique on a ketogenic diet

Adapted from Military Medicine January 2019 by Richard Al LaFountain et al of Ohio State University.

This is the first study of a ketogenic diet in military personnel. Daily ketone monitoring was done to personalise the diet. 29 subjects from various branches of the military took part over the 12 week study.

15 self selected to go on the ketogenic diet (KD) monitored by blood ketones daily. 14 continued their mixed diet (MD). Various measurements were done at the start and end of the programme.

All of the KD group were in ketosis throughout the 12 weeks as assessed by beta-hydroxybutrate levels. The KD group lost 7.7kg more (range -3.5 to -13.6kg) despite no calorie restriction. They lost 5.1% body fat (range -0.5 to -9.6%). 43.7% was visceral fat (range – 3.0  to – 66.3%) and had a 48% improvement in insulin sensitivity. There were no changes in the MD group.  There were no changes between the groups in aerobic capacity, maximal strength, power and a military specific obstacle course.

The authors conclude that this was a very well accepted intervention which showed remarkable improvements in body composition and weight without compromising physical performance in exercise training.

In the USA two thirds of active military personnel are overweight or obese which mirrors the general population. Nearly three out of four young people aged 17-24 fail to qualify for military service mainly due to obesity and failure to meet fitness standard thus posing an impending recruitment crisis.

The military usually follow the USDA’s dietary guidelines that advocates low fat, high carbohydrate foods. Americans have followed these recommendations for decades and have seen a marked rise in obesity at the same time. A diet that emphasises carbohydrate has the effect on suppressing fat oxidation and the production of ketones. Over half of active military personnel report drinking sugar and caffeine containing energy drinks in the past month.

Ketones produced while following a ketogenic diet have been shown to improve fat oxidation, enhance gene expression, inflammation, antioxidant defense and  healthspan. Fat loss without the explicit need to restrict calories is a benefit. Reversal of metabolic syndrome and obesity occurs. Previous studies have shown no detrimental impact on endurance and resistance training performance. The study was done in the military to see if this was a feasible approach.

The success of a ketogenic diet depends on commitment so we did not randomise the subjects. Both groups took part in identical physical training that emphasised strength and power.

Participants were recruited from the Ohio State Reserve Officer Training Corps and other local groups with a military affiliation.  We wanted people as similar as possible to the demographics of serving soldiers regarding age, sex, race and body mass. Participants were excluded if they had had previous experience of a ketogenic diet, were over 50, had certain illnesses, conditions, medications or allergies or who could not exercise safely.

The KD group were coached and were provided with unlimited frozen, pre-cooked meals and grocery supplies.  Carbohydrate was limited initially to 25g per day and protein to 90 g/d until ketosis occurred. Thereafter they could increase the amounts in their diet provided they stayed in ketosis. They were encouraged to use salt.  Carbohydrate was targeted at less than 50g per day including non starchy vegetables, nuts, seeds, selected fruit and berries. Protein goals were 0.6 – 1.0g g/kg of lean body mass. Total energy intake was not restricted. Non starchy vegetables and fats were encouraged to reach satiety. Alcohol over 2 drinks a day was discouraged in both groups.  Participants checked their blood ketones every morning and sent pictures of their readings to the research team.

The mixed diet group had a minimum consumption of 40% dietary calories from carbohydrate.  All participants met with registered dieticians and were encouraged to eat to satiety with no specific caloric limit. Dietary supplements were not allowed.

All groups undertook a progressive resistance training programme two days a week for an hour at a time. They had one additional cardio training session a week consisting of running and body weight circuit training for at least 30 minutes. Each resistance training session ended with 15 minutes of whole body, high intensity circuit training.

Body mass and body composition was measured by DEXA. Fat was assessed by MRI. Indirect calorimetry was used to evaluate resting metabolic rate and the respiratory exchange ratio.

The most noteworthy result was a spontaneous reduction in energy intake resulting in a uniformly greater weight loss for the ketogenic group.  The visceral fat was also markedly reduced which leads to a reduced risk for insulin resistance and cardiometabolic disease.  Insulin sensitivity improved in the ketogenic group.

Normalisation of weight is important for soldiers because non combat musculoskeletal injury is 33% more common in this group.

Subjects in this study were overweight but not obese, so the weight loss effect could be expected to be even more in obese subjects.  Release of fatty acids and ketones are likely the cause of the satiety effect leading to less hunger. The weight loss in the ketogenic group was 80% from body fat mass.  44% of the fat lost was from the viscera, largely in the middle of the body.

Because the subjects decided what diet they would follow, selection bias can’t be ruled out. The KD  group was also slightly heavier at baseline than the MD group.  The two women in the KD group responded similarly to the men.

 

 

 

 

BMJ: Children with type one diabetes do just as well with jags as pumps

 BMJ 13 April 19

Pumps versus Multiple Daily Injections

Across various centres in England and Wales, 294 new onset type one diabetes patients were randomised to receive either pumps or MDI from the very start after diagnosis. The age range was just 7 months to 15 years. There were 144 in the pump group and 147 in the MDI group.

At one year the average HbA1c was around 60 (7.6%) for both groups. There were 14 serious events such as diabetic ketoacidosis or severe hypoglycaemia in the pump group and 8 such events in the MDI group.

It cost £1,863 more to treat the pump group but they had no better outcomes or improvement in quality of life compared to the MDI group. Indeed adverse events were a bit more common in the pump group even though there were fewer of them.

My comment: Looks like they were not advised about low carb diets given the relatively high HbA1Cs at a time that the honeymoon phase can be protective.

BMJ 16 Feb 19

Type one children performed just as well as their schoolmates in exams

Although both high and low blood sugar can affect concentration and memory and cognitive function, Danish researchers found that in national exams, type one children performed just as well as other children.

Enterovirus may act as a trigger for Coeliac Disease

Norwegian researchers looked at infection with adenoviruses and enteroviruses in childhood and later diagnosis of coeliac disease.

They tested children who were already at risk due to a particular genotype. They were recruited between 2001 and 2007 and were followed up till 2016.

They found that infection with enteroviruses but not adenoviruses were associated with higher onset of coeliac later on.

My comment: Enterovirus infection has been associated with the onset of type one diabetes too. People with type one are also more likely to develop coeliac. There could be common genetic susceptibility and environmental triggers.