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A study suggests an intensive exercise program boosts cognitive performance and physical fitness in United States Air Force personnel. A nutritional supplement may also have some additional benefits.

While exercise is known to improve health and cognition, combining it with a nutritional supplement that mimics a Mediterranean diet may provide further advantages.

Scientists at the University of Illinois in Urbana-Champaign, Abbott Nutrition, and the U.S. Air Force Research Lab found that volunteers who consumed the supplement before and after training sessions had an edge in some measures of fitness and cognition 3 months later.

However, intensive exercise alone improved strength and endurance more than intensive training with the supplement.

On two cognitive performance measures, both the placebo group and the supplement group showed a slight reduction in performance, while other measures improved.

“The physical and mental health benefits of exercise are well known, but this study demonstrates how optimal nutrition can help boost brain function as well,” says study leader Chris Zwilling, a postdoctoral researcher at the University of Illinois.

“We are excited by the results because they provide critical insights into how simple dietary changes can make a big difference in helping people be as efficient and productive as possible in today’s world,” he adds.

The research appears in the journal Scientific Reports.

Strength and fitness training

The scientists recruited 148 active-duty male and female Air Force personnel from Wright Patterson Air Force Base in Dayton, OH, and randomly assigned them to two groups.

Both groups underwent a 12-week exercise program involving five daily sessions of 45 minutes, including rotating sessions of high-intensity interval training, aerobic fitness, and strength training each week.

One group drank the specially formulated nutritional supplement 30 minutes before and 1 hour after each session, while the second group consumed a placebo drink that looked and tasted the same. The supplement contained 267 calories of energy, while the placebo contained 100 calories.

Neither the researchers nor the participants knew who drank the special supplement and who drank the placebo.

The high-protein supplement contained a wide range of nutrients, including:

  • lutein, a carotenoid vitamin related to beta-carotene and vitamin A found in kale, spinach, avocados, and eggs
  • omega-3 fatty acids, found in oily fish such as mackerel and sardines
  • phospholipids, an essential component of cell membranes
  • beta-hydroxy beta-methylbutyrate, a supplement that helps increase muscle mass and aids recovery after exercise
  • folic acid
  • B vitamins
  • vitamin D

Participants took a series of cognitive and physical fitness tests before and after the exercise program. The cognitive tests assessed their memory, fluid intelligence — the ability to solve novel reasoning problems, executive function, and reaction time.

The exercise-only group had positive improvements in 5 out of 6 physical fitness measures and 4 out of 8 cognitive functioning measures. The research team recorded cognitive functioning increases in:

  • short-term memory
  • episodic memory
  • executive function reaction time
  • fluid intelligence and processing efficiency

The group who also took the supplement had improvements in all six fitness measures and 6 out of 8 cognitive measures. Compared with exercise alone, taking the supplement was associated with significant additional enhancements:

  • working memory increased
  • fluid intelligence reaction time decreased
  • lean muscle mass increased
  • resting heart rate, a measure of physical fitness, decreased

However, some of the figures in the study abstract were inaccurate. The authors have provided updated figures to Medical News Today and the journal.

Furthermore, the figures in the abstract were determined using raw data, which the paper did not provide. There were also some errors in rounding. Therefore, MNT is cautious about the study’s findings while the authors and the journal update the figures.

Working memory

Matt Kuchan, a research fellow and brain health scientist at Abbott and a co-author of the study, was impressed by the improvement in working memory among participants who took the supplement.

Working memory is a finite, temporary information store that predicts an individual’s ability to multitask and is often impaired in stressful situations. For example, it allows a person to remember a telephone number long enough to dial it or write it down.

“This is a really big deal,” says Kuchan. “First, because working memory is hard to improve. And secondly, because it is relevant to everybody.”

Strangely, two measures of cognitive function were slightly worse after the intervention for both the supplement and the placebo group: short-term memory and executive function accuracy.

It could be that these small performance decreases were due to test anxiety or chance.

The investigators say they did not design the study to determine which nutrients improved physical and cognitive performance. They also remain unsure if the enhanced cognition was due to the supplement, improvements in physical fitness, or a combination of both.

The study also took just 3 months, and therefore, it is not certain that real-life health programs could maintain these enhancements.

The research team discovered a link between the supplements and improvements that could not be explained by exercise in only 5 out of the 23 analyzed measures of cognitive health.

In addition, they made no adjustments in the statistical analysis to assess many variables in a single and relatively small study.

They also believe there may have been further benefits by using whole foods to deliver the nutrients, rather than supplements.

However, this would have presented several challenges in designing the study, for example, how to deliver exact quantities of several different nutrients.

The study provides evidence that intensive cardiovascular and resistance training offer rapid improvement in fitness, and in line with previous research, is associated with improvements in some measures of cognition.

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Red-gloved hands gently dip cotton swabs down nostrils and mouths of people taking turns to stand in front of a tall booth, masks lowered and head tilted backwards. Inside the booth to which the gloves are attached is a COVID-19 sample collector.

Set up by Nigerian health investment firm Flying Doctors in eight of the country’s worst-affected states, the mobile booths, which separate the sample collector from the people being tested, have boosted COVID-19 testing. Between 80 and 100 samples are collected per booth every day, although the number varies among states. Nigeria is conducting an average of 2500-3000 tests daily.

Flying Doctors founder, Dr Ola Brown, explains that at the start of the pandemic, Nigeria had few people trained to take COVID-19 test samples, and collectors would also visit people at homes to take samples, heightening infections risks through exposure.

“It [the sample collection booth] reduces to zero the number of infections on the people conducting the tests. Secondly, it also saves a lot of time compared [with] the people testing having to go to people’s houses to do the tests and thirdly, it saves money because people [are] not having to change their PPE [personal protective equipment]” frequently, says Dr Brown.

For Dr Walter Kazadi, World Health Organization (WHO) representative in Nigeria, “expanding access to services such as sample collection and diagnostic testing are critical for an effective response.” WHO continues to support Nigeria’s Centre for Disease Control and the national response system by providing resources for training and supplies for sample collection and testing.

The COVID-19 response across African has propelled a raft of innovations. Across the continent, innovators have worked to create tools to help public health experts manage challenges ranging from contact tracing and clinical care to local production of equipment and supplies as well as laboratory and testing materials.

Many of the innovations were already existing but have had to be redirected or adapted to COVID-19 response. For example, Zipline, a California-based firm, repurposed its high-speed drones that were in use in both Ghana and Rwanda to deliver medical packages to clinics and hospitals to now identify COVID-19 hotspots and collect samples. In anticipation of new treatments and vaccines that may become available, the company is poised to help with distribution.

In Kenya, to support contact tracing in public transport, a mobile phone-based application, mSafari, was launched in March by its developers in collaboration with the ministries of Health and Transport.

Most of the innovations are homegrown. The mobile booths in Nigeria are made locally. In all there are 14 booths in Abuja, Kano, Kaduna, Lagos, Ogun, Oyo, Rivers and Zamfara states. Flying Doctors also has transformed one vehicle into a mobile laboratory. In total, the organization has three laboratories. It has trained more than 100 molecular laboratory scientists to carry out COVID-19 testing.

Working with various foundations, the organization has made its testing free to encourage people to turn up. COVID-19 testing in Africa still lags other regions of the world. The World Health Organization Regional Office for Africa recommends 10 tests per 10 000 people per week in the region. Just 12 countries recently surpassed the threshold.

While Africa has recorded relatively fewer COVID-19 infections compared with other regions, the decline in cases seen between July and September has plateaued, with spikes in cases reported in some countries. Dr Brown stressed the criticality of testing and maintenance of vigilance on COVID-19.

“I think [that] one of the things that has really impacted the focus on testing is the fact that not many people have died in Africa compared [with] Europe or America. When people aren’t dying and when people aren’t getting horrifically sick and we’re not seeing those numbers of course it [testing] gets deprioritized especially in a country that has limited resources,” she says.

“It’s important for everybody to remain vigilant … and continue to really keep our guard up.”

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A small study in mice suggests that a dosage of vitamin D five times the current recommended amount for older adults could slow the development of frailty. However, the researchers now need to confirm this finding in humans.

Doctors currently define a person as “frail” if they display three or more of the following five characteristics:

  • unexpected weight loss
  • weak grip strength
  • self-reported exhaustion
  • low levels of physical activity
  • slow walking speed

Frailty tends to increase with age, affecting around half of individuals aged over 85 years. It is associated with disability, loss of independence, and increased rates of mortality.

Research suggests that people who have low levels of vitamin D in their blood are more likely to become frail. This is a particularly pressing concern, as up to 1 billion people globally may have insufficient levels.

Having adequate levels of vitamin D is associated with a wide range of health benefits, including healthier bones and teeth and stronger immunity to respiratory infections.

The body can synthesize its own vitamin D when the skin has exposure to the UV light in sunlight. However, during winter months in higher latitudes, and for people who spend most of their time indoors, the principal sources of vitamin D are diet and supplements.

Optimum intake

There is some uncertainty about the amounts of vitamin D a person should consume.

The National Academy of Medicine recommend a daily intake of 600 international units (IU) for adults aged 19–70 years and 800 IU per day for individuals aged 70+ years.

According to a research group at the Veterans Affairs Western New York Healthcare System and the University at Buffalo — both in Buffalo, NY — these recommendations are largely based on optimizing bone health.

They believe that much higher levels are necessary to maintain muscle strength and prevent frailty.

Their previous research in “middle-aged” mice suggests that a long-term insufficient intake of vitamin D in middle age may result in an impaired capacity for anaerobic exercise, decreased muscle mass, and increased amounts of adipose, or fat, tissue.

Their latest work in mice, which appears in the journal Nutrients, indicates that not getting enough of the vitamin in older age may accelerate the development of frailty.

“We found that in aged mice, low levels of vitamin D [resulted] in physical declines, such as reduced grip strength and grip endurance — the ability to sustain a grip — and that they started developing as soon as 1 month after reduction of vitamin D intake,” says first study author Kenneth L. Seldeen, Ph.D.

Crucially, vitamin D only protected the mice from these effects when intake was several times higher than the equivalent recommended intake for older adults.

“To slow the progression of frailty, it actually took greater amounts of vitamin D than what is currently considered sufficient for a human,” says Seldeen.

‘Hypersufficient’ intake

The scientists monitored mice aged 24–28 months, which equates to 65–80-year-old humans. At the start of the study, they divided the animals into three groups:

  • insufficient intake of vitamin D (defined as 125 IU per kilogram [kg] of feed)
  • sufficient intake (1,000 IU per kg of feed)
  • “hypersufficient” intake (8,000 IU per kg of feed)

Over the next 4 months, they assessed the animals’ physical performance and scored them on five tests of frailty equivalent to those that doctors use to assess humans.

By the end of the study period, the mice that had an insufficient or sufficient intake of vitamin D were significantly more frail than they had been at the start of the experiment.

By contrast, the mice with a hypersufficient intake were slightly more frail by the end of the study, but the increase was not statistically significant.

It is also worth noting that although there was an increase in frailty scores, by the 4-month endpoint, none of the groups of mice met the researchers’ definition of frail.

The researchers already recommend that older human adults take a minimum of 2,000 IU of vitamin D per day.

“This is particularly important for our frail geriatric patients,” says senior study author Dr. Bruce R. Troen, a professor of medicine. “But based upon our research, we believe that a lifetime of ample vitamin D supplementation will optimize long-term functional capacity and health.”

The new study suggests that a maximum daily dosage of 4,000 IU, which the National Academy of Medicine consider the safe upper limit, would be necessary to slow the progression of frailty in old age.

A dose of 1 IU is equivalent to 0.025 micrograms (mcg) of vitamin D in a supplement, so 4,000 IU is equivalent to 100 mcg.

Lack of research in humans

A single, brief, and very small study in male mice is limited evidence to address the question of the optimum dosage of vitamin D for older human adults.

Also, the complicated nature of the findings is highlighted by a lack of impact on measures such as muscle mass or treadmill performance.

However, a clinical investigation would need to run for at least 5 years to validate the results in humans, say the study authors. They add that it may not be safe to test persistently high or low levels of vitamin D over such a long period.

As Seldeen explains, “Using an animal model, we are able to examine these potentially riskier levels of vitamin D and the biological impacts during aging.”

“Also, doing so in genetically identical mice all living the same lifestyle, compared to the complexity of human diversity, allows greater focus on the specific effects caused by the different vitamin D levels.” – Kenneth L. Seldeen, Ph.D.

Nonetheless, human studies are accepted to be important in ensuring safe dietary guidelines for people, and the researchers do plan to pursue such studies in the future.

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A team of researchers has identified three repurposed drugs that may be effective in treating COVID-19.

In a new study, scientists have found three previously-available drugs that may be effective at treating COVID-19 in its early stages.

The research, which appears in the journal ACS Pharmacology & Translational Science, is valuable in helping researchers identify treatment candidates for clinical trials.

COVID-19 treatments

SARS-CoV-2 and its associated disease, COVID-19, have had a profoundly negative effect on global economies, culture, people’s everyday lives, and above all, on people’s health.

To date, there have been more than 1,150,000 recorded deaths from the disease. There is also mounting anecdotal evidence of the long-term negative health effects it can have on people who recover from the initial illness.

Due to COVID-19’s lethality, and the fact that the disease is highly contagious, scientists are rushing to develop a vaccine. However, producing vaccines that are also safe and effective takes a considerable amount of time.

According to a report in The Lancet, on average, vaccines take 10 years to develop. Even with experts greatly accelerating research due to the urgency of the global pandemic, the report notes that an initial vaccine may take more than 18 months to be developed, manufactured, and distributed to people around the world.

Consequently, scientists have been researching vaccines and potential treatments that may ultimately reduce the chance of a person dying if they develop the disease.

This typically involves repurposing previously available drugs that may also be effective in treating COVID-19. This is important as, much like developing a working vaccine, finding new drugs that can treat COVID-19 may take a long time.

To date, the only repurposed drug that has shown signs of being effective is remdesivir, originally developed to treat Ebola in 2014.

However, a recent major World Health Organization (WHO) study has found that remdesivir has no significant effect on COVID-19 mortality.

As a consequence, identifying effective drugs that experts can repurpose to treat COVID-19 is particularly pressing.

Alternative approach

In this context, scientists behind the present study took a different approach in the search for potentially effective drugs to repurpose.

Typically, when scientists source drugs to repurpose, they use a technique called high throughput screening (HTS). This involves automating the testing of many different medications, allowing for a much more rapid process than using human teams. Researchers then analyze the results with a computer.

However, according to the current study team, there may be issues with HTS’s reliability and accuracy. Drawing on an article in the journal Patterns, they note that there has been little overlap in the potentially effective drugs identified in HTS studies.

Instead, in their study, the scientists used a ligand-based virtual screening (LBVS) protocol to identify drugs that may act similarly to the drug hydroxychloroquine.

Studies show hydroxychloroquine is effective against SARS-CoV-2 in test-tube experiments, even if it is unlikely to be effective in real life.

Importantly, the scientists verified their findings in test-tube experiments and then had their results independently tested to ensure their findings were accurate.

Three drugs identified

After using LBVS to study approximately 4,000 drugs, then verifying their findings, the scientists identified three that may be effective against COVID-19 and, in their opinion, should be made the subject of clinical trials.

These are the antimalarial drug amodiaquine, the anti-psychotic zuclopenthixol, and the blood pressure medication nebivolol.

The scientists believe that these may be particularly effective if combined with remdesivir or the antiviral drug favipiravir.

As Prof. Tudor Oprea, senior study author and professor of Medicine and Pharmaceutical Sciences and chief of the University of New Mexico Division of Translational Informatics, says:

“Think of it as a whack-a-mole game. Instead of having one hammer, you have two hammers, which is more effective. We’re trying to give the scientific community two hammers instead of one.”

As both remdesivir and hydroxychloroquine show, a drug may be effective in a test-tube while being ineffective in real life. However, in the case of the latter, the risks of treatment may outweigh the benefits.

Nonetheless, if scientists can identify an effective COVID-19 treatment, it could greatly reduce the mortality rate of the current pandemic. Therefore, the first step to doing this is identifying potential treatment candidates.

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The Central Bank of Nigeria has advised all financial institutions to be abreast with emerging risks and other developments while taking proactive steps to address the new and emerging money laundering and terrorism financing.

The banking sector regulator noted that changes in the trends of business activities and financial transactions precipitated by COVID-19 pandemic had inadvertently led to increase in financial crimes globally.

The CBN stated this in a circular titled: “Administrative letters to all banks and other financial institutions,” that was signed by its Director, Financial Policy and Regulation Department, J. M. Gana.

Some of the measures it advised included investing in robust data mining and artificial intelligence software to monitor transactions; report suspicious transactions and update alerts protocol in their Anti-Money Laundering/Combating the Financing of Terrorism (AML/CFT) regulations.

It explained: “The Nigerian Financial lntelligence Unit (NFIU), as the central repository of suspicious transactions and other financial information, had issued an Advisory based on comprehensive analysis of STRs and other information available to it. The Advisory identified increased financial crimes such as, cybercrimes, frauds, counterfeiting and substandard goods; diversion of public Ends and misuse of Non-Governmental Organisations (NGOs).”

Some vulnerabilities and red flags highlighted in the advisory also included e-Commerce merchant with little or no history or internet presence, suddenly receiving multiple payments from unrelated third parties; individual(s) suddenly receiving multiple payment from unrelated third parties; and customer(s) suddenly engaging in the supply or purchase of medical supplies and payment for goods and services associated with known brands, yet the beneficiary is an individual is not a corporate.

It also stated that banks should expect to see more transactions for medical supplies, equipment and medication; payment for goods or services associated with a known brand, yet beneficiary is an individual not a company; unusual volume of transactions; large and frequent cash withdrawals and deposits as well as immediate disbursement of deposited funds to multiple accounts.

“The account signatory also a public/civil servant. Funds transferred from government account to personal account. Non-profit organisatons suddenly receiving donations in favor of Covid-19 patients or victims.

“Customers’ account with like or no activity suddenly receiving funds from one or more unrelated third parties only for the funds to be transferred to one or more unrelated thirds parties.”

The central bank also warned banks that NGOs under the guise of paying COVID-19 victims could actually be paying members of a criminal gang or facilitating terrorist financing.

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Vitamins and supplements are more popular today than they have ever been. But are they all that they are cracked up to be? In this edition of Medical Myths, we address a crop of supplement superstitions and mineral misunderstandings.

The supplement industry is huge. In 2016, the global nutritional supplement sector turned over an estimated $132.8 billion. By 2022, some experts predict that this figure will exceed $220 billion.

According to the National Health and Nutrition Examination Survey, in 2011–2012, 52% of adults in the United States reported using some kind of supplement. In addition, almost 1 in 3 people (31%) took multivitamins.

People, understandably, want to be healthy and free from disease. If popping a relatively inexpensive pill every day ups their chances of a healthy, long life, it is no surprise that supplements are popular.

When you couple the desire to live well with a bold marketing campaign replete with toned bodies and perfect smiles, supplements fly off the shelves.

Before we go on, it is important to note that supplements are important for some people. For instance, the Centers for Disease Control and Prevention (CDC) advise females of child-bearing age to take folic acid supplements.

Similarly, for people who live in colder climes, vitamin D is an important supplement, particularly during the darker months.

If your doctor has asked you to take a supplement of any type, it is important to use it as they advise.

In general, though, for adults without health conditions who eat a balanced diet, the vast majority of supplements are nonessential. As these products sit at the intersection of science and marketing, it is no surprise that there are some misconceptions about their benefits.

1. More is always better

When it comes to vitamins, more is not always better. In fact, more can sometimes be dangerous. As vitamin and mineral supplements are available without a prescription, people can be forgiven for assuming that they are safe at any dosage.

Large dosages of some vitamins can hamper the body’s finely tuned systems, though. For instance, according to the American Cancer Society:

“[T]oo much vitamin C can interfere with the body’s ability to absorb copper, a metal that’s needed by the body. Too much phosphorous can inhibit the body’s absorption of calcium. The body cannot get rid of large doses of vitamins A, D, and K, and these can reach toxic levels when too much is taken.”

Additionally, too much vitamin C or calcium might cause diarrhea and stomach pain. Taking too much vitamin D over long periods can cause calcium to build up in the body, which is called hypercalcemia. Hypercalcemia can weaken bones and damage the heart and kidneys.

2. If the label says ‘natural,’ it must be safe

Sadly, the term “natural” is fairly meaningless in relation to the safety or effectiveness of a supplement. To provide an extreme example, cyanide is a natural compound that ferns produce. Of course, we are not suggesting that any supplements contain cyanide.

Some natural plant compounds do have medicinal properties, but there is more to it than that. For instance, dandelion roots are a laxative, whereas dandelion leaves are a diuretic.

There is also the question of dilution: How much of the plant compound remains in the final product? It might be a minimal trace, or the extract might be highly concentrated.

3. It is fine to take supplements alongside normal medicines

As mentioned above, because supplements do not need a prescription, and many of them claim to be “natural,” there is a widespread misconception that they cannot interact with prescribed medication.

In reality, many of these products contain active ingredients that might interfere with other drugs. Supplements might, therefore, boost or reduce the effects of pharmaceutical drugs.

In a 2012 review, researchers investigated “drug interactions and contraindications associated with herbs and dietary supplements.” They found no fewer than 1,491 different interactions between herbal and dietary supplements and medicines.

In particular, supplements containing magnesium, St. John’s wort, iron, calcium, and ginkgo had the greatest number of interactions.

The fact that the majority of people who take herbal or dietary supplements do not discuss this use with their doctors compounds the potential issues.powered by Rubicon Project

4. Vitamin and mineral supplements protect heart health 

The idea that taking vitamin and mineral supplements will protect our hearts is reassuring. However, a large review and meta-analysis published in 2018 could find no significant benefit. Overall, the authors conclude:

“In general, the data on the popular supplements (multivitamins, vitamin D, calcium, and vitamin C) show no consistent benefit for the prevention of [cardiovascular disease, myocardial infarction, or stroke], nor was there a benefit for all-cause mortality to support their continued use.”

Although they did find that “folic acid alone and B vitamins with folic acid, B6, and B12 reduced stroke,” overall, these effects were small.

5. Vitamin C prevents a cold

Although there is a grain of truth to this slice of “common knowledge,” the evidence that vitamin C can prevent a cold is weak.

For instance, a 2013 Cochrane review dove into existing evidence. The authors’ objective was to “find out whether vitamin C reduces the incidence, the duration, or severity of the common cold when used either as a continuous regular supplementation every day or as a therapy at the onset of cold symptoms.”

The scientists found that vitamin C supplementation did not prevent the common cold in the general population. However, they did conclude that it reduced the severity of symptoms and the duration of the cold.

They also concluded that it “may be useful for people exposed to brief periods of severe physical exercise,” such as marathon runners.

6. Vitamin D prevents cancer

Scientists have carried out a large number of studies to investigate whether vitamin D might help reduce or treat cancer. Despite a great deal of research, as one paper explains, there is still no “consensus on whether vitamin D has a beneficial anticancer effect.”

In 2018, a randomized, placebo-controlled study that involved 25,871 participants investigated vitamin D supplements and cancer risk. The researchers found that “[s]upplementation with vitamin D did not result in a lower incidence of invasive cancer or cardiovascular events than placebo.”

7. Probiotics and prebiotics cure all

In recent years, a dizzying array of products claiming to improve gut health and a myriad of other woes have appeared. In particular, we have all witnessed the rise of probiotics and prebiotics.

Probiotics are foods or supplements that contain microorganisms, whereas prebiotics are foods or supplements that contain compounds designed to promote gut bacteria.

There is no doubt that gut bacteria are vital for good health. The science of the microbiome is still relatively young, but it is already implicated in conditions as disparate as hypertension, diabetes, and depression.

Although there are still large chasms in our understanding of the relationship between the microbiome and health, one fact that this young field has proven beyond doubt is that it is incredibly complex.

Scientists have demonstrated that probiotics might help with several health issues, including reducing diarrhea associated with taking some antibiotics and easing certain symptoms of irritable bowel syndrome (IBS). However, outside of a few specific conditions, there is little evidence that probiotics or prebiotics can benefit health.

Of course, this might change as scientists conduct more studies. Currently, though, it is marketing that drives the sale of probiotics and prebiotics, using vague terms such as “gut health” and “digestive health.”

According to the National Center for Complementary and Integrative Health (NCCIH):

“[I]n most instances, we still don’t know which probiotics are helpful and which are not. We also don’t know how much of the probiotic people would have to take or who would be most likely to benefit. Even for the conditions that have been studied the most, researchers are still working toward finding the answers to these questions.”

As the authorities do not consider probiotics to be medications, they regulate them less strongly, which introduces other concerns. As one author explains:

“Current regulation of probiotics is inadequate to protect consumers and doctors, especially when probiotics are aimed at the dietary management of serious conditions.”

8. Antioxidants extend life

Oxidation is a chemical reaction that occurs as part of many processes in the human body. Oxidation produces free radicals, which are highly chemically reactive and can damage cells and their components.

Antioxidants are compounds that prevent oxidation, and they include vitamin C, vitamin E, selenium, and carotenoids, such as beta carotene.

In general, fruits and vegetables are rich in antioxidants. As these foods are important for good health, it seems a safe assumption that antioxidants might be one of the reasons why they are so good for us. However, this is not necessarily the case, as the NCCIH explain:

“Research has shown that people who eat more vegetables and fruits have lower risks of several diseases; however, it is not clear whether these results are related to the amount of antioxidants in vegetables and fruits, to other components of these foods, to other factors in people’s diets, or to other lifestyle choices.”

The NCCIH also note that large studies have looked at whether antioxidant supplements can help prevent chronic diseases, including cancer, cardiovascular diseases, and cataracts, but that “[i]n most instances, antioxidants did not reduce the risks of developing these diseases.”

Above and beyond a healthful diet, it sounds plausible that taking antioxidant supplements might reduce oxidation further and, thereby, reduce the risk of disease and death. As with most things in medical science, though, the truth is a little more complex.

There is some evidence that taking antioxidant supplements might reduce lifespan. To investigate this question, Cochrane conducted a large review. They combined the results of 78 randomized clinical trials, which included a total of 296,707 participants.

When the researchers analyzed only the studies with the lowest risk of bias, participants who took antioxidant supplements were 1.04 times as likely to die as those who were either not taking supplements or taking a placebo.

Overall, the Cochrane team concludes that “[t]he current evidence does not support the use of antioxidant supplements in the general population or in patients with various diseases.”

The take-home

Vitamins, minerals, and antioxidants are vital for good health. In general, though, eating a varied, healthful diet will provide people with adequate levels of these.

Aside from vitamin D and folic acid, as discussed in the introduction, for adults, the benefits of supplements appear to be minimal at best. Although the supplement industry is thriving, casting a skeptical eye over companies’ marketing materials certainly won’t do people any harm.

Anyone who is planning on taking supplements but already has an existing condition should speak with their doctor first.

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Scientists have proposed a new therapy for type 2 diabetes. If proven effective, the therapy could help some people discontinue insulin treatment.

Scientists have proposed a new therapy for the treatment of type 2 diabetes, with a proof-of-concept study showing positive initial results. If effective, the therapy may mean that some people can stop taking insulin treatment.

The authors of the research presented their findings at UEG Week Virtual 2020, a conference organized by United European Gastroenterology, a professional nonprofit organization for specialists in digestive health.

Type 2 diabetes

According to the National Institute of Diabetes and Digestive and Kidney Diseases, a person may have type 2 diabetes when their blood sugar is too high.

People gain blood sugar, or blood glucose, mainly from the food they eat. Insulin helps cells access this glucose to use as energy. However, for a person with type 2 diabetes, either their body does not make enough insulin or their cells do not respond to insulin correctly.

This then means that the glucose in their blood increases, which can lead to complications of diabetes, such as heart and kidney disease, visual impairment, and loss of sensation in the limbs. The higher the blood glucose over time, the higher the risk of these complications.

According to the Centers for Disease Control and Prevention (CDC), about 1 in 10 adults in the United States have diabetes, and 90–95% of these individuals have type 2 diabetes.

Doctors typically recommend lifestyle changes, such as being more physically active and eating a more healthful diet, to treat type 2 diabetes, as well as medications to manage a person’s blood pressure and blood glucose levels.

Insulin treatment may be necessary if a person is unable to maintain their blood sugar at normal levels. This treatment can take the form of injections, pens, pumps, or inhalers. It encourages the cells in a person’s body to absorb more blood sugar.

However, people’s perception of the side effects of insulin treatment can be quite pronounced. As a result, doctors may be less likely to prescribe insulin, and, when they do, people may not take it regularly.

Consequently, therapies that can avoid these perceived side effects may be valuable in ensuring that people keep up with their prescribed treatment and avoid risking serious health issues.

Proof of concept

In this context, the researchers behind the present study used a novel technique that scientists first reported using in humans in 2016. Based on those preliminary results, it seemed promising.

The technique is called duodenal mucosal resurfacing (DMR). The duodenum is the first part of a person’s small intestine. DMR involves lifting the mucosal layer of the duodenal to allow the ablation of the revealed area using heated water — a process that removes the cells in the targeted area.

The researchers who developed the DMR technique were trying to replicate the positive impact that bariatric surgery (gastric bypass) has on blood sugar levels with a less invasive technique.

Studies of how bariatric surgery improves blood sugar control have concluded that there is a direct effect from the duodenum in addition to the weight loss that results from bariatric surgery.

DMR can take place in an outpatient setting and is minimally invasive. It involves an endoscope catheter to gain access to the duodenal.

The direct effect of the small intestine on glucose control appears to come from the presence of intraepithelial lymphocyte T cells. These are nestled between the gut cells involved in the absorption of nutrients from food.

Mice without these cells are protected from obesity and heart disease, even when eating a high fat diet.

These intraepithelial lymphocytes reduce the amount of a gut hormone called GLP-1. Therefore, in the current study, the researchers added regular doses of a GLP-1 agonist called liraglutide on day 14.

They did so to counteract the reduced amount of this essential lean, antidiabetic hormone. The study participants also received lifestyle counseling to help reduce their blood sugar levels.

The study involved 16 participants with type 2 diabetes receiving insulin treatment. Of the participants who received the DMR therapy with liraglutide, 12 (75%) were able to stop using insulin and maintain their blood sugar control after 6 months.

Promising initial results

The study participants also saw a variety of benefits to their metabolism.

The participants’ HbA1c readings, which determine a person’s glucose control, had all reduced to below 7.5%. After 12 months, this fell further to 6.7%.

Those who responded to the treatment saw a reduction in their body mass index from an average of 29.8 kilograms per square meter (kg/m2) before the study started to 25.5 kg/m2 12 months after the study. Fat in the participants’ livers reduced from 8.1% to 4.6% after 6 months.

Even for the participants who still needed insulin, the required amount reduced from an average of 35 units per day to 17 units per day after 12 months.

According to Dr. Suzanne Meiring, a researcher at the Amsterdam University Medical Center, the Netherlands, and co-lead of the study,

“A single endoscopic DMR ablation with GLP-1 drugs and lifestyle counseling can lead to discontinuation of insulin therapy in a subset of patients with type 2 diabetes while improving their blood glucose control and overall metabolic health.”

“Many patients with type 2 diabetes are very happy to be able to discontinue insulin therapy, since insulin therapy comes with weight gain and hypoglycemic events.”

Further research needed

It is important to note that this is a very small proof-of-concept study. The researchers presented it as a conference paper, and, therefore, few details are available in the public domain for scrutiny.

The intervention combined two innovative treatments. No details of any side effects of the two treatments (DMR and GLP-1 agonist) are available. While promising, there is a need for larger trials to confirm the results.

Importantly, precisely how and why the therapy appears to work is not yet clear.

The scientists believe that it may work because the mucosal cells that the DMR therapy affects undergo changes in response to unhealthful diets that can promote insulin resistance.

“Based on the results of this study, a large international randomized controlled trial, called Revita T2Di Pivotal, will soon start to further investigate its effectiveness in greater numbers,” says Dr. Meiring.

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Researchers may now have gained a better understanding of how the brain causes the disorienting, disruptive sensation of being outside of one’s body.

Most of the time, the mind and body operate seamlessly as a single entity. At times, however, a person may experience a disconcerting sense of “disassociation,” during which they feel as if they are somewhere outside of their body looking in.

According to Dr. Karl Deisseroth — who is a professor of bioengineering, psychiatry, and behavioral sciences at Stanford University in California — almost 3 out of 4 people who experience trauma report this phenomenon occurring either during or some time afterward.

Also, around 2–10% of the general population experience it at some point in their lives, he adds.

Recently, Dr. Deisseroth and colleagues conducted a study that allowed them to identify, for the first time, the brain mechanism that initiates disassociation.

They have now reported their findings in the journal Nature.

The feeling of disassociation begins with nerve cells in the brain’s posteromedial cortex firing synchronously at a specific rate.

Disassociation can be both troubling and disruptive, and it may become chronic. “In order to develop treatments, and to understand the biology, we needed to know more,” says Dr. Deisseroth.

Now, he adds, “This study has identified brain circuitry that plays a role in a well-defined subjective experience.”

“Beyond its potential medical implications, it gets at the question, ‘What is the self?’ That’s a big one in law and literature, and important even for our own introspections.”

The study also describes the molecular foundation underlying the mechanism that causes disassociation.

The brain’s role

Dr. Deisseroth describes disassociation metaphorically “as the perception of being on the outside looking in at the cockpit of the plane that’s your body or mind — and what you’re seeing you just don’t consider to be yourself.”

Indeed, the study is, in part, based on observations of a person who described the experience as being “outside the pilot’s chair, looking at, but not controlling, the gauges.”

The study authors were working with this individual as part of the Stanford Comprehensive Epilepsy Program. He experienced disassociation during preseizure “auras,” which refers to the time period directly preceding seizures.

The researchers recorded electrical signals from the individual’s cerebral cortex in an attempt to identify the brain activity causing his seizures. They noticed a particular pattern of electrical activity that coincided with the aura. It was occurring in the posteromedial cortex.

The researchers observed a particular rhythm being generated by nerve signals firing synchronously. The signal pulsed at 3 Hertz (Hz), or three times per second.

They subsequently found that if they deliberately stimulated this area of the brain electrically, the individual experienced a disassociation aura but no subsequent seizure.

Confirmation in mice

Previous research has suggested that mice experience disassociation as indicated by changes in their behavior.

For example, if a mouse located on an uncomfortably warm surface simply lifts its foot without licking it to soothe it — as would be expected — it is likely experiencing disassociation. Scientists can induce this state using the drug ketamine.

In the recent study, the researchers attempted to cause disassociation in mice by using light to optogenetically stimulate neurons in the rodent equivalent of the human posteromedial cortex.

When they applied stimulation at the same 3-Hz rate they saw in the human brain, they saw disassociative behavior without the presence of ketamine.

Additional research led to the discovery that a specific protein type called an ion channel is necessary for the generation of the 3-Hz pulse.

Recognizing the role of these proteins could lead to the development of new therapies that more effectively address disassociation and the conditions with which it is often associated, such as epilepsy, borderline personality disorder, and PTSD.

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Studies investigating the role of vitamin D in preventing or treating COVID-19 have drawn conflicting conclusions. But should a lack of evidence stop us from topping up our vitamin D levels as the Northern Hemisphere heads toward winter?

Most people know vitamin D as an essential vitamin for healthy bones and teeth. But researchers have attributed a host of other functions to the vitamin, and one of these is supporting the immune system.

A systematic review and meta-analysis from 2017 in BMJ drew on data from 25 randomized controlled trials to look at whether taking a vitamin D supplement could prevent acute respiratory tract infections.

The international research consortium, led by Prof. Adrian R. Martineau, from the Centre for Primary Care and Public Health and the Asthma UK Centre for Applied Research, at Queen Mary University of London, in the United Kingdom, looked at data from nearly 11,000 study participants.

Prof. Martineau and colleagues concluded that “Vitamin D supplementation was safe and it protected against acute respiratory tract infection overall.”

But does vitamin D have a part to play in COVID-19? By now, a number of studies have looked for links between the vitamin and the condition, and their findings have conflicted.

In this Special Feature, we investigate why some experts have suggested a link between COVID-19 and vitamin D, and we dig deep to explore how convincing the evidence from the latest studies really is.

We also discuss whether taking a vitamin D supplement can have realistic benefits, particularly for those in communities that have been hit the hardest by COVID-19.

Why vitamin D?

A number of experts have cited the 2017 study as circumstantial evidence that vitamin D may have a protective effect against COVID-19.

Their articles have appeared in journals such as The Lancet Diabetes & Endocrinology, BMJ Nutrition, Prevention & Health, Metabolism, and Aging Clinical and Experimental Research.

The common thread is that they highlight that adequate vitamin D levels may help our immune systems fight off the SARS-CoV-2 virus, as with other viruses that cause upper respiratory infections. People with vitamin D deficiency may, therefore, not be able to do this as effectively.

One aspect of this is that it provides an elegant excuse about why people from marginalized racial and ethnic groups have been disproportionately affected by COVID-19, as some scientists have suggested.

There is already evidence to suggest that people with darker skin tones who live in Northern latitudes have inadequate vitamin D levels.

To make vitamin D, our bodies convert a metabolite of cholesterol in our skin cells into an inactive form of vitamin D when we are exposed to sunlight, specifically to ultraviolet B (UVB) light. This inactive form then undergoes further chemical modification in the liver and kidneys.

The pigment melanin that gives our skin its color stops UVB light from reaching the cells. Hence, the darker a person’s skin, the more UVB light they need to make adequate levels of vitamin D from sunshine alone.

A study in the American Journal of Clinical Nutrition found that 17.5% of Black study participants in the United States were classed as being at risk of vitamin D deficiency, a figure nearly 8.5 times greater than the percentage of their white counterparts who were at risk of the deficiency.

Data from the past few months have shown that in the U.S. and the U.K., Black people are more likely to die if they have COVID-19 than white people.

Given the relationship between vitamin D and respiratory infections, it is perhaps not unsurprising that many people have suggested a tentative link between the vitamin and the disease.

So, let’s look at the studies that have sought to investigate this link in more detail.

Evidence so far

Back in June, the National Institute for Health and Care Excellence, in the U.K., reported that “There is no evidence to support taking vitamin D supplements to specifically prevent or treat COVID‑19.”

The organization based their statement on data from a number of published studies, all of which they deemed to contain a “very low quality of evidence.”

In August, a research team from the University of Glasgow, in the U.K., looked at the vitamin D levels of 341,484 participants in the U.K. Biobank health data repository. Of these, 656 had been to the hospital with COVID-19, and 203 had died.

Once the authors accounted for confounding factors, they concluded that there was no link between vitamin D levels and the likelihood of needing hospitalization for COVID-19 or dying from the disease.

The main limitation, the team noted, was that the vitamin D measurements had been taken roughly 10 years earlier.

Also in August, researchers in Spain reported the results of a small clinical study looking at intensive care unit (ICU) admissions and vitamin D supplementation.

The team gave one group of patients a supplementary high dose of calcifediol, a precursor molecule to vitamin D, in addition to a range of drugs to treat COVID-19. The other group did not receive calcifediol.

“Of [the] 50 patients treated with calcifediol, one required admission to the ICU (2%), while of [the] 26 untreated patients, 13 required admission (50%),” the researchers reported.

While these numbers seem impressive, the study was small and has several limitations. One is that the vitamin D levels of the participants were not measured before and during the study. There were also differences in confounding factors, such as other health conditions, between the two groups.

In addition, the study was open label, so both the researchers and the participants knew who had received vitamin D, which leaves room for bias.

Who tests positive for COVID-19?

A study published at the start of September in JAMA Network Open looked at the vitamin D levels of people who had received a COVID-19 test.

The research team, from the University of Chicago, in Illinois, used data from 4,314 people who had received a COVID-19 test at the university’s medical center between March 3 and April 10, 2020.

Looking at the medical records, they identified 489 individuals who had their vitamin D levels measured sometime in the year prior to the test, but not in the 14 days before it.

From this group, 71 people had received positive COVID-19 test results. Among them, 32 had vitamin D deficiency when their levels were last tested, and 39 did not have the deficiency.

The difference between these numbers did not reach statistical significance.

The team then used a model to predict how many people likely had vitamin D deficiency at the time of their COVID-19 tests, based on previous vitamin D tests and any information about subsequent vitamin D supplements.

When the researchers looked at positive COVID-19 tests in relation to predicted vitamin D status, their model showed that 21.6% of people who likely had the vitamin deficiency at the time of testing would receive positive COVID-19 test results. This figure was 12.2% among people without the deficiency.

While these data may indicate that vitamin D plays a role in the likelihood of receiving a positive COVID-19 test result, the researchers cautiously described the many limitations of their study.

In the paper, they note that “Randomized clinical trials of interventions to reduce vitamin D deficiency are needed to determine if those interventions could reduce COVID-19 incidence, including both broad population interventions and interventions among groups at increased risk of vitamin D deficiency and/or COVID-19.”

Also in September, the journal PLoS ONE published the findings of a large retrospective study conducted by researchers from Quest Diagnostics, in Secaucus, NJ, and the Boston University School of Medicine, in Massachusetts.

The team looked at data from 191,779 people with recorded COVID-19 test results and information about vitamin D levels from tests conducted in the preceding 12 months.

Their analysis showed that 8.1% of 27,870 people with adequate vitamin D levels had tested positive for a SARS-CoV-2 infection, while 12.5% of the 39,190 individuals with vitamin D deficiency had received positive results.

While the data are once again promising, there are a number of limitations. For example, the researchers used a model that the data did not fit particularly well.

Also, the vitamin D test results may not have accurately reflected each person’s vitamin D status at the time of their COVID-19 test. The team acknowledges that there may be other confounding factors that they did not control for.

In addition, it is worth noting that Quest Diagnostics sells a vitamin D test. And the only author of the study who is not directly affiliated with the company — Dr. Michael F. Holick, from Boston University — receives consulting fees from Quest Diagnostics and has authored a book that advocates vitamin D as a cure for common health problems.

Vitamin D and COVID-19 complications

Medical News Today recently reported on a study that looked at the vitamin D status of a group of patients who required hospital treatment for COVID-19.

The researchers found that only 32.8% of the 235 patients had vitamin D levels of at least 30 nanograms per milliliter, which they classed as sufficient. They also saw an association between sufficient vitamin D levels and having less severe COVID-19.

Although the study adds to the body of evidence that argues for a protective effect of vitamin D against COVID-19, it only included a small number of patients, and the researchers did not account for several potential confounding factors, including socioeconomic status, that could have had an impact on COVID-19 severity.

The authors themselves call for larger studies and randomized clinical trials to gain further insights.

Having a data set that is robust enough to account for a range of confounding factors will make the crucial difference between potential associations or correlations and a link that is underpinned by sound scientific data.

But do the effects really matter, when vitamin D can easily be supplemented?

Vitamin D supplements for all?

Writing in The Lancet Diabetes & Endocrinology, Prof. Martineau and Prof. Nita Gandhi Forouhi, of the University of Cambridge School of Clinical Medicine, in the U.K., recently suggested that it is worth taking a vitamin D supplement to ensure adequate levels while clinical studies into the link between vitamin D and COVID-19 are ongoing.

They explain:

“Pending results of such trials, it would seem uncontroversial to enthusiastically promote efforts to achieve reference nutrient intakes of vitamin D, which range from 400 [international units (IU) per day] in the U.K. to 600–800 IU per day in the U.S.A.”

“These are predicated on benefits of vitamin D for bone and muscle health, but there is a chance that their implementation might also reduce the impact of COVID-19 in populations where vitamin D deficiency is prevalent; there is nothing to lose from their implementation, and potentially much to gain,” the authors continue.

Many governments around the world have set recommended daily levels of the vitamin to ensure that people take in enough. This was true before COVID-19.

In the U.S., the National Institutes of Health (NIH) recommend that children older than 1 year and adults up to the age of 70 obtain 600 IU or 15 micrograms (mcg) of vitamin D each day. They advise people aged 71 or older to aim for 800 IU or 20 mcg.

The NIH recommend reaching these targets through a combination of the diet, sunlight exposure, and supplements.

Natural food sources of vitamin D include oily fish, beef liver, cheese, egg yolks, and mushrooms. Many breakfast cereals and milk and non-dairy alternatives are fortified with vitamin D, as are infant formulas.

In the U.K., Public Health England (PHE) recommend 400 IU or 10 mcg per day for people of all ages. Most people are able to get sufficient vitamin D from their diet and sunlight exposure in the spring and summer. This is not necessarily so during the rest of the year.

“Since it is difficult for people to meet the 10 [mcg] recommendation from consuming foods naturally containing or fortified with vitamin D, people should consider taking a daily supplement containing 10 [mcg] of vitamin D in autumn and winter,” PHE recommend.

They also say that people with little or no sunlight exposure due to work or personal circumstances and “Ethnic minority groups with dark skin from African, Afro-Caribbean, and South Asian backgrounds may not get enough vitamin D from sunlight in the summer and therefore should consider taking a supplement all year round.”

In light of the COVID-19 pandemic, the U.K. government is actively encouraging everyone to take a daily supplement of the vitamin, as many people may be spending more time indoors.

Of course, it makes sense for governments and public health bodies to recommend supplements for those struggling to get enough vitamin D.

But the consumption of dietary supplements is not ubiquitous, and there is variability among different racial and ethnic groups.

A 2016 study in JAMA that looked at trends in multivitamin consumption among U.S. adults found that in 2011–2012, 58% of non-Hispanic white study participants took multivitamins. For non-Hispanic Black participants the figure was 41% and for Mexican American participants it was 29%.

It is worth mentioning that excessive levels of vitamin D are toxic. “Vitamin D toxicity almost always occurs from overuse of supplements,” the NIH warn.

The upper daily limit of vitamin D for children aged 1–8, they report, is 63–75 mcg or 2,500–3,000 IU. For children aged 9 or over, teens, and adults, it is 100 mcg or 4,000 IU.

Vitamin D, COVID-19, and skin color

The risk of dying from COVID-19 is disproportionately high among people from marginalized ethnic and racial backgrounds.

In May, MNT reported on large study from the U.K. that found that preexisting conditions could not explain this increase in risk — but that there was a clear association with being a part of a racial or ethnic minority group or having experienced poverty.

Considering this data about COVID-19 risk and the fact that many people with darker skin in Northern climates do not have adequate vitamin D levels: Is the sunshine vitamin the reason that people from marginalized ethnic and racial groups are experiencing worse COVID-19 outcomes?

So far, the hypothesis remains just that.

Future scientific investigations into the suggested link between vitamin D status, COVID-19 outcomes, and skin color may provide clarity.

“Since African American and Hispanic populations in the U.S. have both high rates of vitamin D deficiency and bear a disproportionate burden of morbidity and mortality from COVID-19, they may be particularly important populations to engage in studies of whether vitamin D can reduce the incidence and burden of COVID-19,” the authors of the JAMA Network Open study discussed above note in their paper.

Yet vitamin D is likely only going to be one part of the complex puzzle that is COVID-19.

In a letter published in the Journal of Human Hypertension, a group from the U.S. and Argentina suggest that genetic susceptibility may be to blame. They point to a range of health conditions that affect African Americans more than white Americans.

“The usual explanation for these differences is the low socioeconomic status and educational levels, the social environment, lifestyle habits, and less access to healthcare services,” they write. “However, there are pieces of evidence that these non-favorable conditions are not enough, and there are other influential factors that may help [lead researchers] to a better approach to the real problem, like some genetic [factors].”

However, Dr. Winston Morgan, from the University of East London, in the U.K., has pointed to the lack of “evidence that the genes used to divide people into races are linked to how our immune system responds to viral infections,” in an opinion piece in The Guardian.

Instead, there is mounting evidence that structural racism is a crucial factor in why marginalized communities are harder hit by COVID-19.

In an exclusive opinion piece for MNT, Dr. Morgan discussed the outcomes of a recent PHE review into why COVID-19 disproportionately affects people from marginalized racial and ethnic groups.

He notes that the review’s recommendations focus on the need to address structural problems in health outcome disparities.

Vitamin D does get a mention. The review’s authors highlight the need for “further evidence as a matter of urgency” in order to deepen our understanding of why people of color are disproportionately experiencing negative outcomes of COVID-19.

In an interview with MNT, Assistant Prof. Tiffany Green, from the University of Wisconsin-Madison School of Medicine and Public Health, explained that “Those of us who work in the health disparities space are saddened but not surprised at the race-based disparities that the COVID-19 crisis has brought to light.”

She pointed to the “racialized class and occupational structures of the U.S.” as a major factor that contributes to who is exposed to the SARS-CoV-2 virus.

To conclude, it makes sense to look after our vitamin D levels as part of our general health, and by extension our ability to fight off infections. But science rarely has easy answers.

In order to navigate our way out of the COVID-19 pandemic, we would be better served if we were able to accept that we are up against a complex interplay of societal and immunological factors.

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Stroke is one of the many debilitating diseases today and a leading cause of death and disability worldwide with a prevalence rate of 1.14 per 1000.

A stroke happens when a major blood vessel (artery) which supplies nourishment and oxygen to the brain ruptures or is suddenly blocked. Disrupting this vital supply line to one-half of the brain results in paralysis on the opposite side of the body. Stroke is often preventable but in low and middle-income countries such as Nigeria, where the primary care services are often limited, the burden of stroke mortality is high.

According to World Stroke Organisation (WSO), 90 per cent of strokes are associated with 10 risk factors that can easily be identified: hypertension, exercise, diet, weight, smoking, alcohol, cholesterol, diabetes, depression and stress, and atrial fibrillation (AF, or AFib).

Stroke prevention
Stroke can be prevented in many ways across all boards, from government and policymakers to healthcare professionals to members of the community. Ways to prevent stroke include:

1- Increasing awareness
Despite being the second biggest killer globally, awareness of stroke risk factors and how to manage them is still relatively low. Coordinated global and national campaigns that raise awareness of how to reduce and manage individual stroke risks have the potential to deliver significant gains in stroke prevention.

2- Discovering risk factors for stroke and managing them appropriately

3-Implementing population-wide preventive strategies
Despite clear evidence of the effectiveness of population-wide strategies, there is still not a single country in the world that has implemented these in full on a population level.

4- Build partnerships and advocacy

To create a lasting impact in stroke prevention, we need to build partnerships between healthcare, government, and provide the evidence to support stronger advocacy from Non-Governmental Organisations (NGOs).
5-Modification of lifestyle and maintenance of healthier lifestyle and blood pressure control can significantly reduce the incidence of stroke in the society. A healthy lifestyle includes not smoking, no binge drinking, being physically active, and a healthy diet characterised by adequate fruit and vegetable intake, reduced dietary trans-fat intake, and reduced sodium intake.

Stroke care international (SCI), a charity-based stroke support organisation working to beat stroke in UK and Africa aims to prevent avoidable strokes, promote, recovery, and support life after stroke.
Mission includes:

– Stroke awareness and campaign actions: This encompasses all approaches that are concerned with screening, raising awareness, health education on risk factors, ways to reduce disease risks, and other health promotion activities.

-Health and lifestyle educational programmes that focus on risk reduction. This helps people to understand the link between high blood pressure and stroke, as well as their other stroke risk factors through organising health outreaches and stroke education to various media stations in Nigeria.

-Stroke support services aimed at supporting stroke survivors, family, and carers on their journey to live the best possible life after stroke by creating a positive environment to meet other stroke survivors and share experiences.

Survivors’ rehabilitation
Stroke survivors live with long-term Consequences such as disabilities and often manage their resulting limitations and health status as a chronic condition.

As the population of stroke survivors increases and the number of survivors with a disability and chronic care needs grow, rehabilitation care and therapy play an increasingly important role in integrating survivors back to society.

Rehabilitation is an important part of recovery after a stroke.
It helps patients relearn skills that were lost and regain independence, and improve the quality of their lives.

Stroke affects each person in different ways and survivors may experience a range of physical limitations such as paralysis of one side of the body, difficulty with language and speech, difficulty swallowing, vision problems, and imbalance.

Stroke rehabilitation may include physical, occupational, speech, and recreation therapies.
Physical therapy: Physiotherapy is an integral component of recovery from a stroke as it will improve function, health, and independence. It uses specialised modalities and exercises to help survivors relearn movement and coordination skills they may have lost because of the Stroke.

Goals of physiotherapy involve: restoring mobility, managing motor deficits, preventing and treating complications, community reintegration, improve independence, maximise function, and coordinate continuity of care.

Occupational therapy: Focuses on restoring the ability to perform daily activities, such as eating, drinking, dressing, bathing, reading, and writing.

Speech therapy or cognitive rehabilitation: Speech therapy helps people who have problems producing or understanding speech.

*Gloria Ekeng is a Stroke Nurse Consultant and executive board member of the World Stroke Organisation (WSO)

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