Your pulse is an indicator how long you will live as well as your fitness

A study published in Heart reports that your resting pulse generally indicates how fit you are. It also modestly predicts mortality rates from the obvious cardiovascular disease but just as strongly with such things as breast, colorectal and lung cancers. A difference of 10 beats per minute equates to a 10-20% difference in mortality.

Also reported in Neurology, Swedish women had their baseline fitness tested in 1968 by ergometry while cycling. There neuropsychiatric status was checked at intervals since.  Women in the highest fitness group delayed in onset of dementia by 9.5 years compared to the low fitness group and by 5 years in the medium fitness group.

Keep it up Emma, all that running about is doing you good. Meanwhile I’m sitting here typing with my resting pulse at 56. Maybe I don’t need to?

From articles originally published in Minerva BMJ 28 April 18 and 7 July 18

 

 

Public Health Collaboration Conference 2018: Achieving your optimal blood sugar target

Videos of the lectures given at the Public Health Collaboration conference 2018 which was held in May over the royal wedding weekend have now been released on You Tube.

You can see my talk, Achieving your optimal blood sugar target, as well as others, on the link below. There are a wide variety of lifestyle topics discussed. Happy viewing.

 

https://www.youtube.com/results?search_query=public+health+collaboration+conference+2018

Exercise games can aid weight loss in overweight children

USA researchers have proven that video games such as Kinect Sports and Just Dance can help overweight children lose weight and improve their cardiovascular risk factors.

Adherence to the programme of one hour three times a week was very high with 94.4 % sticking to the games. 46 families were involved with 23 families in the intervention and control groups.

BMI , blood pressure, total cholesterol and LDL cholesterol all improved in the intervention group.

The study was funded by the AHA.

My Favourite Health & Fitness Freebies

free sign on the Diabetes DietA continuous glucose monitoring system, the MiniMed 670G self-adjusting insulin pump, a personal trainer AND an unlimited food budget so I can buy organic, ethically sourced food all the time…

And, whoops—you interrupted me there in the middle of a reverie relating to the things I’d have to help me manage my diabetes if money were no object. The top of the range monitoring and pump therapy tech is obvious while the food and exercise one less so—but activity and an excellent low-carb diet can help you manage your blood glucose levels.

Stable blood glucose levels don’t guarantee you riches or the partner of your dreams, but a person who doesn’t ride the blood sugar roller coaster is far more energetic, and free to pursue what they want unhindered by the hell of mood swings.

In the meantime, what can we fiscally challenged diabetics do so we can fix our blood glucose levels to the best of our abilities? Here are suggestions for freebies that can help you manage your condition…

YouTube—otherwise known as the exercise channel in our house. Online, you’ll find tens of thousands of exercise uploads—from yoga to Pilates, barre classes, HIIT workouts and weight-lifting. You could spend several years working your way through them and not do the same workout twice. If you find gyms off-putting or their membership fees too expensive, YouTube’s perfect. Look for workouts that don’t need equipment either.

Start with walking workouts (Lesley Sansome’s Walk at Home channel is great). Fitness Blender’s videos are explained well, and the exercises done at a speed you can keep up with. Jessica Smith TV does a huge variety of workouts that offer different fitness benefits, and Heart and Soul Fitness does the same.

MyFitnessPal—there are studies that claim food tracking helps you maintain your weight. Food logs are useful for we diabetics too as they allow us to work out how much insulin we need for meals we eat regularly. MyFitnessPal has a huge database, but you can also add your own recipes and the site will give you a full nutritional breakdown of each.

MySugr – a free app for logging blood sugar results and additional information such as insulin does, exercise, weight, blood pressure and more. The app is useful, but if you don’t log for a day or so you will struggle to remember all the information you need to input for a complete picture of what is going on.

The internet—thanks to the world-wide web, there’s a wealth of information at our fingertips. As a teenager and twenty-something with diabetes, I only knew one or two others with the condition, and we didn’t meet up regularly to swap notes. Now there are forums, websites, charities, blogs, recipes and more online where we can find out more about the ol’ defunct pancreas problem.

A word to the wise… We all know the internet allows unprecedented freedom of speech, which is mostly for the good. But it’s also a place where information spreads unchecked. Blogs—and I include this one too—offer opinions and personal experience, which do not always equate to fact and recommendations suitable for you. Still, the Diet Doctor, Diabetes.co.uk, radiabetes.com and diabetesdaily.com offer gems. (I  apologise if I missed your great site out—limited room here.)

NHS 70 logo on the Diabetes DietAnd finally…drum roll… the NHS! Here in the UK, we folks with type 1 diabetes get free healthcare and prescriptions. I mump and moan occasionally about wanting the latest tech, but I’ve had diabetes for more than 30 years and in that time, I’ve never paid for medications, appointments or equipment. Our fabulous healthcare system has existed 70 years now. It’s shaky on its feet sometimes, but you can’t argue with the wonderful principles at its core—free healthcare for all, based on clinical need.

What are your favourite diabetes freebies? And what websites or blogs do you like?

Retirees are happier when they are active

An Australian study has shown that getting a good sleep at night and being active during the day was the most effective way to boost mood in retirees.

105 people took part in the Life After Work study. They were followed for six month before retirement to 12 months afterwards. They carefully logged their activities and their mood was measured.

The time spent on chores, physical activity, quiet time, screen time, self care, sleep, transport and work, all changed over this period of time. The most favourable substitution was replacing work time with physical activity and sleep.  Replacing work with screen time and social activity showed less effect on mood enhancement.

After retirement, depression, anxiety and stress all reduced.

Olds T et al One day you will wake up and won’t have to go to work: The impact of changes in time use on mental health following retirement. PLoS ONE.2018;13(6);e0199605.doi:101371/journal.pone.0199605. PMID:29953472

Thrity-One-Year-Old Claims Cure for Type 1 Diabetes

A PICTURE OF BLOOD TESTING EQUIPMENT AND NEEDLES

A PICTURE OF BLOOD TESTING EQUIPMENT AND NEEDLESGoogle alerts frequently pairs ‘diabetes’ and ‘cure’ together, but most of the time the words don’t capture my attention. Even when ‘type 1 diabetes’ and ‘cure’ make the same sub-heading, I’m not jumping up and down.

Yeah, yeah, heard it, bought the tee shirt, and no impact on my life so far…

But The Sun newspaper carried a story this week about a 31-year-old who claims to have cured his type 1 diabetes with diet and exercise alone. Again, that approach can achieve results with type 2 diabetes but it’s the first time I’ve seen it accredited to a cure for type 1.

Exercise and diet

Daniel Darkes’ regime isn’t for the faint-hearted. He eats a diet high in zinc (nuts, oily fish and veg) and runs more than sixty miles a week.

But before you dig out your trainers and start stock-piling the Brazil nuts, Daniel’s type 1 diabetes has some qualifications. He has a rare, abnormal gene, which doctors believe might have restarted his pancreas.

The 31-year-old from Daventry in Northants developed diabetes eight years ago and stopped giving himself insulin last January (2017)*. He started cutting down on insulin after experiencing hypos in 2016. He travelled to the US in March 2017 to find out more. Doctors ran further tests to find out what we happening to his body.

Brain sending messages to pancreas

He was put on a fasting diet and exercised at the same time. The medical staff noted his brain had begun sending new signals to his pancreas, and he hasn’t injected himself with insulin ever since.

Daniel told The Sun that doctors believed his abnormal gene combined with exercise is the reason he’s been able to cure himself—it’s as if the gene acts as a back-up immune system and has recharged his pancreas.

He is still being monitored at Northamptonshire General Hospital.

Abnormal genes

I’m fascinated by this story—as I suspect most type 1s will be. I’m no medical expert so my opinions are qualified, but I suspect that Daniel’s abnormal gene plays a huge part in his ‘cure’ (and this won’t be regarded as such until he reaches the two-years-without-insulin mark). It’s also interesting that the description of his diet (scant as it is) sounds like a low-carb diet.

The article said that Daniel’s case “could provide a revolutionary new approach to treating type 1 diabetes”, while Diabetes UK said it couldn’t speculate on whether Daniel had ‘cured’ his diabetes or not, and that there was “no clear cure for type 1 or type 2 diabetes”.

 

*DISCLAIMER – please, for the love of all things injectable, do not skip your insulin injections if you have type 1 diabetes…

 

Coping with T1D in the Heat

Inforgrpahic about the heat by The Diabetes Diet

A screenshot of the weather in Scotland on The Diabetes DietHeavens above—this isn’t a post I’ve needed to write before but the last few weeks of incredible sunshine and heat in Scotland (Scotland! I’ll say it again, Scotland!) necessitates it.

If you’re a type 1, what special precautions do you need to take when the mercury rises? I prepared this handy infographic to help…

Please note—if you have neuropathy (nerve damage) this can affect your ability to sweat and therefore cool down. Go out early in the morning or later in the afternoon if you can, drink water to stay hydrated and exercise in air-conditioned gyms. Cut down on drinks with caffeine and alcohol, and take care of yourself as best you can.

Inforgrpahic about the heat by The Diabetes Diet

Public Health Collaboration Conference 2018: a great success for Lifestyle Medicine

I was delighted to attend and speak at the third PHC conference in London this year.  We met at the Royal College of General Practitioners in London on the sweltering weekend of the Royal Wedding. Apart from superb international speakers we were treated to low carb, high protein food, such as one would typically eat on a ketogenic diet. Instead of picking at our dinners as we often have to do with mass catering  we could eat the whole lot. Great!

Dr Peter Brukner from Australia started off the weekend with a review of what was happening in the low carb world. There are more and more reports coming out describing the advantages of ketogenic and low carb diets to different groups of people but the establishment are fighting back viciously as can be seen by the attack on Professor Tim Noakes in South Africa.  Indeed if his defence lawyers and expert witnesses had not worked for free he would be bankrupt.  This is a terrible way to wage war on doctors who are acting in the best interests of their patients.

Dr Aseem Malhotra also described bullying tactics that had been used against him when he was a junior doctor and first becoming publicly engaged in the low carb debate. I have been subjected to this as well.  Professor Iain Broom showed that the proof that low carb diets are superior to low fat diets goes back 40 years.

Dr Zoe Harcombe gave us an explanation of how the calories in- calories out idea just doesn’t add up. The well known formulas about how many calories you need to avoid to lose weight don’t work in practice because of the complex compensatory mechanisms we have to avoid death from starvation.  How you put this over to patients and give them useful strategies for weight loss and blood sugar control was explored by Dr Trudi Deakin.

Food addiction is a real issue, at least it is for the majority of the audience in attendance, who answered the sort of questions usually posed by psychiatrists when they are evaluating drug addiction.  Unlike drugs, food can’t entirely be avoided but ketogenic diets are one tool that can be used to break  unhealthy food dependence. This worked for presenter Dr Jen Unwin who at one point had a really big thing for Caramac bars.  I haven’t seen these in years but they did have a unique taste.

Dr David Unwin showed clearly that fatty liver is easily treatable with a low carb diet.

Dr Joanne McCormick describes how her fortnightly patient group meetings are making change accessible for her patients and how many GPs in the audience could broach the subject in a ten minute consultation.

The website Diabetes.co.uk will shortly be starting up a type one educational programme online that all are welcome to join. I discussed the issue of what blood sugar targets are suitable for different people and how they can achieve this with dietary and insulin adjustment.

Dr David Cavan spoke about reversing diabetes in patients in Bermuda. Although Bermuda looks idyllic the reality is that good quality food is about five times as expensive in the UK as it is all shipped in. Many inhabitants work their socks off but barely cover their costs and cheap sugared drinks and buns are their staple diet. Despite these setbacks he managed to persuade a lot of diabetic patients to ditch the carbs and this had favourable results even after the educational programme had stopped.

A cardiologist Dr Scott Murray described the effects of metabolic syndrome on the heart and really why sticking stents in diseased arteries is too little, too late. He is convinced dietary change is needed to reverse and prevent heart disease. This is the first time I have been told that certain types of heart failure and atrial fibrillation are direct effects of metabolic syndrome on the heart.

The importance of exercise for physical and mental well being was not neglected and we had Dr Zoe Williams describing the great benefits that even the minimum recommended exercise can produce.

Dr Simon Tobin and Tom Williams spoke enthusiastically about Parkrun. This is a free event that runs every Saturday morning in parks all over the world. You can choose to walk, jog or run the course.

Claire McDonnell-Liu is the mother of two children who have greatly benefited from a ketogenic diet. The conditions are urticaria and epilepsy.  Although NHS dieticians do help families with childhood epilepsy who want to use a ketogenic diet, they can’t do it unless drugs have failed, as this is NICE guidance. I wonder how many children would benefit in fit reduction without side effects of drugs if this guidance was changed?

This was a fabulous conference with a positive enthusiastic vibrancy. Thanks to Sam Feltham for organising this event especially since he has become a new dad as well.

The Public Health Collaboration are putting all the talks on You Tube.

I was interviewed about diabetes and women’s health issues for Diabetes.co.uk and Diet Doctor and these interviews and many others will be available for you all to see to improve your lives with diabetes.

 

 

 

BMJ: Regular, physical exercise is the miracle cure to ageing

Tai chi.jpg

Adapted from Scarlett McNally’s article in the BMJ 21 Oct 17

The NHS and social care are inextricably intertwined. The rising number of older people is frequently blamed. The rising social care costs in this age group can be modified however. NICE in 2015 said, “disability, dementia and frailty can be prevented or delayed”.
The need for relatives or paid carers arises when someone can no longer perform the activities of daily living such as washing, dressing and feeding themselves. For some people the ability to get to the toilet in time is the critical thing between having carers come to their own home twice a day and being admitted to a full time care facility.
The cost of care rises five times for those admitted to residential facilities. An average residential placement costs £32,600 a year and may be needed for months, years or decades.
A cultural change is needed so that people of all ages aspire to physical fitness as a way of maintaining independence into old age. There just doesn’t seem to be the local or national infrastructure to support this however.
Ageing is a normal, if unwelcome, biological process that leads to a decline in vision, hearing, skin elasticity, immune function and resilience, which is the ability to bounce back.
The decline in fitness with age starts around the age of 30 and accelerates after the age of 45. Things move downhill even faster if someone has a sedentary job that involves car driving and computer work. Diabetes, dementia, heart disease and some cancers become more common.
Some may think that fitness in old age is down to genes and luck but social strata differences exist with good nutrition and exercise as major factors in enhancing health and fitness into old age.
Apart from getting older, environment and lifestyle affect disease onset. At the age of 40, some forty percent of people have at least one long term condition and the rate goes up by ten percent each decade. As environmental and behavioural factors stack up over time, more people develop an increasing number of diagnoses. Yet, small habits such as cycling to work, can mitigate the effects of a sedentary job.
As time goes on, a person’s independence can be compromised by well -meaning carers and relatives doing more for their charges rather than letting them do things for themselves.
Genetics are thought to play only 20% of the part in the development of modern diseases. Lack of fitness has more of a part to play than disease and multiple morbidity.
Pain can lead people to limit their activity because they think it could make their illness worse, but strength, stamina, suppleness and balance training are usually needed more rather than less as you get older and accumulate illnesses.
These factors improve cognitive ability in midlife through to a person’s 80s. They can reduce the onset of dementia. Increasing independence results.
The Academy of Medical Royal Colleges go as far as describing exercise as “the miracle cure”. Improving the time to stand from sitting down, walking, and resistance training exercise all produce a dose response effect with the most frail benefitting the most. Any exercise or activity such as gardening that gets you slightly breathless and is done in ten minute bursts or longer counts as the 150 minutes minimum as recommended in the UK.
Stopping smoking and limiting alcohol are also worthwhile interventions. Gyms, walking groups, gardening, cooking clubs and volunteering have all been shown to improve the health and well- being of people of all ages with long term conditions.
When people are admitted to hospital they often experience a rapid decline in function. Patients are not allowed to move about or go to the toilet themselves in case they fall. The numbers of these are considered adverse incidents and are strongly discouraged. Thus the ambulant end up chair or bedbound. Most inpatients spend 80% of the time in bed and more than 60% come out with reduced mobility.
All patients should be encouraged to start an activity programme and gradually increase the frequency, intensity, and time that they do it.
The outdoor environment can be improved by even pavements, open spaces, tables and seating in public areas, safe cycle lanes and restriction in car use.
Money may need to be shifted from passive care and polypharmacy to activity and rehabilitation services.
People need to concentrate on being active every day. A quarter of women and a fifth of men do no activity whatsoever in a week never mind the minimum recommended 150 minutes a week.
In the UK the total social care bill is over £ 100 billion which is virtually the same as spent in the NHS.
The cost of care doubles between the ages of 65 and 75 and triples between 65 and 85. If everyone was just a bit fitter, the savings would add up.
Individuals need to see it as their responsibility to stay fit or improve their fitness. There needs to be more national coordination regarding the environment, transport and our working schedules so that we can all stay that bit functionally younger into old age. We could be making the difference between staying at home or depending on social and residential care.

Kris Kresser: Why has the American approach to heart disease failed?

Why Has the American Approach to Heart Disease Failed?
on April 18, 2017 by Chris Kresser 

Tsimane 2

A recent New York Times article correctly suggests that diet and lifestyle changes are far more effective ways to prevent and treat heart disease than statins and stents. But what diet, and what lifestyle? Is it as simple as avoiding “artery-clogging saturated fat,” as the author suggests? Read on to find out why the American approach to heart disease has really failed.
Jane Brody wrote an article in The New York Times called “Learning from Our Parents’ Heart Health Mistakes.” She argues that despite decades of advice to change our diet and lifestyle in order to reduce our risk of heart disease, we still depend far too much on drugs and expensive procedures like stents.
She says:
Too often, the American approach to heart disease amounts to shutting the barn door after the horse has escaped.
To support this argument, she refers to a recent paper published on the Tsimane, an indigenous population in the Bolivian Amazon. The study found that the rate of coronary atherosclerosis in the Tsimane was one-fifth of that observed in the United States (and the lowest that has ever been measured). Nearly nine in 10 Tsimane had unobstructed coronary arteries and no evidence of heart disease, and the researchers estimated that the average 80-year-old Tsimane has the same vascular age as an American in his mid-50s.
I certainly agree with Ms. Brody so far, and her analogy that the American approach to heart disease amounts to shutting the barn door after the horse has escaped is spot on.
The problem is what comes next, as she attempts to answer the question of why the Tsimane have so much less heart disease than Americans:
Protein accounts for 14 percent of their calories and comes primarily from animal meats that, unlike American meats, are very low in artery-clogging saturated fat. [emphasis mine]
Does saturated fat “clog” your arteries?
Artery-clogging saturated fat? Are we still using that phrase in 2017?
As I’ve written before, on average, long-term studies do not show an association between saturated fat intake and blood cholesterol levels. (1) (I say “on average” because individual response to saturated fat can vary based on genetics and other factors—but this is a subject for another article.)
If you’re wondering whether saturated fat may contribute to heart disease in some way that isn’t related to cholesterol, a large meta-analysis of prospective studies involving close to 350,000 participants found no association between saturated fat and heart disease. (2)

Does saturated fat really “clog” your arteries?

Are “clogged arteries” the cause of heart disease?
Moreover, as Peter Attia eloquently and thoroughly described in this article, the notion that atherosclerosis is caused by “clogged arteries” was shown to be false many years ago:
Most people, doctors included, think atherosclerosis is a luminal-narrowing condition—a so-called “pipe narrowing” condition.  But by the time that happens, eleven other pathologic things have already happened and you’ve missed the opportunity for the most impactful intervention to prevent the cascade of events from occurring at all.
To reiterate: atherosclerosis development begins with plaque accumulation in the vessel wall, which is accompanied by expansion of the outer vessel wall without a change in the size of the lumen. Only in advanced disease, and after significant plaque accumulation, does the lumen narrow.
Michael Rothenberg also published an article on the fallacy of the “clogged pipe” hypothesis of heart disease. He said:
Although the image of coronary arteries as kitchen pipes clogged with fat is simple, familiar, and evocative, it is also wrong.
If heart disease isn’t caused by “clogged arteries,” what does cause it?
The answer to that question is a little more complex. For a condensed version, read my article “The Diet-Heart Myth: Why Everyone Should Know Their LDL Particle Number.”

For a deeper dive, read Dr. Attia’s article.
Here’s the 15-second version, courtesy of Dr. Attia:
Atherosclerosis is caused by an inflammatory response to sterols in artery walls. Sterol delivery is lipoprotein-mediated, and therefore much better predicted by the number of lipoprotein particles (LDL-P) than by the cholesterol they carry (LDL-C).
You might think that I’m splitting hairs here over terminology, but that’s not the case. It turns out that this distinction—viewing heart disease as caused by high LDL-P and inflammation, rather than arteries clogged by saturated fat—has crucial implications when it comes to the discussion of how to prevent it.
Because while it’s true that a high intake of saturated fat can elevate LDL particle number in some people, this appears to be a minority of the population. The most common cause of high LDL-P in Americans—and elsewhere in the industrial world—is almost certainly insulin resistance and metabolic syndrome. (I explain why in this article.)
And what is one of the most effective ways of treating insulin resistance and metabolic syndrome? That’s right: a low-carbohydrate, high-fat diet!
News flash: diets high in saturated fat may actually prevent heart disease.
Perhaps this explains why low-carbohydrate, high-fat diets (yes, including saturated fat) have been shown to reduce the risk of heart disease.
For example, a meta-analysis of 17 low-carb diet trials covering 1,140 obese patients published in the journal Obesity Reviews found that low-carb diets were associated with significant decreases in body weight, as well as improvements in several CV risk factors, including decreases in triglycerides, fasting glucose, blood pressure, body mass index, abdominal circumference, plasma insulin, and C-reactive protein, as well as an increase in HDL cholesterol. (3)
(In case you’re wondering, low-carb diets in these studies had a null effect on LDL cholesterol: they neither increased nor decreased it.)
Saturated fat is a red herring.
Instead of focusing so much on saturated fat intake, which is almost certainly a red herring, why not focus on other aspects of the Tsimane’s diet and lifestyle that might contribute to their low risk of heart disease?

For example:
They are extremely active physically; Tsimane men walk an average of 17,000 steps a day, and Tsimane women walk an average of 15,000 steps a day—and they don’t sit for long periods. Ms. Brody does mention this in her article.
They don’t eat processed and refined foods. We have been far too focused on calories and macronutrient ratios and not enough on food quality. We now know that hunter–gatherers and pastoralists around the world have thrived on both high-carbohydrate, low-fat diets (like the Tsimane, who get 72 percent of calories from carbohydrate) and low-carbohydrate, high-fat diets (like the Masai and Inuit).

But what all hunter–gatherer diets share in common is their complete absence of processed and refined foods.
Perhaps if we stopped focusing so much on the amount of fat and carbohydrate in our diet and started focusing more on the quality of the food we eat, we’d be better off.
And of course we also need to attend to the many other differences between our modern lifestyle (which causes heart disease) and the ancestral lifestyle (which prevents it), including physical activity, sleep, stress, light exposure, play/fun, and social support.
The Tsimane study illustrates exactly why an evolutionary perspective on diet, lifestyle, and behavior is so important. It helps us to generate hypotheses on what aspects of our modern way of life may be contributing to chronic diseases like atherosclerosis and gives us ideas about what interventions we need to make to prevent and reverse these diseases.