A skeptical look at popular diets: The lowdown on low carb

In the seventh post in the series A Skeptical Look at Popular Diets, physician Randall Stafford examines down the pros and cons of a low-carb diet.

By Randall Stafford

As the name implies, this diet reduces dietary carbohydrates, including many common foods that contain sugars and/or starches. To make up for this reduction, the intake of protein and fat can increase. Frequently, however, low-carb dieters do not fully replace the calories from reducing carbs and they lose weight as a result.

This diet has several favorable features, but a high intake of animal-based saturated fats can offset the benefits. One version, the Atkins Diet, was promoted to facilitate weight loss. A problem with interpreting “low carbohydrate” is that there is no consensus on how low is “low.”

Health rationale slogan: Restricting carbs helps you lose weight and solves many metabolic problems.

Analysis: Depending on how low carb you go, a lower carb diet potentially restricts multiple common foods including grains, legumes, fruits, breads, desserts, pastas, and starchy vegetables. Particularly off-limits: processed foods made with flour and added sugars. Food sources higher in protein and fat take their place, such as meats, eggs and nuts.

The diet’s potential benefits are many, including helping reverse insulin resistance, an early stage in the development of type 2 diabetes. It does this by restoring normal carbohydrate processing. By restricting carb intake, the body no longer has to cope with a large, sudden influx of sugar into the bloodstream. In addition, people following this diet may experience less hunger when they restrict calories, which facilitates weight loss (at least in the short term).

Stanford nutrition scientist Christopher Gardner, PhD, studied longer term weight loss and demonstrated similar favorable benefits from a lower carb vs. a lower fat diet when both approaches focused on healthy choices.

The food sources that are low carb range widely in healthfulness. For example, meat has no carbohydrates, but if meat intake is increased to replace carbohydrates, this can boost unfavorable saturated fats. Interestingly, in Gardner’s weight loss study, the group that followed a healthy low-carb diet had no adverse metabolic effects. This group decreased overall calories almost solely by restricting carbohydrate-rich foods, without substantially increasing protein or saturated fat intake.

If the carbohydrate restriction goes beyond added sugars and refined grains, to the point of restricting vegetables, whole grains and beans/legumes, this can result in vitamin and mineral deficiencies. And, if carb intake is low enough, ketosis can occur with its accompanying nausea, headache, physical and mental effects, and bad breath. Additionally, carbohydrate-rich foods are the primary sources of fiber, and low-fiber diets increase the risk of colon cancer and may have adverse effects on the gut microbiome.

Easy to follow?: Depending on how severe the carbohydrate restriction, this diet can be difficult to follow because it can dramatically restrict the intake of most of the major food groups, including fruits, beans/legumes, grains, starchy vegetables, and dairy.

Dominant source of protein: Animal proteins such as meat and eggs, which don’t contain carbs (unlike protein-rich legumes and grains).

Most common fats: Oils and saturated fats from meat.

What about carbs?: Limited carbs, but some variations of this diet can include potentially good carbs found in fibrous vegetables and beans/legumes.

When it goes wrong: Emphasizing meat consumption can lead to problems. High intake of the saturated fats found in meat may increase the risk of future heart disease and cancer. This harm would be greatest from emphasizing fatty red meats (steak, bacon, etc.) or processed meats, as opposed to leaner meats, such as poultry.

To make it healthier: The potential health benefits of lower carb diet can be maximized by focusing primarily on eliminating added sugars and refined grains, and emphasizing sources of fat from plant sources (e.g., olive oil, nuts, avocados), from fatty fish (e.g., salmon), or from lean meats.

Variations: The Atkins diet emphasizes restricting carbs, but allows as much fats and protein as desired. If carbohydrates are severely restricted, a low-carb diet becomes a ketogenic diet.

If you’re going to cheat: Including beans/legumes may make sense because their more complex starches and fiber differ from the simple starches in processed grains and starchy vegetables. Eating these foods provides a much greater range of possible foods, making the diet easier to follow.

Conclusion: A lower carb diet can offer weight loss and metabolic improvements. In its extreme forms where all starchy vegetables, bean/legume, fruit, and grain intake is restricted, it is difficult to follow and has the drawback of high saturated fat and low fiber intake.

Nonetheless, this diet could be a good starting place for initiating weight loss when the focus is on minimizing added sugars and refined grains, and maintaining or even increasing fibrous vegetables.

This is the seventh post in a series called A Skeptical Look at Popular Diets. The series will review the eight currently most prominent diets in America. The next blog post will discuss low-fat diets.

Randall Stafford, MD, PhD, is a professor of medicine at Stanford. He practices primary care internal medicine and studies strategies for preventing chronic disease. Stanford professor and nutrition scientist Christopher Gardner, PhD, examines the impact of diet on health and disease. Min Joo Kim provided research assistance.

Photo by Jakub Kapusnak

Let’s stop fighting cancer.

Today, I woke up to a deeply sad message from Alex Trebek, delivered in his trademark calm and classy fashion, where he announces he was diagnosed with stage four pancreatic cancer:

The video of Alex Trebek announcing he was diagnosed with pancreatic cancer, posted on Twitter.

I wish him all the best and I hope he is able to heal and recover quickly, so he can continue to fulfill his contract to the show for another three years, as he drily quips in the video.

The language of cancer

As you’ve probably observed if someone close to you is being treated for cancer, the treatment regime has two, often three, aspects. The most obvious aspect is the physical — surgeries, radiation, chemo, drugs; the whole medical machinery rolling into action. The second is the psychological — how the patient is able to face the incredibly difficult mental journey they embark on as they contemplate their own mortality and the illness itself. And finally, there’s the spiritual/religious element that plays an important part for many.

The language often used around the treatment of cancer might be helpful for the tactical aspects of cancer — the medical side of the treatment. But for the two others, it is problematic.

Trebek says “I’m going to fight this,” and “I plan to beat this disease,” and “We will win”. I fully understand the sentiment; he’s about to roll up his sleeves and do everything he can to get healthy again.

The language of cancer is the language of war.

While Trebek’s language is relatively mild, it hints at something that is pretty common in our society: The language of cancer is the language of war. It’s ‘the battle against cancer.” We hear “I’m going to kick Cancer’s ass.” It is “I will fight.”

The top reply to Trebek’s post is a great joke — but also relies on fighting metaphors.

The problem with this type of language is that wars have a loser, and while humans have some somewhat sophisticated anti-cancer weaponry on our side, cancer is a formidable foe.

As a patient, you’re about to disappear into a foxhole with dozens of cancer-weapon-wielding doctors who don’t always agree on how to treat you, a bewildering jungle of information available to you on the internet and in the medical literature, and a dawning realization that as a species, we’re not as proficient at curing cancer as we’d like to admit to ourselves.

All of which is to say… When people who are diagnosed with cancer take on the war metaphors, it is reassuring to those around them. “Oh, good. Alex is a man with access to great health care, and he’s going to fight hard. He has a” — dare I say it — “fighting chance.”

I don’t know Trebek, but I do know that most people I know who are diagnosed with cancer are facing a battle at three fronts: Spiritual, mental, and medical. My problem with the language of war is that it is only potentially helpful on the medical side. To mental health and spirituality, war metaphors are anathema and deeply counter-productive.

Facing mortality

When we are talking about cancer as a ‘fight,’ it is problematic because if it looks like someone might fail to recover from the illness, they started the treatment process by promising to ‘fight’, and they put the responsibility to win on themselves.

It’s a very short step from realizing that you are losing the ‘battle’ against cancer, to blaming yourself for not ‘fighting hard enough’.

They promised to fight. They were going to war. They were going to beat this. If things do not go to plan — and they often do not — it has a tremendous psychological impact on the patient. They are being let down by their doctors with dwindling prognoses and deserted spiritually because it turns out the prayers didn’t work as well as they might have. And now, as they are feeling the weakest they have in their whole lives due to a combination of the illness itself and the treatment thereof, the language of war is doing real mental health damage. It’s a very short step from realizing that you are losing the ‘battle’ against cancer, to blaming yourself for not ‘fighting hard enough’.

Undergoing cancer treatment is hard enough without having to blame yourself for it potentially not working. I would like to invite us all to stop using the language of war when it comes to medicine. It is unfair to expect of people to ‘fight’ or ‘battle’ or ‘beat’ a disease that has claimed a great number of human lives — especially as you’re already weakened from the very illness you’re fighting.

Let’s leave the door to self-forgiveness ajar, and leave the war metaphors safely locked away.

Rory Media Kit

What’s Rory?

Rory is an end-to-end service for women’s health offering accessible, high-quality, personalized healthcare to help women through the biological changes of midlife and beyond.

Details

  • Announcement date — Wednesday, March 20th, 2019
  • Pricing — Products start at $9 per month
  • Availability — Rory products will be available nationwide. Telehealth services will launch in 47 states, covering over 99% of the U.S. population
  • Website — www.hellorory.com

Why focus on midlife.

There are two large hormonal shifts in a woman’s life: puberty and menopause; the permanent absence of menstrual cycles (NCBI). While puberty is a largely guided process (moms having “the woman talk” with their daughters) menopause is often a lonely and confusing shift, one that approximately 43M women in the U.S. between the ages of 45 and 64 experience (CDC). Many women are unprepared to deal with the changes they go through during midlife and nearly 55% of women going through menopause don’t do anything at all to treat symptoms (ACOG).

Almost all women will experience at least one symptom of menopause, if not many. These can include low libido, mood changes, weight gain, chills, hair loss, dry skin, insomnia, vaginal dryness and hot flashes.

Hot flashes, for example, are estimated to occur in over 75% of women (ACOG). They typically last 5–7 years but can last up to 10–15 years (HHP). While simply annoying for some, hot flashes can be debilitating for others.

Unlike hot flashes and other general menopausal symptoms, vaginal changes do not improve with time. While symptoms such as lack of lubrication and pain with sex affect up to 45% of women in midlife and older, only a minority seek help or are offered help by their health provider (NAMS). When women were asked how vaginal discomfort affected their lives, 80% said it affected their lives negatively, 75% said it had negative consequences on their sex life, and 68% said it made them feel less sexual (VIVA).

Even healthcare providers grapple with conditions in midlife. When asked specific questions about vaginal dryness, a quarter of gynecologists, and one third of general health practitioners were not able to correctly answer the questions (NAMS).

The unmet need here is huge.

Rory’s homepage

Why is Rory a game changer?

Rory is the first nationwide telehealth service for women in midlife. Developed by experts in women’s health, Rory provides women with a much needed menopause treatment plan to restore their quality of life and serve as a confidante. Rory offers white-glove care, education and resources to better understand and deal with menopausal symptoms anytime they come up.

Rory offers both holistic and prescription solutions backed by science for common menopause symptoms. Rory meets women where they’re comfortable — equipping them with options to make more informed decisions about their treatment options.

How Rory Works

1. Doctor’s Visit — Complete an online doctor’s visit about your medical history, lifestyle and menopause symptoms. A Rory-affiliated physician will review your information, follow up with any questions via message, phone or video, and determine if prescription treatment is appropriate for you.

2. Treatment — Should the physician deem it safe and appropriate for a prescription via telehealth, they will recommend a personalized treatment plan. The treatment will be shipped (for free) from Ro’s own pharmacy network.

3. Support — Rory members receive ongoing support from their Rory-affiliated physician, and can message them at anytime. They can also join Rory’s online community, Roar, to get support from other women experiencing menopausal symptoms.

Rory is not a replacement for in-person doctor visits, it’s a complement to help women safely and easily seek help for bothersome menopausal symptoms outside of their interactions with their primary care physician.

Farewell, Dr. Gottlieb, you will be missed

What his resignation means for the industry

This past Tuesday, March 5th, the life science and healthcare worlds were gripped by near-universal shock and sadness when Dr. Scott Gottlieb announced his resignation as the commissioner of the Food and Drug Administration (FDA), effective next month.

Gottlieb entered office with nearly the perfect resume for being FDA Commissioner — a medical doctor, former FDA Associate Commissioner during the GW Bush administration, a regulatory policy wonk, and a biotech VC — he had an ideal set of lived experiences for navigating a very difficult job that requires balancing the interests of different stakeholders with often diametrically opposed views. And, he performed that job splendidly, earning praise from industry, Congress, President Trump, and the press. Unlike many of his predecessors, it is difficult to find people who are critical of his tenure.

And contrary to the belief of those who are critical, industry’s support of Dr. Gottlieb was emphatically not because he was an “anything goes, let’s neuter FDA” shill for Big Pharma. Indeed President Trump was considering, before choosing Dr. Gottlieb, candidates of exactly that mindset, which frightened the industry. Scott Gottlieb was loved, especially those of us who work primarily with startups, because he moved incrementally in a pro-innovation direction, while being transparent about his objectives. No one benefits from a (presumably Republican) FDA Commissioner who plays it fast and loose. In life science you must think in decade-long terms, and with that mindset you inevitably realize that the next FDA Commissioner can reverse any policy that their predecessor may have implemented by fiat.

What industry needs from a regulatory agency is predictability and responsiveness to new trends in innovation. Gottlieb delivered both. He was attentive to, effectively, every new trend in medical technology: digital health, synthetic biology, generics, biosimilars, the widening epidemic of teen e-cigarette use (vaporizers with e-liquids containing nicotine and flavors), and addressing opioid misuse. In nearly every arena one got the sense that FDA was actively monitoring and thinking about how to further its mission of protecting public health while helping to speed innovations that make medical products more effective, safer, and more affordable.

So what does his resignation mean?

Immediately, not much. The FDA Commissioner has little to do with day-to-day facility inspections and product approvals that characterize much of the Agency’s work. Center directors Dr. Janet Woodcock (of CDER) and Dr. Jeffrey Shuren (of CDRH) remain in place, and they will continue implementing policy directives developed over the past two years. But the Commissioner acts in a sense like the captain of a supertanker, setting direction and cadence, and defending those decisions to outside stakeholders (notably Congress). Dr. Gottlieb has done this well and established a significant legacy in a short period of time; his tireless efforts to drive innovative policies at FDA is matched by his dedication to family and his decision to return full-time to their home in Connecticut. Whomever is next appointed to succeed him has big shoes to fill.

Though we at Enzyme have great respect for Dr. Gottlieb and his handling of a difficult position, and more broadly his public service, we also think this is a time to reflect: Why does the choice of an FDA Commissioner matter so much? Ultimately, it’s because the process of regulatory approval for drugs and medical devices is still too opaque and arbitrary, forcing stakeholders to ‘read the tea leaves’ about how their regulator might react to new, particularly novel, products or initiatives. A leader at FDA perceived as being pro-innovation bolsters confidence (and investment). But this is a dynamic that is not particularly healthy.

That’s why at Enzyme, we spend each day building products that add clarity and certainty to the regulatory process. Our mission is to advance human health by reducing the time and cost of the medical product lifecycle. If you’re building medical technology, or you’re interested in helping all those who are get their products to market faster, and therefore benefit all of us, please get in touch.

We offer Dr. Gottlieb our thanks and best wishes and wish him happy trails for whatever comes next.

Importance Of Eggs In Your Diet

Remember the scene in Rocky, where he gets out of the bed, breaks 12 eggs in a mug and drinks them raw…. Yaaaa ….

Apart from speed and agility, reflexes and endurance the most important part of a players ability which can make the real difference is strength. The first thing that comes to mind when I think of tennis and strength together is of Nadal, crushing the ball with his big powerful arms and legs.

Diet plays such an important role in a player’s progress and performance. What goes in reflects outside right? So, are you looking to hit the ball with increased spin and power? Well, then its time to increase your strength and power.

What’s The Eggs Made Of

The best way to increase strength in the most inexpensive way is to eat eggs. According to Authority Nutrition, it is considered the highest nutritional food available. Here is a more scientific and detailed view on what the egg really contains –

Source — Authority Nutrition

A single large boiled egg contains –

  • Vitamin A: 6% of the RDA.
    • Folate: 5% of the RDA.
    • Vitamin B5: 7% of the RDA.
    • Vitamin B12: 9% of the RDA.
    • Vitamin B2: 15% of the RDA.
    • Phosphorus: 9% of the RDA.
    • Selenium: 22% of the RDA.
    • Eggs also contain decent amounts of Vitamin D, Vitamin E, Vitamin K, Vitamin B6, Calcium and Zinc.
    • This is coming with 77 calories, 6 grams of protein and 5 grams of healthy fats.

Well that is huge. Imagine you are feasting upon around 3 to 4 eggs a day after a gruesome training session, and you will see the difference within 1 week or so.

How They Help You In Your Game –

• Eggs are way more fulfilling and keep you lean as you do not consume unnecessary calories. In short, you get fit and not bulky, which is very important for tennis players
• They supplement your muscles and help you stay longer on the court and hit the ball with extra power and energy.
• They further heal up those torn fibres and help you built strong muscles.
• Help in recovery process too

In the end I will conclude with the most renowned slogan of NCC –

“ Sunday ho ya Monday, Roz khao ande”

8 Foolproof New Year’s Resolution

Goodbye, 2017. Hello, 2018! 👋

If you’re reading this: give yourself a pat in the back. You’ve managed through all the goods and the bads that 2017 has thrown at you 👏

Now that the New Year is just right around the corner, it’s time to think about the good things that happened this year and jumpstart your 2018 for success! We usually take the time to reflect what we’ve accomplished so far and make some goals to make ourselves better for the upcoming year.

New Year symbolizes a new beginning, a step towards a better self.

What’s your New Year’s Resolution for this upcoming year?

1. Eat more fruits and vegetables

According to MyPlate, eating an overall healthy diet that is rich in fruits and vegetables may reduce risk of heart disease, certain type of cancers, obesity, and type 2 diabetes. As fruits and vegetables tend to be low in calories, it can lower calorie intake. Furthermore, eating fruits and vegetables that are high in fibers keep you full for longer — perfect to lose some of that holiday weight!

Keep track of your fruits & vegetables servings with EatLove

2. Drink more water

Did you know that two-third of our body consists of water? Thus, it seems like a no-brainer that getting enough water everyday is essential for our bodily function. CDC mentions that water aids in balancing body temperature, lubricates joints, protects spinal cords and other sensitive tissues, and get rid of wastes.

3. Meditate

Set aside a few minutes of your day to de-stress and clear your mind. Studies suggest that meditation improves emotional health, helps to develop stronger understanding of oneself, increases attention-span, fights insomnia and pain, and decreases blood pressure.

4. Get moving 🏃

Be it going up the stairs instead of taking the elevator, parking in the farthest lot when you go grocery shopping, or a full on workout — every little step you take (pun intended) counts. Some of the health benefits of physical activity includes weight management, reduced risk of some cancers, heart diseases, type 2 diabetes, and improvement of mood and mental health, CDC mentioned.

Tip: The Physical Activity Guidelines for adults is 150 minutes per week of moderate-intensity aerobic physical activity (think brisk walking) or 75 minutes of vigorous-intensity aerobic exercise (like jogging or swimming laps) per week.

5. Try out 1 new (healthy) recipe each week

Get out of your dinner rut by challenging yourself to try venturing out from your typical ‘chicken & broccoli’ recipe. By choosing a different variety of food across different food groups, you are more likely to obtain different nutrients and have a well-balanced diet. And who knows if you end up discovering your new favorite recipe?

Which one of these will be your new dinner rotation?

6. Meal plan + prep

A study conducted by USDA found that foods that are prepared outside of home are higher in saturated fat, sodium, and cholesterol and lower in dietary fiber than food prepared at home. Meal planning also helps you to stay within your budget, save time, and decrease food waste.

EatLove — Save time & money, and decrease food waste every week!

7. Get enough sleep

How many hours of sleep are you getting each day? According to National Sleep Foundation, younger adults & adults (age 18–64) should be getting 7–9 hours of sleep daily. And no, you can’t save it all for the weekends!

8. Be kind to yourself

Give yourself some recognition when you hit your new plank record or crush you weekly work goal. But also remember to not beat yourself up too much when you’re feeling stressed out and forgive yourself when something did not go as you planned.

Interview with David Lester

David Lester

Wikihospitals — Today I’m introducing David Lester from NIESM, an Australian entrepreneur. David, welcome to Wikihospitals.

David, perhaps you can give a brief overview of the product that you’re developing and how it can help people.

David — We’re focusing on providing solutions to help patients with epilepsy achieve better outcomes.

At present, the methodology and the clinical practise is very poor. About one-third of patients actually found to be resistant to therapy, which means they don’t have good outcomes. A big part of that, if you talk to clinicians around the world… is that they rely on the patients to keep accurate records on their seizures.

The reality is, patients don’t do that for a variety of reasons. Consequently, it’s very, very, challenging for the clinician to develop patient management programmes that are personalised and will provide these better outcomes.

We’re using wearable sensors that have been found to be correlated with patient seizures. These are sensors that capture activities such as motion, heart rate, galvanic skin response, transdermal activity, sleep, and a variety of other physiological measures.

What we’re doing is we’re integrating these various solutions, these sensor activities, to come up with personalised methodology for capturing those patient seizures over time. That’s a critical point.

…whereas now days to monitor up a patient for up to five days using EEG, you have to… hospitalised (them).

NIESM

Wikihospitals — In today’s world, if people are to be diagnosed with epilepsy they have to be admitted to hospital… for a week. (Diagnosis is) a slow process. Even just booking in for an epilepsy unit could take six months.

David — Yes, there’s a variety of different epileptic seizure types… five or six of them are the dominant ones. Some of them are very, very, difficult to capture.

The other complexity is that every patient will have at least two or three of these different seizure types. Every patient has a different seizure profile.

Wikihospitals — …what percentage of people in the population have epilepsy?

David — It’s pretty much globally uniform at about 1%. Interestingly, a very recent report in the US said it’s gone up to 1.3%. It’s climbing and, because people are living longer now… you actually see higher incidence of epilepsy in people with Alzheimer’s.

Wikihospitals — The reality for them is, if they don’t have a proper diagnosis, if they’re waiting too long, or if the diagnosis is incorrect, then they get incorrect treatment.

David — Absolutely. It’s even more complicated than that, because not all seizures are epileptic. About 25% of those patients that have been diagnosed with seizures are non-epileptic. To your point, Delia, you get a very, very, different intervention treatment for those patients than you would the others. Consequently, you’re getting the wrong patient treatment.

Wikihospitals — It sounds as though your product is tending towards the new world of using smart wearable devices, sucking in big data, and then giving a much more accurate (diagnosis). Is that the case?

David — Absolutely. The smart technologies and the digital health are the way of the future, whether you’re talking about the location where everyone is closely linked, or whether they’re remotely associated.

“It’s about understanding what the clinician wants and how clinical practises actually works.”

David — I just came back from a visit to India. If you don’t talk remote monitoring in any management of disease, they’re not going to bother with you. The reality is that translates to better care and lower costs. It’s … a significant improvement all over.

The challenge is, in the western world when you bring in a new technology there’s a lot of resistance generally to it. The clinician doesn’t want to change their standard of practise or standard of care.

What we’re doing is working very, very, closely with leading clinicians around the world to ensure that we’re giving them services … that will not disrupt what they’re doing. On the contrary, what it’ll do is allow them to analyse a lot more patients than they’re doing now far more effectively, which is what they want. The difference in what we do between us and the normal technology company is we’re clinician-driven, not technology-driven.

From Pixabay

Wikihospitals — What sort of device does the patient actually have to wear? Can you give an idea of what this involves for the patient?

David — We like to call it compliant independent. In other words, we rely on the patient as little as possible… it’s a matter of wearing the device and every three to five days you take the device off and then recharge it. At that time of recharge, the information is then being transferred into the network up to our cloud base system. We manage the rest.

What we are doing is very, very simple, putting on the device, and then every three to five days taking it off and recharge it in a docking station similar to what you see with Fitbit or Apple watch. Then once it’s charged, which doesn’t take long, put it back on again and away you go.

Wikihospitals — What size of a device are we talking? Is it large and bulky or is it small?

David — (It’s a) little bit more cumbersome than like Fitbit or Apple watch. At this stage we opted to use devices that have been proven to be clinically competent and performed at a level that’s required for clinical use.

It’s got an elastic arm band, and a couple of electrodes you got to attach. It doesn’t look that great. But, we expect as we evolve this technology that we will develop devices where the patient feels comfortable just walking around every day and not feel that they are stigmatised, because they are wearing some sort of clinical device.

Wikihospitals — For the viewers, that’s in contrast to waiting up to six months to get into an epilepsy ward and then have an EEG cap with tabs all over your head and then staying there for the weekend or longer and being hooked up to monitor continuously, not being able to leave the unit.

EEG cap

“People are non-compliant with medication, I believe up to 50%…”

Wikihospitals — You can damage your brain if you continuously have seizures. Not having an accurately diagnosed epilepsy could have enormous consequences for people.

David — Absolutely. There’s a chunk of people that actually can’t work because of this… there’s a lot of people have seizures multiple times a week, (they) can’t get them under control (and) consequently have no life… It’s really a devastating disease under certain circumstances.

The other thing that I’d add to that is that because patient diaries are also used in clinical trials, a lot of the big pharma companies that were in epilepsy have moved out. Because they’ve found that the reliability of the data they capture using patient diaries were not acceptable and would not give them the value that would allow them to get new drugs on the market. We also are hoping — we are engaged with pharma that we will see an increase of activity in pharma to bringing better drugs out on the market.

From Pixabay

Wikihospitals — How many neurologist who specialise in epilepsy work in the UK?

David — In the UK there are about 600,000 people with epilepsy and there are an estimated 50 or so Epileptologists. Just coming back from India, it’s even worse, not surprisingly. There’s about up to 14 million, 15 million people with epilepsy and I was told by one of the leading practitioners there, there’s about 500 Neurologists in the whole country that can treat epilepsy.

Wikihospitals — That’s terrible.

David — Look, I think these numbers are pretty much uniform. There’s a dramatic shortage of experts in treating epilepsy. I should point out that there’s Neurologists that’s good, Epileptologist are the best, GP is the worst. A big problem with that is the accessibility the epilepsy expert or even knowing that you’d require an epilepsy expert.

“The outcomes very much depended on the present practise — depend on the experience of that doctor that you get.”

Wikihospitals — Tell me about the clinical trials that you’re about to commence.

David — We’ve decided to initially launch our products in the UK. The reason for that is the NHS is very, very progressive in terms of introducing digital health technologies. The first study that we’re doing is with — in Scotland, with the Scottish NHS.

Additionally, we’ve got a site in Portugal and we’re working with the leading Epileptologist there to develop an application there.

It’s been tough for me here, because I’ve had some local Australian parents contact me saying the children are suffering with epilepsy, can I help them? The challenges that people have to understand it’s a long task to bring products to the level where they will be accepted in the clinical healthcare market.

The complexity of developing a medical device really influenced the length of time it takes to get to market.

Wikihospitals — So if moms and dads here see this video, (and) they want to access their product, you telling me you got to wait at least a year and a half?

David — Look, we are working and doing some work — some initial studies with the Royal Melbourne Hospital locally.

There will be a stage, I think, because we are seeing such demand, we will be able to release it to the general public. I can’t put time lines on that.

“The fascinating thing about the Indian healthcare system, is that many of the leading health care providers have remote hospitals. This is the way it’s managed.”

Wikihospitals — You’ve spoken a bit about your son. Would you like to re-visit his issues and how he’s reacted to them?

David — Yes, he was at the age (of) seventeen, diagnosed with juvenile myoclonic epilepsy… it’s interesting talking to him. He noticed that a couple of times he started stuttering and stumbling for words and getting lost. I actually noticed at that time, not knowing as much as I do now about epilepsy, that he would start and suddenly just become immobile for about 60 to 90 seconds. We took him to a Neurologist, who’s local, living in the states at that time… and he… diagnosed him as having juvenile myoclonic epilepsy, and put him on a medication.

I was working at Pfizer headquarters in New York at that time (and) I said, well, let’s get a second opinion. I asked my colleagues and they referred me to the top epilepsy specialist for juveniles in New York, probably in the East Coast. He went through (the history) and said the diagnosis was correct but the drug was wrong. He… would not provide that drug to (young people) because they have all sorts of side effects that are really horrendous. He put him on a different drug.

It took my son having a grand mal, to realise you’ve got to take the drugs every day, which is very important. When I talked to him (my son) said it took about five years until he felt good… and we don’t quite know what feel good means because it’s not just the seizures… there’s other activities because you’re dealing with the brain, obviously, that we just can’t really quite get a handle on. That makes it a challenge.

But, to be honest Delia, our platform… is agnostic… to… technology…

We are capable of integrating imaging very high powered imaging data, genomics data, any form of data that we want we can integrate into it. Why I mention that is because when you start putting all this data together you start to get a better picture of what that person’s phenotype in terms of the disease actually is.

We are very, very optimistic… You will start to see this more generalised overview of a patient. It’s almost like a portal.

Wikihospitals — That’s a huge difference of what we currently have, which is really hit and miss… patients come in… for appointments, maybe every two months. Like you said they present a diary, not very scientific, and they… might or might not (get) the correct treatment.

David — That’s right. And, they’ve got to keep coming back for appointments. That is what happened with my son, it was every six months. It took a long time till he basically became seizure free.

Another challenge, I noticed, that caused the patient — the patient’s not getting good outcomes in a timely manner. If you don’t trust the doctor, you are not going to get good care. That relationship is also another added impact we can have (with our) technology.

Wikihospitals — So, better outcomes for the patient means more compliance with their treatments.

David — Absolutely. It’s generally found that the young, the teenagers — are least compliant. Because they don’t want to be labelled as having some disease.

Image from Pixabay

Wikihospitals — Can you talk about the data that this is… going to pick up.

David — Yes, the basic unit that we’ve got… is a very high powered Fitbit, if you want to talk about simply. It catches motion three different ways; it catches it through accelerometry, it catches through magnetometery and it catches it through GPS. What you end up is with an XY and Z axis for each one of those different types of activity captured. That means you’ve got nine axis of motion. It’s a lot of information.

Then there’s the ability to capture heart rate through pulse oximetry. You can get heart rate variability which a lot of people talked about as a very good measure for certain seizures.

There is, as you mentioned, skin temperature…, (there are) heart rate are sensors that you plug in…. You can also plug electrocardiogram leads… if you want to get very accurate cardiovascular measurements… (also) electromyogram, which is muscular activity.

You can (also) do a whole variety of different monitoring of activities including sleep. What we see is a combination of two or three of these activities that will be specific to that type of epilepsy that you’re looking at. That distinguishes us from anyone else.

“Healthcare should be a lot better than it is. It’s just a giant behemoth. (There is) so much money behind it. It’s very resistant to change.”

Wikihospitals — Can you give us a little bit about your background. You’ve been a serial entrepreneur.

David — I didn’t start as a serial entrepreneur. I started in the basic research.

I started in Australia went to Israel, went to the States. After about 15 years, I came to the conclusion that there are better researchers than I am, even though I was successful at it. So, I said let’s try something else.

I was in the US at the time and I got accepted into the US Food and Drug Administration doing what’s called regulatory research, and I spent time there and moved up the ranks. I was trying at that time also to bring new methodologies into clinical trials to help move them along. I realised it was very hard to be innovative in the FDA at that time. I then moved into the pharmaceutical world. I was responsible for introducing new technologies into clinical trials. I moved to Pfizer headquarters in New York… we (were) looking at clinical practice (and realized that) if we add healthcare technologies such as diagnostics to a drug, we (might) end up with better outcomes.

I left them and… joined a couple of companies, one of them was very, very controversial. I learned a lot… on how not to run a company. Then I started up on my own. Had a few attempts. There’s one that’s still ongoing, a Boston based company, called Inside Tracker, which is focusing on health and wellness.

I came back to Australia for personal reasons. I tried working with the CSIRO, and realised that I’m not suitable for large organisations. After advising and mentoring some people said, get back to what you do (best). Hence, about two and a half years ago I started NIESM.

It’s been a long journey. I think the cause of all experiences I’ve had, good and bad, this is going to be the best. Very, very exciting the response we’ve seen globally from the missions around the world. I think, this is a long haul and we’ll take it all into the finish line.

Wikihospitals — You also have the power of relatives lobbying for better treatments… they are are becoming willing to argue and look around see what else is available.

David — You raise a great point… — those advocacy groups play a major role in expressing the voice of the patient. In Australia, they’re active. They just don’t have the power and the money that you see in the UK or the US… The Epilepsy Foundation is very big in the States. It’s just tough in Australia, because people don’t give enough money to support these charities. They’re spending too much on horse racing and gambling… where as, actually providing money… will help them and their families and ultimately the community. It’s a shame you don’t see more of that sort of giving in Australia.

“Get prepared to fail. Because it is going to happen time and time again.”

Wikihospitals — Do you have words of wisdom for Australian entrepreneurs?

David — First of all, (in) biotech’s… Australia’s had limited success. It’s (now) med tech… medical devices…that’s the key thing you hear anywhere in the world.

First of all, it’s your management team. I’ve got two people in the US, two people in the UK and one in Portugal. Right? And why I got those people is because they’re the best around. That’s the first thing.

Secondly, your investors. You need investors that are going to give good value, not just money. Because there is good and bad money. Some investors can drive you nuts. They can ask for the wrong terms for investment. That can do a lot of harm.

The third thing is the board of directors and the advisory boards. Get the best people in the world that understand from day one you’re in a global community that’s trying to provide global resources. …that… helps you to identify your market…

So… I’d say, (don’t just concentrate on) the Australian market… cause that’s really messy and complex. That’s probably the biggest challenge… Then the other thing is putting the components together to make sure you’re setting the company up right.

“Focus on the need. Forget about building a product and then forget what you’re going to do it for.”

David — Even though you’ve heard me talk technology, as I said before, I’m driven by the clinicians, I’m driven by the clinical need. I can generally find a technological solution, even if I have to compromise sometimes, that will serve that purpose. That’s the key thing.

Wikihospitals Okay. So, look for the problem to solve, rather than the product to present?

David — Absolutely.

Wikihospitals — Do you think that you have some way that we could improve what we support or encourage entrepreneurs in Australia?

David — Yes, look investments a big, big issue. I think the Australian governments don’t have long term views of this industry, as you see in countries like the US and Israel, and now in the UK. But, I think we need more Angel Investors that understand healthcare because a lot of them come from engineering backgrounds don’t understand clinical. We know there’s a lot of wealthy doctors out there, it would be great if they could set up some sort of consortium.

In general, I think, (we need) the high net worth people. If they could be a little bit more risk taking, that would make a huge difference. They’ll actually end up in better returns. It would make a big difference on the local environment in terms of successes. There’s a lot of activity going on, but most of (it) will fail. Largely (because if you) don’t have the management team, you don’t have the money.

Wikihospitals — When do you think your product might be coming to Australia?

David — Keep your fingers crossed, one and a half to two years could well be in Australia as well.

Wikihospitals — Could we say that neurologists if they’re interested could contact the Royal Melbourne Hospital, because some (the) trials are going through there?

David — Yes. I think you can. They’re very busy. It may be easy just to contact me via our site or on info@niesm.com and then we’d be happy to refer them to those clinicians. I’m happy to do a bit of a screening for them.

Wikihospitals — Well, thank you very much for this interview David. We look forward to your product coming onto market and giving people with epilepsy and their families much, much, much more diagnosis and treatment.

David — Thanks for the opportunity Delia.

© Wikihospitals 2017

New drug target confirmed for chronic pain treatment

Chronic pain can lead to a decreased quality of life in patients who suffer from long-term conditions that can lead to it, including sciatica, cancer, and rheumatoid arthritis. The mechanisms that often lead to chronic pain are also multi-factorial and complicated which is why pain management can be difficult in these patients.

Inadequate pain relief, however, can lead to a decreased quality of life overall in chronic pain patients. General pain relievers, even more potent like morphine, often still prove to be inadequate, especially in those with more severe conditions, like cancer patients. This is why establishing new therapeutic options is so urgent in these treatment-refractory patients.

A research group at Hiroshima University observed that previous research had only looked at one pain model at a time and emphasized the importance of covering multiple molecules that mediate chronic pain.

This led them to look into a type of cell receptor, REV-ERBs, that previous research showed sends chemical signals inside the cell to block the production of certain genes regulating pain and inflammation-causing molecules in the body.

“Nobody checked the effect of REV-ERBs agonist [stimulator] on nociceptive behaviors [pain reactions] or chronic pain so first we checked the effect of REV-ERBs agonist on chronic pain,” explains Assistant Professor Yoki Nakamura, Department of Pharmacology, Graduate School of Biomedical & Health Sciences, Hiroshima University.

REV-ERBs agonists were used to determine if activating the REV-ERBs in astrocytes, a type of spinal cord cell, resulted in pain relief in chronic pain mice models. It was found that untreated mice with the same type of chronic pain felt more pain compared to those that were treated with a REV-ERC stimulator when they were touched with a filament on their hind paw.

Based on the results, the researchers at Hiroshima University believe that this new drug target may lead to potential new therapeutics being developed for patients who suffer from chronic pain.

For more information, please visit ScienceDaily.

Questions: How frequently do you counsel patients with chronic pain? Does this new research sound promising in terms of decreasing pain in chronic pain patients?

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Discover The Health Benefits Of Pregnenolone

When it comes to boosting and supporting your overall health, it is incredibly important to consider various aspects of your internal chemistry. Pregnenolone is the primary steroid that your body manufactures from cholesterol. There are some impressive benefits that this steroid can provide, primarily when used in a supplemental capacity and a wholly responsible manner.

This steroid is neuroprotective. As such, is designed to support and protect the health of your brain. In fact, it may play a critical role in staving off certain degenerative brain diseases like Alzheimer’s or Parkinson’s disease. Also, this steroid boosts both memory and learning. These results mean that there are benefits in supplementation even before reaching old age.

Many researchers believe that it can also have mood-boosting properties. This outcome may be good news for those who suffer from depression, anxiety and other chronic and potentially debilitating, mental health issues. If you are continually feeling melancholy, you may be missing support in this area.

Beyond boosting your mood, this supplement is thought to be anti-stress. This effect is why it is often used by students, pilots, and professionals within the medical and dental health industries. If you are always in high-stress environments or maintain a high-demand job, this could be essential for maintaining a sense of normalcy and balance.

As with all steroids, however, moderation remains vital. If your body is currently capable of producing sufficient amounts of this chemical on its own, you certainly don’t want to add more to the mix. Excessive amounts of any compound will always cause problems in other areas and lead to side effects. As such, you should check with your doctor rule out other potential causes for problems like low memory, depression or anxiety, before opting to use this type of supplement.

From LUMS to Pind Begwal: Saving 9 on “Agency Moments”

In November 2017, Saving 9 formally launched their operations to a promising start. An Islamabad-based boutique consultancy company, Saving 9 seeks to ensure that medical first aid training is not just restricted to hospitals and medical centers but that it should be effectively disseminated in communities with scarce to no medical resources. Being the first trailblazer of its sort, the co-founders of Saving 9, Usama Javed Mirza & Ovais Siddiqui, endeavored to bring a change in the way we think of healthcare in remote communities. Their mission is two-fold:

1. To prioritize the health of community members.

2. To give community’s citizens the power to save a life or to prevent common injuries to becoming critical ones.

Co-founders of Saving 9: Ovais Siddiqui & Usama Javed Mirza (L-R)

The motto of Saving 9 is: Educate. Enhance. Change. Save Lives.

For communities in underprivileged areas, the idea was to transform our own mindset. The more practical skills one learns and applies, the more one gets better at training oneself in medical first aid and then training the members of the community one lives in.

This model is popularly known as ‘train the trainer’ which has become highly sustainable all over the world.

Train the Trainer model in action. Trained Emergency Medical Personnel (EMP) train an employee from an NGO.

Saving 9 is seeking to solve some of the most pressing questions of our times. How can the people of any community be mobilized to address their problems? Take a scenario for example. If a community member is bitten by a snake, what steps should be taken immediately before professional help arrives? Who can take those steps? In most cases, hospital service is non-existent or the only doctor in the community may be too far away, having knowledge of first aid training can greatly reduce the incidence of shock and sepsis, and potentially save lives.

How did it all begin for Saving 9? One of the co-founders, Mirza joined one of the societies in LUMS called Emergency Medical Service (EMS). As part of this society, members are trained to respond to physical and psychological emergencies in their campus. He spent considerable time to improvise the teaching of the curriculum and adding new modules as Head of Training and Development at EMS which also culminated in his receiving intensive training as a Medical First Responder (MFR). He further went on to get trained and licensed as an Emergency Medical Technician from New York during his Fulbright scholarship program from Teachers College, Columbia University.

Determined to launch more such models of Emergency Medical Service, Mirza partnered with Siddiqui and together they founded Saving 9. A question arises: Why was there a need for a consulting company like Saving 9?One thing the co-founders knew was that Saving 9 would be a unique, boutique consultancy company which will focus on healthcare and education services based on latest medical and educational research. Saving 9 started to spread first aid literacy in Pakistan through school teaching, local community master trainers, annual awareness events as well as social media awareness campaigns. They also started to participate in competitions, the first of which was Harvard University’s Seed for Change competition where they were awarded seed money to launch and expand their operations on a bigger scale. Consequently, they learnt that a startup company could be sustained over several years through the power of community-driven leadership and knowledge sharing. In their first year of operations, Saving 9 has trained over 500 people in first aid such as how to care for fractures, bleeding, snake bites, allergic attacks, choking, panic and anxiety attacks to bigger emergencies such as heart attacks and stroke.

In order to pilot their training project as well as set up a model Emergency Medical Service (EMS), Saving 9 had chosen Pind Begwal, a remote community near Rawalpindi area. After a thorough needs-based assessment, Pind Begwal appeared to be an accessible community but was in need of a proper EMS system. “Once we are satisfied with our model, and our pilot yields success, we will be able to scale up to other regions through our partner organization, Mera Maan,” says Mirza. “There are lots of innovative ideas and the community is eager, but it takes time to understand all that we are doing. The idea is to give everyone (from children to adults in all socio-economic brackets) the know-how to be able to carry out pre-hospital care up to their maximum potential”.

Saving 9 team at Harvard University for Seed for Change competition

Often during an emergency, by-standers are usually the first persons to arrive at the scene of incident. “By-standers in Pakistan tend to cause more harm (leading to loss of life) than good out of good intentions but ignorance”, says Mirza. “Through a public first aid literacy campaign, by-standers can learn what to do that will help, and what not to do as well”.

Additionally, according to Siddiqui, “ A lot of deaths happen due to delayed emergency response or no response, in Pakistan. There have been cases of deaths due to excessive blood loss and blockage of air passage. These are avoidable casualties and only requires some basic first aid knowledge.”

Middle school students practicing first aid

This is where Saving 9 was born:

To grant everyone they meet to “experience an agency moment”!

True to its essence, Saving 9 is already enjoying the positive benefits of having provided such unique moments in underprivileged communities, by way of training in schools, colleges and corporate organizations.

Corporate employees practice calling ambulance service during their first aid training course

However, are these small successes enough for a change-maker to be inspired? Not so in the words of Mirza who have had to deal with many challenges, which fortunately he viewed as normal experiences for a startup or implementation of a difficult idea with constrained resources. One of the biggest challenges for Mirza, a Fulbright scholar and an alumni of Teachers College, Columbia University, was trying to achieve the status of having done a “service” to his country however minuscule in appearance.

One struggle is for sure: We are and continue to be on the spectrum of battling societal stereotypes. In the context of entrepreneurship, the story is no different. For those with little to better knowledge and understanding of medical training and service extension to an underprivileged community, a startup company like Saving 9 has great stories interweaved with emotive brilliance to offer.

So what is this challenge against stereotypes? There was the idea that some people think Saving 9 was teaching them how to become ‘nurses’, which is equated with being feminine, and so this is not for ‘boys’. Mirza adds on,

“There are stereotypes about youth that I, and those I know have experienced in our work. When meeting older businessmen, there is a tendency to not take me seriously because I am younger than 30 years”.

The most interesting stereotype was tech-related. In the words of Mirza,

“Everyone in the entrepreneurship ecosystem assumes that we must be crazy about tech, and that the grand scheme of things will ultimately culminate into creating an app. We do not have a tech focus, and that kind of social entrepreneurship business model is considered exotic in Pakistan, and we are considered backward because we’re not developing apps or using virtual reality for everything”.

Siddiqui adds, “We have a lot of identities. We are judged based on our gender, age, nationality etc. on a daily basis. I have experienced the same. But what I have done is, I have always tried to be surrounded by people who genuinely care about the people around them”.

It is often said that the things which inspire us rarely inspires others on a personal level but the collective good that we do for a social cause pushes us to our edge. The recent on-going pilot project of Saving 9 in Pind Begwal community received quite a lot of support and admiration from community members. Saving 9 recently partnered with Glucose Trail for early detection, management and prevention of diabetes through telemedicine service which is a much-needed intervention for a community which has a scarcity of on-the-spot medical and health providers. Usama described, “Ambulance drivers are almost trained; they have 3 hours of classes left to take. We are purchasing the ambulance in the next 6 days*. We are working with schools to set up a scouts system for students, in order to further spread first aid literacy and create an informal response system. We are also finalizing dates for training roadside shopkeepers in first aid, as they are the by-standers that are closest in case of a car crash”. The Glucose Trail project now has a total of 48 patients who are being provided with diabetes-related medical support through a telemedicine app. Several medical camps and focus groups were conducted to train patients to self-manage their health needs.

How does Saving 9 plan to sustainably run in the near future? The first aid workshops need to be continuously run along with new development operations. “Our development operations are growing and are working well with the support of our sponsors. Glucose Trail provides us over $1000 every month, and we have received financial support from Harvard University and private individuals as well”, adds Mirza.

Moving forward, Saving 9 intends to scale up their current projects to other regions after evaluating the success of Pind Begwal pilot project. They also plan to secure more sustainable sources of revenue through their educational and healthcare consultancy services. Moreover, they are already expanding their focus to include mental health awareness and teacher training. “A key challenge in creating the EMS system has been molding a financially sustainable model. Pind Begwal is our pilot project, so we are doing a lot of learning, experimenting and pivoting”. Saving 9 is also striving towards greater social inclusion by not only diversifying their core team but also encouraging people with disabilities and unique needs to be a part of their training workshops and courses.

With regard to getting first aid training,

“Physical disabilities are stigmatized in this line of work. Generally, people can’t appreciate that you can still practice first aid even if you’re differently abled”, Mirza concludes.

Note: A model ambulance service “Maseeha” was successfully launched in the first week of 2019 in Pind Begwal. To date, trained Emergency Medical Personnels (EMPs) have handled around 35 emergency cases for all age-groups.

Emergency Medical Personnels (EMPs) with their Maseeha ambulance in Pind Begwal