PHC: How low carbing can help the NHS, meeting in Edinburgh

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The Public Health Collaboration is hosting a morning meeting on Saturday 18th March in Edinburgh from 9 am till 1pm.

The morning speakers will be explaining the role low carbing has on:

Improving mental health and particularly the results with bipolar disorder.

Improving weight and glycaemic control in type two diabetes.

Reducing the costs of managing type two diabetes.

Public education and group coaching initiatives in Scotland.

The PHC Ambassadors are having an afternoon meeting to discuss their projects.

The meeting is at the Quaker Meeting House in the old part of Edinburgh at the bottom of the castle and the fee is £15.

Please contact Sam Feltham at the Public Health Collaboration for more details and to register for the event.

Metabolic Multiplier: Help for type two diabetics who want to adopt a low carb diet

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The site Metabolic Multiplier have compiled a toolkit that you can use to educate yourself about the low carb diet and have included information that you can give to your doctor or other health care professional so that they will be more likely to help you monitor your condition.

I was part of the development group last year.

The dietician Adele Hite was extremely active in the group and always seemed so full of energy and enthusiasm. She put in many hours into the project as well as her day job. Little did I know that she had a returning cancer and that she was to die from it in less than a year. In retrospect, I think that this is what drove her. She was determined to leave a legacy to help others.

If you know of any newly diagnosed diabetics or any who are experiencing friction with their GPs or health care providers, please let them know about the Metabolic Multiplier site. It is organised by the highly efficient and versatile Cecile Seth.

GP apprenticeships will start in September 2023

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Adapted from BMJ 30 July 2022

The idea of GP apprentices has been discussed for a few years now, but at last the scheme is starting up in September 2023.

The new scheme hopes to solve a lot of problems with one fell swoop.

There is a great shortage of doctors in the UK and particularly in General Practice, the foundation of the NHS system. At the same time, the expense of becoming a doctor, with student debt on qualification reaching £100,000, is making it a difficult choice for students who don’t have wealthy parents.

Universities have limited places for medical students. Although a few new medical schools have opened their doors such as Buckingham University, which is entirely privately funded, this has been insufficient to maintain GP numbers which continue to fall.

For several years conversion courses for graduates from other disciplines have been running at for instance Dundee University. This results in qualified doctors after a four- year course.

Courses for physician assistants have also been taking in graduates from careers allied to medicine in for instance Aberdeen University. Yet, there are simply not enough physicians and physician assistants to fill gaps in provision, as many of our UK readers will have noticed, whether they are seeking a GP or a hospital appointment.

What is different about GP apprenticeships is that the student will earn a wage from their very first day. I don’t know what that wage will be yet. Hopefully enough to make the experience worthwhile and at least prevent them ending up in debt.

The aim is to make medicine more accessible to students from state schools and poorer backgrounds. They want to see students from diverse backgrounds rather than just the white upper middle- class students from private schools who currently predominate.

Apprentices will complete both academic and practical education and come out with a medical degree and licence to practice from the General Medical Council.

Dr Mark Cucuzella: Online resources for low carbing for patients and doctors

Adapting Medication for Type 2 Diabetes to a Low Carbohydrate Diet- Frontiers 2021

https://www.frontiersin.org/articles/10.3389/fnut.2021.688540/full

The above link gives the full paper from Dr Cucuzella about the medication adaptations, including insulin adaptations that need to be done if you are transitioning to a low carb diet. There is a helpful traffic light summary. Some medications do not need altered and these are discussed too.

Diet Doctor video on article “Why deprescription should be your new favorite word”

What your new diet will consist of and how to avoid unnecessary expense or complicated recipes is fully discussed in the following links. They are the same booklet but in different formats.

Our new “Low Carb on any Budget  – A Low-carb Shopping and Recipe Starter Begin a Life Free of Dieting and Indulge Yourself in Health” patient guide- Print and share with your patients

Pdf version

www.tinyurl.com/lowcarbanybudget

online flipbook

www.tinyurl.com/lowcarbanybudgetebook

For clinicians through guideline central

These booklets are quite complex and are for doctors who want to know more about low carb diets and fine tuning of medication and insulin. The first is in USA units and the second is the UK format. It does no harm for any diabetic or their carers to read these too but bear in mind that they do go into some depth.

-Guideline Central: Low-Carbohydrate Nutrition Approaches in Patients with Obesity, Prediabetes and  Type 2 Diabetes

http://eguideline.guidelinecentral.com/i/1180534-low-carb-nutritional-approaches-guidelines-advisory/0?

UK version – http://eguideline.guidelinecentral.com/i/1183584-low-carb-nutrition-queens-units/0? 

Want to pass that exam? Here’s how.

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Adapted from Human Givens No 1 2013 Dunlosky et al. Improving student’s learning with effective learning techniques. Psychological Science in the Public Interest.

Researchers have found that the best way to get good results in exams is to spread out your studying over time and to make sure that you quiz yourself on what you have learned.

They looked at ten common learning techniques and found that many of the most popular were of next to no benefit either in remembering information or passing exams. Some of these are the most common and are being recommended by teachers.

The most useless ways to revise are: highlighting and underlining, summarising, keyword mnemonics, use of imagery for memorising text and re-reading.

You may think you are doing something by adopting these, but you are kidding yourself!

Improved life expectancy for severe kidney disease on keto diets

Teresa Rodriguez is a Florida USA specialist dietician who has undertaken training with the Charlie Foundation to provide help to patients who have severe kidney disease of various types. Some conditions, previously thought to be untreatable, such as Polycystic Kidney Disease respond to the ketogenic diet and the quality of life and life expectancy for these people has been transformed.

Teresa sees patients in person and coaches them online and via Facebook. She is expecting her book, aimed at both physicians and patients, Keto for Kidney Disease, to be published in March 22.

Teresa comes from Puerto Rico and speaks fluent Spanish and American English and can provide learning in both languages.

I was one of several doctors who were treated to an online presentation by Teresa recently, and was amazed to see how different her approach and results are compared to NHS “usual” treatment and results.

I was taught that there wasn’t really much you could do about Polycystic Kidneys except for dialysis and transplantation when the kidneys eventually failed. She explained that PKD is actually a metabolic condition and that it responds to a ketogenic diet of usually 20g carbohydrate a day. There can be other aggravating factors such as oxalate overload and the kidney needs support to avoid the formation of kidney stones. Many patients will need to drink lemon juice in the mornings and have a much higher fluid intake than usual.

She optimises the patient’s diet based on the results of a detailed clinical history and blood and urine results. She finds that Cystatin C is a much more reliable predicator of kidney function than standard tests such as Creatinine Clearance. She often has to modify drug prescriptions. The blood pressure must be kept within normal limits to reduce deterioration in kidney function but Calcium channel blockers are not beneficial in PKD compared to ACE inhibitors and Sartans. Metformin, however is beneficial.

There is increasing interest in Ketogenic Diet Therapy and Therapeutic Carbohydrate Restriction worldwide.

Tim Noakes: Nutrition Network Courses for Health Professionals

Homepage | Nutrition Network (nutrition-network.org)

Tim Noakes shot to fame in the low carb community by being accused of malpractice by two South African dieticians for giving dietary advice when he was not a registered dietician. After five long miserable years and the support of international colleagues he won the case. Anna Dahlquist, a Swedish GP had gone through the same thing a few years before this, and not only won her case, but managed to get the Swedish food guidelines for people with diabetes changed.

Professor Noakes has established online training for health professionals covering a variety of useful topics. Participants can be from all over the world and will receive accreditation. The full list of topics can be found by clicking on the homepage in BOLD above.

Public health collaboration online conference 2021

Sam Feltham has done it again. This year’s conference is now available on you tube right now.

Last weekend there were many contributors from diverse fields including members of the public, doctors, academics, and the scientific journalist Gary Taubes who gave the opening talk about ketogenic diets.

The courses that particularly interested me were about the experiences of type one diabetics who had adopted the low carb approach, how to achieve change, and how to increase your happiness.

There are talks about eating addiction and eating disorders, statins, and vegetable oil consumption.

Much of the material will be familiar to readers of this blog. There are some new speakers and topics which do indicate that a grassroots movement in changing our dietary guidelines is gaining ground.

Fitter, better, sooner

From BJGP May 2020 by Hilary Swales et al.

Having an operation is a major event in anyone’s life. There is a lot a patient can do to improve their physical and mental health before surgery that will improve their recovery and long term health.

Fitter, better, sooner is a toolkit was produced by the Royal College of Anaesthetists with input from GPs, surgeons and patients.

The toolkit has, an electronic leaflet, an explanatory animation and six operation specific leaflet for cataract surgery, hysteroscopy, cystoscopy, hernia, knee arthroscopy and total knee joint replacement.

These can be seen at: https://www.rcoa.ac.uk/patient-information/preparing-surgery-fitter-better-sooner

The colleges want more active participation with patients in planning for their care.

The most common complications after surgery include wound infection and chest infection. Poor cardiorespiratory fitness worsens post op complications. Even modest improvement in activity can improve chest and heart function to some extent.  Keeping alcohol intake low can improve wound healing. Stopping smoking is also important for almost all complications. Measures to reduce anaemia also reduce immediate and long term problems from surgery and also reduce the need for blood transfusion. Blood transfusion is associated with poorer outcomes particularly with cancer surgery. HbA1Cs over 8.5% or 65 mmol/mol causes more wound complications and infections.  Blood pressure needs to be controlled to reduce cardiovascular instability during the operation and cardiovascular and neurological events afterwards.

This toolkit is already being used in surgical pre-assessment clinics but access to the materials in GP practices will also help. After all, the GPs are the ones who are initially referring the patients for surgery, and improving participation early can only be helpful.

It is hoped that this initiative will result in patients having fewer complications, better outcomes from surgery but also from their improved lifestyle.

 

Diet doctor: free online course with credit for medical professionals

This is a message from dietician Adele Hite:

I am thrilled to announce that Diet Doctor is now offering a free CME activity to all interested clinicians, patients and carers: Treating metabolic syndrome, type 2 diabetes, and obesity with therapeutic carbohydrate restriction.

Thanks to the support of our members, we can offer this CME at no cost to clinicians.

This fully referenced, evidence-based CME activity is certified for three AMA PRA Category 1 Credit(s)™. It is jointly provided by Postgraduate Institute for Medicine (PIM) and Diet Doctor and is intended for physicians, physician assistants, registered nurses, and dietitians engaged in the care of patients with metabolic syndrome, type 2 diabetes, and obesity.

The course was designed by clinicians for clinicians. As this course outline shows, it covers all clinicians need to know about dietary carbohydrate restriction and how to implement it safely and effectively with patients for whom it is appropriate. In keeping with Diet Doctor’s mission to “make low carb simple,” the course also comes with supplemental materials for clinicians and their patients to make it easy to translate evidence into practice.

We hope that this course will help reaffirm the scientific and clinical support for this approach and — along with other efforts by LowCarbUSA and expert clinicians — act as another step in solidifying a standard of care around low-carb nutrition. We would love it if you would share the news about this course with colleagues. You can forward this email to them or use this flyer to share or post.

Diet Doctor also has some new resources to help make low carb simple for patients and clinicians alike. For patients, we have:
‒ a sample menu
‒ shopping list
‒ a meal planning guide
‒ a substitutes for favorite foods handout
‒ simple meals and planned leftovers, and
‒ information about target protein ranges

For clinicians, we have handy one-pagers on:
‒ monitoring ketones
‒ fasting insulin and HOMA-IR ranges
‒ lab tests and follow-up schedule
‒ type 2 diabetes medication reduction, and
‒ a 5-day food diary for patients who need to monitor their intake

Of course, for those on the list who are not clinicians, anyone can register for and view the course. You just won’t be eligible for CME credits.

For clinicians, please let us know if we can help you help your patients in other ways. And if you are interested in supporting us as we continue to develop materials to make low carb easy for clinicians and patients, please think about becoming a Diet Doctor member yourself.

Finally, we are happy to hear suggestions for improvements moving forward. If you take the time to view the course, we’d love to hear what you think.

Best regards,
Adele