Tuesday, 24 January 2017

2016 achievements in brief

2016 - A good year

2nd in ACT bouldering comp (masters division)
Ranked in the top 10 nationally in my age group in orienteering
Top 20 of my age group in the Hoppet ski marathon
Best Parkrun - 3rd on handicap (out of 197 runners)
Sub 95 minute half marathon
Best backcountry skiing for many seasons
Plus the occasional unicycle or 20km on inline skates.

T1 and Addison's are no impediment to competitive performance, even if like me you do not have a sporting background and are past retirement age.
But to be competitive at my age, you really should ignore most of what doctors and dietitians say.

Thursday, 18 August 2016

Friday, 8 July 2016

So you think muesli and sushi are healthy?






A comparison of two isocaloric diets for a diabetic with blood sugar control as the endpoint. Some carbohydrates in menu 1 were replaced with fat of equal caloric value and insulin was optimised in each case.
The diet with a higher proportion of fat produced much better blood sugar control for Dave. How well will it work for you? The scientific way to test this is to perform an N-of-1 trial.
If you are keen, learn the technique yourself, because most doctors don't have a clue how to do it.

Pic from nz herald.

Friday, 1 July 2016

A conference of 21 EU scientists in Parma concluded there was insufficient evidence to conclude that drinking water eases dehydration.

Brexit has brought into prominence EU edicts that their loopy academics have forced onto the UK.
Banning diabetics with purely nocturnal hypoglycaemia from driving meant people lost their licences unnecessarily. The 1994 EU regulation that bananas be "free from abnormal curvature", and not sold in large hands was "daft"

But how could a conference of 21 EU scientists in Parma concluded there was insufficient evidence to conclude that drinking water eases dehydration?

It is the same lack of logic that enables doctors to conclude that low carb diets do not work. When academics with absolutely no common sense insist that a large randomised trial analyzed by intention to treat must be published before anything can be listed as a possible treatment, both water for dehydration, and low carb diets for diabetics are rejected.

And as many have said before, it also leads to the conclusion that there is no evidence that parachutes work. After all, it is only a series of anecdotal cases that supports their use.

 James Heckman won a Nobel prize for showing how wrong these academics are. Unfortunately most doctors are too under-educated to comprehend the implications of his work.


Doctors try to ban social media posts on alternative treatments.

After years reading thousands of web pages and social media threads from around the world, I am unable to find anyone my age with T1D and Addison's who is even close to being able to do all the activities I engage in on a regular basis. And that is coming from someone whose only sporting award at school was for chess.
I attribute this to my novel non-pharmacological methods, most of which have still not been revealed in any forum.
Yet Canberra doctors have described my methods as inappropriate without even knowing what they are.
They have refused to allow me to present them in any departmental meeting. Apparently they consider their current treatment methods to be perfect, despite  ample evidence to the contrary.
As the excepts from the letter below show, they also believe they have the power to prevent me from posting details of my success on social media and stating that the methods I use are not even close to current Australian guidelines.



Their use of legal thuggery against me is pure harassment. But it will not stop me skiing, running and bouldering this winter in a way which no one my age and with my diseases can match. A dozen bottles of expensive wine to the first person to prove me wrong.

Thursday, 23 June 2016

Dramatic new figures on the number of insulin-dependent Australians

RMIT and Diabetes Australia think that more than a million Australians will die if insulin becomes unavailable. That is more than 4% of the population.
As the punchline to the two positives make a negative joke goes, Yeah, right!
Medical academics really are some of the most clueless people you will ever meet.



Wednesday, 22 June 2016

An audit of 545 consecutive cases of anaesthesia for elective cardiac surgery


An audit of 545 consecutive cases of anaesthesia for elective cardiac surgery was conducted for the purpose of quality assurance. This comprised all elective cases up until the end of 2014 in which I was the primary anaesthetist.
Outcomes of interest include the scope of operations for which anaesthesia was provided, the usage of and complications from trans-oesophageal echocardiography (TOE), and adverse outcomes, both major and minor.
Scope of surgery
Operation type
Freq.
Percent



Cabg
329
60.37
Avr +/- cabg
128
23.49
Mitral +/-cabg
36
6.61
Opcab
11
2.02
Other
12
2.20
Other valve
8
1.47
Redo cabg 
9
1.65
Redo valve
12
2.20



Total
545
100.00

Other valve cases included tricusip and multiple valve surgery. Other non valve cases included ASD closure, atrial myxoma and lipoma, HOCM surgery, pericardiectomy on bypass, aortic root replacement and Bentall procedure. Arrhythmia ablation was performed concomitantly in 3 cases.
Not included in this review are emergency cases for cabg or dissection, cases such as pericardial window which did not use bypass, take-backs, or combined AAA/cabg surgery. The cases that are included are those which provide useful information for prospective patients about to undergo elective cardiac surgery.
Adverse outcomes
Death: Death within 24 hours of anaesthesia is a definition which fails to capture the majority of anaesthesia-related deaths, so was not used. Death within 30 days of surgery is a standard measure, but data for this is not available to me. Failure to leave ICU alive was the most inclusive definition for which I have reliable data. There were two cases – a patient who died in ICU 4 days post-operatively with an IABP that had been placed before surgery. A second patient also died in ICU more than 24 hours after surgery.
Other: There were no major airway, TOE, CVL or other problems complications.
Summary

An audit of 545 consecutive cases of anaesthesia for elective cardiac surgery was conducted for the purpose of quality assurance. This information can be used to inform prospective patients about the performance of this particular surgical unit. The audit is to be repeated once a total of 750 patients is reached.

Monday, 13 June 2016

Wikipedia knows more than most doctors about diabetes.


This was standard advice in the 1970s and earlier, but nowadays doctors seem intent on imposing their own ignorance on patients, with not so much as a case series showing long-term high level functioning with low fat eating.

The Canadian Diabetes Association love the Banting LowCarbHighFat diet so much they made it their phone number.



I'm sure they love Fred too.


Monday, 6 June 2016

More bullying and harassment by Canberra doctors

Last year I wrote "Someone with the appropriate knowledge has told me that almost every patient in The Canberra Hospital catchment with Type I diabetes and on steroid replacement is in quite poor health. I am not. 

Despite almost 20 years with T1DM, and 10 years on steroids, my arteries are in superb condition, and I would be very surprised if you have heard of anyone with both conditions in the Southern hemisphere who matches me in physical performance.

I did not get this way by subscribing to local medical dogma. Quite the opposite. In many aspects of treatment I act completely contrary to the recommendations of local researchers. If you think it is just a coincidence that I am also the only doctor at TCH who has managed to complete the M Biostat, think again."

When this was reported to AHPRA, they decided it constituted evidence that I was impaired and that they needed to "investigate (my) health" They claimed that this constituted an "Own Motion notification" and was justification for applying the full force of the coercive powers they have been given.

There is no one in the world my age and with my diseases reporting anywhere near the success I have had in living a full life. (not in English anyway)
How this constitutes impairment is beyond me.

Unfortunately, the Senate Inquiry into medical bullying has been postponed due to the Federal election. But sooner or later, those clueless Canberra doctors will get their comeuppance.



Wednesday, 25 May 2016

How do doctors treat a blood sugar of 13 mmol/l (234 mg/dl)? They give intravenous glucose!!!

Here is the local protocol for treatment of diabetics on insulin.


It dictates that a diabetic with a blood sugar of 13 (234) be given intravenous glucose, in the form of 4%dextrose/saline, usually at 120 ml/hr. That is 120 g of glucose per day for a standard hospital patient resting in bed.
Many type 1s lead very active lives on much less carbohydrate per day than this, yet when they are confined to bed, doctors obsession with high carbs give them much more. They then treat the resulting hyperglycaemia with massive doses of insulin. The recommended starting rate equates to almost 100 Units per day, a massively supra-physiological level.
Mammalian evolution has equipped injured animals to deal with immobilising injuries without exogenous glucose, yet doctors still feel the need to overdose patients on sugar, and insulin.

Even if this results in a near normal blood sugar, problems are not infrequent. Insulin is one of the medicines most commonly listed in adverse drug reports. Any interruption of the dextrose delivery means that the patient is receiving a large amount of insulin unopposed. A low-insulin/low-glucose protocol would see hypoglycaemia developing much more slowly, and much more likely to be detected before harm was done.
Dilutional errors in the preparation of infusions are also frequently reported. A high delivery rate magnifies the effect of these.
I could also go on and on about the water load, effects in head injured patients, infection risks, longer term effects and the larger variability of blood sugars with a high glucose load...

You will also note that the protocol contains 2 contradictory thresholds at which saline should be started.
Have I previously mentioned doctors poor numeracy skills?

Monday, 16 May 2016

Should I work standing up. The evidence says NO.

The bizarre and incompetent advice from medical academics never stops coming.
They are the people who said that Vioxx was the best drug for elderly, dehydrated people with broken hips.
They are the people who told you to eat vegetable oils that at the time were full of unlabelled trans-fats.
They are the ones who say that the solution to a high blood sugar is to eat more carbohydrate.
This is the profession that prescribes antidepressants to 1 in 10 Australians, one of the highest rates in the world.
And they are the people who say I should work standing up.


I'm not going to point out the obvious mathematical inadequacy of the original research on which that advice was based. (unless someone pays me to do so) Most doctors only read the abstract of such research, so couldn't tell.
Suffice it to say that if you don't include all confounding factors in such a study, you can prove just about anything. And if you parametrise activity in time units, you are not going to get the right answer. An hour spent chatting and stretching at the gym does not expend nearly as much energy as the hour I spent racing in the mountain run yesterday.

Lets look at the research that better adjusts for the problem of confounding.

First, there was the Whitehall II study. More than 80,000 person-years of follow-up and 450 deaths, showed NO effect of sitting on mortality. It also pointed out inadequacies of previous research and chided policy makers for over-interpretation of poorly controlled research.

More recent research (doi: 10.1186/s12966-016-0349-y) showed a trend towards better health outcomes people who sit at work, even after allowance for income/SES differences. Of course that does not prove that sitting is better, for the same reason of inadequate adjustment of confounding, but makes it unlikely that it is worse.

So don't just do something, sit there.



Thursday, 12 May 2016

Bizarre ACT Health Laws - more illegal maths


ABC radio did a story this morning on bizarre laws from around the country, so I thought I would chip in with another.
Protection of confidential data by altering just some of the numbers is a technique that is used and accepted around the world. See the example below. But is it accepted inCanberra?
The technique means that the recipient is unable to determine which values have been altered, and are unable to tell whether a specific datapoint is true or false. However, because most values are intact, the recipient can glean useful summary information such as the average of certain values.
But a little-known ACT law apparently makes it an offence to transmit false health data.
This would make it illegal to create a hypothetical teaching scenario where a patient did not want some of their private details revealed to students.
Even fictional data, which is declared as such, seems to be caught by the breadth of this law.



Stay tuned for an update on the legality in the ACT of this standard statistical method.


Tuesday, 10 May 2016

The reason for my success. Is it because I am "prescribed a range of steroids, including prednisolone .. to manage (my) Type 1 diabetes"?


Canberra's medical investigators may have stumbled on the reason why I have been so successful at managing Type 1 diabetes.
Certainly I am pleased with my results of late. Recently running 5km in 20 minutes and 20 seconds is faster than I have run since I was 19. That was 37 years ago. ( 76% for Parkrunners)
That equates to a VO2max of nearly 50, which is an excellent prognostic factor.
How have I improved this much?
Those Canberra doctors have suggested that I use a range of steroid, including prednisolone, hydrocortisone and fludrocortisone to manage my Type 1 diabetes.

No, this is not a mistake. Those doctors were given ample opportunity to amend or retract this statement, but chose to repeat it.

In any case, why would I self-prescribe medications that are essential for me to stay alive? It would only be necessary for me to do that if my own doctor had NOT prescribed them. In which case it is my doctor who should be investigated, not me.

And what was the evidence I self-prescribed? Allegedly it is in my blog. Huh? Read for yourself. My blog says no such thing, and I promise I have not deleted anything on this.

Clearly this is a vexatious action by Canberra doctors who are desperate to discredit anyone who claims success from LCHF, or any other alternative approach, to diabetes.


Monday, 9 May 2016

Alteration of insulin dose - does it constitute illegal self-prescription? Legal clarification at last.


Following threats made against me by AHPRA for allegedly self-prescribing drugs, I sought legal clarification on the issue of patients using doses of insulin and steroids other than those prescribed by their doctor from various State Health Departments and State diabetes organisations.

The only organisation to provide a detailed response to this question was the WA Department of Health, whose reply stated that not only was dose alteration acceptable for those drugs, but self-prescription of insulin and prednisolone was also perfectly legal.

Why then the threats against me by AHPRA? It couldn't possibly be retribution for the embarrassment my blog posts have caused to some of its committee members, could it?

(WA Health also noted that although self-prescription of insulin and standard Addison's drugs are legal, this does not apply to any Schedule 8 drugs, or to any Schedule 4 medicines classified as "specified drugs" under the Poisons Act)

Thursday, 5 May 2016

Can you believe why Calvary Hospital is the second most expensive in Australia?

Can you believe why Calvary Hospital is the second most expensive hospital in Australia?
According to the Health Minister "Specialist services, such as open-heart surgery, some complex brain surgery, bone marrow transplantation, and some high-level care for babies offered in the ACT do not have the same economies of scale possible in larger jurisdictions."
Calvary does NOT do open-heart surgery, complex brain surgery, bone marrow transplants, or have a high-level neonatal ICU.
How can a politician get away with such a statement? Because voters let him. Canberra people get the politicians they deserve, and the health system, and the funding cuts in other areas to pay for ACT Health incompetence.


And if you think expensive health care means good service look at the KPIs of the clipboard army.





Of course, none of this will be any surprise if you have read my previous blog posts. And if you think all that money means state-of-the-art equipment look at what happened when a surgeon repeatedly complained that the operating theatre was too hot, and the manager kept saying it was fine. Eventually, the manager brought along their thermometer to show the surgeon they were wrong.
After procuring a polystyrene cup, water and ice from the tea room, the thermometer was found to read minus 4.6 degrees C in ice water. Theatre temperature was then adjusted to what it should have been. Battle won. War goes on.




Using maths to optimise steroid regimens


Efficient solution of the most difficult Sudokus requires an appreciation of the conditions under which numbers are exchangeable, or at least the learning of rules of thumb that can be derived from such an appreciation.
Exchanging steroids, a necessity for many patients who do not thrive on a particular regime (see BMJ ref. in a previous post), also requires an understanding of the parameters that need to be matched. Merely exchanging based on daily dose equivalence is insufficient.
Perhaps that is why so many Australian patients with Addison's disease are reporting poor treatment outcomes on social media, and, unlike other countries, so few are reporting any sporting achievement.
And rather than believe those ignorant doctors who say that social media does not constitute evidence, check out the peer reviewed research publication showing that useful information on disease patterns in society can be determined from tweets, (Lee et al J Am Med Inform Assoc. 2015)




Number gnomes have hidden the middle of this standard puzzle, but not to worry. They have actually helped you by showing where you don't need to look to find the next cell value. Do you see the pattern?

17.5.16 Another.


Thursday, 28 April 2016

For decades, doctors encouraged patients to consume trans-fat laden oils and margarine. Why?

Don't believe me? Look at the facts. From the late 1970s, doctors persuaded  many patients to give up the butter they had previously used on their sandwiches and for cooking, and instead use margarine and vegetable oils.

As the BMJ records, there was never any good evidence that butter was contributing to cardiovascular disease. In fact, even in 1980, it was widely known that the French were consuming large amount of butter and full fat cheese, with relatively low levels of arterial disease compared to other Western countries.
Note that while dairy food does contain trans fats, these fats are completely different in their health effects from the industrially produced trans fats from hydrogenation and other processing of vegetable oils. You can find a comprehensive review of this at
Adv. Nutr. 2: 332-354, 2011

Many people currently in their 60s were conned into giving up butter and instead spent the next few decades using vegetable oils, margarines and processed foods, many of which were high in industrial trans fats.
It is only very recently that trans fats have been largely eliminated from most Australians' diets, but the damage to coronary arteries from decades of medically sanctioned consumption of trans fats is extremely difficult to reverse.
Even as recently as 2012, the Medical Journal of Australia (Editorial MJA 196 (1) 18 June 2012 ) reported many common foods such as, breakfast bars, chips, popcorn, savoury and sweet biscuits, and pastries contained unacceptable levels of trans fats, often without labelling. This particularly applied to the cheaper brands.

Those health nutters who have always believed in consuming the same natural, minimally processed foods that their ancestors had eaten for centuries never fell for the margarine and hydrogenated vegetable oil  trap. They didn't need to read all the scientific literature to tell them that doctors didn't have a clue. We stayed with butter and olive oil, ghee and coconut cream. And we certainly didn't eat bars for breakfast.


Coles canola oil 4.6g Trans fat/100ml

Tuesday, 26 April 2016

How well do you understand food labels? Try this quick quiz

I have 2 brands of the same product. The ingredient list is the same for both.  Neither contains any artificial sweetener or alcohol. Both have been processed the same way and both are about 21% protein. Numbers are per 100g serve.

                     Energy   Carbs   Sugars   Fat      SaturatedFat   Fibre           Sodium

Brand A     1550kJ    11g        1g          21g        13g                28g               30mg

Brand B      1620kJ   39.5g    <1g        23g        14.5g             not stated      16mg


What is the difference? Why?

If you would vary your insulin depending on which brand you were using, ask yourself whether you really get it.

Added 29.4: if you understand the above, you should also understand why the food label on a related grocery item I bought at Woolies today showed ingredients adding to 120g/100g. (no, I was not adding the sugar and total carbs together, or counting both the saturated and total fat, etc)

How is your maths? Are your diabetes and steroid algorithms as good as mine?

Oops! Nearly half of this standard 9X9 Sudoku is missing, but there is still enough information to determine the next move. Just add one correct number.

Saturday, 23 April 2016

I'm sick of hearing doctors say healthy eating is expensive

It is completely untrue to say that take-away and junk food are cheap calories, and that people eat them because healthy food is expensive. Do the maths.
Yes, activated organic jimbu salad from a trendy hipster cafe is beyond many families, but there are cheaper options.
Even if you buy coca-cola cans in bulk for the cheapest price around here, you are still paying $A10.00 per kilo for the carbohydrate content. The same supermarkets sell rice for a dollar per kilo, or about SA1.40 per kilo of carbohydrate. And take-away is hugely expensive as a source of protein.


These PNG highlanders lived on not much more than a dollar a day, had very little formal education and didn't speak English, but they knew how to eat healthy. No, they are not cannibals, but they do know how to set up an interesting photo for a gringo.
What little communal money they had was spent on 20 kg sacks of rice and the cheapest fish they could buy - usually boxes of tinned mackerel. They grew/gathered vegetables and occasionally caught small animals and birds in the forest. They never bought take-away or junk food. They couldn't afford it.

Attempts by health groups to supply fresh vegetables to people in remote parts of central Australia are completely misguided, expensive and wasteful when the produce wilts before reaching its destination. Tinned and dried vegetables are extremely nutritious. I know of no research which shows a convincing health benefit of fresh vegetables over an ample supply of preserved ones.

In fact, in his book Guns, Germs and Steel, Jared Diamond theorised that learning to manage without fresh produce contributed to the success of Western civilization. In fact it is really only since the end of WW2 that much of northern Europe has had year-round access to fresh salad vegetables.

Take-away and junk food are industries supported by ignorance, not lack of money.