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.
A Scottish study showed that one in 20 people diagnosed with type two diabetes gained remission long term. This was defined as having a HbA1c of below 48 mmol/mol.
In comparison with those who did not gain remission, they tended to be older, to have a lower HbA1c at diagnosis, not to have taken glucose lowering medications, and to have lost weight since diagnosis. They were also more likely to have had bariatric surgery.
A review of weight loss diets in diabetics reported in Diabetolgia, reported gloomy results for all of the diets that they reviewed. Meaningful weight loss did not occur often.
These included low carbohydrate diets, high protein, Mediterranean and vegetarian. The best results were for low calorie liquid shakes when these replaced normal food. But even then the weight loss was only a few kilograms.
Most people with type two diabetes need to lose weight to improve their cardiovascular risk, especially if they don’t want to rely on lifelong medication.
A North American study has demonstrated that the brains of type one diabetics of middle age or older showed structural changes in brain volume and white matter compared to similar aged and demographically similar control subjects without diabetes. MRI studies were used.
The differences are the equivalent of 4 to 9 years difference in brain aging.
Adapted from Nutrients Volume 15 June 25 2023. Effects of consuming once equivalent portions of animal v plant based protein foods, as defined by the Dietary Guidelines for Americans on Essential amino acid bioavailability in young and older adults: Two cross over randomised controlled trials. Gavin Connolly et al. Department of Nutritional Science. Purdue University, West Lafayette, Indiana.
The 2020-25 Dietary Guidelines for Americans recommend that protein foods are consumed as part of a healthy dietary pattern. This includes animal based protein such as red meat, poultry, fish and eggs and plant based. These include soy products, beans, peas, lentils, nuts and seeds.
One ounce of protein equivalents are one whole egg, one ounce of meat, 0.25 cups of beans, or 0.5 ounces of nuts.
Protein foods differ up to three fold in metabolizable energy and macronutrient contents. For example, one ounce of pork contains 7g of total protein and one oz of almonds contains 3g of total protein. Protein quality can be defined as the ability of a dietary protein to provide adequate amounts and proportions of essential amino acids (EAA). These can then be used by the body to make proteins and maintaining and growing body tissues.
Animal proteins contain all the EAA whereas plant proteins, apart from soy lack one or more of them. This is why vegans and vegetarians are urged to eat a wide variety of plants.
Research has previously found that in young adults, animal protein sources resulted in better whole body net protein balance (anabolic response) compared to plant based foods. Up till the study presented in this paper the protein balance had not been assessed in older adults.
The study group of the young adults ranged in age from 22-39. The study of the older adults ranged from 55-75 years. BMI was 22-35, stable weight, not pursuing moderate to vigorous exercise more than 3 hours a week, not ill, non smokers, not diabetic, not pregnant or lactating, and willing to not exercise for 48 hours before the testing days.
Each participant completed four 300 minute trials. These were randomised, investigator blinded and of cross over design. The trial meals were two oz equivalent meals of 1. unprocessed pork loin, 2. scrambled whole eggs. 3.black beans and 4. raw sliced almonds. Blood samples were taken at various timed intervals on 8 occasions after the meals.
Of the young adults 30 completed the study. There were equal numbers of men and women. Average age was 26, average BMI 26.4. Ethnicity was mixed.
Of the older adults 25 completed the study. 15 women and 10 men. Average age was 64.2, BMI 26.1 and again there were mixed ethnicities.
The results showed that the pork and whole egg meals resulted in greater essential amino acid bioavailability compared to the beans and almonds. This was true for both the young and older adults. This was a similar result to a previous study where pork, whole eggs, beef sirloin, tofu, kidney beans, peanut butter and mixed nuts were compared.
There were no differences in the protein bioavailability between the younger and older groups.
My comment: Apart from the very sensible advice given to vegans and vegetarians about consuming a wide variety of plants, this study would demonstrate that eating enough plant protein, aiming for a bit more than you may expect from plant protein estimates, would be potentially helpful in maintaining healthy body composition.
Damian Dy ´nka , Katarzyna Kowalcze , Anna Charuta and Agnieszka Paziewska * Institute of Health Sciences, Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, 08-110 Siedlce, Poland; damian.dynka24@gmail.com (D.D.); katarzyna.kowalcze@uph.edu.pl (K.K.); anna.charuta@uph.edu.pl (A.C.)
Correspondence: agnieszka.paziewska@uph.edu.pl
Abstract: The most common and increasing causes of death worldwide are cardiovascular diseases (CVD). Taking into account the fact that diet is a key factor, it is worth exploring this aspect of CVD prevention and therapy. The aim of this article is to assess the potential of the ketogenic diet in the prevention and treatment of CVD. The article is a comprehensive, meticulous analysis of the literature in this area, taking into account the most recent studies currently available.
The ketogenic diet has been shown to have a multifaceted effect on the prevention and treatment of CVD. Among other aspects, it has a beneficial effect on the blood lipid profile, even compared to other diets. It shows strong anti-inflammatory and cardioprotective potential, which is due, among other factors, to the anti-inflammatory properties of the state of ketosis, the elimination of simple sugars, the restriction of total carbohydrates and the supply of omega-3 fatty acids.
In addition, ketone bodies provide “rescue fuel” for the diseased heart by affecting its metabolism. They also have a beneficial effect on the function of the vascular endothelium, including improving its function and inhibiting premature ageing.
The ketogenic diet has a beneficial effect on blood pressure and other CVD risk factors through, among other aspects, weight loss.
The evidence cited is often superior to that for standard diets, making it likely that the ketogenic diet shows advantages over other dietary models in the prevention and treatment of cardiovascular diseases. There is a legitimate need for further research in this area.
Adapted from The State of Musculoskeletal Health Report 2023 by Versus Arthritis
Over ten million people in the UK have arthritis.
Health inequalities are defined as “unfair and avoidable differences in health across the population, and between different groups in society”.
One health inequality is deprivation. For example hip and knee osteoarthritis is commoner in the most deprived compared to the least deprived. Some ethnic groups are also affected considerably more than others. As a reference point, White British people have a 16.8% prevalence of a long term musculoskeletal problem (MSK). UK Chinese people have a 7.4% prevalence and UK Pakistani people have a 20.8% prevalence.
People with a MSK problem are 20% less likely to be in work compared with those who don’t have such a condition. In 2021 23.3 million working days were lost due to these conditions making it the third most common reason for working days lost.
I in 3 current UK employees have a long term health condition. 1 in 10 have a MSK condition. I in 3 of these employees with a long term MSK condition have not discussed it with their employer.
Of people who have no long term health condition 82.1% are in employment but this drops to 62.4% of those with a MSK condition. Of those with no long term health condition 15.2% are economically inactive. This rises to 34.9% of those with MSK conditions.
MSK conditions account for the third largest area of NHS spending at £4.7 billion in 2013-14 and are estimated to have cost £6.3 billion in 2022-23. The cost due to just Osteoarthritis and Rheumatoid arthritis will be £3.43 billion by 2030.
For many people, joint replacement surgery is the most effective treatment for their MSK condition. But many operations were not carried out over the Covid period. The conditions have not got better, the waiting lists have just got a lot longer. Approximately half of the operations done in 2019 were carried out in 2020 and the figures were still lagging in 2021.
Rheumatoid Arthritis affects 27,000 new patients each year. 30% of those with the Rh A develop osteoporosis. One in ten will develop interstitial lung disease over their lifetime. 60% of people with Rh A are physically inactive. One third of them have a mental health problem such as anxiety or depression. About a third of diagnosed people will stop work within five years of diagnosis.
Risk factors for getting the condition include age. It comes on most commonly between the ages of 40 and 70. It is 2 to 3 times more common in women compared to men. Being overweight increases the risk. There are hereditary factors involved. The gut microbiome is thought to play a part. Smoking increases the risk, worsens the disease and weakens treatment response.
My comment: As a GP I had hoped that new therapies and operations would revolutionise the outlook for musculoskeletal conditions and indeed there has been a lot of positive change. There is still some way to go. There isn’t much you can do about your heredity or gut microbiome but you can be a non smoker, keep slim and keep active. Meanwhile I wonder if anyone is researching how people of Chinese extraction have much fewer MSK conditions than any other group.
I was asked recently what I thought the definitions of good metabolic health and bad metabolic health should be. These were my criteria.
Metabolic health consists of two groups of factors: what you have and what you don’t have.
Metabolic health exists on a spectrum and your place on this spectrum may change over time. Perfection in anything is rarely obtainable and if obtained may not be sustainable. In general as we age we lose metabolic health for instance. Conversely exercise improves metabolic health at almost any age.
If you have good metabolic health you have:
Adequate or good muscle mass.
Normal to low fat mass for your life stage and gender.
A blood pressure of less than 140/90 and ideally lower than 130/80.
Fasting blood sugar less than 6.0 mmol/l.
HbA1c of 5.6 or lower.
Normal kidney function, liver function, haematology, low inflammation markers, and low insulin.
Low triglycerides and high /normal HDL.
Be able to move quickly and without undue effort while walking and running appropriate to your life stage.
Be able to get up from a chair or the ground without using your arms depending on your life stage.
Have good grip strength.
Have good coordination, balance, memory, problem solving abilities, and sensory function.
You sleep well.
You are in a good mood most of the time.
If you don’t have metabolic health, remember the spectrum issue. You can always aim to improve some of these parameters.
Signs that your metabolic health needs some work are:
You have low muscle mass.
You have excess fat mass.
Your blood pressure is consistently over 140/90.
You require medication for blood pressure.
Fasting blood sugar over 6.1 mmol/l
HbA1c over 5.6.
Less than normal kidney function, liver function, haematology, raised inflammation markers other than transiently due to acute illness, and raised insulin.
High triglycerides. Low HDL.
Can’t move at a reasonable pace for the circumstances eg you can’t keep up with your classmates or friends during walks, dancing, games or exercise classes.
You can’t get up from the floor without using your arms if you are under the age of 40 (and have no disabilities) or from seated in a chair otherwise.
Your grip strength is poor.
You have poor coordination, balance, memory, problem solving abilities, and sensory function that is not correctable with aids.
Yours sleep is habitually poor and you are tired most days.
Melatonin is a hormone that is secreted by the pineal gland in the skull. It is also available in many foods that include cherries, olives, walnuts and goji berries.
A Japanese study evaluated the amount of dietary melatonin reports that over a 16 year period, those who had higher dietary melatonin intakes had slightly lower mortality form cardiovascular and non-cardiovascular mortality.
American Journal of Epidemiology
My comment: We already know that cherries are beneficial for gout, that olives contain healthy fats, and that walnuts have useful Vitamin E. Here is another reason to eat them.
Exercise training for resistant hypertension
A small trial from Portugal reports that blood pressure can be reduced by a moderate intensity aerobic programme. The participants were supervised in 40 minute sessions three times a week. The systolic blood pressure dropped by 7 mm Hg and the diastolic by 5 mm Hg.
Journal of the American Association of Cardiology
Blood sugar control affects cardiovascular mortality across the whole spectrum
A follow up of 300,000 people in the UK Biobank Study shows, as we know, type two diabetes substantially increases the risk of atherosclerotic cardiovascular disease, chronic kidney disease and heart failure. The gradient of severity of these conditions exists on a gradient of risk from pre-diabetes to poorly controlled type two diabetes. This indicates that we should strive for normal blood sugars if we reasonably can.
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.
