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.
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.
Discover more at the 15min-City platform, which showcases how cities worldwide are embracing the 15-minute city concept, where services are accessible within 15 minutes by walking or biking.
Re-organising cities so that essential services are easily accessible on foot or by bicycle is an appealing idea. It could reduce carbon emissions, help people get fitter, and reduce inequalities and deprivation.
Apparently most European cities are already at or close to this ideal. However, most cities in North America and the Far East are not set up for this at all.
My nearest city is Glasgow. I lived there for thirteen years in all from the age of 10 to 23. My family didn’t have a car so we walked a lot and took the bus or train when the distances were more than around half an hour. I’m pleased to say that Glasgow does very well in the 15 minute concept. I do know, however, that certain areas eg the Castlemilk housing estate on the south of Glasgow, do not have a supermarket within walking distance. This affects the type, price and quality food that can be purchased, particularly fresh vegetables, meat and fruit.
Otherwise Glasgow does have many beautiful parks thanks to the foresight of the Victorian’s who built them. There are good shopping areas, libraries, museums, transport links, hospitals, doctors’ surgeries, dentists, schools, and sports and entertainment facilities.
The Ayrshire towns in which I have lived are also well set up for many activities but I’m sorry to see the loss of council run sports and library facilities that affect young people in particular.
There is a app called Libby. If you join a library, you can have a loan of e books and magazines totally free. You get them for three weeks before they disappear off your screen.
Although turkey is perhaps the most traditional Christmas dinner in the UK and USA, I don’t really like it that much, and prefer chicken.
Today I’m going to discuss different ways that I’ve seen chicken roasted. I’ve tried all of them, and my recent favourite is the New York Times, “Salt and pepper roast chicken” recipe, which has five stars.
For years I simply did what it said on the package. This is to place the chicken in a pre-heated oven at 180 degrees and roast for about one and a half hours. Then, let it rest for 10-15 minutes and serve. This has the advantage that you can season the chicken as you like. The results are good, but sometimes the breast is overdone compared to the legs. Some chefs even take the legs off and roast these separately for this very reason.
A variation on this is the “roast in a bag” chicken. These chickens are usually quite large and come pre-seasoned. They are readily available from big supermarkets. The advantage is that you don’t need to touch the raw chicken at all and the seasoning is done already. They also save on cleaning pans. These are suitable mainly for families due to the size of the bird. I have often found the flavour disappointing.
For at least 15 years I used the Australian chef, Tony Blakemore’s method. I use a big cast iron wok. Pre-heat the oven to 180 degrees. Rub plenty of butter into the skin of the chicken and season generously. Place breast down in the middle of the pan. Add whatever vegetables you have in the fridge round about. Pour some olive oil onto the vegetables and season. Add such items as chopped garlic and chili peppers if you like. Vegetables I commonly use are chopped onions, carrots, potatoes, celery and peppers. Cook for 45 minutes with the lid on. Then take out of the oven and turn the bird breast up. Then cook without the lid for the remaining 45 minutes. This browns the skin on top. The advantage of this method is that you have a well cooked chicken with a delicious buttery vegetable accompaniment. If you are on a ketogenic diet, you would omit the potatoes. The breast and leg meat are equally cooked.
For all of these chickens, you need to plan ahead. I like to take the chicken out of the fridge for about 15-30 minutes prior to roasting, 1.5 hours in the oven and sometimes a bit more, and 15 minutes resting. I put dinner on the table at 7.30 pm. This means the bird must be taken out of the fridge by 5.30pm at the latest. Many people eat dinner earlier than this. This can be a problem for working mums.
Recently I saw that the NY Times had a 5 star roast chicken recipe and I decided to try it. Having done this several times, I’m so impressed that I’ll probably abandon Tony’s method, although my younger son, can’t bear the thought of me doing this, as he loves the buttery, tasty chicken so much.
Prior to cooking, you are urged to season the inside and outside of the chicken with salt, pepper and herbs to your taste, perhaps rosemary, thyme and sage. Put the chicken back in the fridge for an hour or overnight if you can. (Cover it and keep away from other food items).
Heat the oven to 220 or 230 degrees. Red hot! Now place in a roasting tin breast up. Roast for just 50 minutes. Then, take it out and baste the skin with the fat and juices. Test the internal temperature of your bird. It needs to be 165 F or 74 C. If you don’t have a meat thermometer you can pierce the part of the chicken between the thigh and the breast and the juices should run clear. Any hint of blood and it needs to go in the oven again. Re-test every 10 minutes.
So far I have used small and medium chickens at 220 degrees. I have not had to keep them in longer, but if you have a big bird, and depending on your oven, you may need to.
The skin is delicious and crisp and the taste excellent. I’ll let you know if my son is converted or not in the comments after the Christmas holidays.
Emma and I wish you all a fuss free(ish), pleasant, Christmas Day.
This year, my husband was expected to be working off shore, so we are having our Christmas Dinner on Hogmanay. The four of us will all be here.
Like last year, I have bought a Marks and Spencer’s dinner, which only needs heated in the oven. It will be a seafood extravaganza with a chocolate dessert, as my younger son and I are seafood daft.
Unexpectedly my husband got back home off the boat, so there will be three of us, but we are going to stick to the original plan which is to delay the Gordon Ramsay Chili/Treacle Ham to Hogmanay. There is plenty of food and a Kobe beef steak pie if my husband doesn’t want the lobster and prawns.
Whatever you are doing, I hope you have an enjoyable time.
Particularly if you are on your own, I will raise a glass to toast you. If you are the cook and organiser, you do have my sympathy. Now that I’ve discovered the joys of a totally heaty up/ tin foil Christmas Dinner, there is no going back for me.
Dr Kendrick in an Aberdonian who works as a GP in England. He may be familiar to British readers as a so called “statin denier” as termed by a popular newspaper. Dr Kendrick and Zoe Harcombe PhD, sued the paper for libel, and after five years of litigation have finally won their case.
Dr Kendrick has been interested in the causes of ischaemic heart disease for about 20 years and published The Great Cholesterol Con about 15 years ago. This book delves into what does and does not cause coronary arterial plaque and heart attacks and recently he has also published another, The Plot Thickens.
His presentation at the Public Health Collaboration Conference in Glasgow explained what actually causes coronary plaque. He took us on a referenced revision of why previous theories, which have been accepted by many as fact, are not valid.
He spoke about the Minnesota Experiment. This has also been discussed in Gary Taubes’ books. Residents in Mental Health facilities in Minnesota were given different diets for several years and the outcomes were evaluated. In those days, indeed before neuroleptic drugs like Largactil and Haloperidol were invented, people with a diagnosis of schizophrenia could spend years of their lives in mental hospitals, so the population tended to be quite stable.
The intervention was the replacement of saturated fat with polyunsaturated fat. This was thought, by the influential Ancel Keys, to be the main cause of coronary artery disease, following the publication of his Seven Countries Study. (Although the data from 22 countries was available at the time). The patients’ cholesterol levels did indeed go down in the polyunsaturated diet group, but unfortunately the death rate went up.
Although this RCT should have led researchers to look elsewhere for the cause of coronary heart disease, the study results were simply not published, and the war on saturated fat continued, and still continues up to the present day.
The Q Risk 3 is the most up to date questionnaire that is administered by GPs or indeed yourself if you know your lipid blood results and blood pressure. It lists 20 risk factors for heart disease. These are really associations and are not necessarily causative. For example, your postcode is included.
The LDL result, when taken in isolation, shows no increase in risk. Other markers of dyslipidaemia such as low HDL and high triglyceride levels do.
The health of the Glycocalyx, which is like a shimmering brush border that lines all of our blood vessels, is key to the development of coronary plaque. If it is lush, it wafts our blood cells along, and stops them from sticking. It could be compared in some ways to Teflon. Certain things reduce the depth and function of the Glycocalyx such as: sugar, starch, alcohol, SLE, Hughes Syndrome, ageing, stress, smoking, diabetes, dyslipidaemia, and high blood pressure.
If the Glycocalyx is breached, the lining of the blood vessels can be injured, and to prevent bleeding, a vigorous platelet aggregation ensues. This is intended by nature to be helpful. The clotting cascade is controlled by just over 100 different cytokines and chemicals in the body. Endothelial progenator cells are released from the bone marrow, and these plug the holes in blood vessels. These form the basis of the plaque that covers the holes in the lining of blood vessels.
Plaque never forms in veins. It forms in arteries, especially where damage has occurred due to high turbulence, such as at forks in arteries. It is when plaques break off, and another burst of clotting ensues that heart attacks may occur.
Dr Scott Murray
Dr Murray is a Scottish Cardiologist who now works in England. His talk dealt with the practical things you can do to improve your cardiac risk and how he uses the Coronary Artery Calcification Score.
He says that a low carb or ketogenic diet is key to improving your lipoprotein type and size. Smaller and denser lipoproteins are more atherogenic than big fluffy ones. He showed pictures of healthy hearts compared to unhealthy ones that tend to have a lot of fat around them.
Taking at least 150 minutes of exercise a week including brisk walking and resistance exercise can reduce cardiac risk by 20-14%. Stopping cigarettes reduces your risk by 37%. A reduced carb diet can reduce your risk by 31-18%. Weight loss can reduce risk by 18%. Stress management can reduce risk by 41%.
Oestrogen use for women within ten years of the menopause also reduces cardiac risk. He advises you to keep thin if you possibly can.
If your CAC score is 0, your cardiac risk is 2.5%. If it is over 150, he advises a statin. These reduce plaque rupture.
Four in five women get hot flushes during the menopausal years. These can cause embarrassment, lack of sleep, low mood and problems concentrating. The main group of women who can’t take HRT to treat these vasomotor symptoms is women who have a personal or strong family history of breast cancer. Worldwide only 10% of women actually use HRT for flushes.
Fezolinetantis a new drug that reduces flush frequency, severity and sleep disturbance. It blocks neurokinin in the thermoregulatory centre of the brain.
The drug works within a week of starting treatment. So far it has been compared to placebo but not HRT. There were no side effects that required withdrawal from the trial.
This sounds like a very helpful medication for those women who cannot or don’t want to take HRT.
Other Women’s Health Updates
Women in the Nurses Health Study, who had a history of Endometriosis, Adenomyosis or Uterine Fibroids had worse total mortality ratings compared to women without these conditions. Premature death extended past the reproductive years and was measured to the age of 70. The causes included an increase in gynaecological cancers, cardiac disease, respiratory disease, other cancers and other causes. The reasons for this increase in total mortality is not clear.
Adapted from BMJ 21 Jan 2023 Gestational age at birth and later cognition.
It is always a worry for parents when they have a premature baby. Will my baby be physically normal? Will they have brain damage?
A Danish study looked at almost 800,000 children who had been born between 1986 and 2003. Comment: this is of interest to me because I was born at 34 weeks and weighed 2 pounds 3 ounces. Also I worked in obstetrics in 1984 and neonatal paediatrics in 1986.
They compared their characteristics at birth with language and mathematics assessments at age 16. The assessors had no knowledge of the children. Sex, birth weight, malformations, parental age at birth, parental educational level, number of older siblings and shared family factors between siblings were adjusted for, as these are known to have effects on intelligence levels.
The results showed that for both language skills and mathematics, levels plateaued off at 34 weeks and remained constant till 41 weeks. Babies born at 42 or more weeks actually showed a slight decrease in language and mathematical skills.
For babies born at 27 weeks or more, there was a reduction in both language and mathematical skills. Week on week there was a steady improvement till 34 weeks. Mathematical skills were over twice much impaired compared to language skills.
Exactly how these differences affect real life outcomes such as educational attainment or lifetime income has not been assessed in this study.
Diabetes Diet 