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.
Alexei A Birkun, associate professor, Simferopol wrote a letter into BMJ:
Walker and colleagues explore whether coffee makers are a source of nosocomial pathogens (Champagne Problems Christmas 2023).
The researchers took swabs from the drip tray outlets, buttons, water tank handle, and inside the water tank of coffee makers. But what about the less accessible interior parts?
A couple of days before reading the article, I cleaned the infuser of our home coffee maker. To my surprise, a round shaped fungal colony was sitting on coffee residues left on the infuser.
While hospital fungal pathogens might invade the interior of coffee makers is unclear, but internal components are probably less commonly cleaned and could be a favourable humid environment for fungi.
Previous research has shown that coffee can be a good medium for fungal growth, and toxigenic fungal genera are well known coffee contaminants.
Fungal species living in the interior of coffee makers should not be overlooked in future research.
An analysis of the medical records of 5 million adults under the age of 50 in the USA found that myocardial infarction was six times more frequent in cannabis users compared to non-users.
Ischaemic stroke was also four times more frequent.
Cannabis is also the most used illicit substance used in pregnancy. Eight new studies found that cannabis use doubled the risk of a baby being born with low birthweight.
Preterm birth and being small for gestational age was also raised.
As people age they tend to lose lean muscle mass. My comment: I, as well as many of us, regularly weight train, in the hope of preventing age related muscle loss, also known as sarcopenia.
A multi-national trial of two thousand adults gave disappointing results.
The group of physically active older adults was randomised to: daily supplemental vitamin D, omega 3 fatty acid supplements, and a home exercise programme undertaken three times a week, either alone or in combination.
After three years intervention, NONE of these interventions improved muscle mass or influenced the incidence of sarcopenia, as measured by dual energy X ray absorptiometry.
As exercise and vitamin D supplements have been shown to improve other important health parameters, I will continue to exercise daily.
One in four UK adults has obesity and one in three is overweight. These factors increase the rate of diabetes and cardiovascular disease. Although many people lose weight after starting various types of dietary intervention, they are often dismayed that weight is usually regained.
A systematic review and meta-analysis of 249 weight management programmes for adults worldwide was conducted. Intense weight management programmes were compared to less intense or no intervention at all. Intensive programmes included diet and exercise but not medications or surgery.
All trials ran for at least a year after the interventions were completed and some as far as four years afterwards. The average follow up period was 28 months.
Those who had little or no support had lost 2.1kg and those who had had intensive support lost 4.9kg. Those who lost the most weight gained it back the most quickly.
The researchers found that five years after the end of a weight management programme, people who had been offered support still weighed less than those who got little or no support. They also had lower blood pressure, cholesterol, and blood sugar levels despite the weight regain.
Photo by Katie Rainbow ud83cudff3ufe0fu200dud83cudf08 on Pexels.com
Adapted from BMJ 27 Jan 2024
Dissecting Health by Scarlett McNally
The body positive movement correctly states that weight based discrimination can contribute to poor health and even more weight gain. Even so, obesity causes considerable health and economic damage.
The Tony Blair Institute calculated that obesity costs the UK £98 billion a year including £19.2 billion from related illnesses.
People who have obesity have seven times the likelihood of type two diabetes and the complications such as infection, amputation and kidney failure. Obesity can cause heart disease, cancer and chronic pain.
A person under the age of 50 who is obese, is more than ten times more likely to have complex multi-morbidity than someone of healthy weight. Hip and knee joint replacements are needed earlier, need longer operating times, a 50% greater risk of infections and a higher chance of needing postoperative intensive care.
Several treatments can successfully reverse obesity and type two diabetes including bariatric surgery, low carbohydrate diets, intermittent fasting, ultra-low calorie diets, and now regular injections to suppress the appetite.
Prevention of obesity is different. Obesity is caused by the type and availability of food and a lack of physical activity. Exercise alone doesn’t reverse obesity, but it can help prevent it.
Obesity is a product of our environments. People in the most deprived areas have the fewest food and exercise options and are twice as likely to have obesity (36.8%) as those in the least deprived areas (19.2%).
We need to go back to basics: affordable fruit and vegetables, unprocessed foods, less snacking, smaller portions, and less alcohol.
Many organisations have suggested such interventions such as play parks, limits on junk food advertising, and more PE in schools. We need safe cycle lanes, green spaces, and 20 mph limits in built up areas. Despite swimming being a great all round exercise, many affordable swimming pools have closed.
The obesity epidemic matters more about health than just appearance. Poor health results in unaffordable health needs and reduced tax income from the economically inactive working age group.
We cannot afford the inevitable human and financial costs of inaction.
A randomised controlled trial by Mikko Raisanen in Finland compared treatments for Dupuytren’s contracture.
This condition is common in those of Viking ancestry. Famous afflicted people include Ronald Reagan, Margaret Thatcher and Frank Sinatra.
Thickening and tightening of the tendons in the palms of the hands occurs. Progression is usually slow, but as the pinky finger and others become unable to extend, it can cause real difficulty in dressing and holding objects.
Three treatments were compared: surgery, needle fasciotomy and collagenase injections.
At the three month point, all seemed equally successful with 70% improved considerably, but after two years, surgery was 78% effective compared to 50% and 65% respectively.
Diabetics are prone to this condition too, as tendon glycation worsens the problem.
No excess prostate cancer has been found in hypogonadal men who were treated with replacement testosterone over 20 months follow up.
A randomised trial of 5,000 men found no difference in genital problems between the treated group and the untreated group.
The incidences of prostate cancer, acute urinary retention, prostatic surgery, and drug treatment for urinary symptoms were all low and no different between the groups.
My comment: This should be reassuring for those men who need to take testosterone for sexual health reasons and also to correct their hormonal status, as testosterone deficiency can be one cause of type two diabetes in older men.
Should women have grade 2 cervical intraepithelial cancer treated with large loop excision or should they just be kept under surveillance?
A Danish study sought to find out. Women who had CIN 2 diagnosed between the ages of 18-40 were followed up from 1998 to 2020. The study involved 27.5 thousand women.
The cumulative risk for cervical cancer was only 2.65% but women who had had the loop excision biopsy were four times less likely to get cervical cancer.
What are the chances of having a second epileptic seizure?
After a first unprovoked seizure:
one in four adults and children will have another fit within the first six months
one in three will have a fit in the first year
two in five will have a fit in the first two years
Children have a slightly higher chance of further fits than adults.
More than 633 thousand people in the UK have epilepsy. A diagnosis is made if you have had two unprovoked seizures at least one day apart.
One in 25 people will have an unprovoked seizure in their lifetime. People want to know how much at risk they are of another. This is important for driving, some jobs, bathing, swimming, and travelling.
Studies have put the risk between 24 to 65%. This review looked at 58 studies covering the experience of 12,160 people and covered both adults and children.
If you have a fit in the UK, you will be banned from driving completely in the first six months and for a year if they have a further fit.
Researchers want to continue the work to find out what factors may precipitate further fits in the ten years after the first one.
Although pelvic floor yoga has been advised after childbirth and pelvic surgery for decades, it has never had a firm evidence base.
In California, a randomised trial was conducted with 240 women aged between 45 and 90. All reported urge, stress or mixed incontinence.
One group were given 12 weeks of twice weekly group instruction of pelvic floor Hatha yoga and the other group was given the same time and frequency of general muscle stretching and strengthening exercises. The women all had to keep three day diaries of their voiding habits.
At the start the mean frequency of unwanted voiding occurred 3.4 times a day. This fell to 1.1 episodes with pelvic yoga and 1.5 with general physical conditioning.
There were similar improvements whether the woman had stress or urge incontinence.
My comment: I’ve been doing a wide variety of exercise almost daily for the last 35 years, including pelvic floor exercises. Although pelvic floor exercises are taught to almost every pregnant woman, as a GP, nearly all women I met who had incontinence said they had rarely practised the exercises or had given them up after a few months. Due to my exposure to incontinent women I have been really good at keeping my pelvic floor strong. Whatever your age, but particularly if you have been pregnant or have hit the menopausal years, it seems a good idea to make pelvic floor exercises a daily habit.
Diabetes Diet 