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Resilience matters most for young and old when it comes to living with diabetes

Mar 26, 2016Mar 12, 2016 kaitiscotlandLeave a comment

The Journal of Health Psychology have recently ran a series of articles showing that a positive attitude towards coping with chronic illness gives a better quality of life.

Adolescent type one diabetics who felt competent in their self- care, were optimistic and had high levels of self- esteem coped better than those who did not share these characteristics. Low resilience was associated with higher distress, poor quality of life, maladaptive coping strategies and poor glycaemic control.

Older adults of low socioeconomic status who had low resilience had an increased risk of diabetic neuropathy compared to those in the same financial straits but with higher resilience.

As a GP I see some children struggle with diabetes and I know that their poor glycaemic control will have devastating consequences in future years. Most of these children have parents who are struggling to cope with their lives, regardless of the diabetes, and don’t seem to be able to make the highly structured changes that are necessary to manage the condition really well. To make matters worse they often miss clinic appointments. There are liaison nurses who do house visits and psychologists who try to help. Proper (not current NHS!)dietary advice would help and even meal provision with portioned carb and protein counts would be one way to help these families. After all, meals are made available free to some pensioners and surely this would be cheaper on the long run than dialysis and the dropping out of the job market that early complications often bring.

(Research findings from Jounal of Health Psychology 2015 20,9, 1196-1206 and 1222-8 from Human Givens Volume 22, No 2, 2015.

Fat in the liver is a key sign for metabolic problems

Mar 23, 2016Mar 12, 2016 kaitiscotlandLeave a comment

Obesity does not always go hand in hand with metabolic changes in the body that can lead to diabetes, heart disease and stroke, according to a new published study…

In a study at Washington University School of Medicine, researchers found that a subset of obese people do not have common metabolic abnormalities associated with obesity, such as insulin resistance, abnormal blood lipids (high triglycerides and low HDL cholesterol), high blood pressure and excess liver fat.

In addition, obese people who didn’t have these metabolic problems when the study began did not develop them even after they gained more weight.

The study involved 20 obese participants who were asked to gain about 15 pounds over several months to determine how the extra pounds affected their metabolic functions.
First author Elisa Fabbrini, MD, PhD, assistant professor of medicine, added that, “Our goal was to have research participants consume 1,000 extra calories every day until each gained 6 percent of his or her body weight” “This was not easy to do. It is just as difficult to get people to gain weight as it is to get them to lose weight.”

All of the subjects gained weight by eating at fast-food restaurants, under the supervision of a dietitian. The researchers chose fast-food chain restaurants that provide rigorously regulated portion sizes and nutritional information.

Before and after weight gain, the researchers carefully evaluated each study subject’s body composition, insulin sensitivity and ability to regulate blood sugar, liver fat and other measures of metabolic health.

After gaining weight, the metabolic profiles of obese subjects remained normal if they were in the normal range when the study began. But the metabolic profiles significantly worsened after weight gain in obese subjects whose metabolic profiles already were abnormal when the study got underway.

Senior investigator Samuel Klein, MD, the Danforth Professor of Medicine and Nutritional demonstrated that some obese people are protected from the adverse metabolic effects of moderate weight gain, whereas others are predisposed to develop these problems.”

“This observation is important clinically because about 25 percent of obese people do not have metabolic complications,” he added. “Our data shows that these people remain metabolically normal even after they gain additional weight.”

As part of the study, the researchers then helped the subjects lose the weight they had gained.

The researchers identified some key measurements that distinguished metabolically normal obese subjects from those with problems. One was the presence of fat inside the liver. Those with abnormal metabolism accumulated fat there.

Another difference involved gene function in fat tissue. People with normal metabolism in spite of their obesity expressed more genes that regulate fat production and accumulation. And the activity of those genes increased even more when the metabolically normal people gained weight. That wasn’t true for people with abnormal metabolism.

“These results suggest that the ability of body fat to expand and increase in a healthy way may protect some people from the metabolic problems associated with obesity and weight gain.” He noted that obesity contributes to more than 60 different unhealthy conditions.

Practice Pearls:

Some obese people are protected from the adverse metabolic effects of moderate weight gain.
Some key measurements that distinguished metabolically normal obese subjects from those with problems. One was the presence of fat inside the liver. Those with abnormal metabolism accumulated fat there.
People with normal metabolism in spite of their obesity expressed more genes that regulate fat production and accumulation.

Elisa Fabbrini. Metabolically normal obese people are protected from adverse effects following weight gain, pub Jan. 2, 2014 in The Journal of Clinical Investigation. (Published in Diabetes in Control Jan 15)

Low carb advocate Dr David Unwin named Innovator of the Year by RCGPs

Mar 22, 2016Mar 22, 2016 kaitiscotland1 Comment

Congratulations to Merseyside GP and College Fellow David Unwin who has been named ‘Innovator of the Year’ at the national NHS Leadership Recognition Awards 2016.

David, who practises at the Norwood Surgery in Southport, spent three years working on a project combining the benefits of a low carb diet with psychological support to help patients with diabetes. As well as having much healthier patients, the practice now saves around £45,000 a year on diabetes drugs!

David has been a GP for over 30 years yet this award shows that his mission to constantly improve care for patients and his enthusiasm for the job remain undimmed. As well as being a fantastic personal, achievement, it is excellent to see the work of GPs being recognised on the national stage.

The judging panel said that the results of his work were outstanding and that he was ‘passionate about sharing knowledge to achieve a healthier world’. Hear, hear!

Taste matters more than labels when making food choices

Mar 20, 2016Mar 12, 2016 kaitiscotlandLeave a comment

Despite a recent trend toward healthy eating behaviors, many consumers still tend to overconsume unhealthy foods because of two facts that work in combination. Unhealthy food is widely associated with being tasty, and taste is the main driver of food decisions.

In a study done to see what affected choice of food participants were presented with a variety of yogurts, each with different levels of sugar and fat. Even when given information about the ingredients, the participants were not more likely to select a healthier yogurt.

Unhealthy eaters were least likely to use information about ingredients when deciding which yogurt to choose, the investigators found. However, both unhealthy and healthy eaters said taste was the main factor in their decision about which yogurt to select, and it could not be overcome by providing them with nutritional information, according to the published study.

“Policy planners must instead find ways to make healthy foods more appealing, by improving the actual taste as well as the packaging and marketing,” researchers said.
“Social campaigns that promote the sense that healthy eating is “cool” would also help”.

“A holistic approach is urgently needed in which food companies, consumers and policy makers, instead of working against one another, manage to find mutually beneficial strategies to combat the world’s alarming obesity epidemic,” the researchers concluded.

Practice Pearls:
•Taste exerts the biggest influence on people’s food choices and many believe that healthy foods don’t taste good.
•Unhealthy eaters were least likely to use information about ingredients.
•Taste is the main driver of food decisions.

Journal of Public Policy & Marketing, news release, Jan. 21, 2015. Robert Mai and Stefan Hoffmann How to Combat the Unhealthy = Tasty Intuition: The Influencing Role of Health Consciousness. Journal of Public Policy & Marketing In-Press, doi: http://dx.doi.org/10.1509/jppm.14.006 (Published in Diabetes in Control Jan 2015)

At Diabetes Diet Blog, we think that encouraging people to eat real food that doesn’t come in packets would come a long way to address the obesity epidemic too. Salt, spices and fats such as butter, coconut oil and olive oil can greatly enhance the flavour of food, particularly vegetables, that otherwise can be left on the plate. Demonising salt and naturally saturated fats does not help. A parent can prepare tasty soups at home but if salt and fat is left out it is understandable when children prefer tinned versions with added sugar.

Salt restriction can backfire for heart failure patients

Mar 17, 2016Mar 12, 2016 kaitiscotland2 Comments

Over the years, physicians and researchers have advocated less salt consumption in heart failure patients. Although doctors make this recommendation frequently, patients are not always compliant. Heart failure patients who may also be hypertension patients inspired the DASH diet, which includes decreased to no sodium intake, more fruits and vegetables, skinless poultry, and less saturated and trans fat. In heart failure patients, salt increases water retention, which is quite harmful to the function of the heart.

Researchers have recently stumbled across information regarding salt intake and heart failure patients’ long-term health. In all actuality, salt consumption just may not be harmful to that population. This may be a sigh of relief to heart failure patients, but in an interview from consumer.healthday.com with physician Rami Doukky of Chicago, patients should not jump on the bandwagon just yet.

In a study performed by Doukky, 833 heart failure patients were evaluated with the new findings. Divided into two groups consisting of 130 patients, one group consumed salt without any restrictions. While the other group of subjects were salt-restricted. Each patient was followed for a total of three years, and evaluated using an intake tracking method as well as a survey.

After analysis of results, it was found that 42% of the surveyed population following the salt-restricted diet were either admitted to the hospital with heart failure complications or they died. In comparison, 26% of the subjects without salt restrictions developed further complications and/or death.

Although this gives heart failure patients hope, these findings need to be further studied. The results favor no salt restriction due to a decreased percentage of complications, but different factors in each of the patients could have swayed results. With emphasis from cardiologist Clyde Yancy at consumer.healthday.com, salt should not be automatically incorporated back into heart failure patients’ diets. Salt is still a major contributor to high blood pressure, which can lead to cardiovascular complications.

Practice Pearls:

26% of the subjects without salt restrictions developed further complications and/or death. In comparison, 42% following the salt-restricted diet were either admitted to the hospital with heart failure complications or they died.
Not all heart patients need to restrict their salt intake.
Salt reduction for some heart patients may not be helpful.

Doukky, Rami et al. “Impact Of Dietary Sodium Restriction On Heart Failure Outcomes”. JACC: Heart Failure 4.1 (2016): 24-35. Web. 17 Jan. 2016.

Consumer HealthDay,. “Reducing Salt Intake Might Harm Heart Failure Patients, Study Claims”. N.p., 2015. Web. 17 Jan. 2016.

Samantha Ferguson Doctorate of Pharmacy Candidate Florida A&M University, reviewed by Dave Joffe, BSPharm, CDE (Published in Diabetes in Control Jan 16)

Jason’s travelling tips

Mar 11, 2016Mar 12, 2016 kaitiscotlandLeave a comment

Jason Biondo enjoys travelling and writing about it. Here is a post from his blog that will be of help to all of us adventurers.

https://trekeffect.com/travel-blog/17-ways-to-stay-fit-and-fab-when-traveling

One tip I picked up from the internet was to roll up a T shirt and pants into a sausage shape and use the legs of socks at either side to keep the whole lot together. This can be helpful to have in your hand luggage for overnight stays or flights.

If you have any other travel tips please share in the comments section.

Katharine

What can you do to improve erectile dysfunction?

Mar 8, 2016Mar 1, 2016 kaitiscotlandLeave a comment

Blood vessel problems and diabetes are the leading causes of not being able to get or sustain an erection in men. “ED” is a very common diagnosis, perhaps more so now than ever before, partly due to the increase in diabetes but also because there are more treatments available now and men are less likely to suffer in silence.

Diabetics tend to get the problem 10 to 15 years earlier than other men. The degree of glycaemic control over time is a significant factor as this determines the extent of microvascular and macrovascular complications. Neuropathy, insulin resistance, endothelial dysfunction, and atherosclerosis all affect the mechanisms behind erectile function.

Even men who are not diabetic but are aged over 50 and have features of metabolic syndrome are at almost a 50% more chance of getting ED. Indeed the severity of ED reflects the degree of blood pressure, waist fat, and abnormal blood fat pattern that a man may have. If a man with diabetes has ED he is at significant risk of coronary artery disease. Low testosterone is a risk factor for ED by itself and makes metabolic syndrome and diabetes worse as well.

The main drugs to treat ED, such as Viagra and Cialis, rely on an intact neural response, so they don’t always work that well when this is impaired in diabetics. Testosterone replacement therapy can reduce cardiovascular risk in men and also enhance the response to these sorts of drugs. When drugs are still not successful vacuum devices, penile injection drugs, and penile prostheses can be used.

Men can find that following a Mediterranean style of diet can improve erectile response as can exercise.

So in brief:

Keep to as normal a weight as you can.

Keep blood sugars control as good as you can for as long as you can.

Make exercise part of your daily routine.

Eat a low carbohydrate diet with plenty of olive oil, fresh vegetables and moderate amounts of fruit.

Don’t smoke.

Reduce stress.

Sleep well.

Keep your blood pressure under control.

Seek medical advice if you have abnormal blood lipids especially low HDL and high triglycerides.

Include a testosterone check if you notice your waistline creeping up or erectile problems when you have your other diabetic blood tests.

Maintain a normal blood pressure.

Ask your doctor’s advice if you are on medication because many anti- hypertensives and anti-depressants interfere with penile function.

If you do have ED and diabetes discuss cardiac assessment with your doctor.

Thermometer - Confidence Level — A thermometer with mercury bursting through the glass, and the words Confidence Level, symbolizing a positive attitude

Based on the article: Endothelial dysfunction is the link between ED, DM and CAD by Sabair Pradhan, Doctor of Pharmacy Candidate USF College of Pharmacy. Published in Diabetes in Control February 2016.

Diabetes exercise expert launches great new site

Mar 5, 2016Mar 1, 2016 kaitiscotlandLeave a comment

Dr Sheri Colberg has been studying diabetics and their response to exercise for many years. She has written several books to help diabetics achieve their best results and now she has launched an online site that will help you for free.

She writes:

As a leading expert on diabetes and exercise, I recently put my extensive knowledge to use in founding a new information web site called Diabetes Motion (www.diabetesmotion.com), the mission of which is to provide practical guidance about blood glucose management to anyone who wants or needs to be active with diabetes as an added variable. Please visit that site and my own (www.shericolberg.com) for more useful information about being active with diabetes.

She aims to help the entire range of people affected with diabetes from the “getting on a bit” couch potato to the fit competitive athlete.

Here at Diabetes Diet Blog, Emma and I are convinced of the benefits of regular and varied exercise for all, whether you are diabetic or not. Just figuring out where to start can be difficult if you haven’t been a regular exerciser before or are troubled with complications. For insulin users, they are sometimes put off by the adjustments they need to make with their food intake and insulin doses. This site is here to help and Sheri contributes personally to the comments section in her site to help you.

Riesling Chicken Stew

Mar 1, 2016Mar 2, 2016 kaitiscotland3 Comments

Riesling Chicken Stew

Servings: 4
Time: 60 mins
Difficulty: easy
Print

2 tbsp olive oil
4 chicken portions
15g smoked, streaky bacon, chopped
12 shallots
1 teaspoon tarragon
1tbsp flour
150ml Riesling or dry white wine
500ml hot chicken stock
3 tbsp creme fraiche

Heat half the oil in a large pan and fry the chicken in batches, over a medium heat until golden. Set aside.
Put the bacon in the same pan and fry gently to release its fat. Turn heat to medium, add the shallots and cook for 5 min, stirring occasionally, until both are lightly coloured.
Remove the leaves from the tarragon and set aside. Sprinkle over flour and stir to absorb the juices. Cook for 1 min, then gradually add the white wine, stock, and tarragon stalks. Return chicken to pan, cover and simmer over a gentle heat for 45 min to 1 hr until chicken is cooked through.
Remove chicken, bacon and shallots with a slotted spoon and keep warm. Discard tarragon stalks. Simmer sauce rapidly until reduced by half. Stir in the creme fraiche and tarragon leaves. Season to taste.
Turn off the heat, then return the chicken, bacon and shallots to the pan. Serve with veg.

Invigorate your taste buds with spice rubs

Feb 28, 2016Feb 29, 2016 kaitiscotlandLeave a comment

Many of the world’s greatest culinary discoveries were made serendipitously. But very few had greater impact than the discovery of using spices to flavor and preserve food.

Anthropologists have shown that thousands of years ago, our hunter-gatherer ancestors would often wrap their kill in leaves and bark to preserve and transport the contents inside. Only later did they discover that this method of preservation could also improve the taste of their food.

And so the worlds’ love affair with spices began…

Spices & Herbs: The Culinary Curatives

As civilization advanced, the use of spices became ubiquitous in culinary tradition. But it wasn’t just for their ability to enhance flavor. It was also for the health-promoting properties they possessed:

Texts from Ancient Egypt (1555 BC) deemed coriander, fennel, juniper, cumin, garlic and thyme as powerful medicine. It is also known that the laborers who constructed the Great Pyramid of Cheops (using advanced alien technology, of course) consumed onion and garlic as a means to promote health.
Black pepper, cinnamon, turmeric, cardamom have been used by Indians for thousands of years for both culinary and health purposes.
Hippocrates wrote extensively about spices and herbs, including saffron, cinnamon, thyme, coriander, mint, and marjoram. Of the 400 herbal remedies he created, at least half are still used today.
Theophrastus, the “Father of Botany”, authored two books summarizing the knowledge of over 600 spices and herbs.
Dioscorides, a Greek Physician of the 1st century, authored De Materia Medica – an extensive medical and botanical guide that was used for over 1,500 years.
In the Middle Ages (600-1200 AD), European apothecaries used herbs and Asian spices including ginger, pepper, nutmeg, cinnamon, saffron and cardamom in their remedies.
Plants were used as the primary source of medicine in the United States from the time of the Mayflower (1620) until after World War I (1930).

Science now proves that the instincts and knowledge of our ancestors were correct: Spices and herbs are powerful medicine.

Countless studies show that herbs and spices possess a wide range of phytonutrients that can kill bacteria, viruses and parasites. They also act as powerful antioxidants and can promote cellular health, reduce inflammation, and more.

And one of the most convenient ways to harness the health-and-flavor enhancing power of herbs and spices is a homemade dry rub.

Five Chef-Inspired Dry Rubs: Potent Flavor – With Benefits

Complimenting just about every kind of food – from meat, chicken, fish and vegetables – a dry rub is a combination of herbs, salt and spices that is applied before grilling, broiling, baking or roasting.

As you know, there are many commercial seasoning blends available. However, these often contain chemical preservatives, MSG, anti-caking agents and other unsavory additives.

By creating your own custom combinations at home, you can ensure a higher quality, additive-free product that is personalized to your tastes.

Using just one or two spices and herbs can produce delicious results. But if you really want to elevate your food to new heights, don’t be afraid to experiment with new ingredients and unique combinations. You can make a dry rub from nearly any combination of herbs, spices and salt. Here are four chef-tested dry rubs to try in your cooking:

Za’Atar

Use On: This exceptionally versatile Middle Eastern spice mix can be used on every kind of meat, fish or vegetable.
The Blend: ¼ cup sumac, 2 Tbsp. dried thyme, 1 Tbsp. roasted sesame seeds, 2 Tbsp. dried marjoram, 2 Tbsp. dried oregano, 1 tsp. sea salt
Yield: ~2 Tbsp.

Ras El Hanout

Use On: The name of this Moroccan spice mix translates to “head of the shop” – as it often includes the best spices the purveyor has to offer. Try on grass-fed steaks, wild salmon and chicken.
The Blend: 2 tsp. ground ginger, 2 tsp. ground coriander, 1½ tsp. ground cinnamon, 1½ tsp. freshly ground black pepper, 1½ tsp. ground turmeric, 1 tsp. ground nutmeg, 1 tsp. ground allspice, ½ tsp. ground cloves
Yield: ~¼ cup

Mediterranean Dry Rub

Use On: This classic blend goes with just about anything – from pastured pork, lamb and chicken to wild seafood.
The Blend: ¾ cup dried basil, ¼ cup dried thyme, 2 Tbsp. dried sage, 2 Tbsp. fennel seeds, 1 Tbsp. sea salt, 1 Tbsp. black peppercorns
Yield: ~1¼ cups

BBQ Dry Rub

Use On: A classic BBQ favorite that complements pastured chicken, ribs, and brisket
The Blend: ¼ cup paprika, 2 Tbsp. granulated garlic, 2 Tbsp. granulated onion, 2 tsp. black peppercorns, 1 tsp. dry mustard, 1 tsp. chili powder, 1 Tbsp. cumin seed (toasted), 3 Tbsp. coriander seed (toasted), ¼ cup sea salt, 2 Tbsp. coconut sugar
Yield: ~1¼ cups

Tips For Using Dry Rubs

Now that you have a few flavor combinations to start with, I’d like to share how you can maximize the seasoning power and life span of your dry rubs:

Toast to Get the Most: Many spices – especially cinnamon, cloves, allspice, coriander and cumin – benefit from a little heat. A brief toast in a dry skillet will coax more flavor out of these, in particular.

Grind Fine: Finely milling your spice and herb blends allows more surface area to come into contact with your food and your taste buds, producing deeper flavor. Use a spice mill or coffee grinder to powder your dry rub to a uniform consistency.

Prepare The Canvas: For each pound of meat, poultry, or seafood coat the entire surface with 2 to 3 teaspoons melted lard, tallow, duck fat, avocado or coconut oil. Then apply one to two tablespoons of dry rub.

Coat Well: When using dry rubs, coat the entire surface of the food, ensuring it sticks. Not only will this ensure you get the full flavor, but it will also produce a beautiful crust. To produce a stronger flavor, cover pre-rubbed meats or chicken and refrigerate for up to 24 hours to allow the flavors to penetrate. Then cook as desired.

Store Properly: Spices and herbs lose potency over time. Light, heat and oxygen accelerate the process. Store in a cool, dry place in an airtight container. Use within six months or sooner for best results.

Adding dry rubs to your cooking repertoire won’t just add more flavor to your food, but also more health-promoting nutrients. So season often and liberally with these flavor-packed dry rubs, and change up the spices and herbs you use to get the full-spectrum of their healing powers.

Written by Kelley Herring, Healing Gourmet