Kris Kresser: The Carnivore Diet, is it really healthy?

The Carnivore Diet: Is It Really Healthy?
by Chris Kresser
Published on February 6, 2019

 

My comment: There has been a lot of publicity about the benefits of an all meat diet, the opposite end of the spectrum from veganism.  Dr Jordan Petersen’s daughter has overcome considerable health problems and she puts it down to an all beef diet. In this post Kris shares information, the good and the not so good about such an extreme diet.
The carnivore diet is a hot eating trend, and many people have reported significant benefits from adopting an all-meat diet. But is consuming only meat healthy in the long term? Read on to understand the mechanisms behind the diet, the potential consequences of not eating plant foods, and a few alternatives to going pure carnivore.

Is an all-meat, carnivore diet healthy? 
In my recent debate on the Joe Rogan Experience with Dr. Joel Kahn, I touched briefly on the carnivore diet. I’m a huge believer that meat is an essential part of a healthy diet, but eating an all-meat diet is an entirely different subject, and I think we need to be very careful about assuming that an intervention that works well in the short term will also be safe and effective in the long term.
In this article, I’ll discuss the diets of ancestral populations, how the carnivore diet affects the body, my concerns about the potential consequences of such a restrictive diet in the long term, and alternative dietary approaches that might offer the same benefits without having to go pure carnivore.
Are you considering going carnivore? The all-meat diet is trending, but completely dropping plant-based food off your plate could have a significant impact on your health. Check out this article for a breakdown on the strengths and weaknesses of the carnivore diet. #chriskresser

What Is the Carnivore Diet?
The carnivore diet is pretty straightforward: eat only animal foods and stay away from all plant foods. This means that you are primarily getting your energy from protein and fat and are consuming close to zero carbohydrates.
Many people who have adopted the carnivore diet report faster weight loss, improved mental clarity, healthier digestion, and even improved athletic performance. I certainly don’t doubt the anecdotal reports of people that have found remarkable relief from debilitating chronic health problems with this diet. For many of these people, nothing else they had tried worked.
However, when considering the health of a dietary or lifestyle intervention, I’ve long believed that we should look at the big picture: historical evidence from other populations, plausible mechanisms that explain its effect on our bodies, and scientific data regarding outcomes.
Were Any Ancestral Populations Carnivores?
Let’s start with a brief look at the diets of some supposedly “carnivorous” ancestral populations. Indeed, many ancestral groups thrived on large quantities of animal products. However, every single one of these groups also took advantage of plant foods when they were available:
The nomads of Mongolia nourished themselves on meat and dairy products, but also gained nutrients from their consumption of wild onions and garlic, tubers and roots, seeds, and berries. (1)
Gaucho Brazilians consumed mostly beef, but they supplemented their diet with yerba mate, an herbal infusion rich in vitamins, minerals, and phytonutrients. (2)
The Maasai, Rendille, and Samburu from East Africa primarily ate meat, milk, and blood. Young men almost exclusively ate these animal products but also occasionally consumed herbs and tree barks. Women and older men consumed fruit, tubers, and honey. (3)
The Russian Arctic Chukotka subsisted on fish, caribou, and marine animals but always ate them with local roots, leafy greens, berries, or seaweed. (4)
The Sioux of South Dakota ate great amounts of buffalo meat, but they also ate wild fruit, nuts, and seeds that they found as they followed the buffalo herds. (5)
The Canadian Inuit lived primarily on walrus, whale meat, seal, and fish, but they also went to great lengths to forage wild berries, lichens, and sea vegetables. They even fermented some of these plant foods as a way of preserving them. (6)
Every culture we know of that has been studied ate some combination of animal and plant foods. This does not necessarily mean that animal or plant foods are required to remain healthy, but it does speak to the ancestral wisdom of these cultures.
Five Reasons Why the Carnivore Diet Works
When any diet, drug, or other intervention “works,” it’s important to try to understand the mechanism behind it. In the case of the carnivore diet, there are several reasons that might explain the benefits people report.
1. The Carnivore Diet Can Restrict Calories and Mimics Fasting
Ever felt stuffed after you ate a huge steak? Protein is very satiating, meaning it fills you up and sends signals to your brain that you’ve consumed enough food. It’s no surprise that people report not feeling very hungry and start eating less frequently when they adopt an all-meat diet.
Food habituation may also play a role here. When you eat the same thing day after day, your brain doesn’t get as much reward value from food, so you start to eat less food overall—even if the food is usually something you find rewarding, like a big juicy steak.
The ultimate result is unintentional caloric restriction. Caloric restriction sets off a number of changes. When caloric intake drops, the concentration of insulin, insulin-like growth factor 1 (IGF-1), and growth hormone are significantly reduced. This condition triggers autophagy, which literally means “self-eating”—an internal process of cleaning up old cells and repairing damaged ones. Autophagy is also induced during fasting.
This may be why caloric restriction is so effective at reducing inflammation and alleviating symptoms of autoimmune disease. (7) Of course, caloric restriction also results in weight loss. These are arguably the two primary reasons that people seem to be drawn to the carnivore way of eating, but these effects might also be achieved through simple caloric restriction.
2. The Carnivore Diet Is a Low-Residue Diet
“Residue” is essentially undigested food that makes up stool. A low-residue diet is a diet that limits high-fiber foods like whole grains, nuts, seeds, fruits, and vegetables. It is often prescribed for people with inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS) to alleviate symptoms like diarrhea, bloating, gas, and abdominal pain. (8)
Meat is made primarily of protein and fat, which are absorbed high up in the GI tract, leaving little residue leftover to irritate or inflame the gut. In other words, an all-meat diet is effectively a very low-residue diet and gives the gut a rest.
3. The Carnivore Diet Is Often Ketogenic
If you’re eating large amounts of meat but are only eating once or twice a day and adding extra fat to the meat, your diet is likely ketogenic. A ketogenic diet is a high-fat, moderate-protein diet, with:
60 to 70 percent of energy from fat
20 to 30 percent of energy from protein
5 to 10 percent of energy from carbohydrates
While the carnivore diet has no such macronutrient ratios, it’s likely that some of the benefits that come with eating meat alone are due to the body being in a state of ketosis.
Ketogenic diets have been shown to be helpful for a wide variety of conditions, including multiple sclerosis, diabetes, and neurological conditions like Parkinson’s disease and Alzheimer’s. (9, 10)
4. The Carnivore Diet Changes the Gut Microbiota
Switching to an all-meat diet can also rapidly alter the gut microbiota. A 2014 study found that putting healthy human volunteers on an animal-based diet resulted in significant changes to the gut microbiota in less than 48 hours. (11) The animal-based diet increased the abundance of bile-tolerant organisms and decreased the levels of microbes known to metabolize different plant fibers.
The gut microbiota has been linked to virtually every chronic inflammatory disease that has been studied, so it’s no surprise that an intervention that drastically changes the gut microbiota could have significant implications for health. (12)
The Biggest Potential Problem with This Diet: Nutrient Deficiencies
Now that we’ve established some of the mechanisms involved, the big question is: is the carnivore diet safe?
The short answer is that we really don’t know, since there are no long-term studies that have tracked large groups of individuals on carnivore diets for any significant length of time. One of my chief concerns about it is that it lacks several nutrients that are crucial for health.
There are four micronutrients that are especially difficult to obtain on a meat-only diet. Based on a typical carnivore diet and the Dietary Reference Intakes (DRIs) established by the Institute of Medicine, these include:
Vitamin C: An antioxidant that boosts immune cell function and is important for stimulating collagen synthesis
Vitamin E: An antioxidant that prevents the oxidation of lipids and lipoproteins
Vitamin K2: A fat-soluble vitamin that reduces the calcification of blood vessels
Calcium: A mineral required for healthy bones, muscle contraction, and nerve transmission
If dairy is included in the diet, this will cover vitamin K2 and calcium. However, if you don’t like organ meats, the number of potential micronutrient deficiencies increases significantly. In that case, you can add to the list:
Vitamin A: A fat-soluble vitamin important for proper vision and maintaining immune defenses
Folate: A B vitamin important for cell growth, metabolism, and methylation
Manganese: A trace mineral needed for the proper function of the nervous system, collagen formation, and protection against oxidative stress
Magnesium: A mineral that supports more than 300 biochemical reactions, including energy production, DNA repair, and muscle contraction
It’s also important to note that vitamin C is extremely heat sensitive, so only fresh or very gently cooked organ meats will have appreciable amounts.
Many carnivore dieters claim that the nutrient requirements for the general population simply don’t apply to them. Anecdotally, I know of several individuals who have consumed a carnivore diet for three or more years without any overt signs of nutrient deficiencies.
Still, we’re lacking data. Currently, the DRIs are the best we have to go off of, and I don’t think we have enough evidence to unequivocally say that this diet has no risk of producing nutrient deficiencies in the general population.
Should We Be Aiming Higher Than the Daily Recommended Intake?
Even if the carnivore diet were sufficient to prevent outright deficiency, we should also consider metabolic reserve. Metabolic reserve is the capacity of cells, tissues, and organ systems to withstand repeated changes to physiological needs. In other words, it’s having enough nutrients “in the bank” to be able to deal with a major stressor, injury, or environmental exposure. (13) So if an all-meat dieter manages to meet a recommended nutrient intake, it still may not be enough for optimal health.
Other Reasons an All-Meat Diet May Not Be Healthy
It Lacks Beneficial Phytonutrients
Phytonutrients are chemicals that are produced by plants to protect against environmental threats, such as attacks from insects and disease. They can also have major benefits for our health. Curcumin, beta-carotene, quercetin, and resveratrol are all examples of common phytonutrients.
Some proponents of the carnivore diet suggest that phytonutrients are toxic to humans, and that it’s best to eliminate them completely from our diet. However, many of these “toxins” act as acute stressors that actually make us stronger through a process called hormesis.
Much like resistance training is an acute stressor that leads our muscles to adapt and get stronger, exposure to small amounts of phytonutrients is a hormetic stressor that activates several different pathways in the body, ultimately serving to reduce inflammation, enhance immunity, improve cellular communication, repair DNA damage, and even detoxify potential carcinogens. (14, 15)
It Might Affect Hormones, Fertility, and Thyroid Function
We have zero long-term data about how an all-meat diet impacts hormones, thyroid function, and fertility. I have written before about why carbohydrates are particularly important for female fertility and why very-low-carb diets may not be the best choice during pregnancy.
Carbohydrates are particularly important for supporting thyroid function since insulin stimulates the conversion of inactive thyroid hormone T4 to active T3. In fact, traditional cultures that ate largely animal products and had little access to plant foods often went to great lengths to support fertility, including eating the thyroid glands of the animals they hunted. (16)
My guess is that most modern “carnivores” are not consuming the thyroid glands of animals and are therefore at risk for suboptimal thyroid function and (at least temporary) infertility.
It Could Overtax Your Liver (If You’re Eating Lean Meat)
When you don’t eat sufficient carbohydrates and fat, your liver can make glucose from protein via a process called gluconeogenesis. This process creates nitrogen waste, which must be converted to urea and disposed of through the kidneys.
While this is a normal process that occurs in every human being, there is a limit to how much protein the liver can cope with safely. More than 35 to 40 percent of total calories as protein can overwhelm the urea cycle, leading to nausea, diarrhea, wasting, and, potentially, death. For pregnant women, this threshold may be as low as 25 percent of total calories. (17)
Interestingly, anthropological evidence suggests that hunters throughout history avoided consuming excess protein, even discarding animals low in fat when food was scarce. (18)
In short: When eating meat, it’s important to have a good amount of healthy fats or quality carbohydrates as well.
Is the Carnivore Diet the Ideal Human Diet?
In the last section, I outlined several potential concerns with the carnivore diet. But this leads me to another important question: even if the carnivore diet is safe, is it really the best diet for optimal health?
While you might be able to get away with a vegetarian or carnivorous diet for a short while, the evidence suggests that the ideal diet includes both animal and plant foods. Dr. Sarah Ballantyne broke this down in part three of her series “The Diet We’re Meant to Eat: How Much Meat versus Veggies.”
While you can theoretically get all of your nutrients from one group alone (and potentially supplement with any missing nutrients from the other group), we need both sets of nutrients to be optimally healthy, and consuming animal and plant foods in their whole form is the best way to accomplish this.
Five Alternatives to the Carnivore Diet
Here are some options that might provide the same therapeutic benefits that the carnivore diet can offer—but without as much potential risk.
1. A Low-Carb Paleo Diet
Some people trying a carnivore diet are going straight from the Standard American Diet to pure carnivore. Oftentimes, a low-carbohydrate Paleo template might provide some of the same benefits, including weight loss, improved insulin sensitivity, and an alleviation in autoimmune symptoms. (19, 20, 21)
2. A Fasting Mimicking Diet
A fasting mimicking diet can reverse type 1 and type 2 diabetes, alleviate age-dependent impairments in cognitive performance, and protect against cancer and aging in mice. (22, 23, 24) In humans, the fasting mimicking diet was found to significantly reduce body weight, improve cardiovascular risk markers, lower inflammation, and potentially improve symptoms of multiple sclerosis. (25, 26)
3. Periodic Prolonged Fasting
Undergoing a 72-hour fasting once every few months could also achieve many of the benefits boasted by the carnivore diet. Prolonged fasting causes organs to shrink and then be rejuvenated as damaged cells are cleared out and stem cell pathways are activated. (27)
4. A Ketogenic Diet
The ketogenic diet has been very well studied and has documented benefits for epilepsy, neurodegenerative disease, and autoimmune disease. Ketones themselves are potent anti-inflammatories. (28, 29)
5. Addressing Gut Pathologies
If a healthy lifestyle coupled with the dietary approaches above is insufficient to control your symptoms, consider working with a Functional Medicine practitioner who is knowledgeable about gut health. If you’re thinking about becoming a strict carnivore because you’re experiencing adverse reactions to even very small amounts of plant foods, that’s likely a sign of an underlying gut infection that should be addressed.
Share this with friends and family who might be considering an all-meat diet, and be sure to leave your thoughts in the comments below.
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Sheri Colberg: Debunking some physical activity and training myths

Adapted from Sheri Colberg’s article in Diabetes in Control July 6 2019

Exercise does NOT make you more tired.

Most people feel more invigorated after a workout. Regular exercise helps you cope better physically and mentally with your work and personal life.  During periods of acute stress, at work for instance, a short brisk walk can help clear your mind and bump up your energy levels.  Exercise helps reduce insomnia too.

You do NOT have to work out in a “fat burning range” to lose weight.

Just exercise as long and intensely as is reasonable for you if you want to lose weight.  You do use up a little more fat at lower intensity exercise but this mainly happens during the recovery phase.

Your muscles will NOT turn into fat if you stop weight training.

Keep your muscles strong and noticeable by physical activity and exercise and aim to avoid fat gain.

Weight training will NOT bulk you up if you are a woman.

It takes a great deal of effort for men to bulk up doing weight training and this effort is magnified in women because they have very little testosterone. Your total weight may increase if you weight train as muscle is heavier than fat. Pay attention to how you look and feel and how your clothes fit rather than have a fixed idea of the optimum number on a scale.

No pain does NOT mean no gain.

You need to distinguish the feeling of lactic acid in the muscle from a well executed exercise set and delayed muscle soreness a day or two afterward with acute muscle tears and overtraining. The time it takes to recover is a good guide. Also adjust your timing and intensity gradually.

Lifting weights slowly does NOT necessarily mean you will build more muscle.

Lifting slowly can increase the total time that your muscle is under tension. This can increase muscle endurance. Lifting the heaviest weight quickly helps you recruit more muscle fibres and will result in bigger muscles. So if you are lifting a weight slowly during a particular exercise but could lift it faster, to build muscle you either need to move that weight faster or use a heavier weight.

Working on your abdominal muscles WON’T give you a flat belly.

You can’t spot reduce. You can tone up your belly and back muscles but what really helps is getting rid of excess fat covering the muscle. You can do harder workouts to increase your muscle mass and this will help you burn more calories including at rest.

More exercise does NOT mean more fitness

Overuse injuries are more common if you are working out for more than 60-90 minutes of aerobic exercise a day. Cross fit and high intensity interval training are likely to be more beneficial than very long workouts.

You DO NOT have to eat huge amounts of protein.

If you do weight train you do need more protein but only up to twice that for a sedentary person. That is 1.6 to 1.7 grams of protein per kilogram body weight. Most people, especially those on a low carb diet will naturally be eating enough protein. Some protein after exercise may be beneficial especially whey protein. You can eat natural foods eg egg whites or drink chocolate milk (careful about sugar) instead.

You DO NOT need to sweat profusely to do good.

Sweating varies a lot between men and women and individuals. If you are physically trained you may sweat sooner and more. The exercise intensity will affect it. So does the ambient temperature and humidity. Sometimes not sweating enough can be a sign of dehydration so it doesn’t always reflect your effort.

Sheri’s book The Athlete’s Guide to Diabetes: Expert advice for 165 Sports and Activities is available on Amazon and at Barnes and Noble stores.

She has websites to help you:Sheri Colberg.com and DiabetesMotion.com

 

 

 

BMJ: Taking glucosamine long term may reduce cardiovascular disease risk

Adapted from BMJ18 May 19. Association of habitual glucosamine use with risk of cardiovascular disease. Ma h, Li X, Sun D et al. BMJ 2019:365:1628

Just over 466 thousand participants from the Biobank who did not have cardiovascular risk at that point completed a questionnaire about supplement use including glucosamine. Subjects were enrolled between 2006 and 2010 and were followed up in 2016.

After adjusting for age, sex, BMI, race, lifestyle factors, dietary habits, drug use and other supplement use, glucosamine was associated with a significantly lower risk of cardiovascular events. A limitation is that the association may not be causal. Perhaps those who use supplements are healthier than those who don’t.

The results they found were that there was a 15% less risk of total cardiovascular events.

There was a 22% lower risk of cardiovascular death, 16% less risk of ischaemic heart disease and a 9% lower risk of stroke.

My comment: I have been taking glucosamine regularly for the last 19 years because I have found that it completely solved the knee pain I had had for the previous five years. As I have a very strong family history of osteoarthritis of the knee and other joints I was keen to try it. Osteoarthritis is linked to inflammation in the joints, and we know that cardiovascular disease is linked to inflammation in the arterial walls and the bodies attempt to repair minute tears with cholesterol containing plaques. Thus there is a possible mechanism to explain the reduction in cardiovascular disease for those that take it. It is of course also possible that supplement takers take more exercise and I’m not sure to what extent the “lifestyle” factors were adjusted for. 

BMJ: Flu jag timing matters

From BMJ May 2019: Minerva BMJ 2019;365:1993

A review in Science indicates that vaccines for mumps, whooping cough and yellow fever lose their effectiveness more quickly than those for measles, diptheria, tetanus and flu.

The flu vaccine at best only protects about 60% of the people given it in any given year. Its effectiveness also declines after just a few months. If you are first in the queue to get it towards the end of September, much of its effects will be lost by January and February which are the peak months for flu infection.

My comment: Maybe you should plan to get the jag any time from mid November to mid December  if you are very keen on getting maximum effectiveness to prevent flu?

 

BMJ: Flozin effects in type one diabetes

 Adapted from BMJ 13 April19 Efficacy and safety of dual SGLT 1/2 inhibitor sotagliflozin in type one diabetes Musso G, Gambino R. Cassader M, Pascheta E. BMJ 2019:365:1328

Flozins are increasingly used for patients with “double diabetes” in practice. The authors of this study searched for randomised controlled trials for the drug Sotagliflozin to find out how effective they were and what safety issues were apparent. Over three thousand patient responses were studied. There were six trials that were of moderate to good quality and they ran between four weeks and a year. The relative pluses and minus are listed.

lowered HbA1c by  0.34% (small)

reduced fasting and post meal blood sugars

reduced daily total, basal and meal insulins

reduced time in target blood sugar range

reduced body weight by 3%

reduced systolic blood pressure by 3 mmHg

reduced protein in the urine

reduced the number of hypoglycaemic events

reduced the number of severe hypoglycaemic events

On the other hand these factors were increased:

Ketoacidosis increased by a factor of x 2 to x 8 depending on the study looked at

genital tract infections increased by a factor of x 2 to x 4.5

diarrhea increased up to x 2

volume depletion events increased by up to x 4

Patients got better blood sugar results from the higher dose of 400mg Sotagliflozin compared to the 200mg dose without increasing the risk of adverse events.

Most DKA episodes occurred as the drug was being started and patients cut their insulin dose too much, in anticipation of reduced blood sugars.

My comment: The risk of DKA in type twos is not very common but is a known effect of flozins, so it is not that surprising that this is increased in type ones too. The reduction in hypoglycaemia events and severity is a new finding and suggests an increasing role for flozins in type one management.

 

 

 

Type ones on low carb diets experience less hypoglycaemia

Adapted from Why low carb diets for type one patients? Jun1 2019 by Emma Kammerer Pharmacy Doctorate Candidate Bradenton School of Pharmacy originally published in Diabetes in Control.

Both Dr Jorgen Neillsen and Dr Richard Bernstein have shown that insulin users have fewer attacks of hypoglycaemia and that the attacks are less severe.  A new randomised controlled study by Schmidt et al confirms this finding.

Studies have shown that when a high carb diet is consumed there 20% greater error in carbohydrate estimation compared to when a low carb diet is chosen. This then affects the insulin dose administered, and thus the resulting blood sugars.

Schmidt wanted to look at the long term effects on glycaemic control and cardiovascular risk in type one patients on a low carb diet compared to a high carb diet.

The study was a randomised open label crossover study involving 14 adults who had had diabetes for more than 3 years, to eliminate the honeymoon effect. The patients went on one diet for 12 weeks, had a washout period of another 12 weeks, and then took up the other diet.  This was done so that the glycated haemoglobin levels would not be carried over from one diet to the next.

A low carb diet was defined as less than 100g carb a day and a high carb diet as over 250g per day.

Patients were given individualised meal plans and education on how to eat healthy carbs, fats and proteins. They all were experienced insulin pump users. They were asked to record total carbohydrate eaten but not the food eaten. Measurements were taken on fasting days on the first and last day of the study periods.

Blood glucose levels were downloaded from continuous glucose monitoring devices.

Four patients dropped out of the study so ten completed the test which was considered satisfactory by the statistician involved.

Results showed that the time spent in normal blood sugar range 3.9 to 10 mmol/L ( USA 56-180) was not significantly different for each diet.

The time spent in hypoglycaemia, below 3.9 (USA 70) was 25 minutes less a day on the low carb diet, and six minutes less a day below 3.0 (USA 56).

On the low carb diet glycaemic variability was lower and  there were no reports of severe hypoglycaemia.

On the high carb diet, significantly more insulin was used, systolic blood pressure was higher and weight gain was more.

There was no relevant changes in factors for cardiac risk between the two study arms.

The study showed that a low carb diet can confer real advantages to type one patients but education on how to conduct a low carb diet and manage the lower doses of insulin is required.

Schmidt, Signe et al. Low versus high carbohydrate diet in type 1 diabetes: A 12 week randomised open label crossover study. Diabetes, Obesity and Metabolism. 2019 March 26.

 

 

The natural low carb store: Cinnamon pinwheel biscuits


Biscuit Ingredients
200g almond flour
75g Inulin or a tablespoon of granulated sugar substitute
50g butter (soft but not melted)
1 medium egg
1 tsp vanilla extract
20ml double cream
Filling Ingredients
30g butter (soft but not melted)
1 tbsp cinnamon
½ tsp vanilla extract

Method:

Mix biscuit ingredients. Make into dough. Form into a square shape.

Roll out on silicon liner or parchment.

Mix filling ingredients. Spread on the dough.

Roll up tightly using the silicon paper.

Put in freezer for ten minutes or the fridge for 30 minutes.

Put the oven on to 180 degrees.

Take the dough out of the fridge/freezer and cut into slices.

Arrange these on a silicon sheet and bake for 12-18 minutes depending on thickness of dough slices.

Nice eaten warm.

Food 4 your mood: Breakfast banana bread and pancakes

Pancakes

Ingredients
1/2 c. almond flour
4 oz. cream cheese, softened
4 large eggs
1 tsp. lemon zest
Butter, for frying and serving
Method
— In a medium bowl, whisk together almond flour, cream cheese, eggs, and lemon zest until smooth.
— In a nonstick skillet over medium heat, melt 1 tablespoon butter. Pour in about 3 tablespoons batter and cook until golden, 2 minutes. Flip and cook 2 minutes more. Transfer to a plate and continue with the rest of the batter.
— Serve topped with butter.

Banana Bread

Ingredients
1/3 c. coconut flour
1/4 c. almond flour
1/2 tsp. ground cinnamon
1/2 tsp. baking powder
1/2 tsp. baking soda
1/2 tsp. kosher salt
1/4 c. coconut oil
1/4 c. smooth unsweetened almond butter
2 large ripe bananas, mashed
2 tbsp. agave syrup or 1 tbsp. granulated sugar substitute (optional)
1 tbsp. pure vanilla extract
2 large eggs
Method
— Preheat oven to 350° and line an 8″-x-5″ loaf pan with parchment paper. In a medium bowl, whisk to combine coconut flour, almond flour, cinnamon, baking powder, baking soda, and salt.
— In a large, microwave-safe bowl, combine coconut oil and almond butter. Microwave until coconut oil is melted and almond butter is more liquid, 10 seconds on high. Whisk in mashed bananas, agave, and vanilla, then whisk in eggs. Gently fold in dry ingredients until just combined.
— Pour batter into prepared pan and bake 40 to 45 minutes, until top is golden and a toothpick inserted into the center comes out clean. Let cool completely before slicing.

Vitamin D shown to improve blood sugar control in gestational diabetes

From Ojo O et al. The effect of vitamin D supplementation in women with gestational diabetes mellitus. A systemic review and meta-analysis of randomised controlled trials. Int J Environ Res Public Health. 2019:16(10)

A meta-analysis has indicated that various factors relevant to improved blood sugar control are likely to be improved by vitamin D supplementation in  a total of 173 women with gestational diabetes.

Fasting blood glucose decreased by a mean of 0.46 mmol/L

Glycated haemoglobin decreased by a mean of 0.37%

Serum insulin reduced by a mean of 4.10 uIU/mL.

 My comment: Although the improvements are small, vitamin D supplements are inexpensive, easy to take and do not have the side effects of other medications.