Before we start this weeks newsletter in which I get told off by an elderly lady (again), well done to the right “honourable” Matt Hancock, who has finally listened to something he seems immune to called “facts”.
After months of me and most people on facebook and indeed the world pointing out that:
– Vitamin D is critical for immune system function and linked to increased respiratory infection
– Low levels of vitamin D were linked to poorer outcomes in COVID-19
– Vitamin D is deficient or insufficient in 90% of the UK population (100% if asian, black or obese)
– People from the BAME groups and obese all have far poorer outcomes from COVID-19
– Recent interventional studies showing massive reductions in intensive care and death from vitamin D prescription.
Matt joined the vitamin D party by actually being lead “by the science” and suggested we SHOULD take vitamin D!
The NHS is even doing its OWN triamhl of vitamin D and no doubt it will be a “world beater”, just like our track and trace…….
Anyhoo……once again this week I felt the full force of a lady in her mid 80’s.
Shelia’s prescription medication list is in double figures and despite my best efforts, it has remained that way.
The majority of them are “preventative” – statins for cholesterol for example, though as I regularly point out they do not actually reduce the risk of death in low risk patients
and even in higher risk the benefits are like my hair line, thin.
And that is if you believe the pharmaceuticals own research – remember they refuse to hand over the raw data so independent researchers can asses it.
The BMJ editor has called for it on numerous occasions to settle conflicting results between independent research and drug company research, especially in terms of side effects like muscle pain.
Strangely the drug companies say it is almost non-existent (1-2%) while independents find it alarmingly common (10-20%).
Critics point out that in the “run in phase” to a full study, any patients complaining of muscle pain are kicked out of the study……you couldn’t make this up and yet it is the truth.
Patient in their 80’s they are much more inclined to take anything the GP suggests and so usually it is easier to try and ameliorate some of the side-effects with supplements.
This week when she came in, I noticed little red cracks at the corner of her mouth, nothing severe but definitely not normal.
A bit like this:
Now, once you understand a little bit of metabolic jiggery pokery called methylation, the mouth takes on a whole new meaning.
You see methylation is part of making new cells and needs lot of stuff to run smoothly including B12, folate, B6 and B2.
That is partly why low B12 and folate can lead to anaemia – incorrect new cell production.
But red blood cells last 4 months so anaemia is the last thing to show up, but the mucous lining of the mouth/gut is turned over and completely renewed every 3-5 days.
Think about that for a moment – if you are treating a patient with some kind of tissue damage like a disc or rotator cuff or ligament damage, if they can’t make enough cells to have normal gut mucosa, how will they heal the disc, rotator cuff or ligament?
So the mouth is a window into your cellular function and vitamin status.
Little cracks at the corner of the mouth aka angular stomatitis are associated with B12, folate and B2, now you now why – methylation.
So I suggested to Sheila she might take a B complex and the potential benefits of that. After some bad language, gesticulation and glaring (I was a bit hypoglycaemic to be fair), she agreed.
But I also let her know that B2 turns your wee a rather vivid yellow (flavin is from the latin, “flavus” meaning yellow).
It is something to do with riboflavin absorbing the blue part of light that makes it look really yellow.
This is important because a few of my older patient prone to urinary infections have stopped taking B vitamins because they thought it was a UTI.
I also told Sheila to eat some liver, which is the most nutrient dense food on the planet. The one benefit of treating an older patient is they generally will eat liver as they were raised with it.
ACTIONS TO TAKE:
– Have a quick look at peoples mouths and tongues, you can get all sorts of useful info.
– Always warn patients about the yellow wee with B2.
– Eat liver it is the king/queen of foods