Glucosamine supplements related to lower cancer mortality

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Adapted from Medscape 5 Dec 2022 by Vinod Rane BS Pharm

Glucosamine, popularly used for osteoarthritis, has previously been found to have anti-inflammatory properties and regular use has now been shown to reduce cancers overall and particularly kidney, lung and rectal cancer.

This was a large prospective study that included 453,645 participants aged 38 to 73 who did not have cancer at the start of the study.

19.4% were taking glucosamine regularly and 80.6% were not. The patients were followed up for a median of 12 years.

Cancer was reduced in cancer overall 0.95, kidney cancer 0.68, lung cancer 0.84 and rectal cancer 0.76.

The study did not include the dose, form and duration of supplement use and there could be a risk that the people who took glucosamine also followed other healthier behaviours than those who didn’t.

My comment: I have been taking glucosamine for 23 years now and it has been a great benefit to my joints. I can see that confounding could be a problem. Non smokers greatly reduce lung cancer, vitamin D users are less likely to get rectal cancer, and slim people are less likely to get kidney cancer.

Zhou J et al Associaton between glucosamine use and cancer mortality. A large prospective cohort study. Front Nutr. 2022;9:947818.

Covid infection as good as two vaccinations in prevention of future attacks

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BMJ 18 March 2023

The Lancet has published research concerning the effect of clinical Covid 19 infection protection against further infections.

Looking at 65 research studies, the conclusion is that alpha, beta and delta variants strongly protected against future infection. There was 78% protection at 40 weeks post covid. The Omicron variant however was less protective, immunity only being 36% at 40 weeks.

Any infective agent however was highly likely to protect against hospital admission or death. The effectiveness was 90% at 40 weeks.

This was considered as useful has having had two mRNA vaccines.

Good news for those who have had Covid infection.

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.

Worsening obesity in children can be reversed with a ketogenic diet

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Adapted from Independent Diabetes Trust Newsletter March 2023

The National Child Measurement Programme 16 March 2022

In the western world obesity rates continue to climb in children. In the UK when children start primary school at the age of 4-5 14.4% are obese and a further 13.3% are overweight. In Primary 6, at the age of 10-11 25.5% are obese and 15.4% are overweight.

My comment: from my own schooldays, there was only one overweight child in my primary class and she was on steroids and had a heart complaint that stopped her from participating in any exercise. In primary 7, there was one girl who was overweight and she had started puberty earlier than the rest of us.

In the USA in 2019 more than 30% of children were overweight or obese, similar to the UK figures. Physicians are reporting that since the Covid epidemic children are usually between 5 and 10 pounds heavier than they were at any given age, so these figures are likely to worsen even more.

Since 2006 Duke University has treated more than 15,000 children with a restricted carbohydrate diet which encourages the eating of vegetables, fatty fish, nuts and other features of the Mediterranean diet.

Meghan Pauley and colleagues from the Marshall University School of Medicine in Huntington West Virginia have cut the carbohydrate intake for children further to 30g or less a day and have been effective in short term weight loss in severely obese children and teenagers.

The ages of the subjects ranged from 5 years to 18 years. The study lasted 3-4 months. The children were otherwise told to eat as much fat and protein as desired with no limit on calories.

Two groups of analyses were done of different intakes into the programme in 2017 and 2018.

 In Group A, 310 participants began the diet, 130 (42%) returned after 3-4 months. Group B had 14 enrollees who began the diet, and 8 followed up at 3-4 months (57%).

Girls compared with boys were more likely to complete the diet. Participants less than 12 years age were almost twice as likely to complete the diet compared with those 12-18 years, however, the older group subjects who completed the diet had the same percentage of weight loss compared with those under 12 years. Group A had reductions in weight of 5.1 kg , body mass index (BMI) 2.5 kg/m2 , and percentage weight loss 6.9% .

Group B had reductions in weight 9.6 kg , BMI 4 kg/m2 , and percentage weight loss 9% . In addition, participants had significant reductions of fasting serum insulin and triglycerides.

This study demonstrated that a carbohydrate-restricted diet, utilized short term, effectively reduced weight in a large percentage of severely obese youth, and can be replicated in a busy primary care office.

Intermittent fasting: what are the results?

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Adapted from Medscape, What do we know about intermittent fasting by Carla Martinez Nov 28 2022

A session was dedicated to intermittent fasting at the 63rd Congress of the Spanish Society of Endocrinology.

In animal studies it has been shown that the same number of calories consumed in the morning result in greater weight loss/less fat deposition compared to when the same number of calories are consumed in the late afternoon or evening. Results in humans are less consistent though. My comment: perhaps because they watch television and have well stocked cupboards and fridges!

In humans who ate late, they reported twice as much hunger as the early eaters and energy expenditure and body temperature both reduced by 5%. Thus early eating seems to be more favourable.

Intermittent fasting regimes can very greatly in the window of opportunity allowed for feeding. Researchers found that being consistent with whatever schedule they followed resulted in reduced body weight, an improvement in metabolic efficiency, sleep duration and sleep quality, cardiovascular health, level of mood and quality of life. My comment: so many of us work variable shifts or have different wake and sleep times, feeding times and exercise patterns on work days compared to off days.

Caloric restriction with a generous ten hour eating window resulted in weight, blood pressure and lipid improvements in people who had metabolic syndrome. Even in healthy subjects such as firemen who worked 24 hour shifts, limiting food intake to ten hours resulted in a reduction in HbA1c, LDL and diastolic blood pressure.

Dr Labayen is working on the Extreme Project which is testing obese people from Navarra and Grenada in Spain. There are 200 subjects, evenly spread between men and women, and they are advised to follow a Mediterranean diet and consume all their food within an 8 hour eating window. They are divided into early eaters, late eaters and free choice of eating window eaters. How easy the diet is to maintain and its effectiveness on body measurements and any side effects are being measured.

So far there have been fewer side effects than expected with night time hypoglycaemia more pronounced in the early eating group. There is more fat and muscle loss in the time restricted eating subjects compared to a control group who are not restricting their eating time, and the window time has not made any difference. Cardiovascular factor improvement seems to be the most noticeable effects.

Rafael de Cabo PhD, on the other hand primarily works with animals, particularly monkeys and mice. Perhaps, as these animals are not free to cheat on their diet, the effects have shown to be much better than in humans. Fasting has been shown in animals to improve cardiovascular disease, diabetes, cancer, and neurodegenerative disorders. A smaller eating window produces more positive effects than a larger window. Circadian rhythms improve, they eat fewer calories overall, weight and body fat reduces, blood pressure, oxidative stress, inflammation, and arteriosclerosis all are reduced. Hunger is also reduced. These effects occur whether the animals are obese or not. The difficulty is transferring these results to the general public. Currently there are at least 50 human trials underway with increasingly larger cohorts and different forms of intermittent fasting are tried out.

BMJ: Group programmes for weight loss are more effective than one to one sessions

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Adapted from BMJ 26 Feb 2022 NIHR Alert

Around one in four UK adults is living with obesity. Previous research has established that the most effective way to lose weight is through behaviour change with diet and physical activity counselling. It has not been clear whether one to one sessions or group sessions produce the better outcome. Thus a review of 7 studies which included 2,576 participants from the UK, US, Australia, Germany and Spain was done.

The study looked at the outcome of reaching at least a 5% reduction in body weight after a year. This means that a person of 100kg would lose 5kg.

Compared to one to one sessions, people in group sessions:

Lost on average 1.9kg more weight

Were 58% more likely to lose at least 5% of their body weight

Group classes had 12-55 hours treatment time and those in one to one sessions had 2.5 to 11 hours.

The costs of treating people in groups is also lower than one to one sessions. The quality of life of people who are obese would be more likely to improve and their would be fewer cases of diabetes, heart disease, stroke, and cancer that all require medical treatment.

NICE are intending to publish revised guidelines on the treatment of obesity in 2023.

Healthcare professionals can now confidently say that group educational programmes are at least if not more effective than one to one sessions when referring or advising patients. Social support in groups and more intensive interventions may account for greater success but for some people eg who are anxious in groups or who need translators, or even just patient preference, will mean that one to one sessions will still need to be offered. Further research into what specific factors improve results would be helpful.

No chips with mine thanks!

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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?

Low carb diets are beneficial for weight normalisation after childbirth

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Everyone knows how hard it is to shift body fat after having a baby. A recent study suggests that adopting a low carb diet featuring plentiful meat/poultry/fish and animal fats was more successful than having a low carb diet based mainly around plant foods.

Readers who are keen to shed their post holiday season weight gain may also find this information useful.

Low-carbohydrate diets (LCD) have been considered a popular dietary strategy for weight loss. However, the association of the low-carbohydrate dietary pattern with postpartum weight retention (PPWR) in women remains unknown.

The present study involved 426 women from a prospective mother-infant cohort study.

Overall, animal or plant LCD scores, which represent adherence to different low-carbohydrate dietary patterns, were calculated using diet intake information assessed by three consecutive 24 h dietary surveys.

PPWR was assessed by the difference of weight at 1 year postpartum minus the pre-pregnancy weight. After adjusting for potential confounding variables, women in higher quartiles of total and animal-based LCD scores had a significantly lower body weight and weight retention at 1 year postpartum (P < 0.05). The multivariable-adjusted ORs of substantial PPWR (≥5 kg), comparing the highest with the lowest quartile, were 0.47 (95% confidence interval 0.23–0.96) for the total LCD score (P = 0.021 for trend) and 0.38 (95% confidence interval 0.19–0.77) for the animal-based LCD score (P = 0.019 for trend), while this association was significantly attenuated by rice, glycemic load, fish, poultry, animal fat and animal protein (P for trend <0.05).

A high score for plant-based LCD was not significantly associated with the risk of PPWR (P > 0.05). The findings suggested that a low-carbohydrate dietary pattern, particularly with high protein and fat intake from animal-source foods, is associated with a decreased risk of weight retention at 1 year postpartum. This association was mainly due to low intake of glycemic load and high intake of fish and poultry.

Co-enzyme Q10 in cardiovascular and metabolic disease

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Adapted from Co-enzyme Q10 in Cardiovascular and Metabolic Diseases: Current State of the Problem, by Vladlena I Zozina et al. Current Cardiology Reviews 2018 Aug: 14(3) 164-174.

Co-enzyme Q10 (CoQ10) is an essential compound of the human body. There is growing evidence that it is tightly linked to cardiometabolic disorders. Supplementation can be useful in a variety of chronic and acute disorders. This review article discusses its role in hypertension, ischemic heart disease, myocardial infarction, heart failure, viral myocarditis, cardiomyopathies, cardiac toxicity, dyslipidaemia, obesity, type 2 diabetes mellitus, metabolic syndrome, cardiac procedures and resuscitation.

CoQ10 is made in the inner membrane of the mitochrondia. These are the little batteries which power your cells. It exists as ubiquinone which is oxidised and ubiquinol which is does not have oxygen attached. It is a key component of electron transfer in ATP production, which is how cellular energy is generated.

It is also an intercellular anti-oxidant. It also plays a role in cell growth and differentiation. There are many diseases and degenerative states associated with CoQ10 deficiency such as type 2 diabetes, atherosclerosis, hypertension, dyslipidaemia, muscular dystrophy, Alzheimer’s disease and Parkinson’s disease.

Administration of selenium and CoQ10 in a group of elderly people over 4 years resulted in significantly reduced cardiovascular mortality over the next ten years. This new review aims to sum up current possibilities in a variety of conditions with an analysis of the impact on health and quality of life.

CoQ10 is found in all organs but the highest concentrations are in the heart, kidneys, liver and muscles.

Three out of four patients with heart disease have low levels of CoQ10, particularly in ischaemic heart disease and cardiomyopathy.

In 2010 31% of all adults had hypertension. This rate is rising, particularly in low income countries.

CoQ10 has a direct effect on the lining of blood vessels, the endothelium, which dilates the blood vessels in hypertensive people and so reduces blood pressure. It also has a blood pressure lowering effect via the angiotensin effect in sodium retention and lowers aldosterone. Blood pressure can be lowered as far as normal levels with CoQ10 and has been measured as reducing systolic bp by 11 mmHg and diastolic by 7mmHg.

Giving 300mg daily of CoQ10 has been shown to reduce inflammatory markers and raise anti-oxidant enzyme activity. It is well known that a pro-inflammatory effect is a major component of chronic disease.

In 2013 cardiovascular diseases were a worldwide leading cause of death causing about a third of all deaths. A randomised study showed that in patients with myocardial infarction and hyperlipidaemia, supplementation resulted in lower blood pressure and a beneficial rise in HDL. After primary angioplasty after a heart attack, patients with higher levels of CoQ10 had better ventricular performance at 6 months follow up.

In rat studies infusion of CoQ10 results in less cardiac damage when their cardiac vessels are occluded to provoke cardiac ischaemia.

Heart failure causes less blood to be pumped out of the heart with every heart beat. This can be from a combination of structural and functional heart problems. HF is the cause of a huge amount of hospitalisation and cardiac impairment. Deaths from HF range from 10% to 50% per year. The plasma level of CoQ10 has been found to predict mortality in HF patients. Supplementation has been found to be beneficial in raising the level and decreasing mortality rates.

CoQ10 helps the heart muscle beat with more power. 100mg given three times a day to HF patients showed a reduction in cardiovascular mortality (9% v 16%), all cause mortality (10% v 18%) and number f hospital stays. Exercise tolerance was improved at the end of 2 years observation.

In those patients on the waiting list for heart transplants, CoQ10 users had a significant improvement in functional status, clinical symptoms and quality of life. Although the drugs for HF are still essential, there can be some additional benefits to CoQ10 supplementation.

Atrial Fibrillation is increasing worldwide year on year and is associated with symptoms and mortality. Supplementation has been found to reduce arrhythmias after surgery or drugs to stimulate the heart muscle after surgery.

In mice studies survival rate was higher in those given CoQ10 than those who were not when they had viral myocarditis. In humans both CoQ10 and trimetazidine have been found to be effective.

Cardiomyopathy is associated with a high mortality and poor quality of life. It is linked to increased oxidative stress. Supplementation has been found to improve both cardiac structure and function. Fatigue and breathlessness improved. These studies have been done in both adults and children.

Cardiac toxicity is an unwelcome side effect for certain cancer drugs used in chemotherapy. CoQ10 and L-carnitine together have been found to be cardio-protective.

Supplementation has been found to reduce side effects of statins in heart failure patients. This is because statins deplete CoQ10 levels.

Although low CoQ10 has been found in type 2 diabetes patients, supplementation had no effect on glycaemic control, lipid profile or blood pressure. Triglyceride levels were reduced.

In patients with metabolic syndrome had a beneficial effect on insulin levels with supplementation.

Women with polycystic ovarian syndrome had a beneficial effect on glucose metabolism, and cholesterol levels with supplementation.

Studies have been done during and after cardiac surgery and in the management of post cardiac arrest care. In one study hypothermia plus supplementation resulted in considerably improved outcomes compared with hypothermia without supplementation. The three month survival was 68% v 29%.

Supplementation studies have shown a potential role in septic and haemorrhagic shock patients.

Further research needs to be done to establish the optimal doses to give for various conditions and situations.

Levels of 100 -300mg of CoQ10 per day seem to be effective for a wide range of problems.

Colorectal cancer is affected by your experience in the womb

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Adapted from BMJ: 18 Sept 2021

A longitudinal study of women from Oakland California has been following 19 thousand of their offspring since the early 1960s.

So far 68 people have been diagnosed with colorectal cancer.

Risk factors include: obesity in the mother, weight gain during pregnancy, and a high birthweight. This suggests that uterine life has something to do with why this cancer develops. This could explain why there has been a relatively recent increase in colorectal cancer in younger aged adults. Unfortunately there is little you can do yourself about these factors.