These included record-breaking opioid settlements, a new treatment for cystic fibrosis, the promise and peril of large IT brands like Google and Apple moving into the healthcare space, and a devastating outbreak of serious lung disease in healthy young persons from vaping illicit THC.
But in terms of the health story with the greatest potential for taming sickness and the ballooning cost of healthcare, a case can be made for the recognition by health officials in 2019 of the ketogenic diet as a first line-treatment for type 2 diabetes.
The ketogenic diet, as many by now know, is a low-carb diet on steroids, a calorically-unrestricted eating pattern in which just 10-20% of daily calories (or less than 50 grams) come from carbohydrates, with dietary fat making up the majority of remaining energy (roughly 70% of daily calories).
Type 2 diabetes, on the other hand, is an acquired metabolic disorder affecting 340,000 Minnesotans and 30 million Americans, one that currently extracts $250 billion in direct costs each year in the US, and which can lead to heart disease, hypertension, Alzheimer’s, amputation, blindness and cancer.
Because it is often accompanied by obesity, type 2 diabetes is routinely attributed to overeating and lack of exercise, but a more precise description of its mechanism comes down to an elevation of the body’s hormone insulin. Given that the body only releases insulin in response to dietary carbohydrates, type 2 diabetes is arguably a food-borne illness, with the food in question being carbohydrates. That is the rationale, in any event, for treating the predominant illness of our time with a ketogenic diet.
“We need to recognize that conventional diets have not worked well, and reduce the scientific barriers to studying novel approaches, like the ketogenic diet,” says Dr. David Ludwig, an endocrinologist at Boston Children’s Hospital and professor of pediatrics at Harvard Medical School, in an email to Forum News Service. “These long-term studies will provide the definitive data to understand effectiveness for various chronic conditions, and potential side-effects.”
Ludwig recently authored a paper in the Journal of Nutritioncompiling the evidence for ketogenic diets, past and present, a paper complete with a section heading noting there is no human requirement for dietary fiber or carbohydrate. “A century ago,” he reminds readers, “the ketogenic diet was a standard of care in diabetes, used to prolong the life of children with type 1 diabetes and to control the symptoms of type 2 diabetes in adult.”
It was only following the discovery of insulin in the 1920s, Ludwig writes, that high carbohydrate diets gave us our present day medication protocols for type 2 diabetes, treatments anchored by the use of pricey commercial insulin analogs and daily ingestion of glucose-control medications.
Ludwig says he wrote the article to counter “a spate of negative articles (that) have been rewritten about the ketogenic diet by nutrition experts,” articles focusing on rare side-effects.
The case for keto in 2019 kicked off in May, when the American Diabetes Association released a Consensus Report calling low carbohydrate or very low carbohydrate diets a “a viable approach” for certain patients with T2D, including those hoping to reduce medications.
Describing the diets as “among the most studied eating patterns for type 2 diabetes,” the nation’s diabetes authorities added the caveat that ketogenic therapy for diabetes generally requries medical oversight to prevent hypoglycemia. In other words, keto can work so effectively in diabetics that should patients fail to carefully taper medications with medical guidance as their condition improves, they can become dangerously overmedicated.
June of 2019 saw the release of still more arguments for keto, in the form of second-year trial results by researchers from Indiana University Health and Verta Health. Their non-randomized clinical trial of the diet produced data showing that more than half of 262 patients studied had reversed their illness on a remote-monitored ketogenic diet, with many having discontinued the need for all medications except for Metformin.
While noting that the Verta Health results should be interpreted with caution, Ludwig says these “exceptional outcomes at two years, with many participants coming off diabetes medications and improving blood glucose control, highlights the exciting possibility that diabetes can be reversed without bariatric surgery.”
The arrival of keto for type 2 diabetes comes along at a time when the standard of care is increasingly coming up short. The year saw widespread shortages and price hikes for insulin, leading politicians to threaten price control legislation and stirring insurers to issue competing press releases touting their full- or highly discounted insulin coverage packages.
As endocrinology researchers from Mayo Clinic recently wrote in the journal BMJ, “the body of evidence shows no meaningful benefit” for intensive glucose-lowering regimens when it comes to the health outcomes that matter most to patients. And as researchers from Norway confirmed in 2018, telling high-risk individuals the advice to eat more “fiber and polyunsaturated fat,” plus the familiar five servings of fruit and vegetables with “plentiful intake” of beans, wholegrain and low-fat dairy, produced no improvement either.
For its part, the device industry is taking steps to build a ketogenic diabetes care product line, offering portable ketone breath meters and continuous glucose monitors allowing patients to see the effects on their blood sugar of carbohydrate rich foods in real time.
Still to be determined is whether dietary officials will heed the call by groups like the Low-Carb Action Network to include a true low-carbohydrate diet in the next installment of the dietary guidelines. Under the current USDA definition, diets up to 45% carbohydrates, are deemed low-carbohydrate, a too-high allowance for carbohydrates potentially washing out the ability of researchers to accurately test the intervention for disease reversal and prevention.
Its new research on an old method. As Ludwig notes, “before insulin was discovered, a very-low-carbohydrate diet was considered the standard of care for diabetes. From this perspective, modern nutrition science may be in the process of ‘rediscovering the wheel,’ so to speak.”
Fear of Coronavirus sparks run on face masks at pharmacies in Rome.
Rome pharmacies have sold out of protective face masks amid a surge in demand due to concerns over the deadly Coronavirus, reports Italian news agency ANSA.
The scramble to buy masks has been driven largely by tourists and Italians preparing to leave for the airport, according to Federfarma, the Italian pharmacy owners federation.
The move has been described as a “psychosis”, similar to the time of SARS when Rome’s hand sanitisers sold out – Federfarma Roma representative Laura Cesaroni told ANSA – “however the masks will be available again shortly, there are no stock problems.”
The run on face masks in the capital comes as Rome’s Chinese community cancels its Lunar New Year celebrations out of solidarity with China, where the fatal virus originated at the start of 2020.
Passengers arriving into Fiumicino on the three weekly flights from Wuhon, the epicentre of the outbreak, are being segegrated from other travellers and channelled through a separate health corridor for special screening.
With more than 100 dead and thousands infected, the World Health Organization now says the global risk from the deadly virus is “high”, admitting that it got it wrong in its previous assessment which described the risk as “moderate”.
The Chinese government has imposed strict travel restrictions, locking down 20 cities and closing tourist sites in a desperate attempt to rein in the mysterious virus which scientists believe may have “jumped” from bats or snakes to humans.
Since the virus broke out it has spread to more than a dozen countries, from Japan to the US, with the first confirmed case reported in Germany on 28 January.
Severe chills. Aches and pains. Full-body weakness.
Bruce England says those intense symptoms began one night in 2003 after he’d wrapped up a shift as a Toronto paramedic.
“I couldn’t get out of bed, I couldn’t lift my head. I couldn’t go to the washroom,” he recalled. “I just didn’t have the strength. It was like being hit by a two-by-four and not being able to move.”
England called his team to report his sudden illness. Soon after, he says two fellow paramedics arrived at his home in full protective suits to take him to a hospital — where he was whisked right into an isolation room.
His eventual diagnosis? SARS, or severe acute respiratory syndrome, the condition caused by a coronavirus that spread through much of the world in the early 2000s, killing hundreds of people and afflicting thousands more.
As concern grows over the recent outbreak of another newly discovered strain of coronavirus, with two cases now identified in Toronto — one officially confirmed, and one presumed due to the results of an early lab test — England says his experience offers lessons for protecting Canadian frontline workers from a new but familiar threat.
Transparency, communication, and access to personal protective equipment are all key to ensuring the safety of paramedics and hospital staff, he said, echoing the recent comments of Canadian health officials who have stressed that protections are indeed in place.
“To me, there’s no question, we’re going to have more patients,” England warned. “And I worry about the health-care workers. They are putting themselves in harm’s way.”
Lessons learned from SARS
Rising concern over the impact of a coronavirus in Canada follows news on Saturday of the country’s first presumptive case.
That since-confirmed case involves a man in his 50s who recently travelled back to Toronto from Wuhan, China — the city thought to be the origin point for the new virus — who is currently in stable condition at Sunnybrook Hospital.
Health officials now believe his wife is the country’s likely second case; she’s currently in self-isolation, with less severe symptoms that haven’t required hospital care, according to provincial health officials.
Another 19 people in the province are also under investigation for possible infection, said Dr. David Williams, Ontario’s chief medical officer, on Monday.
While Canada grapples with a number of infected patients that could potentially rise, Chinese health commission officials said the number of deaths from the virus in Hubei province — where Wuhan is located — has climbed to 76, with four deaths elsewhere in the country, including one in Beijing, and several thousand others infected.
Ontario’s chief medical officer says preparedness is ‘well ahead’ of 2003 and SARS 3:15
During the SARS outbreak, which also originated in China, England said there was a lack of details flowing from both Chinese officials and medical professionals in Canada.
“I think back then what we didn’t have was transparency,” he said. “We weren’t sharing information quickly.”
England stressed the need for ongoing communication between medical professionals and the public, along with ensuring there are adequate supplies of personal protective equipment for personnel who may transporting or treating patients with the new coronavirus.
Previous research also suggests the added importance of isolating patients and implementing hospital-based screening measures.
“Canada’s experience with SARS illustrates the importance of identifying and isolating every infected individual in stemming the spread of the disease,” reads a 2004 report on the lessons learned from the National Academy of Sciences.
Early on in the Toronto epidemic, undetected patients went on to infect “scores” of others in several different hospitals, even after increased infection control measures were taken. The province later halted between-hospital patient transfers, created separate SARS hospital units, minimized visitor access, and establishing a screening process.
“Because the spread of SARS in Toronto was largely restricted to the hospital setting, these precautions were effective in controlling the outbreak,” the report notes.
Protections, ‘screening measures’ in place
In recent days, health officials have stressed efforts are being made to ensure there isn’t a repeat of a SARS-level outbreak in Canada, which chiefly affected health care workers and patients.
For one thing, the province has implemented “enhanced screening measures” at all emergency medical services’ communication centres to identify potential cases of the cononavirus before dispatching paramedics, said Dr. Barbara Yaffe, associate chief medical officer of health in Ontario, during a Monday news conference.
Speaking to reporters on Monday, Toronto Mayor John Tory strived to quell fears over the virus, saying front-line workers in the city are “well-protected.”
There are now “detailed protocols” in place at both the paramedic and hospital levels, thanks to sweeping changes made in the aftermath of SARS, he added.
During the emergency call from the man who has since been confirmed as infected with the new coronavirus, for instance, paramedics did use “full personal protective equipment,” according to Dr. Rita Shahin, Toronto’s associate medical officer of health.
Looking back on his time during the SARS outbreak, England wishes a similar procedure had been in place then.
Protective equipment procedures weren’t typically in place during those early days, he noted, and he believes he caught his illness from a patient in a hospital about two weeks before his symptoms showed up.
Now 68 and retired, he said getting hit with the illness in his early ’50s took a toll on his health.
England spent two weeks recovering in hospital and another month at home, but still felt unwell after he returned to work, and eventually shifted out of his front-line duties to work in Toronto’s office of emergency management.
Close to two decades later, England said he still has trouble breathing and experiences numbness in his hands and feet — lingering reminders of his brush with a deadly illness.
His message now for policy makers?
“Communicate with the public and look after the health care workers,” he said. “Remember, they’re the front-line staff — if they get sick, look after them.”
While an outbreak of coronavirus in Sudbury is not considered imminent or even likely, health officials are doing their homework and liaising with partners to make sure the city isn’t caught off guard.
Penny Sutcliffe, medical officer of health with Public Health Sudbury and Districts, said there was a meeting Monday of the Community Control Group – a leadership team for emergency planning that includes herself, the chief of police and city managers – “to make sure we are in a state of readiness.”
Public health also met Friday with clinical providers and education officials “to ensure we had good lines of communication with each other and were all accessing the same sites for valid and credible information, and could ramp up quickly if anything needed to happen,” said Sutcliffe.
That meeting was scheduled before the first case of the troubling virus was confirmed in a patient in Toronto.
“Just knowing that the situation was occurring globally, we thought let’s at least think about a scenario,” Sutcliffe said. “We don’t have a crystal ball and we can’t spend all of our time and resources to prepare for something that may or may not happen, but we for sure have to be responsible and be ready to respond.”
The Toronto patient had returned with his wife aboard a flight from China, where the couple had visited the Wuhan area. It is here that the new strain of the virus, which has now claimed more than 80 lives, first began to circulate, causing an outbreak of pneumonia.
On Monday, Ontario health officials said the Toronto man’s wife was also presumed to have caught the bug. She was self-isolating at home while awaiting the results of a diagnostic test.
Sutcliffe said there is a “two-step process” to confirm the presence of the coronavirus.
“It’s a swab that goes down the back of your nose into the back of your throat,” she said. “That sample then goes to the Public Health Ontario laboratory in Toronto, and in parallel, it will also get sent to the national microbial lab in Winnipeg for confirmation.”
While that may involve a waiting period, “at least we have a diagnostic test for this, which we did not have for SARS (Severe Acute Respiratory Syndrome) at the same point in time,” she noted.
Sutcliffe was in Sudbury when SARS — a different type of coronavirus — struck Toronto in 1993, killing 44 people. Nobody in Sudbury was infected, but the local health unit was definitely concerned, and Sutcliffe also spent time in Toronto helping to assist with the emergency.
She said public health learned a lot from that crisis and is in a better position now to deal with similar scares.
“Staying really well informed is critically important and we are much better at that since SARS happened 17 years ago,” she said.
Having a case of the new threat confirmed in Toronto might seem a little too close for comfort, but Sutcliffe said it is far from a given that it would spread to Sudbury.
“We’re being told the risk for Ontarians is still low and I certainly believe that to be the case,” she said. “A certain set of circumstances would have to be in place for it to happen in Sudbury, and at this point, it would have to be a travel-related case – perhaps somebody returning from a business trip or a student returning from a trip home.”
She said those working locally and provincially to track the spread of the virus are in a “vigilant” mode, but “certainly are not panicked. I would say the leaders and participants we’ve spoken to, it’s on their radar, they’re staying apprised and ready to mobilize if need be, but otherwise going about their daily business.”
Health Sciences North is definitely paying attention and taking the potential problem seriously.
“We want to assure the public that HSN is following the guidance of the chief medical officer of health and that we have all the recommended processes in place to ensure both our staff and patients remain safe,” the organization said in a statement.
Apart from working with health unit and the city on a coordinated approach to the threat, “we are also actively screening patients who come to the hospital for fever, acute respiratory illness and pneumonia, as well as for any relevant exposure or travel history,” the hospital said.
While there is no vaccine to protect against the new type of virus, Sutcliffe said Sudburians who haven’t yet been immunized for the flu should definitely still do so now.
“We know it is influenza season and numbers show about 3,500 Canadians die every year from this,” she said. “We have a vaccine, and it’s free, but not everybody gets it.”
Symptoms of the coronavirus can be quite similar to those associated with flu and colds – a fever and/or cough, along with difficulty breathing.
Anyone who has paid a recent visit to Wuhan, China, or been in contact with someone who has done so, and develops such symptoms, should avoid contact with others and follow up with their doctor or nurse practitioner, the health unit recommends.
Such individuals are urged to call TeleHealth Ontario or their health-care provider to make special arrangements before going to the emergency department at HSN in order “to help limit the potential spread of infection.”
Sutcliffe said the coronavirus situation is rapidly evolving, and the virus itself could mutate and become more virulent, but “at this point in time, a person is not at risk if they have not travelled to the Wuhan area of China, or been in contact with somebody who has travelled there and is ill themselves.”
So if you are experiencing respiratory symptoms but have no connection to Wuhan, “it would be the same old boring but effective advice,” said Sutcliffe. “Stay home, get lots of fluids, get lots of rest. Make sure you do your best to not infect other people by covering your nose and mouth when you sneeze and cough. Wash your hands. And get your flu shot.”
For more information on the coronavirus and how to reduce your chance of getting an illness and spreading it, visit www.phsd.ca.
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