Mediterranean diet (MD) has been related to reduced overall mortality and improved diseases’ outcome. Purpose of our study was to estimate the impact of MD on duration of admission, financial cost and mortality (from hospitalization up to 24 months afterwards) in elderly, hospitalized patients.
Research Methods & Procedures:
One hundred eighty three elderly patients (aged >65 years), urgently admitted for any cause in the Internal Medicine department of our hospital, participated in this observational study. Duration of admission and its financial cost, mortality (during hospitalization, 6 and 24 months after discharge), physical activity, medical and anthropometric data were recorded and they were correlated with the level of adherence to MD (MedDiet score).
In multivariate analyses, duration of admission decreased 0.3 days for each unit increase of MedDiet score (p<0.0001), 2.1 days for each 1g/dL increase of albumin (p=0.001) and increased 0.1 days for each day of previous admissions (p<0.0001). Extended hospitalization (p<0.0001) and its interaction with MedDiet score (p=0.01) remained the significant associated variables for financial cost. Mortality risk increased 3% per each year increase of age (HR=1.03, p=0.02), 6% for each previous admission (HR=1.06, p=0.04) whereas it decreased 13% per each unit increase of MedDiet score (HR=0.87, p<0.0001).
Adoption of MD decreases duration of admission and long-term mortality in elderly hospitalized patients with parallel reduction of relevant financial cost.
I often get pages from hospital nurses regarding a patient’s request for a sleeping pill. (Or is the request really from the nurse because a sleeping patient is less hassle? LOL.) My hospital’s formulary limits me to ambien, restoril, trazodone, benadryl, and melatonin. Of those, melatonin seems to be the safest in terms of adverse effects and drug interactions. But does it work?
The evidence is mixed and weak. There is some positive evidence for melatonin, and side effects are mild. I wouldn’t discourage anyone who wants to give it a try, but I think good sleep hygiene measures would be a better first step for treating insomnia.
The optimum dosage has not been established. In studies, the doses have ranged from 1 to 12 mg. Supplements typically contain 1-3 mg. Dosages between 1 and 10 mg can raise melatonin levels to 3-60 times the levels normally found in the body.
Caution is advisable, since quality control is a documented problem. 71% of products did not contain within 10% of the labelled amount of melatonin, with variations ranging from -83% to +478%, lot-to-lot variability was as high as 465%, and the discrepancies were not correlated to any manufacturer or product type. To make matters worse, 8 out of 31 products were contaminated with the neurotransmitter serotonin.
If melatonin works by placebo effect alone, it will help ~10% of users, almost always without adverse effects. I dose it at 1.5 mg, with a repeat dose an hour later if needed.
Most of you don’t remember the 1976 flu epidemic. Early on, it appeared to be on track to equal the 1918 Spanish Flu death rates. Politicians and public health authorities felt like they better do something, anything, to avert disaster. Their response didn’t work out too well. COVID-19 isn’t the flu, but it’s a viral illness that often looks like the flu clinically.
From Discover magazine:
Vaccines were once thought of as an axiomatic good, a longed-for salvation in the form of a syringe, banishing crippling and deadly infections like polio, smallpox and tetanus. But within the past few decades we have seen the emergence of anti-vaccination movements and a rise in cases of childhood diseases that are entirely preventable with a quick jab to the arm.
Some of the American public’s hesitance to embrace vaccines — the flu vaccine in particular — can be attributed to the long-lasting effects of a failed 1976 political campaign to mass-vaccinate the public against a strain of the swine flu virus. This government-led campaign was widely viewed as a debacle and put an irreparable dent in future public health initiatives, as well as negatively influenced the public’s perception of both the flu and the flu shot in this country.
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But while the World Health Organization adopted a cautious “wait and see” policy to monitor the virus’s pattern of disease and to track the number of emerging infections, President Gerald Ford’s administration embarked on a zealous campaign to vaccinate every American with brisk efficiency. In late March, President Ford announced in a press conference the government’s plan to vaccinate “every man, woman, and child in the United States” (1). Emergency legislation for the “National Swine Flu Immunization Program” was signed shortly thereafter on April 15th, 1976 and six months later high profile photos of celebrities and political figures receiving the flu jab appeared in the media. Even President Ford himself was photographed in his office receiving his shot from the White House doctor.
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The American public can be notably skeptical of forceful government enterprises in public health, whether involving vaccine advocacy or limitations on the size of soft drinks sold in fast food chains or even information campaigns against emerging outbreaks. The events of 1976 “triggered an enduring public backlash against flu vaccination, embarrassed the federal government and cost the director of the U.S. Center for Disease Control his job.”
One aspect of the fiasco was that of the 45 million U.S. residents hastily vaccinated against Swine Flu, 450 developed a severe neurological disorder called Guillain-Barre syndrome.
For folks taking insulin, Diabetes Daily has a good article by endocrinologist Dr Francine Kaufman. An excerpt:
Everyone with diabetes who takes insulin needs to have a sick day plan. This is something you develop with your healthcare professional to help you manage the high and low sugar levels that can be associated with an illness. The following advice applies to people with type 1 diabetes and people with type 2 diabetes who take insulin – the advice may be different if you have type 2 diabetes and do not take insulin.
Click to jump down to a section:
What happens when you are sick?
Track of your important numbers in a sick log
Vomiting, diarrhea, and dehydration
Insulin, amount and time
Key messages from Dr. Kaufman
When you get sick, you are at risk of becoming dehydrated from poor intake or from excessive loss of fluids due to nausea, vomiting, diarrhea, and fever (your body may lose more water when you have a high temperature). In addition, dehydration is common in diabetes because high glucose levels (above 180-200 mg/dL) cause sugar to enter your urine, dragging an excess amount of fluid with it. Illness also puts you at risk of developing ketones, which when coupled with high glucose levels can lead to diabetic ketoacidosis (DKA), a very serious condition. How do you know if you have ketones? Good question, click here!
The purpose of your sick day plan is to try to keep your glucose levels in a safe range – to avoid dehydration and to prevent ketones from rising to a dangerous level.
Cardiovascular and renal systems simplified in one pic
The cited article below is by Milton Packer, who may have conflicts of interest since he has done work on behalf of drug companies. His article is a review of existing published literature showing beneficial effects of SGLT2 inhibitors on congestive heart failure, cardiovascular death, and kidney disease.
There is compelling evidence that sodium–glucose cotransporter 2 (SGLT2) inhibitors exert cardioprotective and renoprotective effects that are far greater than expected based on their effects on glycemia or glycosuria. In large-scale randomized controlled trials, SGLT2 inhibitors reduce the risk of hospitalizations for heart failure by ∼30% and often decrease the risk of cardiovascular death. This benefit is particularly striking in patients who have the most marked impairment of systolic function prior to treatment. In parallel, SGLT2 inhibitors also reduce the risk of end-stage renal events, including the occurrence of renal death and the need for dialysis or renal transplantation by ∼30%. This benefit is seen even when glomerular filtration rates are sufficiently low to abolish the glycosuric effect of these drugs.
That milk mustache is a tell-tale sign she’s not eating pure paleo
I don’t know, and I’m not sure anybody knows.
The biggest concern about inadequate calcium consumption is that your bones will be weak and brittle, leading to fractures.
Dr Harriet Hall at Science Based Medicine reviewed a NEJM article written by Drs Willets and Ludwig on the health effects of milk.
From Dr Hall:
I was surprised to learn that the US recommendations for milk consumption were based on small, flawed studies of calcium balance. Other countries recommend lower levels of calcium intake. The US recommends 1000-1200 mg for adults, the UK 700 mg, and the World Health Organization, 500 mg. Counterintuitively, countries with high milk and calcium intake actually have the highest rates of hip fracture. Clinical trials of calcium for fracture prevention are complicated, because of confounding factors like vitamin D, phosphorous, and adult height. High calcium intake during childhood and adolescence was thought to serve as a way to “bank” calcium, but studies have not supported that hypothesis. In fact, men’s risk of hip fracture increased by 9% for every additional glass of milk consumed during adolescence.
I’ve been cross-posting about coronavirus and COVID-19 among my three blogs. In view of time limitations and efficiency, I’m going to be posting nearly all my coronavirus thoughts at Advanced Mediterranean Diet. Check it out if interested.
Thus far I haven’t treated a confirmed case of COVID-19 although I’m a full-time hospitalist in Scottsdale, AZ. I’ve been off-duty for four days but return to work soon. If the mainstream media is correct, I’m about to be overwhelmed by cases. So far, I’m overwhelmed by the damage this thing is doing to our economy, not to mention my 401k, which I just did.
Spicy times, indeed.
Steve Parker, M.D.
Click pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.
Why are people with diabetes more vulnerable to infections and complications of infections? It has been shown that people with diabetes are at a higher risk for infections and related complications, and, in particular, for various bacterial infections. Although the reasons for this are not completely elucidated yet and are likely multifactorial, research has shown that high blood glucose levels can directly and negatively impact the immune system and that “…good control of blood sugar in diabetic patients is a desirable goal in the prevention of certain infections and to ensure maintenance of normal host defense mechanisms that determine resistance and response to infection.”As it relates to the COVID-19 outbreak, it follows that maintaining target blood glucose levels is an important preventative strategy for avoiding serious related complications, such as a secondary bacterial infection (i.e., pneumonia) and is likely an important determinant in the patient prognosis for anyone who becomes infected.
Great exercise, but with risk of concussions, broken bones, and torn menisci
Obesity is a risk factor for type 2 diabetes in adults and also plays a significant role in the development of the disease at younger ages. Obesity is highly prevalent among US adolescents and young adults. Many adolescents and young adults with obesity already have blood sugar metabolism abnormalities, which is of great public health concern in view of the sharp increase in type 2 diabetes in adolescence.
From JAMA Network:
In the United States, about 1 of 5 adolescents and 1 of 4 young adults have prediabetes. The adjusted prevalence of prediabetes is higher in male individuals and in people with obesity. Adolescents and young adults with prediabetes also present an unfavorable cardiometabolic risk profile, putting them both at increased risk of type 2 diabetes and cardiovascular diseases.
“These commandments that I give you today are to be on your hearts. Impress them on your children. Talk about them when you sit at home and when you walk along the road, when you lie down and when you get up.”