The best diet for optimal blood sugar control & health
In this interview, which you can listen to or read, neuroscientist Stephan Guyenet discusses various topics related to a big issue with a lot of people, how we get fat and what we can do about it, with Kris Kresser.
Paediatric endocrinology clinics have a non-attendance rate of 11.4% in the south west of the UK. The majority of these patients have diabetes.
Children who did not attend were more likely to come from families living in areas of high deprivation and to have a child protection alert in their hospital records.
In 60% of the cases, the GP was not informed that the child had not appeared, so they were not in a position to follow the child up themselves. Some of the children were sent other appointments, some were given an open attendance appointment and some were discharged.
About half of the children were eventually seen within a year and a third attended A and E. Almost a quarter went back to see the GP and half of these were re-referred.
My comments: In my own practice I am aware that a minority of parents are very poor at attending diabetic clinics with their children. We are always informed and keep out an eye for opportunistic intervention when the child attends for another matter. Our hospital has a good nurse liaison service and they do their best to keep a dialogue open with the parents and visit at home. Sometimes lack of money for bus fares is given as an issue. Sometimes work commitments or having to make arrangements to look after other children in the family is the reason. For one reason or another, the child’s diabetes management does not have the priority that it is given in other homes, and that doesn’t work out well on the long term.
Reported in BMJ 24th June 2017 by Ingrid Torjesen BMJ 2017;357:j2983
2 cups of (4 sticks) unsalted butter melted and lightly browned
6 large eggs
2 cups of finely milled almond flour
2 cups of sugar substitute
1 ½ teaspoon of baking powder
½ teaspoon of sea salt
1. Pre-heat oven to 350 degrees. Lightly grease a 10-inch spring-form pan with butter.
2. Melt and lightly brown the butter in a saucepan and allow to cool completely.
3. Beat all the eggs and sugar substitute in a stand-up mixer on high until mixture is thick and a shade of pale yellow, about 6 minutes.
4. Add the almond flour by ¼ cup increments into the egg and sugar-substitute batter folding gently with a rubber spatula. *Do not over stir, mix only to combine
5. Once the batter has been mixed add the now cooled melted brown butter gently fold into the batter until fully incorporated.
6. Pour the batter into the prepared pan.
7. Bake the cake for 35-40 minutes until a toothpick inserted in the center comes out clean.
8. Allow this cake to cool completely before serving. Store in the refrigerator.
Enjoy in good health!
Cake makes 16 servings at 3.2 net carbs per slice
Traditional cooking uses meat bones as a base for delicious stock because it is the secret to cooking great recipes. But it’s also incredibly nutritious and has scores of health benefits. Read on to learn more about bone broth and why you should make it a staple in your diet.
The Weston A. Price Foundation and advocates of the Paleo and Primal lifestyles favor bone broth for its wide array of nutrients that are difficult to find in any other food source. Dr. Natasha Campbell-McBride has made bone and meat stock the foundation of the GAPS protocol because of its ability to heal and seal the gut lining and reduce overgrowth of harmful microbes. Chicken broth has also been suggested to reduce the migration of immune cells during illness. These are just some of the many reasons to love bone broth.
Bone broth is mentioned in dozens of articles on my blog, but I haven’t really provided a thorough analysis in a single, convenient place for my readers. So here it is: everything you need to know about bone broth! In this research-dense article, I will cover the role of broth in traditional cultures, the nutritive components of bone broth, the numerous health benefits, and the best ways to source it.
A South American proverb says “good broth will resurrect the dead.” While this is certainly a stretch of the imagination, the ability of broth, and chicken broth in particular, to treat the common cold has long been touted as ancient folk wisdom. Scientists at the University of Nebraska sought to test this folklore in 2000 and found that in vitro (in a Petri dish), some components of chicken soup were able to inhibit the migration of innate immune cells called neutrophils, effectively acting as an anti-inflammatory that could, in theory, reduce symptoms of illness (1). Whether this effect occurs in vivo (in a living organism) is still unclear, but this preliminary data suggests that our ancestors may have been onto something. We’ll explore the bone broth–immune system connection more in a later section.
Evidence of the existence of soup can be found as far back as about 20,000 BC (2), and it’s well accepted that broth of some sort was, and remains, a staple in many traditional cultures. In Danish and German culture, large hens were specifically reserved for making soup, and the cooked meat was retained for other dishes or added back to the soup. In East Asian diets, dishes like miso sometimes contain meat stock. In Greece, beaten eggs mixed with lemon are commonly added to chicken broth as a traditional remedy for colds and digestive upset. Chicken soup in Hungary usually included organs like chicken liver and heart, while in Vietnam and the Philippines, beef bone marrow was used as the base for making soup. In India, chicken soup is popularly sold by roadside vendors in the winter and takes on many different forms. Chicken soup was a traditional dish of Jewish kitchens; it has even been called “Jewish penicillin” and is used to treat and prevent illness. In American tradition, chicken soup was prepared using old hens that were too tough to be roasted or cooked but still made excellent soup. Unfortunately, the only soup that most Americans eat today is canned, highly processed, and devoid of nutrients.
Traditional cultures wisely practiced nose-to-tail eating and consumed all parts of the animal, including the skin, cartilage, tendons, and other gelatinous cuts of meat. This provided a balanced intake of all the amino acids necessary to build and maintain those same structures in the human body. Some anthropologists have even suggested that in some regions of the world, early humans were scavengers rather than hunters, using tools to crack open the bones of carcasses left by lions and other large predators to expose the rich bone marrow (3). Unfortunately, many modern cultures have lost the practice of whole-animal eating, and the old-age tradition of having a pot of broth constantly simmering on the hearth has been lost in favor of modern convenience, microwaves, and highly processed canned soups. Bringing bone broth back into the modern diet offers a simple and delicious means of obtaining the nutrition from parts of the animal that traditional cultures prized.
Bones contain an abundance of minerals as well as 17 different amino acids, many of which are found in broth as proteins like collagen and gelatin. Though the exact nutritional content varies based on the bones used, cooking time, and cooking method, the following nutrients are consistently found in most bone broths.
Collagen
With 28 different types, collagen makes up about 30 percent of the protein in your body (4) and is the main component of connective tissues like cartilage, ligaments, tendons, bone, and skin. It is also present in the blood vessels, cornea, and lens of the eye. The name collagen comes from the Greek “kólla,” meaning “glue,” and the suffix “-gen,” which means “producing.” In fact, early glue was made from collagen more than 8,000 years ago, likely by boiling the skin and sinews of animals (5). In addition to providing structure, collagen also plays an important role in tissue development and regulation (6, 7).
Gelatin
When collagen is simmered, it forms gelatin. This hydrolysis of collagen is irreversible and results in the breakdown of long collagen protein fibrils into smaller protein peptides. However, its chemical composition is very similar to its parent molecule, collagen (8). Gelatin is what gives bone broth or stock its Jell-O-like consistency once it has cooled.
Glycosaminoglycans
Glycosaminoglycans (GAGs) are complex carbohydrates that participate in many biological processes. They can attach to proteins in order to form proteoglycans, which are integral parts of connective tissue and synovial fluid, the lubricant that surrounds the joint (9). If the connective tissue, such as tendons, ligaments, and cartilage, is still attached, the bones in broth will provide our bodies with the whole spectrum of GAGs, including keratan sulfates, dermatan sulfates, chondroitin sulfates, and hyaluronic acid, which are the raw materials for skin, bone, and cartilage formation.
Glycine
Glycine is an amino acid that makes up more than a third of collagen. It also acts as a neurotransmitter, binding to glycine receptors present throughout the nervous system and peripheral tissues. Signaling through this receptor is particularly important in mediating inhibitory neurotransmission in the brainstem and spinal cord (10, 11).
Proline
Proline is an amino acid that makes up about 17 percent of collagen. The addition of hydroxyl groups to proline significantly increases the stability of collagen and is essential to its structure. Though small amounts of proline can be manufactured in the body, evidence shows that adequate dietary proline is necessary to maintain an optimal level of proline in the body (12, 13). Proline is not typically thought of as a neurotransmitter, but it is able to weakly bind to glutamate receptors and glycine receptors (14).
Glutamine
Glutamine is yet another important amino acid found in bone broth and is the most abundant amino acid in the blood (15). It is one of the few amino acids that can directly cross the blood–brain barrier (16). Intestinal epithelial cells and activated immune cells eagerly consume glutamine for cellular energy (17, 18).
Bone marrow
Inside the center cavity of the bone is the bone marrow, consisting of two types, red and yellow. Both types contain collagen. Red bone marrow is the site of manufacturing for new immune cells and red blood cells, while yellow marrow consists of healthy fats (19, 20). It is thought that important nutritional and immune support factors might be extracted from marrow during cooking, but the bioavailability of these factors has not been studied.
Minerals
Bone is also full of minerals, including calcium, copper, iron, magnesium, manganese, phosphorus, potassium, sodium, and zinc (21). An acidic medium is necessary to extract these minerals from food. When making broth, always add a splash of vinegar or other acid in order to extract the most minerals from the bone.
At this point, I hope you have a solid understanding of the components of bone broth. Now let’s get on to the health benefits!
Skin health
Skin is composed of two layers, the epidermis and the dermis. The epidermis, or upper layer, is composed of keratinocytes and is largely responsible for skin barrier function. Underneath is the dermis, a dense matrix of collagen, along with some GAGs, that provides structural and nutritive support (22). Keratin, collagen, and GAGs are abundant in bone broth, particularly if the skin from the animal is included in the cooking process.
In a 2014 randomized and controlled trial, collagen consumption significantly improved skin elasticity and tended to improve skin moisture content (23). Collagen scaffolds are widely used in medical applications to promote tissue regeneration and heal wounds (24). One study in mice found that supplementing the diet with gelatin was able to protect against UV-induced skin damage (25). GAGs offer additional skin benefits. The GAG hyaluronic acid has been shown to promote skin cell proliferation and increase the presence of retinoic acid, which improves the skin’s hydration (26), and dermatan sulfate has been shown to aid in cell turnover and wound repair (27).
Metabolic and cardiovascular health
Remember glycine, an amino acid that is particularly abundant in bone broth? Glycine plays a role in blood sugar regulation by controlling gluconeogenesis, the production of glucose in the liver (28), and has even been suggested to counteract some of the negative effects of dietary fructose consumption (29). Glycine has also been shown to reduce the size of heart attacks (30).
Furthermore, glycine balances out methionine intake. Muscle meats and eggs are high in methionine, an amino acid that raises homocysteine levels in the blood. High homocysteine is a significant risk factor for serious diseases like heart disease, stroke, mental illness, and fractures and increases our need for homocysteine-neutralizing nutrients like vitamins B6, B12, folate, and choline (31). Those eating lots of animal protein need adequate glycine to balance out the methionine from meat, and you’ll get that from bone broth. For more information, check out Denise Minger’s awesome presentation in which she discusses this very issue.
Muscle and performance
Glycine is also important for the synthesis of hemoglobin and myoglobin, which transport oxygen throughout the blood and muscle tissue, respectively (32). Glycine also increases creatine levels, which leads to an increase in anaerobic (high-intensity) exercise capacity, and stimulates the secretion of human growth hormone (HGH), which may enhance muscle repair (33, 34, 35). Recent evidence suggests that proline may play a role in regulating the mTOR cellular signaling pathway, which integrates signals from nutrients, growth factors, stress factors, and cellular energy status to affect cell function and growth. Proline, together with other amino acids, activates mTOR, resulting in enhanced muscle protein synthesis (36).
Adenosine triphosphate (ATP) is the chemical form of energy in the body that can be used to perform work. Phosphorus is required for the formation of this compound, and ATP cannot be biologically active unless bound to a magnesium ion. Phosphorus deficiency has been shown to reduce muscle performance (37, 38). Both phosphorus and magnesium are present in bone broth in modest amounts.
Bones and joints
It should be pretty obvious that the best way to get the nutrients necessary to build bone is from bone itself! Drinking bone broth provides all of the raw material for building healthy bones: calcium, phosphorus, amino acids, and more. A deficiency of the raw materials for building bone can result in a number of different conditions. For example, osteoporosis is associated with reduced levels of collagen and calcium in the bones (39, 40). Of course, you’ll also need the nutrients required to support the building process, like vitamins D, K2, and C. (To learn more about building healthy bones and where to get these nutrients on a Paleo diet, check out this article.)
As for joint health, lubrication by GAGs is the key to a full range of motion, whereby part of one bone can slide smoothly and painlessly over part of another. Sure, you could buy expensive supplements containing glucosamine and chondroitin sulfate to keep your joints healthy, but why, when these and a host of other beneficial nutrients can easily be obtained from bone broth? After all, GAGs are not the only component of broth that improves joint health. Collagen supplementation has been shown to reduce joint pain in athletes (41).
Gut health
A healthy colon contains a single tight layer of epithelial cells, a thick mucus layer, and a diverse collection of microbes. Microbial dysbiosis and a thinning of this mucus layer can quickly compromise the integrity of the epithelial barrier. Microbes and dietary proteins can then “leak” into the bloodstream and invoke an inflammatory response by the immune system. Lipopolysaccharide (LPS), a component of bacterial cell walls, stimulates a particularly robust immune response (42).
Bone broth is a staple of gut-healing diets, and rightfully so! Gelatin absorbs water and helps maintain the layer of mucus that keeps gut microbes away from the intestinal barrier. In a mouse model, gelatin supplementation reduced the severity of colitis by strengthening the mucus layer and altering gut microbiota composition (43). Gelatin and glycine have also been shown to reduce the inflammation caused by LPS (44, 45). Glycine has been shown to protect against gastric ulcers as well (46). Glutamine also helps maintain the integrity of the gut mucosa and intestinal barrier (47).
Digestion
Bone broth has so many benefits to gut health that I had to make digestion its own section! Drinking broth with meals is an excellent way to aid digestion. Glycine stimulates the production of stomach acid, which is essential for the proper digestion of food (48). Low stomach acid (hypochlorhydria) is surprisingly common in developed countries and can lead to a number of health issues.
Glycine is also an important component of bile acid, which is released to aid in the digestion of fats in the small intestine (49). Bile acid is important for maintaining normal blood cholesterol levels. The presence of gelatin in the gut also draws fluid into the intestine, improving gut motility and supporting healthy bowel movements. Low blood levels of collagen have been associated with inflammatory bowel disease (50).
Detoxification, liver, and kidney health
Recently, there has been some concern regarding the lead toxicity of bone broth. However, the vitamins and minerals that are abundant in bone broth, and in Paleo diets in general, can protect against the harmful effects of toxins like lead. Glycine also stimulates production of glutathione, the body’s master antioxidant (51). In animal models, glycine has been shown to speed recovery from alcohol-induced fatty liver disease (52), protect liver cells against hypoxia (53), and improve survival after liver transplantation (54). In humans, glycine reduces oxidative stress in patients with metabolic syndrome (55).
Proline plays a role in apoptosis, the process by which the body breaks down old cells, clears up waste products, and recycles raw materials for use in healthy cells (56). Proline can scavenge free radicals, effectively acting as an antioxidant (57). Glutamine, on the other hand, acts as a nontoxic nitrogen transporter, carrying amine groups safely through the bloodstream to the kidney. In the kidney, the conversion of glutamine to glutamate regulates acid–base balance by producing ammonium (58).
Eye health
Yes, bone broth may improve eye health. The cornea consists of three primary layers: an outer epithelial layer, a middle layer, and an inner endothelial layer. Hyaluronic acid stimulates proliferation of the epithelial cells that line the cornea (59) and is commonly used during eye surgery to help replace lost fluids (60). The middle, or stromal, layer is largely made of collagen, keratan sulfates, and chondroitin sulfates. Keratan sulfates have been shown to be essential to the transparency of the cornea (61), while chondroitin sulfate has been shown to influence the development of neural pathways in the retina (62). The amino acid glycine has also been shown to delay the progression of cataracts in a rat model of diabetes (63).
Brain health
Numerous components of bone broth influence the nervous system. The healthy fats in bone broth, particularly if made with marrow bones, provide a source of fuel and raw material for the brain. After all, more than 60 percent of the human brain is composed of fat (64). Glycine has been shown to protect against neuronal death after ischemic stroke (65) and likely plays a pertinent role in the development of the brain in the womb and during the first few months after birth (66). Calcium is essential for nerve conduction. When a nerve cell is stimulated, the influx of calcium triggers neurotransmitter release, allowing the signal to be passed on to the next nerve cell. Calcium deficiency affects this transmission and can result in symptoms of depression, insomnia, and hyperactivity. Lastly, chondroitin sulfate plays an important role in regeneration and plasticity in the central nervous system (67), meaning it is essential for learning and memory.
Mood and sleep
Bone broth can also improve both mood and sleep. Glycine is an inhibitory neurotransmitter, meaning it can decrease anxiety, promote mental calmness, and help with sleep (68). One study found that three grams of glycine given to subjects before bedtime produced measurable improvements in sleep quality (69).
Unlike methionine, glycine does not compete with tryptophan for transport across the blood–brain barrier (70). Tryptophan is the precursor (raw material) for serotonin, a neurotransmitter that contributes to feelings of well-being. Serotonin, in turn, is a precursor to melatonin, a hormone that regulates sleep–wake cycles. This is why a diet that includes bone broth and fattier cuts of meat can help prevent the depression and insomnia that some people may experience when eating a diet high in methionine-rich lean meat and eggs.
Immune function
While ancient folk wisdom suggests that bone broth can cure the common cold, modern science has confirmed that the components of bone broth do indeed influence the immune system. For example, glycine receptors have been identified on the outer surface of several different types of immune cells (71, 72). The effect is a dampening of the immune response, resulting in reduced inflammatory signaling molecules and oxidative stress that may reduce damage to lungs and other tissues (73). The GAG heparin sulfate has been shown to influence B cell function, T cell function, and macrophage activity (74).
To summarize, bone broth has an incredible number of potential health benefits and is rooted in a long history of human use. It makes an excellent addition to any diet and can be used in a multitude of dishes. Bone broth can be made at home or it can be bought pre-made.
Homemade bone broth is simple to make. Ask your local farmers if they have soup bones, or roast a whole pastured chicken and save the bones for making broth. Chicken feet, chicken necks, calves’ feet, and marrow bones are particularly valuable additions to broth. You can find a good basic recipe over at the Weston A. Price Foundation website.
Pre-made bone broth is also a good option. Be sure to:
However you choose to get your hands on this liquid gold, be sure to make bone broth a staple in your diet!
Physical exercise improves your sense of wellbeing but different intensities give different results.
Healthy adults were tested after doing various types of exercises and activities and compared how they felt.
Office work and driving a car were considered light intensity and were associated with an improved mood.
Housework or walking were considered moderate activities and not only improved mood but reduced pain, in those that suffered this.
Doing nothing reduced people’s moods.
Journal of Health Psychology doi:10.1177/1359105317691589
Adapted from article in Human Givens Vol 1 2017
Low Carb Brownie Shortbread Cookies |
I love the rich buttery taste that shortbread cookies offer. It reminds me of those Danish cookies that come in a tin can. I must admit, I probably kept those people in business single handedly until I learned to bake. Frankly, I don’t know why it took me so long to sit down and create a low carb option. All I can say, is you’ll be glad I finally did.
This particular cookie has a layer of brownie on top. Why? Because you know what’s better than a low carb shortbread cookie? One that has a low carb brownie layer. It’s perfect for those times you can’t decide what you prefer.
1 cup of finely ground almond flour (it needs to be finely milled)
¼ cup of sugar substitute
½ cup (1 stick) of unsalted butter allowed to soften at room temperature.
¼ teaspoon of sea salt
3 ounces of unsweetened baking chocolate bar
½ cup (1 stick) of unsalted butter
2 large whole eggs
1 cup of sugar substitute
½ teaspoon of baking powder
½ teaspoon of sea salt
Enjoy in good health!
Thank you very much, we don’t get these in Scotland!
Smoking decreased in all age groups in England between 2010 and 2016. Overall 15.5% of the population smoke compared to 19.9%.
The greatest reduction was seen in young adults in the 18-24 age group, down from 26% to 19%.
Men are more likely to smoke, 19% than women, 14% but those who are unemployed are almost twice as likely to smoke compared to those who have jobs. 16% v 30%.
My comment: Diabetes and smoking is particularly hazardous long term. Unfortunately General Practitioners are reporting that smoking cessation schemes are losing funding due to budget cuts. If you don’t smoke, please don’t start.
If you do smoke and think that you’ll never find the motivation to give it up, there are some people who managed it, who discuss what was important to them in the videos in this link:
https://www.cdc.gov/tobacco/campaign/tips/resources/videos/index.html?s_cid=OSH_tips_D9390
I have been many things, husband, father, coworker and patient. I am also a person with type 1 diabetes. I have lived with type 1 for 42 years and I have to admit I am at least one more thing. I can be a prick when I am low. It’s true. I acknowledge it. Of course I often prick my finger to test my blood sugar, but I am also a prick.
Having a low blood sugar is like being in an automated car wash without a car. Having a low blood sugar feels like all the stimuli are coming at one thousand miles per hour and yet all you can think about is food. It causes those around us to suffer sometimes. I have many low blood sugar stories, some funny, some sad, and a few dangerous. It is the accumulation of stories that show up after 42 years of taking an artificial hormone that allows me to live.
Low blood sugar is caused by not adequately matching food, exercise, and insulin. An insulin user can go low if they eat too few carbohydrates, exercise more than estimated, their body is assaulted by emotional stress (good or bad experiences), too much insulin is delivered, or a thousand other inputs that get out of balance. No matter the cause; the result can be extreme sweating (I hate that one), rapid convulsive movement in hands or legs, unconsciousness, blurry vision, confusion, hunger, crying (I hate that one as well) or in some cases no discernible symptoms at all. My most typical symptom is anger. I tend to get defensive when I have a low blood sugar and I can turn into a raging lunatic.
I can turn into a raging maniac based on the stimuli around me. I have been known to throw things, yell, take off my clothes, laugh wildly, hit, and disobey those trying to help me. I once opened and ate a box of Kellogg’s Frosted Flakes in the store. When the manager asked why I was doing that I said the most important thing I could think of. Because they’re GREAT!!!!!!
However, when I get upset is when someone remarks about my care while I am low. These phrases always start with same words, If you, you need, you should, if only followed by some prescription for what I did wrong or could do better to manage diabetes. It angers me to hear these things, as if I wanted this outcome, or the speaker could do better.
Inputs and OutputsTaking insulin is not strictly an input/output arrangement. The human body is much more complicated than the sum of its inputs. I know this because sometimes I eat the same food, do the same exercise and take the same insulin and I get widely varying results. It seems unfair that if I am sitting at home I can go low because my body metabolized its inputs differently. Sometimes stuff happens.
Yes, we can control some parts of the equation. I can put in less insulin, I can eat more or less carbohydrates and I can stay home while the family goes on a walk or swim, but that is like sitting on a four legged stool with two legs cut off. Most of the time I get it right. I can usually keep the stool balanced but often, I make a mistake and my blood sugar goes too high or low.
What I have learned after 42 years of managing diabetes 24/7/365 is that no one can do it perfectly. We miss and sometimes those misses are big. When that happens, I may need some help. And if I ask for that help, know I do not mean to be a prick, but if I am also know my apology is sincere. After all I hate pricks those on my finger or the one that comes out when I am low.
Parsley and Lemon Sauce
This goes well with fish or vegetables
1/2 shallot
75ml double cream
2 tbsp fresh parsley
Lemon juice
1 tsp butter
Salt & pepper
Finely chop the shallot and cook gently in the butter until softened. On a low heat add the cream and parsley and cook until hot, stirring. Add a little squeeze of fresh lemon juice, and salt and pepper to taste. Add a dash of milk if you prefer a thinner sauce and pour over your fish and green vegetables.
Creamy Mushroom and Garlic Sauce
This goes well with white or red meat
100g mushrooms
75ml double cream
1 tsp butter
1 garlic clove
Salt & pepper
Crush the garlic and add to a pan with the butter. Cook gently for 1 minute then add the mushrooms. Cook until the mushrooms soften then pour in the cream. Heat gently until hot. Season with salt & black pepper and serve over white or red meat.
Reflective jackets are a great safety aid for cyclists riding in the dark, if they have them and wear them consistently. A possible way to overcome a cyclists reluctance to wear the said jacket, say for example if they think to themselves, “I’ll be back before it gets dark or it’s too warm for my jacket” is to take the decision out of the equation.
Researchers have found that reflective tape attached to the rear frame of the bike and pedal cranks does the job of increasing visibility just as well as jackets do, but without any active behaviour required of the cyclist.
“Reflective tape is highly recommended to complement front and back lights in bicycle riding at night”, they conclude.
Human Factors, 2016, doi:10.177/001872081667145
Adapted from article in Human Givens Volume 24 No 1 2017
