Women have long been advised to take iron supplements with orange juice to increase iron absorption. This is mainly done through the years of menstruation and particularly in pregnancy and the post partum months.
A study was done using radioactively labelled iron to establish how effective or not this advice was.
Women with low iron levels were divided into three groups. Iron with orange juice, with coffee, and with a breakfast that included both orange juice and coffee.
Taking iron with just orange juice increased the iron absorption by four times the amount by taking it with coffee or a breakfast with both coffee and orange juice.
You can increase the absorption by 20mg per dose by doing this.
Another use for iron supplementation is in older people who get leg cramps. Sometimes iron deficiency is the cause, and they will benefit from this advice as well.
Photo by u0412u0430u043bu0435u0440u0438u044f u0428u043au043eu0434u0430 on Pexels.com
PURE Study and Full-Fat Dairy
The world’s largest observational study, the Prospective Urban Rural Epidemiology (PURE) Study, released its most recent paper with one of the key findings being that whole-fat dairy should be included as one of six foods that comprising a healthy diet.
Multiple papers have been published from the PURE data. This one is focused on developing a globally applicable healthy diet score, called the PURE Score.
The researchers analyzed data not only from PURE but also from five independent studies encompassing a total of more than 244,000 individuals from 80 countries.
The PURE scoring system defined a healthy diet as one relatively high in fruits, vegetables, nuts, beans, fish, and whole-fat dairy. A higher score was attributed to diets composed of more of these nutrient-dense foods.
A higher intake of these foods correlated with improved health and a reduced risk of illness, the study found.
This research has the same limitations of all epidemiological studies in that it shows correlation, not a cause-and-effect relationship. However, PURE’s contrary finding on full-fat dairy is meaningful in that it contradicts the conventional wisdom.
Dariush Mozaffarian, the influential former Dean of the Friedman School of Nutrition Science & Policy at Tufts University, cited this paper and acknowledged that full-fat dairy can indeed be part of a healthy diet. U.S. health recommendations have favored low-fat dairy for decades, but the PURE finding imply that high-fat dairy is the better option for health.
My comment: The debate about what a healthy diet is continues. I’m still on an Atkin’s style diet and still on about 35 -85g of carb a day. I’m more willing than I used to be to enjoy my favourites such as mushroom risotto, seafood risotto and paella. I easily meet the legumes, nuts, fish and dairy intakes but don’t tend to eat the fruit and vegetable amounts suggested unless I’m on holiday where they have big self serve buffets. I know that eating more vegetables in particular is good for fibre, vitamins, and antioxidants, and are generally low in calories, but I just don’t find them as appetising as meat, fish, eggs, cheese and nuts. I probably eat one of each a day on average.
Sadly this is NOT a post about how eating these gorgeous looking cup cakes will make you slim!
Adapted from BMJ 30 Sept 2023
Association between changes in carbohydrate intake and long term weight changes. Wan Y et al.
This study looked at the association between changes of different types of carbohydrate and weight changes measured at four yearly intervals.
The data was retrieved from the Nurses Health Study, Nurses Health Study 2, and the Health Professionals Follow up Study. These studies were done between 1986 and 2015.
The participants at the start had to be in good health and aged 65 years or younger. They then completed follow up questionnaires every four years. They were asked about personal characteristics, medical history and lifestyle. Carbohydrate type and amount was calculated from validated food frequency questionnaires. The weight changes were self reported every two years.
Over 136 thousand health professional were questioned over the years.
On average participants gained 1.5 kg every four years amounting to 8.8kg on average over 24 years.
Foods higher in glycaemic index and glycaemic load tended to produce more weight gain. For example, a 100g a day increase in starch or sugar was associated with 1.5kg and 0.9kg greater weight gain over four years. A 10g a day increase in fibre however, tended to result in 0.8kg weight loss over four years. Other foods that increased weight were refined grains and starchy vegetables such as peas, corn and potatoes. The foods that tended to reduce weight were whole grains, fruit, and non starchy vegetables.
For example, over 4 years a 100g daily increase in non starchy vegetables a day equated to 2.6 kg extra weight. If non starchy vegetables increased by 100g a day the weight loss was 3kg.
The effects were more noticeable in women and in those who were already overweight or obese.
This study shows that not all carbohydrates have an equal effect on body composition. For long term weight management limiting added sugar, sugar sweetened beverages, refined grains and starchy vegetables would seem prudent. These can be helpfully replaced with whole grains, fruit and non starchy vegetables.
Adapted from paper by Dr David S Ludwig and Dr Jens J Holst published in JAMA May 1 2023
Treatment that focuses on the root cause of a disease has guided research and clinical practice for centuries. The American Academy of Pediatrics (AAP) published a clinical practice guideline for the evaluation and treatment of children with obesity earlier this year. This guideline emphasises the use of weight loss drugs and bariatic surgery. Diet received little attention apart from advising the USDA’s MyPlate recommendations and the limitation of sugar sweetened beverages.
The researchers are of course constrained by available evidence and the results on weight loss for drugs and surgery do seem superior to the changes achieved by diet. Yet, the physiological changes that occur on a carbohydrate restricted diet have many similarities to what occurs in the body with drugs such as GLP-1 receptor antagonists.
GLP-1 RAs improve beta cell sensitivity to glucose so that the same amount of insulin will be released at a lower glucose concentration. It also slows the rate that the stomach empties after eating food. Thus people feel fuller up after eating for longer, and the lower blood sugars released from the stomach over time result in lowering the total amount of insulin from the pancreas. The lower the rate that the stomach empties, the more weight is lost.
Slower digesting carbohydrate, for instance, must travel farther down the gut before being fully absorbed. This causes lower post meal blood sugars and insulin secretion. Protein and fat also digest more slowly and stimulate less insulin secretion than an equivalent amount of rapidly absorbed carbohydrate. Additional similarities between low glycaemic load diets and GLP-1 RAs include lower leptin levels, suggesting lower leptin resistance, lower ghrelin levels and higher adiponectin levels. This dietary strategy shares mechanisms with gastric bypass surgery which shifts nutrient absorption from a more proximal to a more distal location in the intestines. Of special relevance is that natural GLP-1 secretion is increased with a low glycaemic load diet, which slows gastric emptying thus improving satiety, and bariatric surgery.
Although in theory a low carb diet should be able to replicate the results of GLP-1 RAs (15% weight loss) results are usually disappointing, except where a ketogenic diet with intensive behavioural support (12% weight loss) is provided. In other words, the results can be almost replicated but the person must stick to the diet.
GLP-1 RAs cost $1,400 per adolescent per month. Treatment of all adults with obesity would cost $1 trillion and all adolescents $100 billion per year. Instead of spending this sort of money to solve the obesity crisis, it would be more worthwhile to enhance dietary quality and create environments that would encourage physical activities and outdoor play as an alternative to screen time and electronic gadgets. This would improve mental as well as physical health.
Unfortunately, once GLP-1 RAs are stopped, the weight is usually rapidly regained. Therefore we are really looking at potentially lifelong drug treatment for the obese population. We do not know the effects of prolonged drug treatment on other health factors. A low quality diet could still produce a raised lifetime risk of cardiovascular disease, cancer and other chronic conditions, independent of weight.
Perhaps low glycaemic load diets when given in conjunction with GLP-1 RAs would improve the therapeutic effect and thus allow drug use at lower dosages. This could reduce adverse effects.
To advance science and social justice we must fund research into new dietary treatments and overcome obstacles to the provision of intensive behavioural interventions. Especially for children, diet and lifestyle must remain at the forefront of obesity prevention and treatment.
Mortality Reduced With Adherence to Low-Carb Diet in Type 2 Diabetes
Mar 24, 2023
Lower mortality seen with increases in total, vegetable, and healthy low-carbohydrate diet score
By Elana Gotkine HealthDay Reporter
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FRIDAY, March 24, 2023 (HealthDay News) — For individuals with incident type 2 diabetes (T2D), a greater adherence to low-carbohydrate diet (LCD) patterns is associated with lower mortality, according to a study published online Feb. 14 in Diabetes Care.
Yang Hu, Ph.D., from the Harvard T.H. Chan School of Public Health in Boston, and colleagues calculated an overall total LCD score (TLCDS) among participants with incident diabetes identified in the Nurses’ Health Study and Health Professionals Follow-up Study. Vegetable (VLCDS), animal (ALCDS), healthy (HLCDS), and unhealthy LCDS (ULCDS) were also derived.
The researchers documented 4,595 deaths, of which 1,389 cases were attributable to cardiovascular disease (CVD) and 881 to cancer among 10,101 incident T2D cases, contributing 139,407 person-years of follow-up. Per each 10-point increment of postdiagnosis LCDS, the pooled multivariable-adjusted hazard ratios for total mortality were 0.87, 0.76, and 0.78 for TLCDS, VLCDS, and HLCDS, respectively. Significantly lower CVD and cancer mortality was seen in association with VLCDS and HLCDS. From the prediagnosis to postdiagnosis period, each 10-point increase in TLCDS, VLCDS, and HLCDS correlated with 12, 25, and 25 percent lower total mortality, respectively. For ALCDS and ULCDS, no significant associations were seen.
“Our findings provide support for the current recommendations of carbohydrate restrictions for T2D management and highlight the importance of the quality and food sources of macronutrients when assessing the health benefits of LCD,” the authors write.
Adapted from The Displacing Foods Age Related Macular Degeneration by Chris A Knobbe. Medical Hypotheses 109 2017 184-198
Chris A Knobbe from the University of Texas has studied factors that are thought to be important in the causation of Age Related Macular Degeneration. (AMD).
AMD is the leading cause of irreversible blindness in developing nations. In 2020 some 196 million people were affected worldwide. And Dr Knobbe thinks this is almost always down to dietary factors, in particular the consumption of processed food such as sugar, vegetable oils, refined white flour and trans fats.
Historically, between 1851 and 1930, AMD was a rarity. It rose modestly in the 1930s but became an epidemic in the UK and USA by 1975.
By 2009 63% of the American diet consisted of processed sugars, starch and oils. My comment: Dr Google now puts this at 73% “hyper-processed foods”.
By looking at the food intake and AMD in 25 nations, it was seen that as the traditional diets were replaced with processed foods, the incidence of new onset AMD correspondingly rose.
If sugar intake is moderate but polyunsaturated fat ingestion is rare, AMD does not rise.
It would therefore appear that processed and nutrient deficient foods are toxic to the retina.
AMD could probably be entirely preventable through reverting back to ancestral dietary patterns, should that be feasible, or eliminating processed foods that have become ubiquitous. Avoidance of these foods is likely to be extremely important for people who have been diagnosed with early or moderate AMD.
My comment: I was recently at a Hospice ladies lunch group and was sitting at a table with six other women who were about 10-20 years older than myself. Five of them were currently getting eye injections for AMD. Diets that are considered the healthiest by Dr Google are the Mediterranean, Japanese, South Korean and French.None included processed foods.
After considerable number crunching a low carb colleague has come to the very reasonable conclusion that the worst food in the world for weight gain is the fried potato in its several incarnations.
In the USA French Fries are what we in the UK call Chips. In the USA Chips are what we in the UK call Crisps.
These are ubiquitous and difficult to avoid particularly if you eat in fast food restaurants. Even if you order a sandwich you may be given a side order of chips or crisps.
Tucker explains that the vegetable and seed oils that these items are fried in play havoc with the appetite control centres of your brain. This article serves as a reminder, since we are all still at least trying to keep to our New Year’s Resolutions, why it would be better to avoid having them on your plate or hand in the first place. And just the one or two….who are you kidding?
Everyone knows how hard it is to shift body fat after having a baby. A recent study suggests that adopting a low carb diet featuring plentiful meat/poultry/fish and animal fats was more successful than having a low carb diet based mainly around plant foods.
Readers who are keen to shed their post holiday season weight gain may also find this information useful.
Low-carbohydrate diets (LCD) have been considered a popular dietary strategy for weight loss. However, the association of the low-carbohydrate dietary pattern with postpartum weight retention (PPWR) in women remains unknown.
The present study involved 426 women from a prospective mother-infant cohort study.
Overall, animal or plant LCD scores, which represent adherence to different low-carbohydrate dietary patterns, were calculated using diet intake information assessed by three consecutive 24 h dietary surveys.
PPWR was assessed by the difference of weight at 1 year postpartum minus the pre-pregnancy weight. After adjusting for potential confounding variables, women in higher quartiles of total and animal-based LCD scores had a significantly lower body weight and weight retention at 1 year postpartum (P < 0.05). The multivariable-adjusted ORs of substantial PPWR (≥5 kg), comparing the highest with the lowest quartile, were 0.47 (95% confidence interval 0.23–0.96) for the total LCD score (P = 0.021 for trend) and 0.38 (95% confidence interval 0.19–0.77) for the animal-based LCD score (P = 0.019 for trend), while this association was significantly attenuated by rice, glycemic load, fish, poultry, animal fat and animal protein (P for trend <0.05).
A high score for plant-based LCD was not significantly associated with the risk of PPWR (P > 0.05). The findings suggested that a low-carbohydrate dietary pattern, particularly with high protein and fat intake from animal-source foods, is associated with a decreased risk of weight retention at 1 year postpartum. This association was mainly due to low intake of glycemic load and high intake of fish and poultry.
Adapted from: BMJ 3 Sept 22 People need nourishing food that promotes health, not the opposite by Carlos Monteiro et al.
Everybody needs food, but nobody needs ultra- processed food with the exception of infants who are not being breast fed and need infant formula.
The foods that are “ultra- processed” include: soft drinks, packaged snacks, commercial breads, cakes and biscuits, confectionery, sweetened breakfast cereals, sugared milk based and fruit drinks, margarine and pre-processed ready to eat or heat products such as burgers, pastas and pizzas.
These foods are industrial formulations made by deconstructing whole foods into chemical constituents, altering them and recombining them with additives into products that are alternatives to fresh and minimally processed foods and freshly prepared meals.
In low amounts, they wouldn’t necessarily be a problem. But most ultra- processed foods are made, sold and promoted by corporations, typically transnational, that formulate them to be convenient, ready to eat, affordable, due to low -cost ingredients, and hyperpalatable. These foods are liable to displace other foods and also to be overconsumed.
Systemic reviews of large well -designed cohort studies worldwide have shown that consumption of ultra-processed foods increase: obesity, type two diabetes, hypertension, cardiovascular and cerebrovascular diseases, depression, and all- cause mortality.
Other prospectively associated conditions include dyslipidaemias, gout, renal function decline, non-alcoholic liver disease, Crohn’s disease, breast cancer and in men colorectal cancer. They also cause multiple nutrient imbalances.
It is calculated that ingestion of these foods compared to fresh ingredients, matched for macronutients, sugar, sodium and fibre adds a typical 500kcal daily, which leads to the inevitable fat accumulation.
US investigators have found that dietary emulsifiers and some artificial sweeteners alter the gut bacteria causing greater inflammatory potential, so replacing sugar with these isn’t a good idea either.
In the UK policies to limit promotion and consumption of ultra-processed food have recently been rejected, mainly because of the belief that in our current economic situation people need access to cheap food. As no one really wants to support foods that cause illness, the obvious solution is to promote foods that are fresh and minimally processed, available, attractive and affordable. Such a strategy would improve family life, public health, the economy and environment.
Adapted from Diabetes in Control Sept 18 2021: Effects of earlier dinner times on glycaemic control by Andy Dao, Pharm D candidate, University of South Florida.
Growing up you may have heard from your family that eating close to bedtime isn’t a good idea. Eating later has indeed been shown to cause weight gain and metabolic dysfunction. Type 2 diabetes develops 10% more commonly in those who work shifts for instance. It is though that hormonal disruption of the circadian rhythm is the problem.
A recent study looked at how blood sugars were affected by eating earlier than 6pm or after 9pm over the whole 24 hour day. Adults over 20 wore blood sugar monitors over three days in this experiment. They were assigned to have their last meal of the day by 6pm or after 9pm. They had to eat or drink nothing but water after this meal. They were given identical meals three times a day. How they felt, what exercise they took and how well they slept were all assessed.
12 subjects completed the tests. Each group were of comparable height, weight and BMI.
There were significant reductions in blood sugar levels in the early diners in mean blood sugars throughout the whole day, night and early morning. Post prandial levels were also better in the evening for the early diners compared to the late diners but not for breakfast and lunch post prandial levels which were the same regardless of the evening mealtime.
The early diners did report more hunger and capacity to eat in the evenings than the later diners. There was no difference in sleep or physical activity.
So, if you do eat earlier, you can expect improved blood sugars all day long, and perhaps less likelihood of getting diabetes. The downside is more evening hunger. This study was done in healthy non-diabetic people and it would be interesting to see what the results in diabetic subjects would show.
Comment: Sitting down at 5 to 5.30 pm just wouldn’t work well for me, yet this is what we did in my childhood, and we didn’t eat snacks in front of the television after this. In my own house we have dinner at 7.30pm. This however is because I didn’t usually get home before 6.30 pm or even 7pm for many years so an earlier mealtime was not possible for me. I also tend to watch television from 8 pm for about 40 minutes or so before bath and bed. I couldn’t abide eating after 9pm as a regular thing, yet this is very common in Italy. I do think that I would be reaching for the oatcakes and cheese or more if I was in front of the television having eaten at 6pm.
Diabetes Diet 