Health Topics – Johns Hopkins Medicine Podcasts

Anchor lead: A new study suggests quite a few people who look to be headed to develop diabetes may not, Elizabeth Tracey reports

Prediabetes refers to a host of conditions such as elevated blood markers that seem to point the way toward frank diabetes, but now a new study that breaks people with the condition down into several subgroups shows that although many will go on to develop diabetes, not all of them will. Rita Kalyani, a diabetes expert at Johns Hopkins, comments.

Kalyani: I think it’s absolutely true that in clinical practice we would tell any patient who has risk factors for diabetes and is obese to lose weight, to follow a healthy lifestyle, to do more exercise, perhaps meet with a dietician. What research studies such as this tell us though is that not all people who have prediabetes will necessarily convert at the same rate, nor will they convert at all to diabetes. Perhaps that’s something that we really need to be mindful of that we are still understanding who’s at highest risk of developing diabetes.  :34

Kalyani notes that healthier choices will benefit all aspects of health, including diabetes risk. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: If you have diabetes what you eat really does make a difference, Elizabeth Tracey reports

Low carb diets do help people with diabetes improve their health, a recent meta-analysis found, although the benefits seemed to wane after a year. Rita Kalyani, a diabetes expert at Johns Hopkins, did a study finding a similar impact.

Kalyani: What we found in a real world setting, so not in a study setting, was the low carbohydrate diet was effective at reducing A1c, at reducing weight and in some of these metabolic outcomes too, even at three months and even up to six months later.  :15

Kalyani cautions that adopting such a diet may prove challenging for some.

Kalyani: Having greater availability of foods to choose from is important. Unfortunately many of these foods that we might consider quote unquote higher quality also are more expensive, so I think looking at the translatability and to prompt us to multiple communities of diverse backgrounds will be important.  :18

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How can the impact of carbohydrates be tested best? Elizabeth Tracey reports

Carbohydrate consumption may be an important tool in helping control diabetes, a new meta-analysis suggests, and most helpful is knowing which carbs to avoid. Rita Kalyani, a diabetes expert at Johns Hopkins, says there is data on that.

Kalyani: The best study model of that is the glycemic index. Where you really look at how carbohydrates lead to elevation of blood sugar, both how fast and how high. It is definitely true that not all carbohydrates are the same. There’s the very simple carbohydrates that are concentrated sugars that spike the sugar right away and then the complex carbohydrates whole grains that might take a little bit longer. The issue is a bit more complicated when you talk about the effects on appetite. We still need to better understand how the quality of the carbohydrate impacts metabolic disease.  :33

Kalyani says that while research is ongoing, educating yourself about which carbs raise blood sugar fastest may be helpful. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What is the impact of a low carbohydrate diet in people with diabetes? Elizabeth Tracey reports

Low carbohydrate diets seem to go in and out of favor, with a recent analysis of studies looking at their impact on those with diabetes. Rita Kalyani, a diabetes expert at Johns Hopkins, says there did seem to be benefits of these diets in the first several months of their adoption.

Kalyani: There was significantly greater weight loss, there was lower fasting glucose, and there was also beneficial effects on lipids. And interestingly they found that at 12 months most of these effects became less significant. What I concluded from this study is that while the low carbohydrate diet can be very beneficial and is safe for these multiple outcomes at six months, by twelve months perhaps because of the difficulty adhering to the diet for that length of time, many of these metabolic benefits were attenuated.  :29

Kalyani notes that this effect is similar to what is seen in many diet studies, but encourages those with diabetes who’d like to try to talk with their physician. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Many healthcare workers have died in this pandemic, Elizabeth Tracey reports

Almost 3000 healthcare workers in the US had died of Covid-19 at the end of December 2020, Kaiser Health News reports. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says she can only imagine what an outcry there would be if 3000 construction workers or long haul truckers had died.

Davidson: There has to be an acknowledgement from a national perspective from an occupational health and safety issue that there are real issues for all healthcare workers. Around the nation, healthcare workers, from the very junior, less trained to the professors have been losing their lives. So we really need to take a strong look at occupational health and safety in this context of the pandemic. And as everyone says this is not going to be the last.  :28

Davidson says some healthcare systems have fared much better than others in protecting their workers, yet standards and practices need to be implemented to help keep everyone safe. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Even as the pandemic slows down, clinicians are wearier than ever, Elizabeth Tracey reports

Long shifts at the hospital, constantly wearing personal protective equipment, worrying about whether you might bring home Covid-19 to family and friends, and high rates of death. Many studies are pointing to these factors as important in the high rate of clinician burnout, with loss of experienced people from medicine. Patricia Davidson, dean of the Johns Hopkins School of Nursing, comments.

Davidson: This is not a new problem. We know the National Academies of Medicine have had a strategic focus on clinician burnout. It’s been really exacerbated during Covid-19. All the pandemic has done apart from the devastation has laid wide open the cracks in our society, in our institutions, and I would also say particularly within healthcare it’s identified frailties but opportunities.  :28

Davidson says the pandemic has given us the chance to look closely at our healthcare system and implement changes to support those who have chosen medicine as a profession. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: A new treatment for those with methamphetamine use disorder points to how big a problem this has become, Elizabeth Tracey reports

Methamphetamine use is responsible for a staggering number of drug overdoses in the western and midwestern United States, with a new study describing one intervention using two medications that may help. How do we account for so much methamphetamine use in some areas of the country while opioids predominate elsewhere? Eric Strain, a substance use disorders expert at Johns Hopkins, comments.

Strain: What are the circumstances early in trying a drug versus later when you’ve become habituated to its use. The circumstances under which somebody first uses a substance tend to be governed more by the social circumstances, there might be peer pressure or maybe they’re depressed, but then as the person hones in on using the substance I think its more what is going on with that person specifically, their genetic vulnerability, thing like that, as well as physical dependence. :31

Strain notes that in parallel with the pandemic, overdose deaths have also almost doubled, the latest CDC data report. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How worried should we be about new Covid-19 variants? Elizabeth Tracey reports

Variants on the Covid-19 virus have popped up from at least three places around the world, scientists have found, with the potential for enhanced transmission person to person. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says his main concern isn’t the existing variants, it’s the overall rate of infection.

Garibaldi: The thing that I’m more concerned about is the fact that we’ve let this virus run rampant. And with so many people who are infected it has so many more opportunities to gather these mutations that by chance, might lead to a virus that does evade the vaccines. Now it is true that these vaccines can be modified very easily the platform that they’ve used, the mRNA vaccines they can modify the mRNA so that we make an immune response to these new variants if they become problematic. Right now I don’t think we need to do that. We certainly need to see more data in people who’ve been vaccinated.  :29

Garibaldi emphasizes that the best course for us all is to keep up with masking, distancing, and limiting interactions with others and to be vaccinated as soon as possible. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Why does air pollution reduce life expectancy? Elizabeth Tracey reports

How does air pollution impact life expectancy? A recent study suggests exposure to air pollution may be a major factor accounting for differences in life expectancy among residents who live just a few miles from each other. William Checkley, a critical care medicine physician and international air pollution and health researcher at Johns Hopkins, comments.

Checkley: Any exposure to air pollution leads to inflammation in the lungs, or even throughout the body. There are multiple components that affect life expectancy in adults, whether it is that you develop a chronic respiratory disease, a cardiovascular condition, inflammation itself increases risk of stroke, of heart attacks, and also the damage of course in the lungs that also makes you more susceptible to infections. It can all be related to a decrease in life expectancy.  :29

Checkley notes that in some polluted cities internal air filters are used by those with means to reduce their exposure to particulate matter found in air pollution. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Will testing saliva for Covid-19 replace nasopharyngeal swabs? Elizabeth Tracey reports

Testing saliva for Covid-19 has multiple advantages over the gold standard nasopharyngeal swab, two new studies report. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says these results must be viewed in context.

Garibaldi: When you think about these tests you have to think what is the reason I’m using this test? How am I going to put that positive or negative result into context? So the saliva based tests are easier, they don’t require putting a catheter up your nose so you don’t require any training to do them, they’re quicker to do, I think people will find them less invasive and less unenjoyable to get done, they’re fairly sensitive but they’re not as good as a PCR test, they’re not going to give you the same level of sensitivity so you’re going to miss cases. I think it’s a balance between if we can get more people tested it’s okay to miss a few more cases.  :32

Garibaldi says when transmission and cases are high, saliva may be okay for providing a broad picture of rates of infection in a community. At Johns Hopkins, I’m Elizabeth Tracey.