The 2 Minute Medicine Podcast Episode 33

We begin this episode by discussing our article of the week which comes from the BMC Nutrition Journal and is entitled “Clusters of carbohydrate-rich foods and associations with type 2 diabetes incidence: a prospective cohort study.”

We begin with a discussion about blood donation, and the decline we are seeing in blood donors. Then we take a closer look at lead poisoning in the context of a recent recall of contaminated cinnamon applesauce products. After that, we investigate multiple sclerosis and how it can affect one’s life. Finally, we discuss the cold winter temperatures, the risks of the cold, and how we can stay safe this winter.

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Transcript

[Deepti] Welcome to the 2 Minute Medicine Podcast, summarizing the latest medical studies, curated and written by practicing physicians.

For our full suite of daily medical study summaries and updates written by practicing doctors, please visit our website at 2minutemedicine.com to start reading new daily content right now, for free. On this podcast, twice a month, we cover the latest in health care news and research evidence. We are your hosts Deepti and Andrew. On today’s episode, we’ll start by discussing our two articles of the week. In the second half of the episode, we will look at health issues that have arisen in popular media. 

[Andrew] Our article of the week comes from the BMC Nutrition Journal and is entitled “Clusters of carbohydrate-rich foods and associations with type 2 diabetes incidence: a prospective cohort study.” Diabetes affects a large population worldwide, with dietary intake identified as one of the most common modifiable risk factors for type 2 diabetes (T2DM). Multiple studies have identified associations between different dietary patterns and incidence of T2DM. However, most studies have established dietary patterns a priori and compared the incidence of T2DM in patients with such dietary patterns versus a pre-established control diet. This study aimed to look at the association between computationally determined clusters of carbohydrate intake patterns with T2DM incidences. This was a prospective cohort study of 26,662 adult participants living in Sweden. Participants with limited Swedish proficiency, mental disability, or diabetes at baseline were excluded. The primary exposure was carbohydrate intake, determined by a 3-part dietary history method: a 7-day food diary, a 168-item food frequency questionnaire, and a 60-minute interview. The incidence of T2DM was determined through a diabetes diagnosis by a physician or at least two HbA1c values >6.0% during the study follow-up period from 1996 -2016. There were 5 distinct clusters of carbohydrate consumption identified within the analysis: 1) high vegetables/low added sugar, 2) high sugar-sweetened beverages, 3) high juices, 4) high fruit, and 5) high refined carbohydrates/low fruit & vegetables. The results demonstrated that there was a significantly lower risk of developing T2DM in patients in the high fruit cluster compared to the high refined carbohydrates/low fruit & vegetables cluster. Interestingly, the high fruit cluster had the highest mean age and lowest proportion of current smokers, which may have confounded the results. Lastly, there was no interaction with sex identified for the clusters, suggesting that the associations were similar between genders. This study was limited by possible measurement error due to self-reported dietary data as well as generalizability to a non-Swedish population. Nonetheless, these results suggest more nuanced dietary recommendations in patients with T2DM may be beneficial.

[Andrew] Now for The Scan.

The Story: The American Red Cross has recently announced an emergency blood donation shortage, in part due to a rapid decline in the number of individuals donating blood. Let’s take a closer look at what this blood is used for.

[Deepti]: Well, in a nutshell, it is estimated that in the United States (US), a person needs blood every 2 seconds, with over 10 million units of blood transfused in 2021. These blood transfusions are used for a variety of reasons, including major injuries or surgeries where an individual loses large volumes of blood. In addition to acute incidents, blood transfusions are widely used to help individuals living with chronic illnesses. Individuals living with bleeding disorders may require blood transfusions to replenish coagulation factors and platelets, two key components necessary for blood clotting in response to injury or bleeding.

But what kinds of challenges would this shortage pose?

Given that the amount of blood donations has reached a 20 year low, this represents a clear cause for concern. This presents many issues for healthcare, as patients may struggle to find blood matching the rarer blood types, while the consequences of using non-matching blood are fatal. This may even lead to cancellation or slowing of surgeries if adequate blood is not present, since this is a necessary component of some procedures.

Young adults and teenagers were often donating blood through high school initiatives, but in the wake of the pandemic, this became difficult. As well, more stringent requirements to protect the health of donors, may have contributed to the steady decline in young donors. Past campaigns have aimed to increase the number of blood donations from younger donors, and although these efforts have slowed, it will be vital to recruit more blood donors to reverse these shortages and ensure that there is enough blood to supply hospitals, and those in need. Next, lets discuss metals in food.

[Andrew] Over 60 cases of lead poisoning have been attributed to a recalled cinnamon applesauce brand, and the number of cases linked to this applesauce continues to increase. After extensive FDA testing, the potential culprit may be the cinnamon used in making the applesauce, which had more than 2,000 times the safe limit of lead.

This is especially concerning, due to the potential for lead poisoning, which occurs due to a buildup of lead in the body. Although this occurs primarily over time, young children are particularly vulnerable to the negative effects of lead poisoning. Lead poisoning may have significant impacts on the development of the brain, as well as kidneys and other organs within the body. Despite paints containing lead being banned in US, recognizing symptoms of lead poisoning is important because unintentional exposure is still a risk. Symptoms in children include behavioural changes, hyperactivity, and fatigue.

[Deepti]  That’s right. The effects of lead poisoning cannot be reversed, but specialized medications called chelating agents are able to bind to lead in the blood and prevent the lead from causing damage in other organs. Many famous painters including Michelangelo, were suspected of having lead poisoning, due to the circumstances of their death and the risk of exposure due to lead being in many paints. While modern medicine has given us some medications, it is nevertheless critical to avoid exposure to lead and other toxic metals, and to seek treatment at the first sign of symptoms.

Now, let’s discuss how recent evidence has shed light on the evolutionary spread of genes linked to multiple sclerosis (MS), a disease of the nervous system. 

[Andrew] Part of a class of diseases called autoimmune diseases, the latest evidence is prompting some to say that MS is not due to mutations, but instead is a result of an increasingly sterile environment that the ancient immune system is not accustomed to. MS is a disease that affects the central nervous system, comprised of the brain and spinal cord. It is characterized by the breakdown of myelin, a protective substance surrounding some nerve cells, that helps to increase the speed of transmission throughout those nerves. Although the breakdown of myelin is typically mediated by the body’s own immune cells, the exact causes are not fully understood. Symptoms of MS include vision problems, pain, numbness and tingling, as well as muscle weakness and mobility issues. 

The researchers believe that certain variations in the human genetic code were protective against pathogens carried by animals, but that these are no longer protective in the modern world. In fact, it is estimated that 2.5 million individualsworldwide live with MS, with individuals of Northern European descent having the highest risk of developing this disease. 

A topic discussed in her Emmy Awards speech, actress Christina Applegate has shared her experience with multiple sclerosis, noting the difficulties associated with activities of daily life, including driving, using stairs. Actress Selma Blair has also spoken about her battle with MS, marked by extreme pain and difficulty getting diagnosed. Diagnosis of MS includes blood tests and potentially imaging, though the recent discovery regarding the genetic basis of MS may inform future insights related to diagnosis and treatment of this disease.  

[Deepti] Winter is upon many regions of Canada and the US, and with it comes snowstorms, and potentially record breaking temperatures. Record low temperatures were seen in British Columbia and Alberta, while nearly 150 million Americanswere recently under a cold weather warning advisory.

Although snow may be beautiful to look at, it brings with it some very severe risks. Fatalities related to the cold snap in the US have been reported, as well as power outages and severe disruptions. Cold temperatures can cause hypothermia, a condition caused by extended exposure to cold temperatures which results in an inability of the body to heat itself. Symptoms of hypothermia include severe confusion, pale and cold skin, and uncontrollable shivering. In some cases, frostbite may also occur. Frostbite is a serious injury caused by freezing of nerves and blood vessels below the skin, and often affects extremities such as the hands, ears, and nose. 

Children and elderly individuals are at a particularly increased risk of developing frostbite, since their bodies are less efficient at retaining heat than adults. Preventing hypothermia in these populations as well as adult populations is critical amidst harsh conditions that may not be normal in various regions. Layering clothing with wind-resistant outer layers, covering extremities with hats, scarves, and gloves, and avoiding substances that promote heat loss such as alcohol, caffeine, and nicotine, are all important ways to stave off hypothermia. 

[Andrew] That’s right. If someone is suspected of being hypothermic, action is required. Contacting the local emergency services, getting them indoors, offering clothing or blankets that are warm and dry, and offering warm drinks are effective ways to help someone who may be hypothermic. A recent game between the Kansas City Chiefs and the Miami Dolphins resulted in over 60 emergency calls related to hypothermia, highlighting the importance of staying safe during the cold winter, even while enjoying Travis Kelce and the Chiefs. 

We’d like to acknowledge the following members of our team for their contributions to this week’s episode

• Neerav Mullur
• Yidi Wang
• Flaviu Trifoi

Thank you for joining us today for this episode of the 2 Minute Medicine Podcast. New episodes come out every other week and all of our content has been curated and written by practicing physicians.