What will happen in Medicine in 2019

What will happen in medicine in 2019?

I believe this is a time of great change, where the cost of many treatments will be beyond the reach of both patients and governments, and a lot more "back to basics" therapies, which are probably just as effective, will return.

Cancer – our understanding of cancer, and the enormous expenditure on finding specific treatments for specific forms of cancer have lead to an explosion of new drugs. These are incredibly successful compared to previous therapies, but how are we going to pay for them? Supplements and herbs such as turmeric, garlic, mistletoe, and others are becoming accepted by oncologists, and I believe that the ketogenic diet which starves the cancer cells of sugars will become 1st line treatment.

Heart disease – over recent years there has been an explosion of angioplasty and stents for all forms of angina, but many studies have shown that only in cases of unstable or uncontrolled angina are these any better than medical treatment. Many predict that the number of stents being inserted will drop dramatically. High doses of fish oils (greater than 2 to 3 g a day) have been proven to be beneficial, as well as regular gentle exercise, and Coenzyme Q10. Interestingly around the world the incidence of heart attacks appears to be dropping.

Diabetes – drug treatments and diets have all been unsuccessful in reducing the incidence of the horrible side-effects of this disease. The ketogenic diet with or without intermittent fasting can virtually cure type 2 diabetes, and with great care can also be helpful in type I. (I'm writing a booklet on this which will be available in the next few months).   Gastric bypass surgery will also become more available.

Alzheimer's disease – the incidence of this continues to rise, and we really don't know why. The ketotic diet, or taking ketone supplements does seem to improve the symptoms, and some have suggested that intermittent fasting might help clear the nerve cells of the buildup of amyloid tissue which seems to cause the condition.

With drugs are becoming increasingly expensive, health professionals are beginning to look back towards the benefits of lifestyle, diet and supplemental treatment, leaving the introducing drug treatment as late as possible.

Omega-3 fish oils reduce heart disease, vitamin D and fish oils do not seem to affect cancer.

At the recent American Heart Association and Congress of Cardiology, two very important studies were presented. The first (VITAL) trial followed 26,000 people over five years, some had vitamin D, some had fish oils (1 g daily), some have both and some have none. They looked at the incidence of cancer, and also cardiovascular events which they described as heart attacks, strokes and heart deaths. The conclusion was that there was no significant benefit from either vitamin D or fish oils, however, when they looked at just heart disease (and removed stroke) there was a 30% reduction in heart attack and heart deaths. (Because this was not prespecified, and was called a subgroup analysis, people are saying this is a negative trial!)

At the same meeting, the REDUCIT trial was published, with 3 g of fish oils taken daily, and in the study there was a 25% reduction in heart attack, cardiac events and death. This was incredibly significant (p<00000005), even more so because many of these people were already on full medical management including statin drugs.

It is amazing how the profession does its best to ignore complementary treatments, but I don't think there is any doubt now that omega-3 fish oils, provided it is quality oil (mercury free and pure) and taken an adequate doses does make an enormous difference to people with heart disease, or more importantly people at risk of heart disease. It is such an easy and innocuous preventive treatment, particularly when compared with most of the drugs we have available.
I believe that everybody at risk of heart disease or with disease should be taking 3 g of omega-3 fish oils per day.

Fish oil supplements are fantastic for heart disease!

Fish oil supplements are fantastic for heart disease!

Recent publications have suggested that fish oil supplements in low doses make little difference to heart disease, and people have been advised not to take them. Note I discussed this in my blog three sections down.

However, this has been turned upside down in a recent huge study called the REDUCE-IT trial used 4 g of fish oils daily, in a double-blind randomised trial involving 8179 patients followed over 4.9 years. The results were incredible. All cardiovascular events (death, non-fatal heart attack, non-fatal stroke, need for angioplasty or bypass surgery or unstable angina with all reduced over 25%.
This result is incredible and better than anything claimed by the statin drugs.
It obviously shows that omega-3 fish oils are extremely effective in people at risk of heart disease, but you need to take enough, and it does need to be a quality product.
A smaller study performed in Japan (JELIS trial) using a slightly lower dose of 1.8 g daily achieved in 19% benefit.

So fish oils are very beneficial to people at risk who want to avoid heart disease, or who already have it., But you need to take enough, and I would personally recommend 2 g twice a day of a quality product. There are no significant side-effects, and we have no medicines that can compete with these results.

Dairy is good for us

Dairy consumption coming out of the closet!

For many years Heart Foundations and Associations have been strongly recommending their patients eat a low fat diet, and the current American Heart Association recommends "fat-free and low-fat dairy products as part of healthy eating pattern".

A recent study published in the September 11 online Lancet medical journal has thrown considerable doubt on this. The PURE study looked at over 136,000 adults in 21 countries (both rural and urban) and followed them for nine years, showed that those who ate two or more servings of whole fat dairy products per day at a lower rate of cardiovascular disease, mortality and total mortality than those who did not. The incidence of stroke was also halved in those individuals who consumed dairy products.
Previous studies have also demonstrated the positive benefits of dairy products, most have been conducted in North America and Europe, and this study coordinated from Canada has suggested that we should be taking a very different approach to dairy products, and probably saturated fats.
There is quite a strong emphasis around the world to reduce sugar intake which is leading to the epidemic of obesity, and the only way to do this is to replace the sugar with fats. The study confirms that doing so is highly unlikely to do anything other than good!
It also means that diets such as the Paleo and ketogenic diet are a great deal safer and in fact more beneficial than the conventional authorities have recommended in the past.

I suspect in the not too distant future the guidelines on fat intake will be making a significant U-turn.

Should we be taking aspirin

Should we be taking aspirin?

Even though doctors have been recommending patients to take aspirin for many decades, there is still considerable uncertainty on whether we should be making this recommendation, and if so to whom, and what dose?

A recent study suggested that perhaps when people were larger they needed more aspirin, rather than the conventional dose of 100 mg. Two large papers coming from Europe (one involving more than 15,000, and the other more than 12 a half thousand people) have fortunately clarified the situation and confirmed that 100 mg is fine. (More greatly increases the risk of stomach bleeding, with little or no benefit). Large and small people should all take the same dose (100mg).

Primary prevention – people with no evidence of heart disease, we don't have enough evidence to suggest that this is beneficial, and the risk of stomach bleeding is far greater than any possible benefit. Sadly the studies do not confirm that aspirin has any benefit in preventing cancer. Conclusion - don't take aspirin as a preventative.

Those at higher risk – i.e. people with diabetes or family history, again we don't have enough evidence to suggest that this is necessary or beneficial.

People with established heart disease – the data suggests that taking aspirin does reduce the risk of further heart events by about 12%, and I don't think is any doubt that unless there is some contraindication, people who have angina or a heart attack, had angioplasty or bypass surgery should be taking 100 mg of aspirin.  There is a slight increase in the risk of bleeding (usually from the stomach of between 0.5 and 0.9%)

Should I throw away my fish oil supplements?

Should I throw away my fish oil supplements?
Not yet, not if you are taking the right dose or the right brand!

Three recent studies have thrown doubt among the population on the benefits of fish oils, despite many years of evidence from populations on the benefits from cardiovascular disease, rhythm problems and strokes. I have reviewed these below, but in summary, they have all used a low dose of fish oils, and the quality of the fish oils used is almost certainly suspect. Two trials did show a slight improvement in heart attacks and rhythm problems, and suggested that perhaps if a higher dose had been used the results may have been different.

The take-home message is yes use fish oils, they can do absolutely no harm, and if given in sufficient doses using a quality supplement, could make a major difference in heart attacks, strokes and rhythm problems.

Is today's world affecting pacemakers and defibrillators? Electric cars.

More and more people are having pacemakers inserted, and a large number of internal defibrillators are being used in patients with serious heart disease. These can be affected by magnetic fields, in fact, when the pacemakers are checked different magnetic signals are used to interrogate (find out previous rhythms) and also program these very complicated electronic machines. It is potentially possible for strong magnetic fields either to turn off the pacemakers or defibrillators temporarily or possibly even reprogram them.
I've discussed this a little more on my website (click here) .
Metal detectors at airports can make a temporary change in pacemaker function, and people with pacemakers should be encouraged to walk relatively rapidly through these. Also asked the man or lady with the wand detector to move the wand past the pacemaker area fairly quickly.

One recent real concern, however, has been electric cars which are becoming increasingly common, and with the electronic fields created by charging, and also the magnetic component of the motor and possibly batteries – could this affect pacemakers? In a recent study reassuringly the modern electric vehicles appeared to make no difference to either pacemakers or implantable defibrillators. The magnetic fields are highest when the cars are being charged, so it is probably best not to sit in the front seat of the car or near the batteries while the car is being charged. The message, however,
is very reassuring. Whether this will apply to the new super-sized electric cars or extremely rapid charging we do not know, but at the moment they appear to be to be very safe.