Verena Briner, Switzerland Paracelsus, a famous physician of the 16th century, wrote ‘everything is poison and nothing is poison. It is a question of the dose’. It is true in alcohol consumption. Factors such as gender, cultural reasons, comorbidities and genetics may contribute to alcohol toxicity. The danger of alcohol consumption lies primarily in alcohol addiction, leading to chronic abuse and organ damage. This results in impaired function of the brain and nerves, the heart, the liver, the pancreas, gastro-intestinal tract, immune system and metabolism. In addition, chronic heavy drinking affects family life, work and causes often economic problems. Alcohol is absorbed fast and about 15 minutes after consumption reaches all organs of the body. Alcohol is mainly metabolized in the liver. However, in the stomach and intestine, alcohol results in the production of acetaldehyde (ACD). The ACD formed is an important factor in alcohol dependence. ACD also increases the release of mediators (histamine and bradykinin) to cause flushing. The of ACD is most severe in the brain and the heart. Abstinence from alcoholcauses increase in calcium uptake in  the cells, causing arrythmia, tremor and even seizures. ACD does not pass the blood-brain barrier. In heart muscle, alcohol causes inflammation […]

Should sodium glucose co-transporter-2 inhibitors (SGLT2-i) be the first choice in the treatment of diabetes type 2? Jan Willem Elte The Netherlands For many years metformin has been the first choice drug in the treatment of diabetes type 2  after, of course, life style modifications have been applied. Recently, however, new classes of diabetes drugs have been investigated.  A new consensus report on the management of hyperglycemia in type 2 diabetes developed and published by the joint scientific associations of diabetes in Europe (EASD) and the United States (ADA) has appeared (published in Diabetes Care 2022). This report now recommends that patients with cardiorenal (heart and kidney ) risks should start with a SGLT2-i or a GLP1-RA ( glucagonlike peptide1-receptor agonist) with proven CVD (cardiovascular disease) benefit. In heart failure (HF) SGLT2-i is prefered. A combination of SGLT2-i and GLP1-RA may also be considered in patients with a very high atherosclerotic cardiovascular disease (ASCVD) risk. Use of both agents is recommended independent of HbA1,c, even if not on metformin. It should, however, be realized that the agents (GLP1-RA even more than SGLT2-i) are expensive. Before going into somewhat more detail, it is good to define what is meant by high […]

Source: BMJ2022;379: e072833 (GA Gaesser et al, Phoenix, AZ, USA) Recent research has confirmed results which have in fact been known for a long time. The walk of Mr Teabag (John Cleese) and Mr Putey (Michael Palin) in the legendary Monty Python Ministry of Silly Walks (MoSW) skit in 1970 were duplicated in 13 healthy adults (22 – 71 years, six women and seven men) with no known gait disorders. Participants performed three 5 minute walks around an indoor 30 m course in an exercise physiological laboratory. The first trial consisted of walking at a freely chosen speed. The next two trials consisted of low efficiency walks similar to the ones of Mr Teabag and Mr Putey (Figure).  The famous silly walks of Mr Teabag (the fictive Minister of Silly Walks) can be described as walking with bow knees, throwing the legs in the air every few steps, and walking backwards sometimes before walking on. The walks of Mr Putey were less pronounced. Ventilation and gas exchange were recorded and collected to determine oxygen uptake (VO₂) and energy expenditure (EE), which were the main outcome measures. VO₂ and EE were about 2.5 times higher during the Teabag walk, but not […]