Diabetes and lifestyle adjustments

A decade-long study published in the venerable New England Journal of Medicine (NEJM) which means these findings are akin to coming directly from God (everyone knows, of course, that God is clearly a doctor) has concluded (very depressingly) that among diabetics, a group that has an exceedingly high risk of stroke and heart attack, losing weight does not seem to reduce the risk of dying from cardiovascular disease.

In this study, the control group and the group that focussed intensely on weight loss and lifestyle adjustment had roughly the same number of deaths over the nearly 10 years of the study, which terminated early because of the lack of evidence to continue it.

So: losing weight won’t help, right?

Not so fast.

First, neither of the groups lost as much weight as one would have liked to see to figure out if weight control has any effect.

Second, the intense lifestyle group did have better kidney function and fewer eye complications (both are frequent complications of diabetes).

Anyway, for me, the bottom line is something else: by the time you try to change your life around after you’ve been diagnosed with diabetes, it may be too late to make a big difference in your life expectancy, so why not, eh, make those adjustments before you develop diabetes.

Just suggesting. 

Healthy diet in teens

A lesson that should apply to lots of teachers, mentors, coaches: lectures are usually the least effective teaching tool.

A study published in JAMA Pediatrics looked at over 2000 teens and their parents, some of the teens being overweight, some of normal weight.

Both among the overweight and normal teens, those parents who used simple information to inform their kids about eating well were more likely to have that teen follow a healthy diet than were those parents who ‘hectored “my choice of word) their teen to eat better in order to lose weight.

Even more instructive to me because I strongly believe this is always the case, those parents who ate a healthy diet themselves were much more likely to have their kids eat well, too.

You want your kids to eat well?

You want them to exercise?

You want them to use alcohol judiciously?

You want them not to text and drive?

Follow those healthy guidelines yourself and your kid is more likely to follw them, too.

End of lecture.

Flu shots work and are safe

The very good news about flu shots is that they work.

And they’re safe.

First, a recent study estimated that flu shots (which are recommended for nearly everyone in the US) resulted in 13 million fewer infections over a 6 year period in the US.

That’s 13 million, a pretty impressive number.

Then, a second study from the meticulous record-keeping Kaiser Permanente Vaccine Study Center in Oakland, California, concluded that there is no evidence that flu shots cause Guillain-Barré syndrome (GBS), which is has long been one of the main concerns about this vaccine.

Bottom line: flu shots are not perfect.

In fact, they are not even very good vaccines in the very elderly.

But they’re all we have and they work and are safe.

Get your flu shot when it becomes available this fall. 

HCV testing for boomers

Important note for all baby boomers: The U.S. Preventive Services Task Force (USPSTF), which is a pretty conservative group in what it thinks needs doing, has just come out with a recommendation that all baby boomers be tested for hepatitis C (HCV).

Why now?

Because of "the strength of evidence on the benefits of HCV testing linked to care, treatments, and improved health outcomes”

In other words, according to the USPSTF (and according to most other experts, too), we have improved HCV therapy so much that it’s now worth – from both a persona perspective and as a benefit to society in terms of medical costs - finding it and treating it, thus significantly reducing the complications of HCV, which include cirrhosis of the liver, liver cancer and liver failure.

And since the US CDC estimated that a couple of million Americans are HCV positive and don’t know it (applying similar numbers to Canada, which is probably accurate, would yield roughly 200,000 HCV Canadians who don’t yet know they carry this virus), on top of which the majority of those unknowing individuals are baby boomers, that’s the reason for this recommendation.

So if you’re a boomer, and especially if you ever experimented with IV drug use, even only once or twice, this is worth paying attention to.

No cognitive benefit from HRT for menopause

A study about hormone replacement therapy (HRT) in menopause (yes, an issue that just goes round and round and round) just published in JAMA Internal Medicine was reported with some very interesting headlines.

Basically, the study found that giving HRT to younger women (aged 50-55) going through menopause, something that’s become quite trendy, offers no benefit in terms of cognitive function.

Nor does it harm cognitive function.

Most headlines covering this story were accurate and pointed out that there was neither a benefit nor a risk from using HRT in young women.

A couple of headlines, though, including one for a medical web site that is widely read by doctors reported the study as No Mental Harm from HRT in Early Menopause.

I mean, given that HRT is being pushed once again on this cohort for its reputed benefits and given that most experts believe that the risks are pretty well documented now, seems to me that it would be the lack of benefit that would be the most important part of this story to report.

But in fact, in this article that is meant to help doctors decide what to do in respect to HRT, it wasn’t until the 4^th paragraph in the story that the reporter stated that “the results showed no obvious benefits of HRT with respect to cognitive function.”

Curious.