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.
In young adults sleep deprivation has been found to cause fat accumulation in the belly for the first time.
Naima Covassin from the Mayo Clinic Rochester Minnesota studied 12 healthy slim young people aged between 19 and 39. The poor souls were randomised to two weeks of just 4 hours sleep a night or 9 hours sleep followed by a three day recovery period. During this time the subjects were kept in hospital and factors such as calorie intake and energy output were measured.
Over the two weeks of sleep deprivation, the subjects put on an average of a pound or half a kilogram and all of it on the belly.
This was because they consumed an extra 308 calories a day compared to the 9 hours a night group.
Despite stopping the study after two weeks and then during recovery sleeping more, eating fewer calories and their total weight coming down, their bellies continued to get bigger, by an average of 3 cm by day 21 of the study.
This could be why shift workers are so prone to gaining fat around the belly.
The continued rise in belly fat could have been missed if body weight, BMI and overall body fat percentage were the only factors measured.
Dr Harold Bays who is an endocrinologist and president of the Louisville Metabolic and Atherosclerosis Research Centre says “Sleep disruption results in fat dysfunction and this may result in increased cardiovascular risk factors and unhealthy body composition including an increase in visceral fat.”
A survey of overweight adults from six countries in western Europe found that most strategies didn’t work.
The analysis was lead by diabetologist Dr Marc Evans from Cardiff said, ” It is important that we tackle Europe’s growing obesity problem to reduce hospitalisation from the multiple illnesses that result. Our survey results show that most adults with obesity are actively trying to address this, but most are unsuccessful whatever strategy they choose”.
The study looked at 1,850 adults from the UK, France, Germany, Italy, Spain and Sweden. All had BMIs of 30 or more. A quarter of the participants reported no ill effects from being overweight and the others commonly reported high blood pressure, lipid abnormalities and type two diabetes. 78.6% of them had tried to lose weight the previous year.
The most common methods used were: Calorie controlled or restricted diet 71.9%, an exercise programme 21.9%, drug treatment 12.3%, joining a gym 12%, using a digital health app 9.7%, alternative treatments 8.1%, weight loss service 7%, and cognitive behavioural therapy 2.1%.
The results were that 78% of those who attempted to lose weight did not lose 5% or more of their initial weight and some weighed more than this afterwards.
For those who tried calorie controlled or restricted diets 26.5% of people did lose weight but 17.1% of them gained weight.
For those who undertook an exercise programme 33.3% lost weight but 15.5% gained weight.
The gym goers lost weight 27% of the time but 32.4% gained. (We don’t know if this was muscle gain or fat gain though)
It seems that apart from baratric surgery few interventions achieve long term weight loss but an article in iScience published in 2021 found that health effects of obesity were considerably reduced or eliminated by having moderate or high levels of cardiorespiratory fitness. It argued that it might be better to emphasise the benefits of physical activity than stress weight loss as being the most important goal.
Meanwhile results from 80 thousand participants in the UK Biobank cohort show that more time spent in moderate to vigorous activity is associated with lower mortality. It doesn’t matter if you do these higher levels of activity in one go or in multiple bouts.
In a German study of ten thousand people aged between 40 and 80 years old, 21% of men and 17% of women had white rings round their irises of the eyes. You may have noticed these in your parents or yourself and may have wondered what this means.
The average age of the group was 60. Researchers noted that corneal arcus is more likely in men than women, increases with age, and increases with lipid levels.
Corneal arcus has no relevance to socioeconomic status, body mass index, arterial blood pressure or HbA1c levels.
Adapted from A ketogenic drink improves cognition in mild cognitive impairment: Results of a 6 month RCT by Melanie Fortier et al. Alzheimer’s and Dementia.2021.
Brain energy rescue is being tested to see if it can reduce cognitive decline in patients with mild cognitive impairment. It has previously been discovered that the brain has problems using glucose for fuel even before symptoms develop, but brain ketone use remains constant in both Alzheimers (A) and Mild Cognitive Impairment (MCI). Increasing ketones available to the brain has been shown to improve cognitive symptoms.
A really easy way to increase blood ketone levels is to give a drink containing ketogenic medium chain fatty acids. This has been found to increase brain energy uptake via PET scans. This follow on trial was done to assess whether improvement in cognition after six months occurred.
This study was conducted in Quebec Canada. Very strict entry criteria were applied and the patients were randomised to the ketogenic drink or to a placebo drink. The drinks appeared and tasted identical.
122 participants were enrolled. In total 39 completed the ketogenic arm and 44 the placebo arm. They were well matched regarding age, sex, education, functional ability and cognitive scores, absence of depressive features, blood pressure, blood chemistry and APOE 4 status. ( A genetic variability that greatly increases the chance of developing dementia).
More participants dropped out of the ketogenic group mainly due to gastrointestinal side effects. The drop out rate overall was 32% and 38% in the ketogenic group. None of the side effects were serious.
The results showed that performance on widely used tests of episodic memory, executive function and language improved over 6 months in the ketogenic group compared to the placebo group. Improvement was directly correlated with the plasma level of ketones.
The dose used was 15g of kMCT twice a day.
This seems to be a very reasonable intervention for early cognitive decline particularly since no drugs are approved for MCI and drugs used for Alzheimers do not delay cognitive decline in MCI. It is possible that effects would be enhanced if patients also undertook a ketogenic diet. Further trials are now warranted to see if diagnosis of Alzheimers can be delayed in those suffering from mild cognitive impairment.
Adapted from BMJ 30 Oct 21: A study from the Mayo Clinic indicates that cardiorespiratory fitness tests were a better predictor of of survival in older people than blood lipids, diabetes, smoking and hypertension.
6,500 people aged 70 or over were tested on treadmills. The fittest showed the lowest mortality rates ten years on, and the burden of other risk factors made no difference at all.
Adapted from Diabetes in Control 10 August 21: Sheri Colberg says: Aging successfully takes a lot of work, If you don’t use it, you lose it. Physical fitness peaks around the age of 25 and then declines. Balance gets worse after the age of 40, bones get thinner, muscle bulk diminishes, and even with training maximal aerobic capacity declines. Your reflexes get slower and recovery from workouts takes longer.
The good news is that you can’t stop the aging process but you can slow it down to some extent. This means paying attention to regular physical training, nutrition, sleep and stress management.
Her advice is:
In addition to regular activities like walking, cycling, and swimming, add in some faster intervals to any workout such as walking faster for ten to sixty seconds at a time during your normal walk or doing a hill profile on a cardio training machine. This will improve your cardio respiratory fitness and improve insulin sensitivity for longer. It is fine to to high intensity interval training once a week, but if you don’t already do this you need to work up to it slowly. You should vary the intensity of your workouts to allow recovery and reduce the risk of injury.
Pick at least eight to ten resistance exercises that cover the major muscle groups in the upper, core and lower body and do them two or three days a week. You can use your own body weight, weights, kettlebells, resistance bands or water bottles. Improving muscle mass and strength is critical to being able to live independently through your lifespan.
Improve your balance by standing on one leg for a minute at a time. Make sure you can grab something if you feel unsteady. Once you can do this, make it harder by moving the raised leg in different directions. My comment: Wii Fit has a lot of balance exercises included. Ballet and Yoga also include balance exercises and Tai Chi is a good starting point.
High blood sugars take a particular toll on the flexibility of joints and tendons. Stretch two or three times a week. The worse your flexibility and the older you are the longer you should hold the stretch. Up to a minute with each stretch may be necessary. My comment: There are lots of You Tube videos on stretching. You may like to use rubber bands and yoga blocks or use props such as chairs.
Weight bearing exercises to reduce bone loss can be achieved by weight training, carrying shopping in both hands, and hopping up and down on one leg at a time, and by doing body weight exercises such as press ups.
It is very important that you can get off of a chair as you get older. Practice standing up from the sitting position without using your hands. You can enhance your strength by sitting against a wall with your knees at 90 degrees. My comment: I used to do this for two minutes at a time. I would suggest 30 seconds to start with.
Last, but not least, pelvic floor exercises. You pull in all the muscles around your urethra and anus and practice a combination of long holds and pulses. This improves continence.
Adapted from BMJ 6 Nov 2021 NICE: Routine antenatal care for women and their babies.
Although the evidence base is small, evidence suggests that after 28 weeks of pregnancy, women who fall asleep on their backs, have an increased risk of having a baby born small for gestational age or even stillbirth.
They suggest that women use pillows to alter their position in bed so that lying on their side is easier.
This was the main new bit of information from this updated review which is important for women to know. The last review was published in 2008.
Women don’t need to go via their GP to access antenatal care. They can self refer, make an appointment with a midwife, any other appropriate health care professional, or via school nurses, community centre or refugee hostel. At a midwife led booking appointment she will be given information on all the things she can modify, by doing or not doing things to improve her chances of having a healthy baby. Partner involvement is considered to be helpful at all stages of pregnancy and delivery.
They also state that if a woman has vaginal bleeding after 13 weeks of pregnancy, she should be referred to hospital. (This normally happens and is not new advice).
Rates of maternal mortality and stillbirth are highest among women and babies from deprived areas, and higher among black, mixed ethnicity and Asian women compared with white women.
Routine ultrasound scanning is not recommended in low risk singleton pregnancies during the third trimester.
Food Insight have published a survey of just over a thousand young adults aged 18 to 34 to question them about their dietary habits over the previous year. The study was published in 2018.
At that time a third were following some sort of diet. 16% were following some sort of low carb diet. The most frequent eating pattern was intermittent fasting coming in at 10% of those questioned.
In order of frequency the dietary patterns were:
Intermittent fasting, Paleo (10%) Gluten free, Low carb, Mediterranean, Whole 30, High protein, Vegetarian or Vegan (about 5%), Weight loss plan, Cleanse, DASH diet, Ketogenic or high fat diet, and other.
My comment: my personal diet is a mixture of Gluten fee, Low carb, Mediterranean, High Protein and High fat so I can see that there is certainly room for difficulty in assigning your diet a category. There seems to be a lot of publicity over Vegan and Vegetarian diets and I was surprised that there were not more young people on these. I would imagine that it would depend where the sample was from and other demographic information.
The National Office for Statistics from 2018 to 2020 show that men born in the poorest areas of the UK are expected to live ten years less than men from the most affluent areas. Poor men can expect to live a healthy life till the age of 52 and die around the age of 73. Wealthy men may expect to live in good health till they are 67 and die around the age of 83.
Women in the poorest areas can expect 19 fewer years in health compared to wealthier women. They can expect to be healthy in poor areas till they are 52 and this is 71 for wealthy women. Women in poor areas can expect to die around the age of 70 and wealthy women around the age of 86.
There has been a bit of a decrease in life expectancy generally in the last few years, pre-covid. David Finch of the Health Foundation says that improvement in incomes is needed to cope with the rising cost of living, secure jobs and decent housing.
My comment: What goes on at the doctor’s surgery and hospitals is just the tip of the iceberg regarding health. Housing, employment, a good diet, access to green spaces, social interaction, education, good transport, reduced pollution, clean water, freedom from violence, and good health behaviours such as diet and exercise habits, known collectively as the social determinants of health are much more important. Policies that will improve these factors are necessary to improve the situation. I would argue that living a healthy life is more important than an extra few years in a nursing home.
Adapted from JAMA Editorial August 24/31 2021byEdward W Gregg and Tannaz Moin
The point for screening for diabetes is that early treatment will prevent complications.
In this article, the US Preventative Services Task Force (USPSTF) discusses its Recommendation Statement and its Evidence Review on screening for pre-diabetes and type two diabetes. They now recommend that adults aged 35 – 70 who are overweight or obese should now be screened and that those with pre-diabetes are referred for effective prevention interventions. Previously the age to start screening was 40 and they have also suggested that the drug metformin is used as a preventative intervention.
A recent study by Wang et al shows that 14% of the US population have diabetes and that there have been no consistent improvements in glycaemic control and risk factor management for 10 years. There has been also no improvement in diabetes care and outcomes.
The USPSTF actually found that there was little direct evidence that screening improves health outcomes for people diagnosed with diabetes. The rationale from screening relies largely on the 25 year old UK Prospective Diabetes Study Group which showed that glycaemic and blood pressure control in new diabetics reduced micro and macro vascular complications, myocardial infarction, diabetes mortality and all cause mortality. This was without the advantages of new drugs and monitoring techniques to boot.
More than 40% of the adult population will now be eligible for screening and a third of these are expected to be referred to an intervention programme. Young adults have had the biggest relative increase in diabetes prevalence, yet they get proportionately the lowest degree of preventative service and risk factor control and not surprisingly this has resulted in an increase in diabetes related complications.
An estimated 24.3% of young adults aged 18-44 have pre-diabetes. Only 44% of these reported being tested in the previous 3 years and they were less likely to be referred and to take up prevention services. Young adults also have more problem affording food, housing and medication. The new screening recommendations are an opportunity to improve this dire situation. Without effective intervention the burden of future diabetes complications will be immense.
Sorting this problem out calls for new ideas, new science and perhaps new frameworks. Metformin has shown to be cost saving, and most effective for pre-diabetes among younger, more obese patients and those with gestational diabetes but it tends not to be prescribed to these groups. More personalised prevention programmes may help. We must address the barriers to accessing effective risk factor management and this must be done throughout the lifespan of the affected group.
The HPV vaccination programme was started in England in 2008 on 1st September. According to an observational study vaccination has almost eliminated cervical cancer.
The women who have benefitted are now 26 years old or younger. 13.7 million years of follow up of women aged 20 to 30 showed that vaccinated women had much lower rates of cervical cancer compared to unvaccinated women in previous cohorts.
The reduction ranged from 34% in those who were offered the vaccine aged 16-18, 62% for 14-16 year olds and 87% for 12-13 year olds. There were even greater reductions in grade 3 cervical intraepithelial neoplasia and the trend was similar regarding vaccination age.
The results would suggest that the earlier the age of vaccination, the better.
Although this is great news for younger women, those over the age of 26 are still at risk of cervical cancer. Despite this 30% of women who were eligible for screening did not take this up in 2021.
A survey of 3,000 patients asked “Why?”
Embarrassment was the most common reason for 42%. Difficulty fitting in appointments was the reason for 34% and concerns about it being painful was the reason for 28%.
My comment: In my experience as a GP, all of these reasons have validity. However, losing your life or fertility to cervical cancer is devastating. Most cases are avoidable by regular screening and early treatment of cervical lesions, since we don’t know which ones will go onto cause cancer in any individual. Well woman clinics and family planning clinics are often open in the evenings if Practice Nurse clinics are not suitable. Remember that (almost) every woman has a vagina, including the nurse or doctor who does your smear. She knows what it is like! Muscle tightening can cause pain and to reduce this I would suggest putting a pillow under your bottom and possibly getting 5-10mg of diazepam from your GP. You would then need someone to drive you to and from your appointment.
Diabetes Diet 