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.
Adapted from Medscape 5 Dec 2022 by Vinod Rane BS Pharm
Glucosamine, popularly used for osteoarthritis, has previously been found to have anti-inflammatory properties and regular use has now been shown to reduce cancers overall and particularly kidney, lung and rectal cancer.
This was a large prospective study that included 453,645 participants aged 38 to 73 who did not have cancer at the start of the study.
19.4% were taking glucosamine regularly and 80.6% were not. The patients were followed up for a median of 12 years.
Cancer was reduced in cancer overall 0.95, kidney cancer 0.68, lung cancer 0.84 and rectal cancer 0.76.
The study did not include the dose, form and duration of supplement use and there could be a risk that the people who took glucosamine also followed other healthier behaviours than those who didn’t.
My comment: I have been taking glucosamine for 23 years now and it has been a great benefit to my joints. I can see that confounding could be a problem. Non smokers greatly reduce lung cancer, vitamin D users are less likely to get rectal cancer, and slim people are less likely to get kidney cancer.
Zhou J et al Associaton between glucosamine use and cancer mortality. A large prospective cohort study. Front Nutr. 2022;9:947818.
The Lancet has published research concerning the effect of clinical Covid 19 infection protection against further infections.
Looking at 65 research studies, the conclusion is that alpha, beta and delta variants strongly protected against future infection. There was 78% protection at 40 weeks post covid. The Omicron variant however was less protective, immunity only being 36% at 40 weeks.
Any infective agent however was highly likely to protect against hospital admission or death. The effectiveness was 90% at 40 weeks.
This was considered as useful has having had two mRNA vaccines.
I attended the PHQ conference in Edinburgh on 17 March 23. This was the first such meeting in Scotland and it was well organised, interesting and well attended.
Moira Newiss is on your far left of the photo in her navy dress and black boots. Moira organised the meeting and also spoke about her experience of having post viral fatigue twice in her life. This led her to explore the functioning of the mitochondria in our cells. She found that the mitochondria don’t function normally and become depleted in chronic fatigue syndrome and fibromyalgia but that primitive pathways in the cell using ketones for fuel are still active. She started a ketogenic diet and recovered completely from her chronic fatigue syndrome. She now runs for a hobby.
Dr David Unwin is standing next to her and is wearing a bow tie and suit. He is now 65 years of age and has been promoting low carb diets in his practice for the last ten years with great results. He is having so much fun that he doesn’t want to retire!
He found that in many cases type two diabetics can reverse their condition completely by the adoption of a low carb or ketogenic diet. Statistical analysis showed that the people most likely to reverse their condition had had been diagnosed in the previous 18 months. There is thus a great window of opportunity for advice and coaching to be provided to these patients at the earliest opportunity after diagnosis.
Results after 18 months are more variable, with a great improvement in diabetes seen, but sometimes not to the extent that complete remission occurs. Some medication support is often still necessary. Insulin may be able to be substantially reduced or stopped but some alternative medication may still be required.
Monitoring of patients blood sugars will still be required for both groups lifelong in case high blood sugars return. This can be due to secondary beta cell failure and may require tightening up of the diet, the addition of medication and sometimes insulin. If higher blood sugars and weight loss is reported, pancreatic cancer requires consideration and this is detected by urgent MRI scans. Sometimes a patient has been wrongly diagnosed as type two when they are really type one. In all cases they will need to see their GP for diagnosis.
Dr Iain Campbell is standing next to Dr Unwin and is wearing a waistcoat and white shirt. Iain told us about his struggles with bipolar disorder. There certainly could be a creative advantage to this illness, as Iain spent his young day in a rock band and even now is a successful composer. He has now settled into fatherhood and medicine and since starting a ketogenic diet has been mentally stable. My comment: Dr Christopher Palmer in the USA has also researched this phenomenon and there is a blog article on this site about him. Iain works at the university of Edinburgh, and has done preliminary studies in other patients who have bipolar disorder and has found that anxiety, depression, mood swings and impulsiveness all improve with a ketogenic diet. Further research is planned.
Dr Rachel Bain, on your far right, is a psychiatrist and works with Ally Houston, who is standing beside her, to promote coaching for mental health patients in the low carb diet. The site is metpsy.com.
Rachel explained that the gut and brain are very intimately connected and share the same neurotransmitters. The gut microbiotica are affected by what we eat. This affects our mood. If leaky gut occurs inflammatory substances can gain access to our blood vessels and cross the blood /brain barrier to cause neuro-inflammation. This is one cause of degenerative brain conditions such as Alzheimer’s disease and Parkinson’s disease. The foods most likely to disrupt the junctions between the gut cells are sugar, starch, gluten and alcohol. She and Ally as well as other team members treat people who have Attention Deficit Disorder, Obsessive Compulsive Disorder, Binge Eating Disorder, Bipolar Disorder and Schizophrenia. They don’t aim for a person to stop their medication so much as to gain control of their lives.
Ally Houston used to be a physicist but is now a chef and low carb coach. Comment: Ally also appears in a previous blog post on the site. He explained what coaching was and wasn’t. It isn’t telling someone what to do. It is exploring with the person how their life works now and how they can introduce positive changes around eating sugar, starch, vegetable oils, exercise, stress reduction and sleep.
The services at met.psy.com are out with the NHS and there is a fee for the services, but it is very reasonably priced.
PHQ are expecting videos of the conference to be available on You Tube now or very shortly.
Mortality Reduced With Adherence to Low-Carb Diet in Type 2 Diabetes
Mar 24, 2023
Lower mortality seen with increases in total, vegetable, and healthy low-carbohydrate diet score
By Elana Gotkine HealthDay Reporter
×
FRIDAY, March 24, 2023 (HealthDay News) — For individuals with incident type 2 diabetes (T2D), a greater adherence to low-carbohydrate diet (LCD) patterns is associated with lower mortality, according to a study published online Feb. 14 in Diabetes Care.
Yang Hu, Ph.D., from the Harvard T.H. Chan School of Public Health in Boston, and colleagues calculated an overall total LCD score (TLCDS) among participants with incident diabetes identified in the Nurses’ Health Study and Health Professionals Follow-up Study. Vegetable (VLCDS), animal (ALCDS), healthy (HLCDS), and unhealthy LCDS (ULCDS) were also derived.
The researchers documented 4,595 deaths, of which 1,389 cases were attributable to cardiovascular disease (CVD) and 881 to cancer among 10,101 incident T2D cases, contributing 139,407 person-years of follow-up. Per each 10-point increment of postdiagnosis LCDS, the pooled multivariable-adjusted hazard ratios for total mortality were 0.87, 0.76, and 0.78 for TLCDS, VLCDS, and HLCDS, respectively. Significantly lower CVD and cancer mortality was seen in association with VLCDS and HLCDS. From the prediagnosis to postdiagnosis period, each 10-point increase in TLCDS, VLCDS, and HLCDS correlated with 12, 25, and 25 percent lower total mortality, respectively. For ALCDS and ULCDS, no significant associations were seen.
“Our findings provide support for the current recommendations of carbohydrate restrictions for T2D management and highlight the importance of the quality and food sources of macronutrients when assessing the health benefits of LCD,” the authors write.
Adapted from The Displacing Foods Age Related Macular Degeneration by Chris A Knobbe. Medical Hypotheses 109 2017 184-198
Chris A Knobbe from the University of Texas has studied factors that are thought to be important in the causation of Age Related Macular Degeneration. (AMD).
AMD is the leading cause of irreversible blindness in developing nations. In 2020 some 196 million people were affected worldwide. And Dr Knobbe thinks this is almost always down to dietary factors, in particular the consumption of processed food such as sugar, vegetable oils, refined white flour and trans fats.
Historically, between 1851 and 1930, AMD was a rarity. It rose modestly in the 1930s but became an epidemic in the UK and USA by 1975.
By 2009 63% of the American diet consisted of processed sugars, starch and oils. My comment: Dr Google now puts this at 73% “hyper-processed foods”.
By looking at the food intake and AMD in 25 nations, it was seen that as the traditional diets were replaced with processed foods, the incidence of new onset AMD correspondingly rose.
If sugar intake is moderate but polyunsaturated fat ingestion is rare, AMD does not rise.
It would therefore appear that processed and nutrient deficient foods are toxic to the retina.
AMD could probably be entirely preventable through reverting back to ancestral dietary patterns, should that be feasible, or eliminating processed foods that have become ubiquitous. Avoidance of these foods is likely to be extremely important for people who have been diagnosed with early or moderate AMD.
My comment: I was recently at a Hospice ladies lunch group and was sitting at a table with six other women who were about 10-20 years older than myself. Five of them were currently getting eye injections for AMD. Diets that are considered the healthiest by Dr Google are the Mediterranean, Japanese, South Korean and French.None included processed foods.
Adapted from Medscape Get More Sleep, Lose More Weight: A Randomised Trial by F. Perry Wilson MD MSCE.
Feb 7 2022
A study in JAMA Internal Medicine has shown that you can lose more weight just by lying in bed, having a good sleep. Because, if you sleep poorly, you will eat more the next day.
The whole thing becomes a vicious circle. Sleep loss leads to poor impulse control, and a preference for hypercaloric food. Long term stress can even increase eating disorders such as emotional eating.
Sleep loss increases Ghrelin and decreases Leptin which increases the appetite. Stress increases the Hypothalamus and Pituitary hormones and this increases Cortisol which attempts to dampen these down. Weight increases due to more calories being ingested and insulin resistance increases. Adiponectin decreases and you store more of your calories as fat. Your risk for obesity and diabetes increases.
My comment: When I worked as a Police Surgeon and GP I was often working all day, then a lot of the night, then all day. At 5 am when I often got home from a call out, I would crave toast, butter and Marmite. I have this about once a year now that I’m retired and when I wake through the night I may have a cup of tea, but I don’t feel like eating anything at all.
Dr Esra Tasali from the University of Chicago randomised 80 people, all of whom were overweight and getting less than 6.5 hours of sleep a night, to get personalised sleep recommendations to boost their sleep time or routine study visits where nothing was advised.
The suggestions were to decrease ambient light, create a bedtime routine, limit phone and TV use in bed, decrease caffeine intake and increasing daytime exercise. Each person was given a goal bedtime and wake up time schedule.
After two weeks, wrist monitors indicated that the intervention group was sleeping an extra 1.5 hours a night, which is approximately one full sleep cycle. This was maintained over the next two week monitoring period.
The calorie intake and output in the subjects was also measured by using doubly labelled water. Don’t ask me how this works!
They found that the extra sleep randomised group consumed 150 fewer calories a day. There was no increase in energy expenditure. On average they lost a pound in weight over the study period. They also reported being more alert, having a better mood and having more energy through the day.
Another tip I’ve heard elsewhere to improve sleep is to get outside in the morning for a bit of light exposure and exercise, even if it is winter or raining.
Adapted from Medscape The Male Biological Clock- How to Tell the Time by Mark Trolice MD
Most women know that their fertility declines from the age of 30 onwards. From then on it will become more difficult to become pregnant and there will be an increase in the rate of miscarriage and in infants with chromosomal abnormalities. Yet, due to our modern lifestyles, the availability of contraception and the economic situation, first births in women aged 35 to 39 has increased six fold. To give an increased chance of conception women are increasingly freezing their eggs in their late twenties and early thirties.
Men are also becoming fathers for the first time at later ages. Over the last 40 years this has increased by 3.5 years.
Men over 45 years need five times longer to achieve a pregnancy than men under 25 after their female partner’s age is adjusted for. Sperm counts start to decline from the age of 41 and sperm motility decreases. Chromosomal abnormalities in sperm also increase.
At all ages, being overweight, alcohol consumption, cigarette and e cigarette smoking, can lead to impaired semen production.
The first treatment will be to correct lifestyle factors and then consider ovulation induction and intrauterine insemination. Men over 45 have lower pregnancy rates and higher miscarriage rates with Intrauterine Insemination Treatment.
During IVF cycles injecting the sperm into the egg can improve fertilization rates but in men over 45 there is still reduced fertilization rates and decreased embryo development to the blastocyst stage.
The offspring of older men have higher rates of stillbirth, low birth weight, preterm birth and birth defects. Men older than 40 to 45 have twice the risk of having an autistic child and three times the rate of schizophrenia.
A consideration is that men consider sperm freezing at younger ages, similar to what women do. Another way to tackle the problem is pre-implantation genetic testing of embryos from older men.
Adapted from Journal of Forensic and Legal Medicine Feb 2023Insulin murder and the case of Colin Norris by Alan Wayne Jones University of Linkoping, Sweden.
Although insulin is an essential medicine and a life saving drug, it has been used in many poisonings. These can be accidental, suicidal or to deliberately cause harm. An insulin overdose causes severe low blood sugars, and if untreated can lead to coma, irreversible brain damage and death.
Normally, in non- diabetic individuals, the beta cells in the pancreas secrete the same amounts of insulin and C peptide into the portal venous system. In the liver, the insulin is broken down faster than the C peptide, so normally there is more C peptide in the general circulation than insulin. When there is more insulin in the system than C peptide, that is a very strong indicator that insulin from a non- pancreatic source has been administered.
Sophisticated biochemical measuring systems can identify insulin analogues. This provided part of the evidence that convicted Colin Norris, a nurse, of injecting insulin into five of his patients, four of whom died as a result.
Clinical symptoms of low blood sugars occur when the blood sugars drop below 2.5 (UK) or 45 (USA), although the exact threshold can vary between individuals. If this is prolonged for up to 6 hours or more then the brain damage can be irreversible and death can occur. The hormonal response to correct low blood sugars also prolongs the QT interval in the heart electrical pacing mechanism leading to an increase in cardiac arrhythmias and sudden death.
Proof of insulin poisoning requires positive identification of the causative agent in plasma or serum samples taken from the victim before the low blood sugar is corrected.
The first proven case of murder by insulin occurred in the mid 1950s and forensic evidence was obtained from analysing tissue samples from around injection marks on the victim’s buttocks.
During an investigation into suspicious deaths caused by insulin, the entire case scenario and totality of the evidence must be carefully considered. Tissue samples around any injection marks need to be kept for later analysis of insulin and C peptide levels.
In a Leeds hospital, in September 2002, a Mrs Hall was recovering from a hip joint operation and seemed to be making good progress. In the early hours she was found unresponsive. A bedside test showed that her blood sugar was only 1.5. Although intravenous dextrose was given, she never regained consciousness and later died. She did not have diabetes. Assays showed that the insulin level was far higher than the C peptide level indicating that pharmaceutical insulin had been injected. It was believed that she may have been mistakenly injected with insulin which was kept for patients in an unlocked fridge.
Nurse Colin Norris became the prime suspect. As part of the investigation a retrospective review of other unexpected deaths and incidents which could have been due to insulin administration were found. Four incidents had occurred in the previous year when Colin Norris was on duty. Three earlier deaths had been attributed to natural causes at the time and there was no toxicological evidence that any of them had been injected with insulin. Colin Norris maintained his innocence throughout the investigation.
In October 2005 Colin Norris was charged with murdering four patients and attempting to murder a fifth by the injection of insulin. The trial started at Newcastle Crown Court in October 2007. In March 2008 he was found guilty and was sentenced to life imprisonment. He was described by the judge as a “thoroughly evil and dangerous man…arrogant and manipulative….with a real dislike of elderly patients. There cannot be any suggestion that you were motivated to hasten their ends to spare them suffering”.
After the first appeal against Norris’s conviction failed in 2009, clinical evidence emerged that spontaneous attacks of hypoglycaemia in elderly and frail patients are not as rare as the jury had been led to believe. Indeed, a literature review showed that 2-10% of elderly frail patients, who can be malnourished, with co-morbidities such as sepsis, liver disease, or kidney failure are vulnerable to attacks of hypoglycaemia.
Other weaknesses in the case were:
The insulin vials on the ward were not subject to any inventory.
No insulin or needles were found near Mrs Hall.
The fingertip blood sample showing low blood sugar was not verified with a venous blood sample.
The very high insulin level was found on an NHS assay machine, not a more accurate forensic one. Rigour in following chain of custody procedures were not done. A confirmatory sample had also not been done.
The low blood sugar had been corrected before the low C peptide versus high insulin was found.
Spontaneous hypos can indeed occur in the elderly and frail.
Another hypoglycaemia related death had occurred at the hospital but it had not been mentioned as Norris had not been on duty. Thus the police were suspected of cherry picking cases to incriminate Norris.
Toxicological evidence of hypoglycaemia was only found for Mrs Hall. Death certificates for the other suspected hypoglycaemia deaths had been attributed to old age and other natural causes.
The cause of death of Mrs Hall was brain damage due to insulin induced hypoglycaemia but it was not known if the pathologist had looked for any insulin secreting tumours.
One of the senior police officers had been involved in the Dr Harold Shipman case two years previously and he may have been primed to find another serial killer in the health profession.
The Criminal Case Review Committee, which is the official authority in the UK charged with looking into miscarriages of justice, have examined the evidence and recommended that the court of appeal have a fresh look at the case.
My comment: It will be interesting to find out what happens and what their reasoning regarding this case will be. Meanwhile, look after yourself, look after your diabetes, keep up a healthy lifestyle and keep out of hospital!
Dr Lade Smith is the first black woman president of the Royal College of Psychiatrists. She is particularly concerned about the rise in psychosis in young people. Much of this is driven by cannabis consumption, particularly from smoking it.
Far from being a benign, relaxing, recreational drug with few downsides, cannabis use in the teens can mar their future. Because cannabis is now quite potent, even use once a week, can drive a five fold increase in psychosis in male users by the age of 25.
She is concerned that recent publicity of the plus sides of cannabis oil use has increased its use overall.
If there is a family history of mental illness, if younger teenage boys use it, if it is smoked, if there are other adverse childhood experiences, then it becomes progressively unsafe. Oestrogen in girls seems to protect them somewhat from the psychotic problems that are more common in boys.
My comment: As a Police Surgeon I was very familiar with the huge increase that I saw over the years in the incidence of psychosis and drug induced psychosis in young people over the years. The brain in these people actually shrinks in size. As they usually need a lot of life long supervision from their families and medical carers, and because they usually become economically inactive for their future lives, it is not good news for the individuals, their families and society in general.
Adapted from Independent Diabetes Trust Newsletter March 2023
The National Child Measurement Programme 16 March 2022
In the western world obesity rates continue to climb in children. In the UK when children start primary school at the age of 4-5 14.4% are obese and a further 13.3% are overweight. In Primary 6, at the age of 10-11 25.5% are obese and 15.4% are overweight.
My comment: from my own schooldays, there was only one overweight child in my primary class and she was on steroids and had a heart complaint that stopped her from participating in any exercise. In primary 7, there was one girl who was overweight and she had started puberty earlier than the rest of us.
In the USA in 2019 more than 30% of children were overweight or obese, similar to the UK figures. Physicians are reporting that since the Covid epidemic children are usually between 5 and 10 pounds heavier than they were at any given age, so these figures are likely to worsen even more.
Since 2006 Duke University has treated more than 15,000 children with a restricted carbohydrate diet which encourages the eating of vegetables, fatty fish, nuts and other features of the Mediterranean diet.
Meghan Pauley and colleagues from the Marshall University School of Medicine in Huntington West Virginia have cut the carbohydrate intake for children further to 30g or less a day and have been effective in short term weight loss in severely obese children and teenagers.
The ages of the subjects ranged from 5 years to 18 years. The study lasted 3-4 months. The children were otherwise told to eat as much fat and protein as desired with no limit on calories.
Two groups of analyses were done of different intakes into the programme in 2017 and 2018.
In Group A, 310 participants began the diet, 130 (42%) returned after 3-4 months. Group B had 14 enrollees who began the diet, and 8 followed up at 3-4 months (57%).
Girls compared with boys were more likely to complete the diet. Participants less than 12 years age were almost twice as likely to complete the diet compared with those 12-18 years, however, the older group subjects who completed the diet had the same percentage of weight loss compared with those under 12 years. Group A had reductions in weight of 5.1 kg , body mass index (BMI) 2.5 kg/m2 , and percentage weight loss 6.9% .
Group B had reductions in weight 9.6 kg , BMI 4 kg/m2 , and percentage weight loss 9% . In addition, participants had significant reductions of fasting serum insulin and triglycerides.
This study demonstrated that a carbohydrate-restricted diet, utilized short term, effectively reduced weight in a large percentage of severely obese youth, and can be replicated in a busy primary care office.
Diabetes Diet 