Replies

• Grimes DS. Statins and Changing Number Needed to Treat (NNT). J Cardiovasc Disord. 2015; 2(3): 1018. "For women age 50 or less, the Number Needed to Treat with a statin for 5 years to prevent one death is 5000 people." Your patient is over the age in this study, but not by far. https://doi.org/10.1136/bmj.f6123 "A review of statins for primary prevention of cardiovascular disease could alter guidance for those with a 10 year risk of less than 10%. John Abramson and colleagues argue that statins have no overall health benefit in this population" Kristensen ML, Christensen PM, Hallas J. The effect of statins on average survival in randomised trials, an analysis of end point postponement. BMJ Open 2015;5:e007118. doi: 10.1136/bmjopen-2014-007118 "The median postponement of death for primary and secondary prevention trials [using statins] were 3.2 and 4.1 days [based on 11 studies spanning 2.1-6 years] respectively.
  May 2, 2021

• I'm going to answer my own question after listening to an excellent presentation by Dr Catherine Croft. The problem with fasting insulin testing is that insulin is a reactive hormone, it's not in a steady-state and is highly variable. This makes repeatability very challenging. When you look at different insulin measures, it's hard to achieve meaningful sensitivity and specificity. For this reason, performing a Kraft assay (2-hr insulin test after 100g oral glucose load) is preferred over fasting insulin.
  March 17, 2021

• In one of the Nutrition Network lectures by Megan Ramos, she differentiates Time-Restricted Eating from Intermittent fasting, where TRE includes eating 3 meals but condensing each eating window to only 60-90 minutes thus no snacking in-between meals but also no absolute feeding window. IF is more along the long the lines of an overall condensed feeding window with roughly 2 meals and optional snacking in-between. That was the first I've heard it stated that way, thought it was interesting. TRE is a useful concept for patients who are hesitant or afraid to go too long without a meal. So with this approach they focus on learning how to cook healthy, satiating meals on their journey to trying IF.
  January 7, 2021

• In the context of SMHP leaving behind "low-carb" in it's title and encompassing a broader approach to metabolic health, it think the term "Therapeutic Nutrition for Metabolic Homeostasis" is useful for those who need medical intervention, or"Therapeutic Nutrition for Metabolic Optimization" for those who are healthy and looking to improve performance.
  January 7, 2021