Trio of experts speak at WCM-Q Grand Rounds
An expert in low-carbohydrate ketogenic diets and two authorities on the heart disorder Brugada syndrome spoke at the latest instalments of Weill Cornell Medicine-Qatar’s (WCM-Q) Grand Rounds.
Dr. William Yancy, associate professor of medicine at Duke University and director of the Duke Lifestyle and Weight Management Center in Durham, North Carolina discussed the benefits of low-carbohydrate eating plans and some of their drawbacks in terms of weight loss and management of diabetes, with reference to his own research and other studies in the literature.
Pointing to a systematic review that analyzed perceptions of hunger while following various eating plans, Dr. Yancy explained that people on a low-carb regime (defined as less than 20g of carbohydrate per day) reported greater fullness, less hunger and less desire to eat compared with other plans. Research also shows that low-carb eating plans also proved to be more effective for long-term weight loss than low-fat plans, and led to increased HDL (good) cholesterol while slightly decreasing or not affecting LDL (bad cholesterol). Low-carb diets also led to reduced levels of harmful triglycerides, allowed people with diabetes to reduce their medication, lowered the incidence of hypoglycemic events, lower blood pressure, and led to reduced levels of hemoglobin A1C (which is associated with diabetes). People on low-carb eating plans also had higher levels of daily energy expenditure compared to people on low-fat or other eating plans.
However, Dr. Yancy pointed out a number of undesirable side-effects of low-carbohydrate diets, which include water loss, sodium deficiency, fatigue, dizziness, constipation, headache, weakness, bad breath, diarrhea, and muscle cramps. He said these symptoms were most common in the first two weeks of a low-carb diet plan and could be mitigated by increased fluid and sodium intake, use of constipation remedies, and adequate consumption of vegetables.
Dr. Yancy said: “Low-carbohydrate diets have some unique benefits, including reduced hunger, greater daily energy expenditure, reduced hemoglobin A1C, reduced hypoglycemic events, more weight loss, and they allow diabetes patients to reduce and, in some cases, stop taking their diabetes medications entirely. But it can also cause some side-effects, particularly when people are just starting a low-carbohydrate plan, and so it is important to emphasize fluid intake, especially in the first two weeks, and even to advise a sodium supplement to help people maintain their hydration and avoid symptoms like dizziness, headaches, fatigue and constipation that can occur with dehydration.”
Dr. Amar Salam, senior consultant cardiologist and chief of cardiology at Al-Khor Hospital, Hamad Medical Corporation (HMC), and Dr. Rasha Kaddoura, chief pharmacy specialist at HMC Heart Hospital, gave a presentation titled ‘Brugada Syndrome, the New Silent Killer: What Every Physician Should Know About It’. Brugada is a genetic disorder characterized by abnormal electrical activity in the heart that causes abnormal heart rhythms and increases the risk of sudden cardiac death. It is more common in men and in people of Asian descent and symptoms often occur alongside febrile episodes.
Dr. Salam explained the diagnostic criteria for Brugada syndrome, which is based on the presentation of patients, use of ECG tests, examination of family history and genetic testing. Dr. Kaddoura and Dr. Salam then discussed the medications to use to manage the condition, which include drugs to counteract ion current imbalances and antiarrhythmics such as quinidine and bepridil. They also explained which medications should be avoided as possibly harmful to people with Brugada syndrome and discussed two illustrative case studies.
Dr. Salam said: “There is a strong interest in Brugada syndrome as this is a relatively new disease to us all and it can kill people, so it is good that so many healthcare professionals are interested in learning how to recognize this syndrome. What I hope people will find most useful and memorable from this presentation is how to recognize Brugada syndrome from an ECG test.”
Both lectures were accredited locally by the Ministry of Public Health’s Department of Healthcare Professions – Accreditation Section and internationally by the Accreditation Council for Continuing Medical Education (ACCME).