The best diet for optimal blood sugar control & health
I am a Scottish doctor who is working to improve the outcomes for people who have diabetes using a low carb diet, and advanced insulin techniques when necessary. Professionally I provide expert witness reports in the clinical forensic and family medicine areas and I also provide complementary therapies. I enjoy cooking, cinema, reading, travel and cats.
After considerable number crunching a low carb colleague has come to the very reasonable conclusion that the worst food in the world for weight gain is the fried potato in its several incarnations.
In the USA French Fries are what we in the UK call Chips. In the USA Chips are what we in the UK call Crisps.
These are ubiquitous and difficult to avoid particularly if you eat in fast food restaurants. Even if you order a sandwich you may be given a side order of chips or crisps.
Tucker explains that the vegetable and seed oils that these items are fried in play havoc with the appetite control centres of your brain. This article serves as a reminder, since we are all still at least trying to keep to our New Year’s Resolutions, why it would be better to avoid having them on your plate or hand in the first place. And just the one or two….who are you kidding?
The site Metabolic Multiplier have compiled a toolkit that you can use to educate yourself about the low carb diet and have included information that you can give to your doctor or other health care professional so that they will be more likely to help you monitor your condition.
I was part of the development group last year.
The dietician Adele Hite was extremely active in the group and always seemed so full of energy and enthusiasm. She put in many hours into the project as well as her day job. Little did I know that she had a returning cancer and that she was to die from it in less than a year. In retrospect, I think that this is what drove her. She was determined to leave a legacy to help others.
If you know of any newly diagnosed diabetics or any who are experiencing friction with their GPs or health care providers, please let them know about the Metabolic Multiplier site. It is organised by the highly efficient and versatile Cecile Seth.
A study published in the Journal of the Canadian Medical Association in Dec 2020, has found that type two diabetics who are on Metformin have about two thirds of the risk of having a hip or knee joint replacement compared to diabetics on other medications.
The study was undertaken by Dr Zhaohua Zhu from Zhujiang Hospital in Guangzhou in China. They compared the records of over twenty thousand patients in each group and compared the duration that they were on the diabetes medications and surgical outcomes.
As they found that Metformin use was associated with a significantly reduced risk of joint replacement, this suggests a potential therapeutic effect in patients who have osteoarthritis. They recommend that randomised controlled trials are undertaken to see if there is a beneficial effect in this group.
My comment: As Metformin has already been shown to reduce cancer incidence, is inexpensive, and reasonably well tolerated both by diabetics and non-diabetics, it would seem a good idea to me for such trials to be carried out.
Everyone knows how hard it is to shift body fat after having a baby. A recent study suggests that adopting a low carb diet featuring plentiful meat/poultry/fish and animal fats was more successful than having a low carb diet based mainly around plant foods.
Readers who are keen to shed their post holiday season weight gain may also find this information useful.
Low-carbohydrate diets (LCD) have been considered a popular dietary strategy for weight loss. However, the association of the low-carbohydrate dietary pattern with postpartum weight retention (PPWR) in women remains unknown.
The present study involved 426 women from a prospective mother-infant cohort study.
Overall, animal or plant LCD scores, which represent adherence to different low-carbohydrate dietary patterns, were calculated using diet intake information assessed by three consecutive 24 h dietary surveys.
PPWR was assessed by the difference of weight at 1 year postpartum minus the pre-pregnancy weight. After adjusting for potential confounding variables, women in higher quartiles of total and animal-based LCD scores had a significantly lower body weight and weight retention at 1 year postpartum (P < 0.05). The multivariable-adjusted ORs of substantial PPWR (≥5 kg), comparing the highest with the lowest quartile, were 0.47 (95% confidence interval 0.23–0.96) for the total LCD score (P = 0.021 for trend) and 0.38 (95% confidence interval 0.19–0.77) for the animal-based LCD score (P = 0.019 for trend), while this association was significantly attenuated by rice, glycemic load, fish, poultry, animal fat and animal protein (P for trend <0.05).
A high score for plant-based LCD was not significantly associated with the risk of PPWR (P > 0.05). The findings suggested that a low-carbohydrate dietary pattern, particularly with high protein and fat intake from animal-source foods, is associated with a decreased risk of weight retention at 1 year postpartum. This association was mainly due to low intake of glycemic load and high intake of fish and poultry.
Adapted from Medscape Nov 20 2022 by Miriam E Tucker a freelance journalist from Washington DC.
At last humans have caught up with mice!
Since my son was diagnosed with type one diabetes, some 28 years ago, it has been possible to reverse type one diabetes in mice. At last the huge effort to find a suitable agent to use in humans, and particularly children, has been approved by the FDA.
Thank you everyone who has contributed to this marvellous discovery. The Juvenile Diabetes Research Foundation was set up with this end point in mind and they have been successful in the development of the new drug which they helped fund. The thing is that now such an agent is available, we need to be able to find the people who would most benefit from taking the drug. Thus screening for early type one diabetes is going to become crucial.
The new drug is called Teplizumab-mzwv (Tzield, Provention Bio) and it is a anti-CD 3 monoclonal antibody. It was approved in Nov 17 21 and is the first human disease modifying therapy for impeding the prevention of type one diabetes. It delayed onset by around 2 years and longer in some subjects.
It is given by an intravenous infusion once daily for 14 days and costs around $200,000 dollars for the course of treatment.
It is licensed for children over the age of 8 years. The group it is targeting is those who are asymptomatic but who have raised blood sugar levels and at least two type one diabetes antibodies. Most of those screened are first degree relatives of type ones. The JDRF is offering a screening blood test for $55. But because 85-90% of people who do develop type one diabetes don’t have a first degree relative, screening will need to be developed further.
In Bavaria, Germany, screening of all schoolchildren for type one diabetes has been done, and the organisers said that a major benefit, was that education about the signs of diabetes occurred so that diagnosis occurred before Diabetic Ketoacidosis developed. This is known to cause deaths and wears out the pancreas much faster.
In another study 2 year olds and 6 year olds in the USA and western Europe were screened for islet autoantibodies and this detected almost all of those children who developed type one diabetes by mid adolescence.
Using a genetic risk score at birth has been suggested as more cost effective by Dr William Hagopian of the Pacific Northwest Research Institute in Seattle. 10% of newborns have HLA genes that can identify 80% of those who will get childhood type one diabetes.
My comment: I’m particularly pleased to see that the JDRF has been successful because if my son has offspring they have a one in three chance of developing type one diabetes in childhood. As time goes on, it is to be hoped that the interventions will become cheaper and more effective.
Today I will be enjoying my second work free Christmas at home with my husband and both sons and four cats.
I always make a low carb gluten free Tiramisu the day before. Starters are always tinned or a jar of lobster bisque and bought tempura prawns. One Christmas my husband made them from scratch and they were fantastic but the kitchen was covered in flour and grease.
My husband always makes Gordon Ramsay’s Ham with chilli treacle glaze with roast potatoes and as few vegetables as we can get away with, being Scottish. We always have our dinner at 7.30pm.
This tradition arose because I was always on call for the police on Christmas day and I’m hoping to avoid doing the Christmas dinner for many more years to come.
Last year I played with the boys and their toys and hope to do the same this year.
Have a lovely time and especially if you are on your own, I wish you a peaceful, warm, and comforting Christmas and winter.
The idea of GP apprentices has been discussed for a few years now, but at last the scheme is starting up in September 2023.
The new scheme hopes to solve a lot of problems with one fell swoop.
There is a great shortage of doctors in the UK and particularly in General Practice, the foundation of the NHS system. At the same time, the expense of becoming a doctor, with student debt on qualification reaching £100,000, is making it a difficult choice for students who don’t have wealthy parents.
Universities have limited places for medical students. Although a few new medical schools have opened their doors such as Buckingham University, which is entirely privately funded, this has been insufficient to maintain GP numbers which continue to fall.
For several years conversion courses for graduates from other disciplines have been running at for instance Dundee University. This results in qualified doctors after a four- year course.
Courses for physician assistants have also been taking in graduates from careers allied to medicine in for instance Aberdeen University. Yet, there are simply not enough physicians and physician assistants to fill gaps in provision, as many of our UK readers will have noticed, whether they are seeking a GP or a hospital appointment.
What is different about GP apprenticeships is that the student will earn a wage from their very first day. I don’t know what that wage will be yet. Hopefully enough to make the experience worthwhile and at least prevent them ending up in debt.
The aim is to make medicine more accessible to students from state schools and poorer backgrounds. They want to see students from diverse backgrounds rather than just the white upper middle- class students from private schools who currently predominate.
Apprentices will complete both academic and practical education and come out with a medical degree and licence to practice from the General Medical Council.
Adapted from Nutrients and exercise affect tumour development by Carla Martinez May 27 2022 and
Three pronged approach may reduce cancer risk in the elderly by Nadine Ekert June 7 2022 Medscape
In a Madrid Oncology conference researchers discussed an update on lifestyle factors and cancer.
Diet and lifestyle can have an influence on each of the successive stages that occur in the development of cancer: initiation, promotion and progression.
A deficit of certain nutrients is one of the factors involved in the initiation stage. Various deficiencies affect different parts of cell metabolism adversely. Such nutrients include folate, B12, B6 and B3, Vitamin C, Selenium, Zinc, Magnesium and Vitamin D.
Aflatoxins from foods of vegetable origin are detrimental. The foods include cassava, pepper, corn, millet, rice, sorghum, wheat, sunflower seeds and peanuts, but the effect very much depends on how these foodstuffs are stored.
Added nitrates to foods such as processed meats and sausages because they become nitrosamines which affect cancer development. Natural nitrates in food however do not cause cancer.
Smoking causes 72% of lung cancer and 15% of all cancers. Eating processed meat causes 13% of intestinal cancers and 1.5% of all cancers. The most problematic foods for nitrosamines are cured meat, and smoked meat and fish. Cooking meats also causes polycyclic aromatic hydrocarbons especially chicken.
Various cooking strategies will reduce the formation or dilute the effects of polycyclic aromatic hydrocarbons.
Marinate mean in an acid solution for more than one hour.
Season meats and fish before grilling them. Good spices to use are: pepper, paprika, garlic, onion, ginger, turmeric, cumin, cinnamon, clove, fennel, and star anise.
Cook at a low temperature eg boiling.
Eat meats with lots of brassicas such as broccoli, cabbage, kale, turnip, brussel sprouts and mustard.
Grilled foods contain benzopyrene which can cause a mutation in DNA and thus cause cancer. Brassicas are rich in sulforphane which works on genes that produce glutathione s-transferase which promotes the elimination of benzopyrene.
Other factors that promote cancer include psychological stress, circadian disruption such as shift work, physical inactivity, obesity, hyperglycaemia, hyperinsulinaemia, gut bacteria disruption, and vitamin D deficiency.
The common factor here is increased inflammation. Some nutrients act as anti-inflammatories including the omega 3 oils EPA and DHA. Ginger, green tea, turmeric and broccoli all help too.
Daily rituals determine our health, so think about how you can optimise your routines.
The influence of exercise on cancer has only been studied in the last ten years.
Hypoxia is one of the main triggers of tumour aggression. Exercise has been shown to improve oxygenation and reduce hypoxia. Physical exercise in combination with chemotherapy has been proven to reduce tumour volume and progression. The best exercises in this regard are those that build up lactate in the muscle such as resistance exercise and cycling.
In the DO-HEALTH study, more than 2,000 healthy elderly people over the age of 70, were observed over three years. A combination of high dose vitamin D, omega 3 fatty acids and a simple home training programme reduced the risk of cancer by 61% compared to placebo.
The risk of getting cancer increases as you get older. Apart from not smoking and sun protection, getting appropriate vaccines and screening, there is not that much left to do. As Vitamin D, omega 3 fatty acids and physical exercise are all promising factors in cancer reduction, various combinations of them were tried. Blood pressure, physical performance, cognition, fractures and infections were looked at. They were divided into 8 groups looking at placebo, training only, and then various combinations and single interventions.
Most groups showed no difference from placebo but the combination of vitamin D, omega 3s and training did. The number needed to treat to prevent one cancer over the three years was 53 which is considered pretty good. Researchers thought the outcome was good enough to recommend this to any one over 70 who was looking to improve their health.
Adapted from Co-enzyme Q10 in Cardiovascular and Metabolic Diseases: Current State of the Problem, by Vladlena I Zozina et al. Current Cardiology Reviews 2018 Aug: 14(3) 164-174.
Co-enzyme Q10 (CoQ10) is an essential compound of the human body. There is growing evidence that it is tightly linked to cardiometabolic disorders. Supplementation can be useful in a variety of chronic and acute disorders. This review article discusses its role in hypertension, ischemic heart disease, myocardial infarction, heart failure, viral myocarditis, cardiomyopathies, cardiac toxicity, dyslipidaemia, obesity, type 2 diabetes mellitus, metabolic syndrome, cardiac procedures and resuscitation.
CoQ10 is made in the inner membrane of the mitochrondia. These are the little batteries which power your cells. It exists as ubiquinone which is oxidised and ubiquinol which is does not have oxygen attached. It is a key component of electron transfer in ATP production, which is how cellular energy is generated.
It is also an intercellular anti-oxidant. It also plays a role in cell growth and differentiation. There are many diseases and degenerative states associated with CoQ10 deficiency such as type 2 diabetes, atherosclerosis, hypertension, dyslipidaemia, muscular dystrophy, Alzheimer’s disease and Parkinson’s disease.
Administration of selenium and CoQ10 in a group of elderly people over 4 years resulted in significantly reduced cardiovascular mortality over the next ten years. This new review aims to sum up current possibilities in a variety of conditions with an analysis of the impact on health and quality of life.
CoQ10 is found in all organs but the highest concentrations are in the heart, kidneys, liver and muscles.
Three out of four patients with heart disease have low levels of CoQ10, particularly in ischaemic heart disease and cardiomyopathy.
In 2010 31% of all adults had hypertension. This rate is rising, particularly in low income countries.
CoQ10 has a direct effect on the lining of blood vessels, the endothelium, which dilates the blood vessels in hypertensive people and so reduces blood pressure. It also has a blood pressure lowering effect via the angiotensin effect in sodium retention and lowers aldosterone. Blood pressure can be lowered as far as normal levels with CoQ10 and has been measured as reducing systolic bp by 11 mmHg and diastolic by 7mmHg.
Giving 300mg daily of CoQ10 has been shown to reduce inflammatory markers and raise anti-oxidant enzyme activity. It is well known that a pro-inflammatory effect is a major component of chronic disease.
In 2013 cardiovascular diseases were a worldwide leading cause of death causing about a third of all deaths. A randomised study showed that in patients with myocardial infarction and hyperlipidaemia, supplementation resulted in lower blood pressure and a beneficial rise in HDL. After primary angioplasty after a heart attack, patients with higher levels of CoQ10 had better ventricular performance at 6 months follow up.
In rat studies infusion of CoQ10 results in less cardiac damage when their cardiac vessels are occluded to provoke cardiac ischaemia.
Heart failure causes less blood to be pumped out of the heart with every heart beat. This can be from a combination of structural and functional heart problems. HF is the cause of a huge amount of hospitalisation and cardiac impairment. Deaths from HF range from 10% to 50% per year. The plasma level of CoQ10 has been found to predict mortality in HF patients. Supplementation has been found to be beneficial in raising the level and decreasing mortality rates.
CoQ10 helps the heart muscle beat with more power. 100mg given three times a day to HF patients showed a reduction in cardiovascular mortality (9% v 16%), all cause mortality (10% v 18%) and number f hospital stays. Exercise tolerance was improved at the end of 2 years observation.
In those patients on the waiting list for heart transplants, CoQ10 users had a significant improvement in functional status, clinical symptoms and quality of life. Although the drugs for HF are still essential, there can be some additional benefits to CoQ10 supplementation.
Atrial Fibrillation is increasing worldwide year on year and is associated with symptoms and mortality. Supplementation has been found to reduce arrhythmias after surgery or drugs to stimulate the heart muscle after surgery.
In mice studies survival rate was higher in those given CoQ10 than those who were not when they had viral myocarditis. In humans both CoQ10 and trimetazidine have been found to be effective.
Cardiomyopathy is associated with a high mortality and poor quality of life. It is linked to increased oxidative stress. Supplementation has been found to improve both cardiac structure and function. Fatigue and breathlessness improved. These studies have been done in both adults and children.
Cardiac toxicity is an unwelcome side effect for certain cancer drugs used in chemotherapy. CoQ10 and L-carnitine together have been found to be cardio-protective.
Supplementation has been found to reduce side effects of statins in heart failure patients. This is because statins deplete CoQ10 levels.
Although low CoQ10 has been found in type 2 diabetes patients, supplementation had no effect on glycaemic control, lipid profile or blood pressure. Triglyceride levels were reduced.
In patients with metabolic syndrome had a beneficial effect on insulin levels with supplementation.
Women with polycystic ovarian syndrome had a beneficial effect on glucose metabolism, and cholesterol levels with supplementation.
Studies have been done during and after cardiac surgery and in the management of post cardiac arrest care. In one study hypothermia plus supplementation resulted in considerably improved outcomes compared with hypothermia without supplementation. The three month survival was 68% v 29%.
Supplementation studies have shown a potential role in septic and haemorrhagic shock patients.
Further research needs to be done to establish the optimal doses to give for various conditions and situations.
Levels of 100 -300mg of CoQ10 per day seem to be effective for a wide range of problems.