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.
Almost 200,000 people in the UK Biobank Study were free of cardio-metabolic syndrome when they were recruited. Tea and coffee consumption was analysed.
Those who drank three or more cups of coffee a day, or the equivalent amount of other caffeine containing beverages, were 40-50% less likely to develop cardiometabolic multimorbidity. This means two of: type two diabetes, coronary heart disease, or stroke. This was in comparison to those who drank less than 100mg of caffeine a day.
Asking my computer AI system about what this means in real life consumption, it means drinking a fair bit of tea and coffee a day.
100mg of caffeine is found in 1.5 to 2 espressos. 1.5-2.5 cups of black tea. and two cans of diet coca cola.
Thus to gain the protective effects, you would need to consume around double this. I easily meet this amount but the downside is that my teeth get badly stained and I need to get them polished every three months.
What is less effective for metabolic syndrome is time restricted eating.
108 participants were randomised to limiting eating to 8-10 hours a day. This was at least a four hour reduction in their usual eating window. The other group received nutritional counselling alone.
After three months, time restricted eating improved HbA1c by 0.1% after three months.
Which recently surveyed their readers about their personal use of the Zoe app. As a reader, I contributed too, but was dissuaded from buying the App as I have wheat intolerance and irritable bowel syndrome, both of which make their food recommendations impractical. I was impressed with their integrity about this, as they could easily have taken my money, and then given me advice that wouldn’t have helped me.
Zoe is a self testing and nutrition plan, headed by Professor Tim Spector. Zoe has signed up more than 120,000 people so far. 241 Which members contributed to their survey about it.
67% said that they wanted to find out about their gut microbiome. 44% wanted dietary advice. 37% wanted to improve their health. 30% wanted to lose weight.
The top five changes that they made to their diets after using the app were:
They ate fewer carbohydrates, ate more protein, ate more nuts and seeds, ate more vegetables, and ate less red meat.
The response was generally very positive with most people getting out of the app what they wanted.
78% had a better idea of what to eat, 48% said their guts worked better, 42% said they felt healthier, and 41% had lost weight.
29% said it was good value for money. 46% said it was reasonable value for money and only 20% said it was poor value for money.
Subscriptions to Zoe costs between £400 for four months and £600 for a year.
When you join up, you have to eat various biscuits that they supply, and then send off faecal samples and blood samples. After this you get feedback on the variability of the bugs in your gut, and how well or not you handle fat and sugar in your body.
For the next stage, you log in all your meals, snacks and drinks. You are advised as to whether they are “green”- go ahead, “amber”- just now and then, or “red” -you really should avoid. One user was advised to eat more avocado, green lentils and olive oil, and to avoid canned chicken soup, rice, white bread and ice cream. She was also advised to add wholegrains, vegetables, nuts and seeds. Reading this, I could understand why I had been advised not to purchase it.
The app contains tutorials, information, recipes, and support groups. To increase meal “scores” you generally need to eat more plant food, less refined carbs, sugar, processed meat and processed food. Such advice is common to many healthy diets, so whether it is truly individualised, is difficult to ascertain.
Although the Zoe app also measures blood sugars, for most people who are not diabetic, this becomes unnecessary, when sugars and starches are restricted, as these are the culprits when it comes to blood sugar spikes.
In general, users are advised to increase the range of plant foods that they eat, such as lentils, pulses, legumes, nuts, wholegrains and seeds. Reduce ultra processed foods. Include fermented foods such as kefir, kimchi, kombucha, cheese, yoghurt, coffee and some teas.
Finally they also advise lifestyle improvements such as being active, managing stress, get enough sleep, and look after your mental health.
Dementia is perhaps the disease we all most dread. It kills you slowly and gradually. You stop being able to learn new things, you forget a lot of your past and relationships, and your personality changes along with your physical abilities.
Bruck CC et al, searched for longitudinal studies on survival and admission to nursing homes, in people who had been diagnosed with dementia. Studies had to include at least 150 people and follow them up for at least a year.
Median survival from diagnosis seemed strongly dependent on age, ranging from 8.9 years, mean age 60 in women to 2.2 years at a mean age 85 for men.
Overall, women survived for fewer years than men, but this was due to them being diagnosed at later ages than men. The mean difference between the sexes was 4.1 years.
Median survival was 1.2 – 1.4 years longer in Asia, than in the US or Europe. My comment: I wonder if this is due to the tendency for older people to be looked after in extended families there.
Survival time with Alzheimer’s disease was 1.4 years longer than with other types of dementia.
One the whole, survival tends to be longer now than it was pre-2000.
The median time to nursing home admission was 3.3 years. 13% of people were admitted in the first year after diagnosis, increasing to 57% after five years. About a third of the time of remaining life expectancy was spent in a nursing home.
These figures are averages, and are potentially helpful when it comes to health and social care planning for governments, health boards and councils. The individual prognosis, however, is highly dependent on personal and clinical characteristics, offering potential for individualised prognostic information and care planning.
My comment: In my work as a GP, I often was consulted by worried relatives about suspected dementia. I would assess the patient, and particularly if I knew the patient well, I could be pretty sure that there had been a definite cognitive deficit, and I would refer to the memory clinic. More often than not, the patient would come back with no diagnosis. 18 months to two years later, I would refer again, and this time the dementia diagnosis would be made. It seems to me that the tests used for diagnosis are not that accurate in getting a diagnosis in the early stages. Dementia symptoms can have a lot in common with other problems such as depression. At the same time, there are still no good treatments for it. There has been a little success with ketogenic diets and ketone supplementation. Meanwhile, what tends to be good for your blood vessels, tends to be good for your brain.
If given the choice, you will not experience more immunisation side effects if you decide to get a covid-19 vaccine at the same time as a flu shot.
Three hundred people were randomised to receive either vaccine plus a placebo injection or to have both together. The placebo or real vaccine was then given two weeks later. (That was very sporting of the participants!)
Adverse reactions were reported by a quarter of participants but were not more likely when vaccines were administered together or separated by two weeks.
My comment: In my health board area, the vaccines are offered together, probably to improve uptake. I was able to have them both in the same, non- dominant arm. I was given the option of different arms.
In older patients, lowering the blood pressure too aggressively can do more harm than good.
A retrospective study of over 1.33 million Us veterans, 91% men, mean age 71, showed that in those admitted to hospital for at least three days, who had a blood pressure medication added, did not do as well as their doctors expected.
70% of patients will have blood pressure measurements over 140 mm Hg systolic. Sometimes anti-hypertensive medication is added to their existing drug regime, but ischaemia can result, if this is done too rapidly, particularly in older patients.
None of the veterans needed intensive care or surgery. As you all know, admission to hospital is a stressful experience. This can raise the blood pressure on its own. When an extra blood pressure medication was added within 24 hours of admission, the treated group tended to have a rapid drop in blood pressure, acute kidney injury and a 1.69 higher chance of having a stroke, myocardial infarction or death, compared to those who were not given the extra medication.
Researchers say that this aspect of care needs further research to determine when acute blood pressure lowering is really of help.
JAMA Intern Med doi:10.1001/jamainternmed.2024.6213.
Advances in diagnostic technology have increased the variety and volume of direct to consumer commercial tests without clinical consultation. In the USA these have surged from $15m in 2010 to $1.15 billion in 2022. These include such tests as covid-19, genetics, HIV, prostate, thyroid, food sensitivity and cancer markers.
It can be argued that these tests provide choice, accessibility and privacy. They can however trigger unnecessary investigation for false positives or false reassurance. The Royal College of Obstetricians and Gynaecologists does not support over the counter tests to measure follicle stimulating hormone to detect the menopause due to poor accuracy. The anti-mullerian hormone test, advertised as being able to predict the chance of conception, is not supported by evidence.
HIV tests have been found to be not accurate enough to rule out infection. Thus a person could be falsely reassured.
In Australia, 40% of online tests are marketed as “health checks.” Testosterone levels can be a gateway to selling testosterone to “optimise” levels. The market for testosterone is $400m in the USA. The American Urological Association has warned that inappropriate use can cause infertility and the Food and Drug Administration is concerned about cardiovascular side effects.
Multicancer early detection tests aim to detect multiple cancers before they become symptomatic. They measure various substances including abnormal DNA. They have not been shown to reduce mortality or to extend life expectancy.
In the USA, the US Preventative Services Task Force recommends screening for breast, cervical, colon and lung cancer. Multi-cancer tests claim to detect over 50 types of cancer. NHS England has announced the purchase of a million of these tests.
In the USA over 6,000 people in seven US medical centres were followed up for one year after having a multi-cancer test. The sensitivity of the test increases as the stage of the cancer worsens, because small cancers tend to shed fewer, harder to detect, fragments of abnormal DNA than larger cancers. Therefore, these tests tend to detect cancers at advanced stages, which tends to limit the benefits of pre-symptomatic diagnosis.
In this group 19 solid tumours were detected, 10 of which already have their own screening tests, and all were late stage, either III or IV. In 57 of the 92 people who had a positive cancer signal, the results were a false positive. To find out what was going on, 88% of the positive group had invasive procedures lasting two to eight months. The economic and emotional costs are considerable.
For some patients, these tests are found helpful due to the difficulty in getting GP appointments. There are calls from various bodies to provide clear information to users as to usefulness and what to do when results are abnormal. Currently most jurisdictions do not have clear definitions, clinical guidelines or regulatory frameworks for direct to consumer tests.
My comment: My husband and I have both used direct to consumer testing and have found them helpful. The reasons we have used them is difficulty in getting GP appointments, as have many others. Popular testing can include blood sugar levels, thyroid levels, lipid testing, and haematinics. Have you found them helpful?
Research published in Nature Human Behaviour, has found that labelling restaurant and takeaway food to show calorific content does not seem to change people’s eating behaviour.
Mandatory calorie labelling came in for certain types of restaurants in England in 2022. The idea was that people would look at the calories they intended to eat and choose more wisely and healthily.
Surveys on 6,578 customer before and after the change, indicated that there was no significant fall in self reported calories purchased or consumed.
My comment: An epic fail then! For myself, I tend to eat a double cheeseburger quarter pounder at Burger King, if I am stuck without an eating option. I put the bottom burger on the top of the cheese, mayo, lettuce and tomato, and eat it with my hands like a very messy, greasy, meat sandwich. I discard the bun as I don’t tolerate wheat. This comes in at around 1,000 kilocalories, but doesn’t stop me. It does fill me up for many hours. I have not changed my order since the rule came out. Has it changed your order pattern at restaurants?
Paternal use of Metformin during the period of sperm development is not associated with congenital malformation in the offspring. Thus men who have type two diabetes mellitus, and who are prescribed the drug, can continue using it.
These results were found from a large study conducted in both Norway and Taiwan.
Metformin is used in metabolic syndrome and type two diabetes. In the UK 24 million prescriptions were issued for it. It is also used in diabetic pregnant women. Although it crosses the placenta, it does not cause fetal harm. These studies in both the mothers and fathers should give reassurance to both patients and clinicians, particularly as type two diabetes is occurring at earlier ages in the adult population than previously.
The current maternal death rate in the UK is the highest it has been in the last 20 years. These deaths include all deaths in women who are pregnant or within 6 weeks of delivery. The most frequent causes are blood clots 16%, Covid-19 14%, and cardiac disease 13%. 275 deaths occurred.
Deaths between 6 weeks post partum and one year also occurred in 329 women. Most of these were due to mental health problems 34%. Substance misuse and suicide were the leading causes.
Black women had three times the death rate of white women. Asian women had double the risk.
Women over the age of 35 had triple the risk of those aged 20-24.
Women in the most deprived areas had triple the risk compared to women in the least deprived areas.
9% of women who died had multiple disadvantages such as mental ill health, substance abuse or domestic abuse.
Overall, the death rate rose from 11.66 per 100,000 pregnancies in 2017-19 (pre-covid) and 13.56 per 100,000 in 2020-22 (during Covid). Some of the deaths were related to delays in pre-hospital care which were directly related to the pandemic. Others were due to the fact that women are getting pregnant later in life and obesity continues to rise.
One in four women who died of venous thrombo-embolism died in the first trimester of pregnancy, sometimes before any risk evaluation by hospital teams could be done. The Royal College of Obstetricians and Gynaecologists want the VTE risk assessment tool to be restructured so it is clear and easy to use. They want GPs to obtain timely specialist advice, with clear pathways of referral.
My comment: In most of my work as a GP, the first port of call for a woman who thought she was pregnant or who had confirmed a pregnancy was the GP. In the last ten years of my work, since around 2010, however, the entire pregnancy referral process was put in the hands of midwives. Once in the hands of the midwife, I would imagine that it would be easy for screening tools to be employed, and appropriate consultant referrals made. It would seem to me that in order to identify women who are at risk of VTEs in pregnancy, a screening tool that could be done online by women themselves or by other health care professionals will be needed. This could be done when a woman presents for contraception advice or opportunistically when she seeks routine health care. This could identify to individual women whether they need to be fast tracked to an obstetrician in the event of a pregnancy occurring, instead of waiting on the usual midwife led pathway.
The NHS Targeted Lung Cancer Programme, which has been running in England since 2019, has led to earlier diagnosis of lung cancer in 5037 people.
This programme uses mobile scanning trucks to visit areas of with high rates of lung cancer. Current and ex-smokers are encouraged to attend. In depth tests are done.
This has led to lung cancer being detected in 76% of people at stages 1 and 11, when the cancer is potentially curable by surgery and chemotherapy.
My comment: A colleague of my husband’s from Holland, was a very heavy smoker in his young day, and was so worried about it that he managed to persuade his GP to give him an annual Chest X Ray. He was diagnosed with cancer, and had surgery to remove one lung. He got back to work, and all seemed fine, but he then developed cancer in the remaining lung. He had vigorous chemotherapy but eventually succumbed. I do thing that this prolonged his life. He never made it to retirement age.
Diabetes Diet 