Tag: health

The link between poverty and poor health is complex

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Adapted from BMJ 26 July 2025

Mothers and children in low income households have poorer health than those from high income households. A trial in four cities in the USA compared results when monthly unconditional cash transfers were made. In theory, those given more money should see an improvement in health.

A total of 1,000 mothers were randomised to receiving either $333 dollars or $20 a month until their child was six years old.

After four years, no difference between the groups was found n maternal mental health, maternal or child BMI, or maternal report of the child’s health.

My comment: I would have thought that an extra $333 would have led to some improvements in diet, house heating, clothes and shoe provision. It could also have led to less paid work being necessary for the mother to do, which I would also have expected to help. I am surprised that health outcomes didn’t improve at all. Perhaps, much more money is needed? Or is it being spent on things that don’t improve health?

Dr Richard Bernstein has died

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Richard Bernstein

June 17, 1934 – April 15, 2025
Obituary of Richard Bernstein

IN THE CARE OF

Sinai Chapels

Dr Richard Bernstein, 90, of Mamaroneck, NY passed away peacefully on Tuesday, April 15, 2025. Born in 1934 in Brooklyn, New York, he was stricken with Juvenile Onset Diabetes at the age of 12. He earned an engineering degree from Columbia University and had a career in the laboratory and medical devices industry. In the early 1970s he adapted a blood glucose meter for personal use and pioneered Diabetes Home Glucose Monitoring. Using self- experimentation to develop a regimen of glucose monitoring, diet and multiple daily insulin shots, he radically improved his own health. He enrolled in the Albert Einstein College of Medicine and graduated at the age of 48. He subsequently practiced medicine as a Diabetologist in Mamaroneck, NY until his death. He published multiple books on Diabetes including the #1 selling Diabetes book on Amazon.Com “Dr. Bernstein’s Diabetes Solution: A Complete Guide to Achieving Normal Blood Sugars” and “Diabetes Type II: Living a Long, Healthy Life Through Blood Sugar Normalization”. His “Diabetes University” videos on YouTube brought his Diabetes treatment strategies to a global audience. He made many discoveries and published articles in prestigious medical journals about Diabetes, complications of Diabetes and autoimmune disorders suffered by diabetics. He credited his longevity and good health to tight control of his blood sugars, exercise and his low carb diet and insisted that all diabetics have the right to normal blood sugars. In his spare time, he was an avid boater, sailor and astrophotographer with a particular passion for photographing eclipses. He is survived by his partner Joyce Kaplan, daughter Julie Borhani and husband David, daughter Lili Goralnick and husband Howard, son Jeffrey and wife Michele and grandchildren Jody, Bella, Nathan and Adin.

A funeral service for Dr. Bernstein will be held Thursday, April 17, 2025 from 12:00 PM to 1:00 PM at Sinai Chapels, 114-03 Queens Blvd, Forest Hills, NY 11375, followed by a committal service from 1:15 PM to 1:45 PM at the Mount Lebanon Cemetery, 7800 Myrtle Ave. Glendale, NY.See Less

Amitriptyline improves irritable bowel syndrome in RCT

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Adapted from BMJ 2-9 Nov 2024

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.

Total mortality rates are improved when type two diabetics follow a low carb diet

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Adapted from Diabetes in Control March 24 2023

Mortality Reduced With Adherence to Low-Carb Diet in Type 2 Diabetes

Mar 24, 2023

Lower mortality seen with increases in total, vegetable, and healthy low-carbohydrate diet score

By Elana Gotkine HealthDay Reporter

×

FRIDAY, March 24, 2023 (HealthDay News) — For individuals with incident type 2 diabetes (T2D), a greater adherence to low-carbohydrate diet (LCD) patterns is associated with lower mortality, according to a study published online Feb. 14 in Diabetes Care.

Yang Hu, Ph.D., from the Harvard T.H. Chan School of Public Health in Boston, and colleagues calculated an overall total LCD score (TLCDS) among participants with incident diabetes identified in the Nurses’ Health Study and Health Professionals Follow-up Study. Vegetable (VLCDS), animal (ALCDS), healthy (HLCDS), and unhealthy LCDS (ULCDS) were also derived.

The researchers documented 4,595 deaths, of which 1,389 cases were attributable to cardiovascular disease (CVD) and 881 to cancer among 10,101 incident T2D cases, contributing 139,407 person-years of follow-up. Per each 10-point increment of postdiagnosis LCDS, the pooled multivariable-adjusted hazard ratios for total mortality were 0.87, 0.76, and 0.78 for TLCDS, VLCDS, and HLCDS, respectively. Significantly lower CVD and cancer mortality was seen in association with VLCDS and HLCDS. From the prediagnosis to postdiagnosis period, each 10-point increase in TLCDS, VLCDS, and HLCDS correlated with 12, 25, and 25 percent lower total mortality, respectively. For ALCDS and ULCDS, no significant associations were seen.

“Our findings provide support for the current recommendations of carbohydrate restrictions for T2D management and highlight the importance of the quality and food sources of macronutrients when assessing the health benefits of LCD,” the authors write.

No chips with mine thanks!

kaitiscotland4 Comments
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After considerable number crunching a low carb colleague has come to the very reasonable conclusion that the worst food in the world for weight gain is the fried potato in its several incarnations.

In the USA French Fries are what we in the UK call Chips. In the USA Chips are what we in the UK call Crisps.

These are ubiquitous and difficult to avoid particularly if you eat in fast food restaurants. Even if you order a sandwich you may be given a side order of chips or crisps.

Tucker explains that the vegetable and seed oils that these items are fried in play havoc with the appetite control centres of your brain. This article serves as a reminder, since we are all still at least trying to keep to our New Year’s Resolutions, why it would be better to avoid having them on your plate or hand in the first place. And just the one or two….who are you kidding?

https://yelling-stop.blogspot.com/2021/10/whats-most-fattening-food.html

A forensic pathologist tells us how to live to a good old age

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Adapted from Medscape August 31 2022 Would you like to live to a ripe old age? George D Lundberg MD

Do

Choose ancestors who did not die of natural causes in young adulthood or middle age (oophs…too late!)

Maintain a body mass index within the healthy range using a variety of tools

Maintain blood pressure within a normal range with or without medications

Maintain a low resting heart rate

Do eat whole grains including bran

Consume above ground leafy vegetables, some root vegetables, tree nuts, peanuts and berries

Ingest supplemental fibre such as psyllium husks

Ingest supplemental magnesium and possibly vitamins K2, C and D

Enjoy eating animal and vegetable fats including milk, cheese, meat, poultry, seafood, and eggs in moderation.

Eat two full meals a day

Do drink alcohol after 5pm

Sleep 6-8 hours a night

Walk up and downstairs and use handrails if necessary

Continue to be active physically, mentally, socially and sexually

Study and enjoy birds, bees, trees, plants, flowers and wildlife

Value your family life and participate actively while encouraging individuals to live their own lives

Read great books, fiction or non fiction a little every day

Actively engage in person or electronically with younger people

Stay informed about current world affairs and care about what you can change

Be passionate about culture such as performing and visual arts and sport

Recognise the value of spirituality and religion and feel free to live otherwise if you choose

Do your best to earn and retain as much money as needed to control your environment into old age

Take charge of your own health

Listen to your body

Maintain a long term relationship with a reliable and conservative primary care physician and certain specialists that fit the needs of older people.

Promote good vision in any way you can

Use hearing aids if you need them to retain brain function

See your dentist every 6 to 12 months and practice good oral hygiene. There is a strong correlation between the number of original teeth and length of life

Keep up to date with vaccinations

Maintain a safe distance and use mask if you may be around infective people

Take as few medications as necessary

Have as few diagnostic tests and surgical procedures as possible especially on the back and the knees

Use acupuncture and massage appropriately

Apply moisturising skin lotion especially after sun exposure

Use saline mist often to prevent nosebleeds

Walk at least 2 miles every day

If you can, swim every day

Practice yoga particularly the standing side bend, prone baby cobra, forward plank and windshield-wiper

Eat a protein rich diet and deliberately weight train or lift heavy objects to reduce sarcopenia

stand on one foot to improve balance

Use wearable exercise monitors if you find them useful

If you retire from work do some part time or volunteer jobs

Have something productive and fulfilling to do each day

Don’t

Inhale tobacco smoke

Consume sugar or sugar in anything in home cooked or restaurant meals, in soft drinks, fruit juices, pastries, desserts or processed foods

Use street drugs

Use natural or synthetic opioids except for short term relief of severe pain or the relief of pain from advanced cancer: then use all you need

Use sleep medication

Drink more than moderately or binge drink

Drive a vehicle after drinking or taking certain psychoactive drugs

Keep firearms in your home or workplace

Fret about things in your personal life or world affairs that you cannot change

Completely retire and have nothing useful to do

My comments: Dr Lundberg has a pretty long list of sensible suggestions. To these I would add, get some daily sunshine if you can and enjoy your pets. Have things to look forward to. Keep in touch with your friends and make contact with old ones who you value but don’t see often. Learn new things. What other suggestions do you have?

Blood pressure difference between arms can be a risk factor for cognitive decline…as well as other things.

kaitiscotland4 Comments

From Systolic inter-arm blood pressure difference and cognitive decline in older people, a cohort study. Christopher E Clark. BJGP July 2020

 

A prospective study was done in 1,113 Italians whose average age was 66.4 years. Even a difference of only 5 degrees between the arms was associated with a greater level of cognitive decline.

My comment: In UK GP practices, only one arm is used to check the blood pressure. In my case, it was the arm that was nearest to the desk. Perhaps we should check both ? Inter-arm BP differences are both associated with cardiovascular disease, and this in turn affects dementia. Then of course, is the question, what can you do about it? For a further discussion of the subject here is Pharmacist Antonio Bess from Diabetes in Control.

Cognitive Decline: Just Life, or a Preventable Disease?
Feb 22, 2020

Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Antonio Bess, Pharm D Candidate, Florida Agricultural & Mechanical University School of Pharmacy

Cognitive decline is associated with many diseases and medications, but the exact mechanisms are not clearly understood.
Diabetes, obesity, and declining cognitive function are all associated with increased prevalence with increasing age.

Diabetes is a known risk factor for eye, kidney, neurological and cardiovascular diseases, but its effect on declining cognitive function has been in question. Previous studies have found associations between patients who have diabetes and poor glycemic control and significantly faster cognitive decline. Other studies have demonstrated a pattern in which diabetes, high blood pressure, and high body mass index in midlife predict dementia in late life.

In this prospective study, individuals were followed for up to ten years to find associations between indices in diabetes, insulin resistance, obesity, inflammation, and blood pressure with cognitive decline. The indices of interest were measured separately among those with and without central obesity.
The Monongahela‐Youghiogheny Healthy Aging Team is a population‐based cohort of participants recruited randomly from 2006 to 2008, who were 65 and older, and were from a group of small towns in southwestern Pennsylvania. The study is focused on the epidemiology of cognitive decline and dementia in an area that still has not recovered economically from the collapse of the steel industry in the 1970s.

Participants were analyzed at study entry, and annual follow up. To measure cognitive function, participants were given a panel of neuropsychological tests tapping the domains of attention/processing speed, executive function, memory, language, and visuospatial function. At study entry and annually, BP, BMI, waist‐hip ratio, and depressive symptoms  were measured.
Key variables at the time of blood draw, including age, sex, race (white vs. nonwhite), education (high school [HS] or less vs. more than HS), APOE*4 allele carrier status, mCES‐D score, BMI, WHR, systolic BP (SBP), and the following laboratory assay variables: CRP, glucose, HbA1c, insulin, HOMA‐IR, resistin, adiponectin, and GLP‐1 were all reviewed to identify predictors of cognitive decline.
Among 1982 participants who were recruited and underwent full assessment at baseline from 2006 to 2008, only 478 individuals were able to provide fasting blood samples. Of this group of individuals, the median age was 82 years; 66.7% were women; 96.7% were white, and 49.0% had more than HS education.

Compared to the 1504 original participants without fasting blood data, at baseline, these 478 were significantly younger (74.6 vs. 78.6 years; P < .001); more likely to be women (66.7% vs. 59.2%; P = .004); more likely to be of European descent (96.7% vs. 94.1%; P < .001); more likely to have at least HS education (49.0% vs. 38.6%; P < .001); but about equally likely to be APOE*4 carriers (19.3% vs. 21.5%; P = .350).
In unadjusted analysis in the sample as a whole, faster cognitive decline was associated with greater age, less education, APOE*4 carriage, higher depression symptoms (mCES‐D score), and higher adiponectin level. HbA1c was significantly associated with cognitive decline.

After stratifying by the median waist-hip ratio, HbA1c remained related to cognitive decline in those with higher waist-hip ratios. Faster cognitive decline was associated, in lower waist-hip ratio participants younger than 87 years, with adiponectin of 11 or greater; and in higher waist-hip ratio participants younger than 88 years, with HbA1c of 6.2% or greater. Higher adiponectin levels predicted a steeper cognitive decline in the lower waist-hip ratio group.
Abdominal obesity plays a crucial role in cognitive decline in those with diabetes. The microvascular disease may play a more significant role than macrovascular disease. Midlife obesity contributes to cognitive decline but there was no midlife data in this study. Future studies should include a large minority, midlife population. Adiponectin levels need to be carefully assessed as well.

Practice Pearls:
In individuals younger than 88 years old, central obesity can lead to faster cognitive declines.
Obesity, diabetes, and aging contribute to cognitive decline, so it’s hard to distinguish the most significant risk.
Adiponectin may be a novel independent risk factor for cognitive decline and should be reviewed.

Ganguli, Mary, et al. “Aging, Diabetes, Obesity, and Cognitive Decline: A Population‐Based Study.” Journal of the American Geriatrics Society, John Wiley & Sons, Ltd, Feb. 2020, p. jgs.16321, doi:10.1111/jgs.16321.
Ganguli, Mary, et al. Aging, Diabetes, Obesity, and Cognitive Decline: A Population-Based Study. 2020, pp. 1–8, doi:10.1111/jgs.16321.
Tuligenga, Richard H., et al. “Midlife Type 2 Diabetes and Poor Glycaemic Control as Risk Factors for Cognitive Decline in Early Old Age: A Post-Hoc Analysis of the Whitehall II Cohort Study.” The Lancet Diabetes and Endocrinology, vol. 2, no. 3, Elsevier Limited, Mar. 2014, pp. 228–35, doi:10.1016/S2213-8587(13)70192-X.
Cukierman, T., et al. “Cognitive Decline and Dementia in Diabetes – Systematic Overview of Prospective Observational Studies.” Diabetologia, vol. 48, no. 12, Springer, 8 Dec. 2005, pp. 2460–69, doi:10.1007/s00125-005-0023-4.

Antonio Bess, Florida Agricultural and Mechanical University College of Pharmacy

Dietary gluten in pregnancy is related to an increased risk of type one diabetes in the child

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Adapted from Antvorskov JC et al. Association between maternal gluten intake and type one diabetes in offspring. BMJ 22 September 2018

This research was based on a study of Danish women’s food frequency questionnaires completed 25 weeks after their first pregnancies ended. The incidence of diabetes in the children was then noted from January 1996 till May 2016 from the Danish Registry of Childhood and Adolescent Diabetes. After certain exclusions had been made over 63,500 were analysed.

The mean gluten intake per day was 13g ranging from 7g to more than 20g per day.

The incidence of diabetes in the child increased proportionately according to gluten intake. The women who had  20g or more intake had double the type one diabetes in their offspring compared to those who ate 7g or less.

As type one diabetes has risen seemingly inexplicably over the last few decades, there has been a lot of consideration into possible environmental triggers. Gluten is a storage protein found in wheat, rye and barley.  In animal studies, a wheat free diet in the mother has been found to dramatically reduce the incidence of diabetes in the child.

It has been suggested that gluten can affect gut permeability, gut microbiotica and cause low grade inflammation.

Although there is this association between gluten and type one diabetes it could be that other factors, for example the advanced glycation products from the baking process, that are to blame.  Unwanted additives to grain  could also be a factor eg mycotoxins, heavy metals, pesticides and fertilisers.

Mothers who eat a lot of gluten may similarly feed their children a lot of gluten. They also may pass gliadin from wheat into the breast milk.

Although this research suggests that high amounts of gluten may be problematic in pregnancy, further research will need to be done before dietary recommendations are likely to be changed.

Metformin improves side effects of steroid treatment

kaitiscotland2 Comments

From Pernicova I et al. Lancet Diabetes Endocrinol 25 Feb 2020

Long-term glucocorticoids, most often prednisolone, are prescribed for about 3% of European adults. The long term exposure can raise metabolic, infectious and cardiovascular risks.

This was a trial of 53 adults who had inflammatory disease treated with prednisolone but did not have diabetes, who were given either 12 weeks of metformin or a placebo.

The dose of prednisolone was 20mg or more for the first month and then 10mg or more for the next 12 weeks. The dose of metformin given was up to 850mg three times a day.

What improved:

Facial fatness was in seen in 52% of the placebo group but only 10% in the metformin group.

Increased blood sugar was seen in 33% of the placebo group and none of the metformin group.

There was improvement in insulin resistance, beta cell function, liver function, fibrinolysis, carotid intima media thickness, inflammatory parameters and disease activity severity markers in the metformin group.

There were fewer cases of pneumonia, moderate to severe infections and all causes of hospitalisation for adverse events in the metformin group.

What got worse:

Diarrhea was worse in the metformin group.

What didn’t get better:

Visceral to subcutaneous fat ratio was unchanged between the groups.

My comment: Looks like a clear winner for adding metformin to long term prednisolone treatments.

Younger women more likely to get urine infections with Flozins

kaitiscotland3 Comments

From Univadis Nakhleh A et al. Journal of Diabetes Complications 18th April 2020

It is well known that patients on Flozins are much more prone to urine infections and thrush due to the extra sugar in the urine which is excreted by taking these drugs, also known as SGLT2 inhibitors.

An Israeli study of over 6 thousand women with type two diabetes sought to clarify who was more or less likely to be affected by this very annoying problem.

They found that those most likely to get urine infections were:

Women who had existing gastro intestinal problems

Pre-menopausal women

Women who had been taking oral oestrogen in the form of the contraceptive pill or HRT

Women less likely to be affected:

were older (over 70)

had prior existing chronic kidney disease

My comment: From my GP experience I found that these drugs were highly effective and generally well tolerated. A few patients were indeed badly affected by recurrent urine infections and thrush and had to discontinue the drugs.