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#DietSpeak: slaying the high fat dogma

It is about time we started rejigging our diets away from carbs to high-fat foods. #DietSpeak
Although this is not a randomised control trial we can use observational studies to draw conclusions. It is becoming increasingly clear that high carbohydrate intake is bad for you and that a high-fat diet is better for you. 
In this large macronutrient study higher carbohydrate intake is associated with an increased risk of total mortality whereas intake of total fat and each type of fat was associated with lower risk of total mortality. 
This is just the latest piece of evidence showing a high-fat diet is good for you. 

Dehghan et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet. 2017 Aug 28. pii: S0140-6736(17)32252-3. 
BACKGROUND: The relationship between macronutrients and cardiovascular disease and mortality is controversial. Most available data are from European and Nort…
Recent posts

#PredictPD: Is this the disease modifying therapy the PD community has been waiting for?

Is exenatide the game-changer we need in Parkinson's disease? #PreventiveNeurology #PredictPD
Would you participate in a study to define your future risk of getting Parkinson's Disease (PD)? In other words would you like to know you are likely to develop PD in the future? A lot of people answer by saying it depends if you have a treatment to prevent PD. At present we don't, but the study below of a exenatide,  a glucagon-like peptide-1 (GLP-1) receptor agonist, suggests it may be neuroprotective in patients with established PD. If this study's findings are confirmed in larger phase 3 studies and leads to exenatide being licensed as a disease-modifying therapy, or DMT, for PD changes all this. This means we can take people at high-risk of developing PD and randomise them to receive either placebo or exenatide to see if it can prevent, or at least delay the onset of, PD. This study alone creates the incentive for people from the general public to participate in population…

#PreventiveNeurology: falling incidence of dementia

Will treating the whole population with the polypill reduce the incidence of all-cause dementia? #PreventiveNeurology



The falling incidence of dementia in England and Wales may be explained by cardiovascular risk modification and supports our ambition to test the polypill at a population level to reduce all-cause dementia. A falling incidence does not sort out the issue for the society and the government because the prevalence of dementia (number of people alive and living with dementia) is still increasing. There is also a very good podcast from the BMJ on the finding's. 



Ahmadi-Abhari et al. Temporal trend in dementia incidence since 2002 and projections for prevalence in England and Wales to 2040: modelling study. BMJ 2017;358:j2856

Objective: To forecast dementia prevalence with a dynamic modelling approach that integrates calendar trends in dementia incidence with those for mortality and cardiovascular disease.

Design Modelling study: Setting General adult population of England a…

#PreventiveNeurology: misdiagnosis needs a solution

How are we going to get the general population to sign-up for screening for neurodegenerative diseases? #PreventiveNeurology
Two of the three diseases we are targeting as part of our Preventive Neurology initiative will capture people with Diffuse Lewy Body (DLB) disease, i.e. Parkinson's disease and all-cause dementia. The BMJ commentary and DLB consensus report highlight the problem of misdiagnosis. If we are careful and embed in our prediction algorithms the right patient-related outcome measures and cognitive testing we should be able to identify a cohort of people with early DLB. May be this is wishful thinking. One of the obstacles we are going to find is getting members of the general population to sign-up for screening. Any ideas? 

Joseph Freer. UK lags far behind Europe on diagnosis of dementia with Lewy bodies. BMJ 2017;358:j3319

Excerpts:

..... Around half of UK patients who have dementia with Lewy bodies (DLB)—about 60 000 people—have it misdiagnosed, usually as the far mo…

#PreventiveNeurology: is life a sexually transmitted neurodegenerative disease?

Age is a disease vs. Ageing as a natural biological process: have your say #PreventiveNeurology #HealthyAgeing

I have always cracked the joke 'that life is a sexually transmitted neurodegenerative disease with a 100% mortality'. This usually gets a mutated laugh until people start pondering the implications of the joke and realise that I am being serious.



Evolution never designed, and selected, the human brain and nervous system to function much past 35 years of age. It is only relatively recently that life expectancy has increased with the requirement of our brains to function into old age. It is clear that when we measure cognitive function, and brain volume, it is all downhill from about 35 years of age. Those of us who are older than 35 notice the subtle cognitive impairments that increase with age and the gradual malfunction of our nervous systems. When last have you tried tight-rope walking? Your failing balance system is simply a reflection of the global rot that is also …

#BrainHealth & #PreventiveNeurology: can we afford a biological therapy for Alzheimer's disease?

The costs of modifying the course of Alzheimer's disease with a biological therapy are mind-blowingly large. #BrainHealth #PreventiveNeurology
The perspective in this week's NEJM is a sobering reminder of why we need effective preventive strategies for Alzheimer's disease (AD). If we have to rely on Pharma to deliver expensive biological disease-modifying therapies (DMTs) to treat the disease it may end up costing society an extortionist amount of money. 
As most people with AD rely on the state for their healthcare can society afford expensive DMTs for symptomatic AD? I am not sure we can. People with symptomatic AD have already lost too much brain and slowing progression of their AD at this stage may be too late to have an impact on their, and their family's, QoL. The other issue is cost-effectiveness; most people with AD (pwAD) are aged and not economically active and hence any DMT will have to be relatively cheap to pass NICE's cost-effective thresholds. It is li…

#BrainHealth: biologics for cardiovascular prevention

I predict a brave new world in which a significant proportion of the population will be receiving pharmacological interventions to optimise the ageing process. #BrainHealth #PreventiveNeurology
The following study is a good example of the revolution that genomics has brought to the practice of medicine. 
The discovery (2003) that gain-of-function mutations in the proprotein convertase subtilisin–kexin type 9 (PCSK9) gene causes autosomal dominant hypercholesterolaemia, and the identification (2005) of loss-of-function mutations in PCSK9 causing lower low-density lipoprotein (LDL) cholesterol levels, led to the PCSK9 pathway becoming a therapeutic target. 
PCSK9 is a secreted serine protease that binds to the extracellular domain of the LDL receptor and targets the LDL receptor to the lysosomal compartment for degradation. PCSK9 prevents recycling of the LDL receptor to the cell surface, thereby attenuating LDL clearance. PCSK9 circulates in plasma, where it is closely associated with lip…