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Dr Malik reads a news story with interest…Regenerate the pancreas…

Dr Malik read a news story with interest: “Fasting regenerates the pancreas in Diabetes Mellitus (DM)”

However, this was a study in mice that were genetically prone to DM. They had 4 days severe dieting (perhaps an equivalent of 1000 calories, but mainly as fat, not carbohydrate or protein), and then a normal diet for 3 days. This was repeated.
Beta-cells in the pancreas make insulin. It seems that periodic starvation could get their beta-cells (which were withered away), to reactivate or regenerate.  In non diabetic mice, they found a drop in beta-cells activity in the diet, which could of course be alarming, but a recovery within 24-48 hours, and a better gene activation pattern. So the beta cells could be “tuned-up”.

Weight Loss is good for you

Weight loss is known to be important in treating type 2 DM in humans. Calorie control is vital in prevention and treatment. Bariatric surgery is now also a validated treatment for severe diabetes. So is pancreas transplantation. This study suggests that you might be able to “auto-transplant” a better pancreas into yourself by dieting.
DONT try this diet at home without medical advice. High fat diets also have risks. Losing weight gradually is a good idea. Long periods of starvation (as in famines and world wars) have been known to increase the lifespan of survivors, but how to apply that in daily life in the world today has not been fully worked out.
Mouse research can take a decade to get to a human equivalent.

Dr Malik on new agents in Diabetes – when should I take them?

When should I take the new agents in Diabetes?

The SGLT-2 Inhibitors have been around for a few years (Empagliflozin, Canagliflozin, Dapagliflozin).

The data on cardiovascular benefits are increasing, but as with all powerful drugs, they can’t be used in all patients.

They are useful in a type 2 Diabetic, with good renal function (eGFR>45 ml/min/kg), but evidence of cardiovascular disease, heart failure, and some albuminuria. Your cardiologist will need to carefully consider if it is worth while in your particular case. Caution is needed as they can cause low blood sugar, ketoacidosis (esp in Type 1 diabetics), dehydration, and genital infections.

How do they work? They block the reabsorption of sugar in the kidney- you pass more sugar and water out.

The Figulla ASD device – see it in action!

Dr Malik says:

It is worth seeing what I put inside you to close a hole in the atrial septum (an atrial septal defect-ASD).

The indications for closure are:

  1. Dilated right heart, showing strain from the abnormal shunting
  2. The shunt from left to right across the ASD being large (comparing flow on the left and right 1.5:1 shunt)
  3. A paradoxical embolism- clot moving from the right to the left

ASD closure is done under general anaesthesia with X-Ray and echo guidance. It is a very safe and effective procedure- please see some of my cases on YouTube.

 

 

 

 

Evolutionary medicine: hypercholesterolaemia

Dr Malik says:

My summary of this interesting article: as humans evolved in a cycle of mainly food shortage, and occasional feast, and did not live into a ripe old age, the authors argue that having more lipids in the blood leads to a reproductive survival advantage. Perhaps you survived starvation better, perhaps you could run from a sabre tooth tiger faster.
Who knows – but to cope with 21st century risks, the reproduction is perhaps not the issue: living well and living longer is; thus the focus on diet, exercise, control of risk factors especially smoking, blood pressure and diabetes.
For the Medics, it explains lipid metabolism. For the non-medics, biologically plausible mechanisms to explain why we are built as we are… BUT it does not mean that is the truth.

Octopus Pot Heart – Takotsubo Cardiomyopathy

Takotsubo Cardiomyopathy occurs when extreme physical or emotional stress causes, not a blocked artery, but a direct effect on the heart muscle – it stops working properly. It looks and feels like a “heart attack”, and it can be fatal.

We need to exclude a blocked artery (a coronary problem) and infections that can sometimes affect the heart i.e. myocarditis.

However, it we can tide you over in the 1st week, the amazing thing is that the heart can go back to normal function again.

Read more here.

How much radiation do cardiac tests give me?

Dr Malik says: “We will pick the best test for you. All are safe. If you are worried about radiation doses – don’t be.”

A dose can be measured in Seiverts.
A 1000 microSeiverts (uSv) makes a milliSeivert (mSv) and a 1000 mSv makes a single Seivert.
Usually we quote in milliSeiverts (mSv).

Ultrasound based tests and MRI scans have no radiation involved.
A CT calcium scan provides about 1 mSv, which is similar to the radiation from a mammogram.
A CT Coronary angiogram ranges from 2 to 7 mSv.
Nuclear medicine stress tests ranges from 4 to 10 mSv.

The average person receives about 3 millisieverts (3 mSv) of background radiation per year from natural sources.