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 study published in Psychiatry indicates that cannabinoids don’t do much, if anything, for mental health improvement.
A systemic review of 54 clinical trials involving over 2,500 participants, showed no consistent benefit for anxiety, depression, or post traumatic stress disorder.
Limited evidence of benefit was seen in insomnia, Tourette’s syndrome and autistic spectrum disorder, but the study quality was low.
My comment: As a doctor I was aware that some patients got a benefit from cannabis/cannabinoids for chronic pain and multiple sclerosis. I’m also aware that some dogs are being given cannabinoids for various complaints and also been told that sometimes it makes a big difference.
Kengo Miyoshi, Assistant Professor, Tokyo states that to avoid weight regain with GLP-1 drugs, Japanese patients enter a programme of structured support to maximise the effectiveness of the intervention.
The drugs are regulated and are only given where there are obesity related co-morbidities and functional impairment. The drugs are only started after six months of lifestyle modification which includes dietary, exercise, psychological and behavioural modifications. These should be continued lifelong. At the six month point, GLP-1 drugs are prescribed but for a maximum of 68-72 weeks. The exit criteria is established at the outset. The continued support mitigates the “weight regain” effect.
Randomised controlled trials have shown that exercise makes a big difference to the effects of the drugs during and after GLP-1s are stopped. While on the drugs, exercise promotes greater fat loss, preservation of lean muscle mass, improved insulin sensitivity, increased cardiorespiratory fitness, and physical functioning. When the drugs are stopped, the preserved lean muscle mass, higher exercise expenditure and sustained physical activity lead to less fat regain. The metabolic improvements need to be supported by structured care long term. Obesity is after all a long term condition and needs to be supported as such.
In a Norwegian cohort study of more than 1.3 million births, they found factors that both increased and decreased the chances of the baby developing multiple sclerosis in adulthood.
The relation between social media use and adolescent wellbeing may not be as simple and linear as many people believe.
In a large Australian cohort followed over three years, moderate after school social media use was associated with better wellbeing than either heavy use or none at all.
Although heavy users were more likely to report low wellbeing in early adolescence, non-users had worse outcomes later on. The patterns varied by sex and age.
My comment: I understand that Australia is planning to ban smart phone use in schools and that some schools in the UK want this or are already doing this now.
Smart phones are little personalised computers that can be used as blood glucose monitors, with the right equipment, calculators, dictionaries, fact checkers, spelling checkers, payment systems, foreign language tutors, game consoles, alarm clocks, fitness checkers, social media hubs, weather forecasters, newspaper sources, bus and train timetables and purchases, and can enable family to keep in touch with their child and vice versa. I can easily see why they could be of real use to everyone and a loss to schoolchildren, particularly type one diabetics, who use them responsibly.
Unfortunately they can also be a source of harm, particularly regarding mental health, when online bullying occurs.
My children are now adults and small mobile phones were around when they were teenagers but since neither myself or my husband had smart phones we never considered getting them for our children.The iphone came out in the USA in 2007 and cost $495-$595 dollars. The only children who had smart phones were those children who came from disadvantaged homes, who were paid £30 a week to attend school. The more affluent working and middle class kids didn’t have them. The Freestyle Libre hadn’t yet been invented and wouldn’t be for a considerable time.
I can see that a blanket ban on smartphones would have disadvantages. If I had had one as a teenager, I can see that it would have been marvellous for all school work, homework, getting to school and even getting up in the morning. The single subject that it would have boosted enormously was language learning. Struggling with a difficult mathematical or science topic? Calculus springs to mind. You tube video could probably explain it much better than some teachers. Although I think blanket bans go too far, I’m not sure what rules would need to be put in place to prevent misuse of social media and how these could be enforced. It’s a problem that I avoided but something that at least some of you will need to decide now or in the future.
The Cholesterol Treatments Trials Collaboration set out to get reliable information on the side effects of statins. These are one of the most commonly prescribed drugs. The long list of side effects that are included in product information and in the BNF are mainly based on non-randomised and non-blinded studies and could be subject to bias.
The Collaboration did a meta-analysis of 19 randomised controlled trials covering 100,000 participants.
The side effects were:
Muscle pain
Diabetes
Less commonly there were:
abnormal liver function tests
urinary composition alteration
oedema (fluid retention)
There were no reliable indication of these previously reported symptoms:
Adapted from BMJ 21-28 Feb 2026 Harmful effects of sexual choking.Anouska Victoire et al NSW Australia.
Strangulation and manual choking during consensual sex is becoming increasingly normalised in the media and also in real life. Medical awareness of the hidden risks, harm, and death in both consensual and non consensual acts is increasing too.
Strangulation is the application of external pressure to the neck that compresses internal structures including blood vessels, the airway, nerves, and endocrine glands. The effects can be serious and can include death. Recent studies have shown that structural and functional changes in the brain can result even during consensual episodes, particularly if these are repeated. Strangulation has also been associated with higher risk of homicide in those experiencing intimate partner violence. Carotid artery dissection, thyroid and brain injury can result.
Mainstream media and pornography tend to romanticise sexual choking and strangulation. But they don’t spell out the risks. In an Australian study of young adults aged 18-35, 57% of respondents said they had been sexually strangled, and 51% reported having strangled a partner. This included men, women, trans and gender diverse individuals. 61% said they had seen this on pornography sites and 40% from films.
Directors of Forensic Sexual Health Services and A and E consultants both in Australia and the UK, suggest that specific enquiries into sexual choking and strangulation should be part of the routine history taking when taking a sexual history.
The UK government is currently implementing legislation banning the publication and possession of pornography depicting strangulation and suffocation.
Education of the general public regarding the dangers of this activity is urgently needed. Sadly, some couples who enjoy this activity and who have got away with it so far, seem reluctant to stop. Sexual choking may be popular in the media and glamorised but it is wrong to portray it as safe as long as it is consensual.
The national cancer plan for England aims to reduce cancer onset and improve the five year survival rate to 75%. It lists 31 steps that should bring us closer to that goal. These include improving patient centredness, care pathways, preparation for treatment, and prevention.
Many people think that cancer should be treated as a chronic condition. Half of us will get cancer and 38% of new cancer diagnoses are in those over 75.
Shared decision making should be realistic and forward looking, discussing interventions and alternatives with patients in line with their values and wishes. Not everyone wants excessive treatment or to face the risk of major complications. End of life care may be their priority instead.
The cancer plan wants to support palliative care hubs and hospice outreach services. Clinicians need to be realistic with patients. Sometimes the quality of time matters to the patient a lot more than quantity.
Physical activity should be promoted to cancer patients. The 2025 Challenge trial showed that an exercise programme reduced the risk of death from bowel cancer by 37% and of recurrent or new cancer by 28% over eight years. In this study, both arms were given information, but the extra intervention was support to actually accomplish the exercise programme. Patients need simplicity, clarity and practical information.
30% of cancers are preventable and action on smoking, obesity and highly processed food needs to be taken. The cancer plan advocates for genomic testing. But with or without this, we can all reduce our chances of getting cancer by physical exercise and activity.
Exercise can reduce the risk of breast cancer by 25% and bowel cancer by 45%.
The plan wants to move towards pre-emptive, data driven cancer care, using genomics, artificial intelligence, digital diagnostics and personalised treatment pathways. Yet, it does not tackle current problems such as recruitment freezes, diagnostic bottlenecks, and a shortage of radiology and histopathology workforce. For instance the target turnaround of histopathology is 98% within ten days. Currently it is achieved 68% of the time.
My comment: My husband and I were picked at random to be included in a target of 5 million UK residents in the Future Health study. They asked about basic health characteristics, previous personal and family history, and will test some baseline blood tests and elicit our genomes. We won’t personally benefit from this, but it is hoped that amassing data about what genes are related to various health outcomes may help others in the future.
Adapted from BMJ 21-28 Feb 2026 Menopausal hormone therapy and long term mortality by Mikkelsen, Bergholt and Scheller.
Is HRT a good thing or a bad thing? Most research veers towards positivity but there are occasional surges of bad reports in the press that can put both women and doctors off. The most telling statistic is the effect on the total mortality rate, rather than the effects on specific disease processes.
In this Danish cohort study, all women born between 1950 and 1977 who were alive aged 45 were included in the study. They were followed up from their 45th birthday till 31st July 2023. Of the original 969,424 women, 92,619 were excluded from further study because of thrombophilia, liver disease, arterial or venous thrombosis, breast cancer, endometrial cancer, ovarian cancer, earlier use of HRT or earlier bilateral ovary removal.
They then looked at who didn’t get HRT, who did, and what type. They looked at the main cause of death and any secondary factors listed in the death certificates. 5.4% of the women died during this period of observation. Researchers were looking at cardiovascular causes, cancer, and other causes. They then adjusted for age, calendar year, parity, educational qualification, income quartile, country of birth, diabetes, high cholesterol, hypertension, atrial fibrillation, valvular disease, heart failure and three or more hospital contacts between 44 and 45 years of age. The average follow up time was 14.3 years.
They found that menopausal hormone therapy was not associated with increased mortality.
In addition, women who had undergone bilateral oophorectomy between 45 and 55 years of age had a 27-34% lower mortality than women who did not.My comment: This is a whopping reduction! I was delighted to see this as I’m in this group of women.For a start, removing potentially cancer developing organs will reduce mortality. Oestrogen only HRT is also known to reduce breast cancer onset to a mild degree, and if given within ten years of the menopause, also reduces arteriosclerosis considerably.
104,086 women took prescribed HRT compared to 772,719 who didn’t. This was only 11.9%. I’m surprised the number of HRTusers was so low.I offered it to all menopausal women who didn’t have a contra-indication to it.
Adapted from BMJ 7-14 Feb 2026 Knowledge gaps in Coeliac Disease by Zachary Green research fellow and Professor Mark Beattie professor of paediatric gastroenterology Southampton Children’s Hospital UK.
Coeliac disease is a disorder of acquired loss of immune tolerance to ingested cereal proteins that affects around 1% of the global population. The clinical presentation is highly variable. There can be gut symptoms, bodily symptoms unrelated to the gut, and asymptomatic disease that can only be detected by screening. You have to do the serological tests while the person is still consuming gluten.
Untreated disease is associated with nutritional deficiency, osteoporosis, infections and sometimes malignancy. Both nationally and internationally, the screening, diagnostic and monitoring practices vary between adults and children, nationally and internationally.
We think that coordinated, prospective research is needed to address knowledge gaps such as:
the health and cost effectiveness of mass screening
the best serological and biomarkers to use in diagnosis and management
which drug treatments could be used effectively
Opinions differ on whether a gut biopsy is necessary or not to diagnose Coeliac Disease. The European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the American College of Gastroenterology (ACG) both think that a biopsy is not necessary if a child has markedly raised serum tissue transglutamase IgA.
ACG also say that a biopsy is not necessary if adults are symptomatic and who can’t tolerate an upper gastro-intestinal endoscopy. The European Society for the Study of Coeliac Disease (2025) say that its fine not to biopsy adults under the age of 45 who have had two separate IgAs ten or more times the upper limit of normal. This stance was endorsed by a meta-analysis of over 12 thousand patients from 15 countries where this level had a specificity of 100% and a positive predictive value of 98%.
Despite this, except for Finland, most guidelines continue to recommend histological confirmation in most adults. During the Covid epidemic, the British Society of Gastroenterology, advised stopping endoscopies. Cost and time benefits resulted. But, variability in assays and upper limits of normal are thought to be barriers to widespread adoption.
In the UK alone, there are 12 different IgA assays and the upper limit of normal varies between 3-30 IU/mL. Upper GI endoscopy has risks and has an environmental and cost burden. If screening is to be considered at all, we need to have pathways for repeat tests and biopsy thresholds.
Ongoing monitoring is also far from standardised. The correlation between symptoms, serology and mucosal recovery remains unclear. Prospective, international cohorts with long term follow up data are needed to determine serological thresholds and quantify population and individual risk. To minimise unnecessary procedures “no biopsy” pathways need engagement from clinicians and multi-disciplinary teams.
A systemic review and network analysis of 76 randomised controlled trials has found that relapses of anti-depressant medication can be completely avoided by bringing down the dose slowly, and by providing psychological support.
Relapse after stopping these drugs is common and many people can be on them for much longer than originally anticipated as a result.
Relapses are a lot higher if the drugs are stopped abruptly or tapered rapidly.
Meanwhile other researchers have been looking into genetic markers for psychiatric illness. Unlike disorders like Huntington’s disease, which is a single gene disorder, most psychiatric illness is due to the influence of multiple genes.
Schizophrenia and Bipolar disorder overlap extensively genetically.
Depression, anxiety, and post traumatic stress disorder also show this overlap with each other.
