Doctor's Diary: Carnivores do not have a higher incidence of cancer than vegetarians
Last week’s decision by the World Health Organisation to ran Kham as major carcinogens is the more baffling for being so readily refutable. If correct then, by definition, carnivores would have a higher incidence of cancer than vegetarians – just as smokers compared to non-smokers. They do not.
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This unreliability of "expert" opinion on dietary matters is no trivial matter, particularly for the millions with type 2 diabetes for whom the standard nutritional advice over the past 33 years paradoxically compounds the difficulties of managing their condition.
To clarify: diabetes, as all know, is due to insufficient insulin responsible for the uptake of the fuel glucose into the cells and which as a result remains in the circulation, causing hyperglycaemia or a raised blood sugar level. The major dietary sources of glucose are the carbohydrates in bread, pasta, rice, potatoes and pulses – hence the logical and long-standing recommendation to restrict the amounts consumed in favour of the other major source of calories, meat and dairy products.
Then in 1982 the British Diabetic Association, in a remarkable volte face, reversed this sensible and clinically efficacious advice on the grounds that the saturated fats in meat and dairy products were harmfully predisposing people to narrowed arteries, with their attendant complications of heart attacks and poor circulation to which diabetics are particularly prone.
And so it has been ever since, with all those newly diagnosed with diabetes routinely encouraged to include a generous portion of carbohydrates with every meal. This has not reduced their risk of vascular complications but has made it more difficult to control blood sugar levels and lose weight.
By contrast, as previously described in this column, those who opt to defy the prevailing orthodoxy and revert to the previously sanctioned though currently anathematized low carb diet can, as many studies now confirm, predictably anticipate a marked improvement in, or even resolution of, their diabetes. Some may wish to discuss this further with their doctor and should usefully peruse Dietary Carbohydrate Restriction as the First Approach in Diabetes Management by Professor Feinman and others, published in the journal Nutrition in January of this year and available on the internet.
Failure to identify fractures is the commonest diagnostic error in casualty
Catapulted over his bicycle handlebars on to unforgiving concrete, Telegraph columnist Jeremy Warner was no doubt relieved to hear his X-rays showed no broken bones, with the considerable back pain he was experiencing being attributed to muscle spasm that would resolve on its own accord. It did not and, as he recently described in this paper, was compelled, when still struggling to stand upright after a couple of months, to privately procure an MRI scan that revealed he had in fact sustained a nasty compression fracture of one of his vertebrae.
His failure to identify fractures on X-ray, notes Bristol orthopaedic surgeon Michael Kelly, is the commonest of all diagnostic errors in casualty departments. Hairline fractures around the elbow and in the hand are readily overlooked, only becoming apparent when a subsequent X-ray shows evidence of healing. Further, normal X-rays of the hip and ankle apparently “do not exclude” the possibility of a fracture warranting the additional investigations of a CT or MRI scan.
The explanation for Jeremy Warner’s overlooked compression fracture was rather more prosaic: his several X-rays, it transpired, had not included that part of the spine causing him “considerable” pain. In busy casualty departments, such mistakes will be made – but it is only sensible to be aware that the reassurance of a normal X-ray does not necessarily mean there is nothing broken.
A cure for the menopause?
Finally, it is most regrettable that over the past decade so many women have been denied the benefits of hormone replacement therapy on the basis, as mentioned in this column last week, of disputed claims about its possible dangers. Nonetheless, while the swing of the pendulum back in HRT’s favour is obviously welcome, it is not for everyone.
“Six or eight times a day I would get this most unpleasant sensation of a rush of adrenalin, followed by a hot flush,” writes one woman intolerant of HRT because it exacerbated her migraine. They would even wake her at night leaving her chronically exhausted and anxious.
Her sympathetic family doctor advised she take instead a low dose of the antidepressant Venlafaxine, whose serotonin boosting effects include (for reasons unknown) preventing the dilation of the blood vessels responsible for those hot flushes. She was initially sceptical but is “happy to report” that both her menopausal symptoms and anxiety are much improved, along with the mood swings that would “leave me down for two or three days at a time.”
