What is the perfect blend of exercise for a healthier, longer life? Now, this isn’t about preparing for ultra-marathons or entering Mr Olympia; it’s about understanding the right mix of physical activities to keep ourselves as fit as possible for as long as possible.
A comprehensive study with over half a million participants has shed light on the best exercise regimen for longevity. The secret lies in a balanced trio: Moderate Physical Activity (MPA), Vigorous Physical Activity (VPA), and muscle strengthening.
The Ideal Exercise Combo: It’s More Than a Walk in the Park
The study, published in JAMA Internal Medicine, found that those with the lowest risk of early death clocked in more than 75 minutes of MPA, over 150 minutes of VPA, and a minimum of two muscle-strengthening sessions per week.
Tailoring for Cancer and Cardiovascular Health
For those focusing on reducing the risks of cancer and heart disease, the formula adjusts slightly. More MPA ( 300 minutes weekly), a moderate dose of VPA, and consistent muscle-strengthening work best. It might sound daunting, but consider it an investment in your future well-being. Do you care for yourself enough to make the investment in your future health?
More: Not Just Better, But Perhaps Essential
This study suggests that when it comes to exercise, sometimes more is indeed better. Interestingly, this study’s recommendations surpass the conventional exercise guidelines by some distance, However, it’s crucial to remember that any amount of exercise is a positive step. Not everyone can or wants to commit to an intensive exercise regimen, and that’s perfectly okay. Consistency trumps intensity every time. You should not feel like you have been flogged after every exercise session.
A Thoughtful Approach to Exercise
Our goal is not just to add years to life but also life to years. While that might mean increasing our exercise regimen, it’s about doing so mindfully and in a way that brings joy and vitality, not injury, dread or monotony.
Your journey to optimal health is just (several thousand) steps away!
Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.
British Association of Sports and Exercise Medicine · European Atherosclerosis Society · Independent Doctors Federation
As seen in The Independent, The Daily Mail and Tatler
For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.
Knee osteoarthritis (OA) is a degenerative joint disease that affects millions. The search for effective treatments has been ongoing, with intra-articular hyaluronic acid (IAHA) injections, such as Ostenil Plus and Durolane, emerging as promising options. However, there’s a discrepancy between the medical evidence backing IAHA and the varied recommendations from international guidelines. So, how effective really is this treatment, and does the method of injection play a role in its success?
The Promising Potential of IAHA Injections for Knee OA
Recent studies have focused on analysing the benefits and safety of IAHA injections. A comprehensive literature review, including randomized controlled trials and meta-analyses, highlighted the following:
Symptomatic Relief: IAHA, including Ostenil Plus, offers moderate relief to those with knee OA without significant safety concerns.
Impressive Benefit/Risk Ratio: When looking at improvements in knee OA outcomes, IAHA might have one of the best benefit-to-risk ratios among pharmacologic options. Notably, patients experience an overall increase in quality-adjusted life years and significant delays in needing total knee replacement.
In light of these findings, it’s worth considering IAHA injections as a viable treatment option. However, the real game-changer might be in tailoring treatments by the stage of disease and specific patient characteristics. The future of IAHA treatment may involve identifying OA patient subgroups that show a more pronounced response to the treatment. Combining IAHA with other treatments might also offer optimised care for knee OA patients.
Optimising Treatment with Ultrasound Guidance
Viscosupplementation involves injecting hyaluronic acid into the knee. It has faced criticism due to inconsistent pain relief benefits. One major concern has been the accuracy of needle placement, especially in obese patients. Enter ultrasound (US) guidance.
A study analysed community-dwelling patients receiving HA knee injections, comparing outcomes between those getting injections with traditional landmark guidance and those with US guidance. The results were compelling:
Similar Patient Cohorts: Both the US-guided and landmark-guided patient groups had similar demographics and arthritis severity.
Surgery-Free Outcomes: A significant number of patients in the landmark-guided group (45.8%) required knee arthroplasty (surgery), compared to only 33.2% in the US-guided group. The difference was even more pronounced among obese patients, with 51.8% in the landmark-guided group requiring surgery compared to 34.8% in the US-guided group.
These findings suggest a clear conclusion: To optimise the benefits of viscosupplementation, ensuring accurate intra-articular needle placement via US guidance is crucial. When done right, patients receiving US-guided HA injections are less likely to require subsequent knee surgeries.
In Conclusion
Knee osteoarthritis is a challenging condition, but modern treatments like IAHA injections offer hope. When combined with advanced techniques like ultrasound guidance, these treatments can provide significant relief and improve the quality of life for many patients.
Debunking Misconceptions and Embracing Comprehensive Solutions
The topic of weight loss injections has gained significant attention, particularly concerning medications like semaglutide, liraglutide (Saxenda, Wegovy), and Ozempic. In this article, Dr Hugh explains everything you need to know about Ozempic and navigating weight loss injections.
However, before delving into the specifics of these medications, it is essential to address the broader issue of obesity and the misconceptions surrounding its treatment. Many individuals who are offered these medications to manage obesity and its associated health risks often hesitate due to perceived stigma and misconceptions about the nature of their condition.
Redefining Obesity: A Chronic Disease
Society’s historical tendency to stigmatise individuals who are overweight has resulted in many viewing obesity as a personal failure. This perception is not only unjust but also hinders effective treatment. It is vital to understand that obesity is indeed a chronic disease and has been classified as a chronic disease since the 1990s. Its impact on health and mortality has been recognised for over 2500 years, dating back to the time of Hippocrates.
Understanding Obesity Pathogenesis
Obesity is not merely a matter of willpower or self-control. Its pathogenesis involves two interconnected processes. The first is a sustained positive energy balance, resulting from small, incremental imbalances between energy intake and expenditure over time. Once an individual reaches a higher-than-normal weight, the second process emerges: the resetting of the body’s weight “set point” at an elevated value.
This phenomenon can be understood through the lens of evolutionary physiology. Our biological predisposition to store body fat for survival was advantageous in times of scarcity but poses challenges in the modern era of abundance and easy access to calorie-dense foods. Consequently, a significant portion of the population is biologically inclined toward excessive weight gain. This intrinsic physiological mechanism explains why weight loss achieved through diet and lifestyle changes often leads to eventual weight regain, posing a considerable obstacle to effective obesity treatment.
Debunking Stigma: Obesity as a Disease
The stigma associated with obesity not only affects individuals emotionally but also hampers their access to appropriate treatments, including medications. It’s crucial to recognise that obesity is on par with other chronic diseases, such as type 2 diabetes. Just as one wouldn’t hesitate to manage diabetes with medication, obesity also requires a multifaceted approach to treatment.
Comprehensive Solutions: Weight loss medications
Weight loss medications, like semaglutide, liraglutide, and others, offer valuable tools in the management of obesity. However, it’s essential to view these medications as part of a broader strategy. Behaviour modification, dietary adjustments, increased physical activity, and in some cases, surgical interventions, all play integral roles in a comprehensive treatment plan. These components work synergistically to promote sustainable weight loss and improve overall health outcomes.
Shifting the perspective on obesity
Shifting the perspective on obesity from personal failure to a chronic disease is a crucial step in achieving effective treatment. By understanding the physiological mechanisms driving obesity, we can debunk misconceptions and encourage individuals to consider a comprehensive approach that encompasses medications, lifestyle changes, and supportive interventions. Of course, not everyone needs medications. Just because a medications offered to you, doesn’t mean you have to take it. Ideally, we would manage disease solely through lifestyle interventions. However, embracing a holistic strategy empowers individuals to fully take charge of their health.
Please reach out to the team if you have any questions about the contents of this article.
Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.
British Association of Sports and Exercise Medicine · European Atherosclerosis Society · Independent Doctors Federation
As seen in The Independent, The Daily Mail and Tatler
For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.
Cardiovascular diseases (CVDs) have long been a significant health concern, but advancements in statin therapy have helped reduce their impact. However, some patients continue to experience CVD events despite high-dose statin treatment. This is known as residual risk. Recent research suggests that this residual risk may be attributed, in part, to inflammation, which can trigger plaque ruptures. Here, we will delve into inflammation’s role in cardiovascular disease and explore the potential benefits of reducing inflammation using low-dose colchicine.
Inflammation’s role in Cardiovascular Disease
Inflammation has emerged as a key player in the development and progression of cardiovascular disease. Dr. Ridker and his team pioneered the use of high-sensitivity C-reactive protein (hs-CRP) testing to identify inflammation in patients. Their study, the Jupiter study, demonstrated the efficacy of rosuvastatin in reducing CV events in high-risk primary prevention patients identified through hs-CRP testing. However, the full potential of the inflammation strategy was not realised at that time and the potential to treat lower-risk patients was missed.
Uncovering the Link between Inflammation and CV Events
A recent paper explored the connection between inflammation and CV events by analysing data from three major studies: PROMINENT, REDUCE-IT, and STRENGTH. Patients were divided into quartiles based on their hs-CRP levels, and the highest quartile group was compared to the lowest.
The results were striking. Patients in the highest hs-CRP quartile experienced a 31% increase in major adverse cardiovascular events (MACE), a 268% increase in cardiovascular mortality, and a 242% increase in all-cause mortality, highlighting the significant impact of inflammation on CV health. Comparatively, the differences in MACE, CV death, and all-cause death were not as pronounced when comparing the highest and lowest LDL-cholesterol (LDL-C) quartiles.
The Inflammation Conundrum
Once patients are on effective statin therapies and their LDL-C levels are well-controlled, the threat posed by LDL-C diminishes. However, the presence of inflammation remains a driving force behind future CV events. Identifying patients with high hs-CRP levels while on high-dose statins becomes essential to intensify efforts in reducing their residual CV risk.
Addressing Inflammation: A New Frontier in Cardiovascular Health:
Presently, there are limited affordable therapies proven to reduce inflammation. As a result, it is crucial to prioritise preventive measures that can help combat inflammation and its consequences. Encouraging patients to quit smoking, manage abdominal obesity, reduce stress, improve sleep quality, and adopt a heart-healthy diet can significantly contribute to reducing inflammation and enhancing overall cardiovascular health.
The Concern of Inflammation Post COVID-19
The aftermath of long COVID poses another concern, as inflammation from COVID-19 may also increase the risk of cardiovascular events in a large number of people. Vigilance and proactive management of inflammation in recovering COVID-19 patients are paramount to safeguard their heart health.
The Power of Low-Dose Colchicine
Colchicine has been used for centuries to treat joint inflammation and is frequently used to treat gout. A recent analysis has shed light on the potential of low-dose colchicine, revealing its significant impact in the management of chronic coronary artery disease by reducing inflammation in the coronary arteries.
The study conducted an in-depth analysis to model the 10-year and lifetime impact of low-dose colchicine in patients with chronic coronary artery disease. The results were striking, demonstrating that low-dose colchicine has the potential to bring about a median 10-year absolute risk reduction rate of 4.6% for major adverse cardiovascular events (MACE). This reduction in risk translates into gaining 2.0 MACE-free years over a lifetime for patients.
What makes this finding even more significant is that the estimated 10-year and lifetime benefits of low-dose colchicine are comparable to the benefits associated with intensified low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure-lowering. LDL-C and blood pressure optimisation are well-established strategies in cardiovascular management, and the fact that low-dose colchicine holds similar potential is indeed promising news.
An exciting opportunity for patients with existing chronic coronary artery disease
The discovery of the potential benefits of low-dose colchicine presents an exciting opportunity for patients with existing chronic coronary artery disease. By adding this medication to their treatment regimen, they may experience substantial improvements in their cardiovascular health, with a reduced risk of MACE over the long term.
Low-dose colchicine is well-tolerated and has been used for years to treat conditions like gout. As always, individual patient needs vary, and decisions about treatment should be made in consultation with healthcare providers. When managing chronic coronary artery disease, healthcare providers will consider various factors, including a patient’s medical history, risk profile, and other existing treatments. By adopting a personalised approach to care, patients can receive the most suitable treatment plan that aligns with their unique health requirements.
Hope for a healthier & heart-protected future
Inflammation has emerged as a critical factor in the pathogenesis of cardiovascular disease, even when LDL-C levels are well-controlled through statin therapy. Identifying patients with inflammation through hs-CRP testing can help us address their residual CV risk and implement personalised strategies to reduce inflammation. The analysis of low-dose colchicine’s impact on chronic coronary artery disease has revealed its potential to significantly reduce the risk of major adverse cardiovascular events by reducing coronary artery inflammation. The estimated 10-year and lifetime benefits are on par with those of established cardiovascular therapies like LDL-C and blood pressure optimisation. Low-dose colchicine offers an exciting new option for enhancing cardiovascular health, providing patients with hope for a healthier and heart-protected future.
If you have chronic coronary artery disease
If you have chronic coronary artery disease, consider discussing the potential benefits of low-dose colchicine with your healthcare provider. Together, you can create a tailored treatment plan that best suits your needs, helping you embark on a journey towards improved cardiovascular well-being. Remember, your heart health is paramount, and with the right care and support, you can take positive steps to protect your heart and live a fulfilling life.
Please reach out to the team if you have any questions about the contents of this article.
Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.
British Association of Sports and Exercise Medicine · European Atherosclerosis Society · Independent Doctors Federation
As seen in The Independent, The Daily Mail and Tatler
For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.
Exercise has long been recognised as a key factor in maintaining a healthy heart and reducing the risk of coronary artery disease (CAD). A recent study called the CENIT trial has provided some valuable insights into the benefits of high-intensity interval training (HIIT) for patients with established CAD. Published in the European Journal of Preventive Cardiology, this research reveals how HIIT can counteract disease progression and promote cardiovascular health.
Coronary artery disease occurs when atherosclerosis, or plaque, builds up in the arteries that supply blood to the heart. Over time, plaques can increase in volume and become unstable and rupture leading to a stroke or a heart attack. Atheroma volume, which measures the amount of plaque present in the arteries, is a crucial indicator of CAD severity and has been shown to increase the likelihood of future cardiac events.
To better understand the impact of exercise on CAD, let’s examine the exercise interventions in the CENIT trial. The study consisted of two groups: the high-intensity interval training (HIIT) group and the control group. Each group had a specific exercise program.
High-Intensity Interval Training (HIIT) Group: Participants in the HIIT group engaged in two supervised exercise sessions per week for a duration of 6 months. Each session began with a 10-minute warm-up at a moderate intensity (around 60% to 70% of peak heart rate). This was followed by four intervals of intense exercise, lasting for four minutes each, at an intensity of 85% to 95% of peak heart rate. Active recovery periods, lasting for three minutes at a moderate intensity, were included between intervals. The sessions concluded with a 5-minute cooldown period. The HIIT sessions involved activities such as walking or running on a treadmill, bicycling, or other exercises that engaged large muscle groups. Participants were encouraged to use a wearable device to track their heart rate and activity levels during the HIIT sessions. This allowed them to maintain the desired intensity and monitor their progress. In addition to the supervised sessions, participants were advised to engage in home-based endurance training. This included performing intervals and any other physical activities that involved dynamic work with large muscle groups.
Control Group: The control group followed contemporary preventive guidelines for physical activity without receiving further supervision. They were encouraged to engage in regular physical activity of moderate intensity for 30-60 minutes on more than 5 days per week. Not only was this exercise not supervised but it was not monitored unlike in the intervention group.
The CENIT trial focused on the effects of supervised HIIT on coronary plaque geometry in patients with stable CAD who had undergone percutaneous coronary intervention (PCI). Here’s what they found:
Regression of Atheroma Volume: Patients who participated in 6 months of supervised HIIT experienced significant regression in atheroma volume compared to those following standard preventive guidelines. This means that the plaque buildup in their arteries was reduced, potentially lowering their risk of future coronary events.
Improved Cardiorespiratory Fitness: The HIIT group exhibited a significant improvement in peak oxygen consumption (VO2peak), which measures cardiorespiratory fitness. By increasing VO2peak, HIIT enhances the overall health of the cardiovascular system.
Positive Body Composition Changes: Patients in the HIIT group also experienced reductions in body mass index (BMI) and waist circumference. These improvements in body composition are important markers of metabolic health and can contribute to a reduced risk of CAD and related complications.
The findings from the CENIT trial provide reasonable evidence for the effectiveness of HIIT in managing CAD and improving cardiovascular health. It is, however, difficult to tease out from the study whether it was the supervision of exercise, or wearing a monitor that someone else was tracking or the HIIT that had the greatest benefits. Based on these results, here are some key takeaways to consider:
Consult An Experienced Personal Trainer: If you have established CAD or are at risk for heart disease, consult a very experienced personal trainer who is confident in managing patients who have stable heart disease. They can provide personalised recommendations based on your health status and previous exercise experience.
Embrace High-Intensity Interval Training (HIIT): Consider incorporating supervised HIIT sessions into your exercise routine under professional supervision. HIIT involves short bursts of intense exercise alternated with active recovery periods, making it an efficient and time-effective workout option. But note, the intervention group did not just do HIIT, they also did low-intensity exercise.
Prioritise Exercise: HIIT’s positive impact on atheroma volume regression, improved cardiorespiratory fitness, and positive body composition changes highlight the importance of exercise as a core component of cardiac rehabilitation programs. When compared to another study looking at the effects of high-intensity statin on plaque lipid volume, high-intensity exercise combined with low-intensity exercise had an effect comparable effect to that of a high-intensity statin.
Monitor Your Exercise: The intervention group wore a wearable and knew they were being monitored. Use a wearable and get an accountability partner to keep you on track.
The CENIT trial provides evidence that high-intensity interval training, supervised by a personal trainer and the wearing of a fitness tracker can effectively counteract disease progression and improve cardiovascular health in patients with established coronary artery disease. Participating in supervised HIIT sessions can lead to a reduction in atheroma volume, improved cardiorespiratory fitness, and positive body composition changes.
Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.
British Association of Sports and Exercise Medicine · European Atherosclerosis Society · Independent Doctors Federation
As seen in The Independent, The Daily Mail and Tatler
For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.
1. What exactly is heat stroke and what causes it – what is going on inside the body on a cellular level?
Heat stroke is the worse end of a big spectrum of heat related conditions.
Exertional heat stroke is the type that is associated with exercising in the heat, it is a very serious condition when our body can no longer control its temperature and it starts to sky rocket.
Usually when we work out we have lots of great mechanisms for helping our body cool off. Aside from our fancy work out gear our body cleverly sends more blood flow to the skin to help our skin produce more sweat which helps our body stay cool. To get more blood flow to the skin we send less blood to our digestive system which is why lots of people can find it hard to digest foods after exercise. In extreme heat this though can cause problems with less water being absorbed in our gut and even the gut becoming leaky and allowing toxins to enter our blood stream.
If we become dehydrated during exercise it gets worse as our heart struggles to pump enough to keep up our circulation and becomes strained. If we can’t get enough blood to our muscles, they can start to overheat too and produce harm toxins which can actually damage the muscle tissue itself.
We really start to worry about people when the body temperature is above 40 degrees centigrade. This is because this is called the ‘thermal threshold’, above this temperature the membranes, or outer layer of our cells, can become damaged, this can cause enough harm to cause the death of cells. In the worst-case scenario, the combination of these events can lead to unconsciousness, coma, multiple organ failure and even death.
2. What can trigger heat stroke?
The biggest risk of heat stroke is when the temperature outdoors is above 28°C, in combination with doing some strenuous activity or high intensity exercise for an hour or more. So even an outdoors exercise class or a fast run could be a risky time.
Definitely if you are not used to that exercise there is a bigger risk. So, the current brilliant weather is a great reason to enjoy being outdoors but not the perfect time to try out that boot camp class.
If you have another complicating factor it can also be enough to get your body in trouble, even if you are super fit. Common things are having a virus or mild illness, being dehydrated before you start exercises, inappropriate clothing and being tired. Some medications such as anti-depressant medicines can also add to the risk.
3. What are the symptoms of heat stroke? – from the most obvious to some which are perhaps a bit more surprising?
Most of us have probably experienced mild symptoms such as feeling a headache and unwell after a long afternoon in the sun. These kind of exhaustion symptoms are probably a really good way our body tries to make sure we don’t keep exerting ourselves and put ourselves at risk of overheating even further
Heatstroke though can progress really quickly, there is often a severe headache, feeling generally confused and restless. It might surprise people that the skin is often dry, they are no longer sweating which is part of the problem and they are usually quite red and dry skinned. Their pulse might be racing. If you measured your temperature it would usually be above 40 degrees centigrade. When symptoms have become this severe it is an emergency to cool that person, they can quickly deteriorate to becoming drowsy and then unconscious.
4. What are the best forms of heat stroke prevention and management?
As in most things prevention is much better than cure. So, try to make sure you are not putting yourself in a high-risk group. Keep well hydrated before exercise, if you are doing a long event such as a marathon it is important you keep hydrated but take care not to over drink. Pre-cooling by using cooling clothing, cold water immersion and taking cool drinks before exercise can help too.
If you know you are not well or are just recovering from an illness, then it is sensible not to push yourself in hot conditions. Make sure you have clothing on which will allow your skin to sweat freely and keep cool. If you are concerned about any medication or illness you may have please check with your doctor before strenuous exercise. Stomach upsets and having had too much alcohol in the day before are common triggers.
Anyone planning to take part in an event or exercise in hot conditions should plan to get their body used to this beforehand. Ideally this would be training in the same environment but if that’s not possible then a training in a hot room can help, it takes the body at least 7 days and up to 14 days to really get used to exercising in a hot climate. Start with 30 minutes at a time and build up to 100 minutes, your body will learn to cool itself better. Ideally this should be daily, but even every day or two will help. Heart rate monitors can help you check you are not pushing yourself too hard. Unfortunately, when it comes to getting used to exercising in heat we are not all equal, women are more at risk than men.
Ice packs and cool flannels can help to reduce body temperature quickly, the back of the neck, underarms and groins are the best places for these. Plus using fans and cold-water sprays to help the body lose heat through the skin. Cool fluids and slushy ice drinks are useful too.
If you or someone you are with is showing signs of heat stroke then it is important to get them to medical care quickly, this would usually be an Accident and Emergency department. Even young and fit people can deteriorate quite quickly. In hospital other techniques such as fluids via a drip and medicines can be used, as well as blood tests and checks to make sure that the person is not suffering any organ damage.
DR LUCY HOOPER MB BS BSc MRCGP MA DRCOG DCH
Lucy is a GP and co-founder of Coyne Medical. She graduated with honours from Imperial College London, trained at St Mary’s Hospital, and holds a Master’s in Medical Ethics and Law. Her clinical interests span women’s health, preventive medicine, and genomics, with a particular focus on using advanced biomarkers to build a more complete picture of long-term health.
British Society for Genetic Medicine · European Atherosclerosis Society · Independent Doctors Federation
As seen in BBC, The Guardian, Women’s Health, The Times and Tatler
For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.
Introduction – The Future of Cancer Screening with Advanced Blood Tests
Cancer screening has taken a significant leap forward with the introduction of advanced blood tests like Trucheck™ and Galleri®. These innovative screening methods aim to detect cancer at its earliest stages, providing vital information for timely interventions and improved outcomes. In this blog, we will compare Trucheck™ and Galleri®, exploring their scientific principles, advantages, and considerations, to help you make informed decisions about cancer screening.
Trucheck™, developed by Datar Cancer Genetics, focuses on detecting circulating tumour cells (CTCs) and circulating ensembles of tumour-associated cells (C-ETACs) in peripheral blood samples. By employing primary negative enrichment, Trucheck™ enables the survival of malignant cells while allowing non-malignant cells to undergo apoptosis (programmed cell death). The subsequent analysis of tissue-specific markers on these cells helps identify cancer types and their likely organ of origin. Trucheck™ offers high sensitivity, specificity, and an overall advantage in detecting over 70 solid organ cancers.
Galleri® – Analyzing Cell-Free DNA (cfDNA) for Cancer Detection
Galleri®, another groundbreaking blood test, detects over 50 types of cancer and predicts the origin of cancer signals with high accuracy. This test examines the methylation patterns of cell-free DNA (cfDNA) found in the bloodstream. Methylation patterns, which regulate gene expression, can be altered in cancer, contributing to tumour growth. By leveraging next-generation sequencing (NGS) and machine-learning algorithms, Galleri® analyses the methylation patterns of cfDNA to identify cancer-specific abnormalities. These patterns provide valuable information about the presence and origin of potential cancers.
Accuracy & Sensitivity of Each Test
Trucheck™ demonstrates an overall sensitivity ranging from 82.5% to 88.2% for different cancer types. It boasts a specificity of 99%, correctly identifying 99 out of 100 individuals without cancer. False positives occur at an estimated rate of 1% to 3% according to the studies available so far. Trucheck™ has been designed as a complement to, not replacement for, standard cancer screening, offering peace of mind to individuals with negative results while prompting further tests or referrals for those with positive results.
Galleri®, as demonstrated in the SYMPLIFY study, achieved a sensitivity of 66.3% overall, ranging from 24.2% for stage I cancers to 95.3% for stage IV cancers. This demonstrates Galleri’s ability to detect cancer signals across various stages but that it is most reliable with later-stage tumours. With a positive predictive value (PPV) of 75.5% and a negative predictive value (NPV) of 97.6%, Galleri®shows promise in accurately identifying individuals with cancer. The test’s specificity stands at 98.4%, further enhancing its precision in distinguishing cancer from non-cancer cases.
Availability & Cost – Which Test is More Accessible?
Trucheck™ is available as a standalone test or add-on service for patients undergoing health screening at Coyne Medical and several other private clinics in London and beyond. It may not be covered by healthcare insurance or the NHS prior to a formal cancer diagnosis. Further diagnostic procedures and referrals prompted by positive results may require self-payment.
On the other hand, Galleri® is currently being evaluated in clinical trials and is not widely available outside of these trials. The SYMPLIFY study demonstrated its potential in a cohort of patients referred for diagnostic investigations related to suspected gynaecological, lung, and gastrointestinal cancers. It is not currently available in the UK in private care. It is only available through NHS research trials.
Considerations and Future Implications:
Both Trucheck™ and Galleri® have the potential to revolutionise cancer screening, but it’s important to consider certain factors. Trucheck™ offers a broader range of tests for different cancer types, while Galleri’s focus lies in detecting over 50 cancer types. Trucheck™ uses CTCs and their clusters as biomarkers, primarily for solid organ malignancies, whereas Galleri® examines cfDNA methylation patterns.
While Trucheck™ and Galleri® boast impressive sensitivity, it’s crucial to understand that false negatives can still occur. Neither test can replace standard screening methods such as mammograms, colon cancer screening, or cervical screening. Additionally, the emotional impact and potential for anxiety associated with both tests’ results should be taken into consideration.
Looking ahead, the development of advanced blood tests like Trucheck™ and Galleri® brings us closer to a future where early cancer detection becomes a reality. These tests have the potential to complement existing screening methods, offering individuals a comprehensive and personalised approach to cancer prevention and treatment.
Trucheck™ and Galleri® blood tests represent groundbreaking advancements in cancer screening, utilising cutting-edge technologies and scientific understanding to improve early detection rates. Trucheck™ focuses on CTCs, while Galleri® examines cfDNA methylation patterns. Both tests demonstrate considerable accuracy and hold promise for transforming cancer diagnosis and treatment.
It is essential to consult with healthcare professionals to determine the most suitable screening approach based on individual risk factors, age, and personal medical history. By considering these innovative blood tests alongside standard screening methods, we move closer to a future where early cancer detection becomes the norm, leading to better outcomes and improved quality of life. Trucheck™ cancer screening blood test is available at Coyne Medical. Learn more on our website here.
Book a Cancer Blood Test in London at Coyne Medical
It is essential to consult with healthcare professionals to determine the most suitable screening approach based on individual risk factors, age, and personal medical history. By considering these innovative blood tests alongside standard screening methods, we move closer to a future where early cancer detection becomes the norm, leading to better outcomes and improved quality of life. Trucheck™ cancer screening blood test is available at Coyne Medical.
Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.
British Association of Sports and Exercise Medicine · European Atherosclerosis Society · Independent Doctors Federation
As seen in The Independent, The Daily Mail and Tatler
For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.
At Coyne Medical, we strive to provide our patients with the latest advancements in healthcare technology. In line with our commitment to offering the best screening options, we are excited to introduce Trucheck™, a revolutionary cancer screening blood test developed by Datar Cancer Genetics. Trucheck™ aims to detect cancer at its early stages which can potentially lead to improved outcomes, streamlined treatments, and reduced morbidity. In this blog, we will explore the features, advantages, and considerations associated with Trucheck™, shedding light on why it is a powerful addition to our health screening services.
The Urgency of Early Cancer Diagnosis:
The statistics on cancer are startling. 1 in 2 individuals born after 1960 will be diagnosed with cancer during their lifetime. Unfortunately, the majority of cancers (48%) are currently diagnosed at later stages (3 or 4). This often leads to more aggressive treatments and poorer outcomes. Detecting cancer early, specifically at stage 1, can significantly improve survival rates and make treatments more effective. Trucheck™ aims to address this critical need for early diagnosis by leveraging cutting-edge technology and scientific advancements.
Understanding Trucheck™: The Science Behind the Test
Trucheck™ is a cancer-screening blood test. It utilises the concept of circulating tumour cells (CTCs) and circulating ensembles of tumour-associated cells (C-ETACs) in blood samples. Through a process known as primary negative enrichment, Trucheck™ selectively allows non-malignant cells to undergo apoptosis (programmed cell death) while enabling the survival of malignant cells. These malignant cells are then analysed using multiplexed fluorescence immunocytochemistry (ICC) to identify tissue-specific markers associated with various different cancer types.
The presence of CTCs alone is not diagnostic of cancer. Instead, a positive Trucheck™ result indicates a high risk of cancer, providing valuable information about the likely type of cancer (e.g., adenocarcinoma) and its potential organ of origin (e.g., lung). A positive result should prompt further tests or referrals, which may involve additional costs and might not be covered by private medical insurance or provided by the NHS until a formal cancer diagnosis is established. False positives, although relatively rare (estimated at 1% to a maximum of 3% in studies), can occur.
The Test Procedure and Pre-Test Consultation:
Detailed information about the Trucheck™ test, including its procedure, can be found on our website making it a valuable resource for patients considering this screening option. To ensure the best possible experience and outcomes, we offer pre-test consultations. During these consultations, we review the patient’s medical history, assess suitability, identify high-risk factors, and address any concerns or questions.
Who Can Benefit from the Trucheck™ Cancer Screening Blood Test?
Trucheck™ is suitable for individuals aged 18 and above who are asymptomatic or have minor symptoms not requiring urgent investigation. It is particularly recommended for patients who wish to take advantage of the opportunity to identify their risk of cancer at an early stage, aiding in timely diagnosis and treatment. The test selection varies based on age and gender, with options such as Trucheck™ Intelli (for over 40 years of age, detecting over 70 tumour types), Trucheck™ Breast (females over 40 years of age), Trucheck™ Prostate (males over 45 years of age), and Trucheck™ Colon (over 40 years of age).
Advantages of Trucheck™:
Early Cancer Detection: Trucheck™ has the ability to detect cancers at an early stage, even before symptoms manifest, leading to better treatment outcomes and improved survival rates.
Comprehensive Screening: Trucheck™ Intelli offers a broad spectrum of detection, encompassing more than 70 types of early-stage cancer within the asymptomatic population.
Sensitivity and Specificity: Trucheck™ demonstrates high sensitivity (e.g., 88.2% for Trucheck™ Intelli) in correctly identifying cancer cases, minimising false negatives, and achieving a specificity of 99% to reduce false positives.
Minimally Invasive: Unlike invasive procedures or radiation-based tests, Trucheck™ involves a simple blood draw, making it a convenient and non-intrusive screening method.
Peace of Mind: Negative Trucheck™ results provide reassurance, indicating a low chance of having an active malignancy.
Targeted Follow-up: Positive results from Trucheck™ allow for fast-tracked and targeted follow-up, utilising imaging, biopsy, or other confirmatory methods, minimising unnecessary medical procedures and exposure.
Comparative Advantage: Trucheck™ outperforms other cancer screening tests in terms of false positive rates, surpassing tests such as PSA testing, FIT testing, and mammograms. However, all of these tests are still an important part of screening for cancer.
Considerations and Limitations:
While Trucheck™ offers significant advantages, it is essential to consider certain factors:
Emotional Impact: The anticipation of results, as well as false positive or indeterminate outcomes, can lead to temporary anxiety for individuals and their families.
Unproven Survival Impact: Although Trucheck™ aids in early diagnosis, further research is needed to demonstrate its impact on long-term survival rates.
Complementary, Not Replacing Standard Screening: Trucheck™ does not replace conventional cancer screening methods, such as mammograms, colon cancer screening, lung cancer screening CT scans, and cervical screening. It is designed to complement these existing tests.
Specific Cancer Types: Trucheck™ focuses on solid organ malignancies and cannot detect blood or lymphatic system cancers.
Coverage and Costs: Trucheck™ may not be currently covered by healthcare insurance, and the costs associated with the test are privately funded by individuals. Additionally, following a positive result, further diagnostic procedures may require self-payment before a formal cancer diagnosis is established.
With cancer being a prevalent and life-altering disease, the importance of early detection cannot be overstated. Trucheck™ provides a groundbreaking opportunity for individuals to proactively assess their risk of cancer and enable timely interventions. While acknowledging its limitations, Trucheck™ offers unparalleled advantages, including early cancer detection, comprehensiveness, convenience, and high sensitivity. At Coyne Medical, we believe Trucheck™ is a vital addition to our health screening services, empowering our patients to take control of their well-being and potentially improve their cancer outcomes and healthspan.
It is really important to emphasise that Trucheck™ should be utilised alongside routine healthcare and standard cancer screening tests, ensuring comprehensive and holistic health monitoring. To learn more about Trucheck™ and its suitability for you, we encourage you to reach out to our expert medical professionals at Coyne Medical.
Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.
British Association of Sports and Exercise Medicine · European Atherosclerosis Society · Independent Doctors Federation
As seen in The Independent, The Daily Mail and Tatler
For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.
Prostate cancer is a significant global health concern. It is the fourth most commonly diagnosed cancer worldwide and the second most diagnosed cancer in men. While certain factors like race, age, and family history are known to influence prostate cancer risk, the role of modifiable factors such as diet has been unclear. However, a recent study aimed to shed light on this topic by investigating the association between “a posteriori” dietary patterns and Prostate cancer risk.
“A posteriori” is a Latin term that translates to “from the effect to the cause.” In the context of this study, it refers to the approach used to identify dietary patterns based on observed data. A posteriori dietary patterns are derived from the dietary information collected from the study participants, without predefining specific food groups or nutrient components. These patterns are created using statistical methods that analyse the actual dietary habits of the population under study. By examining the observed dietary intake and identifying patterns within the data, researchers can draw associations between certain dietary patterns and health outcomes, such as the risk of prostate cancer.
The study used data from the European Prospective Investigation into Cancer and Nutrition Spanish cohort (EPIC-Spain), which included 15,296 men aged 29-69 years. Information on lifestyle, diet, and medical history was collected through questionnaires and standardised measurements. 181 men were excluded from the study for what was deemed “implausible” food intake!
Three dietary patterns emerged from the analysis: Western, Prudent, and Mediterranean. The Western pattern involved a high consumption of high-fat dairy products, processed meat, refined grains, sweets, caloric drinks, convenience food, and sauces. The Prudent pattern consisted of high intakes of low-fat dairy products, vegetables, fruits, whole grains, and juices. The Mediterranean pattern represented high intakes of fish, vegetables, legumes, boiled potatoes, fruits, olives, and vegetable oil, with a low intake of juices.
The findings of the study revealed that high adherence to the Western dietary pattern was associated with a considerable increase in the risk of aggressive prostate. On the other hand, high adherence to the Prudent and Mediterranean patterns did not show significant effects on Prostate cancer risk.
The Western dietary pattern, characterised by its consumption of dairy products, red and processed meats, sweets, convenience food, and snacks, was found to have detrimental effects on Prostate cancer risk. These foods contain compounds that disrupt prostate hormonal regulation, increase oxidative stress, and stimulate inflammation, all of which can contribute to the development and progression of prostate cancer.
Interestingly, the study did not find a strong protective effect of the Mediterranean or Prudent dietary pattern against aggressive prostate cancer. Differences in dietary habits between study populations and changes in dietary patterns over time may explain these discrepancies. Further research is certainly needed to validate these findings, as the number of cohort studies on this topic is still limited.
The study’s strengths lie in its longitudinal design, large sample size, and the use of a posteriori dietary patterns. These patterns provide a comprehensive understanding of the overall diet and its impact on prostate cancer risk, accounting for the interactions between different foods and nutrients.
However, the study does have limitations. It was unable to track changes in diet over time, and information on family history of prostate cancer or race was not available. Nonetheless, the study adds to our knowledge about the association between dietary patterns and Prostate cancer risk, emphasising the importance of reducing the consumption of high-fat dairy products, red and processed meats, refined grains, sweets, caloric drinks, convenience food, and sauces to prevent prostate cancer.
The study suggests that adherence to a Western dietary pattern increases the risk of aggressive prostate cancer, while high adherence to the Prudent and Mediterranean patterns does not significantly impact prostate cancer risk. These findings highlight the need for individuals to make healthier dietary choices by reducing the intake of detrimental foods and focusing on a well-balanced diet rich in fruits, vegetables, whole grains, and lean proteins. However, further research is needed to confirm these findings and deepen our understanding of the complex relationship between diet and prostate cancer.
Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.
British Association of Sports and Exercise Medicine · European Atherosclerosis Society · Independent Doctors Federation
As seen in The Independent, The Daily Mail and Tatler
For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.
Excess dietary sugar has been shown to have a significant impact on overall health, and this impact extends beyond just issues related to obesity. A recent umbrella review of 73 meta-analyses found that excess dietary sugar is associated with a higher risk of endocrine diseases, heart disease, cancer, and behavioural conditions.
One of the most concerning findings was that excess sugar intake in children may lead to an increased lifetime risk of obesity, which can reduce longevity and healthspan. In rat models, excess dietary sugar has been found to lengthen the villi of intestinal cells. Villi are finger-like projections that line the inner surface of the small intestine, and they play a crucial role in nutrient absorption. The increased efficiency of sugar absorption from these longer villi can lead to obesity, particularly when it occurs at a young age
Excess sugar intake during childhood has also been linked to a 27% higher risk of asthma, an inflammatory condition of the airways that can persist into adulthood. Additionally, excess sugar intake has been found to affect behaviour and mood. It has been linked to conditions such as ADHD and depression. Given the huge number of prescriptions being written to manage these conditions, it is always worth considering if there are any dietary interventions that can be made before a medication is prescribed.
Excess sugar intake can also lead to elevated uric acid levels, which can cause elevated levels of uric acid and gout. Uric acid is not only associated with gout, a very painful inflammation of the joints. It has been associated with insulin resistance and cardiovascular disease risk, both of which can impact longevity and healthspan. Fructose, a type of sugar, has been found to increase uric acid levels, worsen inflammation, and reduce nitric oxide, which can lead to endothelial dysfunction, another condition that negatively impacts longevity and healthspan.
Endothelial dysfunction is a condition where the inner lining of blood vessels, the endothelium, does not function properly. It can contribute to the development of several cardiovascular diseases, including hypertension, atherosclerosis, and coronary artery disease. Endothelial dysfunction worsens when nitric oxide levels are reduced, and elevated uric acid levels have been linked to the development of this condition. By reducing sugar intake, individuals can significantly reduce their risk of endothelial dysfunction, which can improve longevity and healthspan.
To mitigate the risks of excess sugar intake and promote longevity and healthspan, this review recommends that individuals keep their total added sugar intake to less than 25 grams per day. This is equivalent to about 5 to 6 teaspoons of sugar daily.
Excess dietary sugar poses significant risks to overall health, which can have an impact on longevity and healthspan. To promote a longer, healthier life, limit your added sugar intake to less than 25 grams per day, and enjoy the occasional sweet treat guilt-free!
Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.
British Association of Sports and Exercise Medicine · European Atherosclerosis Society · Independent Doctors Federation
As seen in The Independent, The Daily Mail and Tatler
For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.
