It’s come round again. Christmas time. Emma and I wish you all good cheer and best wishes this winter season whatever your religious leanings are.
For the first time in many years my family will be split up on Christmas day this year.
My husband will be working on a boat in the North Sea and he is hoping they don’t serve sheep’s head for dinner this year. I’m not kidding. This is a Norwegian “speciality” and it is very much a Marmite thing. Another thing he can’t stand, but could be faced with is fish that has been buried for a while in the ground. Here is hoping that your holiday feast will be better than traditional Norwegian fare.
My diabetic son will be staying in London with his girlfriend so she won’t be spending Christmas alone. She is a midwife in a London hospital and has a lot of shifts rostered over the period.
My younger son will be travelling home for Christmas so we will have a nice meal of some kind but don’t intend to do our usual Gordon Ramsay’s ham in mustard and treacle as we will have Christmas dinner on New Year’s day instead. This is where my fantastic low carb/gluten free tiramisu also shines.
It will be a bit sad this year because two of our four cats died this year of cancer. One death was long expected at age almost 17 and the other was quick and unexpected at 9.5 years. The usual bevvy of expectant wee faces will be missing this year.
Recently I bought the Meta Quest 3 so I won’t be getting any expensive stuff this year (since I’ve already done the deed). I had bought myself the Quest 1 four years ago but it is now obsolete. I absolutely love the upgraded visual effects and expect the boys to love it too.
I hope you all have an enjoyable day, and if you are unable to celebrate on the actual day, like many other workers, patients, or simply due to transport problems, I hope your proxy fun day is just as good as you hope.
Adapted from BMJ Open Access: Assessing the nutrient intake of a low carb high fat diet: a hypothetical case study design.
Abstract Objective: The low-carbohydrate, high-fat (LCHF) diet is becoming increasingly employed in clinical dietetic practice as a means to manage many health-related conditions. Yet, it continues to remain contentious in nutrition circles due to a belief that the diet is devoid of nutrients and concern around its saturated fat content.
This work aimed to assess the micronutrient intake of the LCHF diet under two conditions of saturated fat thresholds.
Design: In this descriptive study, two LCHF meal plans were designed for two hypothetical cases representing the average Australian male and female weight-stable adult.
National documented heights, a body mass index of 22.5 to establish weight and a 1.6 activity factor were used to estimate total energy intake using the Schofield equation.
Carbohydrate was limited to <130 g, protein was set at 15%–25% of total energy and fat supplied the remaining calories.
One version of the diet aligned with the national saturated fat guideline threshold of <10% of total energy and the other included saturated fat ad libitum.
Primary outcomes: The primary outcomes included all micronutrients, which were assessed using FoodWorks dietary analysis software against national Australian/New Zealand nutrient reference value (NRV) thresholds.
Results: All of the meal plans exceeded the minimum NRV thresholds, apart from iron in the female meal plans, which achieved 86%–98% of the threshold.
Saturated fat intake was logistically unable to be reduced below the 10% threshold for the male plan but exceeded the threshold by 2 g (0.6%).
Conclusion: Despite macronutrient proportions not aligning with current national dietary guidelines, a wellplanned LCHF meal plan can be considered micronutrient replete.
This is an important finding for health professionals, consumers and critics of LCHF nutrition, as it dispels the myth that these diets are suboptimal in their micronutrient supply. As with any diet, for optimal nutrient achievement, meals need to be well formulated.
My comments: Achieving nutritional completeness is almost impossible on a high carb, low fat, low protein diet. Despite the nutritional superiority of a well formulated low carb diet, there are some take home notes from the dieticians involved. 1. Your requirements for Vitamin D cannot be met solely by diet. You either need year round sun exposure or nutritional supplementation with a Vitamin D/K2 supplement. 2. In women of childbearing age, they may need extra iron in the diet, even if they eat red meat regularly. This is due to the effects of menstruation and pregnancy. This may involve eating red meat with fruit juice, avoiding tea with meals, and taking extra iron supplements. Latest thinking is that iron supplementation on alternate days or even less often reduces the bowel problems such as constipation that are usually caused.
1Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
2NYU Health Sciences Library, New York, NY, United States
Importance:Non-communicable chronic diseases (NCDs) such as obesity, type 2 diabetes, heart disease, and cancer were rare among non-western populations with traditional diets and lifestyles. As populations transitioned toward industrialized diets and lifestyles, NCDs developed.
Objective: We performed a systematic literature review to examine the effects of diet and lifestyle transitions on NCDs.
Evidence Review: We identified 22 populations that underwent a nutrition transition, eleven of which had sufficient data. Of these, we chose four populations with diverse geographies, diets and lifestyles who underwent a dietary and lifestyle transition and explored the relationship between dietary changes and health outcomes. We excluded populations with features overlapping with selected populations or with complicating factors such as inadequate data, subgroups, and different study methodologies over different periods. The selected populations were Yemenite Jews, Tokelauans, Tanushimaru Japanese, and Maasai. We also review transition data from seven excluded populations (Pima, Navajo, Aboriginal Australians, South African Natal Indians and Zulu speakers, Inuit, and Hadza) to assess for bias.
Findings:The three groups that replaced saturated fats (SFA) from animal (Yemenite Jews, Maasai) or plants (Tokelau) with refined carbohydrates had negative health outcomes (e.g., increased obesity, diabetes, heart disease). Yemenites reduced SFA consumption by >40% post-transition but men’s BMI increased 19% and diabetes increased ~40-fold. Tokelauans reduced fat, dramatically reduced SFA, and increased sugar intake: obesity and diabetes rose. The Tanushimaruans transitioned to more fats and less carbohydrates and used more anti-hypertensive medications; stroke and breast cancer declined while heart disease was stable. The Maasai transitioned to lower fat, SFA and higher carbohydrates and had increased BMI and diabetes. Similar patterns were observed in the seven other populations.
Conclusion:The nutrient category most strongly associated with negative health outcomes – especially obesity and diabetes – was sugar (increased 600–650% in Yemenite Jews and Tokelauans) and refined carbohydrates (among Maasai, total carbohydrates increased 39% in men and 362% in women), while increased calories was less strongly associated with these disorders. Across 11 populations, NCDs were associated with increased refined carbohydrates more than increased calories, reduced activity or other factors, but cannot be attributed to SFA or total fat consumption.
Key Points
Question: What dietary factors contribute to non-communicable chronic diseases (NCDs) among populations transitioning from their original to westernized diets?
Findings: Our systemic literature review examined four populations that transitioned from their original to a more westernized diet and lifestyle. We also reviewed seven additional populations that underwent a similar transition. We identified a strong association between NCDs and increased sugar and refined carbohydrate consumption, and weaker associations with increased total calories with reduced physical activity. Neither fat nor saturated fat intake were associated with risk of developing NCDs in any of the populations.
Meaning: Increased consumption of sugar and refined carbohydrates were strongly associated with the development of NCDs in all four populations. Increased calories and decreased physical activity were less strongly correlated although both of these measures are imprecisely defined and not quantified in any of these group. Neither fat nor saturated fat intake were associated with NCD risk in any population.
Sadly this is NOT a post about how eating these gorgeous looking cup cakes will make you slim!
Adapted from BMJ 30 Sept 2023
Association between changes in carbohydrate intake and long term weight changes. Wan Y et al.
This study looked at the association between changes of different types of carbohydrate and weight changes measured at four yearly intervals.
The data was retrieved from the Nurses Health Study, Nurses Health Study 2, and the Health Professionals Follow up Study. These studies were done between 1986 and 2015.
The participants at the start had to be in good health and aged 65 years or younger. They then completed follow up questionnaires every four years. They were asked about personal characteristics, medical history and lifestyle. Carbohydrate type and amount was calculated from validated food frequency questionnaires. The weight changes were self reported every two years.
Over 136 thousand health professional were questioned over the years.
On average participants gained 1.5 kg every four years amounting to 8.8kg on average over 24 years.
Foods higher in glycaemic index and glycaemic load tended to produce more weight gain. For example, a 100g a day increase in starch or sugar was associated with 1.5kg and 0.9kg greater weight gain over four years. A 10g a day increase in fibre however, tended to result in 0.8kg weight loss over four years. Other foods that increased weight were refined grains and starchy vegetables such as peas, corn and potatoes. The foods that tended to reduce weight were whole grains, fruit, and non starchy vegetables.
For example, over 4 years a 100g daily increase in non starchy vegetables a day equated to 2.6 kg extra weight. If non starchy vegetables increased by 100g a day the weight loss was 3kg.
The effects were more noticeable in women and in those who were already overweight or obese.
This study shows that not all carbohydrates have an equal effect on body composition. For long term weight management limiting added sugar, sugar sweetened beverages, refined grains and starchy vegetables would seem prudent. These can be helpfully replaced with whole grains, fruit and non starchy vegetables.
Nature has reported that an AI model called RETFound has been successfully trained to diagnose diabetic retinopathy from eye scans.
1.6 million unlabelled retinopathy pictures were used to teach the computer what a retina looked like. After this it was taught to diagnose specific conditions using a much smaller selection of images. The machine was excellent at diagnosing diabetic retinopathy and progress has also been made in teaching it to diagnose cardiac failure, stroke and Parkinson’s disease.
Julie Devinsky1 
Diabetes Diet 