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.
Over two thirds of university students don’t get enough sleep and this has knock on adverse effects on cognitive function and mental health.
Students have been found to get very stressed and blame themselves for poor academic performance. This leads to anxiety, depression and poor sleep quality. Researchers wanted to find out if treating yourself with kindness and understanding when you are having difficulties improves sleep quality.
Almost 200 students in the University of Manitoba completed questionnaires measuring self- compassion, sleep quality, and emotional regulation.
The researchers found that self- blame was the most important factor which affected low- self compassion. This also affected sleep quality the most. Students who avoided self- blame were also less likely to resort to other unhelpful cognitive strategies when under stress, such as denial, rumination, not making an action plan, catastrophising and assigning negative judgements.
Adapted from BMJ 20 Nov 21 Vegan diets have mixed effects on children’s health
Dr Malgorzata Desmond from Great Ormond Street Institute of Child Health has studied the effects of a vegan diet in children.
The positive side is that children on vegan diets had less body fat and had a healthier cardiovascular profile but there were also disadvantages.
The vegan children were on average 3cm shorter, had around 5% less bone mineral content and were three times as likely to be deficient in vitamin B12 than meat and dairy eating children.
The findings were from a study of 187 healthy 5 to 10 year olds in Poland. The groups were 63 vegetarians, 52 vegans and 72 meat eaters.
Dr Desmond said that she was also surprised to find that much of the vegan children’s diet came from processed food. She suggests that vegan parents consider giving B12 and Vitamin D supplements to their children.
Adapted from Chang K JAMA Pediatr 14 Jun 2021
Researchers from the Avon Longitudinal Study of Parents and Children Birth Cohort studied children born in the early 1990s from age 7 to 24 years. Three day food and beverage diaries were completed when the children were 7, 10 and 12. Over 17 years BMI, weight, waist circumference and body fat were measured. This is the first study to look at longitudinal associations between ultra processed food intake and health outcomes.
The foods they were looking at included for example: frozen pizzas, mass produced bread, fizzy drinks and ready meals. The groups were split into quintiles for analysis.
The lowest quintile ate 23% of their diet from ultra processed foods and the highest 68%.
The children in the higher consumption groups got fatter quicker. By the age of 24, compared to the lowest ultra processed group, they had a higher BMI by 1.2 kg/m2, higher body fat by 1.5%, were 3.7 kg heavier and had a waist circumference 3.1 cm bigger.
Author Professor Christopher Millet said: We often wonder why obesity rates as so high among UK children and this study gives information why. One in five children are consuming 78% of their calories from ultra processed food.
He suggests that measures to reduce the promotion of these foods and to encourage the eating of normal foods are urgently needed in the UK and globally.
Adapted from Medscape ECO 2021 Parental emotional distress linked to excess weight and fat in offspring 14 May 2021
So are the parents who supply ultra processed food to their children just too overwhelmed to home cook?
Around a third of children in the UK live with at least once parent who experiences significant emotional distress. More than a third of UK children also become overweight or obese by the age of then years.
In the UK Millenium Cohort Study, 19 thousand families born between 2000 to 2002 were tracked. Only two parent households were included in the analysis into parental distress.
Distress in mothers was associated with higher BMIs in girls from the ages of 5 to 14. Distress in fathers was associated with higher BMIs in both girls and boys, compared to undistressed parents.
Adapted from Medscape 17 Nov 20, 13 June 21, 20 June 2022 and 26 July 22
Vitamin D
Vitamin D deficiency was significantly associated with an increase in sight threatening diabetic retinopathy (STDR). There was no association seen between vitamin D deficiency and non- sight threatening diabetic retinopathy (NSTDR).
UK researchers conducted a meta-analysis of 12 studies which had enrolled over 9 thousand patients who had type one and type two diabetes who did not have diabetic retinopathy.
Vitamin D deficiency was significantly associated with an increased risk of STDR (OR 1.8 95%)
My comment: For UK residents, particularly in Scotland, it is a good idea to supplement with vitamin D and vitamin K2 at least over our long winter if not all year round. There are many articles about this in previous blog posts which you can search for.
Melatonin
A short- term study of just over 100 patients was undertaken to see if the addition of melatonin to prescribed pregabalin for painful diabetic neuropathy made any difference compared to placebo plus pregabalin.
The groups were split evenly and 6mg of melatonin was tested over an eight -week period compared to an identical placebo.
Sleep improved in both groups but more so with melatonin. Pain also improved for each group and again this was more so in the melatonin group.
On the other hand day- time sleepiness was more pronounced for the melatonin group as was transient dizziness. More patients discontinued in the melatonin group compared to placebo.
My comment: In the UK melatonin is only available on prescription and except for ADHD patients, usually children, it is only given short term to those who have insomnia mainly due to expense. It is available cheaply and widely in supermarkets and pharmacies in the USA and Canada however. For sufferers of painful diabetic neuropathy who live in North America there doesn’t seem much to lose by a trial of treatment. Apart from aiding sleep, which has a host of benefits on its own, Melatonin is an important anti-oxidant. The authors of the study Shokri M et al have not offered an explanation of how they think the melatonin works to reduce pain in the excerpt in Medscape. The full report is at: Shokri M et al, Adjuvant use of melatonin for relieving symptoms of painful diabetic neuropathy: results of a randomised, double blinded, controlled trial. Eur J Clin Pharmacol. 2021 Jun 13.
Ginger
Patients treated with ginger reported significantly less pain, nausea and vomiting compared to placebo in a meta-analysis of 13 RCTs.
Ginger has already been found to improve the pain of osteoarthritis, period pain and muscle pain but had previously given conflicting results regarding migraine.
227 patients were analysed. There were no side effects from the ginger compared to placebo.
My comments: Again, what would you have to lose by trying this if you are a migraine sufferer?
Resistant starch
There is a familial condition called Lynch Syndrome where there is a genetic susceptibility to bowel and other cancers. Recently it has been found that apart from aspirin, resistant starch supplements reduce bowel cancer in this population if taken long term.
Resistant starch is found in oats, breakfast cereal, cooked and cooled pasta or rice, peas and beans and some other starchy foods.
Lead author John Mathers, professor of human nutrition at Newcastle University explains that although resistant starch is a carbohydrate, it is not absorbed in the small intestine and ferments in your large intestine, thereby giving your gut bacteria a good feed. He thinks that it works to reduce bowel cancer by changing the gut bacteria metabolism of bile acids to reduce the kind that damage DNA and eventually cause cancer.
The CAPP2 trial has been following almost one thousand Lynch Syndrome people for between ten and twenty years. They have been taking over this time either: placebo or aspirin or resistant starch. The resistant starch dose is the daily equivalent of eating one unripe banana.
At the end of the first two years there was no difference in effect between the placebo and resistant starch groups on bowel cancer, but cancers in other parts of the body were reduced by 60% in the resistant starch group. The reduced cancers were in the upper gut and included oesophageal, gastric, biliary, pancreatic and duodenal cancers.
Aspirin meanwhile reduced bowel cancer rates by 50% and there was no effect in the placebo group.
Professor Burn said, 30g daily of resistant starch appears to have a substantial effect in Lynch syndrome on non- colorectal cancers and Aspirin works to reduce bowel cancer.
My comments: I wondered if there were resistant starch supplements available but didn’t find any. Eating the sorts of food recommended gave me terrible wind and I gave up!
Adapted from Medscape 20 June 2022 and 24 June 2022
Throughout my professional career, doctors have never known why some people develop Motor Neurone Disease. This is a devastating condition which leaves the brain intact but weakens the musculature of the body so that most people will have progressive weakness leading to respiratory failure and usually a death from pneumonia within a few years.
Andrew Crosby from Exeter University and others report that a specific gene TMEM63C, affects lipid and cholesterol processing pathways inside brain cells. The area of metabolic dysfunction is between the endoplasmic reticulum and mitochondria.
Dr Julien Prudent PhD states that it is necessary for different organelles within our cells to communicate together by exchanging lipids for example is critical to ensure cellular homeostasis to prevent disease.
There are also other genes known to cause Motor Neurone Disease. It is hoped that more effective diagnostic tools and treatments will eventually have an effect on the impact of the condition in people’s lives.
In another study scientists have discovered a genetic link that shows why some patients develop pain and early failure of their joint replacements.
Cobalt chrome (CoCr) is used in about 70% of artificial joints that are implanted throughout the world.
When a joint replacement fails it causes pain, tissue damage and repeat surgery.
Dr David Langton from Newcastle University explains that a large percentage of joint failures are caused when wear and tear cause small particles from the joint implant to be released into the blood stream and stimulate an immune response in the body. The action is similar to when a person with an organ transplant rejects it. Up until know the reason why some joints are rejected has been unpredictable and unknown.
It has been found that people with some HLA genotypes are at greater risk of CoCr metal sensitivity. This amounts to 10% of the European population.
A collaboration between centres in Newcastle, New York and Perth Australia have produced a machine learning tool called Orthotype which can predict which patients are at higher risk of joint rejection prior to surgery by scanning the patient’s genotype.
In future a great deal of patient misery and expense could be prevented by routine blood testing prior to joint replacement to allow the surgeon to choose the best implant for the individual patient.
At the moment about 10% of the UK population will undergo at least one joint replacement. This number is expected to increase if our weight problems increase too.
Adapted from BMJ 18 June 2022: Type 2 diabetes: summary of updated NICE guidance
When type 2 patients eventually get their diabetes checks, they can expect a few changes to management if their practices are keeping up with NICE guidelines.
Instead of looking at the 10 year risk for cardiovascular disease, type 2 diabetics over the age of 40 will be assessed for lifetime risk. This is usually a pathway to the initiation of statins, if they are not already being taken. If the cardiovascular risk is raised you will also be considered for an SGLT inhibitor.
If you have chronic heart failure or have already been diagnosed with atherosclerosis you will be considered for an SGLT2 inhibitor. These give a proven cardiovascular benefit.
SGLT2 inhibitors work well with Metformin if a glucose lowering drug is needed.
Modifiable risk factors for diabetic ketoacidosis should be assessed before prescribing SGLT2 inhibitors.
Such factors are: Alcohol limit above 14 units a week, use of illegal drugs, use of other medicines, concurrent illness, injury or planned surgery, very low carbohydrate or ketogenic diet.
To reduce the chances of your developing type two diabetes, it is best to keep your belly measurement to less than half of your height. You don’t need a tape measure. A bit of string will do.
NICE say that BMI may still be useful to define overweight and obesity, although it does have considerable limitations in muscular people and in old age. As it is not a direct measure of belly fat which is the driver for diabetes, hypertension and cardiovascular disease it must be interpreted cautiously.
In people of south Asian, Chinese, other Asian, Middle Eastern, black African or African-Caribbean backgrounds NICE are now stating that a BMI of 23 can be considered as overweight and 27.5 can be considered as obese.
These parameters may be important when treatments are being limited by BMI category.
Adapted from Medscape May 25 2022. Why is long term weight loss so difficult? It’s biology, not willpower! by Donna Ryan MD.
When people lose weight changes occur in food regulation hormones and subjective hunger increases. This drives an increase in food intake. The hormones that make you feel full after a meal reduce and the ones that make you hungry increase. Reduced energy expenditure also occurs and this also drives weight regain.
Even when both diet and exercise strategies are applied, regain of more than half of the lost weight occurs by 2 years and 80% of lost weight is regained by 5 years.
People who defy these norms report that they do very high levels of physical exercise, eat low calorie and low- fat diets, have very high degrees of eating restraint, and have low levels of disinhibition. They also tend to weigh themselves several times a week. So, they work really, really hard at it, and can never let up.
The medications that reduce weight work if they are taken for long enough, but on discontinuation, weight gain returns.
This question is a lot trickier health wise than you think. There has been new research on a variety of beverages that show various harms and benefits.
Coffee
A study from Cambridge suggests that coffee in itself is not a dangerous drink but that thermal damage to the oesophagus is the problem that can result in a higher risk of oesophageal cancer.
In the UK we drink 98 million cups of coffee each day. There are 67 million adults and children in the UK at present to put this into context.
Tea
Green tea is known to confer some health benefits and a recent prospective study has shown benefit for black tea drinkers too. Half a million UK participants in the Biobank cohort were assessed. There is a moderately reduced all-cause mortality reduction in those who have two or more black teas a day. There also was a reduction in mortality from cardiovascular disease, ischaemic heart disease and stroke. There was no effect on cancer mortality or respiratory disease. Surprisingly given the coffee study, there seemed to be no effect from the temperature of the drink or the addition of milk or sugar.
It is thought that substances in the tea improve endothelial function and this is the cause of the effect.
Pre-meal whey protein drink
A small whey protein pre-meal drink taken 10 minutes before meals, significantly reduces mean blood glucose concentration and for diabetic subjects, the amount of time they spend in normal blood sugar ranges.
A placebo RCT was done on 18 people who had type two diabetes who had never been treated with insulin. They were given a 100ml drink containing 15.8g of protein to be taken ten minutes before breakfast, lunch and dinner.
The protein drinkers significantly reduced the prevalence of hyperglycaemia over the day, increased the amount of time in the normal blood sugar range by around 2 hours extra a day, and reduced the 24 hour glucose concentrations. There was no effect on night time blood sugar levels. The acceptability levels of this were high at 98%.
The researchers at Newcastle University say that the protein seems to slow down the speed of gastric emptying and stimulating hormones that reduce the spike in blood sugars.
Alcohol containing drinks
Alcohol is a major preventable risk factor for cancer. About 4-5% of cancers are alcohol related. A new study suggests that reducing alcohol intake reduces the risk of getting an alcohol related cancer in a Korean study.
Those who drink three or more alcohol containing drinks a day are at particular risk of cancer. The heavier drinkers at the outset have the most to gain by cutting down. Some cancers are much more likely from alcohol than others. More than 45 % of mouth and throat cancers are drink related, 25% of laryngeal cancers, 12% of female breast cancers, 11% of colorectal cancers, 10.5% of liver cancers and 7.7% of oesophageal cancers.
Health screenings in Korea were done in 2009 and 2011. The average age was 53 years and they were followed up for just over six years. Over that time, new cancers were seen in 7.7 per thousand of the 4.5 million people screened.
Those who increased their alcohol consumption had a higher increase in cancers. Those who lowered their alcohol intake lowered their risk. The risks were dose related.
Fruit juice, fizzy pop and diet soda
Drinks sweetened with sugar but not natural juices or artificially sweetened drinks were related to a higher risk of inflammatory bowel disease in people who drank more than one a day, in a study of more than 120,000 people.
66% of the people did not drink any sugar sweetened beverages a day but those who consumed more than one such drink a day had a higher BMI and consumed higher amounts of total energy and sugar.
The participants were followed up over ten years. There was a significant increased risk for Crohn’s disease but not for Ulcerative Colitis in the sugary drink consumers. Diet drinks or natural fruit or vegetable drinks had no effect.
All the subjects were over the age of 40 so the effect on the younger population was not studied. Dr Hasan Zaki said that this would be of interest to study because children consume a lot of sugary drinks and the incidence of inflammatory bowel disease in children increased by a third between 2007 and 2016.
My comment: I was pleased to see the beneficial effects of black tea because I drink about 4 pints of it a day. I do like a glass or two of wine with my dinner, but maybe I should cut this down and have a tomato juice or just plain water instead? The pre-meal protein drink looks interesting. I would expect that it would reduce the amount of food consumed at each meal as it should blunt the person’s appetite. I wonder what the longer term effects on weight would be?
Adapted from Diabetes in Control Sept 18 2021: Effects of earlier dinner times on glycaemic control by Andy Dao, Pharm D candidate, University of South Florida.
Growing up you may have heard from your family that eating close to bedtime isn’t a good idea. Eating later has indeed been shown to cause weight gain and metabolic dysfunction. Type 2 diabetes develops 10% more commonly in those who work shifts for instance. It is though that hormonal disruption of the circadian rhythm is the problem.
A recent study looked at how blood sugars were affected by eating earlier than 6pm or after 9pm over the whole 24 hour day. Adults over 20 wore blood sugar monitors over three days in this experiment. They were assigned to have their last meal of the day by 6pm or after 9pm. They had to eat or drink nothing but water after this meal. They were given identical meals three times a day. How they felt, what exercise they took and how well they slept were all assessed.
12 subjects completed the tests. Each group were of comparable height, weight and BMI.
There were significant reductions in blood sugar levels in the early diners in mean blood sugars throughout the whole day, night and early morning. Post prandial levels were also better in the evening for the early diners compared to the late diners but not for breakfast and lunch post prandial levels which were the same regardless of the evening mealtime.
The early diners did report more hunger and capacity to eat in the evenings than the later diners. There was no difference in sleep or physical activity.
So, if you do eat earlier, you can expect improved blood sugars all day long, and perhaps less likelihood of getting diabetes. The downside is more evening hunger. This study was done in healthy non-diabetic people and it would be interesting to see what the results in diabetic subjects would show.
Comment: Sitting down at 5 to 5.30 pm just wouldn’t work well for me, yet this is what we did in my childhood, and we didn’t eat snacks in front of the television after this. In my own house we have dinner at 7.30pm. This however is because I didn’t usually get home before 6.30 pm or even 7pm for many years so an earlier mealtime was not possible for me. I also tend to watch television from 8 pm for about 40 minutes or so before bath and bed. I couldn’t abide eating after 9pm as a regular thing, yet this is very common in Italy. I do think that I would be reaching for the oatcakes and cheese or more if I was in front of the television having eaten at 6pm.
Adapted from Medscape News by Megan Brooks July 13 2022
Transmission of anxiety appears to be sex specific. It spreads from mothers to daughters and from fathers to sons, new research shows.
Dr Barbara Pavlova from Nova Scotia says that findings suggest that anxiety is a learned behaviour from parents. Therefore, perhaps it is preventable. Effective treatment of anxiety in young adults, prior to parenthood, could make a difference to children too.
Anxiety disorders are known to run in families. Both genes and environment are thought to be at play.
If a mother for instance has an anxiety disorder, the chance of a daughter developing it, by an average age of 11 years old, is 2.85 times normal, but this is not the case for her son, who would have a normal risk.
Of 398 children studied 27% had been diagnosed with some sort of anxiety disorder including generalised anxiety disorder, social anxiety disorder, separation anxiety disorder or a specific phobia.
The rates increased with the age of the child from 14% in the under 9s to 52% in the over 14s. There was a similar rate of anxiety in both boys and girls. Rates were lower if one parent had the disorder and higher if two parents had the disorder. Dr Pavlova thinks that a child will tend to model themselves on their same sex parent.
Anxiety disorders are the most common psychiatric disorder and emerge earlier than mood disorders.
My comment: I was interested to see this information. My mother had GAD, generalised anxiety disorder, and I have had a specific phobia since I was about 9 (Spiders!). If I was going to get something I suspect that a common specific phobia is a lot less disruptive to life than GAD. The good news is that I’m not a pilot on a jet plane!
Adapted from Medscape August 31 2022 Would you like to live to a ripe old age? George D Lundberg MD
Do
Choose ancestors who did not die of natural causes in young adulthood or middle age (oophs…too late!)
Maintain a body mass index within the healthy range using a variety of tools
Maintain blood pressure within a normal range with or without medications
Maintain a low resting heart rate
Do eat whole grains including bran
Consume above ground leafy vegetables, some root vegetables, tree nuts, peanuts and berries
Ingest supplemental fibre such as psyllium husks
Ingest supplemental magnesium and possibly vitamins K2, C and D
Enjoy eating animal and vegetable fats including milk, cheese, meat, poultry, seafood, and eggs in moderation.
Eat two full meals a day
Do drink alcohol after 5pm
Sleep 6-8 hours a night
Walk up and downstairs and use handrails if necessary
Continue to be active physically, mentally, socially and sexually
Study and enjoy birds, bees, trees, plants, flowers and wildlife
Value your family life and participate actively while encouraging individuals to live their own lives
Read great books, fiction or non fiction a little every day
Actively engage in person or electronically with younger people
Stay informed about current world affairs and care about what you can change
Be passionate about culture such as performing and visual arts and sport
Recognise the value of spirituality and religion and feel free to live otherwise if you choose
Do your best to earn and retain as much money as needed to control your environment into old age
Take charge of your own health
Listen to your body
Maintain a long term relationship with a reliable and conservative primary care physician and certain specialists that fit the needs of older people.
Promote good vision in any way you can
Use hearing aids if you need them to retain brain function
See your dentist every 6 to 12 months and practice good oral hygiene. There is a strong correlation between the number of original teeth and length of life
Keep up to date with vaccinations
Maintain a safe distance and use mask if you may be around infective people
Take as few medications as necessary
Have as few diagnostic tests and surgical procedures as possible especially on the back and the knees
Use acupuncture and massage appropriately
Apply moisturising skin lotion especially after sun exposure
Use saline mist often to prevent nosebleeds
Walk at least 2 miles every day
If you can, swim every day
Practice yoga particularly the standing side bend, prone baby cobra, forward plank and windshield-wiper
Eat a protein rich diet and deliberately weight train or lift heavy objects to reduce sarcopenia
stand on one foot to improve balance
Use wearable exercise monitors if you find them useful
If you retire from work do some part time or volunteer jobs
Have something productive and fulfilling to do each day
Don’t
Inhale tobacco smoke
Consume sugar or sugar in anything in home cooked or restaurant meals, in soft drinks, fruit juices, pastries, desserts or processed foods
Use street drugs
Use natural or synthetic opioids except for short term relief of severe pain or the relief of pain from advanced cancer: then use all you need
Use sleep medication
Drink more than moderately or binge drink
Drive a vehicle after drinking or taking certain psychoactive drugs
Keep firearms in your home or workplace
Fret about things in your personal life or world affairs that you cannot change
Completely retire and have nothing useful to do
My comments: Dr Lundberg has a pretty long list of sensible suggestions. To these I would add, get some daily sunshine if you can and enjoy your pets. Have things to look forward to. Keep in touch with your friends and make contact with old ones who you value but don’t see often. Learn new things. What other suggestions do you have?
Diabetes Diet 