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.
Benign paroxsymal positional vertigo is characterised by brief attacks of dizziness brought on by a change in head position. It is thought to occur from debris entering the balance mechanism in the middle ear.
Observational studies links these attacks to osteoporosis and vitamin D deficiency.
A trial of oral supplementation with vitamin D and calcium appears to give fewer attacks of the dizzy episodes compared to no treatment over the course of the next year.
My comment: The Epley movements are also a treatment but they need to be given in person and by someone who knows how. You tube videos of this are available.
There is no single optimal diet for every individual. Whether you look through the lens of evolutionary biology or biochemistry the conclusion is that the natural human diet contains both animal and plant foods.
The term nutrient density refers to the concentration of micronutrients and amino acids in any given food. Although there tends to be a high intake of calories in the standard western diet, this population tends to lack vitamin A, B6, B12, C, D, folate and iron. Deficiencies of any of these essential nutrients can contribute to the development of chronic disease and shorten lifespan. Animal foods tend to be higher in B12, iron, zinc, EPA and DHA and plant foods tend to be higher in flavinoids, carotenoids, diallyl sulphides, lignans and fibre. Therefore it makes sense to eat a range of both.
Vegetarian and especially vegan diets are lower in several essential nutrients including A, B12, D, calcium, iron, zinc, iodine, choline, selenium, creatine, taurine, methionine, glycine, EPA and DHA. For instance 92 % of vegans and 77% of vegetarians were deficient in B12 compared to 11% of omnivores in a recent study.
Omnivores and vegetarians have the same lifespan as each other and both outlive people on a standard western diet.
Both vegetarian and vegan diets are safe in pregnancy but young children are at risk of short and long term effects if their diet is too restricted.
There is no association between eating foods that are high in cholesterol and the development of heart disease. Low carb diets, that tend to be high in saturated fat, are beneficial for certain cardiovascular disease markers including body weight, triglycerides, fasting glucose, blood pressure, body mass index, abdominal circumference, plasma insulin, HDL and C-reactive protein. Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.
Red meat has been associated with an increase in heart disease and cancer in several studies but correlation does not mean causation. Studies show that people who eat more red meat tend to have a higher BMI, are more likely to be overweight or obese, smoke cigarettes, be physically inactive, less likely to eat fresh fruit and vegetables and and less likely to have higher than a high school education. All of these variables are associated with a higher risk of heart disease and cancer, so it becomes difficult to isolate red meat as the cause. Red meat, particularly grass fed, is rich in B12, zinc, iron, CLA, EPA and DHA that are commonly deficient in the population.
There have been ten meta-analyses of low carb diets. All ten showed that low carb diets were as effective or more effective than low fat diets for weight loss. Some individuals of course may do better on a moderate carb or even high carb approach.
For type 2 diabetics, low carb diets are more effective than high carb diets for weight loss and also improve cardiovascular markers. Low carb and ketogenic diets are more effective than hypo-caloric or low fat diets for improving glycaemic control in type 2 diabetes.
Meanwhile politics, religion and poor science used in nutritional epidemiology have resulted in a lag in change from many institutions who give advice on diet such as the American Dietetics Association, American Heart Association and the American Diabetes Association.
In studies the Paleo diet has compared well against the Mediterranean and low fat diets.
Studies have found that ketogenic diets improves cardiovascular risk factors and have been shown have a beneficial effect in Parkinson’s disease, Alzheimer’s disease and dementia, and epilepsy, and also traumatic brain injury.
The carnivore diet is an “all meat diet” is gaining traction. Although this may improve chronic health problems in the short term, the long term effects are not known. Further research is required.
In general, on urine testing, animal foods are acid forming and plant foods are alkaline forming. However the blood pH is tightly controlled regardless of what you eat.
The low fat, vegan and Paleo diet advocates all don’t eat full fat dairy for various reasons. Dairy is the only food group that has more saturated than unsaturated fat. Meat, including red meat, pork and eggs all contain more unsaturated than saturated fat. Studies show that people who consume more full fat dairy products have either the same or a lower risk of obesity, diabetes and cardiovascular disease.
There is a degree of controversy over the environmental cost of meat eating. There are certainly harms from intensive meat rearing. On the other hand properly managed live stock can regenerate grassland ecosystems and reduce carbon emissions.
It is fully understandable that people who love animals and don’t want to see them mistreated embrace veganism and vegetarianism. Better animal husbandry and methods of transport and slaughter need to be more widespread.
By Matsumyama Y et al. J Am Geriatr Soc 1 May 2021
Older adults with more natural teeth are better able to perform everyday tasks such as cooking, taking medications, managing money, making a telephone call or going shopping, according to research from University College London.
Data from 5,631 adults from the English Longitudinal Study of Aging between the ages of 50 and 70 was analysed. Activities of daily living were self reported.
Being exposed to fluoridated water from age 5 to 20 was found to be associated with having more natural teeth in later life.
Professor Georgios Tsakos said, ” We know from previous studies that tooth loss is associated with reduced functional capacity, but this study is the first to provide evidence about the causal effect of tooth loss on the activities of daily living among older adults in England. This effect is considerable.
Older adults with ten natural teeth are 30% more likely to have difficulties with shopping for groceries or working around the house or garden compared to those with 20 natural teeth.
Even after you allow for factors such as educational qualifications, self rated health and their parents’ educational level, we still found that the more natural teeth a person had, the better their functional ability.”
My comment: Interesting. Would dental implants make a difference?
Adapted from A high fiber diet does not protect against asymptomatic diverticulosis by Anne F Peery et al. Gastroenterology Volume 142, Issue 2, February 2012 Pages 266-272.
The complications of diverticulosis cause considerable morbidity in the developed world. Many physicians and patients believe that a high fibre diet and frequent bowel movements are the key to its prevention. We sought to determine whether low fibre or high fat diets that include large quantities of red meat, constiptation or physical inactivity increase the risk for asymptomatic diverticulosis.
We performed a cross sectional study of 2,104 adults aged 30 to 80 who were getting an outpatient colonoscopy from 1998 to 2010. Diet and physical activity were assessed in interviews using validated techniques.
As we expected the numbers of people with diverticulosis increased as they aged. High fibre intake did not reduce the prevalence of diverticulosis. Indeed, those in the highest quartile of fibre intake had more diverticulosis per person than the lowest. Risk increased with increasing amounts of total fibre, fibre from grains, soluble and insoluble fibre. Constipation was also not a risk factor. Those who had more than 15 bowel movements a week had a 70% higher risk compared to those with less than 7 bowel movements a week. Neither physical inactivity or intake of fat or red meat was associated with diverticulosis.
These results indicated that the generally accepted “risk factors” for diverticulosis need to be reconsidered.
For one poor man’s real life experience with this condition read:
There are several main factors that can reduce your chances of getting bowel and rectal cancer. Weight optimisation, a good diet, exercise, vitamin D supplementation and regular colonoscopies.
A study co-funded by the World Cancer Research Fund, Cancer Research UK and Diabetes UK found that although being over weight was a factor in causation, that body fat position made a difference between men and women.
A higher BMI was more risky for men but for women, carrying the weight on the abdomen compared to the hips was worse. Only a 5 point increase in BMI for men increased bowel cancer by 23% in men but only 9% in women.
Higher fish and fish oil intake was associated with a 7% lower risk of bowel cancer in a European study.
Consuming flavinoid rich foods such as apples, tea and pears reduces both cancer and cardiovascular disease mortality particularly in those who also smoke and drink a lot of alcohol in a Danish study. The effects levelled off at around 500mg a day for all cause and cardiovascular mortality and 1000mg a day for cancer related mortality.
If you are unfortunate and get colorectal cancer, an Edinburgh analysis of seven RCTs has found that Vitamin D supplementation produced a 30% reduction in adverse outcomes.
Vaughan-Shaw et al. The effect of vitamin D supplementation on survival in patients with colorectal cancer: systematic review and meta-analysis of randomised controlled trials. Br J Cancer 2020 Sep 15.
NICE has approved Liraglutide for use in the NHS for weight loss. There are a list of requirements before it will be given though.
They also say that a calorie controlled diet and exercise will be necessary.
The person being considered for it must have a BMI of 35 or 32.5 for certain groups such as South Asians, Chinese, black African or African-Caribbean, who are at higher cardiovascular risk for any given BMI.
The person should have diagnosed pre-diabetes, equivalent to a HbA1c of 6.0 to 6.4% or a fasting blood sugar of 5.5 to 6.9.
They should also have a high risk of cardiovascular disease based on risk factors such has hypertension and lipid abnormalities.
Liraglutide will be provided by a specialist multi-disciplinary weight loss service.
The drug is a once weekly injectable. My comment: in my diabetic GP patients they found it easy to use and very effective for weight loss. It will be an alternative to other measures such as Orlistat and bariatric surgery.
A major problem is that the types of clinics that supply these services are over subscribed in the first place. From my own experience, many patients will meet the criteria, and many would welcome an opportunity to improve their health, appearance and sense of well being by this method. The clinics expect that patients will remain on the drug for two years. The problem is that to maintain the weight loss the drug may be needed lifelong. Currently the British Medical Association are against the introduction of the drug because they think that this will drive up the needs for blood test monitoring and referrals from GPs.
The original study was published in the New England Journal of Medicine by Wilding J et al in 2021. The mean bodyweight reduction was minus 14.9 % for the treatment group and just minus 2.4 % for the placebo group. Blood sugars and lipids improved considerably too. Nausea and diarrhea were the main side effects of the drug but these results tended to be mild and short lived.
In another study of the drug Semiglutide, by Davies M et al, published in the Lancet on March 2 2021, the importance of dose was assessed. They found that the higher dose had better effects on weight and blood sugar than the lower dose but also that the side effects were more frequent.
A randomised controlled trial in older adults with insomnia found that 12 weeks training in Tai Chi improved both subjective and objective measures of sleep quality. Although the effect size was modest it persisted for over two years.
Sleep quality also improved in groups that took part in brisk walking programmes and muscle strengthening exercises.
My comments: With consideration to my last post, about the importance of sociability in brain health, I do wonder if it is the exercise or the social factors that improve sleep.
Frequent social contact has been associated with better health and longer life but is there an optimal contact frequency?
The European Social Survey results suggested that monthly or weekly was enough to see benefits among 350 thousand people over 35 countries.
A second German study found that more contact than this was not associated with better health and in some cases was related to worse health and greater mortality risks. My comment: Of course, friends and relatives may have been visiting more frequently BECAUSE their friend was indisposed.
Psychological and Personality Science 2020
Researchers from Ontario, Quebec and Oxford found that having strong interpersonal relationships was critical for survival across the entire lifespan. Social isolation is a significant predictor of the risk of death. Insufficient social stimulation affects reasoning and memory, hormone balance, brain structure, connectivity and function, and resilience to physical and mental disease.
Feelings of loneliness can cause negatively skewed social perception and in older people it can precipitate dementia.
Professor Dunbar from Oxford said, ” Loneliness has accelerated in the past decade. Given the potentially severe consequences, exacerbated by national policy responses to Covid-19, we have launched the Campaign to End Loneliness. This is a network of over 600 national, regional and local organisations that want to create the right conditions to reduce loneliness in later life.
Bzdok D and Dunbar RIM (2020) The neurobiology of social distance. Trends in Cognitive Sciences.
If you are at the other end of the age spectrum, particularly an only child, a pet can be a great advantage to you.
The Longitudinal Study of Australian Children found that children who had pets had lower emotional symptoms, fewer problems relating to other children and had more positive social behaviour compared to the non pet owning children. The positive social behaviour effect was magnified in only children.
Christian H et al. Pets are associated with fewer peer problems and emotional symptoms and better prosocial behaviour. Findings from the Longitudinal Study of Australian Children. J Pediatr 2020;200:200-206.
Tim Noakes shot to fame in the low carb community by being accused of malpractice by two South African dieticians for giving dietary advice when he was not a registered dietician. After five long miserable years and the support of international colleagues he won the case. Anna Dahlquist, a Swedish GP had gone through the same thing a few years before this, and not only won her case, but managed to get the Swedish food guidelines for people with diabetes changed.
Professor Noakes has established online training for health professionals covering a variety of useful topics. Participants can be from all over the world and will receive accreditation. The full list of topics can be found by clicking on the homepage in BOLD above.