The best diet for optimal blood sugar control & health
Author: kaitiscotland
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.
An Israeli study which looked at 33,000 mother – child pairs found that the higher a woman’s blood sugar in pregnancy the fatter the baby was when they were in late adolescence.
Even after they adjusted for the birth weight of the baby, and sociodemographic factors, the correlation remained.
The very fattest teenagers had the mums with the highest blood sugars.
My comment: This appears to be the result of some sort of programming in the womb. The woman’s blood sugar in her pregnancy is also likely related to the health of her own mother. It is something that is rather difficult to control for.
Adapted from Top Tips for Primary Care. Dr Victoria Barber scrutinises the role of primary care in the identification of Ovarian Cancer, an often overlooked malignancy. August 21 2023.
Ovarian cancer is often considered difficult to diagnose, particularly in the early stages, so women need to be aware of when they should visit their General Practitioner and what symptoms may occur.
The symptoms of ovarian cancer can occur with many other conditions too, and this can lead them to being overlooked by both patient and doctor. Yet, there are a group of symptoms that need attention. Ovarian cancer occurs more often in women older than the age of 50, but does occur in young women too.
The symptoms to look out for are: pelvic or abdominal pain, persistent abdominal distention also referred to as bloating, feeling full after very small meals or loss of appetite, and urinary urgency or frequency that is unusual for that woman. Frequent is considered to be more than 12 times in a month or 2 to 3 times a week. Persistent means beyond the time that you would expect a simple cause of a symptom to resolve.
Other symptoms of cancer in general are unexplained changes in bowel habit, unexplained weight loss, and unexplained fatigue. Ovarian, other bowel or pancreatic cancers, leukaemia, lung, and urological cancers can cause these. Further history and examination will help clarify the likely source of the problem and useful investigative tests and referrals.
If these symptoms are reported to the GP, the GP is best to examine the patient and also to take a blood test called the CA125. Next steps will depend on that blood level. Levels over 35 will usually indicate referral for an urgent ultra sound scan of the pelvis. If the scan is abnormal, an urgent “cancer suspected” appointment to gynaecology should be obtained. This is usually within two weeks in the NHS.
If the symptoms are not thought to be of a potentially serious nature or if a CA125 is not done, it can be helpful to arrange a review appointment for when the GP would expect resolution of the symptoms experienced. This is so that persistent symptoms are not missed.
Breast and ovarian cancer tend to run in families and genetic testing may be indicated in some patients.
Sometimes the urinary symptoms sound like a urinary infection but the dipstix test or bacteriological test will be negative. This can be a situation that calls for a CA125 tests for clarification.
Irritable bowel syndrome should not be considered as a new diagnosis in people over the age of 50. It is more likely to be something more serious such as bowel cancer, ovarian cancer, coeliac disease or colitis.
In young women, under the age of 50, bloating of the abdomen related to irritable bowel syndrome tends to come and go throughout the day, be related to meals or stress, and usually improves with having a bowel movement. In ovarian cancer, the bloating tends to last all day, can be there on waking, and is usually unaffected by passing a bowel movement.
Although we are always being told that having a BMI of 22.5 to 25 is optimal for most of a population’s health, this may not be as accurate as it could be.
A retrospective analysis of data from half a million adults in the USA found that those with a BMI of 25 to 30 had a lower all cause mortality.
In older adults there was no excess mortality until the BMI was above 35.
My comment: The BMI reading is designed for population studies and without specifically knowing about an individual, particularly about their bone and muscle mass, simple statements about BMI need thought about what it may mean to you. In general, wasting diseases, dementia, cancers and degenerative diseases tend to cause a steady fall in weight the longer the condition goes on. Thus there could be higher than expected mortality rate in thinner people. Muscle mass is related to greater fitness and longevity and is also correlated to bone mass. These can raise a person’s BMI to the 25+ and 30+ levels and be an indication of an extremely fit, well muscled person. You would expect someone like this to have a lower total mortality rate. Of course these people are rather rarer than the usual tubby individual who has a high individual BMI. Nonetheless this study seems to indicate that carrying a bit more muscle and fat than indicated by a BMI of 25 may not be such a bad thing after all, particularly if you are “older”. They didn’t say exactly what this meant.I would imagine over 55.
Clinical science Diagnosis of osteoporosis in statin-treated patients is dose-dependent Michael Leutner et al. Department of Internal Medicine. University of Vienna. Ann Rheum Dis 2019;78:1706–1711.
Key messages
What is already known about this subject? ► There is a relationship between statins and osteoporosis.
What does this study add? ► Osteoporosis is underrepresented in low-dose statin treatment. ► There is an overrepresentation of osteoporosis in high-dose statin treatment.
How might this impact on clinical practice or future developments? ► In clinical practice, high-risk patients for osteoporosis under high-dose statin treatment should be monitored more frequently.
Abstract Objective: Whether HMG-CoA-reductase inhibition, the main mechanism of statins, plays a role in the pathogenesis of osteoporosis, is not entirely known so far. This study was set out to investigate the relationship of different kinds and dosages of statins with osteoporosis, hypothesising that the inhibition of the synthesis of cholesterol could influence sex-hormones and therefore the diagnosis of osteoporosis. Methods Medical claims data of all Austrians from 2006 to 2007 was used to identify all patients treated with statins to compute their daily defined dose averages of six different types of statins. We applied multiple logistic regression to analyse the dose-dependent risks of being diagnosed with osteoporosis for each statin individually.
Results: In the general study population, statin treatment was associated with an overrepresentation of diagnosed osteoporosis compared with controls (OR: 3.62, 95%CI 3.55 to 3.69, p<0.01). There was a highly non-trivial dependence of statin dosage with the ORs of osteoporosis. Osteoporosis was underrepresented in low-dose statin treatment (0–10mg per day), including lovastatin (OR: 0.39, CI 0.18 to 0.84, p<0.05), pravastatin (OR: 0.68, 95%CI 0.52 to 0.89, p<0.01), simvastatin (OR: 0.70, 95%CI 0.56 to 0.86, p<0.01) and rosuvastatin (OR: 0.69, 95%CI 0.55 to 0.87, p<0.01).
However, the exceeding of the 40mg threshold for simvastatin (OR: 1.64, 95%CI 1.31 to 2.07, p<0.01), and the exceeding of a 20mg threshold for atorvastatin (OR: 1.78, 95%CI 1.41 to 2.23, p<0.01) and for rosuvastatin (OR: 2.04, 95%CI 1.31 to 3.18, p<0.01) was related to an overrepresentation of osteoporosis.
Conclusion: Our results show that the diagnosis of osteoporosis in statin-treated patients is dosedependent.
Thus, osteoporosis is underrepresented in low-dose and overrepresented in high-dose statin treatment, demonstrating the importance of future studies’ taking dose-dependency into account when investigating the relationship between statins and osteoporosis.
Forever Strong: A new science based strategy for aging well by Dr Gabrielle Lyon.
I read this book when it came out in October 2023. It costs £16.99 from Amazon in paperback.
Dr Lyon has worked in psychiatry, geriatrics and nutrition. She thinks that over fatness is less of a problem to being under muscled when it comes to general health, ageing and efforts to live longer in better shape.
She advocates a high protein diet of no less than 100g of protein a day for all adults. This can be more depending on a person’s ideal lean body weight. It is also a lot higher for those who aim to build more muscle.
She offers three different eating regimes. The first is for longevity. For this she recommends higher protein meals for breakfast and dinner and a lighter protein snack at lunch time. Carbohydrates are generally restricted to the same number of grams as the protein spread over the day. These can be increased for those engaged in more than one hour’s vigorous exercise a day. Fat is eaten according to the remaining calories available to maintain weight.
For those wanting to lose weight, she recommends that protein is spread evenly over three meals a day. Carbohydrate should be no more than 30g per meal. Fat intake should be low as the aim is to cut back by 10-20% of maintenance calories daily. She thinks that it is crucial to prioritise dietary protein as this reduces muscle loss and improves satiety. Carbohydrates should be low sugar fruit and low starch vegetables in order to minimise calories and insulin response.
For those who want to gain weight, protein intake is higher and usually needs to be spread over 4 meals. Carbohydrate and fat can be increased as the aim is to exceed maintenance caloric intake. A well planned exercise regime needs to be undertaken and this will usually require a personal trainer at a gym.
The exercise regime offered is based at the beginner in the book but she offers different programmes from her website. I wasn’t able to find these when I looked but perhaps they are still undergoing development.
The book covers the science behind her nutritional advice, a discussion of the mental roadblocks that stop people taking control of their diet and exercise regimes, baseline measurements that will help you figure out what exactly you should be eating and some recipes.
I exercise daily and have been weight training since the age of 27. I also have been low carbing for 20 years. Did I learn anything? YES.
I’ve been making several big mistakes regarding my diet and exercise regime.
Firstly, although I eat about double the protein that I see my friends eating, this is still not likely to be high enough for optimal muscle gain.
Secondly, I really should be eating a lot more protein first thing in the morning so that dietary leucine levels come up to the threshold that prevents muscle breakdown and ensures the best use of protein in the body and for muscle development.
Thirdly, like a lot of low carbers my fat intake is very high, and I pile it on oblivious of the caloric intake.
Fourthly, I do indulge in the odd sugar /starch item and during weight loss efforts these would be better cut out entirely. Same for alcohol.
Fifthly, my weight training regime needs altered. I used to do alternate days resistance training and something else but various injuries and back pain led me to experiment with more stretching and back exercises and this led to a definite improvement in my chronic back pain. I have altered my regime again to add in more resistance work. Dr Lyon thinks that three times a week is best. I’ll see how this goes but at my age I need to consider the injuries and degenerative problems that accumulate.
Overall this is a very helpful book for those who seek the best of physical health and contains information that I was not previously aware of.
Today as you will know from last week’s post, the Morrison family are having Christmas Dinner today. We will have other meat for our two remaining cats, and a black feral cat called Slinky, who has taken to living in our insulated cat kennel next to the house, and a huge ginger cat we call Slugger, who is a very tame, greedy fat cat who probably lives in the houses that were built nearby last year.
Have you decided on your new year resolutions?
Are you looking forward to the new year?
We all hope that we can continually become slightly better versions of ourselves. Yet, at some point, we need to face ageing and that personal growth aim gets replaced by the desire to just slow down the decrepitude a little bit.
Whatever side of the hill you are on, the upwards climb or the downwards descent, I wish you well in your aims. This blog is often to do with lifestyle measures that you can implement to help you, whether you have diabetes or not.
In Scotland we still have a couple of months or more of the long winter to come. Last year our boiler broke down and we had six weeks over the worst of it without heating or hot water. It was really grim. I hope that doesn’t happen again!
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.
Julie Devinsky1 
Diabetes Diet 