Latest / Morning Medical with Dr. Chow / Sulfonylureas Risks, Brain Aging in COVID, and Painkiller Shortages in Canada

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Sulfonylureas Risks, Brain Aging in COVID, and Painkiller Shortages in Canada · Morning Medical with Dr. Chow

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Welcome to another episode of Morning Medical with Dr.
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Chow.
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I'm Dr.
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Chi-Ming Chow, and today we're diving into a topic that's resurfacing concerns in the
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medical community: the cardiovascular risks associated with sulfonylureas for managing Type
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2 Diabetes.
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Recently, a comparative effectiveness research study has brought to light some old worries
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about sulfonylureas, a class of medications commonly used to lower blood sugar levels in
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individuals with Type 2 Diabetes.
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The study, led by Dr.
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Alexander Turchin from Brigham and Women's Hospital in Boston, compared the rates of major
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adverse cardiovascular events among patients who began treatment with sulfonylureas versus
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those who started on dipeptidyl peptidase 4 inhibitors.
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The findings revealed that glipizide, a member of the sulfonylurea family, showed a
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significant link to increased cardiovascular risk over a five-year period.
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Specifically, the risk of major adverse cardiovascular events was 9.1% for those on
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glipizide, compared to 8.1% for those on DPP4 inhibitors.
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This 13% relative increase in cardiovascular risk is clinically impactful, especially for
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patients already at moderate cardiovascular risk.
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The study's authors suggest that sulfonylureas, particularly glipizide, may not be the best
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choice for individuals with Type 2 Diabetes who are at moderate cardiovascular risk.
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This concern isn't entirely new, as sulfonylureas have been flagged before for
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their potential to increase cardiovascular risk, along with other side effects like weight
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gain and hypoglycemia.
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In practice, glipizide has been more commonly used than other sulfonylureas, partly due to
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its perceived relative safety.
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However, this study's findings challenge that perception, especially when glipizide's
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performance is compared to DPP4 inhibitors—a class of drugs not generally recommended for
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preferential use.
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An editorial accompanying the study, written by Dr.
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Rozalina McCoy and her colleagues at the University of Maryland, highlights the urgency
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of reconsidering the use of glipizide.
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They argue that the persistent use of glipizide may be driven by its affordability, especially
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when compared to newer, more expensive cardioprotective agents like SGLT-2 inhibitors
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and GLP-1 receptor agonists.
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This situation poses an ethical dilemma, as the choice between cost-effective treatments and
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evidence-based, safer alternatives becomes increasingly pressing.
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The editorialists stress the need for healthcare systems to align cost, access, and
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evidence-based practices in clinical decision-making.
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Dr.
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Turchin and his team conducted their study by examining the health records of patients from
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multiple U.S.
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health systems and insurance plans, tracking those who initiated treatment with various
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sulfonylureas or DPP4 inhibitors from 2014 to 2023.
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Their findings underscore the necessity for caution when prescribing glipizide to patients
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with moderate cardiovascular risk.
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Prime Minister Keir Starmer is urging resident doctors in England to reconsider their upcoming
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strike, which is scheduled to start this Friday and last for five days.
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Starmer has expressed concerns about the consequences of this strike, which he believes
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could lead to significant setbacks for the National Health Service and the country as a
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whole.
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In an opinion piece for the Times, he criticized the British Medical Association,
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stating that they are rushing into this decision without fully considering the
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potential damages.
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The strike, set to begin at 7:00 British Summer Time, is part of a pay dispute between the
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resident doctors and the government.
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Despite receiving an average pay rise of 5.4% this year and a 22% increase over the past two
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years, the British Medical Association argues that the real-term wages for resident doctors
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are still approximately 20% lower than they were in 2008.
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They are demanding that pay be restored to the levels of 17 years ago, when they claim their
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compensation began to decline.
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Health Secretary Wes Streeting has also weighed in, expressing regret over the current
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situation.
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In a letter addressed to resident doctors, he stated that the government is unable to offer
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further pay increases but is open to negotiating improvements in work conditions and
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career progression.
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Streeting emphasized that the current pay deal is the highest award within the public sector
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for resident doctors.
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However, the British Medical Association has criticized these negotiations, saying that the
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government missed opportunities to prevent the strike.
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The strike is anticipated to affect around sixty thousand appointments in London alone,
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according to the National Health Service.
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Senior doctors are being called in to cover for the striking resident doctors, as the National
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Health Service aims to maintain non-urgent services as much as possible.
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Hospitals have been advised to cancel routine care only in exceptional circumstances.
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Despite these measures, some disruption is expected, and the British Medical Association
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has warned that spreading staff too thinly could compromise safety.
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During previous strikes, there were significant cancellations, with over a million appointments
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and treatments affected since the strikes began in March 2023.
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While some hospitals have managed to maintain full schedules, others have struggled to
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deliver routine care on strike days.
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Meanwhile, the British Medical Association has recommended senior doctors request premium
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rates for covering shifts, which has led to criticism from National Health Service managers
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over the affordability of such rates.
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It is clear that the ongoing dispute between resident doctors and the government is complex
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and deeply rooted in issues of fair compensation and working conditions.
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As the strike approaches, the impact on patients and the healthcare system remains a
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significant concern, with both sides standing firm in their positions.
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Recent research from the United Kingdom has uncovered some intriguing findings about how
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our brains aged during the COVID-19 pandemic.
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A study published in the journal Nature Communications examined nearly one thousand
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adults and found that the pandemic period was associated with accelerated brain aging,
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regardless of whether individuals were infected with the virus that causes COVID-19 or not.
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This was discovered through magnetic resonance imaging scans, which showed a 5.5-month greater
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brain age gap than expected after the pandemic.
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Dr.
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Dorothee Auer and her team at the University of Nottingham conducted this study using data from
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the UK Biobank.
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The brain age gap is essentially the difference between an individual's predicted brain age and
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their actual chronological age.
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Interestingly, this accelerated aging in the brain did not correlate with cognitive
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performance, except among those who had been infected with the virus.
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This suggests that the pandemic itself, with its accompanying isolation and uncertainty,
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might have had substantial effects on brain health.
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One of the co-authors, Dr.
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Ali-Reza Mohammadi-Nejad, remarked on how surprising it was that people who hadn't
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contracted COVID-19 still showed significant increases in brain aging rates.
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This finding highlights the potential widespread impact of the pandemic experience on
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our neurological health, beyond just the physical effects of the virus.
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Maxime Taquet from the University of Oxford, who wasn't involved in the study, noted that
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while many participants showed brain aging at an expected rate, a higher-than-usual
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proportion exhibited striking increases in brain age, by as much as 15 to 20 months per
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year.
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This raises important questions about the long-term neurologic effects of the pandemic,
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whether from direct viral infection or from the psychological stressors of the time.
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The researchers suggest a biopsychosocial effect might be at play, combining the impacts
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of COVID-19 infection with the psychological and social stresses experienced during the
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pandemic.
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However, they also acknowledge the possibility that undetected or asymptomatic infections
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could have played a more central role than assumed, given that an estimated ninety percent
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of the UK population had been exposed to the virus by the end of 2022.
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While earlier research hinted that COVID-19 infection might lead to long-term cognitive and
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psychiatric changes, especially in those hospitalized, few studies had explored the
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broader impact of the pandemic period on brain aging.
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This study used brain age prediction models trained on pre-pandemic scans from over fifteen
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thousand healthy individuals, applying them to a cohort of nearly one thousand participants
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who had two MRIs conducted, with some taken before and others after the pandemic started.
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The study found that accelerated brain aging was more pronounced in men and those from
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deprived sociodemographic backgrounds.
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However, only those who had COVID-19 infections showed declines in cognitive performance,
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suggesting that the brain aging observed might not have been severe enough to impact mental
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acuity during the pandemic for most people.
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The researchers emphasize that their analysis looked only at associations and cannot
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establish causal relationships.
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They also note the limitation of using only two time points for their study.
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Longer follow-ups are needed to fully understand the persistent effects of brain
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aging and their long-term consequences beyond the immediate cognitive impacts observed in the
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infected subgroup.
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Eating three meals a day has long been a staple in many cultures, but is it really necessary
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for our overall health?
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Recent discussions among nutrition experts suggest that the traditional three-meal-a-day
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regimen might be more of a cultural convention than a biological necessity.
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According to Serena Poon, a certified nutritionist and longevity wellness advisor,
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there's no magic in eating three meals a day.
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Instead, what's crucial is the quality of the food, the timing of meals, and how well these
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align with an individual's unique biology and lifestyle.
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Poon argues that a flexible eating routine, such as having two nourishing meals and a
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snack, or three well-balanced meals within a 10- to 12-hour window, can be just as
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beneficial.
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This approach fits comfortably into modern schedules and has strong scientific backing.
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A 2024 review published in the Journal of the American Medical Association found that lower
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meal frequency, earlier calorie distribution, and time-restricted eating led to greater
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weight loss and metabolic improvements than the traditional three-meal pattern.
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In another study published in Nature Medicine, overweight or obese adults who ate within an
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eight-hour window significantly reduced visceral fat and cardiometabolic risk.
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However, extremely low frequencies of eating, such as consuming only one meal a day, can
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increase hunger and risk micronutrient deficiencies, requiring professional guidance.
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Lauri Wright, a director of nutrition programs and associate professor at the University of
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South Florida College of Public Health, agrees that the concept of eating three meals a day
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evolved from social norms and work schedules rather than scientific evidence.
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She emphasizes that what one eats is more important than when they eat.
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Regular meals can help stabilize blood sugar, support energy levels, and prevent overeating,
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especially for those with diabetes or who are prone to energy crashes.
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Wright notes that there's no one-size-fits-all pattern for eating.
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Some people might thrive on three balanced meals a day, while others do well with smaller,
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frequent meals.
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The key is meeting the body's nutritional needs throughout the day.
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"Three meals a day can be a helpful guideline, but it’s not a strict requirement for health,"
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she states.
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Personalization is key when it comes to eating frequency.
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Most healthy adults benefit from an eight- to 12-hour eating window that starts within two
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hours of waking and ends at least three hours before bedtime.
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This approach has been shown to improve appetite regulation, sleep quality, and morning
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levels of glucagon-like peptide-1 in young adults.
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Listening to the body's hunger cues, fueling it with nutrient-dense foods, and maintaining a
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consistent eating routine that fits one's lifestyle are what matter most.
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For those who rise early, front-loading calories into breakfast and lunch might be
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beneficial, while shift workers may find a later window more suitable.
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Individuals with specific conditions, like diabetes or pregnancy, should consult their
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doctor for personalized diet plans.
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Poon advises that lifestyle, medical needs, age, and preferences should guide one's eating
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habits.
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Some might thrive on three meals a day, others on intermittent fasting or grazing.
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The focus should be on consistency, nutrient quality, and listening to the body.
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Intuitive eating practices have been linked to lower morning cortisol, better mental health,
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sleep, and mood metrics.
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Instead of eating based on the clock, responding to authentic hunger and fullness
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cues can help maintain steady energy, sharpen focus, and avoid last-minute, less nutritious
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choices.
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Whatever eating pattern one chooses, the emphasis should be on whole foods, balanced
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macronutrients, and nutrient-rich options.
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Consistency in a pattern that honors the circadian rhythm, accommodates social life, and
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supports personal health goals is paramount.
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Dana Santas, known as the "Mobility Maker," is a certified strength and conditioning
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specialist and mind-body coach in professional sports, and she brings us insights on how to
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transform our daily walks into full-body tune-ups.
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Walking is one of the simplest and most accessible forms of exercise, offering numerous
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physiological and mental health benefits.
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It can improve cardiovascular health, boost mood and energy, reduce stress and anxiety, and
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even lower the risk of chronic diseases such as diabetes and heart disease.
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However, many people walk on autopilot, without attention to posture, alignment, or movement
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quality, which can lead to negative physical consequences over time.
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Poor walking mechanics can reinforce muscular imbalances, joint stiffness, and compensatory
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patterns that contribute to pain and dysfunction.
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But the good news is you can turn any walk into a full-body tune-up by becoming more
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intentional about your movement, breathing, and alignment.
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So, how can you make every step count?
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The first step to better walking is understanding it as a movement pattern.
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Proper walking mechanics involve more than just putting one foot in front of the other.
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A healthy gait pattern is a coordinated full-body activity.
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The way your foot hits the ground and how your glutes fire, your core stabilizes, and your
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arms swing in rhythm all matter.
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Proper walking mechanics begin with a heel-to-toe foot strike that creates forward
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momentum while activating the muscles along the back of your legs and glutes.
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With each step, your core should gently engage to stabilize your pelvis and spine.
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Your rib cage and hips rotate slightly in coordinated movement with your opposite arm and
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leg swing.
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This alternating and reciprocal motion not only propels you forward efficiently but also helps
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distribute weight and effort evenly through your joints and muscles.
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To assess your walking mechanics, you can check the wear pattern on the bottoms of your shoes.
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Normal wear should be relatively even across the heel and forefoot.
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Excessive wear on one side or more wear on one shoe than the other can indicate an imbalanced
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foot strike or gait asymmetry.
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You can also enlist a family member or friend to capture video while you’re walking so you
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can observe your movement and posture from the side and behind.
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Upper body mechanics play an equally important role in walking quality.
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Limited arm swing creates muscular tension and stress, especially in the neck, shoulders, and
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back.
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Hunched posture with a forward head position throws off alignment and creates muscle tension
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throughout the body.
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Asymmetrical movement patterns—often caused by carrying a bag on one shoulder, holding a dog
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leash in one hand, or even walking hand in hand with a partner—interrupt proper muscle firing
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and create muscular compensations.
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Even breathing patterns can affect walking quality.
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Chest-oriented, shallow breathing creates rib cage stiffness and weakens core stability,
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affecting your overall movement pattern.
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These patterns might seem subtle but can have compounding effects over time, leading to pain
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particularly in the feet, knees, hips, back, and neck.
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As you head out for your next walk, use a checklist to ensure your body is in its best
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walking form.
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Align your joints: your shoulders and hips should stack vertically, with your spine
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providing a centerline from the top of your head to the bottom of your pelvis.
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Avoid jutting your head forward or arching your lower back.
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Mind your foot strike: land softly on your heel or midfoot, rolling through to your toes.
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Balance your weight and effort by feeling that you are evenly distributing your energy from
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one side to the other with equally weighted foot strikes and glute firing.
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Think about driving each step from the back of your hip and feel your glutes engage as your
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foot pushes off.
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Let your arms swing naturally in opposition to your legs.
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Keep your elbows soft and if you have to carry a bag or hold a pet leash, try to switch sides
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at regular intervals.
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Keep your gaze forward: look ahead rather than down at the ground—and definitely not at your
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phone!
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This helps keep you in an aligned, relaxed posture that also improves your overall visual
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field.
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Be present by maintaining an awareness of your surroundings and continually assessing how
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you’re feeling in your movement, posture, and breathing.
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Breathing can significantly influence posture, energy regulation, and movement quality.
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Shallow, upper-chest breathing often accompanies poor posture and elevated stress
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levels.
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During walking, focus on rhythmic nasal breathing coordinated with your steps.
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Try inhaling for four steps and using a slightly extended exhale for six steps.
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This breathing pattern helps regulate your nervous system and encourages the natural
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expansion and contraction of your rib cage to support spinal alignment and mobility while
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walking.
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Doing a few mobility exercises before your walk can prepare your muscles, improve joint range
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of motion, and reduce tension for a more beneficial walking experience.
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Try focusing on your feet and ankles by doing ankle circles, step-back lunges to prepare your
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glutes, core, legs, and feet, and stretching out tension in your legs, back, and chest with
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a windmill twist.
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Walking is more than just cardiovascular exercise or a way to get from here to
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there—it’s an opportunity to reinforce better posture, improve mobility, and reconnect with
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your body.
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By walking with intention, tuning into your breath, and upgrading your mechanics, you can
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turn this everyday activity into a powerful tool for greater health and wellness.
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In recent news, Canada is grappling with a nationwide shortage of prescription
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painkillers, an issue that's affecting many patients relying on these medications for pain
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management.
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Health Canada announced that medications containing acetaminophen with codeine or
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oxycodone, which are typically prescribed to relieve pain, are in short supply.
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This shortage is expected to continue until early August.
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Some of the affected medications include acetaminophen with oxycodone, often known by
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the brand name Percocet, and acetaminophen combined with codeine, sometimes referred to as
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Tylenol No.
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3.
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Other formulations impacted include Teva-Oxycocet, Teva-Lenoltic No.
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1, 2, 3, and 4, and Rivacocet.
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The shortage is attributed to manufacturing disruptions and increased demand, as reported
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by companies like Teva Canada Limited, Laboratoire Riva Incorporated, and
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Pharmascience Incorporated.
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The Canadian Pharmacists Association is actively working with Health Canada and
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communicating with drug manufacturers and suppliers to understand the potential impact of
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these shortages.
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In response, pharmacists have started limiting the amounts dispensed to patients.
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Sadaf Faisal, the Senior Director of Professional Affairs at the Canadian
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Pharmacists Association, mentioned that pharmacists are documenting on prescriptions
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that they are only supplying a 30-day amount due to the limited supply.
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For those affected, Health Canada advises speaking with a doctor or pharmacist to discuss
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alternative pain management options.
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Pharmacists and other healthcare providers can assist patients by identifying alternatives and
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providing guidance on safe and effective pain management strategies, which is crucial since
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pain management significantly affects quality of life.
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However, it's important to note that due to the Controlled Drugs and Substances Act,
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pharmacists cannot change a prescription or offer an alternative without consulting the
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prescribing physician for approval.
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While the shortage may be resolved in a few weeks, Health Canada emphasizes that Canadians
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should only use licensed pharmacies for their medications and avoid purchasing from
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unlicensed or unverified online sellers to ensure safety and authenticity.
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As we wrap up today's episode, I want to thank you for joining me on Morning Medical with Dr.
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Chow.
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We've covered a wide range of topics, from cardiovascular risks in diabetes treatments to
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the effects of the pandemic on brain health and the current painkiller shortage in Canada.
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I hope you found this information helpful and enlightening.
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Until next time, stay informed and take care of your health.